First thing I went for the usual walk over what I am still going to call the jogging route (4.1 miles for the day). For something to do in the morning I actually sat down and did some work on the MG model, the highly tedious work of painting chrome onto the spokes of the insides and outsides of five spoke wheels.
I had the 12-2pm window for using the laundry but checked around 10:30 and nobody was using it, so I started early. Laundry wrapped up, sorted and put away just after lunch.
After a nap I did what I’ve been meaning to do: went for a short walk to a nearby park and sat on a bench to read for a bit: getting the heck out of the room in the middle of the afternoon.
Oh, late edit: I forgot to mention this. After several weeks of “no COVID”, an urgent email arrived about 2pm saying, “We have received notice that a Lee Center staff member has tested positive… Anyone who has been thought to have had close contact with the Covid-positive employee has been notified…” and a bunch of things that were about to open up, are slammed shut again.
At 6am, watching the TV weatherman, I got an idea for a short essay, and drafted most of it by 7am. (Below.)
Did Veronica’s aerobics. Then, at 8am, as I had planned out days ago, I quickly showered and dressed and headed out for the grocery store, getting to Piazza’s at 8:30, still within the early “vulnerable” hours. I bought a few things I wanted and just as I was ready to pay with the phone I got a call from Scott. He wanted to bring me up to date on his medical news, which has been a lot more dire and uncomfortable than mine.
Near the end of October, he went up an extension ladder to trim a decorative tree in his backyard, and apparently fell off it. “Apparently” because he doesn’t remember: the fall gave him a severe concussion and he doesn’t remember it, or five days at Stanford hospital. He suffered several compression fractures in vertebrae and is braced up several ways, but expects to be out of braces, or in more comfortable braces, in another month.
Back home I made another experiment applying clear coat to scrap plastic using the air brush and it is absolutely not acceptable. Far too many little bits of dust, and voids, and wrinkles. I went online to various hobby stores, and ordered some Tamiya spray clear, which had enthusiastic user reviews. It won’t arrive for a couple of weeks, though.
Mid-day I did not get out of the apartment as I had sworn. It was raining.
OK, here’s the essay I wrote this morning and posted to the writers’ group, getting several enthusiastic seconds.
So glad…
The jovial weather guy on this morning’s news, delighted to finally having some weather to report, reminded us “You won’t need your AC for a while, don’t forget to put the cover on it.” Oh lord! The AC cover! My heart warmed with the sudden knowledge that I will never again need to do that. Never again will I get the AC cover down from the dusty shelf in the garage, disturbing a summer’s worth of spider nests. Custom-fitted black leatherette, bought in the prior century, now coated with months of dust, it fits snugly over the bulky AC evaporator unit beside the back door. But it can’t go on yet; first I have to clean the evaporator, getting rid of eight or nine months of dust, bird poop and pittosporum leaves. That takes half a roll of paper towels and many squirts of 409 cleaner. Then, once the big metal box is clean, I need to wax it. If I don’t, it will rust under the cover. Back into the garage to find a bottle of auto polish and some rags. I wax the top and sides, and “tsk” where rust is creeping up the bottom edges of the metal case.
With a summer’s debris cleaned and the paint protected, I can fit the cover. I snug it down over each corner and fasten the velcro at the ends. And now: it is time to clean the dust from the leatherette and make it rain-proof. Back into the garage to dig out the spray bottle of Armor All, and use more paper towels to wipe in the milky protectant and make the leatherette shine.
When the AC box looks like a glossy black monolith, ready to shed rain for a few months, I pull the breaker that powers it so it can’t come on if I mess up setting the thermostat. I pack all the wet, dirty paper towels into the recycle bin, and put away the bottles of cleaners. I have “put the cover on the AC”, a simple job that only takes a couple of hours.
This morning, gaping at the jovial weatherman, I am so, so delighted that I no longer care for any of the details of an old suburban house — the gutters; the roof; the random wiring; the taxes and insurance; cutting back the attractive but greedy Virginia Creeper; denying access to the roof rats; and, in November and May, covering and uncovering the AC. It was only when I was driving away from the place for the last time, on my way to Channing House, that I felt — as the old evangelical hymn says — the burdens of my heart rolled away. And I’m still glad.
Checked around the apartment in a few more places. Somehow my memory of the keys is linked to when I picked up about 3 day’s mail on Saturday morning. Certainly that’s the last time I had them. So on the way out for a walk, I asked at the desk and… the Ethan handed me my keys.
They had been found hanging in the lock of my mailbox. Apparently there was so much mail and I was trying to sort out the trash from the actual bill or two, both hands full of mail, I just walked away from the keys hanging in the mailbox door.
Walked the full jogging route without stopping, which is an improvement. Then met with Margaret in the dining room to deal with problems with her Time Machine backup. She has an external drive that was being her Time Machine until it came up with a hard error last week. I’d pointed her to the inexpensive external drive I’ve been using, and now she’d bought one.
I took my laptop thinking that I would set it to work running Disk First Aid on the old drive, while on her machine I formatted the new one and started a new backup going on it. But the old drive was unrepairable, Disk Utility couldn’t do anything with it (fsck exit code 8, trashed file system). Later I took it home and continued trying to access it, but it appears to be toast.
So got the new one going and then talked about her problems with photos. She has a lot of digital photos and at some point, they got disorganized. Prior machine, hard drive failure, Apple restored her data but the photo organization was lost, or something. She promises herself she will spend an hour a day reorganizing photos but never quite gets around to it. (Been there…) At some point one of my colleagues (she declines to name names) thought it would be a good idea to make backup copies of her pictures so now she has two, not quite identical, folders of photos on her desktop. Which at 15GB each are a bit of a space problem — considering all the same pictures are also being held by the Photos app.
We decided that, since we were taking a brand new complete backup onto a new drive, she would wait until it was finished, and then delete the two folder of (hopefully) duplicate photos. If she ever needs them back, they can be restored with Time Machine!
Since I don’t know Photos, I got her a copy of the latest edition of Take Control of Photos. Possibly if she reads it she will be inspired to do more.
Back at my room I had an email from the tech squad, could I help Randy who has a problem accessing the SF Chronicle e-edition from Safari on a Mac. Unfortunately I couldn’t. I spent ten minutes on the phone with Randy and got nowhere. I wanted to try logging in with his subscriber ID but that didn’t work. I strongly suspect he once set up a unique password for the Chron, and has since forgotten it but the Chron lets him in using Safari. Whatever, I couldn’t get in to replicate (or not) the problem.
Which brought me to lunchtime. Busy morning!
Afternoon was much quieter, so quiet that I was going stir crazy. I determined that from now on, I must get out of the building in the afternoon as well as the morning, even if only for a short walk to nearby park to sit on a bench and read.
Normal Sunday morning, well not totally normal. Took 10 minutes longer with the NYT puzzle than usual. And with cooler weather, the plants didn’t want much water.
During the morning I realized that my key ring was missing from my pocket. I checked everywhere I could think of, including the car but no luck. Emailed Jean asking her to check where we were sitting and walking yesterday. It isn’t a disaster; I have a spare mailbox key, and can easily get a new door key. The car key was a separate item.
After lunch Patty and I drove to the Baylands. The plan was to take both cars, park a car at each end, and walk the full path. However, 2pm Sunday? Poor planning; the parking lots were full. There’s much more room at the southern, San Antonio, end and we eventually got both vehicles parked legally there. Spent a couple hours walking 2.5 miles and talking.
In the evening I watched PBS Great Performances, The King and I. Which brought me to 9:30 and I just toddled off to bed not even thinking of a blog post.
I had canceled CH lunch and supper both for today. First thing I went out to the Farmer’s Market. I bought a delicious huge raisin snail from the baker, and a pork empanada from the Mexican food truck. That plus some grapes was enough food for the day, pretty much.
At 1pm I drove down to visit with sister-in-law Jean. We chatted about various relatives and took a nice walk on the Stevens Creek Trail.
At 4:30 was the much-anticipated Zoom Webinar from SWBB, with Tara introducing the team and saying how “excited” she was about the new season. It was a pleasant event from the standpoint of meeting the team, but very unsatisfying in that there was minimal info about how games will be accessed. There will be “no fans in the gym”, Tara mentioned casually half-way through. Toward the end she said all PAC12 games would be on PAC12 TV, and some on ESPN. Of course, I’m pretty confident that PAC12 TV will time-shift some games, because it’s the West Coast and there will inevitably be USC and UCLA and Oregon games on at the same time as Stanford games. The SWBB staff really have no idea what fans are concerned about, and no idea how to market their wonderful product.
I went for a short walk. A resident has prepared a table of all the walks starting at Channing House to local destinations, with their exact mileage, and Lenny, who is now managing the resident website, put it online. So I walked from CH to the gazebo in Gamble Gardens and back, 1.5 miles. That nicely filled the time until it was time to go to Stanford Hospital to meet Dr. Watkins, who placed my aortic stents.
It was a trace emotional, driving down into the underground parking and walking past the reflecting pool to the main hospital building. That was a trip I made at least 30 times, maybe 50, while Marian was undergoing a series of procedures back in 2018; and I hadn’t made that trip since. (For my own recent procedures I was in a newer building and didn’t drive and park.) Anyway after filling out a form and answering some questions for the nurse coordinator and the nurse practitioner, Dr. Watkins herself entered the room. She’s not quite as dramatic looking as I remember her from last month, but still a big, tall woman, maybe 40? (could be a bit younger but not a lot, to be an experienced surgeon) with lots of red-brown hair, a pleasant face, and thick nerd glasses. She was quite generous with her time, for a busy surgeon, giving me at least 20 minutes of discussion on all sorts of things, during which she made these notes:
First, the aorta. The wiggly lines are the ends of the overlapping wire stents. The bulge on the right is the aorta wall, with its split-off lining inside. The space between the lining and the wall proper is full of blood and starting to clot and will eventually be resorbed by the body. However there are currently a couple of “endo-leaks” (small arrows) where blood is seeping past the stents into the “false lumen”, the space between the lining and the wall.
She expects they will stop and clot also, when I stop taking Plavix (clopidogrel), the anti-clotting med that caused my recent endless nosebleed. And here I learned something: that drug is prescribed for six months following a cardiac stent, and is not needed by the aortic stents in the picture. Remember back during my first hospitalization, as part of clearing the floor for the aortic work, they did a catheterization of my heart and found one artery 80% blocked, and more or less on the spur of the moment, placed a stent? That one. Because of that stent, I’m on Plavix for six months, to March. When I go off it, the “endo-leaks” in the aortic lining should clot up.
We’ll know because, see the stack of dates lower right? Those are the call-backs for CT scans and re-checks. If the endo-leaks don’t clot up, she says there’s a very simple procedure where she goes in with a catheter and inflates a balloon to smush (I think she used that word) the lining outward. Not even full anesthetic, and discharge the next day. Very confident, like all surgeons. Other things to watch for in later scans: dilation of the aorta. Currently it is stable at 4.5cm (see right side of notes), dilating further would be a problem.
The big question raised by Dibiase was, with all that hardware in the aorta, could the complicated catheterization of the TAVR procedure be done? Good news. Dr. Watkins said cheerfully, “Oh yes, I can scoot a TAVR right up there, no problem.” And went on to point out that she does most of the TAVR’s in her group. So that resolved that question.
Then we talked TAVR and she got up the CT scan to check a few things. An experienced person can basically fly through the CT image like a drone, turning through all dimensions. At some points I could see my ribs as a line of ovals, so I was looking in from the left side, and then she swung it around and there were ribs as curving bars so we are looking out or down or something.
Anyway, she looked in detail at the aortic valve. “See the circle of bright dots? That’s the stitching around the valve seat.” The CT didn’t resolve the leaflets in really high res, but she could see maybe a little gap in one that might account for the current regurgitation. But her take was that my valve looked “great”, and it could last “three to five years yet”. She said she looks at a lot of aortic valves when evaluating TAVR prospects. The way the prosthetic valves usually fail is that they get calcified and stiffened, which shows up clearly on the CT. Compared to the usual TAVR candidate, my valve looks pristine.
One caveat, though. She asked if it was a cow or a pig valve. Pig, I said. “Ah. Well, there is one kind of porcine valve that doesn’t get calcified, but just fails anyway.” So there is that uncertainty. Things to watch during the 3/6/12 month scans are listed in the upper left of the notes. In particular, if the valve gets very leaky, the left ventricle tends to dilate in size, which would show up on either a CT or an echo.
We also talked about the carotid arteries because Dr. Dibiase had heard something that didn’t sound right in my neck. Watkins pointed out that in a pre-op carotid echo, the analysis noted one artery had a 50% velocity increase, which usually indicates some kind of blockage. However (see lower left of notes) this is not usually a problem until an 80% blockage. Things to watch for: any neural symptoms, especially episodes where your vision gets blurry for a brief time and then recovers. People tend to brush that one off but it means carotid insufficiency.
Later in the day we had Rhonda’s weekly meeting, which was mostly good news. In particular for the 2nd or 3rd week in a row, we have zero COVID cases. She shared the official guidance on holiday gatherings that was just released by a consortium of ten Bay Area counties. You know the drill: max three households, outdoors, masked, and short. No fun. What’s the point?
First up did the morning aerobics zoom class. Why do people not come to these on time? At 7:30 I was the only person signed in other than Veronica. We started on time. Michelle showed up five minutes later, a couple others logged in ten minutes on. That’s dumb. You miss ten minutes of a 30 minute exercise class, you might as well not come. But my opinion was not requested.
Ten AM brought my video appointment with Dr. Dibiase. Regarding nosebleed prevention she recommends Aquafor ointment to keep the membranes soft. About my relatively high blood pressure evenings, she decides to change my meds, taking the Metopropol 2x, morning and evening.
She looks at the writeup from yesterday’s CT (which is not yet accessible to me under Stanford MyHealth), commenting it shows “no fluid around the heart, arteries to kidneys are open, that’s good.” Later she mentions that it says something about “a mass” on the aortic valve, which might account for the regurgitation. What could it be? Hard to say, and she says it is hard to image with the normal echo, and she doesn’t feel inclined to order the more invasive TEE (where the echo emitter is put down your esophagus under anesthesia) as it “doesn’t resolve the aorta that well anyway”.
“The problem with these old valves is,” she remarks, “they deteriorate in an unpredictable way”. So orders another echo for six months on. If I get any symptoms she’ll order an echo right away.
She orders some blood work to check kidney function in a couple of weeks, which reminds me that Dr. Marx ordered some labs too, and I haven’t done them yet.
We discuss the TAVR procedure at length. I’m to bring it up with Dr. Watkins tomorrow. She may say that the stents she placed may be absorbed by the body so that they are less of an obstacle with time. In any case, would the surgical team please send her (Dibiase) a letter describing the stents and their long-term prognosis.
However (and this may be the most significant item from this conversation) she will message a specialist she knows, Dr. Daniels, “who probably does more TAVR than whole Stanford team in 6 months… Practices at Mills/CPMC/Santa Rosa…” This is what I’ve been wanting, a pointer to real expert in this field. I will google this dude for sure. Later: I think this Sutter Health commercial is him: https://www.youtube.com/watch?v=oUXKwEDfJ8w Besides the testimonials, this video has two things that stand out: a better animation of TAVR than I had before; and multiple comments about very quick recovery time (discharged the next day, etc.)
Dibiase also comments that “Given your age and condition, it is still possible to replace the valve the old fashioned way. We’d like to avoid such an invasive operation, but it is an option.”
Appointment over I had plenty of time for a walk before lunch, and I walked my 3-mile exercise route. This was difficult because I am getting a lot of back pain from walking. But I got it done. This was also DIY linen-change day, so I got another five minutes of exercise remaking my bed. Three exercise sessions in the day, yay me.
Evening I listen to two online concerts, the SF Boogie Woogie festival one during supper, and an SF Jazz special at 7.
The “tampon” up my nose was painful all night. It was very hard to sleep. Mucus (and probably blood) kept seeping down the back of my throat, because I couldn’t blow my nose to send it out the front way. About midnight I remembered I had some “Tylenol PM” which includes a decongestant, and took one of those, which dried things up a lot.
By five am I was ready to murder the doctor who put that thing up there. Lying in the dark I figured out that by holding the left nostril closed, I could exhale through the packing log. That moistened it and softened it. After a while of doing that, I very delicately began to tug on it, and it did seem ready to move, so about 5:30 I got up and eased the sucker out into the bathroom sink. (Sharing all the deets, here.) And the good news: the bastard had actually done the job and stopped the bleed.
The rest of the day I took great care not to blow my nose or to touch it in any way, and the bleed remained stopped. But no way was I going to leave that miserable thing in place “until I saw the ENT.” (Which turned out to be a wise decision, see below.)
Wednesday 11/11/2020
First thing on arising was to think about styptic pencils. I used to have one of those, back in the day, a little rod of alum(?) that would instantly clot up a shaving nick. Why the fuck doesn’t modern medicine have something like that for a nosebleed? What if the nose starts bleeding again? I want to be able to do something more effective than just packing toilet paper up there.
I did some online searches; there are a variety of styptic preparations, from chemicals like alum, to simple cornstarch powders that basically dry up a puddle of blood (not a real clot, just less mess). I ordered a liquid preparation from Amazon Prime for delivery tomorrow. (I’m picturing careful application with a Q-tip; I bet it will work.)
What if the bleed started again today, like while I’m getting a CT scan at 10am? At 8am I drove off to walk the aisles at Walgreens and CVS. Walgreen’s online store listed several styptics but all “not sold in stores.” Hah, don’t believe them. In the first-aid section was a powder preparation which I bought. As it turned out the bleed didn’t come back, but at least I had something to try right now.
At 10 I drove off to a little Stanford imaging annex I had never seen, over by California Ave, for a “CT with contrast”. That means you get an IV infusion of a chemical that makes you feel like you are blushing inside your body, which makes it easier to see something or other. The nurses were very competent; they installed an IV quickly and with no pain, and at the end whipped it out again the same. The CT scanner operator was a young woman, which was cool.
The rest of the day went pretty well, although I didn’t feel like going outside for exercise. At 3pm my neighbor Margaret, a retired doctor, gave an entertaining and very well organized lecture on one of her specialties, the gastro-intestinal tract. She gave a really fun tour of the adventure your food has from your mouth to your anus.
At 5pm was our monthly sixth-floor meeting, which among other things included three new “campers”, former denizens of the fourth floor being displaced by the renovation process. Just a year ago I was a “camper” on the 4th floor, next door to Florrie, and now I think Florrie is going to be camping next door to me.
After that I realized it had been 24+ hours since the Urgent Care doctor had put in a referral for me to see an ENT, and I hadn’t had a call from the appointment clerk. “Urgent”. Riiiiiggghhht. Sutter Health sends a “how did we do” survey email after every visit (that, they can do quickly) and I filled it out with some choice comments.
Watched Dancing with the Stars and went to bed early to read.
Sometimes, lying in bed not quite asleep, I get a feeling as if I need more air, and take a big gasp. I got curious about this. Is it a sign my heart is not delivering enough oxygen? I wonder what my O2 sat percent is? A couple days ago I ordered a $20 pulse/o2 meter off Amazon.
Kept it by the bed. In the night, realized I was having that feeling, so fumbled around and put the meter on. 95% O2. Not short at all.
The device is well worth $20, nicely made and functional. Its only flaw is that the screen is very bright, much too bright for comfort in the middle of the night.
Tuesday 11/10/2020
Did Victoria’s aerobics at 7:30 and at the end found myself quite tired. Decided not to go for a walk.
Lazed around until, near noon, I noticed I had a nosebleed from my right nostril. I have often had spontaneous nosebleeds in the past; they usually clot up and quit in ten minutes or less. Unfortunately at the moment, because of all the stents, I am taking Clopidogrel (“Plavix”) which is an anti-clotting drug. So the bleed didn’t clot. As long as I stayed in my easy chair with my head back, I could read and not make a mess, but if I turned my head down or even very horizontal, I would start leaking blood down my moustache.
About 3:30 I decided I needed help. Rather than going direct for Urgent Care, I visited our in-house nursing station, but they couldn’t offer anything other than to pack the nostril with gauze. Thanks, I can pack it very well with scrunched up toilet paper. So, off to Urgent Care in the Channing House car.
The doctor there verified it was an “anterior bleed” coming off the side of the septum, but he didn’t want to do anything to it. “You cauterize it, and a couple days later the scab is disturbed and you’re right back to square one.” All he could do was to pack it with a stiff gauze tube like a tampon, which hurt like bloody HELL going in. Turns out my septum isn’t straight like normal septums. Did I ever break my nose? Not that I recall? Anyway, that stiff little tampon presses and pretty much stops the flow of blood. He also put in a referral to ENT. I should get a call tomorrow to schedule that, but I have so many appointments this week (well, three) it is going to be touch scheduling it.
So I have a compress up my nostril which seeps bloody snot. I am keeping my COVID mask on, with a folded kleenex, to sop up the seepage. I believe I shall have to sleep sitting up tonight; If I roll over on that right side, one, it is going to hurt, and two, if it doesn’t, it is going to sop into my pillow and sheets.
That sucker is at least two inches long.
I feel decidedly tired and will be going to bed early.
Yeah. Went for a first walk at 7:30. When I got back, COVID testing had begun. Previously they did the testing for the 6th floor (or any floor) in that floor’s dining room, and they would come and summon you from your room. Now they are doing it differently: in the Auditorium, anytime between 8:30 and 10, and people lined up in the lobby. Simpler. So today was the 4th and 6th floors.
After lunch I went for another walk: down Channing to Pardee park, where I read a book on my iPhone for a while before walking back. Yup, that’s what life is down to now. Walking to a park to read, is an event worth blogging.
I finished priming three little pieces of the MG. Now to color them with the lovely red paint. But, hand-brush or air brush? It has gotten too cold to do airbrush outdoors. So I need to my “spray booth” indoors, into the bathroom.
Codgerville 