Sunday, February 23, 2014

THB Enjoys Life in E-ville

One of these days,
I’m gonna sit down
And write a long letter
To all the good friends I’ve known
One of these days,
One of these days,
One of these days,
And it won’t be long, it won’t be long

(well, unfortunately, since it’s THB, it probably will be a very long letter)

More Department of Clarification clarifications:

1.    Here’s the big one: THB got the stuff the doc told us wrong, twice! Wasn’t angioplasty vs angiogram. Blood work logic was different. Bring someone with you to the big meetings!
2.    It was a Physician’s Assistant that came in on the morning after the operation to go over with us what happened (the report of the operation was already on-line and she referred to it on a screen in the room) and next steps. THB is finding out that this is a new growing position, with almost-docs taking on this role (need a lot of training to do it well since there are lots of medical questions to be answered). Actually very helpful! Not the same thing as the computer jocks (i.e., “stenographer”) that some docs are bringing into the examination room with them now.
3.    It is Brilinta, not Brilantia (nor Brilliant, nor Lifeofbrian)
Even after showering, THB can see he is foot-marked
First off, THB would like to reiterate the following:
1.    The revelation stands (for those of you of a certain age): if you start to feel unusual pain and it persists, call 911.
2.    If you don’t call 911 and someone close to you suggests that you should call, make the call.
3.    If you’re having chest pains, don’t be surprised to be treated for heartburn/indigestion since that is by far the most likely cause. Ask if you should have a stress echo test. Then, if you don’t hear a “yes,” demand a stress echo test.
4.    Have someone with you when you’re hearing distressing personal news. THB got the main points of discussion with the doc (even the day after the surgery, when THB was supposedly feeling cured) wrong. DB caught it right away when reading the second posting (see comments above as a proof statement).
5.    More to the point of Travels of THB, the blog is fiction and much of what THB writes about is impressionistic, there ain’t what you might generously call “fact checking” going on, neither while the events are taking place nor afterwards.
As predicted, THB is exhibiting his bruises
Now some quotes from the report:
-        Description of Procedure: …bivalirudin was initiated and a 6-French R4 guide was advanced to the right coronary ostium through which a 0.014 inch BMW wire was advanced to the right coronary artery. Over this, a 2.5 x 15-mm balloon was advanced to the area of stenosis and inflated 8 atmospheres for 30 seconds and withdrawn and then a 2.75 x 15 mm Xience stent was deployed at 14 atmospheres…Angiograms revealed an excellent result…
-        Coronary angiography: There is a right dominant system. The left main is free of disease and branches into an LAD and circumflex. The LAD has no significant disease….there is a 90% plus stenosis with intraluminal filling defects
-        Ventriculography: In the RAQ projection, there is inferobasal hypokinesis. The ejection fraction calculates at 57%
-        Intervention: Prior to intervention, there is a 90% stenosis. Following intervention, there is no residual stenosis.

So, now THB can say he owns a BMW that he drives around all the time, and he is keeping his appreciation for all things French close to his heart (sorry, very bad pun). THB also totally rejects being right dominant. C’mon! Really? As for the RAQ projection, THB is going to dig out his old Bill James abstracts and see what the master-sabremetrician has to say about it. Something tells THB that if it was that important, he would’ve at least read about it in Money Ball.

Finally: THB does appreciate all the follow-up notes, calls and comments. It is amazing to look back on the last month and realize how many fun things THB did (not just the meals, several more of which THB forgot to mention), often with friends. Unusual? A bit because of the big b’day festivities. On other hand, not so much, it is nice to have such a varied and entertaining group of friends. 

Friday, February 21, 2014

THB Moves Over to Concord


Oh a false clock tries to tick out my time
To disgrace, distract, and bother me
And the dirt of gossip blows into my face
And the dust of rumors covers me
But if the arrow is straight
And the point is slick
It can pierce through dust no matter how thick
So I’ll make my stand
And remain as I am
And bid farewell and not give a damn

{HAH: for you skimmers, you have to scroll down to the bottom of this post to find out what happens, and YOU know who you are!)

BIG NEWS (no, not the diagnosis, you have skip to the bottom of this posting to find out what happened on that front): K&E are the high-bidders on the first house they bid on, and if they can finalize the deal, they will be living in Danville, less than 30 minutes from E-ville in non-commute hours. DAMN, inside of 13 months and both daughters will be among the landed gentry.

Book Review: The Last Man in Russia: The Struggle to Save a Dying Nation, Oliver Bullough. Using a priest whose life spanned pretty much the existence of the Soviet Union, the author illustrates the fate awaiting those who cannot liberate themselves from totalitarian governments: the obvious issue being that disenfranchisement means shorter life spans and lower birth rates (quite a topic for THB while in the hospital)

Department of Clarification #1: Along with Nexcium and Xanax, Maeve also ruled out mint, tomatoes, citrus, alcohol and coffee; is that any way to live? THB thinks not….

Department of Clarfication #2: Along with all those other spots, THB also ate at State Bird Provision with R & H (nice of them to include us!)

Where was THB? Oh yeah, he was in Doc Wulff’s office, along with DB, who is listening and watching acutely while THB is thinking that he is lightheaded and a failure. First thing the doc does: puts a nitroglycerin pill under THB’s tongue. Then he takes the history (THB will spare the repetition here, though he forgot to leave out one pertinent family story: his maternal uncle had a stent put in, immediately after having lunch with THB at the Zuni…how did THB forget that? He never forgets a meal!), and sez: you can either go to the emergency room right now and have angioplasty next day or you can go to emergency room right now and have an angiogram the next day. Angioplasty gives about an 85% chance of finding root cause, angiogram almost sure to say what is causing the problem (for those of you extra sharp readers, heartburn and indigestion have been ruled out, THB has a heart problem), and the outcomes can range from still not sure to triple bypass to (about 1 in 2000...true?) something worse (death?). THB is not really listening with full attention anymore, and DB is doing her job and ultra-analyzing what we’re hearing.
It took the EMTs longer to load THB than transport him
THB is no longer in control of his own destiny (he is still in his running shorts, though, and thinking he could make a break for it). And, since he is going to be admitted to the hospital, the doc is obligated to call the EMTs and get THB to the ER in an ambulance (THB would’ve walked, he was in his running shorts!). Wow, this is THB’s first ever ride in an ambulance!! Amazing, and since the hospital ER is across the Doc’s parking lot (true!), the buckling of THB onto the gurney takes longer than the ride. Oh, and the EMTs give THB another nitroglycerin under the tongue, and four baby aspirin. Finally, the mountain of pain has gone away.
The full ER look
We hit the ER around 5 or so, meet a doc who does a decent job of explaining what’s going to happen, and a rookie (it had to be her first patient) tries to get a needle into one of THB’s veins for blood samples. Fortunately, Nurse Mike takes over. It’s a good thing, because it turns out blood work is a huge indicator of problems, and THB finds out later he does have problems: 1.78 treponin (sp?) levels vs norm of .6. At this point, THB also gets to switch from running shorts to a hospital gown. And, at this point, THB also remembers to introduce his lovely wife, DB, to everyone who appears (this is many a soul, THB meets many care-givers in the ensuing hours).

Also, so starts the crush of paperwork sign-offs (THB should’ve brought a stamp). It is also where THB learns his mantra: 2-2-49. The only real confirmation they want to hear is your b’day. By the end of the stay (some time in your distant reading future), THB is starting the conversations with people he’s never met with 2-2-49 (and sure enough, the very last person to show up to take blood, nearing the end of his stay, says, Oh, that’s not right and leaves). THB also gets a beta-blocker (which THB and DB are trying to keep track of the drugs THB is getting, and miss this one, if it was given, the “real” name…it turns out to be something like methoprol or lo-pressor, maybe).
THB got many a foot massage: they are testing for a pulse
Nurse Wendy is in charge of THB in the ER. KB shows up with pizza and salad, LB shows up for additional moral support, and we all get to listen to  first a drug addict loudly bemoan his pain and then a guy with pneumonia loudly bemoan his fate. Around 8, the admitting doc (after reviewing history one more time) gives more of the same info as to what will happen (oh, and admits THB), and around 9:15 or so KB and LB depart, DB leaves around 9:45, and at 10pm THB is wheeled upstairs (and gurney guy manages to leave THB’s paperwork in the ER) and THB is in bed around 10:30, having been weighed twice (once in bed, once standing, both say 185), attached to an IV, attached to a heart monitor, and put to bed.
THB's room in Walnut Creek
Several times during the night, THB is awoken: one time for shot in the stomach and two different medications (lovenox? Blood thinner?) and Lipitor (cholesterol)  and Plavix (??), sometimes to check vital signs, multiple times to take blood, sometimes to…to….THB lost track. THB’s fave visit: the blood guy who said he wasn’t sick, he was allergic to what they use to wash the floors in the wee hours of the morning AND would THB mind taking off the bandaids from prior blood tests (THB was surprised the guy didn’t have him put the needle in the vein also). Oh, and in morning, THB now weighs 183, so IV diet seems to be working. He also gets his levoxyl (thyroid) meds just like at home, very nice!

Quick note: the on duty night staff (May, Sam and Eleanor) all uniformly patient, cheerful and informative (if they know something, they share; if not, they say they don’t know and will find out). They generally work a 7-7 shift.

My lovely wife, DB, re-appears, her sleep was about as bad as THB’s, and Doc Wulff arrives with the details: the blood don’t lie, it’s an angiogram at around noon at a sister John Muir facility that specializes in cardiology. He tells us that all those analyzed blood samples confirm (actually more accurately show) what the Stress Test showed:  THB has a real problem (even if it is atypical, with only the one symptom: GIANT chest pain). Hey, THB is atypical…who could’ve guessed that!

Just about a half hour before departure time, a very strange thing happens. A 50-ish dark-haired woman purells herself just outside THB’s room, walks in and says “I’m the chaplain, would you like to talk” in a very gentle voice. THB is actually in shock!! First, THB is about as non-religious as you can get, so non-religious that he would be categorized as anti-religious. Second, THB is struck by the timing. Sort of like: are you here to administer the last rites? I’m due in surgery soon, damn soon. THB isn’t really mad at the chaplain, THB is mad that on all the forms pushed in front of him, none had a box that you could check that said: NO religious contact.

Another thriller: THB gets his second ambulance ride in two days!! This one lasts about 20 minutes or so, from Walnut Creek to Concord. THB is plunked down in the Operating Room prep area where he is stripped and shaved (let us just say that THB no longer needs to go to the dermatologist to get those annoying little tags removed from his chest or groin), has his monitor buttons ripped off and replaced with new non-metallic monitor buttons, and at 11:30 is rushed to the OR so fast that both THB and DB realize independently that they didn’t get that last I LOVE YOU in before surgery (it, after all, could be the last time THB can effectively communicate such without using eyeball twitches).
Sample of  heart monitor

A team of 3 (or is it 4) finish getting THB in position, including wrapping a gigantic ace bandage around him and the operating table twice, pinning his arms to his sides (a good thing, nobody has asked about his essential tremors!! Can’t you just see Doc Wulff saying: is he having a problem or just waving at me???). At noon, THB does his usual “I’m stuck here, may as well close my eyes and relax” routine, they start poking at his groin and talking about what THB thinks is something to do with the hospital cafeteria, and at 12:30 (or so), THB is told he’s good to go (well, first they have to unwrap his giant ace bandage and move to him to another gurney) and is whisked back into the OR waiting area.
The hole in the groin
According to the accounts of others (Doc Wulff talked to DB, KB, and LB), the operation went well: THB had one artery that was handling smaller volume that the other two (those other two arteries were poster boy specimens for lifelong workouts) and thus needed a stent put in place. My lovely wife, DB, thinks of it as a three lane road narrowing into a one lane road. Hmmmmm…90% blockage, which seems more like what a 5 lane highway looks like after New Jersey gets done narrowing the traffic onto some insignificant bridge leading into Manhattan. 

The hole in the groin cover-up
For the next six hours, THB has to keep his right leg straight (the right groin was the entry point) and his neck straight (to avoid doing any “sit-up” like motions). He starts getting a slight pain in his back (from the awkward position) and notices a slight concern when taking an extra large deep breath. On the positive side, THB can now enjoy the sandwiches and cookies brought by LB. He is feeling much, much better.
THB dressed for the ride home
At around 8, DB heads home. The night nurse takes off THB’s monitors (and thus THB can start typing again), gives THB a slight sleeping pill and beta blocker, and off to never-never land THB goes. A shout out to Brenda Sue and especially Jen, the nurses that nursed THB from hole in the groin to E-ville.

Skimmers: we’re near the end, you can pick up here. My lovely wife, DB, appears with Arizmendi pastry and coffee (now back on the “you can eat it list”), and a nursing assistant for Doc Wullf appears and THB gets the scoop (and a copy of the report) from her. What’s up next: cardiology therapy for 12 weeks and lots of drugs. A generic for Lipitor, Metorprolol (a beta blocker), baby aspirin forever, and Brilantia (a new drug for keeping the stent from failing, for one year).
The chest hair of a 12 year old; note they did NOT shave the stomach

The new drug regime

From stress test to home with a new stent: 43 hours. Oh, and since THB turned 6-5 after all this started up, it looks like that between Medicare and Anthem Blue Cross supplement, THB’s out of pocket will be just one hole in his groin. 

And, THB's big revelation: at the beginning of this saga, he should have got off his bike, called 911, then called DB. For men of a certain age, pain like that is not to be ignored, even if it turns out to be "just" heartburn or indigestion. And, then, THB should have listened to DB when he arrived and said, No, I am not okay. It was too late then, THB had made up his mind, he was going to move on, not ask for help. WRONG!

As always, thanks again to my lovely wife who did all the right things, asked all the right questions, and realized that the last kiss may really be the last kiss

THB Ends Up in Walnut Creek

Weather: the Bay Area is enjoying an extended Spring, now around 9 months long

QOTD: So, Alice says to the mouse: I can see that your tail is very long, why is it so sad?

This is a long not-so-sad tale of THB’s last few weeks. To start at the beginning, in late January, while THB and DB were relaxing at the beach, THB took a bike ride he’s done many times before, including a few weeks earlier, from the beach house to Monterey to meet up with DB for lunch along the wharf area. It’s about 90 minutes; 40 minutes or so into the ride THB starts to feel a pain in his chest, which grows to be pretty severe. Then THB starts to feel lightheaded. His head seems to be up about 50 feet looking down on his body on the bike.

PAUSE #1: If you want to skip the rest of the story, it is pretty easy: just scroll down to the bottom where THB has bottom-lined it for you. The rest is just filler (as they say in the blogosphere).

Somehow, THB is still able to ride the bike and thus decides maybe:
a)    that since they had been spraying the fields near the bike path that morning, maybe it is just an odd reaction to the pesticide
b)    it is some oddity like heartburn or indigestion, time to man-up and keep riding (though THB does not ever get heartburn or indigestion and is all that keen on manning up)
c)     THB really is very delusional, and while he could call DB on her cell to come pick him up, that would mean using his cell phone, something that was even more anathema to THB than just riding on….

THB meets up with DB some 30-40 minutes later, still in significant pain. She asks is there anything she can do; THB says no, and goes to buy the biggest iced tea he can find. DB buys sandwiches, and THB eats a gigantic sausage (massive). For you travelsofthb diehards: two drinks, one tri-tip sandwich, one gigantic sausage, $25 (and the onions and peppers for the sausage are ready about 10 minutes too late).

After lunch, the pain has mostly dissipated and THB loads the bike on the rack, we drive back to beach house, and THB proceeds to immediately start suffering a mild form of that cough/cold that is going around. No more intense pain “episodes” for two weeks (though plenty of coughing and a few sneezes).

In the meantime, DB heads off to Cuba for a week on an art trip, her sister is her roomie. THB stays home and for his big 6-5 b’day, heads to LA for a fine celebratory lunch with his mom, where they have the Sunday champagne brunch at the Hotel Bel Air (no sightings of the most famous woman in the world, she is One of a kind, had been the biggest star On TV for the last 25 years, and has her Own magazine….sorry, that’s another story). On the flight’s descent into LA, THB gets a screaming headache (cabin pressure + head cold).

After lunch, THB retires to the hotel to watch the most depressing Super Bowl ever: for the want of a play or two, it would be the 9ers dismantling the hapless Broncos and Mr.  P. Most-Overrated (not related to the other One of a kind).

Back to Oakland the next day, this time no pain on descent. While DB is gone, THB takes another long bike ride (out to Pt Richmond and back) without incident. He also does his regular daily elliptical exercise, no problema.

Just before DB returns from Cuba, THB has another “episode” of chest pain, lasts for around 30-40 minutes, this time not related to exercise. Maybe more related to something THB ate? DB returns on a Sunday, another episode, so THB sends an e-mail to his primary physician with the subject line: Chest Pains. That means the office calls him early Monday and books him an appointment for 11:30, though not with Maeve, his primary doc, because she does not work on Mondays.

THB and DB show up (we have an agreement that for “serious” stuff two listeners is way way better than one non-functioning human who departs into despair at the hint of bad news) and THB gives the background: never smoked, no family history of heart problems (which turns out to be slightly inaccurate, as THB will relate later), no nothing except hypothyroid and a few drinks per week (not per hour, and the drinks turn out to be a positive). No surgeries (THB does not include vasectomies or colonoscopies as “surgery”). THB still has his tonsils (he thinks…who can remember when you get to be this old).

Back-up doc says it might be heartburn/indigestion and suggests taking prilosec, an over-the-counter drug for acid reflux, something THB had taken maybe 10 years ago (when prilosec was prescription only) for a few days. They do an EKG in the office, no sign of problems. And, just to be sure, the doc recommends THB schedule a stress echo test. THB calls the recommended office, and schedules the stress echo for as soon as they can fit him in (and around his bridge schedule): a bit less than two weeks away, in Walnut Creek (to do the test in the Oakland office would be three weeks away).

A few days go by, some with episodes, some not, some days with multiple episodes. Come  Friday morning, THB and DB are back at the beach and THB sends another note to the office, again titled Chest Pains (THB does not want to imply this is why he gets immediate service; this office replies to e-mails same day pretty much all the time, it is a real joy over fighting through the phone system), and this time his primary doc, Maeve (who has been THB and DB’s primary for a longgggggg time), calls and says it is time to start on Nexcium and Xanax  and Tums for the pain, assuming it is still heartburn or indigestion (DB has all of the drugs on hand since she also suffers from heartburn).

PAUSE #2: This is where the NYT starts interjecting reader suggestions diagnosing what this might be, awarding the first person to guess right a mention right there in the Sunday Magazine. For the earliest correct diagnosis here, THB is not able to get your name in the NYT, sorry. Plus, THB KNOWS some of you will have already skipped to the bottom instead of following this long, sad tail (er, tale) and will cheat and spout out the right answer instead of trying to plasticize your brains.

Okay, Nexcium and Xanax (especially the Xanax) are making THB sleep more comfortably. They aren’t totally eliminating the episodes. Nor is there any pattern to the episodes: sometimes affects exercising (cutting short walks or shortening the elliptical rides), sometimes during or right after meals, sometimes at 10:00pm, all over the board.

On Tuesday of the fourth week, THB gets his robo-call confirmation of his Stress Echo test, out in Walnut Creek. Ooops, the office calls an hour later (a real human) and says Thursday won’t work. Okay, after some maneuvering the scheduler actually moves THB up a day, to Wednesday, and for 3pm (phew, since you can’t eat less than 3 hours before the test, at least THB can eat his lunch at almost a normal hour). Lunch at Graysons, shared pork and ahi tuna sandwiches with fries, an ice tea, $32.

Pause #3: Yes, up until this point, this is only the second detailed meal, and only the big sausage on day one barely relates to this story. However, THB will keep those hungry souls among the blog followers appeased and say that his b’day brunch with his Mom was quite nice (and a great setting), his b’day dinner with K&E and L&R at upstairs at Chez Panisse was terrific and lively, a joint b’day lunch with his sis at Sazon in San Ramon was unique and surprisingly good, and his b’day dinner with DB at Commis  (14 courses, wine pairings, seats at the counter) was also terrific. These chest pain episodes are not keeping this lad from his proper chow-downs.

THB is so confident that he will pass his stress test that he shows up just in his running shorts and his kindle, and DB comes along. So, they do another EKG with THB in rest state; then THB hops on the treadmill and off we go. Level 1, a soft stroll in the park; level 2, a near brisk walk in the foothills, and level 3, somewhere between a fast walk and a run up the side of Mt Tam. Damn!!!!!

Had enough, the technician asks? Oh yes! THB hops down, lays back down on the bench, and they start the second EKG. (DB is outside, the walls are so thin she can hear the second technician, who is being trained, complain her pen isn’t working….which is not distracting THB while he’s on the mountain).

How did THB do, you wonder? Well, here’s how you know: if you pass, they tell you they will send the results to your primary doc and you’ll hear in a week or so the details; if you fail, you get to meet with the heart doc in his office immediately. THB delays the process of deciding if it is door #1 (the exit) or door #2 (the doc’s office) because the pain in his chest won’t go away, and stays lying flat for at least 15 minutes. Finally, the staff gets tired of waiting THB out, it is door #2. All those years on the elliptical, hiking, not-smoking…fail!? Hmmmmm….

Meet with the doc, and the short story (like THB can tell a short story) is that the doc is basically recommending only one option: TO BE CONTINUED