Feline progressive dendritic histiocytosis, follow-up

By | April 28, 2022

In December of 2020 I posted about the aggressive skin cancer — feline progressive dendritic histiocytosis — which was afflicting our large bear-like black cat, Marie. You can read that post here.

Progressive dendritic histiocytosis is unusual in cats. It is more commonly encountered in dogs. Consequently, there is very little material in the veterinary literature about how best to treat it.

In Marie’s case, the surgical removal of the visible large tumors, which took place in November of 2020, had little lasting effect. The site of the largest tumor, now excised, promptly began bulging with a new tumor; one guesses that the excision didn’t get all the cells from that area. By May of 2021, things looked pretty bad again and we took Marie in for a second excision. They checked and there was still no sign of metastasizing to her internal organs, which was one small blessing.

But then, by the mid-to-late fall of 2021, the tumors were back like a bad penny. Red, bulging, oozing and bleeding. Marie’s appetite was undiminished and she showed as much energy as she ever had, which led us to believe that there was again no metastasizing internally. We took her to our local veterinarian who advised us to take her back to the oncologists at Peak Veterinary Referral Center in Williston. The oncologist at Peak said that she did not recommend more surgery; it clearly hadn’t worked. She offered us three options:

  1. Steroid therapy
  2. Chemotherapy using CCNU (chemo capsule every 4 weeks)
  3. Electrochemotherapy: non-surgical way to try to gain local control: may require 2+ treatments for control, can repeat as needed on recurrent or new lesions

We doubted the steroids would work; they hadn’t made any real difference before. Electrochemotherapy — chemo injected into specific locations — seemed unlikely to work because Marie had so many small tumors spread all over. To me, the right option was oral chemotherapy.

Mind you, we had already spent, I don’t know, $4000 or so on all the visits, tests, surgeries, and so on. Most people would probably not spend all that on a cat. I am not most people. As long as Marie’s quality of life was good — eating normally, behaving normally — I saw no reason to consider putting her to sleep. Carole was a lot more cold-blooded about it but I insisted we give it a try. Never mind the expense.

So, we started the oral lomustine (CCNU) in early February.

Four weeks later, the largest tumor had shrunk in size a little but was bulging and bleeding even more. We took her in for another treatment in early March and got her checked out; her white cell count was a little lower than they would have liked so they had us wait two more weeks. She got more chemo at that subsequent visit and the oncologist noted that the tumor had flattened out, though still occasionally bleeding, and that a lot of the small lesions here and there on her body had diminished to the point that we couldn’t feel them. We were worried about the bleeding but we had to trust and hope.

As April went by, we noticed the tumor had entirely flattened out and that skin was starting to grow over the site, a millimeter at a time. The sporadic weeping/oozing/bleeding had basically stopped. That was a very hopeful sign.

Yesterday, when we took her in for her third dose, it really looked a lot better. The oncologist at Peak seemed genuinely surprised by how well it was working — as before, there’s not much out there in the literature to use as a guide and we’d had no idea if this particular chemotherapy regimen was actually going to accomplish anything. But working it was, and there were smiles all around as I left Peak with Marie in her travel carrier.

And that’s where we stand now. She’s scheduled for three more doses of lomustin (CCNU) over the next four months at which time, if all continues to go well, the tumors will be entirely gone and hopefully all the remaining cancer cells will have been obliterated. I imagine that we will need to have her checked pretty frequently afterwards — but “checked” basically means palpating her all over and looking for anything that feels raised or unusual over the skin. All that fur gets in the way of early detection.

 

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Six Months Ago I Had A Heart Attack, and Other Worries

By | March 13, 2022

Whoops!

Six months ago to the day (Sunday, 9/13/2021 — my 24th wedding anniversary, actually, and a week before my 54th birthday), I had a heart attack. I probably had it while diving in Lake Champlain, after overexerting myself lugging all our tanks and gear down to the lake. I know I felt my heart racing like crazy while underwater and something just felt wrong. I didn’t really start feeling symptoms until the middle of the night that night, when I woke up to find my left arm hurting like hell and suffering from “bad heartburn”. I remember distinctly getting up twice to slug down Alka-Seltzer and being confused about why it wasn’t helping.

That Monday was confusing and weird. I didn’t feel right but rather than go to the emergency room I just slept a lot of the day. People encouraged me to go ahead and hit the ER but I had the typical worry that I’d get there, spend a lot of time waiting, and get told that it was all nothing and to take some additional ibuprofen. Or something. Maybe I was afraid they’d smack me around with a wiffle bat. Either way, I didn’t go.

Finally, someone (probably Carole) found links demonstrating that “painful left arm and ‘bad heartburn'” are classic symptoms of a heart attack. That Tuesday I finally sucked it up, grabbed a book to read while waiting, and headed to the ER at the University of Vermont Medical Center, expecting to have a long wait before being seen — I was sure I’d find a waiting room full of Covid patients.

Turns out that the waiting area was maybe 1/3 full — and moreover, almost before I’d given them my name and date of birth, they had me back in the exam area getting an EKG, x-rays, ultrasound, blood tests, bam, bam, bam. Unless things are really bad in an ER, words that hint at heart attack or stroke are taken very seriously. (Carole came over to spend the evening with me and was very kind and gentle. For once, she knew better than to harp on what an idiot I’d been.)

One test led to another and then another, and next thing you know I’d been admitted and was scheduled for a heart cath procedure the next day. If certain tests had come out a little differently, I would have been catheterized that night. Next day, the cath showed that I had some pretty serious blockages, not in the main arteries, but in the subsidiary arteries that feed the heart itself. They found a LOT more plaque in there than they expected in a man my age and consequently I wound up with four stents and prescriptions for blood thinners and more blood pressure meds, not to mention a strict ban on eating salt, saturated fat, and cholesterol. I was sort of hoping for some kind of prize, a big stuffed carnival bear or something, but apparently you only get those if you’re a kid.

I asked the docs, and they said that my diet was actually probably not the primary cause of the heart attack. My heredity is just awful — father who had multiple heart attacks and heart procedurs, and mother who had blood pressure that was just off the charts most of the time. I drew the short straw on both fronts.

All in all, it was not a bad heart attack — I had not done any significant lasting damage to my heart. But it was serious enough to need that catheterization — and without said procedure, no one would have ever known how bad the blockages were. In a sense, I was real damn fortunate to have had my little cardiac infarction when I did; otherwise, when my heart attack finally did come a year or two in the future, it probably would have been a lot worse.

Call me Mister Lucky.

I was sent home one day later, my blood troponin levels having started to diminish at last, and everyone we spoke to assumed that I’d need weeks of recuperative time. Doctors, nurses, Carole, my managers, my co-workers, people from church — they heard “heart attack” and figured I was going to be out of commission for quite some time.

They had not factored in what a complete idiot I am.

What came next?

Friday of that week was the first day of my at-home rehabilitation. I got really bored sitting around the house that morning, so I logged in to my work laptop and spent the afternoon reading and replying to email. Along about four p.m. that day I got an instant message from my boss going “WTF?”

Later that day, around 5 o’clock, I went for a two mile walk — just out my front door, down to the bridge over the Winooski, and back again. Just to see how I felt during and afterwards. I felt a little more tired than I’d expected, but not too bad.

So, of course, two days later I went for a nine mile walk.

The funniest part about that was that I was toddling on down Snipe Ireland Road (yes, that’s a real road) when a car slowed to a stop and the driver said “Jay???” in wild incredulity. It turns out it was a member of our church, Kath, whose husband Ernie had helped ferry my car home from the hospital (since obviously I wasn’t going to be driving it home myself). So she knew I’d just had a heart attack, and here I was walking down a long dirt road, not a care in the world, metaphorically whistling a merry tune (disclaimer: I cannot actually whistle).

I confused the folks at church as well that Sunday by showing up at all — they, like most people, sort of visualized me lying in bed with a visiting nurse attaching IV lines to me and looking concerned. People don’t just have heart attacks and then immediately go about their normal daily routine. And here I was saying “Wotcha, how ya doing?” like I’d just gotten back from a day trip to Poughkeepsie.

I refused to take any time off and got right back to work immediately. Over and over during the following days I got messages from people going “What the hell are you doing logged and sending emails?”

Rehabilitation

I started cardiac rehab about two weeks later. First thing was a stress test, where they stick you on a treadmill and keep increasing the speed and incline until you vomit or you tap out. I didn’t do terribly but I didn’t do well, either. I don’t know how well I would have done before the heart attack — I’d done a lot of walking over the past few years, but very little real cardio.

I was told to get on, and stay on, the “Mediterranean diet” — avoiding saturated fat, salt, cholesterol, red meat, cheese, and Uranium-235 and instead eating as many vegetables and fruits as I could choke down, plus lots of fish (and the occasional chicken). I can’t stand fish so that part was out.

The part I did find rather strange, though, about the Med diet was the insistence that I get as much olive oil in me as I could — and when I say the goal was for me to consume a lot of olive oil, I mean they wanted me to consume a LOT of olive oil — like, over a cup a day, more if I could manage it. I was happy to sauté every vegetable in sight in olive oil and to use olive oil in place of butter in things like mashed potatoes. I think they were in favor of my shampooing with it. All hail olive oil, the universal remedy!

The sort-of hard part was doing completely without salt. I’d cooked a pretty low-salt diet for years and years already; my mom had blood pressure that was up in the stratosphere somewhere, so she almost entirely stopped using salt in cooking when I was around 8 or so. As I tried it in 2021, I found that cutting it out entirely — not using it on potatoes. meats, etcetera — made for some very flavorless meals. At least, until, I found out about the seventeen different flavor varieties of “Dash” (née “Mrs Dash”). I found and purchased salt-free ketchup, mustard, hot sauce, and so on, and so on.

The hardest part was abstaining entirely from cheese. I love cheese. Which, now that I mention it, might help us understand why my blood vessels were so choked with fat and cholesterol.

Rehab went well. I showed up three mornings a week at a building located in a scenic complex right next to I-89 in South Burlington. The rehab center had about ten treadmills, three rowing machines, a set of Nautilus-style weight machines, quite a few exercise bikes of both the recumbent and upright variety, a couple of ellipticals, and one thing they simply referred to as “the Iron Maiden.” I did a half hour intense treadmill session followed by 2000 meters on a rowing machine (trying to get under 10 minutes each time) each day. I did a good bit of walking on my own outside the rehab time, in evenings and on weekends. Then too, that November I walked the entire 60-mile route of the 2021 San Diego Susan G Komen 3-Day.

Back in September at the hospital, they’d changed out pretty much all my meds — my cholesterol drugs, my blood pressure drugs, and so on. My body responded very well to the new regime — my blood pressure went from 155 over 110 (and similar scary numbers) to a routine reading of 110 over 70.

Score 10 for the home team, there. I was ecstatic.

For a decade I had tried every drug in the book and the best we’d been able to do is get my BP below 150 now and then. (I know you’re probably thinking, “maybe the catheterization opened things up and lowered your blood pressure?” I asked, and they said no, the vessels they opened up were not major vessels that would have had a big impact on my blood pressure.) I don’t know why all of a sudden everything clicked with the new regimen, but I was most certainly not complaining.

Between the rehab, my completely overhauled diet, and my revised meds, everything was coming up roses. I lost — and I am not kidding here — 30 pounds. My blood pressure got to absolutely ideal levels. A lipid (cholesterol and triglycerides) test came back with literally the best numbers I have ever had.

This frightened and confused the staff at the UVM Cardiac Rehab department. They noticed that Jay was, week by week, becoming less of Jay. Apparently this was not common among their patients, many of whom took kind of perfunctory interest in pushing themselves on the exercise machines and perhaps cut back from two pizzas a day to just one.

Yes, that’s kind of a mean thing to say, but …

One day the UVM staff actually stopped me and said “You’ve lost a lot of weight and you’re doing really well on the machines, what gives?”

I replied, with some perplexity, “I … did what you told me to do?”

They looked at each other as though I’d just announced the second coming of Lyndon B Johnson and that LBJ would arrive shortly in a UFO pulled by twin unicorns. Apparently, someone actually doing everything they’d been told to do and consequently markedly improving their health as a result was just not something that happened every day, if at all.

I finished rehab on February 1st. Since then I’ve tried to do pretty intense home treadmill sessions on my own and have kept to the diet. I’m now tipping the bathroom scale at 197 — the least I’ve weighed in over ten years, and down from the mid-230s around the time of my heart attack. (Disclosure: I am 6’2″ tall.) If I can lose a couple more pounds I will, per the BMI index, no longer be considered overweight! (I know the BMI is a terrible way of measuring health and weight, but it’s one a lot of people more or less comprehend.)

My goal is the low 180s — and to stay there this time.

Long story short

To make a long story short, I rule. To make it a little less short — I’m doing pretty damn well, proof positive that heart disease can be a manageable, chronic condition if you have the time and inclination to make the hard choices and to realize that actions have consequences. Provided I keep to my diet, keep exercising, and keep checking in with my PCP and cardiologist, there’s theoretically no reason I can’t expect to live a couple more decades, at least.

Now, off on a wild tangent

For 14 years, I’ve taken part in 60-mile, three-day fundraising walks on behalf of Susan G. Komen. I’ve raised something like $60,000 in the course of doing all those events.

Why?

Well, it’s not because I have cancer, or because my wife has cancer, or because a close relative has cancer, or because a co-worker has cancer. I have gotten to know, and seen waste away and die, several beautiful women who I met through the Komen walks.

I did all those walks because, at the age of 40, I realized that I was basically just a drone who worked, ate, slept, and otherwise made almost no impact on the world. Certainly no good impact. And moreover, because I know enough about cancer and what an utter bitch it is, I don’t actually want anyone to experience it. I don’t want anyone having to get up in the morning and look in their mirror and wonder how many more of their children’s birthdays they’re going to get to take part in. I don’t want people wondering if they’ll make it to their next anniversary. I don’t like the idea of people spending eight damn hours a day, day after day, in infusion chairs — with all their hair fallen out, and each evening vomiting up their internal organs.

Yes, the morbidity and mortality rates associated with cancer have improved over the last 25 years but we’re still looking at 40,000+ deaths from breast cancer each year, along with hundreds of thousands of new cases. One in eight women will get breast cancer during her life.

And you know what really sucks? I mean, other than the chemo and the loss of taste and the loss of hair and all the vomiting and losing half or more of your body weight and and and … and all that other stuff. But what really sucks is the knowledge that you can do everything your doctors tell you to do — I mean everything — and it may not mean a damn thing at all. In lots of cases, sure, it can and does help. But in other cases, all it really seems to do is put off the inevitable for a few months.

I am very lucky to have drawn “heart disease” in the Bad Luck Sweepstakes. Like I said, if I keep doing everything my doctors tell me to do, I have every expectation of being around for quite a while. Far more people die of heart disease than breast cancer, but of those, at least 1 in 3 are deemed “preventable”. Okay, I don’t particularly want anyone to have severe heart disease either… and my logic and reasoning here may make no sense at all. You don’t buy seafood from a guy selling it off the back of a truck in a vacant lot and you don’t take medical advice from Jay Furr.

But I’m going someplace with this. Humor me for just a little bit longer.

Until recently, I haven’t had a loved one with cancer. Haven’t had a loved one with cancer that gets treated and goes away and then comes back and gets treated again and goes away and then comes back again and then refuses to respond to treatment.

Now I have.

I have had to learn first hand how powerless a family member feels, wanting to make everything better and knowing they can’t. I’ve had to go through at least three of the five stages of grief — I’ve spent a lot of time in denial and bargaining and depression.

I hate cancer and I want like anything to be able to say “It will get better. I promise.” But I can’t. I don’t know that it will. Wanting it to and having it happen are two entirely different things.

I feel absolutely powerless.

Who’s the family member?

Meet Marie.

No, I’m not joking. I’m posting about my cat.

That’s Marie before the giant tumor showed up on her side. She has a form of skin cancer that is very rare in cats. It has not metastasized inside, not yet anyway. But it looks just God-awful and no, I’m not going to post a photo of the tumor.

Today I got to spend time — twice — mopping up blood off the floor as a result of the tumor opening up and bleeding. Not gouts and rivers of blood — but steady large droplets of blood all across our floors. (We asked the urgent care vet today how to bandage a furry cat and were told that rather than do a half-assed job and wind up creating a nice warm moist environment under a bandage for bacteria to thrive in, we would be better off leaving the tumor open and uncovered. She’s got an appointment with the oncologist in three days anyway.)

Marie has had surgery and medication to reduce the tumor twice now — and each time, it has come back larger. She has smaller tumors here and there that have not so far bulged out of control but the really huge one on her side is flat-out scary to behold.

She’s getting chemotherapy and anti-inflammatories. She still has appetite and still hops up in laps, but we don’t know what each coming week will bring. I lie awake at night talking to myself, saying “I wonder what options we might have if we told the doctors that there was no limit on what we were willing to spend.” Bargaining. Denial.

Are we being abusive by keeping a cat alive just to watch her suffer because we’re not willing to do what’s right? I ask myself that every day. She still seems to have good quality of life. As I said, she still loves her chow and she still begs for lap-time from Carole every single morning and a lot of evenings — and that’s an otherwise standoffish cat asking for love.

I have promised myself that if Marie does begin to suffer and lose a lot of weight…, if the doctors say “We understand that you love your cat, but there comes a point…”, and so on, I will make the hard decision. We’ve had to make that decision three times with other cats, and it’s never been easy, but they were suffering and didn’t understand what was happening and looked to us to make it all go away and we couldn’t.

With Marie, there’s still a chance. There is still a chance that the chemotherapy may make an impact. That the tumor might shrink. Since this is such a rare form of cancer in cats, no one really knows what the prognosis is.

If it’s this upsetting fighting cancer in a cat, I can only imagine how bad it must be to be a family member of a human with cancer, knowing what is happening to them and knowing the odds. Knowing that there’s a chance — a chance — that the cancer might go into and stay in remission… but also knowing that maybe it won’t. I don’t want to be the voice of utter gloom here — survivorship odds go up each year.

I feel so terrible, gloating about how well I’m recovering from a heart attack, knowing that there are people out there willing to work ten times as hard as I have, but who know it may not make a difference at all.

If I thought I hated cancer before, I really, really, really, really HATE cancer now. Every time I see that awful tumor and feel my heart and stomach wrench — I just think unprintable thoughts and wish the black cloud hanging over us would just.

GO.

AWAY.

In closing

It may seem like the non-sequitur to crown all non-sequiturs, but I’d really appreciate it you’d sponsor me in the 2022 New England Komen 3-Day. I like to think that the money we all raise will alleviate suffering and bring hope — and that’s something that’s priceless.

If you wish to sponsor me, you can do so at this link: http://www.the3day.org/goto/jayfurr

God be with you. Be well.

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Well, There’s A Cheerful Note

By | October 1, 2021

I was a little disconcerted when I found out from a cardiologist today how utterly blocked some of the arteries that wrap around my heart are. Not talking about the aorta here — I’m talking about the arteries that supply the heart itself with oxygen. One of them is completely, 100% blocked. One is 80% blocked.

I asked “then how on earth am I not in serious trouble”? The cardiologist said “fortunately, you seem to have a lot of redundancy here. That one there is blocked, but this other one over here is still able to supply that area.”

Diet and exercise are not likely to ever open those up; it’s a case of trying to keep it from getting worse. I may have had a mild heart attack with few lingering symptoms, but I still have a time bomb in my chest.

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My Completely Mystifying Heart Attack Recovery

By | September 27, 2021

As I mentioned in this blog post on September 18, I had a mild heart attack sometime in the wee hours of September 13. I went in to the ER the following day (d’oh) and was promptly admitted, poked, prodded, and eventually catheterized before being discharged with three new prescriptions and a whole lot of follow-up appointments.

So: I am doing well.

Correction: I am doing really well.

It’s just plain strange, but within a day or two of being discharged, I stopped feeling any lingering pain in my chest, any excessive fatigue, any anything out of the ordinary. I got back to feeling pretty much 100%.

I went for a two-mile walk the day after I was discharged. I would have turned around if I’d felt even the slightest discomfort or warning sign. I think I might have been a little tired at the end, but never felt excessively weak or in pain. Otherwise, I was just fine.

I walked another mile on Saturday (there’s a story behind that one mile1On September 6, I was appointed to fill a vacant seat on the Richmond, Vermont town selectboard. The seat was open because of a resignation six months into a three year term. I will serve until Town Meeting in March 2022 at which point in time I’m welcome to run for the remaining two years of the term. One of the first things I had to do as part of my official duties was perform a ‘site visit’ of a Class IV road in our town, a road that exists on the maps but has become completely overgrown and all but invisible. The people abutting the “road” have petitioned for it to be officially discontinued. The “road” was only a half mile or so long but it was a bushwhack and a half., but again, felt fine afterward.

The following day, Sunday, people at church who’d heard about my heart attack were poleaxed to see me wandering right on in, none the worse for wear. After church, Carole had an English country dancing event to head out to and I had nothing better to do, so I had her drop me off at an intersection about seven miles from home. I walked on home from there via relatively quiet Vermont dirt roads. Amusingly, a couple of miles from home a passing car came to a stop and the very bewildered driver called out “Jay?”

I didn’t recognize the driver at first, but it turned out to be a member of our church whose husband had helped Carole by driving my car home from the hospital while I was an inpatient. Thus, she knew perfectly well that only three days earlier I’d been in the hospital for a heart attack. The last thing she expected, I’m sure, was to see me toddling down the shoulder toward her, not a care in the world. I assured her that I was taking breaks and making sure I felt okay, which I was, and I gave effusive thanks for the help she and her husband had given Carole with my car and everything. She seemed a little doubtful about me being out walking so soon after discharge, but I told her I was fine and we went on our separate ways.

I was completely prepared to wake up Monday morning regretting that seven mile walk on Sunday.

Nothin’. I felt fine.

I walked five more miles on Wednesday. On Saturday, I walked eleven miles and then went for an eight mile bicycle ride with Carole. I wore a Fitbit Versa 3 GPS-enabled fitness watch, which tracks my heart rate among other things, and the post-walk and post-ride heart rate plots showed I was never really laboring, never actually even getting up out of the base heart rate zone (well, except for the bicycle ride, because there’re a couple of hills along the route we took that do tax me a little bit).

As for my blood pressure — it’s been fantastic. It was fantastic the day I got home and it’s stayed fantastic. 112 over 79, stuff like that. Sometimes lower. Before the heart attack, before a change in my medications, my systolic blood pressure was rarely below 135. Without the medication I’d been on, it was usually over 150. Now it’s routinely in the 110-115 range. It’s almost surreal to sit down and take my blood pressure and see numbers like that after so many years of seeing the display turn an angry red or amber when the check completed. It’s also possible the Roto-Rooting the cath lab did made a difference by opening up key blood vessels.

I have been carefully tracking my sodium (2000 milligrams of sodium per day, max, which is slightly lower than the RDA of 2300 milligrams per day), saturated fat, and overall calories. I’m trying to lose weight to get down from my current weight of 220 pounds or so to a more reasonable 190-195. I had a “bwah!” moment a couple of days after my hospital discharge when my scale showed me weighing ten pounds less than I’d weighed a week earlier. All I can say is, one or more of my new meds must be a hell of a diurectic, or cutting sodium has worked wonders, or both, but either way, that big of a drop has to be a lot of water being shed.

I had intake for my cardiac rehab program this past week and I have a stress test scheduled for Tuesday morning. After that, I’ll start three-times-weekly cardiac rehab sessions… but as I’ve said to several people in the last few days, the cardiac rehab folks are going to be very confused by one of their new patients rattling off the miles and miles they’ve walked lately. I think part of rehab is walking on a treadmill while connected to an EKG, which makes sense, but otherwise, there’s a certain amount of humor in the idea of them saying “yeah, we need you up on the treadmill, got to get up out of your chair and get you exercising.” (No, I’m not out running or anything really ambitious like that, and I follow a few friends on Strava who go out every weekend and bicycle eighty miles straight up mountains, but I suspect that compared to the average heart attack patient, I’m doing a lot better than most.)

My co-workers have been nonplused, to say the least, by my coming right back to work without taking any time off. I put in four hours the day after my discharge and worked more or less normal hours this past week (except for time spent at various appointments). They think I’m crazy, or really driven, or both. A couple of co-workers who’ve had their own heart problems have been very supportive and full of good advice, for which I’m grateful, but it’s been a little hard to tactfully get across that not only am I already doing all the stuff they advise me to do (watching sodium, trying to do a Mediterranean-style diet, etcetera) but that I’m already feeling this well. I’ve had a few things recommended to me (like Coq10 enzyme pills, or adding a lot of ground flax to my diet) that sound interesting, but I’m going to talk to a doctor first.

Long story short: I feel really weird and confused about this whole thing. The hospital swears I had a heart attack, based on the troponin levels they saw in my system, which kept climbing for the first day and a half before finally starting to go down a day after the catheterization. I don’t know what else they saw on the ultrasounds or chest x-rays or EKGs, but they were quite clear, I had had a heart attack and I had a lot more plaque in my blood vessels than they would have expected for a man my age.

So why do I feel weird and confused? Well, it’s like getting diagnosed with cancer, going in for one treatment session, and seeing it just plain gone afterwards. You’d almost wonder if you ever really had it, right? Or to use another analogy, it’s like telling your parents that you’re too sick to go to school one day, only for one of them to come home early and see you out back jumping on the trampoline without a care in the world. One possibility, in that case, is that you miraculously got well really quickly, but the more likely possibility is that you were faking it.

I have to wonder if people aren’t wondering “did he really have a heart attack? Maybe it was just indigestion!” because I am totally not feeling or behaving like someone who just got out of the hospital after having had a heart attack. I’ve had co-workers ask me if I need or want them to bring meals by, help with errands, anything like that… only to be told “No, no, I’m good, I just walked ten miles, I think I’m recovering fairly well.” There’s a term for faking illness to get attention: “factitious disorder” (also called “Munchausen syndrome”). If I didn’t know better, I’d think I was faking the whole thing.

It also worries me a little bit that my experience might cause others to take their risk of heart attack a little less seriously than they ought to. You know, “Jay had a heart attack, and a few days later he was back wrestling mountain lions, it’s no big deal.”

I have a follow-up appointment with a cardiologist this coming Friday. It’ll be my first chance since being discharged to sit down and ask someone who would be in a position to know how severe my heart attack really was and whether there was anything on the ultrasound or X-rays or EKGs that would have helped spot this sooner.

For what it’s worth, some of you might be thinking “I hope the fact that he recovered so well, so quickly, doesn’t make him take rehab, diet modification, losing weight, and so on, and so on, less seriously.” I’m taking those things very seriously. I don’t ever want to find out the hard way what a bad heart attack is like.

Footnotes

Footnotes
1 On September 6, I was appointed to fill a vacant seat on the Richmond, Vermont town selectboard. The seat was open because of a resignation six months into a three year term. I will serve until Town Meeting in March 2022 at which point in time I’m welcome to run for the remaining two years of the term. One of the first things I had to do as part of my official duties was perform a ‘site visit’ of a Class IV road in our town, a road that exists on the maps but has become completely overgrown and all but invisible. The people abutting the “road” have petitioned for it to be officially discontinued. The “road” was only a half mile or so long but it was a bushwhack and a half.
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Heart attack

By | September 18, 2021

So, I had a mild heart attack the other day.

I woke up Monday morning with a sore left arm and a bad case of heartburn. I rationalized the sore left arm as having strained it carrying heavy scuba tanks and dive weights on Saturday. I don’t know how I explained the heartburn, though, because taking Alka-Seltzer and Gas-X and Zantac did absolutely nothing to help with it. Being stupid, though, I took Tylenol for the pain and got on with life.

Until Tuesday, when the symptoms were still there and not going anywhere. I did a telemedicine appointment with some doctor or another using Teladoc (which my insurance and employer encourage us to use) and the doctor had been on the call with me maybe five minutes before he bluntly told me to get a cardiac workup at an urgent care clinic or something ASAP. I called my primary care physician’s medical practice and my regular PCP was unavailable, but the doctor they could squeeze me in with basically said “Don’t bother coming to see me, get to the ER.”

I wasn’t too sanguine about that, given that our local hospital, the University of Vermont Medical Center, has been lambasted in the media recently for really, really long wait times to get scheduled for specialist services… not to mention Covid-19 patients taking up hospital resources in the emergency room and elsewhere. So I grabbed a thick book and headed on in to Burlington and to the ER.

The ER waiting area was maybe a third to a half full, which boded well. I checked in at the desk — they already had me in the system from seeing various UVMMC doctors over the years. When I said “I need a cardiac workup” the reception clerk said “Chest pains?” I nodded. She said “Take a seat, we’ll call you.”

And what happened next was, frankly, amazing. Almost as soon as I sat down, I was immediately called back up and was whisked into the mazy environs behind the ER desk where they promptly did an EKG. They sent me back out to the waiting room and again, almost as soon as I’d sat down, they called me BACK in and proceeded to do ultrasound and two chest x-rays and take multiple blood samples. “You had a heart attack,’ they said. “Your heart releases an enzyme called ‘troponin’ after a heart attack. Based on your level of troponin, you had a mild heart attack — it could have been much worse, but you definitely did have a heart attack.”

Within an hour I’d been formally admitted and was parked in a bed in a room that used to be the pediatric emergency area (it had all sorts of cute art on the walls) and was scheduled for heart catheterization the next morning, Wednesday. I didn’t get into a real bed (as opposed to an ER bed) until 11 pm or so, but then it was in a nice room on the fourth floor of the Miller building at UVM, the cardiac care floor. Every four hours or so while I was there they did more blood draws to keep an eye on my troponin levels; they kept climbing slowly and minutely but consistently.

I don’t remember much about the actual heart catheterization because once I was on the table where all the magic happens — where they inject the dye and watch your innards on the big screen and then send in the catheter and stents — they’d given me some sort of happy juice in my IV drip that was supposed to leave me awake but not in pain, but in actuality, basically knocked me out. I don’t recall sleeping but I do recall thinking I’d been there five minutes and then asking “Have you started yet?” only to be told that they were actually almost done.

The attending physician was blunt after the procedure was over. I asked how much plaque they found and he rather firmly said “A lot more than we expected.” But that’s why they wound up putting in four stents. They were not able to clear all the minor vessels around the heart but hope to get some of those cleared via the cardiac rehab outpatient program, which I’ll be starting in this coming week. Later on, when I had another chance to talk to him (and after multiple people had mentioned the importance of a low sodium, low saturated fat diet) he said “well, a lot of it is probably heredity. You mentioned a family history? High BP and multiple heart attacks and such?” It’s vaguely comforting to be able to blame my genes for the wretched state of my coronary arteries but it’s also a bit embarrassing to have “a lot more than we expected” at the age of 53 (I turn 54 on Monday, but I was 53 at the time).

I was kept inpatient until my troponin levels started to decline; they kept going up throughout Wednesday and on into Thursday morning. It wasn’t until they analyzed the 9 am blood draw that the troponin had finally begun to go down and I was safe to release.

I can’t say enough about the staff at the hospital. Every single person I encountered, from resident to fellow to nurse to attending, you name it, was extremely courteous. Every question I asked — and I asked a lot of them — was answered thoughtfully and fully, without any of the “oh, you wouldn’t understand, it’s all medical stuff” that I might have expected. I was also just flat-out amazed at how fast they got me back there and started administering care. I didn’t get a chance to even crack that book I’d taken along until along about 10 pm or so the first night; I was always being whisked from one test to the next. (I got three ultrasounds, including one in the middle of the night administered by a rather worried looking doctor that I didn’t encounter again while I was there, so I don’t know what that was about.)

I’m also very grateful to Carole, who didn’t say “I told you so” even once and who came to visit multiple times — Tuesday evening and twice on Wednesday — to see how I was doing and let me know she cared. She knows that going forward some things are going to have to be different around our house; we need to work on reducing stress, balancing chores more evenly, cooking with a LOT less salt (she can add more if she misses it) and avoiding fat, and getting a lot more exercise.

I got a ton of walking in over the winter — going out at night with an orange reflective vest and headlamp on and walking in the dark, in the snow… but come spring, work got so busy that I was often still at my desk at 9 o’clock at night and was too fried to walk. Two things have to change there — one, I have to balance work/personal life better and not BE working at 9 pm, and two, I have to get back in the habit of exercising. Since I have the 2021 San Diego Susan G. Komen 3-Day breast cancer walk (sixty miles in three days) coming up in mid-November I really need to get a lot of walking in.

I feel extremely lucky. Like “six standard deviations from the mean” lucky. I live near a major medical center and in an area where people have taken Covid-19 vaccination seriously. I’ve got insurance, which thoughtfully emailed me a letter the day after I was discharged informing me that they would, indeed, cover the whole thing.

Now I just have to be worthy of that luck and take my own health much more seriously. I can’t guarantee I’ll be so lucky a second time.

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Caffeine

By | September 9, 2021


Parenthetically, I’m on a caffeine fast. I started on Sunday and am most of the way through a week and am doing pretty well.

This will be the second time I’ve tried weaning myself completely off caffeine. The last time I tried was a decade or more ago when I tried going cold turkey at the beginning of Lent. I had been drinking in excess of a pot of coffee a day at that point and all sorts of bad things were happening, like my nodding off behind the wheel of a car because my sleep at night had been so poor. I wasn’t able to function at all going cold turkey so I cut back to one cup of coffee a day and then went cold turkey again with two weeks to go in Lent. And I survived. My head felt like it was stuffed full of cotton balls for a while there but I managed to tough it out. I stayed off caffeine entirely for six months to a year before slowly adding back caffeinated sodas and tea, but I never did go back to drinking coffee. I’ve managed to rationalize consuming other caffeinated products by saying “well, at least it’s not coffee.”

But with all that said, I can truthfully say that I’m not (currently) the kind of person who needs a cup of some hot caffeinated beverage just to get going in the morning. Some days I don’t have any at all and some days I have a whole pot of tea. But it’s not a “I have to have it to function” kind of thing.

Now, though, I’m trying now to cut it out entirely. No Excedrin, no caffeinated tea, no caffeinated sodas, much much much less chocolate, and so forth. I’m doing this for two reasons:

  1. Insomnia. I have terrible insomnia. It seems to have no direct, obvious connection to caffeine; I sleep just as badly on days I have little to no caffeine as on days that I have plenty. But with my doctor trying one thing after another and in ever increasing doses with little to no beneficial effect, it’s worth a try to see what happens if I just cut caffeine out entirely.
  2. On the way down to North Carolina for our Outer Banks vacation, Carole and I listened to most of an Audible Original audiobook titled “Caffeine: How Caffeine Created The Modern World” by Michael Pollan. Pollan made a good case that without caffeine, the Industrial Revolution and the era of colonization would never have gotten off the ground. (Ask yourself when London suddenly had coffeehouses on every corner and then ask yourself what else got going around that time.) But he also compared caffeine to other psychoactive drugs and pointed out that many of us will literally never know what the world would be like without the brain-altering effects of caffeine in our system. He talked about his own caffeine fast and what it was like before, during, and after and I found myself going “you know, it’s probably time I tried one of those myself.”

I don’t regard abstinence from caffeine as an especially virtuous thing. It’s just that there’s always been a part of me that resents the idea of being chemically dependent on something. I’ve never smoked, never done narcotics, and while I do drink alcohol on occasion, I remember acutely what an ass I was back in college when I drank a lot and consequently try to avoid repeating that mistake. I don’t think my life will suddenly be transformed into something magical and wonderful with bunnies and rainbows and stuff overnight, but I do hope that getting caffeine out from behind the steering wheel could have some beneficial effects.

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2021 NAMI VT Walk — October 9

By | August 10, 2021

Hi, all!

I’m a long-time member and supporter (and former treasurer and board member) of NAMI Vermont — the National Alliance on Mental Illness, Vermont chapter.

As someone who suffers from depression, anxiety, ADHD, and borderline personality disorder, I depend heavily on the efforts of NAMI to advocate for the rights of those who suffer from mental illness, to make sure treatment and care is available to those who need it, and to offer support from peers and for families. There are few nonprofits out there that matter more and that touch so many parts of our lives.

This October 9, NAMI Vermont will hold its annual fundraising walk in downtown Burlington, starting at the Unitarian Universalist church at the top of Church Street. The event starts at noon. All are welcome.

I am captain of a (currently very small) team called “Music for Mental Health” and it would mean a lot to me if you would join our team and help raise funds, or, if that’s not an option, sponsor the walkers on our team.

Our team page is https://www.namiwalks.org/index.cfm?fuseaction=donordrive.team&teamID=44570 and you can sign up or donate right there at that link.

Thanks!

— Carole Elaine Furr

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The Mysteries of YouTube

By | April 19, 2021
So some of you may be active enough on YouTube to know that you can’t “monetize” your “channel” unless you have over 1000 subscribers and over 4000 hours of viewers watching your videos in the last 12 months. Monetization means you can add advertisements and such to your videos and get revenue from them.
 
OK. Deep breath.
 
So I’ve been getting notifications every day of one or two people subscribing to my channel. No idea why they’re doing it, but there they are, regular as clockwork, one or two notifications a day. And today, I apparently crossed the 1000 subscriber mark — and, as it happens, have also exceeded that 4000 viewing hours mark.
I say this because, today, I got the email everyone wakes up every day of their life hoping to get:
Woo-hoo!
But — the question inevitably comes up: what the hell are they watching?
I don’t have that many videos on YouTube. And nothing I have out there is worth watching unless you either know me well or you’re really bored.
So let’s check, shall we?
Sorting by number of views, my top videos are:
That’s right.
  1. Three minutes of cement mixer trucks driving by
  2. An ice cream truck driving up to my former employer’s office building
  3. Another cement mixer truck video, this one with holiday lights attached, taken one New Year’s Eve

The views kind of drop off after that — a video of my wife’s sometime concert band playing the theme from Hogan’s Heroes, the local minor league baseball team’s mascot shaking its ass at the opposing dugout, and a 360 degree video of the Richmond, VT July 4th parade. And so on down from there.

So I have to ask: what the hell is it about cement mixer trucks? And ice cream trucks? I mean, really?

And what makes a person, after watching three minutes of cement mixer trucks driving by, go “I don’t want to miss any more videos like that — I’d better subscribe!”?

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Vaccination

By | April 8, 2021


Covid-19 vaccine update:

Carole has had both her shots — several weeks ago, in fact, through her employer. She works for Burlington Housing Authority and they have a population of elderly residents in some of their buildings, so as it happened, the state went ahead and offered all BHA staff shots at the same time those elderly residents were getting theirs. Nice!

I had to wait until this past Monday to get my shot — I didn’t qualify as part of any priority group so I had to wait until Vermont allowed the 50+ cohort to register. My appointment was for Monday, April 5 at Montpelier High School, about a half hour from my house and less than a mile from the Vermont state capitol. It was apparently State Employee Volunteer Day at the Montpelier vaccination center; lots of the people doing non-medical tasks (like reading off screening questions, taking temps at the door, checking people in and out) were state employees who had been given paid time away from their jobs to go help out. I was signed in, for example, by Vermont’s current Lieutenant Governor, Molly Gray.

I received the single-dose Johnson and Johnson vaccine instead of one of the two-dose vaccines — that was just what the vaccination center had that day. No need for me to go back and get another shot, so I guess I should circle April 19 on my calendar as the day our household will theoretically be 100% safe, or as safe as safe can be.

For some strange reason, a New England Cable News reporter and cameraperson singled me out from the dozens of other people arriving for their shots and filmed me at several stages of the process. I got filmed getting my temperature taken with one of those forehead thermal scanners, got filmed getting checked in by Molly Gray, got filmed getting the shot, and got filmed in the hallway outside after it was all over and asked my opinion about what the governmental employees volunteering meant to me and how I felt about getting vaccinated. I gave permission and signed a release and all that, but I still don’t know why they looked at me out of all the others and said “Him!” Perhaps I just looked so utterly completely middle-of-the-road safe/boring that they figured I’d make for a good vox pop.

The footage aired that night on local NBC channel WPTZ and on the NECN cable network itself. If you’re really, really bored you can watch the WPTZ version here. The NECN version, which is a bit longer and also features Vermont’s Governor, Phil Scott, getting his vaccination, is here.

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