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Saturday, January 14, 2017

A-Fib Monologues Deux!




Saw this yesterday evening on seinfeld rerun.....always loved it, but didn't quite understand it. From a real court case in Australia, and an early movie from Meryl Streep!
Saw the electrophysiologist cardiologist in El Paso on Thursday, and we will move ahead with the ablation procedure. The February schedule is not set up as yet, so they will call early next week to schedule me. These 2 guys just do a damn shitload of these and cardiac device implants. So, I will get in when I can. Not looking forward to the procedure itself or the first few days afterward, but will find out if I am on the right side of a fifty fifty coin flip. Would do it twice if needed, and if that didn't work, would be stuck just living with it. Sure miss running and weights as I am reduced to an hour walk each day.....but, such is life......gotta just do my best to accept the results and learn to roll with the punches........

Wednesday, January 4, 2017

The A-fib Monologues!

So on Tuesday January 3rd, I kicked off 2017 with an electro cardiac diversion. Fun stuff. They make you stupid, as apposed to knocking you out, and then stop your heart, hold a second, and then fire it back up. Felt the shut down, and the start up was like a mule kick. Deb brought me home, and about four hours from being shocked, I slowly started to rebuild the A-fib....a few short bursts, and within about three hours, right back to where I started.  Didn't sleep well last night as the two pad sites where they shocked me are burned and itch like crazy. You can see a nice outline of the two pads on my chest! Maybe they will try leaches next! What the hell. So today, I called to try and get the damn ablation scheduled. Instead, I have to go back to El Paso on Thursday the 12th to go over the diversion report, whatever the hell that means, and again discuss trying to get to the ablation. Feel trapped in a loop between two cardiologists and the wonders of medicare treatment protocols. Drives me freakin' nuts. As Terrible says, they have to create as many payment points as possible to get as much money out of medicare and humana as possible. Probably right. So I guess I will just keep walking every day and continue to take toxic medicine and try to keep myself from turning psycho when I see the ablation doc next. 
One of the crazy things about this experience, is that after reading the haywire heart, I blamed myself for those 800 or so races and 75,000 plus miles for being a primary factor in bringing this stupid crap on. While I was getting shocked like a monkey, Deb happened to post on facebook that I was in getting the procedure, and within an hour, every damn cousin from Di Mannen, Jack Mannen, and Mary Mannen Doverspike posted that they have freakin' A-fib, or still have A-fib. They run the gamut from almost all who have had electro cardiac diversion or chemical diversion, and ablation. My younger cousin Dennis had both diversions, chose not to have ablation due to problems his sister Joan had from her femoral insertion site in 2005, and has been in permanent A-fib for over 20 years. And of course, my Grandpa Mannen had multiple strokes in his early 50's and died before turning 55, probably due to this family rhythm problem and the strokes it can produce. Awesome! So, no more kicking myself in the ass for my lifetime exercise history, as I was probably doomed to have this at some damn point, and I actually held out much longer than many of my relatives.....you just can't run and hide from your genetics.....

Wednesday, December 21, 2016

A-fib Diaries!


If the browns lose out, they could tie the lions as the only 16 game winless team in NFL history....quite an accomplishment!
I know it has been a while since a posting, primarily because I needed to educate myself before taking on this  topic. On Nov 7th, I went into persistent A-fib. Didn't know I was in it. Just knew something was terribly wrong with my pulse. I normally take about 20 minutes of running to get into the 120's on heart rate, and unless doing speed work, stay generally below 130. I would run a quarter mile and have a HR of 135, and a half mile later, 155. Had to stop and walk, and it wouldn't drop below 120 in recovery. Thought maybe I was getting the flu or something. On my 65th birthday, I was seeing my GP for the results of some tests and to redo scripts, and after doing an EKG, he immediately sent me over to a cardiologist who told me I was in A-fib. He did an echo cardiogram and said that I had both A-fib and arterial flutter. So both the right and left chambers of my upper heart were beating iradically. He immediately put me on xralta, a blood thinner, to reduce the risk of stroke. Since then, I have seen him and another cardiologist in El Paso, and researched my ass of about this condition. I have some congenital genetic heart issues that helped set this up. It is a progressive disorder that must be addressed, or it will take a good 5 years or so off of your life. The protocol ahead is as follows. I started a rhythm medicine yesterday that I will take for two weeks ahead of Electric cardio version that is scheduled for Jan 3rd 2017. At that time, they will attempt to use shock to restore my normal sinus rhythm. Odds of this working are almost 100 percent. Problem is, that staying in rhythm is incredibly variable. You can be back in A-fib before you even wake up, or stay in rhythm for a more extended period. Problem is that only about 12% of people stay in sinus rhythm a year out, because the causes of the A-fib have not been addressed. I will remain on rhythm medicine after the cardioversion. The bad part about these medicines is that they all have very nasty side effects, so you don't want to remain on them for too long a period of time. My treatment plan calls for catheter ablation about a month after cardioversion. This procedure places a catheter camera combination into a vein up into your heart where they attempt to burn about 40 sites in your heart to stop these aberrant electrical signals from interfering with the normal signals that run your heart. I jokingly call it the Peyton Manning effect....you are trying to stop him from yelling "Omaha Omaha" and trying to change the play. The procedure takes about two hours, and leaves you feeling like a horse kicked you in the chest. There is a period of three months where you find out if it worked or not. This is how long it takes for the scarring to settle in to stop these nerve firings. Chances are around 60% that it will resolve your A-fib. If not, you can have the procedure done again, and that usually gets you to a resolution of around 85-90%. If that fails, there is a surgical procedure called a mini-matrix process, and then ultimately failing all that, a pacemaker. So that is where I am at. No running or weight lifting for a while, just some daily walks. Feel trapped inside my own body. As the smashing pumpkins once sang, "despite all my rage I am still just a rat in a cage"!

Monday, November 21, 2016


Two weeks ago today, I got home from the gym feeling a bit odd. Chest was tight, and felt unusual. On the next day, I went out to run, and within 200 yards, my pulse on my garmin was around 134, and within ten minutes, over 150. Now normally on a run it takes me about twenty minutes to get my heart rate above 120, and I have to push really hard to crest 150. So I knew something was odd and I quit after about twenty minutes. I hit the gym a couple more times, and tried to run, but nothing was working quite right. On my birthday last Monday, I had an appointment to give blood and see the skin doctor, After I gave blood, I asked to see my doctor for a minute, and he saw me and I explained my problem, and he did an EKG. He scheduled me for later in the day for a visit to the cardiologist. When I got there, he gave me an echo cardiogram and said I was in persistent A-fib. Persistent means for longer than 48 hours. My upper chambers were beating three times as fast as my lower chambers. He put me on blood thinners to try and prevent a stroke, and scheduled an appointment for Nov 28th for another EKG, and if I am still in A-fib, will follow up with an electo cardiac diversion where they stop your heart for three seconds and then restart it to try and get your sinus rhythm back. This generally works almost all the time....the problem is that it doesn't necessarily last very long. There is an 80% chance that you will return to A-fib within an hour to a year. If that probability occurs, the next step, which is about 85% successful is ablation, where they put a catheter inside your heart and burn the nerves and tissue that are trying to take over your heart's normal rhythm like Peyton Manning yelling "Omaha Omaha". If I need that procedure, there are two places in the world that do the most.....Penn hospital and Cleveland clinic. I will head to Philly and Billy and Kwonnie for the procedure. I have two issues that make it doubtful that the A-fib will remit for long after diversion.....my left atrium is 6.2 centimeters, and when it grows over 5, A-fib usually arrives. Second, the right side of my heart is small either from congenital reasons or having rheumatic fever as a child. In the mean time, taking short walks, eating my blood thinners, and just taking it generally easy until I get shocked to life. Will be on blood thinners for a month after the procedure, whatever the outcome. If the A-fib returns, want to get to ablation as soon as possible, as the longer you screw with this, the more your heart tries to model in such a way that these signals are perceived as normal.....want the Peyton of my heart to also retire!

Sunday, November 13, 2016

Testosterone Blues!


When I was a child, I did not naturally go thru puberty. I was delayed, and the family doctor gave me androgen shots over 6 months to get me kick started. Add that to the fact I was younger than my school mates thanks to Rita pulling me from kindergarten and plugging me into first grade early, does explain some of my dislike for high school. But I digress...
I was always tall and thin as an adult, and picked out an avocation that matched my genetics.....distance running. When I got into my late 50's, I felt fatigued often and my running and general activities started to just seem tougher to do. My doctor over a few years tested everything from vitamin D, thyroid, B12, etc without much success. Finally, at age 59, he tested my testosterone level and told me that I had the testosterone level of a 7 year old girl. At that time, the only testosterone replacement therapy that was approved thru my insurance was testosterone cypionate injectible.....one 200mg vial every two weeks via injection. So Deb and I learned how to inject, and usually she would inject me in the butt, or if she wasn't around, I would just inject into my quad. Not a biggie, and certainly not much of a hassle. For the first 6 months that I was on it, everything from my mood to my physical performance improved, and that has remained fairly steady to date.
When I was selecting my prescription coverage thru one exchange, there were three that covered testosterone injectable solutions, and the cheapest and largest was silver scripts. So that is what I chose. On Wednesday November 2nd, I went into Las Cruces to see my regular doctor who had moved last summer from Deming to a practice there.  While driving in, I got a call from his office that he had called in sick and that I would be seeing his partner. So I saw his partner and provided him with the 5 medications I take, and he called them into Walgreens for me. When I went to get them, the testosterone was not included. I called the insurance company and they said that this particular prescription needed "prior authorization", which is a fancy was of saying we don't want to cover this unless you  are willing to jump thru a shitload of hoops. I had Wallgreens fax the doctor's office three times before his staff said they finally had it, and then they gave it to the doctor. When he contacted silver scripts, they said they needed blood work to prove that my free testosterone level is below 300 before they would approve it. So now on monday, my birthday, I will be going in early to give blood  before Deb and I see our skin doctor to get checked for skin cancers. Then we will shop and have dinner at a Thia/Vietnamese restaurant. Now, if silver scripts screws with me too much, I checked and I can change script coverage at any time. But, hassles will ensue. My last shot was on Wednesday October 19th. I felt fairly normal thru last weekend, and then on Tuesday, my body started to go thru some crazy shit. It started with palpitations, incredible fatigue, headaches, and just a foggy feeling. Trying to run is crazy.....at easiest pace, my heart rate is about 25 beats per minute higher, and I have not tried to run more than 30 minutes. My heart rate remains high for about two hours post run. Gym is a joke. So I did some researching, and like many other medications, you are never supposed to stop testosterone cold turkey, and if you are stopping, there is a medication you are supposed to take to try and get your gonads firing again. Mine were not working much 5 years ago, and may be dead by now. who knows. So, I am trapped by my insurance problems, and may have to see an endocrinologist and get new insurance before I get this resolved. I was so happy when I was going on Medicare cause I thought I could start to get my spine issues checked and maybe resolved, but instead I have taken two steps backwards, and have to get this resolved before I can move forward. On a brighter note, I was able to do the "poop in a box" test for colon cancer, and those results should be to the doctor within the month......

Monday, November 7, 2016

200 Lbs. For Four Reps!


My favorite machine at the gym...got up 200 lbs for 4 reps today. also went heavy on everything else I did, including doing 30 reps on the roman chair back extension exercise holding a ten pound plate. Slow and steady.....
Ran 9K on Tuesday including a twenty minute tempo interval at 10K race pace. Thursday I did 8K including 5 three minute intervals with only one minute recoveries, with each interval faster than the previous, with the last two at 5K race pace. Saturday ran 12K easy, and Sunday an 8K recovery run for a 37 kilometer week.
Had my first doc appointment under medicare.....my doc called in sick, and I got his partner that I am not initially impressed with. Also the support staff has lost two faxes sent on Thursday and Friday, so I am still without two prescriptions. Did get my "poop in a box" kit delivered by UPS today, so will eat big today and give them a nice sample tomorrow to test for cancer and pre cancer.. Otherwise, just keepin' on keepin' on.....

Monday, October 31, 2016

Medicare For The Old Codger!


Ever the optimist!
In just nine hours, I am finally on Medicare. Couldn't be happier! Lots of things to get checked out...spine first, colon, skin cancer, etc. See my regular doc on Wednesday, and my skin doc on my birthday. Besides scripts, will request an order for an MRI. Don't know for sure that I will necessarily do anything about it if there are identifiable problems, unless there are arthroscopic solutions...no fusions at this time! Running reasonably well, so long as I keep it limited in mileage and focus on at least two days a week of intensity, and weights are going just dandy. Got 190 up 5 times on the bench today. So, just keep on keeping on!