Jan 28

Side effects

A post about my time in the hospital is coming, but I haven’t had much time to work on it this week. In the meantime, I have a health update that has nothing to do with my heart issues. On Wednesday, January 26, I visited my local Harris Teeter pharmacy to pick up a prescription. While I was there, I took the opportunity to get my second dose of the shingles vaccine. (It’s normally given in two doses, 2-6 months apart, and I had received my first on September 11.) I was advised of the possibility of side effects, but I wasn’t concerned; I generally don’t have side effects from vaccines other than the inevitable sore arm.

But the next day, Thursday, I was feeling distinctly under the weather. I had two symptoms. First, I felt very tired all day. This wasn’t the kind of fatigue I was experiencing in December, because that was accompanied by shortness of breath, and I am breathing fine now. But it was debilitating. The other symptom was that I felt cold. My apartment can feel chilly in the winter months, but normally I address that by putting on more clothing: a long-sleeved pullover, warm slippers, or fingerless gloves if my hands are feeling cold. In this case, though, I felt cold no matter how much I bundled up, and my fingers were like icicles.

I looked up the known side effects of the vaccine, and these are pretty typical. They usually pass in two or three days at most. So this is just a temporary inconvenience. But I wasn’t very productive on Thursday. Toward the end of the day, the effects began to ease. I stopped feeling cold, but I was still very tired, and I ended up going to bed early because I just didn’t have the energy to do anything else.

If this is the price I have to pay for the vaccine, it’s acceptable. I have talked with people who had shingles, and it sounds truly awful. The main symptom is excruciating pain. I am willing to put up with feeling sick for a day or two if it enables me to avoid that.

On Friday morning, I felt fine. So the side effects only lasted for one day.

Jan 23

Heart failure: Decline and ER

I promised to use this blog to provide updates on my health — specifically, the ongoing testing and treatment for my congestive heart failure. I expect to have some new information soon, but in the meantime, I want to write a summary of how I got here.

I can’t point to a specific point at which my troubles began, but over the course of 2021, I gradually began to notice some ill effects. Mostly, I was losing stamina and becoming short of breath more often. I chalked this up to my obesity and advancing age, but that didn’t really explain what was happening. My weight wasn’t changing significantly, and I wasn’t aging at an accelerating rate, but I found myself getting tired more easily and having trouble with physical exertion because of shortness of breath. This wasn’t happening all the time, but Bob and Ben can confirm that when I tried to go on long walks with them, I would have to stop and rest frequently, and I still couldn’t keep it up for very long.

It was depressing. I felt like I was getting old prematurely. Things that had been a normal part of my life became more and more difficult. Doing laundry, for example. My apartment is on the third floor, and the laundry room is on the first. Carrying a basket of laundry up and down those stairs hadn’t been a big deal a couple of years ago, but now it was becoming an exhausting ordeal. Even climbing the stairs without a burden was tiring. During the pandemic, I had become more reclusive, going out rarely and relying on grocery and takeout food delivery. At first, that had been more of a convenience; now it was a necessity, because leaving my apartment was a challenge that I was reluctant to face.

Around the beginning of December 2021, the deterioration seemed to accelerate. My weight had been slowly decreasing in November — not a lot, but definitely moving in the right direction. In December, it started increasing, and at a disturbing rate. Between late November and late December I gained 15 pounds. I couldn’t figure out why. I hadn’t gone on an eating binge; in fact, I had cut some things our of my diet to reduce my caloric intake. It didn’t make sense.

Since being diagnosed with deep vein thrombosis (basically, the formation of blood clots) in 2019, I had experienced some edema (swelling due to fluid retention) in my lower legs and feet. This tended to come and go over time. Sometimes there would be no noticeable swelling at all. But in late 2021, the swelling was as bad as it had ever been. And I noticed that my abdomen seemed to be bloating as well. The shortness of breath and fatigue got worse. On recent attempts at long walks, I had been able to walk or speak, but not both at once. I simply couldn’t get enough air for that. And I was tired all the time now, with no energy for anything but basic activities.

I noticed that breathing was more difficult in some positions than in others. It was easiest when I was sitting or standing upright, and most difficult when I was lying down. This made sleeping a challenge. I have an ordinary flat bed, not the kind that can raise the head so that you’re sitting rather than lying. (If I owned a recliner, I would have tried sleeping in it.) I had to carefully control my breathing (in through the nose, out through the mouth) and focus on relaxing in order to fall asleep. And I still wasn’t sleeping very much or very well.

I decided to defy my limitations in order to go to a theater and see Spider-Man: No Way Home. I had been hearing very good things about it, and I was worried that the longer I waited, the greater the chance that I would encounter spoilers. A day or two in advance, I reserved a seat at a showing on Sunday, December 19. But on the morning of the showing, my left foot was so swollen that I didn’t think it would fit into a shoe. I requested a refund for the ticket, and I didn’t go.

By this point, just getting out of my chair and walking across my apartment would cause me to be out of breath. On those occasions when I couldn’t avoid going up or down the stairs, I would have to stop, rest, and catch my breath several times en route. It felt like I was slowly dying. When I turned 62 years old on December 20, I felt 30 or 40 years older than that.

It occurred to me that I might just be sick with an infectious disease. Shortness of breath and fatigue are among the symptoms of COVID-19 and flu. If that was the cause, then eventually I would recover from the disease and get back to normal. I had never thought I would actually hope I had COVID, but that’s how desperate I was. I called my primary medical practice and scheduled a COVID test.

The test took place on December 22. The physican assistant who administered it told me that I would have the results the next day. But I didn’t. When I called the lab company to ask, I was told that it could actually take up to three days. Of course, the third day after the test was Christmas, and it was in the middle of a long holiday weekend. I had planned to visit Mom in Rock Hill for Christmas, but that didn’t seem possible now. I canceled the trip and, for the first time in my life, spent Christmas alone. (Marie had Christmas dinner with friends, and she was kind enough to bring me several plastic containers of food, so I did have Christmas dinner.)

I called again on December 28, the first normal workday after the holiday, and was told that the lab company had no record of my ever having taken the test. Apparently, they had lost it. I would have to retested. I was stunned. But before I could schedule another test, I suddenly received an e-mail from the lab company with the results of the test. They didn’t say how this was possible when they had told me a day before that they couldn’t find it.

I read the results. I was negative for COVID, for both of this year’s strains of flu, and for respiratory syncytial virus. Good news, right? Not at all. In fact, I was frightened by the news. It meant that my symptoms were not going to go away on their own, because I wasn’t sick with a virus. Something else was causing my shortness of breath and fatigue. And at this point, my lung capacity was barely enough to keep me alive. If I did catch something that compromised it further, like COVID or flu, it would probably kill me.

I realized that I had run out of options. I had to go to the hospital. That evening, the night of December 29, I drove myself to WakeMed Cary and parked outside the entrance to the emergency department. Unfortunately, I had to park on the far side of the parking lot. It wasn’t a large parking lot, and had I been in good health, I could have walked to the entrance in a minute or two. But I wasn’t in good health, and I also had some things to carry. Knowing that I would probably be admitted, I had packed a gym bag with a few necessities. And I had the messenger bag that goes everywhere with me (basically my version of a purse). So I slung those bags on my person and started the trek to the entrance.

In my memory, that walk across the parking lot is the emotional low point. It seemed to take forever. I couldn’t move very fast, and I kept having to stop and catch my breath. Would I even make it to the door? Or would I collapse and die in the parking lot? That sounds melodramatic now, even to me. But it’s what was going through my head at the time.

Finally, I reached the entrance, approached the front desk, and explained (stopping frequently for breath) why I was there. Almost immediately, I was helped into a wheelchair and rolled into a sort of anteroom where I answered a bunch of questions from a nurse. Then a doctor checked my vital signs and reviewed what I had reported about my symptoms. On the basis of my difficulty breathing and the recent rapid weight gain, I was taken into a room in the emergency department for treatment.

In my next post, I’ll try to summarize my experience in the hospital and the events that followed.

Apr 15

Sunlight and vitamin D

A concerned reader writes to the science section of the New York Times to ask: “Am I still getting vitamin D when I’m outside on a gray, cloudy day?” The answer from the Times explains that your skin needs exposure to ultraviolet-B rays in order to synthesize vitamin D. Unfortunately, this is the same ultraviolet-B that causes sunburn and skin damage. Finding the optimal exposure time is complicated, especially when the amount of UV-B energy is affected by factors such as cloud cover and latitude.

To strike a balance between useful exposure and protection, the N.I.H. recommends an initial exposure of 10 to 15 minutes, followed by application of a sunscreen with an S.P.F. of at least 15. The institutes say this much exposure, at least two times a week, is usually sufficient to provide adequate vitamin D, though some researchers suggest it may not be enough. At the earth’s northern latitudes for much of the year, and at the midlatitudes in winter, the sun does not stay far enough above the horizon (45 degrees) for the angle of the sun’s rays to guarantee an efficient ultraviolet-B bath.

So even if you follow the NIH recommendations to the letter, the resulting UV-B exposure still may be too little or too much? Sorry, but I’m not going to waste my time on a process as inconvenient and unreliable as this.

Fortunately, I don’t have to. Vitamin D is available in pill form in any grocery store. Yes, your skin can synthesize it, but it doesn’t have to. The pills are inexpensive and convenient; why not use them? You get exactly the right dosage every time (regardless of cloud cover or latitude) and there’s no risk of sunburn or skin damage.

There are plenty of good reasons to go outside and let the sun shine on you, but nobody should feel obligated to do so in order to get enough vitamin D. It simply isn’t necessary.

Apr 10

Unnatural selection

Perhaps I’m missing something, but the following strikes me as a profoundly stupid question:

Why do women long outlive their fertility?

Human ovaries tend to shut down by age 50 or even younger, yet women commonly live on healthily for decades. This flies in the face of evolutionary theory that losing fertility should be the end of the line, because once breeding stops, evolution can no longer select for genes that promote survival.

Women don’t outlive their fertility in their natural environment. The life expectancy of primitive humans averages between 20 and 35 years. And the women fare worse than the men, because a quarter of them die in childbirth.

We non-primitive humans live a great deal longer because of modern medical care, the entire purpose of which is to interfere with natural selection. Nature has plenty of mechanisms for eliminating women from the world long before they reach menopause, but we do everything in our power to prevent those mechanisms from operating.

Saying that this “flies in the face of evolutionary theory” is an indication of staggering cluelessness. Evolutionary theory describes how evolution works in a natural setting. Of course it fails when you try to apply it to a technological society with advanced medical care. Next you’ll be telling me that space travel flies in the face of gravitational theory because space probes go up instead of down.

Women live long enough for their reproductive systems to shut down for the same reason that both men and women live long enough for our teeth to start crumbling and have to be repaired or replaced. In our original environment (the savannahs of Africa), human bodies only had to last for 20 to 35 years. Beyond that point, it didn’t matter what systems might fail; we were never going to live that long anyway.

But now we’ve changed the rules. We routinely keep our bodies running for three or four times as long as they were originally designed to operate. Of course some parts stop working! It is unnatural for humans to live as long as we do. We are interfering with human evolution on a massive scale.

What really baffles me is that the people asking this stupid question are evolutionary biologists, and the article quoting them is in Scientific American. Why do expert scientists and science journalists have so much trouble seeing such an obvious explanation?

Mar 11

Getting scoped

Dave Barry doesn’t write a weekly column anymore, but he occasionally still does special articles for the Miami Herald. His latest, published a couple of weeks ago, is about how he finally had a colonoscopy after years of procrastinating.
My mother’s family has a history of colon cancer, so procrastination was never an option for me. I didn’t even wait for my 50th birthday — with my doctor’s encouragement, I went ahead and scheduled a colonoscopy when I was 44. My experience was similar to Barry’s: it was no big deal, since the actual procedure took place while I was unconscious. (At least I think so, although the anaesthetic they used also causes short-term memory loss. So it’s possible that I was aware of being scoped, but then forgot the whole thing. That’s pretty much the same thing, as far as I’m concerned.)
One difference is that I didn’t have to drink two liters of MoviPrep. My gastroenterologist prescribed a different laxative (probably Picolax or something like it) that requires considerably smaller doses. And it didn’t taste bad at all. I also found the effect to be much more gentle than what Barry describes, although the result was the same.
Like Barry, I was found to be cancer-free. And he’s certainly right in saying that it’s better to know that. The idea of having a colonoscopy certificate signed by Dave Barry appeals to me, so I’m going to take advantage of his Exclusive Limited Time Offer. If you’re over 50 or have a family history of colon cancer, you should too.
My gastroenterologist said to have another colonoscopy done after five years. That was in 2004, so I’ll need to do it again next year. As I said before, no big deal.

Nov 19

Pulling the trigger

On November 13, I went see my hand specialist, Dr. Post. He listened to my description of how the trigger thumb symptoms had returned, and then examined the thumb itself. Clearly, the corticosteroid injection on June 16 had not cured the problem. At this point, he explained, I had two options: a second injection or surgery. The second injection would provide short-term relief and might banish my symptoms for good — but statistically, it was less likely to effect a permanent cure than the first injection. Surgery was a more drastic approach, but it would definitely correct the problem. We agreed that I should go ahead and have the surgery.
So, on Thursday, November 16, I went under the knife. The surgery was a ten-minute procedure performed under local anaesthetic at Duke Raleigh Hospital (which I still think of as Raleigh.com Hospital). Of course I spent more than ten minutes at the hospital, but it was still a brief visit — I arrived at 1:00 and was on my way home by 3:00.
I was coming to the hospital from work, so I drove myself. But I had been told that I would have to be driven home by a family member, because I would be given a sedative. So I arranged for Ben to come to the hospital after school, pick me up, and drive me home. How and when to retrieve my car was something Marie and I would have to decide later.
After signing the requisite papers, I was ushered into the Day Surgery Center, where a prep nurse measured my blood pressure and temperature. She then informed me that Dr. Post’s team was ready for me and could start the procedure as soon as I joined them. Normally, day surgery patients are given a Valium as part of their preparation. But if I took Valium at this point, it wouldn’t take effect until the surgery was already over. I was clearly relaxed and in no need of sedation, so the nurse and I agreed that we could skip the Valium and get on with the main event. (Hospitals and medical personnel don’t make me nervous. I once lived in a hospital for six weeks, and that experience cured me of any anxiety I might have had about such places.)
The actual operation didn’t take long at all. I didn’t have to change into a hospital gown; the two surgical nurses had me lie down on the table and one of them cleaned and sterilized my right hand while the other put a blood pressure cuff and a pulse monitor on my left. They applied a tourniquet to my upper right arm and hung a drape so I wouldn’t see my hand being cut open. Shortly after that, Dr. Post arrived and got right to work. He injected an anaesthetic in the base of my thumb and, after the area was numb, began the procedure.
After making the incision, Dr. Post told me that he’d found something unexpected: there was a ganglion cyst at the base of my thumb, right in the area where the tendon was having trouble moving through its sheath. This cyst was almost certainly the cause of my trigger thumb. He excised it, enlarged the sheath as planned, and then closed the incision.
When the drape was removed, I saw that my hand was swathed in gauze and wrapped in an elastic bandage. My fingers were free, but my thumb was mostly immobilized (although I could wiggle the distal phalanx). Dr. Post told me that I could remove the dressing after three or four days and just cover the incision with an adhesive bandage.
I was escorted to Recovery, where a nurse gave me a Diet Coke and went over the sheet of post-operative instructions, which was all common-sense stuff: no strenuous activity with that hand, keep it elevated to reduce swelling, don’t get the area wet, and so forth. I was given prescriptions for an antibiotic (cephalexin) and a pain reliever (hydrocodone). After that, I was free to go, and since I hadn’t taken the Valium, I was even allowed to drive myself home. I called Ben and told him that his services weren’t required, then headed for the exit. They even let me walk out under my own power instead of having to take the traditional wheelchair ride.
I just want to pause at this point and say that in terms of the time, paperwork, and discomfort involved, this surgery was easier than donating blood. Isn’t that amazing?
I filled both prescriptions and began taking the antibiotic, but I set the hydrocodone aside. This is my fifth hand surgery, and my previous experiences have taught me two things: I typically have very little post-operative pain, and the pain medications that are prescribed on such occasions typically make me feel ill. If I need pain relief, I’m better off with over-the-counter ibuprofen or acetaminophen.
That evening, I felt well enough to go to Cinderella rehearsal, which was a music review and didn’t involve much physical activity. Ensemble players like me didn’t have another rehearsal until Monday, and Friday was a work-from-home day for me, so I was able to rest my hand (no driving required) and generally take it easy for the next three days. It’s now Sunday night and I have removed the dressing, replacing it with a big water-resistant Band-Aid. My hand doesn’t hurt and I can now type again (which is why I’m finally posting this account, three days after the surgery). I’m still being careful not to exert the thumb unnecessarily, but I’m back to functioning more or less normally.
I have an appointment for a follow-up visit to Dr. Post on December 1. He’ll remove the sutures and examine my hand to make sure it’s recovering properly. If all goes well, that will be the end of my trigger thumb story. I’ll have a scar to add to my collection, but that’s a small price to pay for a working thumb.
I mentioned previously that my father had experienced trigger finger in both hands. It turns out that in his case, a second corticosteroid injection cured the problem. He’s been symptom-free for a couple of years. I’m glad that worked for him, but I now know that a second injection wouldn’t have helped me — not with a cyst pressing on the tendon. Surgery was definitely the best option.

Nov 11

Thumbs down

The last time I posted about my trigger thumb, I was careful to say that it was “in remission” rather than “cured”. It turns out that I was right. Starting on October 26, the symptoms began to reappear, and now it’s a daily occurrence again. I am back to using the heating pad every morning to restore my thumb to usability.
So the steroid injection provided only temporary relief. I have scheduled an appointment with my hand specialist for next Monday so that he can examine the thumb again and recommend what to do next.

Jun 28

Thumbs up

On the morning of June 23 (a week after the steroid injection), my trigger thumb symptoms were so mild that I decided to skip using the heating pad and see what happened. Half an hour later, the symptoms had cleared up on their own. The following morning, I awoke symptom-free. So the steroid seems to have worked. My trigger thumb is cured — or perhaps I should say “in remission”, since my father’s experience shows that the symptoms can return eventually.
Today I visited my ophthalmologist for a routine semiannual examination, and my glaucoma is also still in remission. The medication (Xalatan at first, and now Travatan) has kept my intraocular pressure under control for two and a half years.
Modern medicine is miraculous. No other word adequately describes it. A disease that could have blinded me is neutralized by putting drops in my eyes once a day. Another ailment that threatened to cripple my hand is banished by a simple injection. I’m also grateful for the dental restoration techniques (crowns and onlays) that have made my brittle middle-aged teeth better than new. And the orthopedic treatment that, twenty-six years ago, restored my ability to walk. Miracles, all of them.
Historical note: Movable Type tells me that this is my 300th blog post. That’s not a terribly impressive number for a blog that has been in operation for 57 months. Some bloggers post multiple times per day, while I’ve only averaged a little more that five posts per month. But at least I’m still blogging after almost five years.

Jun 19

Trigger thumb

Several weeks ago, I started noticing that my right thumb was behaving oddly. When I first woke up in the morning, I found it difficult to straighten or bend the thumb. It would flex normally for part of its range of motion, but at about the midpoint I would encounter resistance. If I made a greater effort, the thumb would flex past the point of resistance with an unpleasant (and occasionally audible) pop. Sometimes this would actually hurt. The problem would clear up after I had been awake for an hour or so, but it always came back the next morning.
Eventually, I noticed a couple of additional things. First, the problem did not disappear until after my morning shower. It was responding to heat, as an experiment with a heating pad quickly confirmed. Second, the problem was a little worse each day — flexing my thumb was more difficult and painful until it was heat-treated. I made an appointment with my primary physician for Monday, June 12. I also did a Web search on the terms “thumb”, “bend”, “straighten”, and “pop”, and found numerous pages documenting a disorder called “trigger finger” (or, if a thumb is involved, “trigger thumb”) that sounded exactly like what I was experiencing.
My doctor’s diagnosis was, indeed, that I have trigger thumb. He referred me to the Raleigh Hand Center. The earliest appointment I could obtain was for Friday, June 16. The early-morning impairment continued to get a little worse each day, and — more ominously — the problem started to flare up during the afternoon. I don’t have a heating pad at work, so I would have to get a cup of hot water from the break room, put it on my desk, and dunk my thumb in it for a few minutes.
On Friday, I went to Raleigh Hand Center and was examined by Dr. Post. He confirmed the diagnosis of trigger thumb, and explained that the first thing we should try was a corticosteroid injection into the joint at the base of the thumb, which often cures the problem. (If that didn’t work, an outpatient surgical procedure would be the next step.) I agreed, and he gave me the injection after administering a local anaesthetic. Dr. Post said that improvement might take as long as four weeks to appear, but that most patients noticed the benefits of the injection after one or two weeks.
The thumb was sore for a couple of days after the injection, but now feels fine. I phoned my father yesterday to wish him a happy Father’s Day, and in the course of the conversation we traded stories about our recent medical developments. Dad astonished me by revealing that he has trigger finger in the middle fingers of both hands. His doctor gave him steroid injections, which cured them problem for a while. But it gradually returned. The doctor decided to repeat the injections, and Dad is symptom-free again. If the cure isn’t permanent this time, Dad will undergo the surgery.
It’s interesting that we both developed the same problem at about the same time. I suppose there might be an inherited predisposition, but the causes of trigger finger are poorly understood and may be environmental. Dad and I both use computers a lot. (Dr. Post speculated that my thumb seizes up during the night because I’m not moving it. If that’s how it works, the afternoon flareups at work probably happened because my right hand was holding a mouse, which involves very little thumb motion.) In any case, we now have something new to talk about. The next time our extended family gathers around a dinner table, Dad and I can bore everyone else by comparing notes on our trigger finger experiences. And of course I can bore the readers of this blog (if any still exist) by writing about my thumb here.