News

Currently my dad has been in the air for a little bit less than 3 hours so another 5 to go. I really don't envy him. I am not a traveler who can sleep due to my need for control in those situations. So those overnight flights back to England always do me in. I am totally exhausted by the time we get there and I then have to get from London to Norwich. No easy feat on little or no sleep. At least my Uncle is picking him up from the airport.

Me, I have my 3 month check up today. Good news. My weight loss is now at 83 lbs for the total duration since March of 2009. I have lost and managed to keep it off. I continue to lose and that is good. Kidneys, liver and all those internal organ tests came back right where they need to be. My pre-diabetes number is shifting away from the diabetes side of the spectrum and that is a plus.

I like what my doctor told me today - he is really real sometimes - "it is good that you are moving away from the diabetes side of things but I don't want you to think that if we shift far away from that, that you will never have diabetes. Reality is, Philip, that the lifestyle you lived for so many years is going to haunt you for the rest of your life." It is a sobering thought but one that I have always understood. I like it when a doctor is both and optimist while being a realist.

Now however I have to go see a surgeon and that does send alarms up and down my spine. But I will go and see what he has to say. Second and third opinions are always a good thing. So we shall see where this all goes but guess what .. it is all good and necessary.

We live, we learn, we adjust and repair what we can and then, for kicks and giggles, we keep on living.

Good night.

Learning and doing

So I spent a couple of weeks reading all and learning what I could about low-carb diets. How to do it right without damaging yourself. The reasons for and those reasons why people dislike it. I came to the conclusion that I have to try. I have to see as it pretty much mimics what my nutritionist, last year after the strokes, asked me to do and what I lost that first 75 lbs with. This allows dairy and more protein in my diet than the nutritionist had and that was one thing that I did miss.

First I purge the apartment of everything that I needed to eat and consume that would not work with this. I still have a few things and I kept sugar here for those visitors who prefer that in their tea or coffee. I still have not made it through one of those 5 lb bricks of sugar in what ... 4 years here. Amazing.

But last week was the first week and tomorrow will be my first week weigh in. I will see.
I have noticed that by looking at everything from bacon to salad dressings to marinara sauce it is hard to find something that does not have sugar in it. Sugar is, or should I say has become, a staple of this culture we live in. You have to look to find the things without it and of course, without and ingredient they cost more ... go figure.

But it is true, I feel, to say that we are addicted to this granular substance. I did well on meeting the goals this first week. I have the issues that many many people have when switching from a diet with carbs to a diet that has only 20 net carbs a day in it ... and I expected them. I was prepared for lack of energy as the body shifts from burning primarily carbohydrates (in the form of glucose) to burning fat (including the fat that is stored in your body) for energy. You are retraining a living organism and it will fight what it has become accustomed to over the years. But if this is the process that is finally forcing me to get between 8-9 hours of sleep a night I will take it.

Back to my thoughts on sugar ... I was tempted with piles of candy on Sunday night (Halloween) with all the little trick or treaters that showed up on the front porch, with costumes and amazingly polite happy attitudes. So I had a single ... little tootsie roll. Oh my goodness. Just 6 days without that sugar made me drool and the urge for more kicked in. It was both scary from a psychological and physiological point of view as it was amazing to realize that there was truth behind what I had been reading.

So I tested that hypothesis with the single tootsie roll at work today ... of course all the left overs were brought in. Once again I had been doing great all day long. Low carb bar for breakfast,  beef and broccoli for lunch, whey protein shake for snack, chicken with veggies for dinner and then the test. Wham ... one tootsie roll set the craving really high for all those candies all over the place. Thankfully I did this test late in the evening so the shift was almost over and I could flee to my resting place, 32 oz of water and healthy stuff.

So I am sure I will have more thoughts on this to share in the future. I have a coach who lost over 100 lbs herself and her husband lost 130 lbs so we shall see where this goes. Yes the doctor is aware ... remember always make sure your doctor is aware and agrees with your choice of action before starting it if you have conditions that have to be monitored.

But for now ... I keep watching my carbs and staying away from sugar.

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.

Eye see

Well it is one of those trips that I had been putting off. The trip to the optometrist. But all in all not a bad adventure today. I had no appointment but like the fact that I impulsively cleaned the grout lines and washed the fan blades today I walked on in and said help. Kara Nguyen is a really nice lady and her team was great. I was really appreciating all the information she was giving me until the glaucoma test. The solution and then the yellow dye and they still freaking burn hours later.

But I did the extra testing they have that is electronic and shows peripheral vision loss. She strongly advised it due to the strokes and it may have been and extra $25 but the end result is absolutely no vision loss in that area. Actually I had one false positive response and I knew it as it happened and pointed it out. Thus another 100 for Philip. I am wondering if I should get another A on my report card for that one.

Kara did give me some rather interesting information about what happens to the eye after 40 and the hardening of the lens within the eye. Thus the need for bifocals for some and she sees that in my future but today it was still that my lenses were changing in prescription but I pretty much still need to only wear them for driving and maybe watching a movie in the theater or some function in a large hall where the stage is far away. I knew that the prescription needed to be adjusted but I am glad that for right now I do not need anything for reading.

She also walked through the fact that the eyes can also have a stroke and I did not know that. That the eye can have its own stroke. But she thought I should know in light of what I have gone through. I need to read up more on that one.

So glasses ordered and should be in the first part of next week. Thus my eyes can continue to see.

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!

Follow up

Well the follow up visit with the Neurologist is on Sat May 2nd first thing in the morning. I guess this is a good sign as he will be the one who gives me the results and they don't want me in there tomorrow.

But then again I have been off recently in reading the signs.

Can I say last night was a crummy night of sleep. I fell asleep around 11 but then woke up after 1 am and felt feverish but was not, took a long time going back to sleep like something woke me but I could not figure out what. Then woke again at 4 at 6 at 7 and finally at 7:30 got up. I a have no idea if this goes with the sleep apnea but I am hoping so. That is next Wednesday when they fit me for the Darth Vader mask.

OK I am still at work so back to work I go.

Peace.

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.