BUT WHAT HAPPENS IF THE FAX IS BROKEN? – Marilyn Armstrong

In case you haven’t noticed, doctor’s offices rely heavily on faxes to get prescriptions to the pharmacy. Although that has always left me a bit twitchy — personally, fax machines and I get along about as well as my printer and I get along, which is to say, not well — I have come to assume they know what they are doing.

I know, for example, that my doctor’s office is very good about getting prescriptions done quickly. If I call in the morning, the pharmacy usually has the script ready to pick up in an hour or two. Considering I pretty much left my last two doctors because they couldn’t seem to get a prescription ready inside of a week, I consider this amazing.

Windy day in a parking lot

Since two important prescriptions were canceled last week due to unavailability and we are planning to be away on vacation next week, I’ve been trying really hard to get all this stuff worked out. There really isn’t anything crazier than realizing your script ran out and you’re miles from your pharmacy.

I got the prescription worked out for the pain medication over the weekend. Not only did I get a prescription, but it works a lot better than the previous one. I actually wake up in the morning feeling like I can move. Not very fast at the moment because my left knee is pretty dodgy, but the rest of me feels almost like … well … normal. I didn’t think it was possible!

As for the Adderall gone missing, it’s all CVS’s fault. Through some accident — I’m serious about this, so laugh all you want — they ordered ALL the Adderall. All of it. So if you don’t shop at CVS — I don’t because I can go to Hannaford and get a prescription immediately — while it’s always a half an hour wait on a long line at CVS. For just about anything.

But honest to god, that’s what the doctor’s office told me. So all the smaller pharmacies are completely out until the next order. You think maybe CVS did it on purpose?

Eventually, we got this worked out. I’m getting double strength pills and I just have to split them. I already split some of my BP meds, so it’s no big deal … but I had a lot of weird mental issues about CVS ordering ALL the Adderall from the manufacturer. They must have tons of it. Literally tons.

The problem with my regular doctor was far more peculiar. I called, said the medication had worked gangbusters and I was really happy with the replacement and they said they would ship the fax over immediately.

But the pharmacy didn’t have the fax. I called again — both doctor and pharmacy — and the doctor’s office sent another fax and Hannaford didn’t get it.

Because, as it turns out, the fax machine was broken.

Some of the ladies who work in the front office are not tech savvy. They manage to deal with computers, but they always look emotionally and mentally strained. They are sure — always — that something is going to blow up.

I’m very patient with them. They are nice women and work hard. Not everyone does well with electronics, even very smart people. I can do almost anything with a computer but put me in front of a printer or fax machine and my brain dies.

Photo: Garry Armstrong

Their fax machine was broken. That’s why Hannaford didn’t get the fax.

Apparently, they didn’t know anything was wrong until they started getting calls from all the pharmacies in the area that prescription faxes hadn’t arrived. Putting two and two together, they got at least 22. Most of the pharmacies agreed to take the orders by phone — just this once. I guess now they are going to have to (gasp) buy a new machine. Hook it up. Convince it to connect. It’s probably wireless and will only work when it feels like it.

Just like my printer.

So I spent almost all day on the phone because the fax machine in the doctor’s office is broken and they didn’t know it. Apparently, the people at the pharmacy worked through the problem with them.

And meanwhile, my glasses are ready to be picked up tomorrow! Yay! Are things finally beginning to run a little more smoothly? Will we make it to vacation alive? Tune in!

FACTORING IN THE TEST RESULTS – Marilyn Armstrong

FOWC with Fandango — Factor

So my test results came back. After I did a full translation of virtually every word in the report — I’m pretty good with medicalese, but this was way above my pay grade — I discovered that considering my age and stage of life, I’ve got functional, but not perfect arteries. If you want to factor in all the tests that were run initially during my first visit to the neurologist — and then this new set of tests — we know that I’m getting on in years.

Which is exactly what we knew before. We do not know if what the tests found to have anything to do with the visual symptoms. They could be connected, but they could also be entirely separate with no connecting thread. And worse, there’s actually no clear way to address the matter. It’s not like there’s a book which gives answers because what’s bothering me aren’t the symptoms for any known disease or condition or illness.

Thus I know what I knew when I started this process. I was afraid this would be the result and why I didn’t want to begin the process. It’s “non-result.”

A lot of information has been collected,  but are any of these results related to the symptoms? I’m not even sure why I started this process in the first place except that I felt I had some kind of obligation to find out if it meant something — or not.

“Or not,” seems to be the answer.

I’m just as worried (but more confused) than I was at the start. I’m overloaded with information that doesn’t mean anything to me. I suppose — or at least I hope — that this will make more sense after I see the doctor next week.

With all the advances we’ve made in medicine, in the end, a lot of it is more like art than science. Maybe someday it’ll be just like “Bones” on the Enterprise. Just use that little tricorder and poof! Diagnosis, cure, and life renewed.

I’m waiting. Aren’t we all?

VEINLESS – Marilyn Armstrong

FOWC with Fandango — Trickery (OR in this case, just tricky!)

Another day, another trip to the hospital. At least it’s something I WANT to do this time, but I will be gone most of the day. Sorry about that!

I was supposed to be at the hospital yesterday, but they got my tests mixed up, so it got canceled. The same tests, this time properly ordered, will be rescheduled next week.

It all has to do with veins and dye infusions.

I don’t have any veins.

Well, that’s not exactly true. I have lots of them, but they are all tiny and thready. Getting blood out of me is tricky (trickery?). I have often suggested I bring my own knife and slice off a piece of finger like I do at home. Just give me a vegetable to cut and I’ll produce gallons of blood.

Brivo CT325

Whenever I do that (which used to be often), there was blood absolutely EVERYWHERE. For some reason, the hospital never agrees. As I said: getting blood out is just a bit of trickery (and some nurses really have a magic touch for finding a viable vein) — a medical magic trick.

Getting a substance (any substance) into me is a nightmare. I have defeated two hospitals who could not find a usable vein and wound up infusing into my throat. Which, while not terribly painful, is really ICKY in every meaning of the word. And it looks ugly, too.

In both cases, it was that or die so I couldn’t argue the point … but this is a test. The reason they need veins is so they can put dye in me to make the test results sharper.

They should get Topaz’ new AI Sharpen filter. It’s amazingly effective and then, they could skip the dye and still have sharp results.

Regardless, I’m not going through the “hunt the body for a viable vein” experience again. Been there, done it, didn’t like it. We’re not doing hands, feet, or throat, sorry. If that’s the choice, whatever is wrong with me will just have to stay wrong.

I still have to be at the hospital in a couple of hours because I’m getting cortisone shots in my hips. Yay oh yay!

For the past few weeks, there’s almost no part of me that doesn’t hurt and last night I woke up crying because I hurt so much I didn’t know what to do. So of course, called the doctor as soon as he was open and said: “I cannot go on like this.”

More drugs are not an answer I would have to take a LOT more drugs and I’m already thoroughly drugged. I have to find a way to make my life less painful. I want to be able to walk. Even if it’s not a hike, just walk more or less normally for short stretches. Not such a big thing one might think.

So cortisone shots it is. For now.

I know the shots are not a cure. What’s wrong with me (entire spine riddled with arthritis) is painful, but not lethal. It won’t kill me. It might make me wish it would and it will linger on, getting worse as the years roll by. Not a pretty thought.

I remember being 30 years younger, living on Beacon Hill in Boston and hauling 40 pounds of groceries up the long hill to our apartment. Realizing my legs were like iron. I was muscled. Between hauling heavy bags up long hills, horseback riding, and walking everywhere in Boston because if you moved the car you might never find another legal parking space, I was in great shape.

The shoulder is an offshoot of horseback accidents. When you are riding, one of the things you learn is if you fall, hang on to the reins. If you don’t, your horse is going home. It’s a long, long walk in your riding boots back to the stable. It’s entirely possible you don’t even know the way back since as often as not if you are riding alone, the horse was your GPS.

In the course of falling off a few horses and grabbing reins on the way down, my shoulder got pulled out of the socket a few times. The surgery to fix that is normally not a big deal.

I should have taken care of it 50 years ago, but I didn’t.

I also have a left knee without an anterior Crucis ligament due to a bad fall — as well as the shoulder which could have easily been repaired when I was 25, but can’t be fixed now.

I waited too long. Like I did with my hands. Nine years ago they could have fixed the arthritic spurs but today, they can’t. It has advanced too far and I’m too old.

I yearn for those days when I had muscles in places I didn’t know you could have muscles.

I don’t have long-term answers. Cortisone shots a few times a year with some luck will help keep me moving. Nothing will repair the damage. There’s no surgery anyone is willing to do that will fix it. It has degenerated too far and the previous surgery caused as much damage as it supposedly fixed.

Right now, though, I’m glad enough that there’s even a respite — even if it’s just for a few weeks.

Long term? I am still working on that one.

YOUR DOCTOR AND YOU – Marilyn Armstrong

Today is the fifth anniversary of when I went into Beth Israel for my heart surgery. I had found my own surgeon by looking for the one guy who had significant experience repairing (rather than replacing) heart valves. Of course, I had no idea a repair was out of the question for me. For that matter, I had no idea what was going on with my heart at all. Other than breathlessness (which I attributed to asthma) I had no symptoms.

I had a local “heart” doctor who had told me I should wait until I had serious symptoms and then do something. It turns out that the typical first symptom of this particular ailment is sudden cardiac death. But regardless, I did have the definite feeling that my doctor was not a good choice and boy, I was really right.

Picking a doctor is difficult. We all have issues. Some of us prefer a woman or a man. Some want their doctor to be an older person. But most of us simply want a doctor who listens, cares about us. We probably also want an office where we can get a prescription taken care of quickly without a hassle. We want our doctor to be associated with a good hospital and other physicians who are capable in their areas of expertise.

Beth Israel Hospital in Boston.

I’ve had doctors who were great … when you could get to see them. I had one really wonderful doctor who seemed to be going for the “permanently pregnant” award. She was always out having a baby or on maternity leave and as her family expanded, her hours of availability diminished to almost non-existent.

The next doctor was good but had the worst front office I’ve ever experienced. They could never get a prescription written in less than a week, but they got the bills out in nano-seconds. She was also the one who sent me to the nearly lethal heart “specialist.”

I never could forgive her for that. If I had followed those instructions, I’d have died. Her circle of specialists was pathetic. Most of the ones with whom I had contact were a retread from a different specialty. They had minimal training in their so-called specialty and they gave bad advice.

After that, there was the guy who never listened to anything I said. I had the feeling that he didn’t think women were worth listening to. More to the point, Garry disliked him and Garry rarely dislikes anyone.

The office

When we found our current family doctor, it was like a light had gone on in a previously dark house. He’s young and smart and thinks differently. He’s not afraid to give me a prescription, but he’s careful about all the other stuff I take. He knows I’m in pain and he’s always trying to find something that might help. So far, we’ve come up empty. There’s not much I can take that’s safe.

It’s amazing how much help you can get from ice packs and heating pads.

So what about the Hypertrophic Obstructive Myopathy I was talking about and why am I going on about it?

Because it is genetic and often —  in 1 out of 2 cases –is inherited from a parent. It often fails to be diagnosed properly. Even when it is diagnosed, the diagnosing physician frequently fails to tell the patient his or her kids need to be checked for symptoms too.

I had no symptoms that I noticed — which is not the same as not having symptoms. If it weren’t for my primary doctor’s alarm at the sounds my mitral valve was making, followed by testing at Beth Israel, my life would have ended five years ago.

If I had waited, my only serious symptom would have been my sudden death.

If you have something wrong with you — maybe something serious or you’re not sure — and you think maybe the doctor treating you isn’t getting you, isn’t listening, isn’t taking you seriously — get another doctor or at the very least, another opinion.

It can be worth your life.

WORLD WITHOUT WI-FI? – Marilyn Armstrong

FOWC with Fandango — Wi-Fi

Although we have managed to remove cable television from our lives, you just can’t do without wi-fi. As a result, Charter/Spectrum’s wi-fi now cost more than their entire cable package used to cost. $76 for a $10 telephone and the rest, wi-fi.

For the moment. I’m sure it will cost more soon enough.

Considering that wi-fi is no longer a luxury for most people, maybe it’s time to set some controls on how much it costs? It used to cost $30, then $40, $50 and now, $65. Next year, the sky is probably the limit. I bet before we hit 2020, I’ll be paying more for JUST the wi-fi than I was paying for the whole cable package. And we only have ONE source here. We can pick Spectrum (Charter) or nothing. When you live in a small town, you don’t get lots of choices.

There are at least some regulations on electricity and other basic utilities. How about some kind of regulation for wi-fi?

Photo: Garry Armstrong

I’m going to be (again) at UMass today. Transthoracic Echocardiogram. I hope I’m in and out quickly, but you never know. It depends on what they see. I would much prefer they see everything ticking along like the proverbial clock.

It’s all “ultrasonic transducer.” At least something works without wi-fi! If they let me look at the pictures, I’ll be happy. I like it when I can see what they are seeing.

A GOOD NEWS-BAD NEWS KIND OF DAY – Marilyn Armstrong

Hypertrophic obstructive cardiomyopathy.

That’s what was wrong with me.

I had my heart surgery 4 years 11-1/2 months ago. As far as I knew, I never got an explanation of what exactly was wrong with me or what was done during the surgery. I didn’t know I had TWO valve replacements until a few weeks ago and I don’t know which artery was bypassed during my bypass.

To be more technical, the surgeon apparently explained everything, but I was so heavily drugged I’m not sure if I was awake for the explanation. I know I missed the whole thing about the second valve replacement because my best friend knew about it, but I didn’t. She wasn’t floating on Fentanyl.

The good news? UMass and Beth Israel are now connected so they can get my medical records. Eventually, it might sift down to me.

The bad news? My son needs to be checked for the same problem. His father died from heart-related problems as did both of his grandfathers and only luck kept me from sharing the same fate. So he has reason to be concerned about the condition of his heart. His father was only three years older than he is now when he died.

So, you ask, what exactly is “hypertrophic obstructive cardiomyopathy”?


From the Mayo Clinic: Overview

Hypertrophic cardiomyopathy (HCM) is a disease in which the heart muscle (myocardium) becomes abnormally thick (hypertrophied). The thickened heart muscle can make it harder for the heart to pump blood.

Hypertrophic cardiomyopathy often goes undiagnosed because many people with the disease have few if any, symptoms and can lead normal lives with no significant problems.

However, in a small number of people with HCM, the thickened heart muscle can cause shortness of breath, chest pain or problems in the heart’s electrical system, resulting in life-threatening abnormal heart rhythms (arrhythmias).


NOTE: I had no symptoms that I noticed — which is not the same as not having symptoms. If it weren’t for my primary doctor’s alarm at the sounds my mitral valve was making, followed by serious testing that I had done at another hospital because the cardiologist to whom she sent me suggested I not worry about it until I had serious symptoms.

In this case, the serious symptom would have been sudden death, so I’m glad I realized the man was a jerk and went elsewhere for care. Even after all the testing, no one had any idea how serious the problem was until I was already in surgery. At which point, it was oh so clear.


I did not have chest pains, but I did have serious
shortness of breath.

Since I had asthma, I assumed my shortness of breath was asthma acting up. But I was wrong. It was not asthma but my ventricle packing its bags and trying to leave home without me. This is one of the problems of having multiple issues. Symptoms can (and do) overlap.

It’s really easy to assume that the problem you’re having is something familiar — like asthma. Except — shortness of breath can mean many different things. Heart disease is only one of them.

I once badly misdiagnosed a dog who had a known problem, but her problem was not the one I thought she had but something else. She died. We never found out what killed her, even after an autopsy. We assumed it was Lyme, but we never got a firm diagnosis. Lyme is funny that way.

Moreover, I never imagined I had a heart problem because my father’s heart problem was asymptomatic. As mine was until suddenly, it wasn’t.


Symptoms

Signs and symptoms of hypertrophic cardiomyopathy may include one or more of the following:

            • Shortness of breath, especially during exercise
            • Chest pain, especially during exercise
            • Fainting, especially during or just after exercise or exertion
            • Sensation of rapid, fluttering or pounding heartbeats (palpitations)
            • Heart murmur, which a doctor might detect while listening to your heart
Causes

Hypertrophic cardiomyopathy is usually caused by abnormal genes (gene mutations) that cause the heart muscle to grow abnormally thick. People with hypertrophic cardiomyopathy also have an abnormal arrangement of heart muscle cells (myofiber disarray). This disarray can contribute to arrhythmia in some people.

The severity of hypertrophic cardiomyopathy varies widely. Most people with hypertrophic cardiomyopathy have a form of the disease in which the wall (septum) between the two bottom chambers of the heart (ventricles) becomes enlarged and restricts blood flow out of the heart (obstructive hypertrophic cardiomyopathy).

Sometimes hypertrophic cardiomyopathy occurs without significant blocking of blood flow (nonobstructive hypertrophic cardiomyopathy). However, the heart’s main pumping chamber (left ventricle) may become stiff, reducing the amount of blood the ventricle can hold and the amount pumped out to the body with each heartbeat.


Risk Factors

Hypertrophic cardiomyopathy is usually inherited. There’s a 50 percent chance that the children of a parent with hypertrophic cardiomyopathy will inherit the genetic mutation for the disease. First-degree relatives — parents, children or siblings — of a person with hypertrophic cardiomyopathy should ask their doctors about screening for the disease.


Complications

Many people with hypertrophic cardiomyopathy (HCM) don’t experience significant health problems. But some people experience complications, including:

            • Atrial fibrillation. Thickened heart muscle, as well as the abnormal structure of heart cells, can disrupt the normal functioning of the heart’s electrical system, resulting in fast or irregular heartbeats. Atrial fibrillation can also increase your risk of developing blood clots, which can travel to your brain and cause a stroke.
            • Sudden cardiac death. Ventricular tachycardia and ventricular fibrillation can cause sudden cardiac death. People with hypertrophic cardiomyopathy have an increased risk of sudden cardiac death, although such deaths are rare. Sudden cardiac death is estimated to occur in about 1 percent of people with HCM each year. Hypertrophic cardiomyopathy can cause heart-related sudden death in people of all ages, but the condition most often causes sudden cardiac death in people under the age of 30.
            • Obstructed blood flow. In many people, the thickened heart muscle obstructs the blood flow leaving the heart. Obstructed blood flow can cause shortness of breath with exertion, chest pain, dizziness, and fainting spells.
            • Dilated cardiomyopathy. Over time, the thickened heart muscle may become weak and ineffective in a very small percentage of people with HCM. The ventricle becomes enlarged (dilated), and its pumping ability becomes less forceful.
            • Mitral valve problems. The thickened heart muscle can leave a smaller space for blood to flow, causing blood to rush through your heart valves more quickly and forcefully. This increased force can prevent the valve between your heart’s left atrium and left ventricle (mitral valve) from closing properly. As a result, blood can leak backward into the left atrium (mitral valve regurgitation), possibly leading to worsening symptoms.
            • Heart failure. The thickened heart muscle can eventually become too stiff to effectively fill with blood. As a result, your heart can’t pump enough blood to meet your body’s needs.
Prevention

Because hypertrophic cardiomyopathy is inherited, it can’t be prevented. But it’s important to identify the condition as early as possible to guide treatment and prevent complications.

Preventing sudden death

Implantation of a cardioverter-defibrillator has been shown to help prevent sudden cardiac death, which occurs in about 1 percent of people with hypertrophic cardiomyopathy.

Unfortunately, because many people with hypertrophic cardiomyopathy don’t realize they have it, there are instances where the first sign of a problem is sudden cardiac death. These cases can happen in seemingly healthy young people, including high school athletes and other young, active adults. News of these types of deaths generates understandable attention because they’re so unexpected, but parents should be aware these deaths are quite rare.

Still, doctors trained in heart abnormalities generally recommend that people with hypertrophic cardiomyopathy not participate in most competitive sports with the possible exception of some low-intensity sports. Discuss specific recommendations with your cardiologist.


If this wasn’t a good news-bad news day, I don’t know what would be. The good news? All things considered, I’m doing fine. As far as I know, the valves are doing their valve-thing.

I’ve got 8 years — 5, realistically — before I’ll need a replacement battery. I also learned why I will never be able to live without a pacemaker. I had thought that maybe my heart would start doing the job all by itself one day, but that will not happen. But, assuming the rest of the tests next month indicate that all is well, I need to worry about my son, not me.

I think I’d rather worry about me.

If there is a moral to this story, it’s don’t self-diagnose. If you think something is wrong, don’t assume you have the answer. The odds are, you don’t. The internet is a good place to look up an existing diagnosis, but a bad place to get a new one. If it turns out your best guess was right, congratulations, but this is one of those times when an error can prove fatal.

I still think this problem wouldn’t have become such a life-threatening issue had I not also inherited my mother’s breast cancer. The drugs they feed you when you have cancer … well … I’m not even sure the doctor’s know what they do.

For the avoidance of goriness reasons, I decided you don’t need more pictures. You can always Google this yourself and see all the gore you want.

TOM’S CATARACT SURGERY – BY ELLIN CURLEY

Recently, Tom’s cataracts started to give him problems driving at night. He began seeing large halos around the headlights of the oncoming cars, which made driving a challenge. He went to the eye doctor who told Tom that his cataracts were ‘ripe’ and it was time to get cataract surgery in both eyes.

Now, no one looks forward to someone slicing and dicing their eyeballs, but Tom was borderline phobic about anyone touching his eyes. We had two close friends who had recently had the surgery and they both reassured Tom that they had felt nothing during the procedure and little if any discomfort afterward.

Tom listened to them but didn’t believe them on some level. So he procrastinated about scheduling the surgery – and procrastinated, and procrastinated.

When he finally scheduled it, he didn’t feel good about it. He worried more and more as the surgery date drew near and he reached a peak of panic the sleepless night before D-Day. On the ride to the surgery center, as well as in the waiting room, Tom kept repeating that he really didn’t want to do this. I began to worry that he might make a run for it.

Of course, Tom had to wait endlessly at the doctor’s office before he was finally taken in for the seven-minute procedure. So by the time he saw the doctor, his blood pressure must have been off the charts. Fortunately, along with buckets of numbing drops, they gave him some ‘good drugs’ to relax him.

I waited anxiously in the waiting room for an hour before he came out the other end. During that time, I saw a veritable parade of post-surgery patients, smiling in their identical pairs of unfashionable sunglasses. I relaxed as I realized that no one seemed freaked out or even stressed.

So I was not surprised when Tom reappeared, gushing about what a weird but not unpleasant experience it had been. As he had been told, he felt nothing but water being pumped into his eye. He saw strange lights and heard psychedelic music, which made it all feel like a mini acid trip.

Tom in his ‘cataract sunglasses’

Fresh out of surgery, his eye was blurry and totally dilated, and he felt like he had a grain of sand in his eye, but he could already tell how much better his vision was. Everything was brighter and clearer, especially colors. Tom said it was as if he had been looking at the world through a yellow filter and suddenly now he was seeing everything in vibrant, living color.

We bumped into an old friend in the waiting room who was coming in for the same surgery. Tom went on and on about how awesome his vision was now and told his friend not to worry but to get ready to be amazed at how colorful and sharp the world is.

By the next day the dilation was gone and even though only one eye was fixed, Tom’s vision was dramatically improved. He no longer needed his glasses for distance vision but will still permanently need reading glasses. Not a big deal. He also could see that our sunroom was painted bright blue, not green or teal.  And he was telling everyone what a miracle he had just experienced!

Tom seeing great without his glasses for the first time in decades

Now Tom can’t wait for the second surgery!