3 months already???

Quarterly checkup today … yep another 3 months gone on by and blood work pulled last week. Actually it was a little bit on the scary side as the blood was pulled the day after I had a scare with blood loss. I guess that I am really aware when I lose blood now as I am on an anti-coagulant and will be for life. With that when I have an opportunity to lose blood I have an opportunity to lose lots of blood. Scary.

But got to sit down with the doctor today and go over my results. Talk about what has happened in the last couple of months, what is going on but today I was impressed. When I mentioned one of my concerns he counter offered with an option to write a prescription for a muscle relaxer (just 10). I countered with the fact that even though some people may think that I take choose to take hard core drugs when things are bad I do not.

Now let me step to the side and quantify that last statement above. Yes, if you would have asked me in the early 90’s or in 2005 if I took the strongest medicines I could get my hands on I would say yes. The 90’s my sinuses were so screwed up and the pain was intense. I popped pain pills like nobody’s business. In 2005 the ruptured disc in my back [done in 1988] finally shifted and sawed the heck out of the left leg nerve bundle. To sleep, I literally had to stand in the corner of the room and lean on my right shoulder. That was horrible. When they offered to shoot my spine up with pain drugs, even though I could have been paralyzed for life, I did not hesitate to say PLEASE!

So I had countered with the fact that I know I have done things in the past that have stressed my kidneys and liver out. I really have been working on eliminating drugs and have gone from 7 daily meds to 5 and cut two of them in half, as far as strength goes, and do not want to add more. I like life. So he countered with almost an hour of going over each level of what he tested in the blood work, comparison to what he has on record for me since 2007 and well showed me why he suggest what he suggests and why he listens to me when I counter.

That kind of relationship is hard to come by in the medical profession. To be able to interact with a doctor that has a prescribed amount of patients to meet due to insurance companies. To have a doctor tell you that you are wrong and justify it. To have him say that he is wrong and this is why he thinks I am right. No ego there. Just open talk. Someone who I am not fearful of discussing concerns with of any type nor will he be fearful of telling me the honest truth from where he sits. He will not prescribe medicine without cause and I especially like that he will not prescribe antibiotics for those things that do not need them. (i.e. we discussed today how people request antibiotics for colds and colds are viruses … antibiotics work on bacteria … thus why? … because advertising scares people into wanting what they do not need)

This discussion today highlighted the 2 levels of study done on the kidneys and their ability to be active and filter what needs to be filtered. I am well within the norms. The liver. Well within the norm. Blood sugar levels. Have been borderline for 3 years but I have maintained or decreased that. Further weight loss will be the key here to make them back off from the edge of being pre-diabetic. The blood cells themselves are in great shape. Right count in the number of blood cells which countered a thought that I might have had so much blood loss due to bleeding ulcer (not good for someone on anti-coagulant). No anemia. No deficiencies in all levels tested. Cholesterol remains great at 155. But more importantly it raised only due to the fact that my HDL went from 36 to 46. Phew. That lower than 40 number is not good at all for HDL. Now it is getting closer to where I would be happy but the doc is overjoyed that in 3 months I could move it 10 points.

So now we maintain and improve. I had my flu shot. I declined the muscle relaxant. Continued with the nasal steroid as the allergy season is intense upon us here in north Texas. Acknowledged that I have been at plateau too long at this weight and need to focus on moving that needle in the get off pre-diabetes watch list.Continue to watch what I eat, work on paying attention more to my bodies indicators and most poignantly from my doctor ... enjoy life.

This week from the National Stroke Association - Blood Thinner Awareness

Blood Thinners

Always some good information in what NSA puts out. This week was the link above that had this important information in it.

Possible Side Effects

When taking a blood thinner it is important to be aware of its possible side effects. Bleeding is the most common side effect.

Call your doctor immediately if you have any of the following signs of serious bleeding:

• Menstrual bleeding that is much heavier than normal.
• Red or brown urine.
• Bowel movements that are red or look like tar.
• Bleeding from the gums or nose that does not stop quickly.
• Vomit that is brown or bright red.
• Anything red in color that you cough up.
• Severe pain, such as a headache or stomachache.
• Unusual bruising.
• A cut that does not stop bleeding.
• A serious fall or bump on the head.
• Dizziness or weakness.

Some people who take a blood thinner may experience hair loss or skin rashes, but this is rare.


Stay Safe While Taking Your Blood Thinner

Call your doctor and go to the hospital immediately if you have had a bad fall or a hard bump, even if you are not bleeding. You can be bleeding but not see any blood. For example, if you fall and hit your head, bleeding can occur inside your skull. Or, if you hurt your arm during a fall and then notice a large purple bruise, this means you are bleeding under your skin.

Because you are taking a blood thinner, you should try not to hurt yourself and cause bleeding. You need to be careful when you use knives, scissors, razors, or any sharp object that can make you bleed.

You also need to avoid activities and sports that could cause injury. Swimming and walking are safe activities. If you would like to start a new activity that will increase the amount of exercise you get every day, talk to your doctor.

You can still do many things that you enjoy. If you like to work in the yard, you still can. Just be sure to wear sturdy shoes and gloves to protect yourself. Or, if you like to ride your bike, be sure you wear a helmet.

Tell others.

Keep a current list of all the medicines you take. Ask your doctor about whether you should wear a medical alert bracelet or necklace. If you are badly injured and unable to speak, the bracelet lets health care workers know that you are taking a blood thinner.

To prevent injury indoors:

• Be very careful using knives and scissors.
• Use an electric razor.
• Use a soft toothbrush.
• Use waxed dental floss.
• Do not use toothpicks.
• Wear shoes or non-skid slippers in the house.
• Be careful when you trim your toenails.
• Do not trim corns or calluses yourself.

To prevent injury outdoors:

• Always wear shoes.
• Wear gloves when using sharp tools.
• Avoid activities and sports that can easily hurt you.
• Wear gardening gloves when doing yard work.

Common Medical Conditions

If you have any of the following medical conditions or are at risk for having them, your doctor may have given you a prescription for a blood thinner. A blood thinner helps your blood flow more easily and lowers your risk for developing blood clots in your body.

Atrial fibrillation. Atrial fibrillation (A-tre-al fi-bri-LA-shun), a type of irregular heartbeat, is a fairly common heart disorder that you may or may not feel. Sometimes your heart will beat too fast or out of rhythm and may cause blood clots. Sometimes atrial fibrillation is also called A-fib.

Blood clots in the lung. A blood clot that forms in another part of your body, such as in your leg, can break loose and move through the blood to your lungs. The clot then gets stuck within a blood vessel that brings blood to the lungs (called a pulmonary embolism, PULL-mun-ary EM-bo-lizm). If the lungs cannot get enough blood, they will be damaged, and you could stop breathing.

Blood clots. Blood clots (DVT, deep vein thrombosis, throm-BO-sis) form in a vein. The veins deep inside your leg, especially the calf and thigh, are the most common areas where clots occur. Blood clots can lead to damage of the blood vessels in your leg and break loose and cause other organ damage.

Family history. Some people are more likely to get blood clots because of a family history. You may have a genetic condition that causes your blood to form potentially dangerous clots.

Heart attack. A heart attack is caused by a lack of blood supply to the heart. The lack of blood happens when one or more of the blood vessels pumping blood to the heart are blocked.

Heart valve disease. Heart valve disease is any problem in one or more of the four valves in the heart. Heart valves keep blood flowing in one direction. They act as a door that swings open, allowing blood to flow through the sections of the heart.

Heart valve replacement. There are many types of artificial valves that are used to replace your own heart valve. The material used to make these valves may cause blood to stick and form clots.

Stroke. A stroke is caused by a blood clot that blocks a blood vessel in the brain. This blockage cuts off the blood flow to a part of the brain and can cause problems with your speech, swallowing, or movement of different parts of your body. You may be at a higher risk for a stroke if you've had a heart attack.

Cardiologist

So yesterday morning, at like the edge of the witching hour in the morning, I remembered that Sarah had called me at work (the end of last week) and said Dr. Malik had called her to let me know that my appointment had been moved to Tuesday morning. I never wrote that down so I am shocked at 2 in the morning I woke up and remembered. Although I thought 10:30 ... showed up at 9:55 and it was supposed to be 9:30. OOPS!

Had no idea why my heart doctor needed me there and neither did they. Eventually after much prodding and probing into the books we determined that it was just the annual follow up. Hmmm have catheters and what not shoved in arteries, scoping out right ventricles and atrium, checking the passageways trying to find a PFO that contributed to the strokes, never to be found and guess what you have a specialist in your world for life. Yippee.

EKG was done with some really cool sticky things that actually had a little tab on them so when my nurse was done she just pulled that tab and they released. She did not have to shave parts of my torso - thank God cos that ends up itching like the dickens and I really do not want to be scratching the torso at Tammy's family reunion when lots of these people will be meeting me for the first time (oh the pressure of that but I am not going there ... yet). But that was so cool.

So EKG showed that I am still an abnormal but normal person. Essentially the same abnormalities in my readings that have existed over a few but show nothing abnormal in the operation of my heart are just all the same as they have been and will be. Huh? Yeah that is what I think.

Heart sounds - okie dokie.
Lung sounds - okie dokie.
Artery sounds - okie duh dokie.
Extremity blood flow - peachy. (hmmm never thought of red blood as peachy but OK)

So I check out. Continue to lose weight, exercise, control cholestrol and get a stress test. I look at him and say "I work - is that not enough" Just kidding doc I have had those and I know. See you in a year.

Well that was nice. I think. Then again I assumed that my heart was still beating as I am still here. :)

What time was my appointment?

What time is that appointment? 10:15 am. But I do not have that on paper anywhere so I assume I could be wrong and go in at 10. Plus that is me, always wanting to be just a little bit early to any appointment. Why do I do that to myself? I think I learned from the people I grew up with, my friends, who were almost always late. I did not like that.

Regardless I am there and waiting, and waiting and …. well why is there a desolate desert wall mural on the wall I have been staring at for 1.5 hours? There is not a drop of water in site, no sign of redemption, no second chance here with the lizards, cactus and sidewinder snakes. Why does this take up the whole wall of this office? A heart hospital of all places.

I digress. Finally at noon I am called back. I had already discovered that my appointment was at 10:45 so that was my bad anyhow. And then I get my 10 minutes with Dr. Malik.

At the TEE he gave his initial findings – nothing – knowing full well that I would have no freaking memory of that. Knowing that the drugs would have made my mind mush but he always does that. I remembered enough to know that he found nothing and not to take the meds for the following week surgery. Then he takes the results back and has a couple of weeks to make sure nothing was missed (I am sure his interns do this).

This in depth study found – nothing. Was that a surprise? To me it was not. There are no holes that are of normal or abnormal size. There is evidence that there is a hole but that is not supported by there actually being one there. Thus I fall into the less than 1% of the people with a hole in their heart whose hole is wholly confounding the field of medicine by not being a whole hole that can be found by normal means. Rather my hole is masquerading as a heart.

“Why are you looking frustrated?” “Well a hole could have been wholly closed and this whole nightmare could have had a resolution with my heart being whole again.” “But this is good news!” “Why?” “Well we do not have to do the surgery and with medication you should be OK.”

Notice the “should be” OK. So we discussed that. In all reality I may have another stroke. If I take my medicine, lose weight, control blood pressure, exercise and live healthy there is a huge possibility I may not have another one. But if I do? Well at that point I would need to go to Dr. Malik right away and the book would be thrown aside for this … and a right-sided cardiac catheterization would be performed.

Definition:

Cardiac catheterization (also called heart catheterization) is a diagnostic procedure which does a comprehensive examination of how the heart and its blood vessels function. One or more catheters is inserted through a peripheral blood vessel in the arm (antecubital artery or vein) or leg (femoral artery or vein) with x-ray guidance. This procedure gathers information such as adequacy of blood supply through the coronary arteries, blood pressures, blood flow throughout chambers of the heart, collection of blood samples, and x rays of the heart's ventricles or arteries.

A test that can be performed on either side of the heart, cardiac catheterization checks for different functions in both the left and right sides. When testing the heart's right side, tricuspid and pulmonary valve function are evaluated, in addition to measuring pressures of and collecting blood samples from the right atrium, ventricle, and pulmonary artery.

What is key to me here is this:

1. Cardiac catheterization is categorized as an "invasive" procedure which involves the heart, its valves, and coronary arteries.
2. Dr. Malik has done this procedure once (1) yes once. He would actually be looking at the wall of my heart on the right side and testing it, probing it, looking for this elusive hole.

This pretty much makes the decision a clean cut one for me. Thus I followed up with two questions:

1. What else did the TEE show? -- Nothing abnormal. He could actually see everything and I have a normal heart.
2. Last time I was here you said the following “it is not a matter of if you have another stroke but when” --That was when he was working off of the assumption that led him to believe there was a large (respectively speaking) hole in my heart. With the findings it is now, in his opinion, “if you have another stroke”.

So I think and ask a question that was not on my list but I have been thinking about.

This is all with the assumption that I take this Aggrenox every day for the rest of my life – correct? Well what are the long term affects on other parts of my body?

The answer to this is that it is something I will always have to be aware of – internal bleeding in events of extreme trauma, that it will take longer for wounds to stop bleeding and I need to avoid bleeding ulcers.

So that about sums this visit up. I have to go to my neurologist next month and see what he says. I have an appointment with Dr. Malik a year from now and I trudge merrily along making myself right again in the sometimes surreal world that has become mine.

Continuing onward....

From what I have been able to piece together I am possibly part of 1 or less percentage of the population. Well let me narrow that down a bit and say of the population of people whom have had a stroke with signs of a PFO (grade 3) in a test, yet have nothing show up when the pictures of my heart were taken through the esophagus. Yep I am a fluke.

But lets see that 1 percent or less has a PFO that is not standard. Most of these PFO have a flap that covers them and it is usually on the left side of the heat which is why under the right pressures it opens. Now that is 99% of the people in my situation. Now the other 1% have the flap on the right side. Thus held close pretty much all the dang time by pressure except for when the planets align, an asteroid is streaking by the earth, the beings in Jupiters clouds and drinking a vanilla frosty from Wendys all at the same time then the flap opens and a little clor gets through. Causes a stroke. Or in the impossible likeliness that this happens twice in one month (me) there are 2 strokes.

But the darn hole has hidden itself from the eyes in my esophagus and my cardiologist. There is an invasive test where we go into the heart with a mini camera from the veins and run the tests of micro bubbles while closely examining the walls. I just don't know at this point. I think my cardiologist is at the same point.

So I have a meeting with him on the 6th of July, it is confirmed that there is no surgery this Friday to fix what is potentially there but cannot be found and I have to once again find answers and questions, or is that questions and answers.

At this point all I can do is keep on doing what I am doing.

See ya!

The Good, the Bad and the REALITY

There is a story in progress here....hold on folks....

Sent via BlackBerry by AT&T

Well I am going to hold on to the good and go from here but this was today.

Check in at 9:30 (efficient). Almost as soon as I get finished on the 9000 page history and questionnaire I am off into the Cath lab. Storms are churning up the city and I am just thinking "peachy". Shelli is my nurse and she has the same level of insanity that I have thus we get along just fine.

Chest shaved - ekg hooked up. Wrist shaved - IV plugged in. All is well and moving along and they let mum come on back. Then we wait for Dr Malik. ....and wait....and wait.....

"Just peachy" I think.

Finally found out that he is running an hour late. Complications begin to arise within the Cath lab and well they have to move me. To the pre-actual Cath lab area. I was just in the Cath lab prep and recovery room.

Now Dr. Malik is downstairs eating. Which is fine by Shelli and I because we would prefer a happy doctor. I think about the fact that he is eating before me and my tummy rumbles even louder. "Just peachy"

There is the man of the hours. Cool. Sprays my throat with the numbing juice. Swallow. Repeat. He warns me that is the second to the worst part of this procedure.

"Finestkind" I think.

Now they put the plug in my mouth and strap around the head. Then Shelli hits me with the cocktail. I am asked if I am feeling sleepy yet. Nope. Hit him again. Feeling anything yet. Nope.

OK lets start. Tube inserted into mouth and I am asked to swallow. That was the worst part. I think it was when it hit the bend around the back of the throat. Good news is I can breathe fine and that was honestly my biggest concern about this.

I watch as they perform the procedure. Watching the electrocardiogram screen and coughing when asked...they are shooting the micro bubbles of air into the IV.

Am I supposed to be asleep. I know I am not fully lucid for even now the thoughts about this I realize are disjointed. I came and went. When it was finished I heard Dr. Mailk say something to Shelli and she said my mother was there (she was not allowed back here).

Next think I know is that Dr. Malik is telling me that they did not find a hole. I know I asked questions and he answered. I know he said about an different type of procedure. My mother later fills in the fact that he was saying that there is still a possibility that there is a hole there and it is either really small of the flap is on the right side and just opens under the most perfect of conditions. Conditions that include those that allowed the clots to come over and give me a stroke.

He told me (once again not totally lucid) that it is a chance that with the medicine there may not ever be a problem again. But there is also another procedure where they do the electrocardiogram from within the heart. They go in with a tiny probe through the vein or artery and that gives them an inside picture.

Once again I remember bits and pieces of this. I have to call his office tomorrow to set up an appointment. "just peachy and finestkind"!

So surgery for the 19th is off the table. Not going to happen.

Shelli could not figure out why I just lay there tapping my oxygen sensor finger on the hospital bed rail. What is up?

"Well I am relieved that there is no surgery next week." "But what?" "Well this was the reason why I had the strokes and this was the procedure that reduces the inevitability of them happening again." "Oh." "Yeah, now I have to keep looking as to is this the possibility or is there something else."

She left me alone for an hour and I think I came and went out of lucidity. But I realize that this is one step forward and one issue that has been addressed and for now that is all I can ask.

I have a direction and that is forward. I am making and have been making the necessary changes in my life. I cannot change what has happened but I can undo the damages done and live again.

I need to talk to the Dr. tomorrow and get more information. I need to hear this when I am lucid.

I need to thank everyone for the good wishes, prayers and positive energy. No surgery next Friday and that is a serious load off of my shoulders and some off yours. Now we just keep on working together to get well, get fit, get leaner and have fun every single day.

See ya.

Today is a good day.

I seriously walked today. My cousin's son is in Austin at the State finals for the last time and I am in Dallas wandering around 68 acres of gardens. He is clearing the 800 meter in 1:57 and I am taking 120 times that to wander around almost 3.5 miles of trails.

He goes and preps for the one miler tomorrow and I come home and every muscle, ligament, tendon and joint just lock up on me. But I feel good. I feel as if I have done something for myself today. I wonder about the sanity when we have a Orange Ozone alert but I needed to get out. I needed to walk. I needed to take photographs.

Dallas Botanical Gardens

A little while ago I wandered over to Marinik's Blog and read the Open you Hearts posting. This is one of the first blogs I have been tempted to speak my mind on and have posted twice now to her. She has an uncanny knack to have a post that resonates with something that I have just thought about or experienced. But I like her blog and hope that if you have the time you will read it to. I will not tell you the premise for her blog. It is for her to in her pages but I admire her heart and resilience.

Well I think I am going to go and collapse here shortly. By the way I am making it longer and longer with the BiPAP mask on. I actually had a conversation with a quiet man at work about an hours over his CPAP mask. He has had it for years and now cannot even nap without it. He takes it where ever he travels and just listening to him and his experience made me realize it is a way of life and there is no reason to fight it. I actually am beginning to feel a hint of security and need to have this mask on at night and to me that is a huge leap in the right direction.

I wonder if they will let me bring it to the hosptial. Need to ask them. Then again do I want it in the hospital?

See ya!

Time to Repair!!!

Today was really an information gathering session. Dr. Malik is one of the junior partners at the Heart Center of North Texas and really good at what he does. I found out from Cynthia (his nurse for 22 years) that he is booked through December of this year and most of next year is filling up. They fly in from other states and one of his specialties is closing PFO’s.

But the discussions he and I had were intense. Some things became clear to me. I had been reading about this but it was not as clear as he made it. We all develop little clots and such when we bruise or hurt our body. These clots are little and travel through the venous system, the blood going back to the heart. This enters the right chambers and is then pushed through the lungs. This serves two purposes. One is to apply the necessary oxygen to the hemoglobin in the red blood cells. The other is the lungs act as a filter. The filter the dust and such that we breathe in and they filter these little blood clots. The clean air returns to the left chambers of the heart where it travels out to supply the body and brain with oxygen.

Now a PFO that does not close after birth sits there as a little potential short cut from the right side to the left side of the heart bypassing the lungs. This can happen when we sneeze, when we cough, when we strain while sitting on the loo and what I just found out…when we have sleep apnea.

When I stop breathing at night my heart jumps when my body is forced to wake up and take a deep breath. This is the prime opportunity for that clot to move over from one side to the other. Then a TIA or stroke occurs.

I found him to be a very knowledgeable man speaking on both a high intellectual level and knowing that I was understanding this, then also dropping into layman’s terms easily when he could tell I was struggling with a concept.

He was rather interested in how the stroke happened, what symptoms I had and then did some physical examination and had me do some tests that seemed to be more neurological. The first things he said after the examination was that my breath and heart sounds were good. That my neurological disorders were still a little off but mostly normal, that I probably was having issues with numbers, that I was probably still having issues getting the message across and was jumbling up sentences. Sorry but WTF.

I have not really discussed with many that my brother is dealing with my finances as I just cannot deal with it. I had to ask the apartment manager how much my check needed to be written for as I cannot remember numbers. There were no sentences I had to write on the 8 pages of documentation I had to fill in and well he even knew that my short term memory was still a little off. Can I be Hurley here…Dude this guy was kinda creeping me out a little bit. But on the flip side I was impressed.

Good news is he believes that I will gain full functionality back as I am young. Then he dropped the bombshell on me that I have been skirting with avoiding. “Philip, you can keep taking the aggrenox for the rest of your life and not have the surgery but it is not a matter of if you will have another stroke it is a matter of when you will have another stroke if we confirm there is a hole in your heart.”

I know that is the case. I have not wanted to face that reality but it is true. So I have to make a decision. I have to make the decision. I have to make a decision about my life. I know there are lots of factors that have contributed to me being where I am today and most of them are of my own making. I did not take the weight off seriously. I procrastinated. I did not pursue the sleep apnea in Maui. I have made choices that I can change and work on now. I have time. But I cannot do anything about a hole between the right and left chambers of my heart and my body has already suffered. The organ that I need to live and live at the level of intelligence that I want to live at has suffered.

There is no one to make this decision for me. As terrified as I am of having someone invade my heart the prospect without this invasion is just as chilling.

I have to make a decision.

TEE is on the 11th – I go in at 9 and the process starts at 11 am.

Closing the hole in my heart (if the TEE confirms that) is scheduled for the 19th. I go in at 9 am, procedure at 11 – takes about 1-2 hours. Actual process is about 15 minutes long. I will be under anesthesia as they will have the ultrasound scope down my throat as well as going into my heart. I will stay overnight in the hospital and come home on the 20th.

I have made my decision. (my hand trembled when typing that last paragraph but my inner mind lets me know that it is right)

Plans change for the month of June but that is alright. We have to adjust as the world around us adjusts.

I have a direction and that direction is forward.

REPAIR, LEARN and most importantly LIVE

I gotta ask more information

You see I knew what I was going in for kinda. I forget to ask how to spell things and things slip out of my brain really easily.

So the procedures were really benign in that they were not intrusive...but they may show the reason for the stroke. We shall see.

Sticky patches or electrodes are attached to the chest and shoulders and connected to electrodes or wires. These help to record the electrocardiogram (EKG or ECG) during the echocardiography test. The EKG helps in the timing of various cardiac events (filling and emptying of chambers). A colorless gel is then applied to the chest and the echo transducer is placed on top of it. The echo technologist then makes recordings from different parts of the chest to obtain several views of the heart. You may be asked to move form your back and to the side. Instructions may also be given for you to breathe slowly or to hold your breath. This helps in obtaining higher quality pictures. The images are constantly viewed on the monitor. It is also recorded on photographic paper and on videotape. The tape offers a permanent record of the examination and is reviewed by the physician prior to completion of the final report.

The additional use of Doppler helps to identify abnormal leakage across heart valves and determine their severity. Doppler is also very useful in diagnosing the presence and severity of valve stenosis (pronounced stee-no-sis) or narrowing. Remember, unlike echocardiography, Doppler follows the direction and velocity of blood flow rather than the movement of the valve leaflets or components. Thus, reversed blood direction is seen with leakages while increased forward velocity of flow with a characteristic pattern is noted with valve stenosis.

Some good description

• Doppler ultrasound test — Uses high-frequency sound waves to detect blockages in the carotid artery. A Doppler probe or instrument capable of generating ultrasound waves is placed on the neck very near to the carotid artery. Ultrasound waves from the probe travel through the neck and bounce off the moving blood cells. The reflected sound wave, now returning to the probe at a different frequency, is then detected by the same probe. The change in frequency of the sound waves relates to the speed of the blood cells and thus the blood flow. This test takes an hour or more, and causes no discomfort.


• Carotid phonoangiography — A sensitive microphone is placed on the neck, very close to the carotid artery, to record sounds. Ordinarily, in a normal artery, blood flows in a smooth and controlled manner. However, the presence of blockages, such as those caused by atherosclerosis, causes the blood flow to become turbulent. This turbulent blood flow can create a sound, called a bruit (BROO'e), that can be detected and registered by the microphone. The presence of a bruit may indicate a blockage in the carotid artery and is cause for more tests.

Stroke Tests

Of course I had the Doppler that has another name that is gone out of my head. They looked at the arteries in both my temples and above the ear area, both of my eyes, just under both side of my chin and both sides of the spine. Then they put in an IV drew blood, added air and agitated it and shot it in while looking at the arteries. This was done with me normal, holding breath, holding breath and abdominal contractions and then holding and moving a gage 40 marks while exhaling. It was all rather interesting and eerie to hear my own blood moving through my arteries.

No results yet. But the main thing they are looking for is a hole in the heart (supposedly we are all born with this) it was always thought that it usually closes up but they are now finding that 1 in 4 or 5 people it does not. This can create an eddy in the heart chambers where a blood clot can form. Rather interesting. So if there is one they do the surgery through a catheter. But at least I have more information this time. Just forgot what this was called exactly.

I am thankful that the day is over and work is over as I have a splitting headache.

Peace.