Tag Archives: doctor

What Annoys Jeff this Week?

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1. Water. The guidance from the medicos is to drink water and then when I think I’ve had enough water to go and have some more. That’s fine. Wonderful. But honestly, if you want me to drink 647 cups of water a day, water should actually have some kind of flavor. I never had any problem drinking copious amounts of tea, or coffee, or gin, but the common factor there was that all three of those things tasted like something instead of just existing as being wet and “good for you.” The amount of things I’ve spent the last nine months doing on the ephemeral promise that it’s good for me yet with no other obvious tangible benefit is honestly just a little bit horrifying.

2. Better living through chemistry. I’m still adjusting to the most recent medication changes. It seems that this round is all about reminding me of the virtue of incremental change, as each day I seem to feel every so slightly better than the day before. The first day or so of the change was downright insufferable and now we’ve moved on to somewhere between annoying and obnoxious. The head fog and general feeling of disaffection is absolutely real. I’m trying to go along and remember that it can take a month or more to really adjust, but frankly sometimes that month really just sucks and it feels marginally better to say it out loud for an audience.

3. All you can eat. I grew up in what I’ll always consider the golden age of all you can eat dining. Within a dozen miles from home we had a Western Sizzlin, a Western Steer, wings at every local fire department on various nights of the week, a Pizza Hut lunch buffet, and a whole damned salad bar at Wendy’s. There were buffets everywhere. I don’t remember them being particularly food safe but I remember them being tasty. I had a dream about a fictitious all you can eat joint that never was – a big neighborhood bar and grill that pulled out all the stops with everything from burritos the size of your head to every carving station imaginable. It was a happy dream… but as it turns out. I’m a little sad that my days of drinking there in this bar of my imagination are over (perhaps temporarily), but that my days of all you can eat are in all likelihood dead and gone forever.

What Annoys Jeff this Week?

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1. The limits of better living through chemistry. My doctors and I like to play a fun game. The goal of this game is to wait until I am just about feeling normal and then decide it’s time to add, take away, or otherwise screw around with one or more of the medications I’m taking. The whole thing seems purposely designed to leave me feeling vaguely disoriented, tired, out or sorts, and anxious as often as possible. As we are closing in on a year of this abject medical fuckery, I’d hoped we were a bit closer to reaching some kind of steady state with all this. So far, however, that doesn’t seem to be the case.

2. Eternal cold. I’m approximately 2/3’s the man I used to be. Apparently all of that represents lost insulation and I am, therefore, always uncomfortably cold. I’m forever wandering around the house putting on additional layers. I have extra fuzzy coats at the office. I have four layers of blankets on my bed. Every seat in the living room has at least one blanket… and I generally use multiple while watching TV in the evening. File this as yet another problem that I foolishly assumed would somehow be resolved by now. It’s very strange not having any idea what was the last time that I really felt warm. I didn’t realize it was something I was taking for granted.

3. Streaming television. The number of people who look at me like I have 16 heads when I tell them I still subscribe to old fashioned cable television is pretty astronomical. I get everything from stunned disbelief to pitches for satellite, antenna, and every streaming platform under the sun. The truth is, aside from cost, I’m basically satisfied with cable. There’s one “box” to deal with and every program it supplies is available with the push of one or two buttons. My user experience with streaming services has rarely been so seamless. Whether it’s updating passwords, constantly switching between apps hunting for the generic “something to watch,” or some episodes of a series being available on one service while other episodes are on another, or the sheer cost of building out an array of stream services to match the programming natively available through cable. Most of my television “watching” is in fact, listening to television in the background while I do other things. Cable excels at performing this function. It simply doesn’t require any thought at all as something is always on when you push the power button. Sure, I’ll keep rotating through the myriad of streaming options as I slowly consume their “prestige television” contenders, but I don’t see any world where I’m happy with seven or eight streamers attempting to replace or replicate the proper channel surfing experience. I’m sure streaming is a brave new world for others, but for the foreseeable future, I don’t see it being much more than an add on for me.

Bait and switch…

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Back in July of last year, when the medical appointments were coming fast and furious, the doc advised me to, among other things, drop 100 pounds. I weighed in at 330 that morning. I can’t argue that I hadn’t been carrying around too much weight for too long. 

At last week’s follow up, I tucked in about 8 pounds short of the goal. I was feeling reasonably proud of myself for not immediately reverting to old habits the moment I started feeling a bit better. 

That’s when the old boy did a bait and switch on me. 

I know we talked about an even hundred, he said, but I want you to take it down another 30 from there. 

Two hundred pounds flat is where they want me now. I’ve been trying to play along with all this like a good little trooper, but fuck me. 

I was close enough to taste a meal that didn’t have to have every ounce of joy sucked out of in an effort to stay under an 1800 calorie daily limit while not being ravenous enough to ponder gnawing off my own arm. And then they moved the fucking goalposts. 

I woke up this morning with 33 pounds left to drop instead of the 3 I was expecting. Bet I’m not just a little bit salty about that.

What Annoys Jeff this Week?

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1. Plant based. I like my GP. I’ve been seeing him since I returned to Maryland and in that time I’ve never felt rushed or blown off. As I’ve started losing weight though, he’s gotten a bit fixated on the “value of a plant based diet.” I’ve had to remind him repeatedly that I’m not in any way on the cusp of going veggie. I like beans and lentils well enough, but not as an absolute substitute for proper meat. Chicken features prominently and I’ve dramatically cut down on red meat and pork, but I need this guy to come to terms with the fact that every so often I’m going to have a cheeseburger or a good slice of roast. I’m willing to compromise and adapt, but I’m not entirely forgoing the best things in life indefinitely. Otherwise we’re not so much prolonging my life as just making it feel longer while every ounce of pleasure is sucked out of it.

2. Egg whites. I like eggs and used to eat a lot of them. A three or four egg omelet wasn’t unusual for breakfast. Because of the seemingly unsettled science of dietary cholesterol I’ve made an effort to cut back to just 3 or 4 eggs a week. But, they say, you can use egg whites and miss the cholesterol completely. Sure. I tried that. It’s hard as hell to turn egg whites into dippy eggs though. Egg whites make the worst egg salad I’ve ever put on a plate. An egg white omelet. Hard pass. I’ve given it the college try but I’m so very much not impressed with cartoned egg whites. They may be “better for you,” but in my estimation they’re not worth needing to clean the damned skillet.

3. Star wars. When I was a kid, one of America’s great presidents stood up and proposed a Strategic Defense Initiative to shield the United States from Soviet nuclear missiles. Never mind that the technology wasn’t there. Never mind the incredible cost to deliver it. Never mind that it would take decades of research to deliver on the promise of securing America from the ballistic missile threat. The very existence of SDI made the Soviets absolutely nutty and helped send them into a spending spiral from which their already questionable economy never recovered. So when, in 2024, I hear vague news reports of Russia wanting to put missiles in orbit, all I hear is history rhyming. I still like our chances of being able to spend this new Red Menace into oblivion if it comes to it.

What Annoys Jeff this Week?

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1. Insurance. For the most part I have had very good luck with my health insurance provider. Presently, though, they’re picking a fight over the bill for the 30-day heart monitor I got to enjoy last year. “Not medically necessary,” they say, though the cardiologist who called for it seems to disagree with their assessment. Just now I haven’t been billed for anything yet, so I’m on the sidelines while Phillips, my doctor, and Blue Cross throw shade at each other. I assume at some point they’re going to fling a $9,000 bill at me just to see if maybe I’ll pay it on spec. Being a professional bureaucrat, though, I’m entirely prepared for whatever paper drills may come. Hopefully, though, this doesn’t devolve into a full-blown pain in the ass… but I’m not overly optimistic.

2. Clothing. I almost never have a reason to do something like put on a dress shirt or, god forbid, a suit, but almost isn’t never. What I’ve discovered this week, while raiding my closet looking for something to wear is that even the suits I held over from my long ago time working in DC no longer fit. In fact most of them have me looking like a kid trying on his father’s clothes. One or two of them might be salvageable, with a tailor who knows their business, but otherwise, I’m going to have to go shopping for clothes… and there’s honestly no variety of shopping I want to do less.

3. Congress (and the average American). If it weren’t tied directly to my ability to make a living, watching the ongoing fuckery that is the United States Congress would be entertaining as hell. There seems to be no hope of passing a budget. Republicans in the Senate just shot down the most conservative border security bill proposed in my lifetime. Republican leaders in the House of Representatives can’t manage to muster votes from their caucus to do… well… anything at all. It’s certainly the most dysfunctional government I’ve lived through – and it has no real signs of improving any time soon. But, we’ve gotten the government that the American people, in their wisdom, have voted for… which I suppose just goes to prove how deeply stupid the average American is.

On normalcy and not hitting the panic button…

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For as long as I can remember, every medical professional I’ve encountered told me that I’d feel better if I lost weight. Having lost a not inconsiderable number of pounds, I think they may have sold me a pig in a poke. The fact is, as far as I can tell, I don’t feel any better in February 2024 than I did in February 2023. How much of that is reality versus looking backwards with rose tinted lenses, I couldn’t tell you with any degree of accuracy.

I can say with some confidence that I’m feeling better today than I have since the end of June when all my latest health fuckery kicked off. I’ve worked myself off of being medicated for diabetes. I suspect the next time I see my GP, I’ll be instructed to start back off blood pressure meds. The anxiety, which at times was just about debilitating, has receded into a background hum which mostly crops up when I have the occasional odd ache or pain or when some vital sign pops off with an outlying reading.

Since none of my extremely well credentialed doctors seems to be concerned beyond “continue to monitor,” trying to get my head into a place where I don’t hit the panic button on a daily basis is probably the right thing, but it’s been challenging. Being someone who as a child was perfectly capable of worrying himself sick, this is a bit of a work in progress.

Even if none of that were true, I know I’m feeling better than I was in the summer and fall because my reading pace is picking up. Instead of sitting here in the evening holding a book and idlily flipping pages and being entirely distracted, I’m actually reading, comprehending, and burning through pages. My attention span is coming back. I’m intensely grateful for that… it’s been a long time coming.

What Annoys Jeff this Week?

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1. Heartburn. You know what you should definitely throw at a guy who’s trying very hard to get his cardiac health improved? A sudden onset burst of god awful heartburn, that’s what. Because there’s no chance at all that would trigger 17 bloody flavors of panic and hundreds if not thousands of dollars in fun new medical tests and their corresponding bills. This week proudly continues 2023’s ongoing effort to be marked out as the worst of my 45 years… so far.

2. Samples. Well, the do it yourself stool sample package they sent me home with in hopes of ruling out a stomach ulcer and more or less confirming acid reflux has definitely unlocked a new level of disgust. It also reminded me that modern medical science is apparently not nearly as far away from reading entrails, casting bones, and balancing the humors as they like to think they are.

3. Fall yard work. It’s not so much that it’s a lot to do as it is that fall yard work is just bloody continuous. In the summer, I cut the grass once a week and trim every second week unless it’s growing unusually fast. In the fall, however, the minute I’ve finished mulching up leaves and blowing what can’t be mulched, the yard is every bit as covered as it was before I started. Yes, I know this was a self inflicted wound when I decided to live in the woods, but still it’s just a little bit maddening.

What Annoys Jeff this Week?

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1. Results. I’m a reasonably intelligent man with a fairly analytical mind, but I’m at a loss for what to do when results from something like an MRI drop into my online patient portal long before my doctor has a chance to look at and comment on them. As wide as my academic interests are, it’s never ranged as far as internal medicine, so the reports end up being a lot of gibberish with lines, arrows, and color codes that mean precisely nothing to me. That, of course, doesn’t prevent me from using Google to try gleaning a bit of understanding… which never results in anything other than low grade panic or mild confusion. I can’t believe I’m saying this, but I almost miss the olden days when the doctor received the report and the patient didn’t know dick about it until the medical professionals called to explain what’s what. I’m not at all sure this current model of complete transparency is helping me in any way.

2. Retirement. In my little slice of Uncle’s big green machine, there are 3 people who do more or less what I do. We’ve been a decent little team for the last half a decade or so. One of the three (lucky bastard) is retiring in a few days. His backfill is nowhere in sight. With three people, in all but the most extraordinary circumstances, we could work around everyone’s schedules and keep the trains running on time. With two, well, I’ve already identified two days that’ll be listed with “no coverage” in the next two months. That number will explode when the other guy adds his scheduled time off to the mix. All of that’s before we’ve even talked about the week or two gap for Christmas and New Year’s. None of those issues should be surprising. We’ve been warning the bosses about it for months. But not to worry… there’s allegedly a “temporary” fill-in coming and the bosses are going to hire a permanent replacement with all the speed and agility the U.S. Government is famous for displaying. With the pace at which the bureaucracy moves, I don’t expect to see either of those things happen until well after the new year, if ever. The only thing I know for sure is that for the foreseeable future, there’s going to be 24 manhours per day of work to do and only 16 manhours of personnel on hand to do it. The math, as they say, just doesn’t math. I know I won’t magically be doing an extra 4 hours of whatever every day, so I reckon the powers that be should probably get prepared for a diminished baseline of productivity and discovering that they’re just going to have to wait until we get around to some things. That’ll go over like a fart in church, but this was an issue that could have been addressed any time in the last six months…  so, I’ll be damned if I’ll be treating the inevitable result of bureaucratic fuckery as any kind of emergency for me. 

3. Exercise. Everyone on the internet loves to tell you that “once exercise becomes part of your routine, you’ll love it.” Maybe that’s true for them, but for me, I can assure you that no, the fuck I will not. Every daily walk or session on the exercise bike is 30-40 minutes I’m allocating under protest, because it’s sucking up an incredibly finite resource that I’d much rather put towards reading, or writing, or anything that I might even partially enjoy. Maybe it’s better than being stabbed in the kidney, but as something to pass the time, exercise is easily the least enjoyable part of my day. I’ll do it because it’s being required of me by someone who has far more knowledge about modern medical theory and practice than I have. Still, there isn’t a power on earth or in heaven that can convince me I’m having a good time. 

Diagnostic tests, doctor shopping, and medical snobbery…

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Since my original diagnosis of “probable SVT” way back in July took place under the umbrella of the ChristianaCare hospital system over in Delaware, my first appointment with cardiology was also made within their system. That was fine. Their main campus is reasonably well reviewed and I could get seen by a cardiology nurse practitioner in August, which I’ve found out through this process is a fast turnaround for a new cardiology patient who isn’t inactively laying in a hospital bed. 

In the intervening days and weeks, though, I had a follow up with my primary care doctor, who operates as part of the Johns Hopkins system. He was less enthused about my decision to use Christiana for my cardiology needs – explaining that their cardiology department, while fine, is “not ranked” whereas Hopkins cardiology is currently ranked 13th in the nation with the hospital consistently ranking very near the top of any list of “America’s best hospitals” that’s ever put together.

Yes, my primary care doctor is a medical snob.

Despite his cajoling, I kept my original appointment, which led through a series of tests and reports that I was going to need anyway. I also reached out to Hopkins Cardiology to get myself on their waiting list for new patients and ended up with an appointment scheduled deep into October. It wasn’t ideal, but since I was going through all the preliminary tests and could then hand over a pretty good sized file, the timing wasn’t a major issue for me. I was able to take advantage of their wait list option to get my first appointment in the books last week – with a guy who has been practicing for 40+ years and has the look and feel of someone who has seen just about everything. In other words, he’s exactly the guy I want even if all we’re doing at the moment is preventative and exploratory. 

With all other things being equal, if being able to access some of the best cardiologists in the country means driving 45 minutes west instead of 25 minutes east, ultimately it feels like not much of a decision at all. 

It turns out, like my primary care doctor, I too am a medical snob.

So, I’m going all in. My optometrist recently retired. Instead of going over to the doctor that took over his practice, I’ll let Hopkins run the show for my eyes too. I’ve got my first appointment set up with the closest branch of the Wilmer Eye Institute later this year. That puts all but one doc under a single banner… and when the time comes sometime in 2024, I’ll bring that one into the fold too.

All of these new faces on my medical team are a little further away than I’d like, but I feel like what I’ll lose in adding a few minutes of extra travel time, will pay me back in the convenience of having them all working under the same organization. I was woefully unprepared for the level of coordination I’d need to do myself when my primary care doc and everyone else had electronic records systems that refused to communicate with each other. 

I’m in no way fool enough to believe that being “nationally ranked” is any guarantee of better outcomes. For now, it appears that most of my problems are fairly benign, but should something become more involved or I develop a novel condition over time, I’m going to put my faith in the big name going forward. Hopefully they’re not just riding their 135-year-old reputation. 

Some people would take this opportunity to rail against the American healthcare system. Undoubtedly, it has challenges – but I’ve been absolutely amazed by the level of services and the array of options that have been presented to me over the last three months. Don’t think for a moment I’ve failed to realize my great good fortune to have both the geographic proximity to one of America’s great medical centers and an insurance plan that makes walking through their doors possible. There hasn’t been a day go past recently when it hasn’t been at the forefront of my thoughts.

Good news… it wasn’t a heart attack…

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There are, as you know, things that I don’t discuss on social media. It’s an old fashioned notion, even sharing as much as I do, that some things at least ought to remain private. I say that only to note that what follows is an incomplete telling of the tale. The salient points, however, are unmolested.

My trouble started on a Wednesday night. I wasn’t doing anything more dramatic than sitting in the living room watching TV after dinner. Out of nowhere, my heart revved up to a roaring gallop and stayed there. No pain. No trouble breathing. No light headedness. I’ve never understood what people meant when they said they experienced an impending feeling of doom. I do now though. All in, the trouble lasted maybe an hour or 90 minutes before it began subsiding.

After first trying to power through it and then consulting the family medical professional, I eventually conceded that it was probably something I needed to have checked out. Shortly thereafter, I was being given the once over at the local emergency department, where they quickly ruled out a heart attack and monitored me for four hours before sending me on my way.

The next night, same time, same place, same experience. Well, not quite. It wasn’t as bad and didn’t last as long. It was still deeply disturbing and I spent the rest of the night felling like absolute trash.

By Friday morning, I still felt decidedly “off,” for lack of a better description. I later described it as feeling like someone had filled my head with wool and then pressurized it. I knew if I called for emergency services they’d just dump me back where I had been on Wednesday night. That wasn’t an especially comforting thought.

Whether it was entirely advisable or not, I drove myself over to the “main campus” facility of the local hospital system. After many of the same tests given to me two days earlier, but finally having met with two cardiologists, they confirmed that I wasn’t having and didn’t have a heart attack. Their most likely diagnosis was supraventricular tachycardia (SVT) – essentially a (probably) not life-threatening electrical problem in one of the upper chambers of my heart that can cause an erratic heartbeat.

They prescribed some new meds to slow my heart rate and scheduled me in for a proper cardiology appointment after which I assume we’ll start the full battery of diagnostic tests and determine a long-term treatment plan. My first proper cardiology appointment is later this week. 

I haven’t had any more incidents, but I spent the better part of a week feeling entirely wrung out. If it wasn’t for needing to feed the herd, it’s hard to say how little I’d have forced myself up off the couch. All told it was every bit of two weeks before my head stopped feeling wooly and I was able to concentrate for any length of time. Even the meds they gave me as a temporary expedient aren’t entirely benign. Over the last week or so a couple of side effects have gotten more pronounced and working with the medicos to get that dialed in has been significantly less than fun.

Look, I’m thrilled that the diagnosis is “not a heart attack,” but going into the second month of feeling like warm trash isn’t exactly the summer adventure I envisioned for 2023. I’ll know soon enough if this week marks the end of the beginning or if just kicks us right back to go. Given the abuse I’ve hurled at my body for 45 years, I should probably be impressed that it’s just now starting to seriously object. I only wish the good times would last a little longer. That not being the case, we’ll just have to play the ball from where it lies.