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.]

TUESDAY — Living with an ICD

Nancy’s report on first week’s check-up on incision and device, that is the recently implanted cardiovertor defibrillator, known as an ICD.  (John thinks we should name it something, perhaps Hypatia : )

We were up early to start a long day.  John had to spend time home with the roofer to meet the delivery team who trucked in supplies for the roof of our barn and house.  I went with the roofer’s wife to my appointment at the Yakima Heart Center, in Yakima, an hour away.  We left John in charge of watching mama and puppies.  She was disturbed by all the noise on the roof and strangers outside her window.  She was upset most of the day, even after I got back home.  She has now calmed down after 6:30 p.m. and is back eating, with John’s company.  He is reading today’s news on the web, via computer.  I’m in my recliner writing this entry for the blog and anticipating eating dinner before John puts it out on the blog.  He also has to move the horses off grass and back to their pen.

My appointment was with a device specialist, of which there are two at the Yakima Heart Center.  They were trained in classes paid for by the manufacturer of my defibrillator (with pacemaker included).  I will need to go back in for periodic check-ups every 3 months for the life of my device.  I thought today I would get the gizmo to put by my bedside that would broadcast my records every night to a satellite and on to the manufacturer.  That did not happen today and won’t until my next visit, in 3 months, in September.

Today, I was ushered into an examination room with a recliner.  It was an automatic one with a remote handled by the examiner.  She put some wires and connectors on me such as those used in an EKG, and put a receiver on top of the place where my device resides.  I was told I am thin (haven’t heard that since the 7th grade), and that my device would stick out a bit.  She then started a machine which was downloading information from the device and displaying it on charts and graphs on a printer tape output.  I wish I had asked for a copy, but I didn’t think to do it.  I saw some of them, such as shocks.  Knowing I had not felt a shock, I asked her what that was.  She said it was from after the implantation, when they put me to sleep for a few minutes, and induced the device to make my heart fibrillate, so they could see if the ICD functioned as intended and shocked the faltering heart beat back to normal rhythm.  It had.   She reviewed all the reports and stated that all was well, and it was operating just fine.

I asked her what the shock was like and when it would occur… after I had fainted or before.  She said patients have told her it is like a horse kicking a person in the chest.  Well, that doesn’t sound like fun, so I’m happy they put me out for the testing.  She also said people respond differently.  She asked if I had ever fainted and I told her I had not.

She finished that test and said we would talk about the recovery time and the things I should not do.  I told her about the “squishing” sound I heard over the last week, but she had never heard that from anyone.  Not surprising; I’m always the individual with different reactions to medical procedures.  She told me not to worry about it.

I reported the pain I had that I thought went on too long.  She said I might have pain from this for months.  So, the fact I’m pretty much controlling it, with regular acetaminophen, is a positive note.

I told her about what the representative (from the device company) told me after the operation.  He had told me not to pick up more weight than a coffee cup with my left arm, and not to raise my arm above my shoulder for 6 to 8 weeks, and NOT TO DRIVE for 8 weeks.  This was different from anything I had been told previously and read on the web… or in talking with people, including my cardiologist.  I realize they don’t want me pulling out the wires, but that was going to be very constrictive on my activities, and getting myself to town for physical therapy, music or anything else.  Bummer.  I didn’t forget to ask about this issue.

Right away she said, no, you may drive, right now, just be cautious not to jerk your left arm and lift it above your shoulder.  Those were sweet words to my ears, and my reaction was that I wanted to hug her but couldn’t raise my arm to do so!  She got a laugh from that comment.

I’m so happy to have my freedom back.

The next discussion was about whether I would agree to participate in a study of my progress, by sharing my records (from the device) with a research team seeking to improve the technology.  Of course, so I signed on the line and got a description of the study.  (from John: I wonder if the patient’s medical history will be transmitted to the research team?  If so, they need to order more paper and ink.)

Then she removed my dressing / patch over the incision.  She remarked that it was healing very well, and told me I could shower now, and let water fall on the wound, which is not sutured with stitches, but is held together with little strips of tape.  In time those will curl up and fall off.  I am not supposed to scrub the spot.  I couldn’t look down and really see it and she didn’t have a mirror.  Once in the car I got to view it.

So, that’s my story, and I’m truly a happy person.

[The barn got its new roof before dark and it is now raining.  Awesome.]

SATURDAY — one of a thousand stories*

* “Refers to the TV series ‘Dragnet’, where Jack Webb played Sergeant Joe Friday (Badge No. 714).” Each story began “My name is Joe Friday, I’m a cop — Yeah, there are a thousand stories in the naked city and this is just one of them.”

Nancy’s Impressions of the Defibrillator Implant Day, June 1

John has commissioned me to write my impressions of the recent procedure to implant the defibrillator, because he has no idea what to put on the blog.  I will try with apologies to the few friends I have already bombarded with emails or phone calls after the procedure.  I’m afraid this will be longer than John usually likes to print on the blog, but it contains my feelings of the experience, and that’s what he wanted to report.

June 1st actually started  at midnight without being able to have anything but water except to take my pills in the morning, before taking off for an 8:30 a.m. entry to ER (what they had set up).  Knowing I would not be allowed to drive myself home, and worried about John spending so much time away from the Brittany mom and a few-days-old puppies, I asked R to drive down with me, get me settled and to drive my car back home and then come back for me the next afternoon to transport me home.  We took off from her house about 7:20 a.m. and had nothing out of the ordinary happen till we got to the 16th street exit.  Coming off the freeway ramp, I stopped and looked to the left (used to be a stop sign there, but now is a yield and the traffic to the left has to stop).  A guy behind me went into road rage and honked loudly and crowded me.  We got through that, and were coming down 16th Avenue in Yakima headed for Tieton Drive and the hospital, Yakima Memorial.  There was an accident we managed to drive around.  Had we been in the opposite lane headed north, we would not have made it through in a timely fashion.  Turns out I found out in the operating room that the X-ray technician’s wife was the car hit in the accident, by a woman who pulled out and didn’t see her, smashing into the front of the car.  The husband was not too far away, so got there to take their daughter from the back seat carrier and take her to day care.  He also checked to see that his wife was all right.

We got to the hospital and found a parking space close to the entrance.  Made our way to the ER (not ambulance) entrance and were promptly told to go to the person two spots to the right, that I really wasn’t being admitted to ER.  They had my name and were expecting me for the procedure.  Then we were ushered to a small room and computer operator, to the right of there.  R came in with me.  The “operator” could not get her computer to boot to find me in the system and start the paperwork.   After giving my medical insurance cards, I asked if I could find a restroom close by, while they got the computer going.  Yes, directions were given, and I took off without any of my stuff, to the restroom, around the counter.  I walked by a “cop” who stopped me and wanted to know where I was going.  I said, “To the restroom there, please.”  He okayed my going but told me to check back in with him when done.  So, I did, and walked back to the “computer entry room.”  I think by then a woman from the room behind had come out and “fixed” this computer.

It still took awhile, but they said I would be carried (in a wheel chair) directly to the Catheterization Lab.  R went along with me to a little room where I dumped all my stuff on a table, hugged her good bye, thanked her, and she wished me the best.   I was introduced to Anne, my nurse for the next hour or so for a huge list of questions about my past medical history and my medications.  First, I had to strip and put on a night gown and sock slippers.  Packed all my stuff in a bag they gave me.  As she was questioning me, she put heated blankets on me and kept pulling them over my arms if I became uncovered.  That was toasty, as the room was cold (but not as cold as the operating room would turn out to be, and where I was no longer pampered with a heated blanket or anything soft.)

Questions–all about my medications, which I had been told to take with me, but that was erroneous information.   They had to issue the pills from the hospital pharmacy and I could not take anything I was told to bring along.   There was nothing to be taken until later in the day after the procedure.  So, she went through the list of my medications (which she had in the records), asking me what time I last took each one.  The names were not always the same; I had to recognize that Lasix in my case was Bumex, or Bumatanide.   That interrogation lasted awhile, and while she was doing it, an assistant from the Blood Lab tried to install an IV in my left arm.  She failed and created a hematoma on the crease in my elbow.  Just as well, because I hate having IVs there.  I had to warn them not to flush with Heparin because of my previous severe reaction to it, and it would kill me.  Finally after several painful pokes, she left and they sought another person to insert an IV.  I was beginning to be concerned, but happily the second lady found a place on my hand to set it up and it remained that way till removed the next day when I was to check out.  As far as I know it was never used, except during the surgery.  The last thing to be done in this session was for Anne to set up a VCR 20-minute story about what to expect in the procedure I was about to have and the recovery period and restrictions afterward.  My blood pressure and heart rate were taken.  I watched the movie and then was resting waiting for the time to come to be taken across the hall.

I had left the entrance area at 8:30 on the dot, and my procedure was scheduled for 10:30.  There were still questions from the manufacturer’s representative, E, of my defibrillator, in my room after 10:30.  He asked me if I knew the name of it.  I told him Biotronik, a defibrillator with a pacemaker included, but I didn’t remember the model number.  One would think they would have had that information.  He went away and came back again asking me if I already had a pacemaker implanted.  I told him I did not but had had one back in December, but it was only in temporarily and removed before my valve replacement.   He said, “Oh, that makes sense now.  The paperwork said you had a pacemaker.”  I began to be annoyed that he had bad information, and he said it was apparently a clerical error.  Those are not good, and it didn’t make me feel comfortable.  He said all was well now and they were on the right track.  Well, hello!  Not much longer and they would walk me into the operating room.  I asked if I could go potty first so had a long walk to the restroom with the aid of a nurse, but when I was done, she was not around, so I walked back to the door of the operating room.

They ushered me in and gave me a stool to boost myself up on a table, very thin, the size and shape of an ironing board, without any padding whatsoever.  It was too narrow to put my arms beside my body.  So they got some extensions and put them in for my arms.  COLD.–everything was very cold.  I needed a pillow under my head, which nurse Judy provided, but mentioned it would not be able to stay there through the entire procedure.  Then they started putting various patches and things on me.  The coldest was a bright shiny metal looking thing but they claimed it was not metal, on my right leg attached above my knee.  I asked what it was for and they said it was a ground.  Hmmmm… interesting.  They needed me to turn my head to the right but were covering me up with a drape so I wouldn’t be able to see the doctor nor the monitors, which I was watching my blood pressure and heart beat and pattern on, prior to being blocked.  I was not under sedation except for pain, so they could talk to me and I could talk to them through the procedure.  I was not supposed to remember all that happened, but I do, except for the 3 minutes or so when they had all the stuff installed and had to set off the shocking mechanism of the defibrillator to correct an arrhythmic condition they set up.  I wonder how they did that.  After the operation was done, I was walked back across the hall to my room where I had been earlier.  The nurse changed from Anne to Judy, to whom I had been introduced earlier, and who was with me throughout the procedure.

Once back in the room (some time after NOON), so it was only about a 45-minute procedure, I was allowed to take my cell phone to my right ear (cannot use on the left side where the device is), to call John.  I told him I was all right, and asked nurse J to verify as she had been there the whole time as well.  She spoke to him for a minute and handed the phone back to me.  Then they brought me lunch.   That was a welcome sight.  There was white bean soup, pretty good, and a casserole mostly noodles with chicken flavor, but I only ate a small amount of that, and carrots.  I requested a chocolate milk shake.  That eventually made it to me, but the nurse told me it required an act of congress.  There was a black coffee that I did not drink.   I don’t remember getting any water until I was in my hospital room.

A room upstairs in the telemetry area did not open till 4:00 p.m. for me to be moved.  They rolled me up there in my bed with all my belongings piled on top of my legs (another narrow bed).  I was able to get up and get into my new bed, and requested a pillow for beneath my left arm and removed the sling that was VERY uncomfortable.   I was introduced to my private room, with a shared bath, and told it was like a bed & breakfast.  Yeah, right.  Well, as it turned out the gentleman next door never used the bathroom.  He must have been on a catheter and they just used it to pour down the toilet from the catcher container.  I know all about that from ICU for so long.  It was nice to be able to go on my own when I wanted.

Dinner was served at 6:00 p.m. and it was quite good.  The nursing assistant cut up the meat for me, and it surprised me how tasty it was.  She cut off the fat as well.  It was flank steak cooked tender in a gravy, and there were little potatoes that still had skins and were good too.  Coffee again, which I traded for hot cocoa.  Dessert was a tapioca pudding… that was actually edible, so I ate it – minus a gob of white fluffy stuff and an embedded rose petal.

There were frequent visits taking my blood pressure and temperature, even though I was hooked to the outside desk in front of the nurses, with 6 pieces of information being telemetered to them–that’s what the telemetry floor means.   I carried the unit in the pocket of a new gown I was transferred into once I got to this room.   I think this “floor” is basically an Intensive Care Unit (ICU).  I was on 2 South in room 265, where there are but 7 beds in the unit.  The other unit has 20 beds, and I do not know its location in the hospital.

My cardiologist, Dr. K, stuck his head in the door and surprised me.  I said, “Oh, Dr. K, I didn’t expect you!  He said (always addresses me this way), “Professor, I saw your name on the board and thought I would visit you.”  What a cool guy.  He said he was happy to hear the procedure went well, but when he heard my concerns about the strictness of the recovery actions for up to 8 weeks, he said that sounded a little extreme to him.   He wondered if perhaps they had had trouble with the operation.  I told him I would ask that in the morning of the Dr. or his physician’s assistant who was supposed to meet with me before checkout.  I also told him that I was awake during the operation and heard nothing out of the ordinary, and that it seemed to go well, as I had been told that once done.   I thanked him for his visit.

Next visitors really were a surprise– two married students from my past.  We had a nice visit.  They are geography graduates from CWU and now live in Yakima and have jobs there.  They had read about the planned procedure on this blog.

The rest of my evening and night was largely interrupted by taking my vitals, even though I was wired into the telemetry board.

The most disturbing thing to me was that the room across the hall in full view and within earshot was in “isolation.”  This did not make me comfortable to watch everyone who entered don a gown and gloves and head piece.  I assume the patient had Mersa (MRSA or Methicillin-resistant Staphylococcus aureus, a type of bacteria that can cause skin infections), which I had been tested for earlier.  I don’t know how long the test takes before they have to isolate a person.  She was in obvious distress as well.  I’m happy that for whatever reason, very late at night, they moved her completely up a floor.  That experience was a bit unnerving.

I started having the pain killer from the operation wear off after 4:00 and my first pain killer given at 4:30, a dose of Tylenol with Codeine.  They could only give it every 3 hours.  I was complaining still of pain 2.5 hours into the first pill.  This kept on all night, but the pain never ceased.  They did give me an ice pack, but finally I requested more of a pain pill in the morning, and they provided (not until noon) a Vicodin.  I think that should have been taken care of sooner in my aftermath of the procedure.

I did have two more visitors (friends) during the morning hours, and visits from a cardiologist (not my own), and G, a physician’s assistant to Dr. F, my surgeon for the procedure.  I did not get to talk to him, but she had reviewed my case and said everything went according to plans.  Nothing was out of the ordinary.

They needed my room for another person coming in from ER, so I was to be ushered out before noon, if possible.  It was not possible, because I had to wait for my “ride” home.  I had also ordered lunch, and it was brought a little sooner than normal.  I asked them to fix it up “to go” and I would eat it at home.  It was chicken stir fry with veggies and rice.  There was also strawberry cheesecake which my friend B ate, and the fruit had watermelon in it, which I detest, so we left that behind.  I still needed to get dressed, but needed to wait for R to get there and bring a different blouse from what I arrived in, because I figured it would be too tight for my left arm that cannot be lifted above my head.  All this occurred in good time, and we must have pulled out of the parking lot at 12:30. They had to be sure I didn’t drive away, and so Nurse L, pushed me in a wheel chair there, and waited for R to retrieve the car, and watched me enter the passenger seat .  B was there too, carrying the flowers and my stuff.  What would one do without friends?

So, off to Ellensburg, and home.  I’ll stop there.   Well, not quite yet.

I’m unhappy about the recovery time and limitations.  I cannot lift my left arm above my shoulder nor lift more than a coffee cup (one person said); another place on my release paperwork, says not more than 5 lbs. for 6 to 8 weeks–and NO driving.  That’s really going to cramp the style I’ve gotten used to over the past couple of months.  Cannot play my fiddle in the normal way– unable to keep it from over the incision.

I am going back for a device check at the Yakima Heart Center on Tuesday morning this week at 11:30, and R is going to be kind enough to drive me down again.  We can also pick up the device transmitter once there and ask more questions about playing the violin and driving.  Or, maybe I won’t ask, just figure how to cushion the area.

The bottom line is that I do have a new lease on life with the defibrillator installed.  So the story goes on.  [Next installment – Tuesday, the 8th.]

Nancy, thanking you for all your thoughts and prayers in my behalf.

FRIDAY — resting is good

Nancy was inspected on Wednesday morning and found to be fit and promptly exited the hospital.  Seems they needed the room for someone that was actually in need of attention.

The odd thing is she seems to be experiencing more pain from the small incision than she did from having her sternum split with a reciprocating saw, slicing through various layers of flesh, and cutting her heart open.

Further, she is not supposed to move her left arm much, especially in the up direction, nor move anything heavy, nor drive, nor . . . the list is long.

She is taking enough pain medication that she isn’t even as active as she is allowed to be and thus has not described much of her experience.  On this coming Tuesday she has a follow-on appointment and will be given the bed-side electronic gizmo that will send digital reports to someplace out there in the “cloud” from where big sister/brother will watch over the functioning of her heart and their device.

Meanwhile, she is mostly resting.

TUESDAY — post-implant

Nancy now has a cardiovertor defibrillator monitoring her heart functions and ready to intervene should said heart develop electro-mechanical problems.  The worst of these, sudden cardiac arrest, can lead to death in minutes.<Insert big sigh of relief here.>

Nancy and I have been playing puppy-tag for the past week – meaning when Nancy would show up at the whelping box I could leave and then I would return and she could leave.  Six of the puppies would likely survive an extended period without intervention but the seventh, a small male, is not bulky enough to keep from getting shoved aside by the others.

One plan was for us to use the pick-up with the canopy and cart mother and pups along to Yakima in separate housing, then there, I could put them together for a bit, then isolate them again, and so on.  The truck is designed for heavy loads and trailer pulling and is a rough rider.  This, I thought, would shake all of the animals, and us, unnecessarily.  Also, when contemplating this maneuver I did not know what the weather would be like.  If “hot and sunny” the back of the pick-up could be like and oven.  So, while doable, this appeared to be a humungous hassle and prone to problems.

Instead of attempting the shake-&-bake approach Nancy enlisted the driving prowess of a friend, R, and I stayed home.  Nancy left home about 7 A.M.  R lives (almost) on the path Nancy would take so the extra time needed was very small.  Nancy got checked in starting at about 8:30, saw a short video on what to expect, got prepped, and began the procedure shortly after 11.  They finished in about an hour and called me shortly after Noon.

Nancy was with a nurse in a room near where the procedure was done and lunch had been ordered.  Sometime in the afternoon she would go to a room to spend the night.  Not knowing any more, that is all I can write.

SATURDAY — Sweet Clover

I (John), being raised in Pennsylvania, took a college class about the geography and history of my home State.  One region we learned of was “The Land of Milk and Honey,” also known as the Wyoming Valley in the northeastern part.  Honey implies bees and bees need blossoms, and blossoms need, what else, Sweet Clover.  [The Wyoming Valley played an important role in the Revolutionary War, including an early battle and later providing food for soldiers.]

Down through the years from the time of settlement sweet clover has been used as a cover crop (for green manure) and as a hay crop in northern U.S. and Canada.  A problem can develop because a component of sweet clover is coumarin.  It has a sweet scent, readily recognized as the scent of newly-mown hay. Some say it smells like vanilla.  In its succulent stems Sweet Clover hay can harbor fungi, some of which can transform the coumarin into an anticoagulant called dicoumarol.

Anticoagulants can be useful or deadly.  Sweet clover was widely used as hay in the early part of the 1900s when a series of wet summers, and lush clover, led to an epidemic of “bleeding disease” in cattle.  One such place this occurred was in Deer Park, Wisconsin in the northwest part of that state.   In 1933 a farmer from Deer Park showed up at the School of Agriculture and walked into a professor’s laboratory with a milk can full of blood which would not coagulate. In his truck, he had also brought a dead heifer and some spoiled clover hay. He wanted to know what had killed his cow.  When the researchers succeeded in isolating the anticoagulant the Wisconsin Alumni Research Foundation (known as WARF) became involved in seeing that the University benefited from the commercial application of the compound.  For a name they concocted Warfarin from WARF + (coum)arin. A major early use was for rodent killer. The compound Warfarin Sodium is marketed by the global biopharmaceutical company Bristol-Myers Squibb as Coumadin®.

Coumadin® (Warfarin Sodium) is used to help prevent and treat blood clots in the legs, lungs, and those clots associated with heart-valve replacement or an irregular, rapid heartbeat called atrial fibrillation.  Despite its effectiveness, treatment with Warfarin has several shortcomings. Many commonly used medications interact with Warfarin, as do some foods, and its activity has to be monitored by frequent blood testing for the international normalized ratio (INR) to ensure an adequate yet safe dose is taken.  The test is used to determine the clotting tendency of blood.

After trial-and-error adjustments over the last couple of months Nancy’s INR has just recently settled into the desired range.  Thus, it seems the appropriate dosage for her has been determined given her current diet, exercise, and whatever else is involved.

So yesterday she stopped taking it.

We are in the approach period for the implantation of a cardioconverter-defibrillator.  The clotting ability of her blood has to happen faster for the procedure to be safe, that is, excessive bleeding is to be discouraged.

We expect the implantation to be on Tuesday, June 1, mid-morning.  One night in the hospital is scheduled and she should be back home by late afternoon on Wednesday.

We’ll celebrate with a warm toasty muffin spread with Sweet Clover honey.

SUNDAY — searching

Today I’ll continue with the “life happens while you are making plans” theme.

Nancy woke up long enough to take two pills and is now sleeping again.  It is cold and windy outside and I need to feed horses and uncover my garden – that is, 4 tomato plants.  I’ve about given up growing veggies and things here but figured I could handle 4 plants.

We had below freezing temperatures Friday and Saturday nights.  The first week of the month it was so cold that all the main buds died on the walnut trees (both black and Carpathian).  The black walnut trees are about 18 years old and the others about 10 years and all were producing.  Just this week they were starting to push out new leaves from secondary buds.  As neither are native to this area and frosts are common here at 2,200 feet elevation, I have to keep this in perspective.  If they do not recover I can try something else or just photograph the naked trees and call it my contribution to folk art.

Nancy’s sore throat and sniffles are fading so won’t threaten the implantation scheduled for June 1st, a week from Tuesday. Meanwhile she has gone through several boxes and sorted out a few keepers but most of the stuff will be recycled or go to the “covered” transfer station – the place we take our garbage.  Times change.  Years ago the place where one took garbage was called a dump, was outside, and was home to rats and mice.  My father (when young) and a friend would each get a nickel and buy a box of 22 ammo for a dime, go to the dump and practice shooting.  After tiring of hitting cans and bottles and a few rats they would hold sticks out with their hands or with their teeth and try to hit what the other was holding.  About the time I got big enough to try such things they closed the dump and Father and older brothers monitored shooting activities more closely.

Two months ago, when I thought I was monitoring our dogs closely by closing our “in-season” female into a bedroom – I goofed.  She was in a different room.  When I let the male in from the yard he ran down the hall and found her and we had a mating before I had the sliding-glass door closed.  Oops!  So as fast as Nancy could clear away a stack of boxes I replaced it with a new set as I made space for whelping quarters for our expectant mother (that would be “b—h” in dog language).  Luckily the mother-to-be has gotten too wide to crawl under the bed so I have a chance to get her to accept the whelping pen (this has inside panels so she can’t crush a puppy against the inner wall) as the preferred birthing place.  She may attempt to carry them under the bed afterward (when she is thinner) but I’ve seen that trick before and will be firm in refusing her intentions.

There are lots of other things going on this week so we do not need and did not want this puppy-thing.  At least the births will happen a week before Nancy’s ICD is implanted.  That’s good.  I will have to contend with week-old puppies and their new mother while Nancy spends two days in the hospital in Yakima, 50 miles away.  I’m having a hard time finding the good in that.*  It must be there so I’ll keep searching.


*To read “The Pony in the Dung Heap” visit the link below and scroll down to the “Michele W—- on December 30, 2009 at 3:48 pm” entry.

THURSDAY — Making plans . . .

It is said, by whom I have no idea, that life happens while you are making plans.  The truth is, and you can quote me on this, one has to do both.  So we went to Yakima to have a session with an assistant to the implantation doctor.

The session was designed for us to review the reasons for having and ICD implanted and to have the nature of the procedure explained to us.  As I have been searching the internet for information and showing it to Nancy, and summarizing some for this to report here, we were able to ask questions and understand the answers.  There are small pamphlets available at the Heart Center about various heart issues but we find them short of information.  From the internet we can get detailed drawings, photos, animations, and video.  Only about 18 months ago did we get a high speed connection to the Web and we could not have learned what we have without it.

So, back to life and plans.  Life first.  Nancy has developed a sore throat and head cold but these seem unrelated to anything other than being out-and-about. She continues to function doing the things she has, such as music and physical therapy and an increasing number of domestic chores.  This approaching week has been scheduled with master thesis defenses for students that Nancy has had in classes.  Now retired but as an Emeritus Professor she can (and wants to) participate in these activities.  Guess who looks on this situation disapprovingly?  The up-side is that she may throw off the sore throat and cold before she goes to the hospital.

We have managed to squeeze this potential life saving procedure into the very busy schedule on June 1st — twelve days from today.  With that date set we can back off from that 5 days and cease taking Coumadin® so that Nancy won’t bleed overly-much when the implant is done.  The dropping level of anti-coagulation will be of concern but can’t be avoided.

There is a nice vein below one’s collarbone within which leads can be threaded into the right atrium.  From there the lead will pass through the tricuspid valve into the right ventricle.  Near the bottom of that chamber where the wall-muscle is close to the left-ventricle, the plastic-coated metal lead will be stuck into the muscle (the myocardium).  This will be near pathways (bundle branches) for the movement of electrical signals along and through the ventricular walls.

The device can monitor the heart rhythm and sense and record any problems with the coordinated contractions and relaxations.  As necessary it can slow the beating if it is too fast (called tachycardia, TAK-ih-KAR-de-ah), speed it up if it is too slow (called bradycardia (bray-de-KAR-de-ah), and convert a fibrillating (quivering) pattern into a regular one.  This last situation – especially ventricular fibrillation, can stop the forward motion of blood through the body and lead to sudden death.  See the following for more info:

The implanted device is a sophisticated tiny computer with storage and the information it monitors is available for review.  A companion unit can be placed on a bed-side table and then at night the information about your heart will be moved to the bedside, then to a distant computer, analyzed, and searched for anything that suggests a problem.  If anything is found then you and your doctor can be alerted and in you go for a LOF.  Well not exactly but that is what the dealer said when I called about the car – Her exact statement was “So we need to schedule a LOF.”  I had to ask. It’s a lub-oil-filter procedure.  What the tune-up for an ICD is called, I have no idea.

Next entry is “planned” for Sunday morning.  Enjoy your weekend.  Enjoy life!

MONDAY — defibrillation issues

On Tuesday (May 18th) Nancy is scheduled to have an examination meeting with an assistant of the doctor who will soon outfit her with an implantable cardioverter defibrillator (ICD).  There are many pages on the web that can be found using this 3-word phrase.  However, the basic concept is that of using something to provide an electric impulse to convert an abnormal heartbeat into a normal heartbeat.  Just a few years ago there was interest in (chemical) medications to accomplish cardioversion (the conversion of one cardiac rhythm to another) but rapid development of implantable devices (following the introduction of the simple pacemaker) has driven the modern usage to be synonymous with defibrillator.  We’ll get to that in a bit.

A Canadian named John Hopps was trained as an electrical engineer (EE) and conducted research on treating hypothermia (cold core body temperature). While experimenting with radio frequency heating to restore body temperature, Hopps made an unexpected discovery: if a heart stopped beating, it could be started again by using an electric impulse.  By 1950 he had developed a rather large device that could be used (externally) as a pacemaker.  Shortly after that another EE named Wilson Greatbatch had his own eureka moment that inspired his invention of the implantable cardiac pacemaker, and following that he developed the corrosion-free lithium battery to power it.  Wilson Greatbatch is thus considered the inventor of the pacemaker.

The 60 years following these early inventions has seen rapid progress in understanding the electrical nature of the heart, electrical-electronics concepts, and miniaturization capabilities.

The heart is a 4-chambered muscle with blood from the body seeping into one chamber from which it is then forced out when the muscle contracts in response to a body-generated electrical pulse – the beginning of the heartbeat.  That impulse is developed and sent out from the sinoatrial node, often called the SA node. This is located on the inside surface of the upper-right part of the heart in the Right Atrium – the chamber into which oxygen-depleted blood from the body seeps.  When this chamber contracts blood is sent to the chamber below it – the right ventricle – by way of the tricuspid valve.  The blood in the right ventricle will go to the lungs for a fresh supply of oxygen.

Re-oxygenated in the lungs the flow from there is collected in the left atrium, also an upper chamber.  That blood will next pass into the lower chamber on the left – the left ventricle – which is the largest chamber of the heart and its contraction forces blood out into the body.  The more the wall muscle is stretched, the more forceful the contraction and the better the body’s cells receive oxygenated blood.  The mitral valve opens to allow the flow from the left atrium into the left ventricle.  It closes for the contraction so that the blood goes out into the body and not back up into the left atrium.

There is a lot to go wrong as the heart beats, pressures rise and fall, valves open and close, and blood flows.  The electrical impulse that starts in the SA node in the upper right has to move in perfect rhythm to the different parts such that each job is done in collaboration with the others.  One of Nancy’s major problems – now fixed – was the poorly performing mitral valve.  Because some of the blood was forced back into the chamber above it, the blood from the lungs seeping into the left atrium was encountering pressure that should not be there.  That blood should have been going through the aortic valve, into the aorta – the major artery supplying fresh blood to the entire body. The imbalances of pressures and the leakage caused the heart to enlarge.

Also, the left atrium contraction fills the arteries that supply the heart muscle with oxygen.  The two main arteries (lying on the outside surface) of Nancy’s heart were narrowed and this was the site of the clot that sent her to the ER on Friday following Thanksgiving.  The lack of oxygen-rich blood to this part of the muscle caused damage/death to some of the cells of the heart wall.  Thus, it doesn’t stretch and contract as it should.  Furthermore, (the following seems reasonable to me but I can’t find a web article to confirm it) the stretching and dying of the heart wall should alter the paths and timing of the electrical signals flowing down through the heart.  It seems to me that the heart is working around this damage but is more likely to loose its natural rhythm (experience arrhythmia).  When the left ventricle is experience this loss of natural rhythm it is called ventricular fibrillation (v-fib) and instead of stretching and contracting normally the muscle quivers rapidly and irregularly.

When this happens, the heart pumps little or no blood to the body. V-fib is fatal if not treated within a few minutes.  Most cases of sudden cardiac arrest (SCA) are caused by ventricular fibrillation.  What actually sets the heart into v-fib is another matter but studies show that it is more likely to happen when the efficiency of the heart as measured by the ejection fraction is below 35%.  Scroll back to the page for SUNDAY – April 25th where, in the bottom part, this is explained further.

If any part of the heart is experiencing fibrillation (and it is serious) than the solution is to convert it into a normal rhythm, and thus is born the term defibrillation.  The thing that does this is a defibrillator based on the idea of the conversion of a bad rhythm into a good rhythm.  Modern science and medical technique now can miniaturize the necessary components, doctors can implant the unit under a person’s skin with leads to the heart and should the fibrillation occur the patient is saved by the implanted cardioverter defibrillator (ICD).

Simple really.  We are off to the heart clinic on Tuesday to set the plan in motion.