Tag: medical merry-go-round

A Fly in the Ointment  – ECG ST Segment Depression

~ quantumdreamer ~ Leave a comment

Earlier this week we learned that the specialist machine doing CT angiograms is very busy at the big hospital in Saint Brieuc. They are backed up and will not be able to do the study before the date upon which my hip operation is scheduled. This means that the risk is less quantified. They are possibly worried a little about how I might respond to being hacked open and losing a few wine glasses of blood while someone saws off the head of my femur and whacks in a Titanium implant.

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The added concern comes from my recent resting electrocardiogram (ECG) in which the ST level was depressed below the isoelectric point.

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The ST segement is seen as potentially diagnostic for a number of conditions, lowering is correlated with these things.

Causes of ST segment depression:

Myocardial ischemia

Hypokalemia

Digoxin

Cocaine

Left ventricular hypertrophy (with concurrent T wave changes)

Bundle branch blocks (with concurrent T wave changes)

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I can exclude the three middle suggestions unequivocaly.

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The depressed ECG ST wave form is characterised as above into three basic types. My ECG has a lowering of  about 1 mm and is most like the horizontal depiction above

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Bearing in mind that I have spent decades looking at spectroscopy traces on chart paper, oscillosocpes and computer screens it is easy for me to spot “anomalies”.

Whenever I see ECG traces the first thing which comes to mind is, “why is the data so shite?”

Is the test human not grounded, is there a floating earth?

Can’t they do better, develop better machines, improve protocol?

Verbally the cardiologist wanted to check for myocardial ischemia or ventricular hypertrophy. The latter can come from being overly athletic in which case it is ok or it is simply that the heart if gettting old. Back in the last century I had strong athletic tendencies.

He has propsed a so-called cardio stress test. They asked me if I could pedal. Maybe enough to raise the demand on the heart…we shall see.

Going left to right the power output by the human hamster wheel rider increases by 50 watt quanta B-C. This data shows the depression of an ST ECG trace as incresing demand is placed upon the heart.

“Reversible ST-segment depression is the characteristic finding associated with exercise-induced, demand-driven ischemia in patients with significant coronary obstruction but no flow limitation at rest.”

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The jury suggests that this methodology could tend the “diagnosis” either towards or away from ischemia or blood supply insufficiency. The guess was that my aging heart was just as bit too big and aged. The holy trinity of fat, fags and booze have given me their sacred blessing.

If I am losing blood during the operation the heart will pump that little bit harder.

All the articles suggest that when a stress test is done there is a medic present who is cardio-trained in case the stress test causes a heart attack…

It was mooted that an appointment for this stress test may also not be easy to come by. The pre-op anaesthesia meeting is scheduled about 1 month out before the operation.

If the ST depression is unexplained, will they go ahead or will they insist upon more data?

There is a potential fly in the ointment.

We have found that in general the French are more keen on lastminute.com than we are…I foresee a mad clustering of yet more medical appointments early autumn…

Snapshot of Thinking

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Felix our longest resident stray cat has not showed for a couple of weeks now. The last time I saw him he was pretty beaten up with extra open wounds to his face. The vet thought he had feline AIDS and he has been through the wringer. It seems to me that Felix has had his last dinner and gone off somewhere to die.

Bibi our formally adoptive indoor stray caught two birds yesterday and proceeded to eat them a few feet from my desk. This on top on her normal dinner. BiBi in rugby terms has a front row physique and does not jump like a ninja. Anyway she seems to have lost a lot of her fear and anxiety.

Gandalf the newest arrival, the grey and white, has been a bit confused without Felix. Of late she has been increasingly domestic-ish looking for a cwtch perhaps. When she first arrived, she was more tame. Life with Felix made her more wild. Now he has gone she seeks us humans more. I think she may be angling to come indoors.

The swallows are now fledging their second brood of what looks like five chicks in the “corridor” by the back door. That is ten chicks this summer. We should be able to finally power wash the guano off soon.

The frequency of medical appointments and test results has slowed. I am due the result of my sleep apnoea test still. My guess is that most of the threads are going to be dropped with no action. The UK private rheumatologist recommendations for the osteoporosis problem are probably a bit too fancy. The high haemoglobin, haematocrit and ferritin will probably just be noted. I will probably not get tested for myeloproliferative neoplasm via JAK 2 genetics. They will test liver function next spring. I may not start on any osteoporosis treatment until after my pencilled-in first hip operation. If I have no femoral neck there is no risk of a new hip break, the left one is already Titanium reinforced. If nothing too sinister is found in my CT cardio-angiogram, nothing will be done. It will just serve as a baseline.

I have prostate fun scheduled early August which could be nothing or it could be a game changer.

Somethings are simply allowed to pass. No biggie. There is no need to assert or inflict myself.

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So far it all seems like a huge amount of effort that ends up going nowhere.

It is about four months of hip and back pain to go before the operation. Then I will have postoperative pain and rehabilitation exercises. The second hip may be done at the earliest mid to late spring. This means a weird kind of stasis and a waiting game of sorts.

There is little requirement for me to develop any ideas, it is not my job and there is zero likelihood of them going anywhere. I am easily ignored and unimportant. I could try for a vanity patent as already discussed. I can ramble on here to while away the time. I can’t garden as much due to handicap. It will rain soon.

The idea of a move back to blighty is again wafting by. West country or Wales are the current very loose ideas. Given the hip situation a move might be on the cards for summer 2026.

The dreams have not shown any clear indication as to a residual fate, a devoir outstanding. There are vague hints about things like mental health work. These, nice as they may be, are subject to qualifications and things regulatory. They are not feasible. Nothing crystal clear or emphatic is coming through in the dreaming.

The working notion is that I just have to let things pass and get all hippie with it.

The major obstacle to the blighty notion is cost of living. I am 90% sure that I could pick up some “A” level tutoring there. It would be slow the first year but after the good recommendations on-line to my profile came in, it could take off. It should be possible to do ten grand a year. It is funny how much some people need, positively need, just to be listened to without judgement. I used to help bump up grades two to three points from C to A  etc. It is easy to help people pass exams; how much sticks differs. I’ll wager that my 1:1 tutoring has more longevity.

We have found someone local to help with the mowing over summer and into autumn when I am incapacitated and the wife is busier with the patient.

I put out 13 mole traps yesterday and there is mole sign in another place around the pond today. I’ll probably put out some more traps tomorrow. Then I must get down to fixing the slow leak on the pond. It needs fixing so that I can fill it fully before any drought and the inevitable autumn rains fill it to over flow.

Things look to be pretty much the same as we head over summer towards autumn. September the dance cards have already started to fill a little…more medical stuff…

Hey-ho…

Future Plans – Pre-op Chore List

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Assuming that the frequency of hospital appointments remains reduced we can start planning for the future. So far there is no “show stopper” for the pencilled in total hip replacement surgery in late autumn. There are two major appointments for which we do not yet have dates: a pre-op anaesthesia assessment and a CT cardio-angiogram. The latter is due.

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The cardiologist suggested that this would probably be ok, but nobody has imaged me thus, yet. Given they operate on frail old nannas I should be good to go. But it may advise on my increased risk. I also need a full dental 360 degree check.

It seems a long way off but when you have a big garden, scale can eat time. I have to think about doing the heavy donkey work before the operation because I will be very incapacitated for 6 weeks or so, through Christmas. No driving for me…We live alone and have to hope that the wife’s health holds. If that starts to fail we are in deep shit.

I am not a fan of last minute dot com.

Chores:

  1. Sewerage check – lift the inspection covers and use plumber’s rods to clear the 30 metres to the cess pit. Should last 3-6 months.
  2. Wood – we need to order some oven dried wood. There is probably about 1 tonne of wood left over to be sorted and sized. I may need to split the pine left over from Tempest Ciaran. Perhaps another tonne or so. I will need to break and clear two wooden pallets. These can be sized for kindling. Two palettes is about 3 months. They may need to be cut to fire-stick ready size. Perhaps I need a new splitting axe.
  3. I need to move some more earth to shore up the side of the pond which has a slow leak. A couple of loads of 250kg of dirt should help it cope with the full pond. The pond always fills to overflow with the autumn rain.
  4. Need to clean and power wash the external hallway. The swallows who nested there will head off for Africa and leave the guano behind.
  5. We need to secure someone to help out in the gardening. The maintenance pruning needs to be put on hold
  6. The pink rambler rose at 2 metres  high needs dead heading.
  7. I have strimming and mole trapping to be done. There will be one or two full property boundary strims to do at 8000 metres squared that is a bit of strimming frenzy.

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  • Indoors we need to sugar soap wash the room near the wood oven. This will provoke painting of much of the downstairs. That is a big job.
  • The downstairs floor needs to be solvent cleaned with acetone to remove dirt accumulation from excess glue. I will need to use my favourite product Mr Propre floor cleaner with a mop.
  • The upstairs kitchen needs to be floored. It is the only remaining room which we have not done already. We have floored in excess of 200 square metres.
  • It may need a lick of paint too.
  • The repaired volet boxes need cleaned and filled, painted to bring back up to standard.
  • There is one room with loose wallpaper which needs removed and new paper perhaps glued in place.

We need to figure out if I need a downstairs hospital bed. The spiral staircase looks to be a bit tricky. The loo and shower are already disabled enabled downstairs.

Do we need a bigger freezer and for me to prepare spicey foods?

Knowing the way things work here I will need a yellow bio-hazard sharps box for the used anti-coagulant syringes, which I will be self-darting.

This seems to be what the next few months looks like heading into year end.

That is probably the scope of it…

I can already use a Zimmer frame and peg about on crutches.

Where can I get a black eye patch and a parrot?

Circle Game – Merry-go-round

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There’ll be new dreams, maybe better dreams and plenty
Before the last revolving year is through
And the seasons they go round and round
And the painted ponies go up and down
We’re captive on the carousel of time
We can’t return, we can only look behind
From where we came
And go round and round and round
In the circle game

And go round and round and round
In the circle game

Joni Mitchell

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This morning I had yet another scan, a CT scan to test MY diagnosis of diffuse idiopathic skeletal hyperostosis (DISH). This based on my interpretation of a lung CT scan which included data on the spinal column.

“Diffuse idiopathic skeletal hyperostosis (DISH) is a type of arthritis that affects tendons and ligaments, mainly around your spine. These bands of tissue can become hardened (calcified) and form growths called bone spurs where they connect to your bones. DISH can also cause bone spurs in your hips, knees, shoulders, feet and hands and harden bones throughout your body. 

DISH, sometimes called Forestier disease, often doesn’t cause symptoms and is usually found when you have an imaging test for another problem. Some people have pain and stiffness in their  back that may get worse over time.” 

The GP has asked the radiologist specifically so we should get a specific answer. It will then be on record and “official” if indeed the formal diagnosis is made.

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This brings to the end a flurry of medical appointments and scans. Perhaps there will be a hiatus. I have a GP appointment late next week to pull threads together. Then I have a urologist “finger” appointment to discuss my elevated prostate specific antigen (PSA) level in early August. They may order a biopsy {yippee}, but perhaps we are not there yet.  

I am due a CT cardio angiogram at some stage before the hip operation.

A number of the threads will probably go nowhere, be left with no actions.

Of late I have been wondering, “does modern medicine with its endless testing and so-called preventative measures {like statins} actually make you ill? Is it some weird self-fulfilling prophecy?”

There certainly is tendency to obsess about health engendered thereby. What are my cholesterol levels like today? Have I had too many units of alcohol?  Will I die of health related anxiety or a stress induced hypertensive episode? Is the world getting a tad obsessed by medical metrics?

Buggered if I know…

What it looks like is maybe an autumnal new hip, perhaps followed by a second in early spring assuming I can hack it. Which means in summer ’26 I might have a little less pain and a little more flexibility. I am not expecting much.

Off-compound interaction is likely to remain low and we will have to sell the house to get something smaller and more suitable. The blighty or Brittany question will raise its head. Aside from that I do not see any great shakes. I have emailed a couple of people about dreaming.

In general people are vey busy, they have lots on their plates and I am functionally irrelevant to the wider world. I am an anomaly to the mainstream. No biggie…

A recent dream has pointed at some kind of engagement with mental health. Implicit in this has to be anglophone. I am not sounding a trumpet call of excitement. The world out there is a minefield. If someone can get sacked from their high profile job for a single racist jibe whilst half pissed, it is a strange and disproportionate place. Best to say fuck all then. That is the take home message.

I know that I am largely out of touch with the younger people. I do not have any personal data on how people younger than 40 think, because I have not interacted with any. It looks such a  dangerous minefield out there and it makes me so glad that I am not in my erstwhile role in “pastoral care”.

The dreaming has not dreamed in, any vision of the future. I note that in the year 2015 when I had my colon cancer operation there were precious few dreams. Maybe as I approach surgery later, they will cease in a similar manner.

Maybe the painted ponies have stopped going up and down for a while, a brief respite, while other merry-go-round users climb aboard. Soon the garish music will start anew and the ride will begin again….

Feeling Wired… wee, sleekit, cowrin, tim’rous beastie…

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But Mousie, thou art no thy lane,
In proving foresight may be vain:
The best-laid schemes o’ Mice an’ Men
Gang aft agley,
An’ lea’e us nought but grief an’ pain,
For promis’d joy!

Still thou are blest, compared wi’ me!
The present only toucheth thee:
But Och! I backward cast my e’e,
On prospects drear!
An’ forward, tho’ I cannot see,
I guess an’ fear!

Robert Burns

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Well I am all wired up to a polygraph. Looks like it measures heart, noise in the trachea, air flow in the nostrils and the saturation of oxygen in the blood. It is not the latest spec machine and I don’t want to pay twenty euros for a user or technical installation manual. The temptation to take it apart is high but I will resist.

Over the last few months with nearly fifty medical appointments so far this year I have felt a little like a lab rat / mouse. Last time I was like this was around 1994 when they did shit loads of tests to figure out my low B12 and high haemoglobin. They gave me a radio-tracer labelled B12 sample and wanted me to collect my piss. I was off on a night out with the lads, by the end of the night my rucksack was very heavy with ~ a gallon of Tennent’s Extra flavoured sample. They told me to collect it all!! They were taking the piss.

I figured that I was a part of some research project at St Thomas’ so I played along. Perhaps I helped someone’s dissertation.

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I learned today that a diagnosis of moderate to severe sleep apnoea means that you have to stop driving and tell the DVLA!! You then need to get the problem under control.

They say that it can affect concentration. I’ll bet my level and extent of concentration against the bulk of the population. I’ll win.

Either the results will be invalid due to the apparatus falling off during the night, or they will be “normal” or they will have some anomalies due to my decade of dreaming practice and two and half decades of meditation. The first two cases are easy.  The third case might raise an eyebrow; be seen as an artefact or suggest a re-test.

All these scans and tests are getting a bit boring. I would much prefer to be in the control room watching the acquisitions than on the slab in the middle of a polo mint.

I have often wondered on the mentality of those able to torture mice. I did a team development course for those operating a gene related animal house {mice} at the University of Cambridge. They seemed to be regular people a bit annoyed by the unrealistic expectations of the last minute dot com academic demands. The academics wanted the animal house “sorted out”. I suggested to HR that it was the academics who needed to learn team work and to develop their interpersonal skills, which were poor.  I offered to do a course for them. Needless to say my offer to “Olympus” was not taken up. I would have had no problems calling out a pompous Cambridge prof or two.

I take the device back on Tuesday morning before my colonoscopy. We shall see {perhaps} what is recorded thereupon. The fun-filled and action-packed life goes on…

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The Holy Trinity – Fat Fags & Booze

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Brixton Prison, Jebb Avenue London S.W. 2 Inglan

it was de miggle a di rush hour
hevrybody jus a hustle and a bustle
to go home fi dem evenin shower
mi an Jim stan up waitin pon a bus
not causin no fuss

when all of a sudden a police van pull up
out jump tree policemen
de whole a dem carryin baton
dem walk straight up to me and Jim
one a dem hold on to Jim
seh dem tekin him in
Jim tell him fi leggo a him
for him nah do nutt’n
and ‘im nah t’ief, not even a but’n
Jim start to wriggle
de police start to giggle

Sonny’s Lettah – Linton Kwesi Johnson

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Isn’t it funny that when you wait a long time for a bus at the bus stop near Jebb Avenue on Brixton Hill, there are none then all of a sudden three arrive at once?

Every weekday morning for around five years I waited at that bus stop.

Last Friday I had a radio-nuclide bone scan, Tuesday I had an ECG and comprehensive cardio ultrasound, tomorrow I will have overnight monitoring for sleep apnoea, Monday I will start taking industrial grade laxatives with a colonoscopy due Tuesday afternoon and next Friday I am due a CT scan to check for diffuse idiopathic skeletal hyperostosis (DISH).

What a fun-filled and action-packed time I have.  That is quite a lot to cram in. That is a lot of buses.

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Tomorrow I will get fitted for various monitoring including cardio. Later, they may go one stage further and do a hospital admission with full electroencephalography (EEG).

Given hip pain, enlarged prostate and hot weather, I am not sure they will get a good data set.

I don’t know what gizmo I am getting tomorrow. BUT if there is an EEG it could easily generate an anomaly which they may struggle to explain. I know from before and self-test that I can flat-line a fast Fourier transform frontal lobe EEG within the S:N ratio. If this happens in a sleep study it might raise questions or get ignored. I would be an anomaly.

The hospital version has EEG. It may never happen.

As a researcher one is trained to look out for anything unusual. I have a low parathyroid hormone level which seems anomalous. It makes my research bells go ting. It does not seem so important to others.

It seems to me that the consensus is coming around to the idea that the root cause of many of my ailments is being ascribed to the Holy Trinity, fat, fags and booze. My high iron levels will get adjusted during any hip operation by blood loss, in the first instance.

In terms of the Holy Trinity I only have fat left to renounce.

Whenever I watch a medical video, say on a part of the endocrine system, I think to myself that is a whole lot of variables which you are asserting to be interrelated yet you only have very few data points. Is that not a bit of a stretch?

I suspect that I would have been a shit medical student, too many questions. I would struggle with the exams.

In a fortnight’s time I should have a few more pieces of information, including my putative diagnosis of DISH.

Looking at the bus timetable there may be a wait……after a fun-filled and action-packed week.

Touch wood, cross fingers etc.

ECG Anomalies and a CT Coronary Angiogram

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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…

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…