THURSDAY — Double Dang!

I think Nancy feels better today than she has in a couple of months.  A lingering question about the blood loss remains.  If not caused by the bacterial infection, then what?  The heart issues will be treated continually, so, while she is examined, tested, and treated appropriately for her finicky heart over the next few weeks, the anemic aspect will be watched.  Multiple exams ruled out many things, so with respect to this, we are in a period of watchful waiting.

She went to the local hospital for antibiotic infusion via the PICC line today.  The pharmacy folks indicated they were okay with both of the compounds going in at the same time.  That cut the procedure down to about an hour.  They fixed up a nice comfy bed for the duration and when I returned she was ready to go.

I hadn’t stayed.  That’s the “double dang” part.  One of my jobs yesterday was to clear out the hospital room.  Things such as un-opened fruit juice and the plastic pans for holding tape or other incidental items – these things all get sent home with the patient or tossed out. I cleaned up all these things into a couple of small boxes and a plastic bag.  A nurse brought a wheelchair, I went ahead and brought the car to the front door, and minutes later we were on I-82 heading toward home.

Big mistake.  Someone (me?) forgot to unplug two power supplies – one for her cell phone and one for the laptop.  Bummer.  Ensconced in a fluffy bed, Nancy recharged while I boomeranged from Ebrg-to-Yak and back.  Wind gusts today were nearly 50 mph and the passenger side of the car sometimes makes an odd woodwind sound when air begins passing over us at about 100 mph.  I got that a lot today along with the turbulence.  I did see a large column of dust coming from the lower valley south of Yakama and streaming into the area above the clouds over my route. That was very interesting.  On the ground these dust steams make for nasty driving, accidents and closed roads.

Now that Nancy has her computer back I will expect her to write on Saturday.

There is a potluck by and for the Kittitas Valley Fiddlers and Friends tomorrow evening, so, Friday will be an off-day for our communications.

WEDNESDAY — Dang!

I got the day right but missed the time.  Last week I had to pick a time to get the car serviced and hoped to combine activities, thereby having to make one less trip to Yakima.  So, I said to the man, “Sure, lets do it Wednesday.”  Then I estimated they would discharge Nancy right after lunch and picked a 10 A.M. appointment with the service shop.

There was a problem.  Magnesium (Mg).  This element is used by the body in many chemical reactions.  It is an important electrolyte along with sodium, calcium, potassium, and chloride.  The last is discussed here:

http://en.wikipedia.org/wiki/Chloride

Magnesium is discussed here:

http://en.wikipedia.org/wiki/Magnesium

… where it claims it to be the 11th most abundant element by mass in the human body.  Scroll to “Biological role” more than half-way through the page.  Well, the point is that the doctor decided Nancy was a quart low and as long as she was in the shop, why not just top-er-up some.  Why not indeed?

Time is why.  Slower is better.  Look at this: “Supplementation with 1 to 4 g of MgSO4 over 1 to 4 hours is usually adequate, depending on the extent of deficiency; the administration rate should be slower for infusing increasing amounts in nonemergency situations to avoid hypotension.”

http://www.heart-disease-bypass-surgery.com/data/articles/35.htm

Hypotension simply means abnormally low blood pressure.  Sure thing we don’t want to do that to Nancy, so slow it is.  So, over lunch and into the afternoon Nancy was infused with antibiotics and then switched to a slow drip to bring her Mg level up to the “full” line.

Long-story-short:  She exited through the front door at 4:05 P.M. and we were home at five o’clock.  She is feeling good.  Sleeping.

TUESDAY — Oops!

One of my favorite sites on the Web is called the “oops” list:

http://micom.net/oops/

The Oops list has many photos and a few video clips – funny and odd things, many of airplanes in various states of not flying.  Give it a look.

So, my “oops” is that yesterday I wrote that Nancy’s PICC line had been inserted.  I called that one too soon – sort of a “Dewey Defeats Truman” thing:

http://en.wikipedia.org/wiki/Dewey_Defeats_Truman

I was out-maneuvered by the medical folks.  In searching for internal blood loss their tests were coming up with a lot of nothing.  Thus, the PICC inserter was pushed away from the insertee and folks showed up (mid-afternoon) with a yummy barium sulphate drink.  X-rays have an unfortunate propensity to pass through empty intestines but not through barium.  By ingesting and thereby coating the walls of the gastro-intestinal tract (in Nancy’s case now, the small intestines) with barium the snaky little thing shows up clearly on the X-ray pictures.

Barium in its elemental state is not found naturally as it combines easily with lots of other things thereby producing a variety of compounds, one being Barium Sulfate (BaSO4).  In most mineral collections you can find Barium-“Desert Roses” and these are a concentric pattern of increasingly larger crystals stained red with iron.  Picture here:

http://new.minerals.net/mineral-variety/Mineral/Desert_Rose.aspx

That is about as familiar as one gets with Barium unless you are lucky enough to be handed a glass of Barium Sulfate liquid mix.  This is not anyone’s favorite drink.

So you drink the stuff, gag, spit, and wait.  After sufficient time the small intestines are ready for their time before the “camera” and then you wait some more and they are back for second and third exposures.  This exam is sometimes called a “Barium follow through” and in Nancy’s case yesterday the follow-through ended at 10:30 P.M.  She had gone a couple of days without real food and her digestive tract – well cleaned out – was not prepared for crispy chicken and biscuits.  We have one very unhappy Southern belle.

The day ended with no PICC line so that procedure was today but delayed because the PICC-inserter had a full schedule and did get to Nancy until about 3:15 P.M.  They finished with an X-ray to check for proper placement of the end of the catheter.  She called me about 5 P.M. to confirm all is well.   Except for the known issues with her health they have found nothing new.

I have a car-service appointment (a mile from the hospital) at 10 A.M. tomorrow so we are hoping she might get walking papers by noonish.

We’ll see.   John

MONDAY — Anticipation

Yesterday nothing showed up on the CT scan of the pancreas but the spleen had two spots indicating, I think, blood clots.  These so called “splenic infracts” are blockages of the veins or arteries for the blood supply to the spleen.  Atrial fibrillation and bacterial endocarditis are known contributors to splenic infractions.  These are expected to be reabsorbed after awhile.  Nancy’s current case of endocarditis has been halted.  We also hope something can be done to reduce the incidents of A-fib.  In any case, now the infractions are known about and fit into the general situation and are not a big worry.  It is also a relief to know that the pancreas is without problems.

Splenic infarction can occur without symptoms (asymptomatic), which was the case with Nancy until this week.  This week the typical symptom — severe pain in the left upper quadrant of the abdomen showed up.  Sometimes the pain radiates to the left shoulder but that wasn’t the tell-tale sign.  Fever and chills develop in some cases and she did have these, but, again, with the other things happening (including the bladder infection) they were not the symptoms that led to the CT scan.

So, onward.  This morning the nurse told Nancy that her colonoscopy was scheduled for one o’clock.  The nurse didn’t seem aware that an upper GI endoscopy had been talked about and so went off to check.  Sometime later she came back to report that both were to be done – and so they were.  So they looked into her from both ends and found nothing.  Good news.

They refer to the upper GI exam as an “EGD” – and for good reason.  Who wants to say “esophagogastroduodenoscopy” more than once?  Rather than me explaining that you can read about it here:

http://www.gicare.com/endoscopy-center/upper-gi-endoscopy.aspx

A follow-on regarding the duodenum (the first section of the small intestine) is here:

http://en.wikipedia.org/wiki/Duodenum

This test ruled out any bleeding within the three structures, and that’s good.

The last procedure for the day is the instillation of a “peripherally inserted central catheter” (PICC or PIC line) for which, in previous reporting, I used the acronym PICC.  You can read about it here:

http://en.wikipedia.org/wiki/Peripherally_inserted_central_catheter

I will add a bit more on this tomorrow.  We then may have some indication of a release-from-hospital date because there are no more procedures scheduled and the PICC line can be used at the Ebrg hospital to infuse the antibiotic therapy as was done last July.

So while no plans are yet made, we are anticipating escape release soonish.

Cheers, John

SUNDAY — A trip to the CT lab

Being Sunday, this is the one day of the week that we have been writing.  If you are returning for the first time since last Sunday you will want to go back and start on Monday (a catch-up day) or on Tuesday when an early morning event sent Nancy back to Yakima Regional’s ICU.

~ ~ ~ ~ ~ ~ ~ ~

The only news for today is that late this afternoon Nancy had a CT scan of her spleen and pancreas.  This site:

http://pedsurg.ucsf.edu/conditions–treatments/splenectomy.aspx

shows the location of these.  The spleen has important roles in regard to red blood cells and the immune system.  The pancreas is a gland that produces many different substances to both aid digestive functions and regulate other processes.  If you look at the image on the suggested web site you can see that these organs are within a three dimensional jig-saw puzzle with other soft tissue parts, namely, the stomach, liver, and gallbladder.  Projecting X-rays through the body to the far side and onto an imaging surface or film will give a muddled picture.

Think of taking two thin clear wine glasses of different shapes, say one is more cylindrical and tall and the second is more of an onion bulb shape.

Set one in front of the other and look along the line that goes through the center of both.  This might make for a confusing image, at least, more so than if you slid the one out to the side from behind the first.

When trying to “see” internal body parts with X-rays we can’t just move the parts around as with the glasses.  But, by moving an X-ray source and the film to many different positions the technician can get individual thin sections, pick only ones imagining, say the spleen, and then stitch those sections back together again and reassemble a picture; or you can just look at the individual slices.

There is an explanation and color image here:

http://en.wikipedia.org/wiki/Tomography

The word “tomography” is explained there.

Nancy had to drink a bottle of Gastrografin, which contains a molecule with Iodine and aids in producing ‘contrast’ so the image picks up the target tissues, that is, the intended part or parts.

Nancy left her room at about 5 P.M. and was back by 5:30.  She said they took about 400 images.  This information will be sent out to an experienced person who will interpret and consult with the doctors in charge of Nancy’s care.  So at this point we do not have any results.

Meanwhile, she stays on a liquid diet in preparation of the upper-GI and colonoscopy, now planned for tomorrow.

She has given up on the Jell-O and is very tired of the special juice drinks provided for sustenance.  Who can blame her?

FRIDAY — Better and waiting

It is 6:30 as I write.  Nancy has been resting well and improving.  The cardiologist felt she need not be on constant monitoring and so they moved her to the 4th Floor into a big room with windows and a potty.  Except for sky there isn’t much to see out the windows unless one stands up on the sill and looks over the SW wing of the hospital.  Still, the view – any view –is much better than in the ICU.  Likewise, having the ability to use a real bathroom is, compared to a bed pan or movable stool, a major improvement.  It also brings increased movement – we want no regression on the lack of muscle tone.

She is still on a liquid diet in anticipation of procedures to rule out (or in) possible sites for blood loss.  The INR test suggests this could be done on Sunday, but not Saturday.

While I was there this afternoon a blood-draw was done for the purpose of checking on the bacterial infection.  Her color and vital signs suggest a rapid improvement since she went to the ER on Tuesday.  I want to know more about the bacteria and what they measure.

I still haven’t met the infectious disease doctor this go-round.  Last December I sat at opposite ends of the same table with her when I was being briefed by Nancy’s nurse and the doctor was reviewing files.  Later the nurse told me about the doctor but Nancy’s issues at the time did not involve bacteria.  Anyway, Nancy may have to ask for a page or two of notes as the names and spellings of the critters is beyond us and so I have no key words with which to search.

That’s it for Friday.  John

THURSDAY — Progress, I think.

A correction to a previous assumption is in order.  Our thoughts on the ICD have focused on V-fib and that is what we assumed happened.  Upon reading the data stored by the unit we now know the thing fired-off because it sensed a too-rapid heart rate, namely, 188 beats per minute.  This is called tachycardia.  The term tachycardia comes from the Greek words tachys (rapid or accelerated) and kardia (of the heart). The gizmo on the dash of a car that gives RPMs is a tachometer and has the same Greek word origin. Tachycardia typically refers to a heart rate that exceeds the normal range for a resting heart rate – for folks over 15 years this would be any rate over about 100 bpm.

Nancy’s rate had been running a bit high (I thought) during the past few weeks, frequently 80+.  She has had frequent atrial fibrillation …

from the Mayo Clinic:

http://www.mayoclinic.com/health/atrial-fibrillation/DS00291

“During atrial fibrillation, the heart’s two upper chambers (the atria) beat chaotically and irregularly — out of coordination with the two lower chambers (the ventricles) of the heart. Atrial fibrillation is an irregular and often rapid heart rate that commonly causes poor blood flow to the body and symptoms of heart palpitations, shortness of breath and weakness.  Atrial fibrillation can also cause fatigue …”

Monday’s report explained how the “King of Hearts” monitor was rendered useless by the frequent A-fib, and the need to switch to a Holter monitor.

[Small world story: Friends (Brittany related) write:

“Hi. Just read your latest comments and thought I’d share a bit of trivia with you guys. Dr. Holter was born and raised in Helena, MT. In fact, his home was 2 houses south of ours. . . he was a native son, the local history museum had a special display with his old stuff, photos, etc….”]

Now back to the main story:

When (on Tuesday) the ICD sensed the tachycardia it pulsed twice and converted the abnormal rhythm to a regular sinus rhythm.  Nancy was on the kitchen floor and shifted about until she was leaning against the oven.  She thought I was outside and sat there awhile thinking I would come back.  That plan didn’t work because I was down the hall sleeping.  From where she normally spends her time (a recliner overlooking the back forty**) she gets me awake or from the computer by activating the ringer on the house phone.  There on the kitchen floor she didn’t have that capability, so, after about 45 minutes of rest and frustration she yelled for me hoping I was near enough (outside) to hear her.  Had I been outside that likely would not have worked but being only a room away, it did.

**————skip, if you know “back 40”———————–

“back forty” is a reference to plots of land of 40 acres established by the USA’s Public Land Survey System (PLSS) –good explanation here:

http://www.nationalatlas.gov/articles/boundaries/a_plss.html

The settlers house would be located close to the public road that went by the ‘front’ of the property and frequently near the better farmland.  Some claim that if a salesman or other intruder visited the house and the spouse felt there was no need to bother her husband, she would tell the person that the entire crew was out on “the back forty” – far from the house and could not likely be found. (no cell phones then)

————————————————————————

Now it is Thursday afternoon — several phone calls later.  The INR is coming down but the colonoscopy won’t be done until Saturday.  At 1.7 INR the doctor can remove any suspicious polyps.  So we wait on that.  She has had antibiotics, blood infusions, and other liquids pumped into her.  Her fever is gone and her heart rate lower and steady in the high 60s.  She called after having the TEE (see Wed. posting) that did confirm something (filaments of bacteria or ‘vegetation’)

http://en.wikipedia.org/wiki/Endocarditis

on the mitral valve (donated by a pig) .

Here’s an assumption:  When bacteria in the blood inflames the heart it is called endocarditis.  Nancy’s medical problems flared last spring when this happened and she went to the ER in Ellensburg. If you look at the list of symptoms on this site

http://www.mayoclinic.com/health/endocarditis/DS00409/DSECTION=symptoms

there are several that she has been experiencing (again), namely, fatigue, fever, weakness, and weight loss, blood in urine (microscopic).  To me, this appears to be a slow-motion version of sepsis and septic shock.

http://www.mayoclinic.com/health/sepsis/DS01004

http://hopkins.portfolio.crushlovely.com/reference/article/septic-shock

The cocktail of antibiotics has been upped to four (to cover all possibilities I assume).  She is feeling much better except for a bit of raw throat from the TEE.  That and a liquid diet in anticipation of the colonoscopy.  She isn’t happy with the lumpy Jell-O just served and she questioned me on how one screws up making Jell-O.  I don’t know.  Too little stirring or the water is not hot enough, I guess.

It is almost 6 P.M. here so I have to send this to the cloud.

Bye.

John

WEDNESDAY — Take a number.

There should be a sign above Nancy’s door.

While in the Ellensburg ER a test revealed an anemic condition so a unit of blood was started before they transported her to Yakima Regional.  She also had a high white cell count.

The latter is likely caused by a bladder infection – now being treated.  The cause of the low red-cell count is thought to be internal bleeding.  Why is not known.  An upper gastrointestinal (GI) exam is planned, as is a colonoscopy.  With all that is going on with her body the INR (blood clotting test) reading is high so that has to be brought down before any invasive procedure. That is being worked on.  When that reading is where they want it, then those tests can be done.

An  echocardiogram or ‘echo’ revealed something on her heart valve, possibly a bacterial growth (she had this last year).  A blood culture revealed two strains of bacteria in her blood so they started a 3-drug cocktail that may be adjusted when the exact strains of the little devils are known.  However, to get a better look at the valve and its hitchhikers they scheduled a transesophageal echocardiogram or TEE, where the echo transducer (sound producer) is placed in the esophagus or food pipe that connects the mouth to the stomach.  This gives a much clearer “picture” of the inner heart as the waves do not have to travel into the body from the surface. See:

http://www.heartsite.com/html/tee.html

So with all that has been done and all that will be done on Thursday there is a steady stream of nurses, doctors and more doctors, blood takers, blood infusionist, menu bringers, cleaners, and others lining up at the door to get in and question, prod, poke, stick, listen, and so on.  They get in each other’s way.  She needs that sign.

Take a number.

TUESDAY — Yikes!

We’re back in the ICU at Yakima Regional.  Nancy has something going on and not being sure what, the consensus of the medical profession was that Yak-Reg ICU is the best place for her for a few days.

I’ll make this short (for now):  We woke early this morning, I think about 5:30.  I let the puppies out, asked Nancy if she was okay.  She was, then she wanted something to spit into.  I got that for her and went down the hall and went to bed.  At some time later she got up and went into the kitchen and was dumping here tiny waste bucket into the sink.  At that point she apparently had a ventricular fibrillation episode and sank to the floor.  Her ICD responded with a double whammy and converted the beat back to normal.

Her legs and arms are weak (and maybe more so from the incident) and she rested a time on the floor but did not get up.  She thought I had gone outside and expected my return.  After about an hour she yelled for me and, being just down the hall, I appeared after the first yelp.

We then went to the Ellensburg ER where they soon determined the main thing wrong, as far as they could tell, was from a blood sample.  She was quite anemic and the doctor thought that might have triggered the V-fib and set off the ICD.  Test of the kidney function did not suit them either. They cannot download the data from the ICD here and so, with a unit of blood hanging beside her – off to Yakima she went.

I talked with her a few minutes before 5 P.M. and she sounded fine but had little real news.  I’m posting this at about 5:25 and will head on down.

More Wednesday.

John

MONDAY — A phone with a cord?

Did he think we were early-adopters at the cutting edge of technology?

As mentioned Sunday, the week turned out busy again, with me, Nancy, still run down, but at least I am keeping down food.  I spent many hours searching records of former grads that were on the alumni list at CWU marking people to email the invitation of the celebration to, that will occur on Oct 2, a Saturday afternoon, meet and greet and eat and drink.  Also went to a music event at the Rehab center where I spent 6 weeks.  They all call me by name when I walk by, or come stick their head in the door and wave.

There was no exercise class and although I didn’t probably have much energy, I stopped by only to find it was cancelled, Monday.  Wednesday and Friday I was not able to go because Wednesday I was still involved with getting the heart event monitor (supposedly for a week) installed.  John will tell about that, inserting it below, but meanwhile, I just read his treatise (and it is worth reading), and see he wants me to describe the second unit.

The first unit meant for a week is what he describes.  It only had two connections to the relatively light unit, but it was for a week, with a button I could push when I felt stress or to generate a recording.  There are only 9 tracks.  It was too sensitive and picking up (without the ability to filter out) something we already know I have, atrial fibrillation.

We changed to a unit that was only for 24 hours, but weighed a LOT more–really heavy hanging in my pocket and connected to me in six places.  The first top place was poorly placed by the installer on top of the worst, deepest part of scar tissue from my original scar down the middle of my chest (at the top).  This guy needs to be told, and I will.  Where it made the difference was taking it off 24 hours later – when I pulled the tape and the connector I had the worst pain I have had in many months.  I screamed and scared John, and probably everyone else on the Naneum Fan.  I got the dogs’ attention and probably the horses as well.  At least John was not out lifting one of their feet when I screamed.  After getting over that removal, the other five were not over scars, and did not hurt coming off.  But I was worn out from the experience.  My next visit to the cardiologist is 2 weeks away and we’ll get results and suggestions then.

Check below for a nice write-up by John explaining the first old technology I was supposed to live with for a week.

Meanwhile, I will insert the nice things that happened Saturday and Sunday, that also were very taxing on my system.  First thing we did was Saturday, drive to a restaurant on the Lake, at Moses Lake to meet our 40 year long friends (from Iowa) who helped us move to Idaho in 1974.  That trip we were quite a rig, with canoe atop and inside a station wagon, my driving and Ann as a passenger, two dogs, theirs and our Brittany, and two cats.  John and Fred drove a large Ryder van with all our belongings, pulling their VW bus with more belongings that wouldn’t fit in the van.  There are stories with that to remain in our memories.  Anyway, each year they come to Spokane to visit family and either drive to Ellensburg, or last year we tried this place, to which we returned.  The visit was wonderful and the food and the trip took about 5 hours total.  It took me a 4 hour nap to recover and then I slept all night as well.

Sunday was another busy afternoon with a potluck with our Trail Riding Club.  There were 43 people there.  I kept down all the food from both occasions, so that hurdle is over till I have to get a refill on the Reglan.

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John says:

It is not easy keeping track of what is happening to you as you go through the labyrinth of modern medical technology and practice.  Consider the simple suggestion of the cardiologist to wear a heart monitor for a week.  Sometimes the expressions used are historic relicts with no connection to modern understanding of the thing being talked about (for example, sinus rhythm – normal beating of a heart). Also, one finds old and new equipment intermixed because the technology of data recording, storage, and transmission has been advancing rapidly.

There is the problem of terminology.  Nancy was fitted with a “King of Hearts” unit. What’s that name mean? Nothing! It is the Instromedix company’s name for a device described as an event monitor.  It is a bit like telling someone you went to the “Golden Arches” for lunch.  Most everyone you know today would understand that you went to McDonald’s and got a cheeseburger or some other fancy fare.  If a person does not associate McDonald’s and Golden Arches that person could only guess, maybe thinking that you went to an expensive Thai restaurant.  Likewise a King of Hearts unit conveys no useful information.

So the idea of and event monitor is that leads attached to your skin pick up electrical signals and when your heart does something rare (key word) that it is not supposed to do, then signals just before, during, and after the event are stored in the unit for analysis at a later time.  The unit may also have a set of beeps to alert the wearer that an event is triggering the recording of the signals.  I should mention that the unit is about the size of a deck of cards but not as heavy.  They do not have a lot of storage, anticipating that the events to be recorded are rare.  With regard to such assumptions, Nancy rarely cooperates.

Nancy’s heart has very frequent episodes of atrial fibrillation, the most common abnormal heart rhythm or cardiac arrhythmia.  [This is partly the reason she feels tired much of the time.]  After being fitted with the unit we headed for the car and to a Costco warehouse store. The unit recorded 2 events before we were into the car and 7 more by the time we were in the check-out line at the store.

Here is why that is important.  First: The unit makes two beeps to let the wearer know it has been triggered but this one recorded silently. When recording is completed, if there is sufficient memory to record another event, the King of Hearts recorder emits a double beep and automatically restarts normal scanning mode on a loop-type scan.  So in the first 40 minutes we heard 18 beeps.  Second: The unit will only record 9 events and then one has to “upload” the data via a telephone.  One has to call a place in New Jersey (they thought), talk to a live person, send the info, talk to the person again, reset the unit, and start again from scratch.

Did you notice the use of the words telephone, person, and data all involved there?  If you are old enough and have had the experience of using an early connection to the internet you know where I am going with this.  That’s right, the unit uses an acoustic coupler of the sort found in the Novation CAT:

http://en.wikipedia.org/wiki/Novation_CAT

See the picture.  Notice the cord.  We are talking Apple II ® and 1980.

A device that modulates an analog carrier signal to encode digital information, and also demodulates such a carrier signal to decode the transmitted information – thus a modulator-demodulator — is called a modem.  The key idea here is modifying a sound into a digital signal so it can be sent over a copper line.  There is that telephone cord to think about.

Do you still have a phone in your house that is connected with a cord to a line that physically runs from your home to the rest of the world, including New Jersey?  If not, the King of Hearts isn’t for you.  Maybe a neighbor or friend does.  Check to see.

Okay. So once the phone connection is made, one has to lay the telephone  on to the small holes  — see:

http://www.fcminc.com/KOHPatientManual.pdf

Scroll down to see the image of the phone handset on the unit drawing.  Here is an official company site:

http://www.instromedix.com/cardiac_event_recorders.htm

Then sounds are fed into the telephone from the unit’s speaker – such as beep, de-beep beep, beep, de-beep beep, and so on . . . for about 15 minutes per 9 recorded events.  What an extended racket.

[Funny story: one web site has a comment by a person that did the above and freaked out – thought all those high pitched sounds were caused by his heart exploding or some such.  He was too young to have heard an acoustic coupler modem.]

We did the arithmetic.  With 40 minutes wear time for 9 events and 15 minutes of telephone modem noise of upload time and 7 days of monitoring we came up with – who knows?  We called the heart center and went back for an alternative.

The alternative is called a Holter monitor.  I thought the person was tripping over the word holster and was expecting him to give Nancy a leather pouch to wear on a belt.  Not so.  The name comes from a fellow named Jeff Holter who (with others in about 1961) developed a back-pack size unit containing a heavy assortment of radio telemetry and tape recording equipment.  Dr. Holter invented telemetric cardiac monitoring in 1949.  So, the Holter monitor (as well known in the halls of the heart center as McDonald’s is in the halls of your kid’s middle school) was attached to Nancy’s body – she can tell you about that – but only for one day.  It does a continuous recording, makes no noise, and gets mailed back in a padded envelope.  Nice.

Just to pad the story some I’ll direct you to the following sites.  The first shows a horse (last image on the page) with a monitor:

http://www.petcardiology.com/placing-holter-monitor-leads

and the next:

http://www.morgananimalhospital.com/index.php?view=pageView&docid=6345

… has the story of Pico, a Miniature Schnauzer with a heart problem.

The story begins –

“ Pico began to have episodes of weakness and collapse that seemed to worsen over . . .”

and then …

“The monitor revealed that Pico had a heart rate that varied from 28 beats per minute to up to 229 beats per minute.  The normal heart rate for a dog is 70-120 beats per minute.  There were stoppages in the heart rhythm of up to 6.85 seconds long.”

You can read the rest with pictures.  John

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