SATURDAY — a quiet week . . .

. . . but not on the western horizon.  A major storm approaches and at this time next week western Washington (the Olympic Mtns.) is expecting a major wind and rain event.

Again a relatively quiet week.  Sunday, Monday, Tuesday were the same with infusions that worked well.  Actually, Tuesday, the Culligan Softener that broke was replaced and we added a reverse-osmosis system for giving us nice pure drinking water from our own well and our kitchen sink has a matching faucet from which it comes.  The company operating from a phone-hub in Spokane (3.5 hours away) has a sub-base in Yakima (50 minutes away).  There are glitches and this week’s was a requested “first in the morning” scheduling didn’t happen so by the time the installer arrived it was not possible for John “the driver” to perform that function and I had to get myself to the hospital.  Look out Kittitas County! – down the Naneum fan I went.

We returned to routine on Wednesday and added two new stops:  1-a haircut for Nancy; 2-another setup with a 24-hr Holter Heart Monitor, but this time from KVCH in Ellensburg.  This one was very nicely administered with care, and I will go back in the morning to have it tested before removing all the connections.  This is quite different from ripping off the contacts and pushing into a mailing envelope to return to the Yakima Heart Center (never heard the results from that one either).  Makes you wonder…. Hmmm.

Thursday was another busy day.  Back to the morning hospital removal of the Heart Monitor.  That went fast and John got to visit with a friend who volunteers there in Respiratory Services.  On to the grocery for donuts to take by another friend’s house on the way home.  Yum.  It was to talk about taking one of our horses, Myst, back to their house and round pen, and on Saturday, to a horse training clinic.  She needs exposure to different things, and we are too busy going to the hospital for IVs to take her ourselves.  One of their horses is lame so they offered, and we accepted, gratefully.

Once back home, John moved horses around, and they came and picked her up in their rig.  We went to town for me to fiddle with my “group” at a retirement center.  It went well and we had a good turnout, despite vacations.  From there, right away to the Out-Patient services for the IV of Rocephin.  They were ready with room #4 which is most often my room of the 12 there.  They had to change the dressing today on the PICC line (once a week).  They are so good and had my Chocolate Milk Shake with added Glucerna, ready for me.

Friday was less involved.  We played with the puppy, and went for the infusion.  No surprises. Hit two garage/yard sales.

We planned for Saturday to be morning garage sales and a search for paperwork for retirement.  We must have stopped midstream when my health went downhill and lost track of what we were supposed to be doing.  Then buried some papers.  There is no real harm done, it is just that the consolidation we were working on has been delayed.

Did not do the paperwork search, but did the garage sales for a couple of hours.  It was successful, and then home for a good nap, before going for the afternoon infusion.  Sale items, I can remember:  western shirt and knit shirt and pants, $2 for all; nice old axe with a new handle ($5), a couple of bags, just nice looking, and one full of plastic coat hangers, $1 each.  Then to another fun sale a few roads west, where John saw some boots (almost new, hiking type) that fit me perfectly, $1.  We also got tongs and a nice saw for $2 total.  John found a Louis Lamour paperback for a quarter.  Oh, a throw for the furniture to keep the dogs from eating the quilt, $1; and a nice sweatshirt for John, $1.

Then more–  A strange collection of CDs still packaged, one of Shelby Lynne for $1.  Then one with a hat over the ears such as John wears for .25.  On to two sales, one proceeds going entirely to the American Cancer Society, where we got John another sweatshirt for working around the place. $1.  Then we met some friends at a sale in an alley, and found a cute little girl selling her plastic horse collection for 50 cents apiece.  We gave her $2 and will put in the raffle at our trail riding club.  We might keep one that looks like our horse.  Another dust gatherer.  John found two nice new potholders, large, both for a quarter!

Still more.  We went to another at the SR. center where I was going for my exercise class before I ended up so sick in August.  There we found 5 glasses to match the 4 we packed away last week.  They are Christmas glasses which we were told came originally from Dairy Queen!  While there John found me a beautiful quality sweatshirt with inlaid hearts, $2, and the lady in charge gave me a hanger that holds 5 or 6 blouses.

On to the last one, after a stop for donuts at Super One and my medication mouth wash to try to prevent these bacteria from entering my system again!  There we found a leather jacket (a little small, although a large size, but I can wear with a light blouse beneath).  It’s cool and only was $2, and nearly in new condition.  John found a horse lead and rope halter there for $5 total.  Each alone alone costs at least $10 or more from the store… maybe more.  We haven’t bought either in awhile but will do a post-purchase check sometime.

Yes, I know this is not all according to my health, but I’m getting clothes that fit me in my new weight.  And, I get my exercise in walking around the sales.

The infusion today was in the Intensive Care Unit and I had a nurse who was the one who got me there last summer when I was going downhill from the bacteria and they thought I was having a heart attack.  Turns out my lungs were full of fluid from the bacteria loaded on my heart and causing the blood flow to decrease through my heart properly.  That time, in 2009 June, they pulled off 4 quarts of fluid from me.  Amazing.

Well, I’m much better now and able to navigate and might be up to exercise classes when they resume on Sept 20th at the Sr. Center (oh, properly called the Adult Activity Center); no one wants to be politically incorrect.  What’s wrong with saying this place is for old people?  It is a nice provision the city has for its “seniors.”  They have trips planned and also lunch is provided for a reasonable fee every day but Friday and the weekend.

Sunday we go early for the infusion so we can get to a memorial service for an anthropology colleague who died from liver disease.  John will go ahead and post this Saturday night because it could be after 6 or 7 P.M. here on the western edge of the continent before we could return home and add Sunday’s news (or lack thereof).

Have a nice week, and we hope to talk to you next weekend, having gone through a nice normal week.  What a concept!


SUNDAY — Happenings before Labor Day

Many of you were not expecting anything to be written this past week till today, but we sneaked some in on you when things starting happening.  The end of the week was less eventful, thankfully, on the health, antibiotic infusion part.  The rest of the time after the mess on Monday, was pretty smooth sailing.   Today had a funny note, but the infusion went well.

The Out-Patient services put in a standing order for me for a milkshake with boost of Glucerna added to chocolate ice cream, two scoops.  Yesterday went without a glitch and the kitchen provided my shake.  Something got lost from yesterday to today, and first they brought a bottle of Glucerna with a cup, no shake.  The people in Med-Surg sent it back requesting a shake.  What came next was the Glucerna in a cup with ice as the base.  Finally, the third time was a charm, but it was only 10 minutes before I ended for the day.  I drank a bit and took the rest with me for the trip home.  We’ll see if tomorrow the kitchen gets it right the first time.

The other nice thing that happened today was a visit with friends, now in Rockville, MD who we have known a very long time – since starting at the Univ. of Idaho as an undergraduate student, going on through to a Masters, and being involved with me while a GIS manager on the west side, by employing several of my students as interns.  He and his family flew to Seattle, rented a car, and were driving over to Spokane, when they stopped off for lunch and a visit with us.  We met them at the Deli at Super One in town.  That was a good choice because the town is inundated with rodeo and fair goers and all major restaurants probably were packed.

The rest of our last couple of days was filled with moving hay (John), and playing with the puppy, who has taken a liking to the sofa in the den.  He actually made it halfway through the night in the washroom, went out to “pee” at about 2:30, and spent the rest of the night till morning, happily sleeping on the sofa with his mom.

We do not have any special plans for labor day so doubt there will be any blogs till next weekend, but that’s what we said last week.  So we will not speak ahead and just keep you informed if anything big happens.

Much of my time this past week was spent on email, contacting former students and workers who employed my students to invite them to my retirement party.  If you didn’t get an invite and are interested, let me know by email ( and I will send you the invite, knowing you cannot come but might just be interested in seeing the celebration the Geography Department has planned for me, Oct 2, Saturday afternoon.

Former students have responded by email with some good memories that make my day.  There are comments from them about their connection to me (and John) that I would never have known.  There will be a memories book at the reception, for people to write in, and they also can send to our secretary, for her to include in the memory book.  I hope she will just print the emails and save herself  the effort of writing in the book, and just slip them in the back.  Otherwise it might be an impossible task.

Other things have happened this week, on the minor side, but major in my book.  John had planted some tomatoes, but our temps have been low and the winds high, so we had broken plants and not a lot of ripe tomatoes.  Yet, this week he has harvest a few small ones and they are wonderful, tasting like tomatoes.  What a concept !  [from jfh, We have had many clear-sky nights and at 2,240 feet elevation the night temperature will and has dropped well below 50o F.  Tomatoes hate that.]

I’m sure I left something out, but not to worry, there is another week.  Thank you for your phone calls and birthday and get well cards.

Have a nice week, and we will try to do the same.  I still have till September 28 to go daily to the hospital for the infusions, which have decreased this week from two to only one – 30 min., Rochephin.

See you on the blog hopefully only next weekend.   Nancy

THURSDAY — Smooth flow

Have to report on my birthday (67) yesterday, Sept 1.  It was a good uneventful day.  I didn’t want John to make me a Chocolate Cake with Chocolate Frosting, but I did want two presents.  One was a squeaky toy and a rawhide chew for the puppy, Rhu.   He now has a name, and a neat toy hamburger he loves.  He can jump up on the sofa along with it and settle down for a nap with his mom, John, or an aunt.

John put in more time digging for the bottom of the stand pipe where the leak is suspected.  He then went to the pasture to mow old grass, roses, and other nasty weeds, and ended up getting a stick caught under the drive-belt.  Apparently the belt and the stick both fought gallantly until they both died. The mower quit moving forward when the friction and heat stretched the belt.  So, yet something else to fix.

Birthday afternoon at the hospital out-patient clinic was delightful.  They were all attentive and everyone on the staff came by to wish me a happy birthday.  They had a little snuggle bear on my pillow for me to have and take home.  There was a milkshake ready with extra protein and supplements.  All went well, and they changed the dressing on my PICC (has to be done once a week).  It is nice to be able to report nice things.

Today is Thursday and was another great day.  We got my other present I requested when John got a haircut from the lady who has done my hair cuts since I arrived in town in 1988.  I normally do John’s hair, but was unable in the past few months and his hair was beginning to look like Einstein’s.

Then I went to play fiddle and sing at a nursing home and had another good hour.

Finally, left there in time to get to my infusion, which again went smoothly.

That’s all, but wanted to give you some good news for a change.

TUESDAY — A fibrin tale, er, tail

[posted Tuesday, after John said no more reports till Sunday]

A continuation of the drip, drip epistle:  We’re good at prematurely speaking about successful activities.  For my blood draw and infusion today, at 3:00 p.m., we found that the the PICC line would not flow, unlike the water line at home that won’t stop.  There was not a drip of blood to be had because there was a clot in the line acting as a stopper and wouldn’t allow anything by or from.  The first saline solution seemed fine, but subsequent attempts to draw blood resulted in dry air.  This normally is just over an hour in and out for the antibiotic infusion.  Not today.

The problem would have been either a fibrin tail or an intraluminal thrombus.

These and other PICC issues are reported here: Here are quotes:

#1  “Fibrin also may build up on a catheter without completely enclosing it. In this scenario, a small piece of fibrin hangs off the catheter tip. This is known as a fibrin tail, which also represents a persistent withdrawal occlusion. These can sometimes be resolved with an infusion of low-dose alteplase over 2 to 4 hours, but this is not always successful, and the fibrin tail may develop again.”

#2  “An intraluminal thrombus forms inside the catheter and can result in partial or complete occlusion. It often can be dissolved with a small dose of alteplase, a fibrinolytic agent that is instilled for 30-120 minutes and then withdrawn from the catheter.”

~ ~ ~

When the PICC is to be used the first thing done is to apply suction until blood is seen.  When none shows up it indicates a blockage.  Fibrin is explained here:

When fibrin attaches to the inner-end of the line or tube (lumen in hospital speak) it floats in the blood stream until that backward flow from the external suction causes it to be pulled into the open end of the tube. If the lump or clump (thrombus) is formed inside the lumen then the condition is called an “intraluminal thrombus” as in quote #2, above.

If you have a broadband connection, try this video for an explanation of these things and the solution.  (This is an ad-like video for the chemical used in my PICC.)

The production of this stuff involves recombinant DNA technology, fermentation, and Chinese hamster ovary cells.  Why Chinese hamsters?  Who knows?  We didn’t even realize hamsters had nationalities!

Which ever it was, we had to go to plan B.  That meant an extra hour plus while we awaited delivery from the pharmacy of  Cathflo Activase® and its forced entry into the PICC line with turbulent motions.  Push, push, to get the fibrin broken up and the line unclogged.  Meanwhile, John retrieved me a warm blanket to try to get me comfortable.  Those 45 minutes seemed to last forever.  I called a friend on the cell phone to tell her my plight.

Finally, the time came to search again for blood from the PICC turnip.  It came!

First item on the agenda was to draw blood for an INR test, from the PICC.  Before that, one has to clean out the Cathflo Activase® and about 10 cc of throw-away blood.   (No wonder I’m anemic; they put blood in one week and take it out the next).  So we continue.  She draws a full vile of blood for the INR test, more than enough to be on the safe side.

I had started the paperwork over a week ago from my family physician’s office to put the INR on tap for being done by a nurse in the Out-Patient Services where I am every day except the weekend.  This is a great service that prevents being “poked,” but Lab personal cannot take from a PICC line; only a trained nurse is allowed.   When I came in, before she started the antibiotics I mentioned the need to do the INR test and that the paperwork was in place.  Normally, I have a standing order at the Lab, but nothing at the Out-patient Services.   This nurse couldn’t find anything in the records, so off she went to call my family physician’s office to request it before she could draw.  There was plenty of time while we waited for the fibrinolytic agent to work its dissolving wonders.

Once done, as mentioned above, the nurse could change the head on the PICC line (cannot use one through which blood has been taken, and infuse the antibiotics into my PICC.  I think it was 4:16 when this part started that usually takes an hour.  We were about on schedule, only an hour + later than usual.  So begins the drip, drip – one from each bag of the two antibiotics, combining into one tube headed into my superior vena cava — a large diameter, yet short, vein that carries deoxygenated blood from the upper half of the body to the heart’s right atrium.

I slept through the first 35 minutes, but by now my back was hurting, the pillows weren’t right, and I was a basket case for reclining in an uncomfortable set up so long.  Oh, I had made a couple more cell phone calls to friends in the set up stages when we were just waiting.

So, I mentioned my discomfort to the nurse.  I was in a special bed with remote controls to determine height of back raised and the same with knees.  I played with the controls and finally found a good position.

At some point I was really wanting a chocolate milk shake.  The nurse overheard me and said they could order one for me.  They did.

I managed to rest through the last hour of the infusion.  We didn’t walk (wheel) out of there until 6:30.  That was 3.5 hours for an expected 1 hour stay.  I was not a happy camper.  Except I was thrilled to see the double saline solution flushing with a turbulent short pushes motion to force the solution to the line with the hopes of breaking up any clots.  I surely don’t want a repeat.

~  ~  ~  ~

In the “for what it’s worth” department:  At home, the day started with nary a drip.  In order to prevent loss of water from the well John flipped the circuit breaker to the pump; turning it on only as needed to have running water in the house.

A Culligan man was due at 10:00 a.m. but was delayed ½ hour.  He got to the house and John explained the problems.  They determined the Culligan-Softener (21 yrs old was shot) and the Iron removal equipment was doing fine still. (Ours is ferrous iron that oxidizes in the lines and tanks.)  The Culligan-man and John discussed the pressure problem in the tank and decided there was a leak in the house or between the house and the barn somewhere.  Turns out it is between the house and the barn but John hasn’t yet located it.  He has to dig 4 feet down through alluvial fan material that has been refilled in a ditch for the buried water pipe.  He’s hopeful that the leak is in a frost free stand up faucet for the horse tank at the barn. While the exact location of the leak is sought, replacement equipment has been ordered to provide sparkling water inside the house.

Blood and water go drip – drip.  Money goes in clumps.  Ouch!

Life continues . . .

SUNDAY — Drip. Drip!

Nancy’s follow-up to a week of intensive care . . .

Hello folks, I’m back.  We stayed till 9:30 at the potluck and jam session.  Each day at 3 P.M. I get infusions.  Rocephin.  Drip. Drip. Gentamycin. Drip. Drip.

Saturday and Sunday the procedure differs because out-patient services are not open on the weekend.  So I go to the regular Medical Surgical nurse station (MedSurg in hospital-speak) and check in.  They treated me like a million dollars too… and all went well.  John brings a book and I sleep.

I’m a thousand percent better, if that is possible mathematically, from last Tuesday a week ago when I entered ER in Ellensburg.  They still did not really find a source of internal bleeding, so I’m blaming it on the bacteria and hopeful the antibiotics will vanquish them forever and the blood loss. (Maybe it could be suppressed production and not a loss?  Just a thought.  Either way, maybe it will vanish.  JFH)  Only 5 ½ weeks to go.  Drip. Drip.  The Gentamycin was added because of my pig valve in my heart.  Previously, June/July ‘09, I was on straight Rocephin.

I think the one day I had the CT Scan, Endoscopy, Colonoscopy, and a ton of Barium X-rays of the whole track, upper and lower intestines, from 2:45 till 10:00 P.M., and about 5 blood draws, that I deserved the an award for the most procedures one patient was subjected to in one day.  I might have had the TEE that morning too.  That also included a rude awakening early morning by the nurse who had seen a succession of atrial fibrillations and thought there was a V-tac going on.  It was not.  She was obviously upset and wanted to know if I had any chest pain; well no, only the continuing pain from the two clots in my spleen.  I also said I was having a night mare (probably caused by the antibiotics, she said).  So I was ready to go back to sleep and await the morning blood draw at 5:15 a.m.

Rest in the hospital has to come in pieces. One morning (night?) they woke me at 3:30 to weigh me.  Hello!  I’m supposed to rest. I got pretty good at it.  The last few days there I was moved to a MUCH quieter room on the 4th floor in ACU (Acute Care Unit).  That is one step down from ICU (intensive care) but honestly in my case I was still on telemetry and oxygen and still very monitored.

We’ll return to Sunday postings now.  I trust the next reports will continue with my feeling better and improving.  Don’t quite have the stamina back yet after a week of bed rest, but I’m getting there.

~ ~ ~ ~It seems when Nancy has issues the house colludes with her.  Our water system – well, house, barn, yard – seems to be leaking.  We have a 30 gallon pressurized tank.  The pump is supposed to keep water in it and another gizmo inflates an internal bubble and presto we have water when and where we want it. Currently the pump and gizmo do their stuff and then the water drains back out via some unknown leak. Then the pump – pumps again, and it drains out again.  Drip. Drip.

Nice folks came this morning and carried away the penultimate puppy – I turned the pump on and got enough warm water so we could send her off without the dirt.  We still have the male but need to wait a few more weeks until he develops immunity to parvovirus because of the known incidence of it somewhere visited by the family that got the little guy that died (and the virus is now in their own house and yard).  We stopped and got him an extra vial of prevention today.  So he gets a shot tonight. Ouch!  — but hopefully no drip, drip.

We have a report back on the little puppy who left today.  She slept the entire 3.5 hour trip home.  They have introduced her to their securely fenced backyard, and their older dogs in the house.  She has explored the house.  She also found out about a water sprinkler and enjoyed getting her head wet, staying a happy puppy.  We are grateful for yet another fantastic home.

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.

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.


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:

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:

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

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:

and the next:

… 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


SUNDAY — Dog Days of Summer

Please note that Monday is the 12th of July.  In 1969, the 12th was on a Saturday and we married on that date – 41 years ago.  So,  Happy Anniversary to us!

[from John :    Wikipedia < > has an interesting write-up of the Dog Days of Summer which references Sirius, the Dog Star, and “a time period or event that is very hot or stagnant, or marked by dull lack of progress.”  As a side note, years ago Nancy named one of our Britts ‘Sirius Sashay’ and the puppies we now have are her great grand children.]

from Nancy:    John reminded me I am supposed to write an update on my health for the blog, as promised last weekend.   I must say sadly I don’t have a lot of good things to write, except that I’m alive and still kicking but I’m not ready for the Rockettes, just yet.  My energy level has not returned, and I find myself only good to gear up for a couple of hours for an event, and then I have to rest.  It could be that sleep during the night being interrupted with puppy care is part of the problem.  They usually have us up at midnight and then 3:00 and finally when it is light, we can put them out in the backyard as early as 5:30 (this morning).  They turn 7 weeks tomorrow.  We transferred a sweet puppy today to her new owners (more on that later).

Back to my health and lack of energy.  At first we wondered if the change in meds might have prompted some of the problems – that may still turn out to be the case, and tomorrow is a doctor’s visit to my family physician in Cle Elum.    I was scheduled last week at the hospital here in town for blood draws for various lab tests.  I had them all done right after playing fiddle with my group for a little over an hour.  I did not drink during the playing time.  I guess I should have and should have been hydrating my system all along (I thought I was doing this).  I drink an awful lot of lemonade that John makes for me from powder.  However, a call from my family physician’s nurse indicated my lab tests showed I was dehydrated and needed to intake more liquids.  That said, I did.  That probably explains why I had a headache and was feeling so lousy.  I missed my Friday afternoon exercise class because I didn’t feel up to getting there and doing it. It’s from 1:30 to 2:30 MWF and in an a/c room with a bunch of supportive ladies (and one man).

The other tests were apparently okay, although one was still being processed.  I do not know if the results will be back before my appointment right after lunch tomorrow.

The new medication affects my potassium balance and that was one of the tests.  I called my pharmacist Saturday morning (who also is my fiddling buddy), and she ran all my medications through the system to alert them/us to any possible drug interactions.  None were found except for the concern with this new medication and the potassium imbalance, and the need to keep an eye on the potassium.  That was my cardiologist’s concern for this doctor’s visit and the labs drawn, 3 weeks after my last visit with him.  He wanted to stay on top of that.

I’m still on a diuretic (Bumex) and that pulls fluids from my system, contributing to dehydration.  It’s to keep the fluids from piling up in my lungs or my legs.  The potassium was cut back because of the interaction with the new drug that actually helps shed sodium (the Na of salt) and retain potassium.  This means I have to be aware of something called hyperkalemia, or “ higher than normal levels of potassium in the blood.”

“The hormone aldosterone regulates kidney removal of sodium and potassium. Lack of aldosterone can result in hyperkalemia with an increase in total body potassium.  Hyperkalemia may be caused by medications, including medications that affect kidney function (potassium sparing diuretics, such as spironolactone, amiloride, or triamterene) and potassium supplements (especially intravenous potassium).” (Taken from a Mayo clinic site)

Spironolactone is the new med I am on.

My pharmacist continued to counsel me from her records and outlined the symptoms.  My cardiologist had also mentioned some of these and said if I had any such signs of severity that I should check myself into ER immediately.  These are the symptoms in her literature:  muscle weakness, cardiac Arrhythmia (which I have anyway), and hypotension (low blood pressure).

The symptoms mentioned in the Mayo Clinic report are as follows, “Hyperkalemia often has no symptoms. Occasionally, people may have the following symptoms:

  • Irregular heartbeat
  • Nausea
  • Slow, weak, or absent pulse

Well, the first I always have; the second I have occasionally too, as today when my body decided over the noon hour that it no longer wanted to keep the strawberries from morning late breakfast, in my system.  I have had a lower heart beat (in the 60s), but not worth worrying about, and certainly no absent pulse.  In recent checks on my trusty measuring device, my blood pressure has been fine and the heartbeat as well, although it will occasionally show the atrial fibrillation we already know I have.

Well, the few sentences John is expecting me to write have gone on into much more, and I will stop now on the health part.  It’s good for me to review this before I visit my doctor tomorrow.  Food for thought and he will be interested in my research and reporting.

I will end on a nice, fun note.  We transferred a white and orange female, Milly, to her forever home today.  We gave her a bath before the meeting, and she slept afterwards while drying.  I also clipped her little toenails (with a human’s toe clipper) while her toes were moistened.  We did that first drying and changed to a different towel.  She laid in John’s lap awhile and then we changed towels and I had her again in my lap.  She went through the bath just fine; John is good with bathing young puppies, and she handled it well, not fighting it at all.  Her new owners already have a Brittany from us and she was along to meet the new entry to the family.  This will be a wonderful home and we are grateful.

Not much else new in our world.  There is the daily horse routine, plus John has been volunteering time to help our elderly neighbor with his haying, and getting the bales to the barn.  Yesterday and today it was more a re-stacking thing from a harobed.   I know most people not in the rural west do not know what a harobed is.  That truly is what it is called, and it was named after the inventor’s daughter, Deborah (spell that backwards).  It is a piece of machinery that goes through a field of baled hay and lifts them up into a carrier that can be stacked as high as 9 bales, 3 across.  Once filled, the load, having been lifted row by row, is ready for the barn.  The harobed comes back to the barn and a lift stands up the stack and pulls away from it (under good smooth and clean conditions, the stack stays standing).  Under a full load, one of these can carry 3.5 tons.  Yesterday was not working well, and the stacks kept collapsing  — the old shed has an uneven floor and the bales are not as uniform as the ought to be.  Today was a better hay day.

What a technical advancement from loading bales of hay by hand onto a truck or wagon and stacking in the barn!  (And before that loose hay was muscled onto a wagon and off again in a barn.)

Thanks for staying tuned in and I hope for a nice week this week with more energy.  Yesterday, a few of our musical group went to Briarwood Commons (a retirement community in Ellensburg, for people over 55).  We go play for them the second Saturday of every month at 2:00 pm. till 3:00 and they serve us a late lunch for our efforts.  They love us and always sing along and sometimes get up and dance.  It is a worthwhile event that pleases us as much as them.

And on another worthwhile event: Wednesday night last week we had a great experience.  We joined a group of square dancers and host families and friends, at the Swauk-Teanaway Grange.  There are six young people (most are in their Junior year in high school) here from July 5 to Aug 10 in a program called the Children of Chernobyl.

See .

Most are from the region around current day Minsk, Belarus.  One of our musicians in our group that play at nursing homes, and his wife, are again a host family this year, for 3 of the gals.  The other 3 are guys and are in different households.  We met them and had a great potluck.  Afterwards the Blue Agate Square Dance caller got most of the people on the floor to do some dancing (I sat it out and watched and enjoyed seeing how well the kids did).  We stayed also through one of the gals playing a piece on the piano.  She is quite a musician.  Turns out she also plays the guitar, and she joined us at our Rehab facility play date the next day, Thursday.  Amazing.  She was playing songs she had never heard and sitting where she could watch Charlie’s fingering for chords.. and keeping up with us all.  One we had printed words for and she sang along and one she knew the words.  What talented people exist in our wide world !

Hope you have a nice week as well.

WEDNESDAY — Routine stuff

John tells me I need to update this from the June 21st visit to my cardiologist.

I’m still tired from yesterday and not feeling up to much updating, but I will try.

Good news today is that the puppies got moved tonight to their new digs, and they are happy, but Mama Annie is not yet sure she wants to go in the different place.  She got sort of attached to that back computer room pen.  I did manage to do their toenails (cut them) today before the move.

Best news of the day is that our house roof is finished.  It is beautiful.

Okay– back to yesterday.  I drove myself to Yakima Heart Center for a 10:55 (I originally was planning for 10:15) so I was up way too early and with a lousy night’s sleep Sunday night.  I got there 20 minutes early and then had a 25 minute wait to get in to see the nurse, and then the doctor.  However, once there, he spent a full hour with me, so I felt good about that.  First words out of his mouth; “Where’s your hubby?”  John had always been with me since our first visit last July 2009.  I explained that John was working on the roof, and that I could drive now, so I had driven myself down.  I didn’t tell him I used John’s car and I think the seat is not set for my back, so the driving an hour down and back was actually painful.

The cardiologist had briefly seen me when I was in the hospital June 1 for the defibrillator implant and he just happened to see my name on the ICU floor.  He dropped in to say hi.  That was very cool.  Previously, he hadn’t seen me since April 14th and we both agreed that seemed like ages ago.

We debriefed and he looked at all my recent lab blood draws.  He determined that I need to be back on a statin type drug, which I had gone off of over a month ago, because of joint pain when I exercised.  He wanted me to go on Lipitor, but I told him I doubted my insurance would pay for it, and they wouldn’t (well they wanted me to pay a co-pay of $60/month.  Yikes.  I had asked him if that happened, could I go back on Simvastatin, which I was on last fall.  He said yes.  So, I requested a refill on that, and thankfully, it is only 9.99/month.  A lot better for the pocketbook, eh?

He also looked at some test which made him decide to change me to a medication to help my kidneys balance the sodium/potassium components.  The new pill (Spironolact) is meant to help remove sodium and some water while keeping some of the potassium. Thus I can cut back on the intake of potassium.  I should be able to start that tonight.  I was taken off the huge dose / week of Vitamin D, and just have to have 1000 mg (or mE) each day.

Then he asked a bunch of questions about what I was doing, and what, if any symptoms I was having.  He examined me with a stethoscope and pronounced me in pretty good shape.  He also mentioned again that I was fortunate to be alive and what a challenge I was to the medical community.  Not news – that.

He wanted to know what would tire me and cause my heart rate to increase.  I said, “Well, if I ran up the driveway, which I have not tried to do.”  He says that later this summer he will fit me with a heart monitor for a week to see how my heart is responding to the various things I’m doing.

He also went over the meds and the lab tests he wants me to have before I go to my family physician and to do that in about 3 weeks.  Then come back and see him.  I wish it were not so far to visit Yakima but it does have a Costco store and we do buy things there.  I will have to go every 3 months for checking up on my ICD.  My family physician is only 30 miles away, but the driving time can be similar in the winter (bad roads).  Now it is fine and a pretty drive up the Yakima River Canyon to Cle Elum.

His report will be transcribed and I will get that transcription within a couple of weeks.

Then about 1:00 I was out of the office, and needing to eat lunch.  There was not time to make it up for my exercise class that starts at 1:30, and I also wanted to visit Costco for dog food and such.

I picked up a nice grilled chicken salad and ate it before going to shop.  Yum, and I was hungry.  Off to Costco, where I got a motorized cart and asked for help lifting the heavy dog food.  They were happy to help.  I then motored around to get the rest of my needed things, and then got help to put them into my car.  I filled John’s car with gas (his takes Regular, where mine doesn’t recommend it), and got it there at Costco for 2.85.  Sweet.  Then home.  I didn’t make it back home until 3:30 and I was VERY tired.  I might have slept for 1.5 hours– don’t really remember.

But, that’s the best I can do on updating you to my latest.  Nancy

SATURDAY Nancy’s 2+ week . . .

. . . report since the ICD implant happened

Well, it’s really 19 days since, but who’s counting.  We have been very busy with various chores, besides dealing with the healing process and follow-up doctor visits and lab work.  Will get to that in a minute, but for now I may tell you about something I left out of the device check write-up June 8th.   I did say that I will be part of a research study, but I didn’t mention the fancy name.   It is called GALAXY, and the acronym, (don’t we love those?) comes from this.  I’ll try to highlight BOLD and CAPS the letters in the following phrase about the GALAXY Registry (LonG-term EvALuAtion of the LinoX FamilY ICD Leads Registry).   How long do you suppose it took for someone to figure that out?  It’s really not any different from just going in every 3 months for a device check-up, but I had to agree and to sign paperwork to give them permission to put “my data” in a research study.  The purpose is to work toward improving the device technology for the future.  I guess it is pretty good now, but I figured I would participate.  Why not?  Doesn’t cost me anything and I have to go in for all the checks anyway.  I’m interested in participating in good things for the future of others needing the same help as I did.  I have been grateful for all the comments from so many of you about success stories on friends and family who have had defibrillators.  It’s amazing how many are out there and have reportedly been operative for some time.

I am going to visit my cardiologist this Monday, and will be driving myself down to Yakima.  John is staying behind to care for the mom and the puppies, and to help taking off the last of the shingles (old) on the roof of our house – the front part.   While there I will take a trip to Costco to pick up a few items.

So, there is not much new to report on my progress, except I seem to be a little stronger each day.  I have been doing a lot of music venues, and turns out my fiddle would normally be held and rested on the place where the defibrillator is implanted.  That wound is still there and still has on all its little Band-Aids (it has a fancier strip name, but I don’t know what it is).  They haven’t rolled off yet.  So, I moved over the fiddle to under my chin and lower down so I didn’t have to raise my left arm too high.  I still need to use it to finger and to hold the fiddle, so the past 3 days of fiddling have been tiring.  My right arm is getting more use too, so it aches some.  I’m doing all right with Acetaminophen, just more than twice a day.  People enjoy our music so much, and we enjoy providing it, that it all has a happy ending.

The puppies will be 4 weeks old this Monday, June 21st.  That means they are ready for mushy puppy chow and their own water.  This also means they are outgrowing their pen, so we will be moving them (probably Sunday) to new digs where they have more room.  While I was gone to town to play for a 94th birthday party gig at one of the nursing homes, where they also gave us lunch, John took them out to play in the grass.  One ventured away from the rest and into the raspberries.  Then another went and almost got lost under the Nanking Cherry trees.  Funny, but not so for John.  He gathered them up and put them in a box and brought them back in ASAP.

I have not gone back to Physical Therapy because I’m waiting to hear if my insurance will pick up the rest along with Group Health.  If it is costing me $25 for 45-minutes on a machine, and I’m already paying a couple hundred to have medical insurance each month, plus the cost of Medicare each month, it makes no sense.  I am going to the SAIL class (earlier mentioned in this blog), at the Adult Activity Center 3 times/week for an hour, for only $3 for 3 months.  That’s a fine deal.  We get lots of stretching, strengthening and balance exercises each session.  I cannot do anything with my left arm that causes it to be raised above my shoulder, but I still can do a lot of the exercises.

I have done a little bit of walking around our place.  A couple days ago I walked into the lower pasture with John to retrieve the 3 “new” horses.  They now return to their pen on command from John, off the high grass.  It’s amazing to me to see how responsive they have become to his wishes and commands.  They also had not been fed treats before in their life and it is great to see them coming over to him for a carrot.  The day I went, the youngest (4 years old), Breeze, came up to me for a carrot.  (He has not seen a lot of me, so that was a rewarding experience.)

One of our recent times this past week was having the farrier in to do trimming on some of the horses.  While John rounded up the new ones, I held Myst for her trimming.  That was nice to be back in the thick of things around the “ranch”.

Our roofing project is going well too.  The barn was done in time to load it with hay last Sunday.  Lucky for John our provider came with two large trailer loads and a person to help unload and pack into the barn, and a powered bale elevator/conveyor.  Had John had to do this alone as we have in the past, it would have required at least 10 trips in the truck and trailer, across the valley, and back, and also he would have to do all the lifting and packing into the barn.  This was great.  He had only to supervise, open gates (which he had just built) for access for the big tractor trailer truck, and open windows and doors on the barn, plus build fences and tarps to protect the hay in the runway from having the horses nibble and break into the bales.

Other chores around the yard have kept John busy as well as horse training.  This is a year when we have had more rain than usual and the grass is high everywhere.   He has shifted the horses in and out of the pasture (and our backyard) twice a day.  It also has been very windy.  The temperatures have been down, however, which has made the yard work and roof work bearable.  I have been able to join the two guys each day for lunch outside.

Another thing we’ve been able to do is go to lectures at school and in the community.  There was an interesting 6 lectures given in downtown Ellensburg by one of our former colleagues in the Geology Department.  We missed two unfortunately, when I had this recent procedure, but we made the last one, and that was special.  The topics have all been on Washington State geology.  It is totally fascinating.

I guess you must be tired of hearing all this unrelated to the heart procedures, but to know I’m back to doing some of this stuff is very positive.  I’m happy to be alive to enjoy my retirement.

I’m still attending yard sales when I can and picking up bargains.  I had to get a whole new wardrobe because of my weight loss, and while doing that I also have found a few items for John.  There are pretty nice shirts out there that are almost new and of a quality we probably wouldn’t have bought new.

Thanks for staying tuned, and thanks again for all your prayers and thoughts that got me this far.


[from John: I’ll add something medical but unrelated to Nancy’s heart.  In December, while Nancy was in the ICU, I developed a “floater” in my right eye.  This turned out to be something of a false floater called a Weiss Ring and of little consequence, especially for me as I am left-eyed.  My right eye is of little use (sort of a spare) that would wander off until a couple of muscle-relocations brought it into alignment.  However, my brain ignores the image that eye sends and so the “floaters” in it are not noticed. Yesterday the left eye developed its own Weiss Ring and this one is going to take a bit more getting used to.  I’ll have it inspected this coming week because occasionally a small retinal tear occurs during detachment and that could be serious.]