Tuesday, August 30, 2011

What Are Years

By: Maianne Moore (1940)

What is our innocence,
what is our guilt? All are
naked, none is safe. And whence
is courage: the unanswered question,
the resolute doubt,——
dumbly calling, deafly listening——that
in misfortune, even death,
encourages others
and in its defeat, stirs

the soul to be strong? He
sees deep and is glad, who
accedes to mortality
and in his imprisonment rises
upon himself as
the sea in a chasm, struggling to be
free and unable to be,
in its surrendering
finds its continuing.

So he who strongly feels,
behaves. The very bird,
grown taller as he sings, steels
his form straight up. Though he is captive
his mighty singing
says, satisfaction is a lowly
thing, how pure a thing is joy.
This is mortality,
this is eternity.

Tuesday, August 16, 2011

Too Hot to Garden

There once was a guy from Peru
Who had some growin’ up to do.
He’d ring my doorbell,
Then run like hell,
‘Til I nailed him with my old .22.
- Anonymous

Ever walk out to work in your garden, take one look around, and turn around and go back inside? That’s me and that’s today. It’s been hot and dry and I need to hand water. It’s too hot and sunny to water now though. The parched plants can’t believe their eyes when I ignore their silent withering looks and their wilted imploring leaves. Clutching my heart and dramatically promising I’ll be back later when it cools down, I calmly explain the sun will just fry them if I get their leaves wet now. I plead medical reasons. Their glaring silence reproaches me. Ok, then I plead laziness. You’re not the boss of me.

So, last week, after bringing the cardiologist my list of prescriptions and herbal supplements and having it be completely ignored, he proceeded to lecture me on taking my rat poison, excuse me, my warfarin. Two months in, I am still failing my INR lab tests that measure how fast my blood clots. Funny story. Turns out that the package inserts, legitimate medical websites and crazy conspiracy wack job bloggers are unanimous: Vitamin K and cruciferous vegetables like broccoli and cabbage promote good blood clotting. Too good, as it turns out for somebody who is at risk of becoming bedridden broccoli if a blood clot lodges in my brain. Such supplements and vitamins completely offset the blood thinning efforts of the rat poison. Which, it turns out, one of my supplements has 1000 IU of Vitamin K and another has vegetable extracts of broccoli and cabbage. After pointing this out on my medicines spreadsheet, he said: stop taking those supplements. Good to know.

So, if I knew this before he said so, why did I continue to take them despite the failure of every medical professional to tell me so? Because every medical professional told me not to significantly change my dietary and nutritional intake since my body had habituated to whatever I was taking, which they didn’t bother to determine when the information was literally handed to them on a single page with yellow highlighter. It's almost like I expected them to give me informed and correct medical advice or something.

So, today for the first time in two months, my INR has moved from .9 to 1.1, due entirely I am sure to the fact that I stopped the vitamin K and cruciferous vegetable extract supplements 4 days before yesterday's test. But when Coumadin Clinic Cindy called with yesterday’s INR results, and I started to say “Yay, that must be because…” She fucking interrupted me to say that score isn’t good and I should take a double dose tomorrow and test again next week. Shut up you idiot. I know more than you have bothered to glance at before lecturing me like I was 10! I don’t need this shit.

But then again, the garden didn’t offer much of a prospect for peaceful repose. So I’m inside thinking of other supplements that I should research. My medical care fails me now while I’m competent to notice and educate myself and learn what experts would do if they were paying attention. Heaven help me when I get dementia and I’m left to the mercy of these health care experts who don’t have the attention span to read more than the top line on a patient’s chart and ask you to repeat your name back to them like a secret password before they’ll say more than hello. That's what they consider taking a patient medical history.

Then again, it occurs to me that my generation of greedy rich Americans will have only ourselves to blame when we’re warehoused in Medicare nursing homes and eventually killed by medical neglect or mistreatment. We’re sending the next generation of doctors who will replace Coumadin Clinic Cindy to elementary school without lunches and dropping them out of high school for unemployment.

So, perhaps it’s another early happy hour in the air conditioning. I promise I’ll spend time outside once it cools off. Meanwhile, my kitty will have to sit on my lap for a half hour. That’s better than any Big Pharma and/or controlled substance for correcting my blood pressure after talking to Coumadin Clinic Cindy. Idiots.

BTW, I don't have a gun and can't throw a knife, but if you ring my doorbell and run away, I'll shake my fist and yell at you louder than Grandpa Simpson.

Sunday, August 14, 2011

My My, Hey Hey

“My my, hey hey. Rock and roll is here to stay... It's better to burn out than to rust.”
Neil Young, My My, Hey Hey Hey

If you’ve ever considered murder – or as I prefer to call it, third party assisted suicide – you have probably considered the antifreeze appletini. The color is genuine, the taste is divine, and the result is (one must assume) gratifying. Disclaimer: I wouldn’t know. As anybody knows who has ever watched any episode of CSI, the active ingredient in antifreeze is propylene glycol, and enough of it will kill you. (I can’t google specific doses/outcomes or it will leave an Internet history trail on my home computer that I’d prefer not to create.) According to the Internet, this organic compound is used in degreasers, wallpaper strippers, antifreeze, and strangely also in baby powder, shampoo and skin cream. Go figure.

So, on a seemingly unrelated topic, I’ve been trying to get Tech Support Guy to hydrate more. He’s not a fan of appletinis just so you know. He’s apparently also allergic to water. He used to drink diet soda by the liter, until his doctors explained that this leaches calcium out of your bones, and by middle age he had the bones of a ninety-year-old female anorexic meth addict. So, he pretty much sticks to cheap wine and coffee, both of which I have explained using small words, are diuretics. Which means they pretty much do the opposite of hydrate you.

Well then, he’s recently seen this amazing new product advertised on the TV. They’ve patented something I discovered years ago. You can add a tiny bit of fruit juice or red wine to a glass of cold water and you get a pretty and mildly flavored beverage that will in fact hydrate you without rotting your teeth or making you drunk. So TCG gets some of this new stuff. It colors and flavors water like my invention only with a lovely (not!) diet sweetener finish that makes my teeth itch.

Imagine my surprise when I looked at the ingredients. WTF? Have I discovered a replacement for the antifreeze appletini? I suppose the advantage to this stuff is that your guts won't rust.

Monday, August 08, 2011

From Wisdom to Madness Via Woe

"Give not thyself up, then, to fire, lest it invert thee, deaden thee; as for the time it did me. There is a wisdom that is woe; but there is a woe that is madness."
Herman Melville, Moby Dick

Trying to educate myself about my new irregular heartbeat and deadening drug side-effects has been like giving myself up to fire. I’ve had irregular heartbeats intermittently (no, that’s not redundant) for a few weeks. When I finally got to the doctor last week, he blew off my list of side effects from the rat poison and the antiarrhythmic saying I’d had a life-changing experience, so some disruption in mood was to be expected. Which did nothing to make me wiser and a lot to make me madder.

My side effects include menopausal hot flashes that leave me drenched in sweat, itching skin that seems to move around my arms and legs like ants when I try to sleep, mood swings that make menopause look like a slightly cloudy afternoon (no that’s not redundant either), unprovoked crying, feeling totally overwhelmed at the least little problem, and headaches. He increased one of my prescriptions because my blood pressure is also elevated. All doctors do these days is practice medicine with prescription pads - meaning he paid attention to the one symptom a prescription pad purports to cure (without consideration of what new side-effects it might cause). When I drop something on the floor, instead of cleaning it up, I just say fuck this and walk away. I’ve pretty much lost interest in everything except my favorite kitty. So I suppose that’s a good sign – the kitty part, not the other stuff.

The backyard has defeated me. I now consider myself a lapsed gardener. The neglected table-top miniature pots with moss in them have now succumbed to high heat and a shut-off sprinkler. They were to give me something cool and calm to meditate on. I plan to go outside to see what stage of slow and gruesome death by lack of hydration they are in as soon as I finish my caffeine-free coffee that tastes like worn-out socks. I’ve also vitrually stopped drinking alcohol too, which hasn’t exactly contributed positively to my outlook.

Despite its failure to operate as a quilting machine, my new sewing machine works quite well as a sewing machine, so that’s a ray of frickin’ sunshine in my currently dismal life. To restore the balance to the universe, I made pillow cases for TCG’s two tiny pillows and embroidered the following rhyme on one: Goodnight my dear,/ And sweet repose./ Lie on your back/ So you don’t squish your nose.

I did a lot of medical research on line, being careful to distinguish between batshit crazy wacko sites and, say, Mayo Clinic and NIH.gov, a process which involves a minimum of a third grade education and the application of judgment which, surprisingly, doctors seem to think those without a postgraduate degree in some biological science are incapable of exercising. Turns out the cute ER doc who mentioned that cannabis use is linked to tachycardia might have been right. I say might, because he fact that the relevant research was conducted on healthy 20-something men and involved only smoking (rather than oral ingestion of) marijuana may not be significant, and wasn't terribly specific about dosing. Now because I lack a medical-related degree I might just be blowing smoke here, metaphorically speaking, of course. I’m refraining from my go-to herbal cure for depression at least until I finish adapting to the rat poison and apparently non-functioning shit that’s supposed to regulate my heart. I may or may not bother to see the cardiologist. At this point in my research, I’m leaning to getting some blood tests for cardiac blood markers like C-reactive protein and other inflammatory cytokines like Tumor Necrosis Factors that are better indications of stroke risk, but what do I know.

WRT the non-functioning antiarrhythmia med, called Amioderone, I found a study (could only access the abstract) that said: “The management of AF (atrial fibrillation – what I had) can vary among individuals depending on factors such as underlying heart condition, age, stroke risk, and the severity of symptoms associated with AF. The Atrial Fibrillation Follow-up Investigation of Rhythm Management (AFFIRM) trial randomized AF patients into 2 treatment strategies: heart rate control without attempting to maintain normal rhythm versus heart-rhythm control that attempted to maintain normal rhythm through the use of medications. Both groups received warfarin (aka, rat poison). The study showed that there was no advantage of one approach over the other in terms of survival. Patients treated with heart rhythm medications were hospitalized more often for their treatment and were exposed to possible side effects of antiarrhythmic medications. Therefore, the selection of treatment strategy is often guided by symptoms. Anticoagulation should be considered for all patients at increased risk for stroke” (Chung MK. Vitamins, supplements, herbal medicines, and arrhythmias. Cardiol Rev. 2004 Mar;12(2):73–8).

Now, as an uneducated drug-addled old broad, I read that as saying the Amioderone was more trouble than it was worth. My doc read that part of the 9-page research paper I compiled in doing my research, and shook his head patronizingly and said “You should ask your cardiologist about that”. So, should I survive the questionable care of these distracted mechanics, I might do that. Funny story about the side effects of Amioderone: “Though this medication often gives great benefits to people with irregular heartbeat, it may infrequently worsen an irregular heartbeat or cause serious (sometimes fatal) side effects.” I’m pretty sure death is a “fatal side effect” but I’ll have to ask my cardiologist to be sure.

Friday, August 05, 2011

So Much For Docile Earth

"Consider all this; and then turn to this green, gentle, and most docile earth; consider them both, the sea and the land; and do you not find a strange analogy to something in yourself? For as this appalling ocean surrounds the verdant land, so in the soul of man there lies one insular Tahiti, full of peace and joy, but encompassed by all the horrors of the half known life. God keep thee! Push not off from that isle, thou canst never return!"
Herman Melville, Moby Dick

So, I haven’t been to my own Tahiti in the backyard for a while - or to this blog - because I encountered my own white whale in the middle of July. Following a day working outside, I began to feel the horrors of the half known life: the now-familiar racing heartbeat I recognize as atrial fibrillation.

I had spent the third day in a row outside, cleaning up the backyard after the guys put down dg rock where nothing will grow. I moved flower pots, chairs etc and generally rearranged the furniture. I had everything swept and tidy and spent the last hour watering and generally appreciating how lovely everything looks. I take great satisfaction, and Ireceive great peace when my work in the yard is complete. The best part of the day is hand watering and then sitting still to enjoy the fruits of what I considered healthy exercise and hard work. So much for that little theory. I had experienced irregular cardiac symptoms over the past few days and chose to ignore them: when I felt funny heartbeats, I'd stop and sit still for a while until things settled down. Apparently, you shouldn’t do that, despite the fact that I felt ok at the time.

I had some left over dinner while talking to my sister on the phone for a good half hour. I then hit the shower, which is where the unannounced and uncontrollable heart racing began. My pulse went up to 155 over the next hour, and included what the doc calls "palpitations". That word conjures an image of an old lady wearing a flower-print dress with a lace collar, sitting in an overstuffed chair fanning herself with a hankie and complaining of having the vapors. The actual medical term is premature ventricle contractions. To me, it was the kind of pounding and thumping that you can feel in your chest after running too fast too long, but it was irregular and jumpy. I took a few atenelols and tried to get some cat purring therapy, but Lily wasn't particularly interested in rocking quietly on my shoulder, the ungrateful little bitch. At least, I didn't hyperventilate and/or panic like I did when this happened on my birthday a few months ago. So, Tech Support Guy and I decided it was time to avail myself of the health care system’s benefits. Being concerned about hurting delicate feelings, not to mention incurring legal liability, let’s just say my health care system’s name rhymes with Geyser Vermin and Tea, or GVT for short, and the names below have been changed.

So, we drove to the ER, taking it easy on surface streets. TSG had discovered a flat tire on trying to go to the grocery earlier in the day. At least AAA had already been out to change the tire, but we were using the little toy spare tire and didn't want to take the freeway. This time, we didn't snark at each other out of misplaced panic like we did on the ER run a couple of months ago, and by now, the palpitations had stopped. My heart was still racing, but it seemed to be smoother, and we took that as a good sign.

I got right in at the ER by sitting down and calmly explaining I was in a-fib and presenting a list of blood pressure and heart rates and times and meds taken in the prior hour. So far, this was pretty much like before. The difference began when they gave me the first IV med and it didn't stop the a-fib in its tracks. Watching this on a hospital monitor is very instructive. I am convinced I should be able to do some biofeedback and make it smooth out, but no such luck. The pulse rate actually went down to the 100-120 range thanx to the meds, but the distances between the tall upward pointy spikes in the heartbeat continued to be unevenly spaced, and that's what is called atrial fibrillation. By now, it's about 20:00 and we are not amused.

It took about 6 hours and several variations on type of med and type of delivery before my heartbeat settled back into what they call normal sinus rhythm. By now, they were insisting I had to be admitted - something we were both determined to avoid. This isn't out of some misplaced idea that I'm a superhero. It's because the ER is a very loud and stressful place, and the last time I spent the night in the hospital I brought home some bad bug and mother ended up in a rehab facility, and I just wanted to go home to sleep in my own bed. It took until 3:00 am before the very busy ER admitting doc got to us. He not only looked at me instead of the monitor when he spoke, he assumed I had a functioning brain. He also said I should stick around and he could get me a quiet room. So TCG drove home slowly and texted me on his safe arrival (on the toy tire) and said he got to bed at 4 and later said that he got to sleep at 5. I finally got to a room at 5:30 but this talkative nurse kept me up until 6:30 doing her on-line questionnaire (Do you feel safe at home? Do you want to see a Chaplin? I know, but we have to ask this etc.). I finally told her I was exhausted and to leave me alone and fell asleep promptly until awoken exactly one hour later for more shit like getting my temp taken and my IV untangled and making sure I turned over so I wouldn't get bedsores ("I know, but we have to do this" - apparently even if the patient dies from sleep deprivation). As I once again realized, I'm not at my best when cranky and nap-deprived.

By 10:30 the next morning I was off the IV and my heartbeat was regular. I was seen by two shifts of nurses, including 2 more shift supervisors, a dietician wanting to know what I wanted for dinner, an attending doc, a cardiologist, a pharmacist and at least 4 other people who went over several variations of my prescription drugs (though curiously, all reading presumably the same online version of my file) and I think either Zombie Mother Teresa or a homeless bag lady with a hospital ID she stole from a nurse who must have caught her going through the hazardous waste trash looking for syringes and who she had to shank. Pretty sure that's what happened. I had breakfast (that sat there for 2 hours while I tried to nap in between visits from people who didn't realize I wasn't wearing my hearing aids and that I was faking understanding them just to get them to leave me alone). I had lunch. I finally got to pee all by myself. BTW, did you know that when you get several gallons of saline intravenously with a tiny bit of drugs, it goes directly to your bladder? Someday, you'll thank me for this important information. It's apparently something completely unknown to professional medical people.

I finally got discharged at 3:00 just when Nurse Betty promised me she'd let me out. We stopped to pick up my new drugs, and listen to the bored pharmacist read from the pile of papers in front of me and tell me not to be worried by all the DIRE WARNINGS IN CAPITAL LETTERS sprinkled through the quarter-ream of package inserts. The ER Admitting doc mentioned that one of my new prescriptions (Coumadin/warfarin) actually includes an anticoagulant ingredient used in rat poison. Ahh, the miracles of modern chemistry never start to cease to amaze me.

The scariest part of this particular episode was about midnight when nothing would make the a-fib stop and some idiot who took a chest x-ray explained that he was a medic in Iraq and my ER nurse, Heather, (who was about 16 and very competent and nice) was new and he knew this because she didn't want to let people die who were going to die anyway but tried to save them when she should move on to other patients who might actually not die. Upon completion of the x-ray he said: I hope I didn't scare you. The douche.