A-fib Adventures

When I moved to this central-Virginia city in June of 2003, I didn’t have any medical problems that I knew of. I also didn’t have a doctor. Prior to moving here, I had only gone to a doctor when I had a serious reason to go, like strep throat.

In August, 2004, I had my first episode of A-fib (atrial fibrillation). A-fib not only causes quite disagreeable symptoms, it can also cause a stroke. In fact, a person with untreated A-fib has a six percent chance of having an embolic (blood clot) stroke. That’s six percent per year: 18 percent in three years – a nearly one in five chance of stroke. Not treating A-fib is like playing Russian roulette. Treatment involves taking an anticoagulant like Coumadin, or one of the new, “novel” anticoagulants like Pradaxa, Xarelto, or Eliquis. That will lower the risk of stroke to less than 2%.

At the time, I didn’t know what A-fib was, I only knew something was very wrong in my chest. I couldn’t walk more than 50 feet without stopping to catch my breath. I drove to the ER and landed in the hospital with a resting pulse rate of 160. The docs gave me an IV drip to bring down my pulse, and my heart converted back to normal sinus rhythm the next morning. I went home with a prescription for metoprolol, an inexpensive beta-blocker, and I was fine – for a while.

In October, 2011, I had my second episode of A-fib. I landed in the hospital again, and again my heart converted back to sinus rhythm, and I went home with a second prescription: diltiazem, a calcium channel blocker.

In June, 2013, I had my third episode of A-fib. Back to the ER and into the hospital. Again, my heart responded to the meds and converted to sinus rhythm and I went home. I was on the same meds as before but was taking a stronger dose of diltiazem. When I left the hospital, my PCP told me to stop taking metoprolol. Her advice was delivered through a nurse, so I couldn’t question her about it. But I thought her advice was strange, because metoprolol was the medicine I was originally given to keep my heart stable. Nevertheless, I followed her advice and discontinued the metoprolol. Two days later the A-fib was back (fourth episode), and I was pretty sure the cause was stopping the metoprolol. So I took a pill before driving to the ER. While I was in the ER, my heart returned to sinus rhythm. The ER doctor and I agreed that stopping metoprolol was probably what triggered the A-fib and taking the pill was probably what ended it. So I kept taking it.

In March, 2014, I had my fifth episode of A-fib. This time the ER doctors said there was nothing they could do because my heart rate wasn’t high enough to justify medications. And, anyway, I was already taking the medications they likely would have wanted to give me. They wanted to admit me overnight so my cardiologist could see me first thing in the morning. And indeed, both my cardiologist and my PCP stopped by my bedside early the next morning. My PCP wrote me a prescription for an anticoagulant and told me to go home. There was nothing else they could do.

I went to the pharmacy to fill the prescription, but the drug was so expensive ($360/month) that I told them to keep it. Over the course of the day, my heart felt more and more normal, until by the end of the day it felt completely normal.

My sixth, seventh, and eighth episodes of A-fib hit me in May, June, and July, 2015. Episode six lasted 12 hours and episode seven lasted 18 hours. When episode eight hit, I decided to try an experiment. I had noticed that when I drank alcohol, just as the alcohol wore off my heart would beat strongly and very steadily for about ten minutes. So I thought, if I have a few drinks, then maybe that strong, steady heartbeat will return and terminate the A-fib. I drank three shots of vodka. Three hours later, my heart returned to sinus rhythm. Maybe I had “fixed” my heart rhythm; maybe it was coincidence.

My heart’s ninth episode of A-fib hit me in April, 2016. I didn’t go to the ER because the previous time I went there, they could do nothing for me. The earliest appointment I could get with my cardiologist was three weeks away. When I went to see him, I was still A-fibbing and he gave me medical orders and told me to go to the hospital.

At the hospital, I got an echocardiogram, a TEE (trans-esophageal echocardiogram), and a cardio-version to electrically shock my heart into a normal rhythm. That worked but only for five hours. I had a tickle in my throat that made me cough, and the cough triggered the A-fib again. I was discharged with a prescription for Eliquis and advised by my cardiologist to see him in two weeks.

When I saw my cardiologist two weeks later, he told me my heart was beating too fast – the resting rate was over 100 and just walking around would bring it up to 130 or 140. He said my heart would wear out unless the rate was brought down. I said, “Okay, but it will take years, right?” The doctor said, “No – it will be months or weeks.” Frankly, I don’t believe he is correct about the time frame, but he’s the heart doctor and I’m paying him for his advice, so I left his office with a prescription for amiodarone. It’s a drug that can have very severe side effects. After researching it online, I realize I don’t want to take it. I have to see the doctor again in six weeks, and I may ask him to switch me to digoxin. I have more research to do.

So far, my episodes of A-fib have produced medical bills totaling $146,714. Insurance has covered most of that. I am out-of-pocket $12,622 not including medications nor my most recent doctor visits. At this point, it appears medications will cost about $2,000 out-of-pocket annually. In the past year, drug prices have risen sharply, so that $2,000 could double in the next three to six months. In fact, with medicines it appears the sky’s the limit.

Some doctors say A-fib is not a disease but is the result of disease. They say A-fib is the heart’s response to risk factors such as inflammation, hypertension, diabetes, excessive drinking, smoking, sleep apnea, etc. Even growing older is a risk factor. I have metabolic syndrome and perhaps that has affected my heart.

I’ve dieted many times without success. At first the weight comes off, then the weight loss slows down, then the weight loss stops, then, even though I’m consuming the same number of calories, my weight begins increasing! At the same time, I become excessively tired and lacking in energy. It is clear what is happening: my body has decreased its metabolism – its energy usage – in order to regain its original weight. The experience is disappointing but, nevertheless, I may try another diet. I may even try some manner of exercise, but the A-fib leaves my body a little short of oxygen and works my heart harder than normal, even when I’m resting, so I don’t know about that. I’ll give it thought.

I have that end-of-the-road feeling. Like I’m on the edge of a precipice. I’m not having dark thoughts, it’s just how I feel. Maybe I’m not at the end of the road, but I feel it’s in sight.

Time will tell.

Hawking’s Voice

I was watching a show on PBS called Genius by Stephen Hawking in which Hawking, the famous English physicist and cosmologist, induces people to figure out the answers to philosophic and scientific questions like “Why are we here?” and “Where did the Universe come from?”

Hawking narrated the show. Hawking is, unfortunately, almost totally paralyzed by a slow-progressing form of ALS. He can only communicate by a single cheek muscle attached to a voice-synthesis device.

I liked the show, and I imagine its intent was to make me think about the answers to Great Questions such as, you know, “Why are we here?” and “Where did the Universe come from?”

However, what I found myself wondering about was, “Why does Hawking’s voice synthesizer sound like the voice synthesizer in the 1983 movie Wargames?”

That movie is 33 years old. Voice synthesizers have gotten so much better. Automobile GPS systems come with multiple male and female voices that sound like natural human speech. Can’t Hawking get an upgrade for his voice unit?

Sure he can but, as it turns out, he likes the voice and identifies with it. And so do the rest of us. When we hear that robotic, American-accented Wargames voice, we know immediately who is behind the voice: a British genius named Stephen.

Cell Phone Zombies

I heard this on the news tonight: cell phone radiation has been associated with cancer – in rats. Frankly, I think rats should stay off the damn phone. Then they wouldn’t have problems with cell phone cancer.

This news item raises many questions. How in the world do they teach a rat to dial a cell phone, let alone convince it to spend hours talking on the phone? And how do rats manage to hold cell phones up to their ears with their small paws? And who do the rats call on the phone? Are there lots of rats out there with phones? It wouldn’t surprise me. There are probably a number of labs studying the impact of cell phone radiation on rats, and the rats are calling each other out of boredom. “What did they feed you today? Oh, rat chow again! Yeah, I’m getting tired of it, too.” Of course, to us humans the conversation would sound like, “Squeek? Squeek squeek squeek! Squeek squeek.”

I’m pretty sure that cell phones don’t cause cancer in humans. If they did, teenagers would be dropping dead all over America. I have witnessed teenagers getting off a school bus, walking in front of the bus, walking across the street, stepping up on the curb and continuing down the sidewalk, all without ever lifting their gaze from the cell phone they are holding in front of them with both hands.

If cell phones can be made small enough – and it’s a safe bet that one day they will be – people will probably get cell phones implanted inside their brains. Then, we really will have a world filled with walking zombies.

Andee

The song of the day is Black and White Heart from the 2015 debut studio album by Canadian singer-songwriter Andee (Andrée-Anne Leclerc).

Seinabo Sey

The song of the day is 2013's Younger by Swedish-Gambian singer-songwriter Seinabo Sey. Younger was Sey’s debut single.

Trump and the Second Amendment

I read in the news that Donald Trump told members of the National Rifle Association (NRA) that if Hillary Clinton is elected President, she will abolish the U.S. Constitution’s 2nd Amendment. The Donald attributes a shocking amount of power to the U.S. president. The president certainly can’t wave a hand and say, “Begone, bothersome constitutional amendment.” So how will Clinton (if elected) abolish the 2nd Amendment?

Trump says Clinton will cleverly appoint anti-gun justices to the Supreme Court. She will somehow sneak her appointees past the Senate Judiciary Committee, and then, assuming they are approved, sneak them past the full Senate which must vote to approve her appointments. Then, presumably, those new Supreme Court justices will vote to abolish the 2nd amendment.

Except, the Supreme Court can’t do that. The Court has no authority to abolish the Constitution, nor any part of it. In fact, the main job of the Supreme Court is to see that our laws conform to the principles declared in the Constitution. The Court can rule that a law is unconstitutional, but the Court cannot rule that the Constitution itself is unconstitutional.

Trump says Clinton will curtail gun rights. If any President had the power to curtail guns in America, one would think Barack Obama would have done so by now. After all, during his terms in office he has had to address the nation after each of twelve mass shootings (to date).

The truth is: to change or abolish the 2nd Amendment, two thirds of the House and Senate must approve the changes, and three-fourths of the states must affirm the changes. That process has been used 27 times to amend the Constitution. There is another way to amend the Constitution but it’s never been used, and that is for two-thirds of the state legislatures to vote to hold a Constitutional Convention. The Convention can propose amendments, but the amendments must still be approved by three-fourths of the states. The 2nd Amendment is pretty safe. Of course, there was that time when “the People” decided to abolish alcohol in America, so anything is possible.

The Hospital Option

I got home from the hospital Thursday. Home never felt so good.

Backstory: I entered a local hospital on Tuesday with a-fib (atrial fibrillation). It wasn’t the first time I’ve been treated in the hospital for a-fib, but I think it may be the last time. Untreated a-fib can cause a clot to form in the heart, and the clot can travel to the brain and cause a stroke. Strokes are bad.

At the hospital, I had an echo-cardiogram AND a TEE (trans-esophageal echo-cardiogram) which involved running an ultrasound probe down my esophagus (gag) to look for clots in the heart's atrium, then an electric shock stopped my heart momentarily. When it restarted it was in normal sinus rhythm. That lasted five hours until I coughed and my heart went back into a-fib. That's not supposed to happen.

My cardio doc said I had 3 choices. Option One: radiofrequency ablation. In that procedure, a gadget is threaded up a vein in my leg to my heart, and the troublesome part of my heart is zapped away. It's a 3 to 5 hour procedure.

Option Two: begin taking the blood thinner warfarin. It's cheap but I would have to go to the doc's office once a week to have my blood monitored. It has lots of interactions with various foods, herbs, and other drugs. And it can make you bleed to death, or worse, cause a brain bleed which turns you into a vegetable. But not the leafy-green kind of vegetable that is good for you. No, it turns you into a bad vegetable, like okra.

Option Three: begin taking one of the newer blood thinners, like Xarelto or Eliquis. They have the great advantage of not being warfarin, but they cost an arm and a leg. Seriously, you have to give the store an arm and a leg before they will fill the prescription. You get to choose right or left.

To give myself time to think, I left the hospital with a prescription for Eliquis. I also wrangled a 30-day free trial offer from Bristol-Myers Squibb. All I had to do for the free trial was give them my name, address, email addy, and phone number, and agree to give up all my privacy rights and allow them to call me anytime day or night. How could anyone say “No” to a deal like that?

As a footnote, I will add that the hospital staff could not have been more friendly and solicitous. Even so, lying in a hospital bed with nothing more than a crappy television picture to look at all day, being stuck with needles, and carted hither and yon for various tests, was enough to make me want to cut my head off with a dull, plastic butter knife. When I mentioned that to one of the nurses, the plastic knives that had been coming on my food tray disappeared permanently. I can hear the staff now, muttering to each other, “Get rid of the plastic knives. He says he’ll cut his head off, and he’s crazy enough to do it.”

Wee Hours

I awoke in darkness. I rolled over and switched on the bedside lamp. I looked at the clock: 9:54. Wait – 9:54? Why is it still dark outside?  Sleepy brain clicks into gear – oh, it’s 9:54 PM. Momentary confusion: why am I waking up at bedtime? Then I remembered. I drank several shots of vodka this afternoon, something I normally never do at that time of day. Usually, when I drink alcohol I do it just before I go to bed. The afternoon drinks put me to sleep. Now it’s “morning” at 9:54 PM.

So, being not the least bit sleepy, I got up. I sat at my computer and surfed the Web for a while. Did you know that lizards dream? They do. And ravens know if other ravens are spying on them. And slime mold can learn and remember, but it forgets pretty quickly, too. I read that astrophysicist Neil Degrasse Tyson said it’s possible aliens have visited Earth but found no intelligent life here. If they visited in recent times, I can understand the part about finding no intelligent life. I sometimes have doubts, too.

I found myself getting hungry. Why am I so hungry? Oh yeah, I skipped supper. I needed a snack. So I fried a burger patty in a skillet. I put a bun on a plate and put mayo on both bun halves – partly for taste, partly to insulate the bread from the burger juices. When the patty was cooked, I put it on the bottom half of the bun and added salt and a few grinds of pepper. I put slices of onion and tomato on the burger, added mustard and ketchup and, finally, the top half of the bun. I put a spoonful of potato salad on the plate and sat down in front of the TV. I ate my midnight supper while something very forgettable played on the TV. Or was I eating breakfast? I pondered the question and made a Custer decision – a meal must be eaten between daybreak and noon for it to be called breakfast.

I finished my snack, still hungry. I waited a while, but the hunger didn’t go away. So I heated an egg roll and slathered it with Chinese hot mustard. It tasted good and my belly was satisfied – it quit sending “feed-me” messages to my brain.

There’s not much to watch on TV in the wee hours of the morning. I finished season 2 of Unbreakable Kimmy Schmidt yesterday. Season 3 won’t be available until May, 2017, and when it’s released I’ll probably binge-watch the whole season in two days. It’s a funny show, in a 30 Rock way, but with a vein of dark humor running through the episodes. I like it, and Ellie Kemper is perfect for the lead character.

At 4 AM, CyberDave signed into Skype from Roanoke. We had just begun a video chat when don Raphael signed in from Alajuela. (Alajuela is the 2nd largest city in Costa Rica after the capital, San José.)  He joined the chat session. Two-person Skype chats seem to always work fine, but add a third person and sometimes there are problems. Not today. Skype worked flawlessly at this early morning hour, with no glitches, no dropouts, no delays – in other words, it worked as it’s supposed to work. Considering that one of us was in Central America and two of us were 180 miles apart in Virginia, it was impressive that the technology worked so well. The chat session ended just as the sky was beginning to lighten.

Dawn broke over a gray, overcast morning. The coming week is supposed to be cloudy/rainy/stormy – take your pick, they’re all on the menu. It will be a good week to do indoor stuff. Maybe I’ll post a blog. Anything is possible, they say.

Political Spin

My Congressman is fond of sending out mass emails. Or possibly, he is fond of ordering his staff to send out mass emails in his name. In any event, he began a recent email by complaining that the healthcare law is over 2500 pages long, but the Administration’s strategy to combat ISIS is only 7 pages long. This difference in document lengths apparently implies, according to the Congressman’s view, that Obama cares about his healthcare law 357 times more than combatting ISIS. That number is arrived at by simple math: 2500 pages divided by 7 pages. Or inversely, one could say that Obama cares about defeating ISIS only 0.0028 as much as his healthcare law. That is to say: 7 pages divided by 2500 pages. And even if the math is not exactly right (because, for example, the relationship between the two variables might not be linear), the implication remains that the more you care about solving a problem, the lengthier the documented solution should be.

This is just what the Congressman is implying – that the size of a document, as measured in number of pages, is proportional to how much the writer of the document cares about the subject of the document. If that is not what the Congressman is implying, then why mention the numbers?

But this implication is absurd if we think about it. Let’s reverse the numbers. Let’s suppose the healthcare law is 7 pages long, but the plan to combat ISIS is 2500 pages long. Does this make anyone feel better about either the healthcare system or the plan to defeat ISIS?

When I was in high school, I’m sure I could’ve knocked out a 7 page national healthcare law overnight as a homework assignment, but I’m also sure I would have written an absolutely terrible law.

How about this: a 2500 page World War 2 plan to invade Europe by landing on the beaches of Normandy? I don’t know how many pages were in the actual invasion plan, but I doubt that a 5000 page plan would automatically be twice as good as a 2500 page plan. And if General Eisenhower had handed Truman and Churchill a 2500 page invasion plan, I feel certain that neither Truman nor Churchill would have told him, “Not enough pages! Take it away and bring it back when it’s at least 10,000 pages long.”

When a politician says something, especially if it’s rehearsed or stated in an email, you must assume you’re hearing, if not outright lies or distortions, facts that political spin doctors have worked on to make you believe what that politician wants you to believe. Don’t be a sucker. Listen critically and question everything.

John Murphy

The song of the day is Sunshine (Adagio in D Minor) by English film composer John Murphy. The song was featured in the 2007 science fiction movie Sunshine. A variation of the song called Strobe (Adagio in D Minor) was used in the 2010 movie Kick-Ass.