Monday, November 3, 2014

Appointments are not always EZ.

Up at 4:30 to meet a 5:30 hospital appointment for Glenda's scheduled 7:30 carotid artery surgery. She was checked in, undressed, in a bed, prepped, attached to IV and monitors by 6:15. At 7:30 they informed us that the surgeon would not be available until noon due to a scheduling conflict.  Sigh.  So, now we wait. Glenda, at least, is napping. I wish that I were. But at least I can eat. She is on a NPO regimen until after the surgery.

Wednesday, October 29, 2014

Health can be not EZ.

Over the past month, my dear wife, Glenda, has had a series of sudden falls. Twice, now, those have led to EMS response, treatment at the ER, and hospitalization. The first EMS call was on October 1, 2014. She had been on our bedroom patio, leaning against the spa, and simply crumpled to the concrete patio floor. At that point she was unresponsive, so I called 9-1-1. By then she was responsive but could not stand, so I got a towel under her head and unlocked the front door for the medics. They found her blood pressure to be really low but found all else normal. They helped me get her to the bed and advised us to see her primary care provider the next day. We did that. At the doctor's office at 9:30 the next morning, her BP was even lower, so they immediately put took her by ambulance to the nearest ER. There she was tested, monitored, and hospitalized overnight. We left the hospital on October 3, 2014, with a list of follow up and consultation appointments. One of those appointments, scheduled for noon on October 24, 2014, was in Cardiology for a "tilt table" evaluation to test the impact of various postures and positions on her BP. She was also given a "Holter" monitor to wear for two weeks. This is a cell-phone based EKG machine that constantly transmits her heart function information to a contractor (CardioNet) in Phoenix. 

We never made that appointment. At about 4 AM on Friday the 24th of October, she got out of bed to go the bathroom and only made it far enough to go down face-first on our ceramic tile hallway floor. I found her responsive but dazed, laying with her hands twisted under her jaw and chest and in a huge (and spreading) puddle of blood. Hitting the tile had split her skin open above her right eye, and scalp wounds bleeeeeeed. I applied a compress, and, again, called 9-1-1. upon initial evaluation they found her disoriented with BP of about 66/24. This time they did transport her to the ER right away and she was again admitted. During her two day stay she was seen by every medical specialty you can think of, and, again, discharged with a list of appointments to keep.

As of today (October 29, 2014) stitches have been removed with no complications. It took forever to be seen because the stitches were put in by the ER so they had to be taken out by the ER, so no appointment, and she was triaged to the lowest priority known to medical science.  The black eyes have reached their “purple” stage, but the twin bumps and the laceration on her forehead are beginning to look a bit better. The home health care nurse and the physical therapist will be at the house at three this afternoon. One of the things they will do is a “safety inspection” to help avoid future falls. I’m sure they’ll tell us to get rid of our coffee tables, throw rugs, and small pets. They already have her using a walker. The challenge here is she’s not been tripping – most of the falls happened while she was standing rock still and just crumpled.

We saw the electrocardiologist yesterday (October 28, 2014) and he diagnosed her with syncope (blackout) with collapse (fall) caused by orthostatic hypotension secondary to autonomic nervous system dysfunction. That means that when she stands up, her body does not regulate her blood pressure, which falls to around 80/40 or less and the brain becomes oxygen deficient leading to fainting. The doctor had seen the report from CardioNet and found nothing worrisome there. One of the keys in his diagnosis is that when her BP crashes, her pulse rate and respiration remain unchanged and normal, and that with a BP crash, the autonomic system should race the heart and respiration to keep things oxygenated. So some thermostat somewhere is disconnected or not registering. In the meantime, ensure hydration, increase sodium intake, and continue to use a walker when up. 

She is scheduled for vascular surgery to open up the right carotid (85% blocked) on Monday, November 3rd. The left carotid is at 50-60% blocked, so they are going to leave it alone for now. They don’t think this is the cause of her syncope and falls, but that it does need to be taken care of, especially with her history of stroke in 2009. We’ve been advised to expect one day in ICU and 2-3 days on the ward post-surgery.

After this surgery is over, she has a consult with the neurology clinic on November 19th to rule out Parkinson’s. But, the diagnosis we’ve now been given is much the same as Parkinson’s in symptoms and impact, minus the tremors, and, from what I can find, there really is not much in the way of treatment for either problem. We are hoping that the vascular surgery on the carotid will actually fix this problem. The vascular surgeon has told us that there are nerves near the junction of carotid with brain that do play a role in regulating blood pressure, so there is a very small possibility the blockage has been her problem here, but he’s not optimistic about that, primarily because the blockage is not truly bilateral.

I think we are doing all we can do at this time, including prayers and priesthood blessings. We are appreciative of the care and prayers we have received from so very many. 

Saturday, September 13, 2014

An EZ morning.

September 13, 2014.
Rain in San Antonio last night, and a cool front.  For the rain, we thank God. This morning I awoke to an outside temperature of 64 deg. F. with low humidity and grey skies. Big change from the 100+ days we've been having. This is the first morning with starting temps below 78 since last spring. The pool water this morning is at 81 deg. F., down from 88 just yesterday, big change. Still, the water felt very good for my morning laps. The outside air was bracing as I exited the water. My towel that had been hung on the outside line was still damp from the rain, as was my swimsuit (not that I wear one when I swim alone.) It's been a turbulent week for the family, and perhaps I'll be able to write about it soon. But not now. Now, I am going to sit on the patio under the oaks, listen to the wind chimes, enjoy the cool air, and be still and know that He is God.

Sunday, July 27, 2014

Maybe things are too EZ?

I've been considering hardship, and the impact of hardship on human character. Does it destroy or does it build? I have precious little experience on that front. I am not complaining but will freely admit I've had, so far, an easy life. And I wonder.  I wonder would I be stronger, better, had I faced more hardship? Compared to my ancestors and to the pioneers of my culture my life has been easy, and I am soft emotionally, physically, and, probably spiritually as well.

Tuesday, July 22, 2014

19th Century travel was not EZ!

I just learned that my grandfather, William Gowans Moyes, at age 6 travelled west via wagon train in the Edward T. Mumford Company in 1868. He was in the company of his parents and a paternal uncle's family, along with a couple hundred other travelers. They arrived in Salt Lake City, Utah on September 24, 1868. There were seven deaths en-route.

Objectivity must not be EZ.

Here's why we become cynical about the "news" that the media reports:

Taken from the Maine News (http://newsmaine.net/20019-june-2014-breaks-all-heat-records), the headline says, "June 2014 Breaks All Heat Records." The article starts by presenting the following: "The month of June was the hottest month ever, according to reports released by the National Oceanic and Atmospheric Administration (NOAA) on Monday...The month of June has broken all the heat records everywhere." Note, please, the use of words like "all" and "everywhere" in this article that leans on what should be a credible source: NOAA.

But, you see, I knew better. While the local weather is only anecdotal and not indicative of "climate," June was actually cooler than normal here in San Antonio. I looked up the official records, and during June we had 12 days where the high was below the average, 8 days where the high was exactly at the average, and only 10 days above the average. The cooler days were up to 5 degrees F. below average, the hottest of the days was 4 degrees F. above the average, with most of the "hotter" days being only 1 degree F. above average. June was very pleasant in San Antonio.

Later in the article, we learn that they knew that they had lied with their headline and leading paragraphs with the following admission: "...no record has been broken in the US. It was noted that the last month in the US was the 33rd hottest June in the records."

Thirty-third hottest. Far from breaking all heat records.  So, call me a cynic. I believe NO headlines, and am impressed that the authors of the above article were honest enough to admit to lying to their casual, low-information readers (who probably never made it to the end of the article). This is objectivity in reporting?

Tuesday, April 22, 2014

EZ weight loss procedure not so EZ.

Have I mentioned that I love military medical care?

About six months ago, my dear wife of 45+ years was referred by her primary care physician at our nearby Army Hospital for evaluation for bariatric surgery. She is not grossly overweight but has always weighed more than she should and, sadly, thinks of herself as "fat."  She is also a Type II diabetic (which she currently controls without insulin) and some acquaintances have told us their diabetes "went away" after bariatric surgery or other significant weight loss. So, Glenda was anxious for the surgery, as she wants to be more fit and more proud of her body, and would love to see the diabetes go away. So long, I guess, as dieting and exercise are not involved. That's always been my position on the subject, too.

During the evaluation for the surgery she was subjected to nearly every medical test known to mankind, EKG, ECG, MRI, Upper- and Lower-GI series, blood, stool, and urine tests. She had to meet with a psychiatrist and attend group support sessions. All of this took months and hundreds of miles of driving. She passed all the tests and checked all the blocks and was told in late January that she would be called in "two to six weeks." We waited. Then we called. Then we waited some more. Today, she called the bariatrics clinic again, and was told that the bariatric surgery would not be available to her as the surgeon had been deployed. Army doctors must first support Army troops. No question, no argument there.

But I wonder what the paying party thinks of having spent a LOT of money on her surgery evaluation and preparation only to see the anticipated benefits not being delivered? After all, Humana, the insurance company that pays the vast bulk of our Tri-Care Prime military medical care, must have counted on lower life-time care costs due to the better health likely a result of the weight loss the surgery promised to deliver. Otherwise, why would they have approved this elective surgery. No surgery, no related weight loss, no resulting improved health, no reduction in life-time care costs.

I don't know how much all of the exams and preparatory work she underwent cost Humana. I know what our co-pay was and I could guess at the cost of all these exams. I shake my head at the waste of medical resources in this situation.

Glenda is going to speak with her primary care physician to see if it is possible to be referred to a local civilian hospital that has a good reputation in bariatric surgery, but I don't know if that's within his powers. If that fails, we may try to meet with the ombudsman at the military hospital. I'll be back when I know more.

Have I mentioned that I love military medical care?