My brother Henry died four years ago today on April 6, 2018. Here he is with my father and mother.
My brother, kind of nerdy, with the pen in his shirt pocket, and my father, with his Indian belt buckle. I still have that buckle.
This photo was taken probably some time in the early 1990’s or even the late 1980’s. Henry’s hair had not started to turn white. I’m not sure when it was taken, but it was before health problems started making it harder for everyone to smile.
I have written before about how hard it is for me to internalize the loss of my family. When I look photos like this it feels as if they are pictures from a particularly engaging novel or movie, not something that was an actual part of my own life.
But I also feel like they are still here. Henry especially. So it’s two worlds, one where they don’t exist, and one where they do.
I have said that I think (believe? hope? maybe?) that the past actually exists, out of our reach, of course, but still there, if only we could invent a time machine. When I think of my family back there, it’s like seeing into the past, but with a dirty, vignetting telescope.
I suppose the only good thing is that I remember them they way they are in the photograph, not the way they were right before they died.
I think I have mentioned before that our newer dog Zoe is very vocal. She is at her most vocal at dinner time, specifically, while I’m preparing her food.
She is fairly quick to learn commands, at least some commands, but I haven’t figured out a way to make her hush.
As I said in my previous post, my most recent routine visit to my cardiologist and the purely-a-formality electrocardiogram found that I have, or possibly had, an inverted t wave, about which nothing good can be said. The PA didn’t go into detail other than to mention ischemia, so, like all normal people, I immediately went home to do an online search. What I found was enough to keep me worried until I had my echocardiogram, which was last Wednesday, a week ago from the date of this post. I continued to worry, until, finally, on Friday, a person not the PA or the cardiologist called to report the results.
She said my heart function was normal, which I was glad to hear. And then she said my shortness of breath was probably caused by my Covid infection. At that point I started saying, “Wait a minute, wait a minute, I haven’t had Covid and I didn’t complain of shortness of breath!”
There was some confusion on the other end, pretty much matched on my end. She promised to find out what was going on. I was pretty sure I had just been given someone else’s ECG results. I had some hope of hearing the rest of my story later on Friday, but that didn’t happen. So I was able to continue to worry through the weekend.
On Monday, I heard from the PA her own self. She told me that somehow someone somewhere had written my results on someone else’s record, or possibly someone else’s results on my record, but in any case, whatever anyone told me earlier was no longer operative.
Then she told me my results. My ejection fraction had actually improved from the last ECG I had about eight years ago.
The ejection fraction is a measure of how well the heart pumps blood out of the left (or possibly right) ventricle. As I understand, it is the ratio of the chamber volume when it contracts to the chamber volume when it is relaxed. Or possibly the ratio of the areas of the ECG image of that chamber under those conditions. But, whatever. Normal is 50 to 75%. “Borderline” can range from around 41% to 50%. When I first found out about my heart problem back eight or nine years ago, my ejection fraction was about 35%, which is definitely low and indicates a good (or possibly bad) chance of early, heart-related death. The next ECG several months later showed an ejection fraction of 45%, which was sufficiently good that my cardiology team was reduced from two doctors to one, and I began a series of routine yearly visits to the cardiologist. My future looked bright, or at least longer.
So now my ejection fraction, as measured just last week on me I am pretty sure, is 50 to 55%, which is low normal. The PA had no explanation for an inverted t wave with no symptoms or other associated measures of heart function. “Transient,” she guessed. Good enough for me. I will stop worrying about my heart for the time being, and I hope everyone else can stop worrying about my or anyone else’s heart.
We have had a run of luck lately. Unfortunately, it has not been good luck.
I have mentioned that Leah has had a long-term problem with back pain, even after her spinal fusion back in July of last year. So, there’s that.
And then on a rainy evening in early February, I dropped her off at the entrance to the Walmart where we get our groceries, and went to park. That was not the bad luck. What happened after she went into the store was the bad luck. When I came in, she was sitting on the floor next to the shopping carts, holding her left arm and crying. She had slipped on the wet floor. So, she took an ambulance ride to the emergency room. The ER didn’t seem busy from the front entrance, but apparently appearances can be deceiving. There was no room in the ER; she spent the next several hours in a bed in a hall. That’s Covid for you. Plus vaccination hesitancy.
An x-ray showed a fracture in the upper left humerus, close to the attachment points for the rotator cuff. A later CT scan confirmed that. We saw an orthopedist two days later. He recommended against surgery because, he said, he couldn’t get a better result than letting her arm heal on its own. So Leah has been wearing a sling on her left arm 24 hours a day since February 2. Even worse, Leah is left handed.
Now, my turn. I have been seeing a cardiologist for the last eight years. Back in 2014 my heart got kind of irresponsible and decided to take a vacation. I had an irregular heartbeat and a low ejection fraction. The ejection fraction is a measure of how efficiently the heart pumps blood. I was right at the edge of needing an implantable defibrillator. I decided not to let my heart get lazy, so I started exercising on a stationary bike. When I went back for a follow up a few months later, a second exam showed that the irregular heartbeat had disappeared and my ejection fraction had recovered. The doctor had no idea why. He suggested that I might have had a viral infection, which, as it turns out, can attack the heart. But anyway, I have been seeing the cardiologist once a year ever since. At one point he said he didn’t really know why he was seeing me any more. That’s what I told everyone.
I went in for my routine, pointless follow up last Wednesday. They did an ECG as usual. And the ECG showed an inverted t wave. As you might guess, nothing good can come from an inverted t wave.
My inverted t wave is not as deep as in this image, which might or might not mean anything. As my luck would have it, this appointment was the first in all this time that I saw a PA instead of an actual physician. The PA didn’t offer much information on the implications of inverted t waves, so, of course, I looked it up online when I got home. That’s where I learned that nothing good can come from an inverted t wave. I won’t bother listing all the bad things it can indicate.
I did find one study that found no increased deaths from heart-related problems associated with inverted t waves in leads V1, V2, and V3. But I didn’t know to ask which leads had inverted t waves when I had the chance.
I am scheduled for an echocardiogram on Wednesday. That’s the test that shows the ejection fraction. It compares the volume of the heart chamber before and after it contracts to pump the blood, and the ratio of those two measurements is the ejection fraction. A friend who has had his own heart problems said that the echocardiogram machine itself calculates the ejection fraction. It might actually show it on the screen in real time. I’m going to ask to see the screen as the test is done, so maybe I won’t have to wait for another appointment with the cardiologist to get the results.
I suppose the one possible hint of a ray of hope is that the PA made my next appointment for next March. I assume I will get one sooner if the news is bad.
Based on my online research, and possibly on my own experience, exercise can improve heart function for someone with a low ejection fraction. Unfortunately, I wore out my stationary bike, and the elliptical stepper I got to replace it makes me knees hurt, so finding the right cardio exercise routine is going to be harder than the last time.
I’m not sure whether we have had enough bad luck that we can expect a run of good luck next. Maybe it’s time to buy some lottery tickets.
We had to put our cat Dusty down Wednesday evening.
Dusty showed up at our previous house sometime around 2006 with his mother and two siblings. We gave one of the siblings away, but ended up keeping two. The trio became Chloe, the mother; Rusty, the sister; and Dusty, the brother. Rusty died a few years ago from feline immunodeficiency virus.
Dusty was diagnosed with lymphoma last week. His mother Chloe had been diagnosed with the same disease a couple of months ago. She had been eating like a pig but losing weight. The vet gave her a steroid injection, and it helped tremendously. She got a second shot just a couple of weeks ago. And then we noticed Dusty was not eating well, so we took him in. Same disease, and same shot. But the shot did not work for Dusty. A couple of days ago he became lethargic and refused his food. It got worse. On Thursday it was bad enough that we were going to take him to the vet, but I was tied up taking my aunt to the dentist. It was too late to take him in that day.
We considered taking him to the emergency veterinary clinic Tuesday night, but held off. Then Wednesday he was even worse. A doctor’s appointment kept us from taking him our vet, so we took him to the emergency clinic around 7 pm. After the examined him, they told us he was in the process of dying. We already knew that. So we made the only decision we could.
Dusty was probably the most even-tempered of all our cats. He tended to mind his own business. He didn’t roam, and he almost never had disagreements with the other cats. He was a little timid around me, less so around Leah. Like most cats, he spent a lot of time napping.
Sometimes he slept on the top step.
Sometimes his choices of places to nap and napping posture were comical.
His relationship with his mother was reasonably close.
This was taken a few years ago. More recently they tended to sleep in separate houses. A few days ago Chloe started sleeping with him again. Leah thinks Chloe knew something was wrong with Dusty.
We brought his little wasted body home, but it was too late to bury him. Tomorrow afternoon, after the rain stops, I’ll put him near Zeke and Lucy.
We know that Chloe will follow before too long. She’s doing pretty well now, but lymphoma is a death sentence.
Copyright 2013 Mark V. Paris
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