May 21

Fifty per cent

I received the results from my echocardiogram this week. My ejection fraction was estimated to be 50%. That’s the low end of the normal range. It’s also double what it was when I was admitted to the hospital five months ago. So that’s good news. I’m still using my Life Vest wearable defibrillator, but I have an appointment to see Dr. Desai on May 31, and I’m sure we’ll be talking about whether I still need it.

I think he’ll be pleased with my weight. After he expressed concern about it on April 26, I made some changes to my diet, and I’ve lost eight or nine pounds since then.

I completed my home sleep study and returned the kit to the sleep lab on May 11. That must have provided the data they needed, because Dr. Vora called this week to tell me that he’s submitted an order for a new CPAP machine. I probably won’t get it for a couple of weeks, but there’s no rush, since I can keep using my current machine.

I visited Cary Dermatology on May 18 to have a growth on my right arm looked at. Candace, the PA that I usually see there, said it was benign and froze it with liquid nitrogen so that it would crumble and flake off (which it’s already doing). She also froze a couple of other small spots on both arms, and examined the moles on my left arm. One of them was irregular, so she shaved it off and sent it to pathology. A sensible precaution, given my history of skin cancer. So I have a couple of Band-Aids at the moment.

My COVID-19 symptoms are long gone, and I feel fine.

May 13

Too healthy

I visited Cary Cardiology as scheduled on May 10 to have a second echocardiogram, as requested by the cardiologist, Dr. Desai. I couldn’t remember which kind of test an echocardiogram is, but it turned out to be an ultrasound of the heart. This will enable Dr. Desai to measure my ejection fraction, which will help him decide what to do next. (The last time we spoke, he was leaning heavily toward getting rid of the defibrillator that I’ve been wearing since January 3.)

While I was there, I also had some blood drawn for various laboratory tests, and I received a phone call from a nurse today to let me know that the tests were all normal. She said that Dr. Desai hasn’t read my echocardiogram yet, but I can expect another phone call next week to tell me the results.

I got another phone call yesterday that was rather encouraging. I am on the mailing lists of a couple of research organizations in this area that run various studies using paid subjects. It’s a good way to pick up a little extra money while also contributing to medical research. My most recent one involved being a test subject for a new avian flu vaccine — one that has already been approved by the FDA, but they collecting information about side effects. I don’t know whether I received the actual vaccine or a placebo, but I didn’t experience any side effects.

Yesterday’s phone call was about another study for which I had filled out an online questionnaire. It was for heart failure (HF) patients. The call was to ask me a question that wasn’t included in the questionnaire: what class of HF do I have, according to my cardiologist? I wasn’t familiar with that term, so I had to ask for an explanation. It turns out that there are four classes of HF:

  • Class I: No limitation of physical activity. Ordinary physical activity does not cause symptoms of HF (shortness of breath, fatigue, or chest pain).
  • Class II: Slight limitation of physical activity. Comfortable at rest, but ordinary physical activity results in symptoms of HF.
  • Class III: Marked limitation of physical activity. Comfortable at rest, but less than ordinary activity causes symptoms of HF.
  • Class IV: Symptoms occur even at rest; discomfort with any physical activity. Unable to carry on any physical activity without symptoms of HF.

I told the researcher that my cardiologist had never mentioned a classification to me, but I undoubtedly have Class I HF. I described how I was almost certainly Class III when I was admitted to the hospital on December 29, but by the time I was released on January 3, I had none of the listed symptoms. She congratulated me on doing so well, and then said, “Unfortunately, that means you are too healthy to participate in this study.”

I can’t say that I’m disappointed. A little extra cash would be nice, but I would much rather be rejected because I’m too healthy.

May 06

COVID-19

In my last entry, I mentioned that I was sick with a cold. The day after I posted it, Ben contacted me to let me know that he was experiencing “very similar symptoms: fatigue, runny nose, ache, [and] feeling warm despite not reading a fever.” He used an at-home COVID test and got a positive result. So he was letting me know that I might have COVID too.

I didn’t have any home COVID tests, so I requested some from the Postal Service website. They arrived in today’s mail, and I tested myself this evening.

Positive. I have COVID-19. A very mild case, to be sure.

Now what? I checked the CDC guidelines to find out what I am expected to do in terms of isolating myself. It says that asymptomatic and mildly ill people (that’s definitely me) should quarantine for five days after the onset of symptoms. I noticed the first symptoms a week ago, on the evening of Friday, April 29, so my quarantine period was complete at the end of Wednesday, May 4. (At that point, my symptoms had been gone for a couple of days, and I felt completely normal). CDC also says to wear a well-fitting mask for ten days following the onset of symptoms to limit spread to others. I will do that if I need to go out during the next three days.

And that’s it. After more than two years of living in COVID World, I finally got the virus, and it was so mild that I thought it was just a cold. Kind of anticlimactic, but I’m certainly not complaining! Mild is good.

I had planned to go see Doctor Strange in the Multiverse of Madness tomorrow. In fact, I reserved a seat at a matinee showing. I could go to the showing as planned, and just wear a mask in the theater. But it would be more considerate to wait a week, so I have requested a refund. The movie just opened today, and it won’t be going anywhere soon. I’ll see it next weekend.

This has been an eventful year in terms of my health. First heart failure, then severe lower back pain, and now COVID-19. And 2022 isn’t even half over. But I’m still standing. If Friedrich Nietzsche is right, and anything that doesn’t kill me just makes me stronger, then this year has already made me tougher and more resilient. That’s something to be grateful for.

May 02

Health stable, not much happening

It’s been a while since my last health update, but that’s because there hasn’t been much to report. I had an appointment with my cardiologist, Dr. Desai, on April 26. He remains satisfied with the state of my heart. I’ve been wearing the defibrillator for four months now, and it hasn’t had to do anything. Dr. Desai thinks we can dispense with it soon, but before deciding, he wants me to have another echocardiogram. My first one was on December 31, while I was in the hospital. Comparing the two should be useful for measuring my progress. The new echo is scheduled for May 10.

Dr. Desai also commented on my weight. It seems that I have gained a few pounds (four or five, I think), and he would prefer that this trend not continue. He doesn’t think it’s fluid this time, just calories. I told him he’s probably right about that, since I’m been focusing mainly on sodium and fluid intake, and not on calories. After the appointment, I decided that the wisest course of action is to rejoin Weight Watchers. I’ve actually signed up for the service already, but I probably won’t start rigorously tracking my food for a week or so.

I had an appointment with my pulmonologist, Dr. Vora, on April 18. He wasn’t aware of what had happened since the last time we met, so I spent some time bringing him up to date. He listened to my lungs and said they sounded healthly. He asked if I could remove the SmartStick (basically, a USB flash drive) from my CPAP machine and bring it in so that he could download the data. I was a little surprised, because I’ve been using the machine for many years and have never been asked for the SmartStick before. After I dropped it off the next day, his practice called to say they couldn’t read the data. I made a few phone calls and, after talking with a local medical supply store and the customer service line for the company that made the machine, I concluded that it’s probably not possible. The problem is that the machine is so old that nobody really supports it anymore.

I was told that insurance companies will pay for a new machine every five years, and I’ve definitely had mine far longer than that. Current CPAP machines don’t use USB sticks for data — they connect to your Wi-Fi and upload the date over the Internet. They’re also smaller and lighter than the one I have, which will be nice for travel. I called Dr. Vora’s office and asked him to write a prescription for a new machine.

But there’s a snag. The insurance company will want to see the sleep study data that indicates a need for a CPAP. My original sleep study was close to twenty years ago, and I have no records of it. I don’t even remember who conducted it or where. Dr. Vora suggested that we repeat the sleep study. Fortunately, I won’t have to spend the night in a lab as I did the first time. I can do a home sleep study. I have appointment to pick up a sleep study kit tomorrow, at which time they’ll instruct me on how to use it. Afterward, I’ll drop off the kit and they can analyze the data it recorded.

One other health note: I am currently sick with a cold. Nothing major, just a runny nose, achy joints, fatigue, and possible fever. (I feel rather warm at times, but I’ve tried measuring my temperature with one of those forehead thermometers, and it always says 97.6.) I started feeling ill on Saturday evening and spent pretty much all of Sunday in bed, resting. Today is Monday, and I felt well enough to work. But I’m probably going to bed early tonight.

And that’s it for now. Nothing much going on with my health, which is how I like it.

Update: I called Dr. Vora’s sleep lab to tell them that I was sick, and we agreed that it makes sense to postpone my appointment to pick up the home sleep study kit to next week.

Mar 18

That barbecue map

An online magazine called Chef’s Pencil (no, I’ve never heard of it before, either) stirred up a cauldron of controversy involving a cuisine that many people have strong opinions about: barbecue. The magazine analyzed TripAdvisor ratings of the barbecue restaurants in America’s 75 largest cities, and compiled a list of what they claim are the ten best cities in the country for barbecue. This was accompanied by a map showing where those cities are, and here it is:

The map, and the analysis that it was based on, made a lot of people angry. This Newsweek article sums up the controversy pretty well.

I won’t try to enumerate all of the things wrong with this map, because many people have already done that. (Matt Mitchell’s video is a good example.) I’ll just point out a couple of things.

The biggest outrage is that Texas is completely ignored. Now, I’m the first to admit that I’m not objective about barbecue. Of course I’m biased: I was raised on Texas-style barbecue because my father was born in Dallas, and he loved to make that kind of barbecue in his backyard grill. He was always tinkering with the sauce recipe and the way he cooked the beef brisket, in the hope of duplicating the sort of barbecue served in east Texas restaurants. He was never completely satisfied with the result, but I certainly enjoyed eating the meals that he produced. So it’s difficult for me to believe that no city in Texas made it into the top ten.

Some of the cities that did make it seem bizarrely inappropriate. Seattle, Newark, and Miami do not come to anyone’s mind when you ask them where they would go for great barbecue. As Matt points out, New Orleans has incredibly good food, but barbecue is not what it’s renowned for.

And Charlotte? Really? I grew up in the Charlotte area, and I’ve eaten in the city’s restaurants countless times. If it has some of the best barbecue in the country, I sure didn’t hear anything about it. And maybe I wouldn’t, but you can bet that Dad would have known about any good barbecue restaurant in Charlotte, and he would have taken the family to eat there. I don’t think that ever happened. (Maybe the excellent barbecue places in Charlotte only appeared after he died. Okay, I’m game. What are their names? I’d love to try them out. Update: According to TripAdvisor, these are the best barbecue restaurants in Charlotte.)

I think this project was doomed from the start, because its methodology was wrong. If you want to find the best barbecue in the country, why would you look only at the biggest cities? It’s not an urban cuisine. In my experience, some of the best barbecue is to be found in small towns and even rural settings. You’re more likely to find great barbecue at an Alabama church potluck than in any metropolis.

I can’t claim to know where the best barbecue in the country is. But the best I’ve ever tasted was at Bodacious Bar-B-Q in Longview, Texas. Longview isn’t a metropolis by any standard; it’s only the 47th largest city in Texas (81,653 residents in 2019). So the Chef’s Pencil analysis would have ignored it completely. And that’s why the map they produced is meaningless. If you’re only looking in big cities for great barbecue, you don’t understand barbecue at all.

Postscript: I notice that the barbecue analysis, including the top ten list and the map, has disappeared from the Chef’s Pencil website. I can understand why.

Mar 14

Setting the clocks

Most people dislike Daylight Saving Time, myself included. Debates about it can get convoluted, but in my experience, the arguments against it boil down to two objections:

  • The time change gives everyone jet lag twice a year.
  • Resetting every clock you own is an annoying waste of time.

There isn’t much you can do about the first one, but it is possible to reduce the effect of the second. How? By replacing your dumb clocks with smarter ones that reset themselves automatically.

Most of us already have some of the smarter kind, although we may not think of them as clocks. Your smartphone, for example, always displays the correct time. When the twice-a-year time change happens, your phone makes the switch without any action on your part. Your computer probably does the same thing, and if it doesn’t, that’s because the feature is disabled. (In Windows, right-click the clock in the lower right corner of your screen and click Adjust date and time. Then make sure that Set time automatically, Adjust for daylight saving time automatically, and Set time zone automatically are all turned on.)

But what about the other clocks? Most people don’t know this, but you can buy clocks that know how to set themselves. I learned this a decade or two ago when I needed to replace my bedside clock-radio, and while shopping for a new one, I stumbled across an Emerson SmartSet clock-radio that automatically resets itself to the correct date and time “as soon as you plug it in and after every power interruption.” That sounded too good to be true, but I bought one, and it works as advertised. (The model I bought back then has been discontinued, but Emerson makes several similar ones, which sell for prices as low as $15.)

The instruction manual didn’t explain how it performs this miracle, but a little research revealed the answer. The National Institute of Standards and Technology (NIST) is a part of the U.S. Department of Commerce, and it’s in charge of providing a national time standard. The correct time from NIST’s atomic clocks is made available on the Internet (which is what computers and phones use) and by radio signal on several different frequencies. The Emerson clocks are designed to receive that signal and adjust themselves accordingly.

Emerson isn’t the only clock-maker that offers this feature, and it’s not limited to digital clocks. A couple of years ago, the analog wall clock in my kitchen stopped working (it was at least twenty years old), and I decided to see if I could replace it with a self-setting model. After a little browsing on Amazon, I ordered a La Crosse Technology clock that looked almost exactly like its predecessor, except for the words ATOMIC TIME on its face. But despite its old-school appearance, this clock listens to the NIST time signal and resets itself whenever the need arises.

At this point, I have very few clocks left that have to be reset by hand. The analog wall clock in my bathroom still requires that, but I’ll eventually replace it with a La Crosse or something similar. There’s also a digital clock in my living room that has to be set by hand. I replaced my old analog wristwatch with an Apple Watch at the beginning of this year, and it synchronizes with my iPhone. The only other holdout I can think of is the dashboard clock in my car. (My microwave oven has no clock, which is fine with me.)

Someday, I will have no clocks that need to be reset manually. Won’t it be nice to eliminate that minor annoyance from my life?

Update: Since writing this entry, I’ve realized that I have two other clocks in my kitchen. They’re built into my coffee maker and my digital kitchen scale. I normally don’t even notice these, so I suppose it doesn’t matter whether they’re correct or not. But I went ahead and reset them anyway.

Mar 12

A gift for Dad

Health update: I’m almost completely recovered from my flareup of lower back pain. Still some pain when I first get out of bed in the morning, and some stiffness when I get up from a chair if I’ve been sitting for too long. But once I’m up and moving around, I feel fine. I suspect that in a day or two, I’ll be completely pain-free. The muscle relaxant really helped, and I’ll make sure to thank Dr. Raman for prescribing it when I see her for my annual physical in a couple of weeks. Once again, I have my life back, and I’m grateful.


Recently, I was reading one of the blogs I follow, and I found myself looking at the following image, which was presented without any context or explanation.

I was immediately intrigued. A USB flash drive that looks like a vacuum tube? That’s really cool, and I want one! But is it a real thing, or just a picture someone made in Photoshop? After a quick image search, I determined that this is absolutely real, and it’s for sale on Amazon.

Sadly, my design to own one was extinguished when I saw the prices. They vary depending on storage capacity: the cheapest is $49 for 8 gigabytes, and the most expensive is $119 for 256 GB. (For comparison, you can buy a SanDisk 512 GB drive for under $50.) Those prices seemed exorbitant to me until I read the description, and learned that this thing doesn’t just look like a vintage vacuum tube, it actually is one. Each of these drives is made by hand (in Latvia) from a vacuum tube that was manufactured in the Soviet Union in 1981. A genuine collector’s item. Suddenly, the price seems appropriate when I consider the scarcity of the raw materials, and the skilled labor required to craft the finished product.

It’s still too expensive for me to buy just for my own amusement. But if my father were still alive, I would buy him one of these in a heartbeat. Dad was notoriously difficult to buy gifts for, because if he wanted something, he would usually buy it for himself before anyone had a chance to give it to him. So the trick was to find something that he wasn’t aware of, but that he would like if he knew it existed.

Dad was a ham radio operator and electronics hobbyist from the 1950s onward, when vacuum tubes were still in a lot of radio and TV sets, although transistors were gradually making them obsolete. He was quite familiar with these tubes, and I’m sure he would have appreciated the combination of retro and futuristic tech. He had fond memories of the tube-powered radios and TV sets of his youth, but he was also an avid early adopter of cutting-edge technology. It was because of him that our family had a home computer in 1976*, at a time when you couldn’t just buy a functioning computer; you had to build it from a kit.

Dad would have loved this. I wish I could have given it to him for Father’s Day. Seeing the look on his face when he unwrapped it would have been worth the price.

*Correction: Bob informs me that we didn’t get the computer (a Processor Technology Sol-20) until 1977. That’s still years before the arrival of the IBM PC (1981) and the Apple Macintosh (1984). However, a bit more research shows that several home computers that did not have to be built from a kit made their debut in 1977: the Apple II, the Commodore PET, and the Tandy TRS-80.

Mar 07

Setback

My cardiac health continues to improve. I had another appointment with my cardiologist on February 22, and he was quite pleased with my progress. The only change he made was to add one more medication that might further strengthen and support my heart. It’s basically an experiment to see if it helps, and to find out how well I tolerate it. (I can answer the second question now: after two weeks, I have noticed no side effects at all. But then, I have felt no side effects from any of my cardiac medications, and I’m on half a dozen of them now.) He also said that I will probably be ready to stop wearing a defibrillator fairly soon. My next cardiology appointment isn’t until April 26, so I assume I’ll be using it until then. It’s no great hardship.

But I did have a health setback in recent days that had nothing to do with my heart. It wasn’t life-threatening, either, but it sure was unpleasant and inconvenient. I had a flareup of lower back pain. This seems to happen to me about once a decade, or maybe a little more often, and it typically isn’t the result of a back injury. It just happens, for no apparent reason. And it doesn’t seem to be related to my age or my weight, because I can recall having one of these flareups when I was in college, at a time when I was still young and slim.

The discomfort built up rapidly over a couple of days, starting around Tuesday of last week (March 1). By Wednesday morning I was experiencing quite a bit of intermittent pain, but I was still functional. I had planned to take my old desktop computer to the Kramden Institute and donate it, something that I could only do on a Wednesday evening unless I wanted to take time off during a work day. So I was determined to complete that errand despite the pain. Picking up the computer and carrying it down the stairs to my car was not too bad, and driving was fine. When one of the Kramden volunteers offered to come out to my car and bring in the computer, I was happy to accept.

But things got worse that evening. The Kramden building is right next door to a Golden Corral restaurant, and I took the opportunity to eat supper there. I was doing OK during the meal, even though a buffet requires you to get up and move around much more than any other kind of restaurant. After the meal, I visited the men’s room and went into one of the stalls. When it was time to leave, I found the process of standing up, restoring my clothing to normal, and so forth to be agonizing. After washing my hands, I made my way slowly and painfully out to the parking lot. My gait was so stiff and slow that I thought I must look like Frankenstein’s monster shambling through the restaurant, but no one seemed to notice.

Once I got into my car, I was more or less comfortable. (Sitting or lying down doesn’t hurt. But standing and walking do.) I had planned to stop at a Walmart Neighborhood Market that was on my way home to pick up a couple of grocery items, and I decided to go through with it. I probably should have skipped that, but I was too stubborn. I managed to hobble through the store and collect the items I needed, leaning heavily on my shopping cart for support. As I approached the self-checkout, two of the employees saw that I was in distress and asked if I was all right. I explained what was happening and, after I scanned, bagged, and paid for my groceries, one of them offered to escort me to my car. I accepted with thanks, and managed to reach my car without incident. She put the groceries into the car for me and took care of returning the cart.

When I got home, I had to face the ordeal of climbing the stairs to my apartment. Since being discharged from the hospital, I had grown accustomed to traversing those stairs easily and effortlessly. Now it was like climbing a mountain again — not because of shortness of breath and fatigue, as it was in December, but just because it hurt so much. But I made it to the top, unlocked my door, and staggered inside. After putting away the groceries, I took my evening medication, added some pain reliever, and went to bed early.

Thursday morning was the low point. Getting out of bed took about half an hour and involved a great deal of pain. I found myself thinking that I might actually have to call 911 if I couldn’t even walk. But I wasn’t going to do that if I could avoid it. After using the shelving unit near my bed to slowly, gradually pull myself upright, I found that I could manage a shuffling walk. My first concern was, of course, to get to the bathroom. Second on my list was to make it to the door of my apartment and unbolt it, because if I did have to call 911, I wanted to make sure the EMTs could get in.

I was able to do both of those things, get some breakfast, and start my work day. Working was actually not a problem, because I do that sitting down, and sitting didn’t hurt. But the longer I sat in my comfy office chair, the more it would hurt when I stood up. So I made a point of getting up at least once per hour and hobbling around the apartment — going to the bathroom, getting another cup of coffee, or something like that. Standing and walking was still pretty awful.

In the past, I have dealt with these flareups by taking large doses of ibuprofen. It relieves the pain, but it also reduces the inflammation that’s causing the pain, and by using that medication, I have typically been able to clear up the problem in a few days. But now that option was off the table. When I left the hospital, my instructions had included a ban on ibuprofen or any of the other NSAIDs, like naproxen sodium. The only pain reliever available to me was acetaminophen, which I find to be less effective for pain, and worthless against inflammation. So on that Thursday morning, I called Cary Cardiology and spoke to a nurse. I described what I was experiencing and asked them to either give me permission to use ibuprofen or offer me an alternative medication that would do something about the inflammation.

The nurse talked to my cardiologist and called me back. They couldn’t let me use ibuprofen; in combination with one of my other medications, it could cause bleeding. And they don’t prescribe pain medications. She recommended that I call my primary care physician about that. So I did, talked to a nurse there, and she spoke to my physician, who prescribed cyclobenzeprine hydrochloride. It’s a muscle relaxant, not a pain reliever, but it seemed like a good idea to me, because I could tell my pain was being caused by muscle spasms in my lower back.

At my request, the prescription was sent to the pharmacy at the same Walmart Neighborhood Market where I had stopped for groceries the night before. But how would I get it? I was in no shape to navigate the stairs again. Up until this point, I hadn’t told any of my family what was happening, but it was clearly time to enlist someone to help. I called Ruth, and she immediately agreed to pick up the prescription and bring it to me when she got off work. When she arrived, she also took out my trash and insisted on preparing my supper and serving it to me. When she left, she took with her a package that needed to be dropped off at a FedEx store. (I am very grateful that she lives so close and is so willing to help when I need it.) After her departure, I took my muscle relaxant, ate supper, and went to bed early again.

On Friday morning, I didn’t notice any significant improvement. Getting out of bed was still an ordeal. But as the day progressed, I could tell the pain was gradually lessening. I continued taking the new medicine. With the arrival of Friday evening came the weekend, and I resolved to spend it resting and healing as much as I could. I spent Saturday and Sunday quietly at home, taking several naps during the day. Each time I slept, I woke up with less pain. By Monday morning, I was moving around the apartment much more easily. It still hurt, but in a more tolerable way.

It’s now Monday evening, and I’m nearly back to normal. There’s still a lot of stiffness when I get out of bed or stand up from a chair, and I’m still walking slowly and carefully, with some moaning and groaning. But I’m definitely on the mend. The Walmart pharmacy notified me that a refill of one of my prescriptions is ready, and I plan to go and pick it up myself tomorrow evening. That will be my first time venturing out of my apartment since last Wednesday, but I’m sure I’ll be up to it by then.

On Thursday evening, March 10, I am scheduled to have dinner with Bob and Miles. I don’t think I’ll have any difficulty keeping that appointment. I may not feel like going walking after dinner, but the meal itself, and the trip there and back, won’t be a problem.

It seems that I’ve weathered another storm. But it sure would be nice to have calm weather for a while.

Feb 11

Aftercath

I thought I should write a brief post about the days immediately after my catheterization. The temptation to make the title a pun was too much for me to resist, I’m afraid. (It’s a play on “aftermath,” you see. Sorry.)

In my previous post, I mentioned that my post-procedure instructions included some restrictions, like not driving, avoiding stairs, and not lifting more than five pounds. The ban on driving was in case I was still impaired by the anaesthesia (I wasn’t, as far as I could tell), but all the other restrictions were intended to prevent me from causing the spot where they inserted the catheter (referred to with the charming term “puncture site”) to bleed. The instructions also included warnings not to strain during bowel movements or engage in sexual activity. (That last one wasn’t really a problem for a divorced man who isn’t in a relationship and is not looking for one.)

In addition, I was told that the morning after the procedure, I was to remove the dressing from the puncture site and then shower, gently washing the site with soap and water. I didn’t exactly obey that instruction. I did not have to go anywhere or see anyone on Tuesday (the day after the procedure), and I was doing my best to take it as easy. So I chose to leave the site alone. I left the dressing on, and I didn’t shower.

But I had a dental appointment on Wednesday morning, and plans to meet Bob and Miles for dinner that evening. A shower was mandatory. I carefully peeled off the dressing and examined it. Not a speck of blood on the gauze — clearly, there had been no post-procedure bleeding. So far, so good.

But before getting in the shower, I wanted to take a look at the puncture site to see how well it was healing. I couldn’t find it! I had been expecting a puncture something like the one you get when you donate blood, but clearly it had been smaller than that. And in the two days since, it had apparently closed completely. I am not limber enough to bend double and take a close look at my own groin, but I couldn’t see it in the bathroom mirror, and my attempts to snap a picture of it with my phone were unsuccessful. So I shrugged and got in the shower.

Washing the area with soap and water didn’t provoke any discomfort. I wasn’t terribly surprised, because I had experienced no pain whatsoever during or after the catheterization. No soreness or tenderness, nothing at all. This is typical for me; in the past, following surgical procedures, I have had little or no post-operative pain. My gallbladder surgery, for instance, had left me with four new holes in my abdomen, which didn’t hurt at all. They were little holes, but so is a paper cut, and those hurt like hell. Surgical incisions don’t, not for me. I don’t know why.

The instructions said to put a Band-Aid on the puncture site after washing and drying it. But with only the vaguest idea where it might be, that seemed pointless. I didn’t bother.

After having avoided driving on Tuesday, I did an unusual amount of it on Wednesday. First I went to Apex and back (12 minutes each way) for my dental appointment. Then, in the afternoon, I drove to Fuquay-Varina and back (half an hour each way) to pick up a new work computer. And in the evening, I went to the restaurant and back for dinner (about ten minutes each way). I had no trouble at all driving.

In short, I recovered quickly and easily. My only problem is that, between missing a whole day of work for the procedure, and most of Wednesday morning for a dental appointment, I am short on hours for this week. Which is why I will be working on Saturday. But things are finally calming down. After a steady barrage of medical tests and appointments during all of January and the first half of February, I don’t have another one scheduled until March 7. And after that, nothing until late April. That will probably change, since I was told that Dr. Desai would want to see me again about two weeks after the catheterization. But things are definitely getting back to normal.

One more thing that I forgot to mention in an earlier post: The primary measure of heart function is ejection fraction (EF), which measures the percentage of blood inside the heart that is pushed out when it beats. A healthy heart typically has an EF of 50-65%. When I was admitted to the hospital on December 29, my ejection fraction was in the 20-30% range. (That’s why I was diagnosed with heart failure.) Shortly before the catheterization, Dr. Desai told me that the MRI on January 24 had measured my EF in the 40-50% range. So it’s not quite back up to normal, but it’s improved a great deal. My heart is getting stronger. He was very pleased, and so am I.

Feb 08

Catheterization

When I revived this blog, I had thought that I would use it to tell the story of my heart failure experience in chronological order. But it’s taking too long for me to do that, and I don’t think it makes sense to delay updates on recent events just because I haven’t finished describing earlier ones. So today’s post is about what happened today. I’ll catch up on the earlier events when I can.

Today, February 7, I had a heart catheterization at WakeMed Cary Hospital, where I was an inpatient a month ago. This was a procedure scheduled by my cardiologist, Dr. Desai, to look for blockages in my coronary arteries. If any blockages existed, that could be the cause of my heart failure. Procedures for doing this vary, but in my case, the catheter was inserted into my femoral artery in my groin, and then maneuvered through blood vessels to the heart, where it was used to examine the blood flow in the coronary arteries. X-ray imaging is use to track the location of the catheter and aid its navigation. The catheter can also release small amounts of a radiocontrast agent, also known as an x-ray dye, which makes the blood flow visible to the x-ray cameras for a few seconds. By analyzing this imagery, the catheterization team can determine whether blood is flowing normally in a particular location, or is restricted by a blockage.

My preparation for this procedure required me to stop taking Xarelto, the anticoagulant (or “blood thinner”) that I normally take to treat the deep vein thrombosis in my lower legs. I was instructed to stop the Xarelto two days before the catheterization. I was also told not to eat or drink anything after midnight on the day of the procedure. Other than that, I just had to show up at the appointed time, which in this case was 8:00 a.m. I was not allowed to drive myself to or from the hospital, so Ruth agreed to provide transportation. I would be there all day, so she wasn’t required to wait at the hospital while the procedure was happening.

After I checked in, answered a few questions, and signed some consent forms, I was taken to a room in Observation. I went through the familiar process of changing into a hospital gown and putting my clothes and other belongings into a plastic bag for storage until I was ready to reclaim them. (This was part of the preliminaries for my gallbladder and eye surgeries, as well as every colonoscopy I have had, so I know the drill.) Intravenous lines were installed in my right arm and left hand. (I didn’t ask why they needed two of them.) Then I was taken to the “cath lab,” which the equipment required for the procedure. In particular, it has an manueverable x-ray camera that can move around the patient’s body to get the best images of the catheter’s current location.

I was given a sedative and local anaesthesia in the groin area, and the catheter was inserted. I had expected to the sedation to make me groggy or sleepy, but I remained conscious and alert during the whole experience, although I was very relaxed. The local anaesthetic was administered so expertly that I wasn’t even sure when it happened; I didn’t feel a needle. Perhaps they used a topical numbing agent on the skin first? Anyway, the entire process didn’t demand anything of me other than being relaxed and keeping still. At one point I was asked to take a deep breath and hold it for a few seconds. That was my only participation.

I knew that if blockages were found, the plan was to correct them with stents, which would probably be installed by the catheter as part of the same procedure. But I didn’t have any blockages, so no stents were needed. After the procedure was complete, I was taken back to my room for recovery and observation. The main concern was to make sure that I didn’t start bleeding at the site where the catheter had been inserted. I was required to lie on my back and rest for several hours. By this point it was 10:30 or 11:00 a.m., and I was pretty hungry, not having had breakfast. A nurse brought me a turkey sandwich and some graham crackers, which I was able to eat while flat on my back. She also helped me drink some ginger ale through a straw. After that I dozed. I wasn’t able to sleep very well, because I normally sleep on my back, and my neck wasn’t really comfortable despite some fiddling with the pillow. But I just had to put up with it for a few hours, so I drifted in and out while I waited for the required time to pass.

Some time between 2:30 and 3:00, I was allowed to sit up in bed, then stand and walk to the bathroom. Then a nurse took me for a brief walk in the hallway while she observed me to make sure I was moving well. When it was clear that my balance was good and I wasn’t dizzy or lightheaded, she took me back to my room and canceled my Fall Risk status (which is automatic for anyone undergoing anaesthesia). After that, a lunch tray was brought in and placed on the overbed table, and I ate lunch while sitting on the side of the bed. (It was the same kind of meal that I had been served while I was an inpatient a month ago, so I felt a bit of nostalgia as I ate.) Another nurse went over my discharge instructions, and then left me alone to change into my clothes and get ready to leave.

I sent Ruth a text message to let her know that I was ready for pickup. Both of my IVs were removed. A wheelchair had been parked outside the door of my room, so I sat in it and reviewed my printed discharge instructions while I waited. The main point of them was to avoid straining the insertion site and causing it to bleed. I was told to avoid going up and down stairs for 24 hours, which would mean that after getting home, I would be confined to my apartment for a day or so, which would be no hardship for me. (Since I work from home, I sometimes don’t leave the apartment for several days at a time.) I was not to drive or operate machinery for 24 hours as well. The main limitation was that I shouldn’t lift anything heavier than five pounds for three days.

When Ruth arrived, a nurse wheeled me out to the curb where her car was waiting. I explained the restrictions to her, and mentioned that a prescription had also been sent to the Harris Teeter pharmacy that I sometimes use. She agreed to take me there to pick it up, and to get a few grocery items as well (since I wouldn’t be able to go grocery shopping for a while.) Then she took me home and carried the groceries up the stairs for me, since they definitely weighed more than five pounds. After making sure that I felt fine, Ruth left.

I did feel fine. I wasn’t in any pain, and not dizzy or lightheaded. But I was kind of tired, so after a light supper, I took a nap for several hours. But I wanted to get this entry written and posted today, so here I am finishing it up at half past midnight.

I don’t have any blockages in the blood vessels serving my heart. That is both good and bad news. It’s good because blockages are certainly not a good thing, and you’re better off without them. But it’s bad news in the sense that we still don’t know what caused my heart failure. We’ve eliminated blockages as a possible cause, though. So that’s progress.

I’m progressing in other ways. Dr. Desai told me that my heart function is continuing to improve. And he surprised me by telling me to stop taking furosemide, the diuretic that I’ve been on for over a month, and which enabled me to lose forty pounds of excess fluid, restoring my breathing to normal and allowing me to resume my normal life. When I was an inpatient, I was being given furosemide intravenously, so I don’t know what the dosage was. But I was given a prescription for the oral form of it when I was discharged. At first, I was taking one tablet twice a day. At my first follow-up appointment, Dr. Desai reduced it to one tablet per day, and at my second, he cut it again to half a tablet. Now he’s stopping it altogether. It seems that my heart is functioning well enough that my body can eliminate excess fluid without it the diuretic. I continue to weigh myself every day, and if I see a weight gain of 2-3 pounds or more per day over a two-day period, or five pounds in a week, I am to call his office. (He’ll probably put me back on furosemide if that happens.)

I was told that Dr. Desai will want to see me again in a couple of weeks. I expect that we’ll talk about what comes next. In the meantime, I’m going back to work. I took all of Monday off for the catheterization, so I have some catching up to do.