Tuesday, November 25, 2008

What Really Mighta Happened at Plymouth Rock

 "Land ahoy!" cried the lookout in the crow's nest of the constricted blood vessel.  The boat's passengers began to strain their eyes for sight of their salvation.  Pillgremlins, they were called.  They had sailed all the way across the ocean in hopes of escaping their constrictive oppressors.  The journey had been long and weary; the vessel had taken on some water retention so many of the Pillgremlins had become bloated and therefore welcomed the sight of dry land, an outhouse, or even a tree.  
"Launch the life boats my sick mates" yelled the captain.  The crew wasted no time in lowering the boats for the Pillgremlins.  Reaching shore, the captain pronounced "I shall name this place Chevy Hard Rock Cafe." 
"Doesn't that sound a bit commercial captain?" asked one of the Pillgremlins.  "I'm kind of partial to Plymouths."
"Yes, perhaps it does.  Plymouth Rock it shall be then.  Now someone gather firewood, my blood thinner is making me shiver."
And so the Pillgremlins began settling in, some gathering firewood while others made shelters.  Autumn had begun to take the land, leaves changed their colors and fell to the ground.  
"What shall we do for food captain?" asked the cook. 
 "Well normally I just ask the wife to make something but since she didn't make the trip, I'll send out four hunters." 
Three days later on the brink of starvation, the hunters returned.  "What did you find?" asked the captain.  The first hunter replied "Foul."  
"Fowl, excellent!" exclaimed the captain. 
"No, foul as in f-o-u-l.  I found this vegetable that looks like corn, but it's all black and red.  Well beggars can't be choosers.  I suppose we could have some maize-on-the-cob." 
 "And what did you find?" asked the captain of the second hunter.  
"I found leafy greens." replied the second.  
"Bah!" cried the captain.  "You know we can't have those in abundance.  I don't want to increase my coumadin dose.  What of the third hunter then?"
"I found a fruitcake captain!" proclaimed the third hunter.  "But it tastes kind of old."
The captain plants his face in his palm.  "Are we destined to starve? Save the fruitcake until Christmas; it might be better by then."
"All is not lost captain." stated the fourth hunter.  "For I have found a turducken!"
"Rejoice!" yelled the captain.  "You have done very well hunter.  How did you come by such a tasty feast?"
"Twas the natives sir.  They have invited us to their fall festival."
"Excellent." cried the captain.  "Let us meet our gracious hosts."
The Pillgremlins journeyed to the camp of the natives and it was there that they met their leader.
"Greetings, my name is Squanto and this is my blood lab technician Pokeehauntus.  You must be the Lone Rangers?"
"I am Agent Smith, agent John Smith." replied the captain.  "We thank you for your hospitality in our time of need.  I was beginning to think I'd have to eat the fruitcake."

So the natives and the Pillgremlins went on to survive together for many centuries thereafter.  And that's what really mighta happened at Plymouth Rock.

Tuesday, November 18, 2008

PH Awareness Month - The Rest of the Story

November has been dubbed PH awareness month and if you're a regular reader of this blog, then you no doubt have found the blogs that are doing an outstanding job of defining the disease.  Also if you're a regular reader, then you know I do things a bit differently and to that end I give you this week's offering.

It started out like any normal hiking trip.  The plan was to navigate a little over 10 miles of the Uwharrie Mountains ending at my campsite in time to cook dinner and possibly read a chapter or two of a good book.  I was no novice of day hikes and had a 15-miler to my credit the season before.  I had checked and rechecked my gear, attempting to utilize efficiency and limit the amount of weight so I could make good time.  The only thing that weighed much was the water I was carrying.  I decided to err on the side of caution and grabbed two extra bottles to go with my Camelbak backpack.  This section of the Uwharries was new to me but I had no worries.  I had studied the map, memorized routes to take at trail crossings, and even checked elevation changes.  The forecast was for clear skies and an overnight low in the 40's. The weather was briskly cool but I knew the hiking would more than warm me up.    

The first couple miles of the trail went very smoothly.  The forest had been ravaged the previous year by a forest fire and although it was recovering, there was no dense vegetation to go through.  There was no animal activity, other than birds.  After taking a couple of snapshots of the devastation, I headed back down the trail.  The next section of woods was unaffected by the previous year's fire, but it had been hit by hurricane winds and there was deadfall everywhere.  There was some evidence that caretakers had begun to clear the trail, but some of the trail was still blocked by massive trees.  I rarely liked to hike off-trail because of the  harmful effect it can have on the plant life, but I had little choice.  At some points in the trail I could hop up and over the fallen trees, taking care not to step on a copperhead or rattlesnake on the other side.  But the going was slower than I had anticipated and the constant deviation required additional energy.  I drank more often.  
After topping a ridge I decided to break for lunch.  My energy level had dropped and I was taking in more water than I had ever before.  The area ahead seemed to be unaffected by either the fire or the hurricane.  The vegetation was thick.  So lunchtime it was.  I broke out my trail food favorites: peanut butter and jelly sandwich, salted peanuts, and canned peaches for dessert.  I topped it off with some more water and made for the next ridge.  
While the wildlife had awakened in the previous section of trail, this section was abuzz with the sounds of the forest.  I could hear frogs, birds, squirrels, and chipmunks chatting everywhere.  Evidently the cool nights had yet to extinguish the insect life as mosquitoes, horse flies, dragon flies, and locusts flurried about.  The sound of the locusts alone was almost deafening.  I continued to hike, enjoying the change of scenery and sound.  Eventually I reached a point in the trail that had obviously not been maintained in a long while.  The vegetation was so thick I could not see the forest floor.  The parts of the forest around the trail was even thicker.  I decided to take another break to review my options, besides I needed the rest.  I could turn around and go back but I was more than half way and that might have me reach the campsite later than desired knowing that I had to traverse the deadfall again.  The other option, of course, was to go forward hoping that the vegetation would thin out and I wouldn't get lost.  After checking the map and my water supply, I decided to go forward.  I needed to reach my reserves sooner than later.  As I mentioned the vegetation was so thick I couldn't see the forest floor.  So I had to rely on trail markings on the trees as navigation points.  I had made some decent progress through the maze when I heard it, the sound of a rattlesnake.  Being a cautionary type of guy, I listened to various rattlesnakes on the internet so I would be able to recognize their tell-tell sound out in the wild.  I was 90% sure that I was within close enough range of one for it to emit it's defensive rattle.  Normally I would follow a brief shot of excitement with a move in the other direction, but with the deafening sounds of the locusts I couldn't tell which direction the rattlesnake was.  I did know that if it was rattling, then I was too close.

Wikipedia describes the fight or flight response as the biological response of animals to acute stress.  The rattlesnake was stressed due to my proximity and chose to rattle thereby warning me I would have a fight on my hands should I choose to advance.  I suffered no such gallantry.  I broke into a hectic run through the underbrush, crashing through the portion that I assumed to be the trail ahead.  I'm not sure how long I ran, but I ran until I was out of breath.  The good news was that I no longer heard the sounds of the snake and being of sound mind and body I also checked that it didn't have any illusions of chasing me down the trail.  I had also managed to escape the dense underbrush.  After taking at least five minutes to recover, I noticed that I was no longer on the trail.  My flight had taken me to an open area of the forest but there was no trail in sight.  I would have to double back in order to find the trail.  I decided that being lost without a snake was better than knowing where I was with one, so I traveled the perimeter of the vegetation until I saw a trail marking on a tree.  Soon thereafter, I found the trail.  Knowing it was a good time to regroup, I checked the map and had some more water.  The highest elevation of the hike was just over two more ridges.  By the time I reached the second ridge, I was completely exhausted.  I began to take more breaks and drink more water.  I ate the last of my snacks, even my emergency food.  

When I topped the ridge, I expected to see the trail head up on a series of switchbacks (zigzag pattern of trail that allows for easier hiking up steep inclines).  Instead I found a rock ridge, the trail went straight up!  I would have to climb up a rock face in order to continue and believe me there was no turning back after what I'd been through.  As I climbed all I could think about was how snakes loved to warm themselves on sunny rocks.  Each time I pulled myself over a rock I expected to be face to face with one of the cold-blooded reptiles.  As luck would have it, all I encountered was a disinterested salamander.  By the time I reached the summit, I was spent.  I dropped to a knee to recover my breath yet again and drink some more water.  I was met with the slurping sound of an empty container.  Great! I was out of food, breath, and now water.  It took me 30 minutes to recover from my ascent.  I noticed the sun was much lower than I had expected it to be at this point in the hike.  After checking the map and my watch, I realized I was way behind schedule.  Even allowing for elevation change, I had alloted plenty of time to finish the trail and have dinner before nightfall.  What had changed?  It was then that I realized I had taken far more rest breaks than I normally do.  The breaks had become more frequent throughout the hike and had lasted longer than normal.  

The enthusiast in me wouldn't give up.  Even though I hadn't brought my water filter, I could drink from the streams if it became necessary.  And I knew enough woods craft to make a lean-to if I had to spend the night in the forest.  But I wanted these to be a last resort, so I got up.  I got up and I trudged ahead.  The hike would hold no more surprises for me.  I labored into my campsite a full hour after nightfall.  I was too tired to cook, so I grabbed some warm gatorade and a candy bar for dinner.  I put up my tent and crawled into my sleeping bag zipping it almost all the way up.  I had survived my hike, but it would be my last.

On my next trip to the primary care physician I mentioned my hike and how my breathlessness had contributed to my situation.  We both thought it was my asthma, asthma and dehydration.  So he prescribed Advair to go along with the inhaler I had always used.  That was the fall of 2005.  One year before I would be diagnosed with stage IV pulmonary hypertension.

As Paul Harvey would say, "And now you know...the rest of the story."

Tuesday, November 11, 2008

I Don't Speaka Tha Language

I've always been a big believer in picking up a dictionary if you didn't know what a word meant.  Too many times, we see people ask someone else for a definition only to forget what it was a day later.  When I got a copy of my latest echo exam, I knew immediately that it was going to be hard to practice what I preached.  It seems that medical language is something more than a joke uttered about some drug ending in 'pril, 'pro, or 'prin.  Before getting PH, I used to laugh at the medicine prescriptions on the way to the pharmacist, as there was no way they would be able to decipher the chicken scratch and give me the right medicine.  But it turns out that doctors, nurses, and pharmacists do speak a different language, something called medspeak.  

Medspeak started out as a way for village medicine men to communicate with their fellow shaman without upsetting the village leader, or for that matter the village idiot.  If a village person became agitated or distraught, the medicine man would prescribe something called the chilquitadukadukapril.  That was later dumbed down to chill pill.  The tradition has lasted until this day.

Getting back to the echo results, I see some recognizable words like ventricle, valve, and doppler.  But it wasn't the weather that was being measured here.  Evidently there is some tomfoolery going on in my right ventricle and right atrium.  The shaman was back muttering something about tricuspidaorticmitralscleroticregurgitation.  This was definitely something beyond my understanding & also that of Merriam-Webster.  It was time to take a closer look.

Left Ventricle: Normal in size - left ventricular ejection fraction is normal (sounds like a math problem on a genius edition of Jeopardy) - transmitral spectral Doppler flow pattern is suggestive of impaired LV relaxation (OK, rest & relaxation can't be all bad) - flattened septum consistent with RV pressure overload (I don't even own a RV)
Right Ventricle: severely dilated (I promise I didn't smoke anything) - systolic function moderately reduced 
Atria:  left side is normal - right atrium is severely dilated (again with the implications - geesh)
Mitral Valve: normal - no significant stenosis - trace mitral regurgitation  (I don't recall having thrown up recently)
Tricuspid Valve: normal - moderate to severe tricuspid regurgitation - right ventricular systolic pressure is elevated at>60mmHg (OK this sounds kinda serious, but is greater than 60, 61 or 90? All this medspeak and no specifics)?
Aortic Valve: is trileaflet - mildly sclerotic - no aortic stenosis - no aortic regurgitation (Great...mildly erotic leaflets that don't make you throw up)
Pulmonic Value: not well visualized (maybe because they were the ones smoking drugs & had the dilated eyes, not me)
Pericardium/Pleural: no pericadial effusion (evidently, they weren't invited to the party)

The echo goes on to list a number of measurements and calculations, some of which surely could tell you how long the man has lived on the moon.  I knew I should've manned up & paid the cardiologist $50 for the Medspeak-English Dictionary.  I see the Lung Shaman next week.  He better have answers or I might have to break out the voodoo doll.

Wednesday, November 5, 2008

Yes We Can

Last night I heard glass ceilings shatter all across America; I felt a burden lifted from my shoulders; I sensed a change in the fundamental attitudes that have kept us pinned in the roles we were born into; I saw several American iconic figures brought to tears; I tasted tears of my own as I saw history in the making; I thought that my lifelong desire to see good overcome everything that would keep good from victory had finally come to pass, and I breathed without labor for the first time in two years.

Now that I know we can; I hope to live long enough to see that we did.

Tuesday, November 4, 2008

Foliage Wars

This week has seen a rise in physical activity if for no other reason than getting up to answer all the robo calls from political hopefuls.  (It seems an unpublished phone number is no obstacle to those who want to take advantage of the politically uneducated).  I took advantage of a feel good day to cut the grass for the last time this season and in the process blow all the fallen leaves to the wood's edge.  My wife has this thing about leaves.  I guess you might call it a pet peeve.  To me, a yard full of fallen leaves is but a sign of the season.  To her it's like having a sink full of unwashed dishes. The siege towers that gave us a measure of shade and privacy in the summer now spew forth a profusion of optical debris. And when the foliage flies, she declares war.  She will spend an entire afternoon raking leaves, bagging them up, and dragging them to the curb for removal.  She has already blown up the leaf blower we bought just 3 years ago.  Now I have been recruited to help in the fight, an army of two if you will.  By riding the mower, I can theoretically help stem the tide of the enemy.  I think for a moment about using gas prices as an excuse but the serious look in her eye tells me that I'm better served to save that for a winnable argument down the road.  So the choices before me are to buy a leaf catcher for the riding mower, detach the side guard so I can mulch, or leave things as they are and just blow the leaves back to the forest's edge.  I choose the latter.  Catching the leaves and leaving them at the curb to be hauled off seems akin to sending your child off to military school.  Mulching them up may have a nutritious effect on the yard but I'm not crazy about having small oaks sprout up everywhere.  At least by blowing them aside they're still part of the landscape.   Sure the squirrels have to dig a little more for their nuts but Oreo appreciates having a bed of leaves to do her business.   I know you think I'm stretching a bit for justification but lets not forget the PH implications.  The only thing I know for sure is: I won't frown any more when I see a youngling clean their room by pushing everything under the bed.