Feb 22: It's a lot longer than planned!

It always surprises me when I see how long it's been since the last post, because it seems much more recent. It's getting late, so will try to just do short pieces of information.

Marilyn is almost moved out, my new tenant Dave comes in nice and early Monday, March 1. I'm incredibly grateful for finding someone so quickly and with no down time in between. Dave is in construction, currently on unemployment but expecting to start again in a couple weeks. He does road construction, and that's something that has benefited from the stimulus package, much more reliable than house construction right now.

Oreo is still here. A couple possibilities for a home, but nothing firm yet. She's been very good, until the last couple mornings when her scratching on her side of the study door has woken me up. If it weren't so damn cold I'd put her on the enclosed porch, although if she keeps this up that's where she will be.

Zerla is doing really well, her walking has improved tremendously. She still won't jump up on things without using one of her step stools, however. I was changing the bed yesterday, so the thing at the bottom was covered and she couldn't/wouldn't jump the 2 feet to get up there. I'm not sure if she's scared or really can't do it. And while some of her bill is on the home equity loan, the part that the vet hospital itself is financing is now down under $4,000....yeah!

Work is the same, and that's not bad. Neither of the doctors that I do on-call for had weekends this month, so feeling a little lean.

My memory seems to be somewhat worse. Not sure why.

Wasn't feeling well all last week. Lots of GI issues off and on and just tired and feeling lousy. I'd been on a real run of sodium cravings, so I should have figured it out before yesterday.... Finally noticed that despite the fact I'd been resting on the couch with my feet up there were deep indentations from my socks. Suddenly everything fell into place: I had pedal edema and it was bad enough that it had progressed up to mild heart failure. Checked my BP and it was > 30 points above normal, no way to know what the pressure was in my lungs. While you would think being in heart failure should be fairly obvious, keep in mind that was how I spent at least 25 years of my life and gotten used to compensating. So yesterday after finally realizing what was going on I slashed my sodium intake, ate no starch, had a banana, drank a ton of water to flush things through and dropped 3 pounds in about 16 hours. That's a whole lot of peeing, by the way. By bedtime my BP had dropped over 20 points, was normal this morning and this evening. It seems to be an irony of life that the food type you love the most will be the one you develop a problem with. So, clearly, I've got to really limit my sodium and carb intake, both of which make you retain fluid.

Since I'm not sure what will happen with work and health insurance it seems to be a wise move to start investigating things. And preparing. My cardiologists, both here and at Brigham, have always raved about how wonderfully I'm doing. This is, of course, because I was not expected to make much of a recovery. Dr. Baughman's prediction before the third heart surgery was that it would stabilize me, best case scenario being a 25% improvement over how ill I was at that point. That was when he said that we needed to talk about a heart transplant for any meaningful increase in functioning. With my results being so much better than expected everyone is astounded with my dramatic recuperation, which leads to superlatives in their letters to my primary. But, if I ever have to go on disability the letters will hurt me, because they don't say "considering her medical/surgical course", they don't talk about the restrictions or the remaining problems. I'm going to have some serious chats with the local cardiologist and my internist. Not sure if I'll go back to Brigham with the death of Dr. Baughman, but will discuss with my local cardiologist.

Today was very busy at work, lots of patients being cancelled or tests being changed, other patients being put in at the last minute. No breaks. I was absolutely exhausted by the end of the eight hours, and then my brain gets kind of fuzzy which isn't good for trying to drive home.

I'm really trying to concentrate on trusting the universe to take care of me, putting out positive expectations. It's working out, seems to be making a difference. Here's my most dramatic example....

Yesterday is Sunday morning, I'm not feeling too badly (yet), so going to BuxMont for the service. My left foot has been acting up recently and I hadn't been using the manual shift Audi, but decided to take it because I truly love driving that car (almost 11 years old now!). Come onto the turnpike at KOP and merge into pretty light traffic, quickly increase speed to accommodate the 65 mph speed limit. I'm running my typical 5-10 minutes late, was doing 70 or so. The radio's blaring, I'm singing along when all of a sudden there is a medium plus noise and the car wobbles, clearly a tire has blown. Despite the high speed the Audi handled beautifully, there was only one car to my left, so I pulled over to the right lane without any problems, went several yards further than absolutely necessary because there was a wider part of the shoulder coming up. I pulled into the area, in front of an open gate behind which there is a large building with three big bays. It's close to the PSP barracks, always assumed it was a PennDOT facility. I got out to assess the damage to the passenger rear tire, which was much worse than I'd anticipated. The tire had done more than blown, it had almost disintegrated, shredded around the wheel. Having seen more than my fair share of bad car accidents over the years it was still impressive. I sent out thanks to the Goddess/Spirits for their protection, very cognizant that there was little logical explanation that the car hadn't lost control at 70mph+, spun out or even flipped over. And me on coumadin.... Well, at least it would have been a fairly fast death.

A little shaken, I got back into the car and hoped the AAA card was in my purse. In the old days I would have pulled out the jack and spare and changed it myself, hell, I'd been a Vehicle Rescue Tech and instructer. But those were the old days, before having my chest cracked open and remaining permanently fractured. As I started dialing the emergency road assistance number I heard a voice calling:

"Miss, Miss, you can't park here!"

I got out to explain the situation, which the man saw as soon as he got closer.

"Wow, that's shredded!"

"Pretty impressive, huh?" I replied.

"Yes, and I used to work with tires", he responded, "but you can't stay parked here, this is a firehouse."

SCORE!!!!!

The nice man suggested I pull into their drive and parking lot, offered to change my tire even without knowing I was a 'sister'. It was cold and windy, so he and the other nice man who appeared insisted I wait in the crew room. Shortly I was on my way back home, stopping briefly at the house to change into sturdier shoes and left the car at my mechanic's to find today; they are so close that I can walk back home. As the next couple hours went by I started feeling worse and worse, very glad that I was at home instead of out and about, especially upon figuring out why the fatigue and breathing were so bad.

My garage told me today that they had all been very impressed with the tire, and that the damage was so severe there was no way to say what had caused it to blow. I'd had the car in last week because the front tires were leaking, which turned out to be mild corrosion from salt at the wheel and tire juncture. So there is no chance that they or I would have missed any low pressure in the rear tires.

There is an impressive list of things during this situation which lead to such a good outcome, and there could have been any number of things which could have caused major or minor problems, including the fact that it happened not when I was going to work or during the crisis in NY, but on my way to something that was not crucial. And my body was coping with fluid overload, which tiny mitral valve openings really don't like. (My breathing today is much better, although there is probably more fluid inside than should be, but slowing the excretion out by mild sodium intake.)

The most incredible thing is, of course, that the car didn't lose control and crash. That, in and of itself, is a significant miracle. Apparently it still isn't my time.

So, with renewed evidence that the Universe really will take care of me I feel more relaxed about everything else. Nothing like those brushes with death to bring clarity.

Thanks for checking in, Laurie

Feb 10: Snow Day!

Having been in NY for the first storm I missed the fun of watching the snow fall and cover the trees and branches. By the time I came back all that was left was the dirty stuff on the sides of roads and sidewalks. But now it's all fresh! Yesterday my office made the obvious decision to close for the day, at this point planning on opening a little later tomorrow as well. There is something so wonderful about a snow day, an unexpected break. From my standpoint it is even more welcome, because doing stuff at the cousin's tired me out and I have to take an ACLS course over Friday and Saturday (cert ran out, so have to take full class--more CMEs), so really needed some down time.

My lawn guy, who doubles as my snow guy, already made a run through this morning when about 7" had fallen. It's been steady, now about another inch, but the worse is yet to come. One of the nice things about having a health problem is the total lack of guilt in having someone else do these physical things around the house. With the threats of power outages due to wind and heavier snow it seemed the best thing to try and accomplish as many things as possible. So I've already taken a shower and washed my hair, washed all the dishes, cooked breakfast in case cold food happens later and now having quality computer time while watching the DVR'd Daily and Colbert Shows. I figure phone time can be later if the power goes out--having grown up in upper Bucks when it was still pretty rural I've never gotten away from having an old fashioned regular phone, which comes in handy at times like these.

The usual calmness of my little house is now upset with Oreo having re-joined us. Marilyn couldn't take it any more, which is understandable after over 3 months of having to keep Oreo separated from her other two cats because of fighting. So far this morning there have been a couple of growling and hissing confrontations, hopefully it will stay at that level. Still looking for a home for her!

The heat is higher than I usually keep it, just in case the power goes out at least it will have been warmer to start out. The large holly tree in the back yard looks incredibly beautiful covered with several inches of snow. The wind is just starting to increase, which I'm hoping will knock some of the snow off power lines. Snuggled in the house with electricity is perfectly fine with me.

Hope you are similarly toasty, Laurie

Feb 5: Musings on lecturing

Getting into the time of year where cardiology is taught in the PA programs in the area, so back to lecturing, which I enjoy immensely. Today was CAD (coronary artery disease), particularly appropriate as it fell on "Go Red for Women", increasing awareness of women and heart disease.

One of my 'standard' lectures is on valvular heart disease (VHD), which I had done for many years even prior to my diagnosis. My typical presentation is going through all the various different valve problems, exam findings and treatments, then showing echoes for a few interesting patients, saving mine for last. At the beginning of the echoes I explain to the students that there is no way to get the name of the patient off the tape, so to please just ignore them as it's breaking several privacy acts for them to see the images plus names. So most students really don't notice on the last one that it's my name on the study. This gives me a chance to announce "And this last echo is, in my opinion, the worst one of all because it's mine." This leads to a satisfying number of gasps in the room (usually between 40-60 students), fulfilling my need to create a little drama every once in a while. Part of this exercise is to reinforce that women and heart disease can be very difficult to discover, with me being the perfect example. By personalizing the message I hope the students remember when they become practitioners to dig a little deeper, that anyone can have a bizarre and unusual problem.

There have been several polls that show many people's fear of public speaking is on par with their fear of death--no, I'm not kidding! It took me a few years to get really comfortable with speaking in front of groups, get used to the questions often asked, not feel like the dark recesses of my ignorance would be brought to light. Maybe all the theater I did as a child/teen has paid off by increasing my level of comfort.

My least favorite thing, however, is going over complications of valve prosthetics. One book has my type of valve listed with the comment (paraphrased) "St Jude valves have excellent long term results, with 68% of patients not experiencing any significant problems 20 years out." Gulp. Most of the time medicine does not refer to statistics as 'excellent' when there are negative outcomes in 32% of patients.

During the two hour lecture I get up and point at things on the screen occasionally, but mostly remain seated. It is disconcerting to notice how short of breath I get during these lectures. When you are in conversation, you pause while listening to the other person. Lecturing doesn't give that option, and I notice my speaking pattern change. I can't speak an entire sentence without pausing, so try and phrase things as if with commas. This was something I was doing when my breathing was bad all the time, most people don't notice. But taking a break after an hour so that everyone can stretch their legs also gives me a chance to, literally, catch my breath. There is lung damage from all the surgeries, my right lung in particular has lost volume. My heart rate speeds up while lecturing, only natural, but the blood is pumping through a comparatively small opening. These two factors are why even speaking affects me, despite the sitting position.

While trying to breath as naturally as possible, the experience always takes a toll on me afterwards. I'm fatigued, and my chest hurts from the change in breathing pattern and taking deeper breaths.

I tell you these things not to complain, but as a statement in how my regular life is affected and inhibited, even though everyone tells me how wonderful I look. It's sometimes frustrating that everyone assumes that there isn't anything wrong any more because I'm not as obviously ill. And over the years coping mechanisms, such as changing phrases, have become very natural and unobtrusive. But life is still quite different and painful.

I'm up in NY now with John, Lyle and Emma. The last visit was already a month ago, for the memorial service. Jane left to go back to New Zealand 2 weeks ago. The next two weekends the kids are on winter break; Lyle is going on a school trip to England, John and Emma will go skiing. The weekend after that I'm on call, so it was important to come up now. A few practical things that my help has been requested for, and good to be here with them.

Thanks for checking in, Laurie