Speech Therapist

I went to a speech therapist today. As you know since my stroke (or actually a couple years after it), i have battled with twi seemingly related problems: a swallowing issue that feels like something stuck on the right of my throat, and difficulty speaking as loudly and clearly as I used to be able to do. The more tired I get, the worse it gets.  This is most apparent in a six hour long deposition.

The speech therapist started by running a camera through my nose to inspect my vocal chords. She pointed to the muscles immediately adjacent to my vocal chords being red and enlarged.  She said these muscles are working too hard because of stress. These muscles are adjacent to the muscles that shut the breathing passage from the esophagus and this likely explains the globus sensation. Fixing one by exercise may fix both, perhaps in just a few weeks.  These are the only areas of my health that are a source of frustration. 

Have Any of You Had Trancranial Magnetic Stimulation?

Since my left hemisphere stroke in 2014, I have battled with dysphagia on the right of my throat as well exhaustion when talking. Being married to an extreme extrovert, this is a serious problem.

My ENT has decided that my failure to respond to GERD diet (anything you like to eat or drink is prohibited) suggests the problem is stroke damage. I also found out yesterday that my sleep apnea is not only obstructive but what is called central sleep apnea. My brain is sometimes failing to send the breathe command. Fortunately, this is only an occasional lost message.

I discovered from talking to SuperGrok that TMS has been found by meta-analysis of dozens of RCTs to be more effective than swallowing exercises alone or swallowing exercises plus sham TMS (placebo treatment) at treating post-stroke dysphagia.

The RCTs, unfortunately, are almost entirely within 12 months of the stroke. It also appears that Medicare only covers it for depression. If I have to pay for it out of pocket, as my son-in-law says, "It's only money," and there is no shortage of that 

Any experience with TMS?

Urologist Tomorrow

I am hoping this catheter will be removed for good. Inflamed prostrate gland usually shrinks back to normal in 1 to 2 weeks after appendicitis. This is really unpleasant.  The only good side is there are no nighttime needs to urinate. The downside: carrying around a reservoir when you go to bed and get up and a leg bag during the day,  both which require periodic emptying. You will remember the leg bag because it is like wearing a 1 pound weight on your leg after a while.

From watching TV ads, it appears that there are people who have a permanent recurring need for catheters. I cannot imagine what would preclude surgery to fix whatever underlying condition has put them in that state.

UPDATE: Catheter removed.

I Am Home

The surgery sites are finally registering pain. Not bad enough to get the Norco Rx filled and just a bit more than Tylenol can silence. The catheter is both more annoying and a sharper pain when in certain positions.  And a 250 ml of urine sloshing about in a bag on your ankle is annoying, but at least there are nighttime visits to the toilet. Although I would gladly trade that for this nuisance.  I should get priority seating with my urologist to find a solution to this inflamed prostrate gland.

Liquid Diet Stage

I was still allowed Cream of Wheat for breakfast.   Now it is only liquids.  So far, pulp-free orange juice and orange Jello.  I am waiting for the lemon Jello to set.

After colonoscopy in AM, Eggs Benedict. 

"What a Drag It Is Getting Old"

No, this is not about Mother's Little Helper or the absurdity of how the Stones were when they wrote that song.  Friday is Colonoscopy Day.

You should be doing these regularly starting at 45.  I started after a good friend received stage 4 notification.   He had never had one.  

Get it done promptly.  Watching him die of something preventable was very sad.  It was also expensive.   Fortunately for his widow, he had a gun and ammo hoarding problem.  In the year or so it took to first find all the guns in the house and aircraft hangar, she amassed enough to pay all the bills.

How Bad Could It Be?

 Worse than I imagined.  I did nor even get to count backward.  When I woke up, I had IVs in each arm, two in the left arm, one in the right arm, and one in the right jugular vein.  It appears that there might have been a cathether through the right femoral artery at some point.  When I woke up, I coul hear  Dr. Farivar explaining that it was 9:30 PM.  (Drug and trauma induced, i think.  He was done about 2:15.) We both had a long day. At least I did not have to stay awake for ir.  DIY open-heart surgery seems like it is not going to catch on.  I am impressed that the Johns Hopkins Medical School president self-appendectomy is not better known among surgeons.

He explained to my wife that once he got inside, the no longer neighing so well equine aortic valve had apparently ingrown into thc mitral valve.  I did not know that could be that ill-behaved.  This may require a transarterial addition of a clip later on.   That at least, is not a ribcage breaker.

Where he originally  believed that only the left anterior descending (LAD) artery needed a bypass, the ramus artery also needed it.  (When the mechanic gets your transmission apart and tells you that you need a left-handed feebleveetzer, you can at least ask to see the part first.)  They extracted some saphenous veins from my right leg to bypass the clogged arteries.  The saphenous veins cross-collaterize easily so you do need not them as originally installed.  John Hunter first discovered cross-collateralization of blood vessels in the late 18th century, by tying off an artery in a deer's horn.  The horn continued to grow, so he autopsied it and foumd the body had buillt a collalteral blood distrubution network.

Anyway, having done the grand tour of my heart, they closed me up, using steel wire to encourage bone regrowth.  Then, because my heart rate was only 30 bpm they decided that I needed a pacemaker.  They inserted that two days later, and it still hurts a bit.  

The battery is supposed to be good for ten years.  It comes with a  monitoring unit for when to buy some AAA batteries :-)  This is apparently a local anaethesthic replacement.   I rather doubt this will get two swaps.

So, I heard Dr. Farivar's disembodied voice but all I could see looked like a grating and I could feel the gag-inducing breathing tubes.  Days or possibly minutes later, the tubes came out and I could again see something.  Whatever it was, it was not interesting enough to overcome the pain killers.

When finally awake in the wee hours of Thursday morning, I was fuly aware that my ribs had been moved and were protesting.  The next few days were a blur of decreasing pain, Talmador, Tylenol, and muscle relaxants which was much of thc protests, I thimk.

Some time Saturday, I reached the stage I had leaned to fear in 2013, "The Ceremonial Torture of Chest Tube Drain Removal."  Back  then, the nurse said patients described removal as feeling "kind of funny."  In 2013, it hurt like hell for about two seconds.  This time it did feel funny and looked gross.  The tubes were about an inch long and a foot long.  They were covered in goo and blood.

Somewhere along the way, they removed the penile cathether.  This had actually been nice, not needing to use a urinal, which has oftten been less than wonderful in practice.

Throughout, continual injections of heparin to prevent clotting.

Something new that I learned is that major surgeries (and I guess this qualifies) heal faster at high insulin levels so I was getting insulin and regular insulin checks whenever I fell asleep.

Do Any of You Have Experience with This Product or Similar?

ORTONYX Sternum and Thorax Support Chest Brace Post Open Heart Surgery Rehabilitation

After the sternotomy there is nothing but steel wire bracing the ribs while they heal. A severe load on your flying in formation rib cage could look a bit like the chest buster scene from Alien.  They give you a pillow intended to stabilize all those moving parts when coughing or hiccupping which is indeed pretty painful.  I would prefer a solution requiring less human interaction. 

Regrets, I've Had a Few, But Not Enough to Mention...

Unlike Frsnk Sinatra, I like to think that, "I did it His way."

I expect to be blogging in a week and causing trouble for recalcitrant governments in about three weeks 

Surgery. September 4th

Aortic valve replacement and bypass the LAD artery.  It is an all day procedure.  This is mildly scary.  But I know where I am going if it does not go well.

Surgical Aortic Valve Replacement (SAVR) 30 day mortality rate is 1.92%. Bypass graft mortality including high-risk patients (>80 years, emergency treatment, poor mobility, chronic kidney disease) was 1.9%.  You might almost think from the similar numbers that being ripped open is the common risk factor.

my Cardiologist Expects Surgeon To Open Me Ip in a Week or So

I look forward to breathing and walking at same time 

This Was The Least Invasive Entry Point

Upper arm 

Breathlessness

No i have not seen a 1960s Sophia Loren movie (get your head out of the gutter). Since about March, I have been increasingly unable to walk any great distance without getting so out of breath that I have to stop.  1000 feet is about it.  My cardiologist ran an echocardiogram that showed a 51% ejection fraction from my equine aortic valve.  This is leas than optimal but not yet at the cut ne open and replace it level.

Next a nuclear stress test which I mentioned gave me a gamma source for testing my survey meter (me).  When I kept asking whst to do to solve the problem (formally known as dyspnea) the PA's response was, "Mr. Cramer, you have heart disease."  This was not a helpful answer.  I am not ready to spend the rest of my life on a couch waiting to die.

My PCP got me a referral to another cardiologist for a second opinion.   In the meantime,  I realized that there was some overlap with the symptoms of pneumonia so I went into Urgent Care.  They listened for snap, crackle, pop, and did an X-rsy.  Not pneumonia  but they encouraged me to see my PCP.

I think the cardiologist saw no cardiac cause and instead of considering other causes or sending me to my PCP, they just lazed out.  This is a common problem with specialists; they are looking at their piece of the patient.   They still should have directed me to my PCP.

My PCP ordered a CT scan to eliminate pulmonary embolism as a cause and a Pulmonary Function Test (PFT). The pulmonogist saw the CT scan order and asked for a copy as well.  The PFT will be in a hospital in case they find something else thst needs to be tested.   There is a pulmonary equivalent to an angiogram to look for embolisms (basically clots in a pulmonary artery).  

My PCP thinks it is possible although unlikely because the blood thinners have not been completely consistent in keeping my INR levels where they should be.

The second cardiologist appointment is tomorrow and I will be calling back t h e scheduling department for those other tests.

I cannot even roll my telescope out comfortably anymore.  I can write articles, declarations and rebuttals.   These are important but there is, or should be, more to life. 

Below 197 Pounds

198.9

Nine pounds to go before I hit my current target weight.

102/57 BP

I hate Cardiac Rehab but it is clearly good for me 

93/57 BP

I hate Cardiac Rehab but it is helping.

BP 106/53

At the end of cardiac rehab today.  They just upped my time on the cardiovascular workout machines to 15 minutes and we are starting to increase speed and resistance.  Each week's step up is a little unpleasant the first day but is easy by the end of the week.

Cardiac Progress

One of my health problems was that walking any distance (even a mile or more) in either cold weather (below 50) or hot (above 75) caused short-windedness.  Even after the recent stenting, it was only a little better.  The combination of cardiac rehab and clopidogrel means progress.  We just took the dogs to the nearby middle school (which is having a snow day) and walked them until they were tired (an unimaginable event for the younger one, Lillie) and even though it is in the teens, and walked at least a mile in the snow, I was never short-winded. I have 21 visits left to cardiac rehab and my confidence is that they may get me back to where I want to be without slicing me open.

Cardiac Rehab

I am undergoing cardiac rehabilitation at the moment, which is basically an exercise program to get everything repaired by the stents to work properly.  This means treadmilling, arm bikes, and some weight exercises as well.  This is in addition to the treadmilling I have been doing at home.  I am hoping to be finished before they cut me open for aortic valve replacement.  Then I suspect that I will do it again.

The good news was that after today's session my blood pressure was 115/48.  Before the stents it was far higher.