ECG Anomalies and a CT Coronary Angiogram

~ quantumdreamer ~ Leave a comment

Well, more rides on the medical merry-go-round are in store. I have a patchily shaved chest to which they attached the electrodes and they found some anomalies, a slight lowering, in the ST part of my ECG trace.

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These can be due to ischaemia {low blood supply} or muscular hypertrophy. The nice young man was very thorough with a good bedside manner. He has recommended that I get a CT Coronary Angiogram, a new procedure to me. So I have just emailed the request to the radio people.

He was reassuring but you don’t fork out for fancy tests on a whim. There is a reason…

My gut feeling to get the cardio MOT done early was right. I figured there could be some twists and turns.

There are a lot of medical threads out there which hopefully we can make some global sense of {eventually}.

Luckily, I know where the radiography department is, it is near the nuclear medicine place I was at Friday and close to the coffee machines.

More loyalty card points for me…

It Is a Long Way from Kansas – Cardiology

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The world is pretty fucked up right now. When the butcher of Khan Yunis is nominating B2- “Obliteration”- Boi Trump for a Nobel Peace Prize things are more than a little topsy-turvy. This is perhaps a new(ish) if twisted reality for our times. If you remember Franco, Mussolini at al., the unpleasant people, once formed a bad-boys club before and that turned out well…

The world is heading into a very nasty phase. Brutality is holding dominion over compassion and humanity. Rife me-first separatism is being propagated, decency {and common sense} is subdued by the practice of domination, coercion and forced submission. The disproportionate exercise of power is once more in flow. Waving cocks is once again sadly de rigueur.

It is along way from any idyllic Kansas of ere.

Today I get to find out if I have a heart amid all the high iron rust in my arteries and veins. They will probably plug me into the mains and look for traces of Fe2O3 in the pre-operative electrocardiogram. They may look for signs of a still pulsing muscle with an ultrasound device.

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By the 18th of July I will have had 13 medical appointments in a little under three weeks. I will have given blood, had a CT and separate radionuclide scan {bonus CT also included}, a colonoscopy and test for sleep apnoea. I will have seen GP, implant dentist and consultant orthopaedic surgeons, a cardiologist, an osteopath, a rheumatologist and a lung specialist. That is a fair clustering of appointments. My dance card has been and is still full. In August I get to see a urologist for an update on my high prostate specific antigen levels. The next line of attack after the high res MRI I already have had is a prostate biopsy. Yippee!!! That will be fun. You can see from the look on my face above when they try to put a finger on it.

And on the TV in the news we get to see a stage managed travesty as mentioned in the first paragraph…

Are we really in this parallel universe. How the hell did we as a humanity get to this low low place. How much lower must we sink?? When this sort of thing seems quasi-normal?

This stinks, it smells real bad…

Gandalf and Felix – Our Resident Stray Cats

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Yesterday at feeding time Felix, the old beat up neutered tom, did not show. He has been looking increasingly shabby of late, the vet suggested that he has cat AIDS. He has been with us for three or four years. He was fearful and wild. Other younger cats taught him to come close to us. Of late he has let me touch him and he rubs himself up against me at feeding time. We play picky-ups, where I pick him up with my foot and drop him gently out of the way. He keeps coming back for more. It is a game he likes. You can usually set your watch to his stomach. No sign of Felix. Gandalf was fed as per usual.

This morning again no sign of Felix. Something has unnerved Gandalf the young, spayed female. She followed me around the garden like a limpet. I was looking to find a perhaps dead or injured Felix. She was very attentive and seeking physical contact. No sign of Felix. Not in any of his usual haunts.

We understand that our care of Felix is perhaps end of life and palliative.

I just went out to feed Gandalf down by the river and with all the noise Felix arrived. He is in a bad way with what looks like a blunt force wound to his head. There is a swollen open cut like a boxer’s injury. Gandalf seemed pleased to see him and yielded the bowl to him. No contest.  I came back to the house to get another bowl and she followed me, while there was food available. She mewed and followed me back down to where Felix was feeding. It was as if she was asking me to feed them both as is the usual custom.

I put her bowl down and she was edgy, hardly snacking. She kept greeting Felix who was trying to eat. I stood there and petted Gandalf a little. She had a few mouthfuls. I was standing like presidential “security” while the two cats ate. Something bad has gone down and freaked them out. In the past when scared or injured, cats have sought me out. I have taken scaredy-cats out into the dark for a late night piss. Gandalf remembers humans and some of her memories are good. Perhaps some not. She is glued to the side of the house where she feels safe at the moment.

Felix has finished eating and is out by the greenhouse for his post feed snooze. I have been to look and his left eye is closed again like a boxer. He has some kind of injury to that side of his mouth. Looks like a car or dog or fox and not a cat inflicted wound. Gandalf was again following me like a magnet and it looked as if she was getting ready to jump up into my arms. Which would be a first. I “took” her close to Felix and she quieted down a little. She knows he is poorly. At the moment they are sat close to the house near the magnolia.

It might be wise to swing by the vets tomorrow to ask what to do. That wound could go septic, it does not look clean and Felix is not washing after eating, which is something he usually does.

The cats are clearly unsettled by some kind of trauma…

The Old Guard and Toltecs – Speculations

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The second instalment of the Old Guard series has recently hit Netflix. It has a shared plotline of sorts with the Highlander movies of ere. In this Old Guard dramatization physical plane immortals exist adjoint humanity and interact to either good or bad effect depending on mood and predilection. In Highlander in the end there can be only one in the battle between good and evil. In the Old Guard series “Andy” the main protagonist has fought to help, aid and otherwise nudge humanity in a “better” direction. Instead of reincarnating she has one contiguous and very long life in which she preserves her super model looks despite getting slashed and shot. A magical and miraculous healing occurs. She loses her regeneration powers and then regains them.

In each the burden of endless longevity / immortality is touched upon. They do not dwell overmuch on the boredom aspect rather the action and power angle. The omnipotence may appeal to the burdened and downtrodden. It may titillate the sociopath and the narcissist.

For dramatic impact pivotal points in global {human} history are referenced. An allied them is to be found in the “Assassins Creed” franchise though in this case reincarnation is invoked and a DNA bloodline is the bearer and propagator of ongoing conflicts.

It has been suggested to me that the so-called Toltecs were incarnated around pivotal times and played a role behind the scenes in the evolution of human and planetary history. Given that the technique of erasing personal history is part and parcel of the training, it is not surprising that little historical refence can be found. In the Old Guard Andy tries to avoid publicity. However in this day and age and thanks to internet monitoring and various intelligence services it is impossible to leave no trace. The times have changed.

In the Toltec tradition there is such a thing as a nagal being. The word Nagual in Spanish American is similar. The word Naga in the Indian tradition does not differ in root. In the hagiography of Buddhism Siddartha is protected by king cobra, a naga-raja, from the rain. These nagas live in the place or world of the nagas, naga-loka. Wisdom can be elicited from nagas and naga-loka. Serpents are the dreaming symbol for wisdom.

This suggests via speculation and extrapolation that a nagal being was a contemporary and perhaps companion of Shakyamuni Buddha.

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“There is unanimous agreement that Nāgārjuna (ca 150–250 CE) is the most important Buddhist philosopher after the historical Buddha himself and one of the most original and influential thinkers in the history of Indian philosophy. His philosophy of the “middle way” (madhyamaka) based around the central notion of “emptiness” (śūnyatā) influenced the Indian philosophical debate for a thousand years after his death; with the spread of Buddhism to Tibet, China, Japan and other Asian countries the writings of Nāgārjuna became an indispensable point of reference for their own philosophical inquiries. A specific reading of Nāgārjuna’s thought, called Prāsaṅgika-Madhyamaka, became the official philosophical position of Tibetan Buddhism which regards it as the pinnacle of philosophical sophistication up to the present day.”

Stanford Encyclopedia of Philosophy

Nāgārjuna (नागार्जुन). – Name of an ancient Buddhist teacher of the rank of बोधिसत्त्व (bodhisattva).

Wisdom Library

The name also appears in the wider Hindu sources predating Shakyamuni Buddha

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Typically a three pronged nagal is said to distribute knowledge widely. Like a stone thrown into a pond.  If Nāgārjuna is a wider term for a nagal teacher in the Indian sub-continent then this suggests that the core Toltec and Vedic / Buddhist teachings are similarly sourced and may differ only in method of expression and verbalisation. The term is a generic and not a specific and personal name.

I personally have not found any huge glaring clashes between these philosophies. There is a marked difference in emphasis and the cultural refence points and metaphors employed.

The entertainment mentioned above is not completely inconsistent with a hierarchy of spiritual “masters” on overwatch of humanity. However in order to make it dramatically appealing they must have meaty bits and interpersonal relations such as love with hints of corporeal hanky-panky.

Too abstract and the film would not sell. The immortals have to be beautiful people if good and have ugliness if bad. One is not allowed a minger of an immortal. They must be L’Oréal advert fresh out of the shower from time to time.

Having a “hot” teacher can badly detract from learning.

It is not difficult to see that the course of human history did indeed pivot around relatively small and local acts. The execution of Jesus ended up being a game changer. The invention of antibiotics added number density to humanity.  An assassination was used as a pretext for the first world war. If there is tension a simple fuse is all that is needed to ignite. A miscalculation in a Bay of Pigs might cause a nuclear winter. The simple protection of a Buddha from the rain enabled the propagation of the teachings for mind.

Humanity is prone to flying off the handle in rage and “self-righteous” indignation. Humanity has a “cob” on and is very prone to fits of angry pique which kill hundreds of thousands.

In the absence of overwatch might the history of humanity have been even more bloody and brutal?

We are heading into unknown territories with AI and Drone-robotics. What are the two biggest markets? War and sex. Thus humanity will expend effort into developing these for profit applications. Since the theoretical abolition of slavery humanity seeks a replacement.  I read yesterday that progress toward in vitro spermatogenesis is advancing, if the same continues for human eggs it may be possible to make a human-like foetus. A synthetic human is unlikely to have an indwelling Soul. This biological dabbling and getting a blind boner for technology represents a Pandora’s box the lid of which humanity will find difficult to resist. What is unleashed now and later in this century may cease to be readily controllable. The temptation of cash and the arrogant appeal of God-like potential may lead humanity down a very dark path indeed. It may regret…

How might Andy and the Highlander come to the rescue?

Best Ever Dream – Dancing With Ganesh Dream 20-9-19

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Still a bit shaky. I have just woken from my afternoon nap, which usually results from my midday codeine. It is a few weeks after I broke the head of my femur and had it repaired with a Titanium nail. I was taken to A&E in an ambulance. I am using a Zimmer frame and have a hospital bed downstairs.

Wow! That was the most intense dream I have ever had.

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I arrive at the edge of a walled garden and am welcomed through a large gateway by an upright Ganesh. He has all the typical elephant features, but his gait is that of a human being. He is iridescent blue in colour and has a twinkle in his eyes. I am welcomed into his “humble abode”. He shows me around his palace gardens, gardens that are tropical and scented. There are flowers everywhere. The garden is filled with water features. He takes me to a partially covered courtyard which has red-brown gravel. The pieces of gravel are near perfect spheres. He sits me down and we take tea together brought by his servants. I understand that this courtyard is where he practises his dancing.

A group of Indian musicians file in and seat themselves on the ground. Ganesh signals to them and they start playing. He gets up and starts to dance. His movements are exquisite, and his hands alternate between mudras beautifully and each mudra is exact and precise. He beckons me and starts to teach me some steps of his dance. {In the dream my leg functions fine.} Slowly I get the steps and we are starting to whirl and circle. It is entrancing. He stops suddenly and takes a blue-metallic AUM symbol out of his tunic. He walks over to me and presses it on my Anja centre. Slowly it penetrates and dissolves into me. I am left with a tattoo like impression on my skin. Ganesh smiles radiantly and we continue to dance.

I look at my body and notice that it has somehow taken on the same hue as Ganesh, which pleases me greatly in the dream. He laughs, at my surprise.

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I awake with a start and my first instinct is look at my arms. They are not blue. They are lightly tanned and freckled with a few bruises from all the needles. It takes a while to assemble the reality of the room. I get up and go outside to smoke.

London Welsh – Rugby Dream 06-07-2025 – Russia – France

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Here is last night’s dream. We watched a recording of the Wales V Japan rugby match on the TV in which there was little inventiveness on the part of Wales.

The dream starts in a daylit room. I am sorting out some washing and come upon a red old-style rugby jersey made of thick linen and with a white button up collar. It has long sleeves and has been worn before. It is mine.  I pick it up, take off my t-shirt and try it on. It fits if a little tight. There is a strong feeling of Southern hemisphere.

I am next walking with John Williams to a clubhouse facility in the middle of several grass sports pitches some of which have rugby goal posts. I am dressed in normal clothes. We enter the clubhouse and it is the London Welsh rugby club dressing rooms / clubhouse. I am welcomed back by several of the team who recognise me. There are some new faces and everyone is getting changed into the red rugby jerseys with white old-style shorts. There are several teams from elite to social. The club physios and doctors are there. Siân and her team of young female physios are there. She is dressed in t-shirt and shorts with her blonde hair tied back in a pony tail. She has a strong Welsh accent. She is checking that people are fit to play. She comes over and has a cursory examination of my back and hips and clears me.

I am then ushered over to a table by the club “secretariat”. They want me to sign a membership form and pay my club dues. They say that a portion of the fee goes to the WRFU to help the national team. I say that I do not know which address to put in as I am between places. “Do I put in my French address for now?” “Yes”.

We do not yet know if we will be playing because there has been some snow overnight and the pitch might be too hard. We make our way out to the pitch. As I will be playing hooker from the bench I will need to know the lineout calls. One of the props says that he will whisper the actual as opposed to coded call for me so that I know where to throw in. I ask him to “scrum down” with me so that I can test how my hips hold up under pressure. We do this and I am able to hold his push and twist his body and lift him. He says that I will be fine, I cannot keep my Ventolin in my pocket. So I walk to the halfway touch flag and deposit it there, next to the pole.

The referee has declared the pitch match ready and we prepare for kick off. Even though I am old I know that in terms of cardiovascular and strength I will be able to keep up.

The dream ends.

I am reminded of my Dancing with Ganesh dream on waking.

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Around 40 years ago I played in a social rugby team at London Welsh which was filled with young professionals. The pack has several Ph.D. and lawyers.

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I wake up. It is around 5 AM. I feel no pain. Slowly the pain in my spine builds in. I drift off back to sleep.

It is ago, a few hundred years, and I am in Saint Petersburg at some kind of posh social event. I am among a delegation that is working between France and Russia, to try to find common ground. It is delicate work and the French are being difficult and uncooperative. The Russians are waiting for the French to decide and commit to something. A senior Russian court figure says to me that I need to make it clear that to the French it is they the French who are holding things up. I speak both languages. This segment pertains to “pony-tail” man. I am he again.

The dream ends

140 keV Gamma “Ray” Bone Scans…

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My rate of emission of 140 keV photons is now down to lower levels, five radioactive half lives after injection. The concentration has been reduced by biological elution and the radioactivity by decay. It was interesting to read how few suppliers there were for 99mTc. Yesterday, she only injected a few millilitres of tracer.

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I have been reading up and watching videos on the interpretation of bone scans, I can probably note metastatic lesions, depletion in tracer localisation due to prothesis, fractures (old and new), areas of bone formation and depletion. It might be interesting to see what my damaged cervical spine looks like and if my “broken” ribs from rugby can be seen.  Osteophytes are evident on my thoracic spine and near my Titanium pin. The Diffuse Idiopathic Skeletal hyperostosis (DISH) is probably still growing and could localise tracer. {I had a full body scan.} This, if seen, can be cross referenced with an upcoming CT scan.

There could be plenty in my scans for a nuclear medicine professional to discuss with her younger colleagues.

I meet some of the diagnostic criteria for polycythaemia (probably secondary). If it is the malignant form this may interfere with bone cycling in the marrow and could appear in the scintigraphy. There are a few suggestions in the literature to use nuclear medicine to detect this. But it is not common practice.

I guess the single-photon emission computed tomographic (SPECT) images might show something like this below. My hip arthritis is much worse than in the X-ray or CT images below. It does not look like a whole lot of extra knowledge comes from the SPECT data for the hip.

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Dunn’s view of (A) right and (B) left hips of a 48-year-old male patient presenting with left hip pain only. Single-photon emission computed tomographic images shown in (C) anterior and (D) posterior coronal views display more uptake (black arrow) along the superolateral aspect of the acetabular roof on the symptomatic left hip compared with the asymptomatic right hip (white arrow).

Clin Orthop Relat Res. 2008 Dec 17;467(3):676–681

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What might however be interesting is what tips up in the rest of the body scan. The pain in my lower and mid lumbar spine has been explained in different ways by different doctors.  There might be clues as to what is going on.

I guess what I do not want to see is evidence for primary bone cancer or metastatic disease. The main diagnostic differentiation of the latter is a disordered or “random” appearance of tracer localisation. Metastatic disease is incurable and often terminal.

I have joked that I could re-train as a radiographer or a nuclear medicine operator. But you know what they say about old dogs.

It is weird, I feel very up in the air, with little or no idea if/when I will get to see the data. Something which could change the direction of life is hanging ill-defined in the aether. I am in a kind of limbo.

I wonder if people who prescribe scans have ever had to wait and hang like this…

Maybe it should be a compulsory part of training…

Pandora, what does two plus two equal?

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“A bone scan or bone scintigraphy is a nuclear medicine imaging technique used to help diagnose and assess different bone diseases. These include cancer of the bone or metastasis, location of bone inflammation and fractures (that may not be visible in traditional X-ray images), and bone infection (osteomyelitis).

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The most common radiopharmaceutical for bone scintigraphy is 99mTc with methylene diphosphonate (MDP). Other bone radiopharmaceuticals include 99mTc with HDP, HMDP and DPD. MDP adsorbs onto the crystalline hydroxyapatite mineral of bone. Mineralisation occurs at osteoblasts, representing sites of bone growth, where MDP (and other diphosphates) “bind to the hydroxyapatite crystals in proportion to local blood flow and osteoblastic activity and are therefore markers of bone turnover and bone perfusion”.”

From Wikipedia

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I have not long returned from the Nuclear Medicine suite at Yves Le Foll hospital Saint Brieuc. The pretext from my bone scan was to look at where there might be inflammation in my right femoral head / neck and hip prior to an operation. The first orthopaedic surgeon, who prescribed the scan, suggested that it might be done with an Iodine radio-tracer. That is not for bones. He became a little flustered when questioned and pressed on the subject. The second orthopaedic surgeon questioned why he might even order such a test. It seemed incongruous to him.

Nobody in France has yet mentioned the C word! Looking in Pandora’s box can have unexpected results. They could be doing a “Basil Fawlty”.

At the end of my scan today the operatives in the control room were all looking intently at my images, pointing and talking animatedly. Before the scan they did not help me onto the scanner table, after it they were very helpful with the dismount. The images changed behaviour. I was not privy to my gamma ray “only fans” content which had them talking. The secretary suggested that I will get the results in a letter at some unspecified time in the future. The results will go to the first orthopaedic surgeon and my GP.

The following outcomes are possible:

1)  The results simply show osteo-arthritic frictional inflammation in the bony tissues. What I call the pepper mill effect. In which case I will get the results through the post and I can take a good scooby at them myself.

2) There is a long delay during which a conflab occurs. I do not get the results in a timely fashion, some other follow up plan is hatched. Something needing to be followed up has been found.

3) I get a telephone call to tell me bad news. I am being followed for elevated prostate specific antigen and have had colon cancer. There are anomalies in my blood work.

4) The results arrive in a tardy fashion with bad news therein, before anyone contacts me.

This is what the Canadian Cancer Society says:

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Société canadienne du cancer

La scintigraphie osseuse aide les médecins à diagnostiquer et à évaluer différentes maladies et affections osseuses. On peut y avoir recours pour:

  • trouver un cancer des os ou déterminer si un cancer présent dans une autre région s’est propagé aux os;
  • aider à diagnostiquer la cause ou à déterminer l’emplacement d’une douleur osseuse inexpliquée;
  • aider à diagnostiquer des fractures osseuses qui ne sont pas évidentes à la radiographie;
  • voir jusqu’où le cancer s’est propagé;
  • trouver des lésions osseuses causées par une infection ou d’autres affections osseuses;
  • savoir si le traitement du cancer est efficace ou pour faire un suivi.

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Obviously, they are going to have a cancer bias. My gut feeling is that people are not being 100% straightforward with me. My gut feelings are often with substance. The French can beat around the bush so to speak.

Waffle, moi?

Whatever the outcome, knowing what the data says does not change the actual physical plane reality. It does / might affect how things move on from here…

It is out of my hands; I can do nothing…

We shall see…

Piss Up in a Brewery

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“Trompenaars’s model of national culture differences is a framework for cross-cultural communication applied to general business and management, developed by Fons Trompenaars and Charles Hampden-Turner. This involved a large-scale survey of 8,841 managers and organization employees from 43 countries.

This model of national culture differences has seven dimensions. There are five orientations covering the ways in which human beings deal with each other, one which deals with time, and one which deals with the environment.”

From Wikipedia.

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The last course, which was in design phase when I dumped it, was to address problems of cross cultural communication and the tensions inherent in it. I {we} have had plenty of instances of Franco -Britannic cultural differences. If one side imagines that the way they do things is right and dandy it can be very difficult to show to them other ways. They may get ultra-defensive and imagine themselves more highly organised and efficient than they actually are. One might have to learn new ways and adapt to the system in which one lives. These “growing pains” can cause premature baldness. One can be seen as pushy and not “sympa”.

There is a balance between nanny state control and last minute.com freeform. There is also a need to decide and stick to said decisions without continuous flexing. Making shit up on the fly can cause clusterfucks of considerable dimension. Preparation and planning prevent piss poor performance.

One of the things I never put on my CV as a bullet point was

  • Able to organise a piss up in a brewery.

It does not sound like an important life skill but it is. One of things that I am good at is organisation which needs contingency. Organisation should be, wherever possible, simple and clear. The person who has oversight needs to be updated and exercise that over sight. Although not my natural team role I have ended up being Monitor Evaluator on a number of occasions to keep things on track. Slippage is a real problem.

Trompenaars and Hampden-Turner identify France as a diffuse culture in which so-called responsibility is spread out and it is not clear who has oversight or indeed if there is any. Process has been developed and used but rarely questioned and updated. Demain, quinze jours, are not as bad as the Jamaican “soon come”. But time is vague like many other things.

As a INFJ timing is important to me and sticking to what you say about time is vital. I can’t help it but people running late irks. I have literally thought while waiting, “shall I just go home, fuck it!”

I am anticipating a hip-replacement operation. It is down to us to organise a pulmonary and cardiovascular screening before a meeting with the anaesthetics geezer / geezer-ess. We have to order and provide crutches and compression stockings. We have to organise full blood tests including blood typing. The surgeon will have blocked out a space in his diary. No bugger has yet done an assessment if it is safe for me to return home. There is a quasi-magical assumption that everything will fall into place. A couple of cardiology outfits have suggested a screen a week before the operation!! Really?

If there is a problem and the operation needs cancelled there is no lead in time and the slot will have to be abandoned. This kind of “planning” makes me nervous. It lacks foresight. It may be the way things have always been done but that is not good logic.

The possibility for fuckwittery is huge and the probability of things which are time critical going wrong, high.

In the UK no civilian would be given responsibility for collecting very expensive granulocyte-colony stimulating factor from the pharmacist and giving it to a district nurse for injection prior to a harvesting of stem cells. The factor is temperature sensitive. To trust this kind of thing to joe public is in my opinion unwise. The key thing could go very badly wrong and everything need re-scheduling. Do normal people really understand temperature dependent reaction kinetics?

“But that is the way we do things….”

The feeling that I {we} have to be on this is an unnecessary added stress.

Am I a control junky?

Am I sane?

Will this aid my post operative recovery?

Should I just go with the flow in this case?

In my view professional organisational oversight might be a better approach. I could tip up at hospital and have a whole day of tests done a couple of months out. The go / no go question would be answered and, if needed, some interim medical adjustments made ahead of time. Rather than a week before finding out some kind of unknown heart anomaly.

I understand that the summer is in the way and that everything stops for summer. Unfortunately this is not in my cultural DNA.

A bit edgy…