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.
Slept to 6:30, very late arising for me. Pleasant Sunday morning. By 8:30 I was ready for a walk, so took one. Got out the door and went 50 feet into a 50º breeze, turned around, went back in and put on a sweater under my jacket. Out again for a walk.
Back to the room, slouch around. After lunch I went for another walk. 4.7 miles for the day. In the evening I watched One Man Two Guvners recorded off PBS. I’d seen it already at least once, I think twice.
So the whole goddam presidential thing wrapped up (well, there’s no doubt more to come, but wrapped up for now) and what a huge load off my spirit that was.
Patty and I had agreed to cancel lunch today and to go for a walk in the Baylands followed by picking up lunch from Armadillo Willy’s. The weather was nice, the air more clear than I’ve seen in weeks.
Lunch was nice, too. I have three more ribs and a cornbread muffin which I meant to eat for my supper but here it is 8pm and I’m not hungry. Maybe I can force down a muffin before bedtime. (Note that this morning I recorded my lowest weight in like forever, 159.8. Maybe junior in high school? Not since. But I don’t look emaciated or anything.)
Anyway after I returned, I took a trouble call from a resident with an iPad that she was sure had been “hacked” because suddenly it started showing her two keyboard images, neither of which responded, so she couldn’t do email. I think now she may be seeing a “split” keyboard which is an obscure iPad feature.
About 2:30 I lay down for a little nap and slept until 5pm. See above about “my burdens rolled away”. (Rolled away (treble ladies), Rolled Away (bass men), oh heck here, sing along: https://www.youtube.com/watch?v=ntoGbhhESqk)
Lordy lordy lordy I am so bored. I began the day by walking to PAMF for a 7:45 appointment. This was an echocardiagram to check on the operation of my aortic valve. The analysis, posted to my online account later, contained the fairly ominous note, “There is moderate aortic regurgitation. … Compared to prior study from 7/30/19, AR is new.” I have a video appointment with the cardiologist next week to discuss this.
Later I diddled with the model. Painting on primer by brush definitely works. I have a couple of small pieces where I will try painting the color coat with a brush to compare to the airbrush. But I’m pretty sure the clear coat will be better airbrushed.
Just a Thursday. Instead of morning aerobics, which was just a video recording, I went for a longish walk (3.8 miles for the day). Later I paid a bill, and generated the new sign-up sheets for the next week of volunteer activities.
One single piece of the MG model is holding up production. This is the one in which I discovered a short, deep scratch. Since this is one side of the bonnet, the scratch would be obvious, blatant, under the clear coat. It had to be filled. Days ago I stripped the primer off it, filled the scratch with plastic putty, sanded it smooth. Just like the guys on Bitchin’ Rides or Overhaulin’.
But then I got hung up on how to re-prime it. The thing is, each time I use the airbrush I have to clean it. So to spray this one piece, about 1 inch by 2, takes like five seconds. Then clean the brush and wait several hours for the paint to harden. And I screwed it up the first time and had to strip it down again (too wet, it ran). Spray. Clean up. Check it next day: there was some kind of divot in the prime coat, a little shallow crater an eighth of an inch across (in other words, fist-size at scale). Was it in the plastic, or had the primer somehow pulled back while wet? I tried sanding it but no, by the time it was smooth the primer was gone.
So today I stripped it, sanded it lightly, and this time primed it using a brush, just flowing on primer wetly and letting it flatten. Which it did. Not uniform color yet, needs another coat. But I’ll do that with a manual brush too.
I continue to regain appetite generally. I also got up the nerve to read up on the TAVR procedure that will likely be recommended if/when my prosthetic aortic valve breaks down: Transcatheter Aortic Valve Replacement. Note toward the bottom of that page, the procedure is for this, that, and finally “if you have an existing biological tissue valve but it isn’t working well anymore.” Note also in the animation, that they don’t always approach via the aorta. Sometimes they go straight in through the chest wall and the bottom of the heart! Which would be likely for me, I think, given my aorta is full of wire stents.
