Monthly Archives: September 2013

Getting to the heart of the matter

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The last couple of months have been unusual for me, at least in a medical sense. It seems like I have been going to doctors and having procedures a lot more than I ever have before.

It started earlier in the summer when it occurred to me that a pulse rate of 35 was too low. I have a home blood pressure monitor, and it was showing a reasonable blood pressure, but a very low pulse rate. I looked back in the history the machine stores and realized it had been low for months. There were no normal pulse rates since some time last year. So I called my primary care physician and set up an appointment. That was at the end of July.

At my appointment it turned out that my pulse rate was not low, I was just having some unusual rhythm problems that the blood pressure monitor couldn’t handle. So my doctor put a Holter monitor on me for a day.

A Holter monitor is like a portable EKG machine that records your heart activity. I wore it for 24 hours and then returned it at the end of the week when I got back from working in Huntsville. The doctor sent off the recording and, the next week, on the basis of that, sent me to a cardiologist.

The cardiologist was not too worried. I wasn’t having symptoms. No shortness of breath, no faintness, no chest pain. I have a history of fairly strenuous exercise, although that has tapered off since my knees wore out. Back when I was in graduate school, I was a runner. When someone called me a jogger, I thought, no, I don’t jog. I run. I did eight miles a day at a pace I thought was pretty good. Not great, but pretty good. And when my knees hurt too much, I started bicycling. As recently as a couple of years ago I was biking up Fouche Gap Road to our house. That’s not a long climb, but it’s a steep climb. It’s a respectable climb that you don’t do with a bad heart.

The cardiologist said I was having PVCs, or premature ventricular contractions. A lot of healthy people have them with no symptoms and, for the most part, no need for treatment. Of course, I was having a lot of PVCs. The Holter monitor record was pages and pages long, with normal beats in black and PVCs in green. There was a lot of green. A lot. So the cardiologist wanted an echocardiogram, just to make sure my heart function was good.

So I had an echocardiogram. That’s a simple procedure that just requires a little jelly on the chest. I had that test in the middle of August. A few days after the echocardiogram, the cardiologist’s office called and told me that the echo was abnormal and showed a weakened heart, and I should make sure I keep my next cardiologist appointment in three weeks.

So I had three weeks to come up with the worst-case scenario. I started thinking of what Leah should do if I died suddenly. I was thinking that now, at last, I could retire.

Three weeks finally passed and I made sure I went to the cardiologist. He told me that my heart’s pumping efficiency was about 60 percent of what it should have been. He sat staring at the echocardiogram results and saying, “I didn’t expect that.” And neither did I.

According to the cardiologist, 98 percent of cases of compromised heart function are caused by one of two things. The first is blockage of a coronary artery. The second is idiopathic, which means they don’t know what the cause is. So he ordered a heart catheterization to find out which it was.

My cardiologist’s appointment was last Thursday, two days after my colonoscopy. The cardiologist prescribed medication, which I started immediately. Today, Monday, I had the heart catheterization.

When they do a heart catheterization, they stick a wire up an artery in your groin and run it up to your heart, where they look around for blockages. If they find a severe enough blockage, they can do an angioplasty, or put in a stent, or both. If it’s really severe, they schedule a coronary artery bypass.

The idea of wires stuck up my arteries was bad enough. I’m the guy who got faint while watching a documentary that showed a vat of slushy plasma on black and white TV, and plasma isn’t even red. I did not look forward to this.

But my friend Errol assured me it was quick and easy. And it was. I was lucky because they went in through my wrist instead of my groin. Of course they had to prep my groin anyway, just in case. It’s not a full cut, but it’s still scratchy.

The result? No blockage. The cardiologist who did the catheterization, who now becomes my very own cardiologist, said to continue the prescription the other cardiologist ordered and he might increase it in a month. He was pretty upbeat about the whole thing.

Before the procedure, the staff kept asking whether I smoked, did I have a family history of heart disease, was I suffering chest pains, shortness of breath, fainting spells. No. No to all of that. So what brought me to this point, they asked. And I had to explain about the blood pressure monitor and the apparent low pulse rate, and how it wasn’t really low, just hard to count because of all the PVCs.

And that, along with the negative heart catheterization result, is what’s encouraging me right now. After I started taking the medication last Thursday, I noticed a couple of times over the weekend that my blood pressure monitor was able to count my pulse and show a pretty-much normal result. I’m not a cardiologist, but my conclusion is that if PVCs were causing the BP monitor to be unable to count heartbeats accurately, the fact that it seems to count much more accurately now must mean there are fewer PVCs. It makes sense to me, and I’m going with that conclusion for now.

Triple play

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I mentioned earlier that there are a lot of spiders around at this time of year. A few days ago when I took the dogs for their morning walk, I saw this:

The neighborhood is getting crowded

The neighborhood is getting crowded

The lighting conditions were good to get all three of these spider webs. They were illuminated from behind, so the webs show up well against the darker background of trees in shadow.

If you look carefully you might be able to see all three spiders at work repairing their webs.

One of the amazing things about these spiders is how far they go to support a web. There is one behind our house that has one support strand that stretches about 20 feet to our deck.

 

Friday Felines

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Zoe and Chloe have a love-hate relationship. For Chloe, it’s mostly love, so you know where that leaves the hate.

Zoe starts out all lovey-dovey.

Kissy-kissy

Kissy-kissy

But it always turns ugly. First he starts to push her around.

Pushy-pushy

Pushy-pushy

And then, if we don’t bring out the Cat Corrector, he gets really mean. Usually just the sound it makes when we pick up the spray bottle is enough for Zoe to wander off innocently.

He has gotten really mean at times, but Chloe always seems to forgive him.

Chloe, dear, he’ll never change.

 

In the end

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I had my decadal colonoscopy on Tuesday. When I had my last colonoscopy, I had diet restrictions only for the day before. This time I could not have dairy products, raw fruits, seeds, beans, or whole grains on Sunday, two days before the procedure. That meant that when we had a Southwestern lunch on Sunday, I couldn’t have beans, cheese or sour cream on my burrito, and I couldn’t eat the cheese dip. I probably shouldn’t have used salsa, since it has tomato seeds, but the burrito was so bland without dairy products that it wouldn’t have been edible without salsa.

On Monday, I was on a liquid diet. All day. That means I did not eat a meal at all on Monday. Popsicles don’t really count as a meal. Neither does Jello. Or even beef broth.

And then Monday night, the “bowel prep” began. If you haven’t done this, it’s really something to look forward to. Mark your 50th birthday on your calendar, because that’s when you’re supposed to start routine screening for colon cancer or other conditions.

My preparation was split between Monday night and Tuesday morning. Monday night I drank a half gallon solution of propylene glycol, sodium chloride, potassium chloride, sodium bicarbonate and sodium sulfate, eight ounces every ten minutes. It tastes every bit as bad as it sounds, even with a flavor packet (lemon lime). There was a slight scent of lemon-lime just as I was bringing the glass to my lips, and then it was gone.

The next morning I drank the rest. By then I was getting to like it. Not really.

In case you’re wondering, and you probably aren’t, the bowel prep is intended to wash everything out of your entire digestive tract. This means that what goes in soon comes out. So don’t leave home during this process.

The most interesting part (The only interesting part? Is any part of this interesting?) was the sedation process. Ten years ago, when I woke up, I was groggy for hours. I barely remember walking down the hall with Leah. I remember standing in line at Wendy’s for lunch, and Leah ordering me to sit down at the table. I must have been drifting. I remember sitting on my bed and telling Leah I didn’t need to sleep. And then I kind of remember waking up some hours later. Everything else is completely gone. I don’t remember the drive to Wendy’s or the drive back home. I have no memory of anything else.

This time, the sedative was just what the doctor ordered – for Michael Jackson. Propofol’s effect is quite different from what I got the previous time. The nurse-anesthetist said propofol would basically put me to sleep. It would enter my system quickly and go away quickly.

When they stuck me I tried to be aware of the sedation process, but all I remember is things starting to whirl, and then I was gone. Then the nurse-anesthetist told me to wake up. And I did. It was just like being asleep. In fact, I was in the middle of a dream when they told me to wake up.

They wheeled me to recovery and I remember everything that happened. I was about 80 to 90 percent normal. There was no lingering grogginess at all. Not even now, after a not-recommended beer before dinner.

It’s a lot easier for me to understand how a doctor could order propofol for Michael Jackson if he couldn’t sleep. It’s also easy to understand how Michael Jackson could have believed there would be ill effects from the drug. It’s not so easy to understand how someone could administer it to a patient and then walk away from him. I had oxygen and my heart and blood pressure were being monitored the whole time. I guess that’s the difference between waking up alert, and not waking up at all.

Oh, by the way, I had six polyps removed. I’ll hear what they were in a couple of weeks.

Another hummingbird tale

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Another hummingbird found its way into our garage on Friday and couldn’t find its way out again. Leah noticed it around the middle of the afternoon. I didn’t really try to catch it because my recent history of trying to do that has been discouraging. The last time this happened, the hummingbird eventually disappeared. We still don’t know whether it got out or was caught by one of the cats.

In this case, Leah saw our little hunter cat Sylvester up on top of the opened garage door, close to the same height as where the bird was flying. She yelled at him, and he ran. So after that I looked out every so often to see whether the hummingbird was still there, and whether a cat was looking for it.

It was there when we left to eat. We got back at about 9 PM, and the hummingbird was still in the garage. I thought I might have a chance to catch it. I knew that it would tend to fly around the overhead light if I turned it on. I hoped it was desperate enough that it would ignore me, so I erected our 8-foot ladder under the light, got a dark towel, climbed up and waited. I didn’t have to wait long. The bird flew towards the light, bouncing up against the ceiling, and I was able to gently capture it in the towel.

It made one of the most pitiful sounds I have ever heard. Sometimes the trapped hummingbirds chirp, and sometimes they’re silent. This one had chirped occasionally, but the sound it made now was not a chirp. It was the weak, mewing sound of hopelessness.

I carried it out and draped the towel over a tall shrub at the edge of the driveway. It laid on the towel with its wings outspread, breathing hard. It didn’t fly away. I didn’t know whether I had hurt it when I caught and carried it, or whether it was just tired and scared.

It was beautiful. Its body was iridescent in the lights from the front of the garage. I thought I would get my camera and try to capture some of that beauty. So I went in and got the camera. When I got back out, the hummingbird was gone. I looked around but didn’t see it. It was fully dark by then, but our outdoor lights cast at least a little illumination on the surrounding trees. It might have been able to fly up into one of the trees. If it did, I assume it can either find its way home or spend the night and get some rest, and then eat a hearty breakfast at our feeder in the morning.

At least I hope so.