March 31, 2010

PICC line in

I am a pretty princess.

Okay, not really. I am gowned and all ready for PICC placement. I was gowned and ready for close to four hours because the doctor was really, really late. However, I can forgive that, as he was super fast and super efficient placing the PICC. It was literally a five minute process by the time he got started.

The problem with processes like this is that while the actual procedure is fairly straightforward and uncomplicated and often quick, there's a lot of BS surrounding it and leading up to it. I had to be at the hospital by 9 for check-in and have my vitals taken and all that. I had to do the full gown thing, even though it's a waste of time taking one's pants off for a PICC line. They also wouldn't let me keep my cellphone either, which proved to be quite unfortunate when the doctor was running late. Next time, I'll make more of a fuss about what is and isn't reasonable for a PICC line procedure.

I had to have blood drawn because apparently the results from my blood draw two days ago hadn't been faxed over to the hospital. And, of course, the staff keyed in on my diabetes right away, so they had to do a blood glucose test (124, a little high). THEN I had a two hour wait while the coagulant test did its thing. (At least, they tell me that's what the wait is for.)

Finally, about 12:30, the doctor arrived and the nurses started to prep me and the local area with all the needed equipment.

I had a guy named Dr. Huntz Liu, a very professional, nice guy about my age. As he was running late, he got right to work. (I noticed he didn't apologize for keeping everybody held up, nor did he take time on pleasantries after the procedure, but scooted off elsewhere.) I did take a moment to explain to him that while I would prefer my left arm be used, it may be difficult due to scarring from previous PICC lines. I do most things needing strength with my right arm, so it is more natural and easier for me to have the PICC-handicapped arm be the left one. I also want to sort of reserve my right arm as scar-free territory for when it is really needed and there's no other options left. I explained all this to him and then allowed that if he had trouble placing the PICC in the left, he had permission to switch to the right arm. I didn't want to be stuck too many times, nor did I want to be there all day for multiple insertion attempts. The doctor suggested we could try placing another IV - a peripheral - and using that to inject contrast so he could visualize my vein better than he can with ultrasound. Hell yeah! And why hasn't that ever been suggested before?

So after getting strapped to the procedure table and all wired up with heart and pulse ox monitors, and having my arm strapped to a board to my left, the nurse quickly placed the peripheral. I was draped and tucked and generally feeling a lot like more major surgery than this really is, but I know it's all precautions against infection.

When everything was truly prepped, the doctor did his thing. I felt two stings of lidocaine and a few seconds later the doc says, "Ok, a little pressure now" and that's literally all I felt as he put the introducer in. (Introducers are big - and they hurt like hell if you're not numbed up.) He must have evaluated the vein w/ the contrast medium (there's a continuous x-ray going on) and knew exactly where he was going, because one stick was all it took. He VERY quickly threaded the catheter in. This I could feel. It is not painful, just uncomfortable and I'm glad he made short work of it. By the point where other practitioners would be starting to feed the catheter in, he'd already pulled the guide wire, verified placement on the x-ray monitors, and was stitching the base to my skin. Less than a minute later, he pulled the sterile drapes off from around the site; the nurses dressed it, including a new little antibiotic pad I haven't seen before, pulled out the peripheral, and I was on my way out of the room and out of the hospital.

This was VERY neatly done. As far as I can tell, no blood spillage; extremely quick; the dressing is about perfect, and I have a lot less of the residual soreness I'm used to feeling.

Still, I'm very tired. And after having had only one cup of coffee all day (after the procedure - can't eat or drink before it), I have a medium sized headache. I'm now waiting for the home nurse to come so I can do my first doses of my antibiotics: meropenem, tobramycin, and vancomycin. She has to add an extension to that little part dangling down in the picture; and somebody needs to be around while I do the vanco. Despite the Benadryl I'm about to take, I will have a reacting, and she'll need to be on hand to ... I don't know, call an ambulance or something if it gets too severe. Wish me luck!

One last thing: I grabbed that coffee and a muffin at the Dunkin Donuts near the hospital, right after I walked out. Having to dose for the carbs, I found a corner for some privacy, but there was someone else already there. He seemed interested. Turns out his little brother has been using insulin for many years. We talked a little about diabetes and diet and then topics turned to the MTA, Bloomberg, and the like. We must have talked like that for half an hour. It was nice, but ended with me excusing myself for a coughing fit.

March 28, 2010

fresh air; fresh start; fresh run

Two miles this afternoon. Slept 11 hours last night, still tired. Got out for a run while it was still raining, cold, and windy.

Not the fastest I've ever done this two-mile route, but it was good to be out. Halfway through the run, like literally at my turnaround point, the wind died away, the rain stopped, and the sun came out, all in about four minutes. All of a sudden I went from being underdressed for the run to overdressed. Weird.

Fighting the lungs. Legs stiff, too. But right now, during this short post-run grace period, I feel really good. This is my reward. I'm going to go get some coffee and muffin while the sun is still out. I've been working on cleaning off my desk, which is generally a depressing slog through old paperwork, old bills, and piled up medical statements. I have tons to get done tomorrw and Tuesday and would love to start the week with a clean house and clean desk.

March 27, 2010

catching up

Well, been a while since my last post. I'll warn you: this post is long.

Part I: my last run.

A week ago, I did a four mile run down to Ft Hamilton park. This was my first time taking 5th avenue, instead of 4th, and I almost regret it. If you'll recall, the day was beautiful, warm, and sunny. Everybody was out enjoying the sunshine and taking up room on the sidewalks. And 5th ave is all sidewalk - filled with busy businesses all the way down. So the whole run turned into a game of dodging pedestrians or traffic. Fuck me. I don't usually enjoy thsi game, but at least I kept my temper. I wanted to shout and scream and tell these idiots to get the fuck off the sidewalk with their ten-person families and three strollers and snail's pace walking. I wanted to suggest forcefully that if you have to stop and talk to your friend, that you do so to one side of the sidewalk, out of the goddamn way. But I didn't. I kept my calm, concentrated on getting some miles in, and chalked everybody else's rudeness and stupidity up to them being fat, lazy, stupid Americans. Except that a good portion of them aren't fat, lazy, stupid Americans, they're actually fat, lazy, stupid immigrants. OK, I shouldn't be calling anybody fat, lazy, and stupid when I don't know them personally, but it helps me keep my temper.

The run itself was better than I thought, overall. The first part was all uphill - a gentle mile-long rise that I thought was going to kill me. The short breaks afforded by waiting for traffic generally meant I could keep my walking breaks short. And by the end of the run - a mile-long downhill slope with less pedestrian traffic, my overall pace was really very good. There were times I was traveling better than 9:30 per mile and my run ended up averaging just a little over 12 per mile. I was shocked, really. I need more good runs like that.

I also had no pain. Perhaps it helped that I had taken some Tylenol, but there were no shin splints or anything. Nice to run without pain!

Part 2: exhaustion.

So why haven't I run in a week? Well, to be honest, work has caught up with me. I got called in to a local design-build firm that does a lot of display work for NY stores and public art projects. Interesting work and my part was to help produce some renderings for an overseas project. So I worked a solid 40-hour work week, even taking into account leaving early Thursday for a doctor's appointment. In addition to work, I had the appointment to take care of plus two nights of teaching. So by last night I was dog-tired. I went to bed just before midnight and didn't wake up even to go pee. I slept 12 hours. And I still feel tired. So I'll be in bed early tonight again and hopefully make tomorrow more productive than today has been. That should include putting in a run, cleaning the house apartment, and clearing my desk of a pile of receipts.

As tired as I was, I need more weeks like this, where I'm fully employed and earning what I'm worth. Thursday was a $500 day, part of that earned for rendering, part of that for teaching. I wish I made that a lot more often! Well, I'm off Monday from all work and am filling it up with other appointments, such as eye doctor (can you believe I haven't been to the eye doctor in five years??) - and then it's back to work Tuesday, though the work is more holding-the-fort while the company regulars are out of town than it is using my special skills. I'm not complaining! LOL

Part 3: Health.

One of the appointments I need to make - and hopefully actually see the doc before going to Israel - is my diabetes appointment. I thought I had one in April, but can't find it on the calendar. At this point, I've been upping my Lantus dosing on my own, in order to keep my blood sugar under control. I'm not sending in sheets weekly to the diabetes center, so we're not in constant contact. I *am* tracking what I eat, all my carbs, all my medicine, and testing BG several times a day - so I'm on top of it; just not the way my center wants, and I know I'll hear it from them. Perhaps I can work out a compromise and send them screenshots of my tracking charts weekly.

Anyway, it's funny how often diabetes comes up these days and funny how people just don't seem to notice when I'm testing or injecting. Is it so common?

I was watching this show on ABC: Jamie Oliver's Food Revolution. I was simultaneously grossed out, fascinated, horrified, and enamored (of the host). (Go watch the video at the link...) This Brit is stunned by how badly British and Americans eat. He's not trying to bring gourmet food to Americans, he's trying to get them to put down the processed foods and reach for ... well, simple, whole foods. The very kinds of things I prefer eating.

One segment showed a Southern family (typical, I'm sure) at the doctors'. The pediatrician was examining the 6th grader - the 250 pound 6th grader. He pointed out the signs he sees of impending diabetes. They tested his HbA1C and he's not diabetic yet, but the doc told the parents that with their family history, their current lifestyle, and the signs of excess insulin production he sees in their kid, that he's almost certainly going to become diabetic. He then outlined the effects of diabetes and the possibilities of blindness, heart disease, kidney failure, and death. I was... well, I've never heard it put so bluntly. "Diabetes is fatal," he said. True, if not treated. With treatment... maybe not. I know some who have avoided even minor complications and have had good control for fifty years. But... how is it my CF doesn't scare me that much anymore, but diabetes is starting to, now that I've had it for a year? Is it because the animal in me is realizing this is something that's not going to go away?

So my health is not great right now. I'm been worse, but I've also been a lot better. I've been on oral antibiotics for two weeks. For the first few days, they seemed to have great effect, but I have returned to frequent productive coughing and having less energy than normal. My PFTs are exactly what they were two weeks ago. My weight is good, though: 128.6. I'm just a pound and a half from weighing as much as I ever have! And believe it or not, some of it is fat! :D

So we're getting the process going of getting me on IVs. Part of Monday's task list is to get my primary on the line so I can get a referral for a PICC line. I don't understand why this process is so fucking complicated and drawn out. I've been told by Tricare that my specialist can request this and have approval within a day - why is her office so stupid and slow about this? Why must I get my primary's office involved? So first thing I'll do is get on the phone with Tricare and get the procedure straightened out! Hopefully by Wednesday I'll be getting the PICC. My doc offered to have me admitted to the hospital and spend a few days there and get the PICC there right away and while that is an option, it is not one I want to use until absolutely necessary. Even one night in the hospital is horribly expensive and I don't see a clear benefit to speeding this process up by a couple days, especially given that I'll be isolated and damn near starve to death on that hospital's food!

So, yeah, I'm going on IVs again, that's all I'm saying. The timing is good. If I'm on the IVs three or four weeks, I still have a month after that before going to Israel and my experience is that I need that recovery time. Hm. It's been four months since the last round. Not bad. Not great, but not bad.

Part 4: Healthcare.

I see a lot of vehement arguing about the healthcare bill and a lot of frankly crude reaction. What I don't see is a lot of intelligent discussion. Politicians use scare tactics baldly. So do campaigning patients and doctors - on both sides. Now that the bill is passed, people continue to scream and shout.

I will say upfront that I have not read the healthcare bill. I've reviewed some articles in the New York Times and on the Wall Street Journal that sum up key points; that's about it. I also don't know exactly how to feel about this bill.

What I do know is that I am tired of the illogical and invalid rhetoric spouted by both sides. Let's get a few things clear: The sky is not falling. This is not communism; it's not even socialism. This is not free health care. It *is* a requirement for more Americans to get insured, balanced with the government's help in obtaining that insurance, where necessary. This is not going to be easy; change never is. It is not going to be smooth; change never is. But with more people *insured*, we should see fewer uninsured people getting healthcare in emergency rooms, with the taxpayer picking up that bill. We should see a shift where the ER is used for actual emergencies (!) more than not and preventative care being more attended to, which may ease how many costly surgeries and medicines people and insurance companies pay for later. I can't say for sure if these things will come to pass or not. But my point is that, *neither can the politicians*. All the people who stand up and say, "this healthcare bill WILL result in..." are just spouting bullshit. They can't know! There's a lot of "might" and "maybe". There's some "probably" and "possibly". That's all. If the rhetoric were more reasonable, I might be willing to listen or even get involved myself.

March 13, 2010

Happy first D-day to me

I guess I can blow out the candle, but I'll pass on the cupcake.

A year ago today, I had the first clinical indications of my diabetes, in the form of high BG readings in routine pre-IV bloodwork. I have to say that I think I have handled it well and have made the adjustment masterfully. It helps that being overweight is not a part of the problem, as it is with so many other diabetics, and that I was already quite active, so I didn't have to start an exercise habit that was brand new. And, too, I was already used to daily therapy regimines; so adding a little more wasn't too burdensome. I basically just had to start counting carbs, checking blood sugar, injecting insulin, and avoiding mega-doses of sugar.

The only real qualitative change this has made in my life is that now Aisle 13 is a no-go zone, and except for relationship or religious reasons, Halloween, Easter, and Valentine's are non-participatory holidays - just meaningless squares on the calendar, now. Feels a little bit like Lent all the time.

Aside from that, I'm not avoiding sugary foods - I'm dosing enough insulin to control my blood glucose. This is more or less successful, depending on what foods, and how much exercise I'm also getting.

I find it interesting that a year ago I wrote:
This is killing me. It's just fucking killing me. I feel like I'm on a carnival ride and about to puke and all I can do is ride it out, because I have no control over the situtation.

I don't feel like that about diabetes anymore. I've been given the tools of control and the basic training. But I do feel like that about this post-tussive syncope. As I remarked to a friend last night at Apple Bar, I'm concerned about this phenomenon because I have zero control over it, other than trying to remember to, what, stand up slowly? Not stand up when coughing? That's not a positive control. And unlike a temporary low or high in BG, which can be felt and treated quickly before things get dangerous, this syncope sneaks up on you and turns you off as with a switch. Then the switch turns back on a little bit later. I'm not thrilled with that.

On the other hand, this latest episode has made me unafraid of transplant surgery and a little less afraid of death. I mean, if I can get hurt like I did and not even remember it or feel it happening, then surgery should be OK - it'll just hurt AFTER. :) As for death...I only hope it is that sudden. It will be very peaceful.

March 11, 2010

Syndicated syncope

Check THAT out! A near-perfect ECG (as far as I can tell after a couple hours research on the web). All the numbers at the top of the chart are spot-on. And a resting heartrate of 62 isn't too bad, though I've posted as low as 52 at checkups before. (And nothing like The Running Laminator's 37!)

So... WHY did I have an ECG today? Funny story...

You're aware by now that I have some roughness in my lungs that I haven't been able to purge. It comes and goes. I am not bringing up an astounding amount of phlegm, or even a "normal" amount (normal for me, that is.) And what I am bringing up is small amounts and fairly light-colored. I'm also not, for once, suffering from the kind of asthma that causes tightness in the chest or comes on suddenly. Two or three albuterol nebulizers a day is keeping me on an even keel and I feel like I'm breathing fairly well.

However, at last weeks PFTs, my numbers were way down. The nurse wasn't happy, so today I blew again and saw the doctor. My PFTs are improved over last week (at least as long as I have albuterol in me) and my weight is up. All good. However, whatever is going on in my lungs is cause for concern. There are times during the day - or night - when I'm short of breath. I've been sleeping poorly and even waking up breathing badly.

I thought I was going to end up on IV antibiotics again after this doctor visit, but that has been put off in favor of giving the old orals another go. It's been a long time since I've been on the orals - over a year at least - and it's quite possible I'm culturing something very different than I usually do. Time will tell. (Speaking of cultures, it was almost impossible to produce even a sputum sample for the lab today, though yesterday I could have filled a dixie cup.)

But that's all lung stuff. Again, why did she send me for an ECG? Longer story...

I slept very poorly last night, a combination of going to bed too early (for a 6 a.m. wakeup), too much food, and poor breathing. In fact, I only got about 4 hours of sleep total. Now, you may recall me posting a little over a year ago about how I had passed out while coughing in front of the computer. This episode of post-tussive syncope has proven to not be unique. I had an episode in a restaurant last October, during which I didn't quite go all the way out, or rather did, but only for a second - coming to fast enough to catch myself falling on some tables and chairs.

This morning, I woke up at 6:10 a.m., sat upright, starting coughing, took two steps toward the bathroom... and then woke up again at 6:15 a.m., wondered why I was staring at my radiator and the legs of my bed, realized I was sprawled out on the floor (quite comfortable, really), and after ascertaining I wasn't dreaming, got back in bed for half an hour trying to figure out just what the hell had happened. See, the combination of getting up out of bed quickly while coughing hard triggered another episode and I passed out good this time. I mean, this was a full-fledged double chokeslam, with me hitting things on the way down (being unconscious already I didn't actually feel the hits) and staying out for a few minutes.

The aftermath is not good. I have a sizable bump on my head at the hairline on my right side, a bump half that size on my left (from hitting the floor I think), a stiff/aching neck, a scratch on my right arm and thumb, a bruised hip, and a twisted or bashed left knee. Taking stock of my injuries and comparing to a) where I was facing when I passed out and b) my body position when I woke up, I can't quite reconstruct *how* I ended up facing away from the bathroom, on my leftside, with injuries on both sides of my body.

These things will heal. I'll have some Tylenol with my early dinner, get a nap, then go to rehearsal. But there are longer consequences. My doc sent me to get the ECG just in case a heart problem was contributing to this. With that ruled out, the most obvious cause (besides my CF coughing) is the diabetes, which my doc says causes the body to not adjust as well to drops in blood pressure, which occur when a person gets up quickly. And as I noted in my blog post of a year ago, this kind of thing makes me concerned about my safety as a driver, especially if I'm not going to recover in a matter of seconds.

I do not see the situation resolving itself anytime soon. The diabetes isn't going away, unfortunately, though I may be able to control it better with more exercise. The cough isn't going away and isn't going to become predictable; not until transplant (and probably not even then). And let me tell you, I've had some doozies while driving. Another few episodes like the one today and I may have to voluntarily remove myself from the roads. I may sell the bike. I just don't know yet.

So *that*, dear reader, is why I was sent for an ECG. And before I go, I'd like to say bravo to Columbia for the renovation of their labs and x-ray center. Blood-draws, especially, went from waah to wow. And now blood draws, ECG, and x-rays (as well as a few others, I'm sure) are all done in the same area. The labs area is clean, spacious, well-lit, with lots of window space and desk space and the flow is really good. They even have loveseats in the waiting area and pagers!

March 7, 2010

weekend workouts

Did 4 miles around Greenwood cemetery yesterday. Didn't go so well, even though the weather was perfect. Lungs were pretty rough and I was coughing up quite a bit. Legs, too, were tight and sore. So the run was slow, with lots of walking. I was disappointed.

Today's workout was in the gym, with 25 minutes on the elliptical and about 45 minutes lifting weights. The elliptical was normal until I saw "pedal backwards" flash across the readout. So I tried that. Immediately my heart rate shot up and stride rate dropped. It's pretty hard! Very interesting. But I didn't want to do a long, intense cardio workout, just a short one, so that was only 25 minutes. I moved on to weights - haven't lifted in two weeks. I've been concentrating on my upper body and have developed a routine with the machines and free weights that I like a lot.

There is a certain degree of difficulty to some of the machines, like the one pictured above, that's unexpected. Even though they restrict to one axis of movement, the arms move independently, rather than each side being tied together. This increases the difficulty as each arm has to do its own work. (Picture is 40 pounds each side. tried 45, but couldn't quite handle eight reps with that.) Got a real lesson today in just what each arm's realtive strengths are. By the end of my workout, my hands and arms were shaking and I could barely hold my water bottle. When I reach that point, I'm done.

I need to start working some more abs work and some legs work (any at all) into my weights routine. There was a time I could do 45 situps with a ten-pound weight held across my chest on an inclined situp - not anymore! Maybe I can get back to that. I need more core stability for running.

So now I'm sitting here finishing up this post, listening to Academy Awards red carpet dog and pony show, drinking a scotch, and worrying about my Vectorworks class tomorrow. We're a little behind, but not as bad as I'd feared. Given that, I'm not going to move on to the next project yet. I'm going to drill them on some exercises with some 3D commands, demo how to finish their homework for the week, and assign them the last touches to the course titleblock.