Birthday Bizarre

Tomorrow is my birthday and I am the perpetual child. I love my birthday. I want a cake, I want presents, I want to go out to eat, and I want do to what I want to do. I’m not fishing for gifts here (Billy the exterminator swag, cycling gear, food, coffee); I’m just telling a story. I’ve already gotten some cards in the mail (lacking checks) and I am expecting a package tomorrow from, well, from me…ordered by me… to be given to me…on my birthday. But today I got two strange birthday greetings, one in the mail and the second via the great funnel of virtual greetings—the internet. Both were sweet, unexpected and completely impersonal.

One came from a law firm my wife and I did business with five years ago or so. We have a friend who lawyers for the firm and I assume he is still there. I don’t think he is the driving force behind the birthday card…that I get every year. Now my life is pretty low key and doesn’t require a lot of lawyering. I don’t get into much legal trouble and I don’t have a business or lots of assets that need protecting. In fact, I am pretty sure we haven’t brought any more business to this firm since that one time. Yet, each year the entire staff personally signs a card and mails it to me. And they always include a gift—a refrigerator magnet! So thoughtful and unnecessary, but always appreciate for the sentiment it represents.

I mean, at one level it is very nice that they take the time to do this. At another level I have a sneaking suspicion that I am not the only one they do this for. I assume they do it with everyone they do or have done business with. I can see it. Every Monday morning at the end of the staff meeting they pass around a dozen cards that each person signs to be mailed out for birthdays that week. Does this cheap ploy at personal impersonalness buy my loyalty? Hell yeah! Next time I need some lawyering I’ll call them…I’ve got their number right on my fridge.

The other greeting I got was digital and was really, really impersonal. It wasn’t even from a person. It was from a company. Now at this point we are all used to getting birthday emails/solicitations from companies with whom we do business. Some even give you a coupon or something free. In most cases, you can look at the email and know, oh yeah, that is because I bought that lava lamp from Spencer’s Gifts online last year and now they are sending me a coupon for a discount on black lights and fuzzy posters.

Well this one has me scratching my head. I got an email tonight from Knorr. Yeah, you know the company that makes sauces in those little green packets….that I NEVER buy. Well, my friends at Knorr—all of them apparently—sent me this little greeting:

Happy Birthday, Adam!		Take the time to celebrate you! All of us at Knorr® are here to help make your big day as easy and stress-free as possible. Our recipe for the perfect party? Close family, good friends and delicious food. Try one of our favorite dishes to make your birthday wishes come true!

As if that wasn’t thoughtful enough, they also included—wait for it—a recipe for Nacho Supreme Rice! Mmmm, I cannot wait to try it! In fact, I may need to throw a party just to try the new recipe I got for my birthday from ALL of my friends at Knorr! Really, I am such a lucky guy to be on the personal birthday card list of a non-human corporation (Dick Cheney is the only human corporation I know of), made up of lots and lots of really happy humans. I mean, really. Just when I thought I couldn’t be any luckier or feel any more loved. I got a recipe from Knorr! Sigh.

Now I am trying to figure out what I signed up for that somehow got me onto a Knorr mailing list. Given the bizarre interconnections between seemingly unconnected businesses, it probably came when I signed my son up for a video game or created an Amazon.com account. Somewhere on one of the screens was a box already checked indicating that I wanted to get birthday greetings and other promotional information from Knorr. Now that I have made the list, life is filled with endless and thrilling possibilities. I can’t wait to see what they send me for Chanukah! Maybe I’ll get a coupon for a packet of sauce every night for 8 nights. It will be another miracle!

All of this excitement and it isn’t even my birthday yet. It is going to be hard to sleep tonight knowing that untold digital wonders await me tomorrow on my special day. I hope Mickey Mouse remembers my big day. I wish, just once, he’d call instead of sending an email.

P.S. Two postings in one day, I know. One pathetic, one ridiculous. I must be taking pain medication! 

Pain is temporary...when the hydrocodone is near.

I just realized something. My body hurts and I am surprised and a little disappointed. Now that may, and should, sound a little stupid. Feeling the pain pill I just took kick in as I write helps me understand why I feel the way I do. The difference in how many body feels when I don’t take the pain medication and when I do is stark.

For the first week after my surgery I took the pain medication every 4 hours, even after I came home. For the last few days I’ve been trying to figure out the balance between the therapeutic effects of letting my body heal with reduced pain and using pain medication unnecessarily. Thinking it was time I started to reduce my use of them, I started taking them only when the pain really bothered me. That has translated into taking the meds maybe once a day. It has also translated into me feeling more pain and getting tired and cranky more easily…and me drinking more coffee to compensate for feeling tired and crappy.  It has also had an emotional impact. I am not very happy. I don’t know that I am depressed, but I am kind of ticked off.

I guess after a bunch of days taking the pain meds and feeling no pain I started believing that I was recovering from the surgery with little pain. I starting to think that I could and should start to do more things for work and around the house because I felt pretty good. Now after two days of taking fewer pain meds and trying to do more I am tired and wrung out. I am tired in my bones and discouraged because I feel as weak and as sore as…well, as I probably should given that my surgery happened just 12 days ago. Because I felt pretty good, it was easy to forget that I have a broken bone that is healing—not just any bone but the keystone of my upper body. And it is easy to forget that I have a whole bunch of muscles that did all sorts of things they weren’t supposed to because my chest was split apart and spread wide.

So now I sit here tired, unable to bring myself to work on that grant proposal, knowing I should take a nap instead of have a cup of coffee. And I know that the way I feel isn’t helping me get better and it isn’t going to make me any more helpful to my family.

So I say hello nap, hello pain meds, hello reality check.

Once again I prove that my desire to do is not tempered by any sense of what I can or should do. Maybe, just maybe, someday I’ll learn. Unfortunately I am starting to slip into that old dog, new trick territory.

Driving Miss Daisy

Suddenly I am 70 years old. I know it is only a temporary thing, but my recovery is giving me insight into what it is like to be old. And I can confirm that getting old ain’t for sissies. Among the many things this whole experience has done for me, it is making me a bit more aware of what my parents and other older people go through on a daily basis. I hope it will translate into a little more understanding and compassion. In the meantime, I’ll hide a self-indulgent wine behind that search for compassion and understanding.

Shuffle, Shuffle

First, there is the lack of mobility. I move slowly here at home and it still takes a bit of an effort to get up, sit down, bend down, reach high, etc. I feel like I should be wearing a ratty old bathrobe, shuffling about in worn fuzzy slippers, and yelling through my screen door at the neighborhood kids. No matter where I am, though, I move a little slower than the rest of the world. I took my kids to EarthFare (a local healthy grocery store) to meet some friends for dinner—kids eat free on Thursdays. It was a complete zoo with kids and cranky, pushy parents madly rushing hither and yon in a relatively small space. We were all trying to get our kids to pick their meals, buy our own, retrieve our kids’ meals, and go sit down. I felt like a turtle trying to cross the Autobahn. And I could feel the annoyance of some of my fellow parents as I tried to negotiate the chaos. It is no fun to feel like you are in the way.

Does this bus go to Publix?

I can’t drive right now and won’t be able to for another couple of weeks. That has raised the burden on my wife as she has had to do all the driving around of kids to school, home school stuff, music lessons, play dates, etc. It is frustrating and a little demoralizing that I can’t help. Not being able to drive completely cuts off any independence, too. I can’t go to the grocery store because I want to roast a chicken tonight. I can’t drive my kids to the library to get some new reading books and check out a movie. I can’t go to Target to get some new socks or a hoodie for my son—he desperately wants one because I have been wearing one recently. I can’t ask my wife to drive me somewhere every time I get a wild hair—she’s got two other kids she’s already got to do that for, plus a business. I can see how it can become easy to see yourself as a burden, especially when the rest of the fast-paced, mad world is already picking up your slack. Maybe Miss Daisy can take public transportation to get a cup of coffee or buy a chicken.

Can I get a box?

Following the classic stereotype of the elderly, I eat like a bird. You always see older folk who go out to eat taking half their meals home in a box. That is me. I went to a Mediterranean place last night (Thank you to my wife for driving Miss Daisy to dinner) and got some falafel, a gyro and Greek salad. Half the falafel and gyro came home in a box. The funny thing is that I am starting to think like a septuagenarian too, because I thought to myself as I was packing my box, “Oh, good now I have lunch for tomorrow.”

Up before dawn

You hear your older friends and family say it all the time. They wake up at 4am and don’t go back to sleep. Here I am a 6am on Sunday, having been up for 2 hours already. I think what happens is that the need for rest in the middle of the day goes up but the need for total rest in any one day isn’t that much greater. The end result is that I may sleep some in the afternoon, but that means I don’t sleep as much at night. I am tired and ready for bed by 10 or 11 but wake up by 5 or 6. This sort of puts you out of sync with the rest of the productive world, and creates the perception that you are always tired or always sleeping.

As I’ve said, this is only temporary for me. I’ll get out of this mode as my body heals. It won’t hurt to get up or sit down, I’ll be able to move faster, and my doctor will eventually give me back the keys to my car…oh yeah and let me ride my bike. For people who don’t have that kind of recovery to look forward to, it must be a personal struggle to keep life on the positive side. I can see where the understanding of others would go a long way to making it easier for them to get up every day, push on the old slippers, and shuffle off to the kitchen at 5am for another day in paradise.

Paper or Plastic

Life is positively "ate up" with choices. Some of them are pretty low input. (Do I really have to take a shower today?) Others are somewhat more serious. (Do I really have to wash my hair if I do shower?) Periodically throughout our lives, we are all faced with much more difficult choices and right now mine is whether my new heart valve should be mechanical or made of tissue.

Like all hard choices, it is a messy one with no really clear answer. Each choice has its upside and downside. Mechanical valves last a lifetime, so I won’t have to worry about my valve failing and the need to replace it. That is pretty appealing. I kind of like fixing something and not having to worry about it anymore. They make some mighty fine mechanical valves these days—carbon, titanium. The problem is that blood clots tend to form around mechanical valves. Apparently the mechanical valves damage some red blood cells, increasing the potential for clotting. So, mechanical valves come with them the need to take anticoagulant medication for the rest of your life. They are called blood thinners but they don’t really thin the blood, they just slow its clotting. Clots are bad because they can break free and travel to the lungs or brain, causing strokes and deadness.

Among the many unpleasant things about anticoagulants is that when you slow your blood’s natural clotting, you do it for all clots. If you cut yourself shaving, you bleed longer…if you sustain a serious injury with internal bleeding, you increase the chances that you will bleed to death. Also, sometimes anticoagulants can cause spontaneous internal bleeding. Cool, huh? I want to take something that might cause me to start bleeding somewhere on the inside for no good reason! (Did you know an anticoagulant (heparin) is the main ingredient in rat poison? Now you know how those rats die.) The reality is most people take anticoagulants without any serious problems.

But if you do things that already increase your chances of sustaining serious injury, then anticoagulants make those kinds of things much more dangerous. I may not have mentioned it before, but I like to ride my bike. Given the chance, I would ride my bike a long ways as many days a week as I could, and I would travel to exotic places like Virginia and ride my bike there. Biking riding is not inherently dangerous. Still, the longer you spend on the road, the greater the chances that you will encounter someone who: a. hates cyclists and wants to run them down; b. is talking on the cell phone; c. is more interested in their Baconator from Hardees than the road; or d. is a modern-day shaman driving in a chemically altered state of consciousness. You also increase the chances that you will do something stupid like hit a ‘possum carcass or an empty OE 40oz on the road and take a detour into the woods or down an embankment. Under normal circumstances those kinds of things can be a problem, but if you’ve hindered your blood’s ability to clot they can be really bad—like “Good night Irene, the party’s over” bad.

Plus other things can affect how much you are slowing the clotting—other meds, eating leafy green vegetables, boozing it up. So, you have to test your blood regularly…weekly or monthly. If I need surgery down the road—you know a nip here, a tuck there…or say to fix my ptosis (non-functional eyelid muscles)—then you have to stop taking the meds, increasing the chances of a blood clot forming. Yadda, yadda, ya.

OK, so what about the tissue valve? Well, those gems only last so long. In a spry youngster like me, maybe only 5 years but more like 7-10 years. No need for the anticoagulants and they work great, but they have a built-in self-destruct element. Failure of a valve isn’t usually life threatening and I’d know it was happening. The problem is I’d have to get a new one. No biggie, I have insurance. Well, I do now but really I might not in a decade (let’s hope not). Still, the thought of signing up for open-heart surgery AGAIN in 5 or 7 or even 10 years sounds…well, kind of stupid. Shouldn’t I try to avoid major surgeries like that? The mortality rate on heart surgery is very low. It increases on repeat surgeries but not by much. Still I am not excited about multiple surgeries.

Generally, for someone who is over 65 a tissue valve is the way to go. They last longer in older folk and so it is assumed that most tissue valves will outlast their hosts. For someone my age, mechanical valves are the recommended choice because otherwise I’d be back by age 55 for another valve. If I chose another tissue valve, I’d be back for surgery #3 by 65 at which time they’d give me another tissue valve and hope it outlasted me.

Now you could say that medical science will improve over the next decade and surgeries will be less invasive, valves will last longer, etc. So just go get that tissue valve because things will be a lot better in the bright future. Now, I’m not going to advocate ruining the earth because we can move to the moon in future…so that logic doesn’t necessarily play with me. As humans, we’ve gotten ourselves into the messes we have because we’ve continued to kick the can down the road and depend on technological advances to bail us out.

You could say get the mechanical and a life-time supply of blood thinners because civilization as we know it is going to implode in the next decade so you are better off with the permanent fix. I am all for the permanent fix idea, but not because I believe I will be Mad Max (a shell of a man) trading gasoline for food in a decade. Even if that did happen, I’d be OK. I know enough people with guns and they would become rulers of their neighborhoods. I am sure my friend Kyle would take me in once he became King of Murraywood. Plus, I’d have skills that would be valuable in a post-societal collapse world. Archaeologists will be in demand in that world…for digging taters and burying those who displeased the leaders with guns. My cycling would come in handy, too. I could become indispensible as the rickshaw driver for the King of Murraywood—in a world where gas was scarce. I am sure the King of Murraywood would make sure his valued rickshaw driver could get is anticoagulants from the syndicate controlling medication in a post-societal collapse world. Right, Kyle?

Then there is the stem or root of my aorta. It is stretching and if that is allowed to continue it eventually will bust. Blood thinners or not, if that happens I am pretty much toast. That is how John Ritter went. The doctors can’t tell if mine is dilated enough to warrant replacing it and they can’t know if it will continue to stretch or not. They’ll have a better idea after my next echocardiogram (sonogram of my heart), but may not know if it needs to be replaced until I am opened and on the table. According to one surgeon I have spoken with, if that needs to be replaced, my best bet is to go all artificial—aortal root and valve. And that means anticoagulants. Of course, I could get an aorta and valve package from a cadaver and have that installed…but that still will only last 5-7-10 years. Plus then you’ve got someone else’s stuff in you…I’ve seen enough of those horror movies to be just a little worried about that. Then again, if I get pig tissue in me what will I start doing?

It is possible to have my aortal stem and valve repaired, thus saving my own parts. The repaired bits won’t last forever, but will last longer than pig parts or stuff from someone who has crossed over. That is only possible if the stem and valve aren’t too badly messed up…so it’s another game time decision. My surgeon here in Columbia won’t do that procedure, so off to Charleston I go on Tuesday to talk to another surgeon (in my insurance network, of course). He works at the Medical University of South Carolina—I wonder if I get an employee discount?

So, either choice has its problems. I am, by nature, conservative—not politically, but in terms of not taking unnecessary chances. However, I am not thrilled with the whole bleeding to death thing, either. The problem with this choice is that there are few external factors pushing me one way or another. This one is purely about what I want to do…the hardest of all choices. So, I’ll do what any rational person would do. I’ll do my research, discuss my options with family and friends, reflect, kill a chicken and look for tell-tale patterns in its spattered guts, seek advice from the homeless man who used to cut my grass, and then flip my lucky penny.

Still the Fat Archaeologist

When I started this blog, and started trying to lose weight and get into cycling, I weighed 208.6 lbs. After a good 6-8 months, I dropped to about 180 lbs. I've stayed at that weight until this summer. Surprisingly, a few weeks of constant fevers and sleeping and a week in the hospital all combine to make a pretty effective weight loss strategy...not pleasant, but effective. When I came home from the hospital, I weighed just over 170lbs and as of this morning I weigh 171.7 lbs.

Now when I weighed 208lbs my body mass index (BMI) was 31.9. Anything over 30 qualifies as being obese...so I wasn't the fat archaeologist, I was the obese archaeologist. When I dropped down to 180 lbs my BMI went down to 27.6. Anything above 24.9 ranks as overweight, so I was still fat. Now that I've lost another 10lbs, guess what? My BMI is 26.3...and I am overweight. That means I can still call myself the Fat Archaeologist! To lose the right to call myself the fat archaeologist, I need to lose another 10 lbs. I am not sure I even want to do that.

I may have lost more weight, but I also lost any semblence of physical fitness I had back in April. That is one of the consequences of the fever-bed ridden diet plan...if you were in any kind of shape before you started it, you'll lose it. Since I declared myself well a few days ago, I have been trying to return to a normal routine...and really increase my activity some so I can get back a little fitness before I go in for surgery. The idea is that I will be better able to handle surgery and recovery, and I won't have as far to go to get back into some kind of shape. Really, I'll only be off my feet for a few days after surgery...not really enough time to lose a lot of what I had before surgery...assuming I had any real strength and stamina before surgery.

I found out today just what I've got...or lost. Yesterday I put in a full day of some work, running kids hither and yon, and household chores all followed after dinner by a trip to the Carolina Children's garden for a nature walk with my kids and friends--a program organized by our homeschool group. We might have walked a mile over the course of an hour or so. I felt a little tired when we got back and crashed pretty early. Today, I was fine in the morning but an afternoon nap became an imperitive. I haven't done a nap in days. And since dinner I've been pretty tired, again. I even had a half cup of cofee after dinner and I'm already ready for bed. So, its pretty clear that I don't have a ton of stamina and I will need a rest day after any even remotely strenuous stuff. My work is cut out for me if I want to get even a little bit better before surgery.

Of course, if my cardiologist has his way I'll have a good 6 or 7 weeks to build that stamina back up...and although my impulse is to resist that timeline, I understand why he wants it that way. If I get my way, I'll cut that wait to about a month. I see my cardiologist after the long weekend and I'll pepper him with questions and pitch my version of the timeline. I keep telling myself to be smart and listen to what seems like sound advice, so we'll see whose timeline will prevail.

The timing of surgery is important, but the more I look into what is ahead of me the more I realize I have much bigger things to worry about. Is my hospital and my surgeon the best one for my circumstances or do I need to look elsewhere? Should I choose an artificial heart valve and a lifetime to taking anticoagulants (and increased risk of bleeding and eventually stroke) or a tissue valve with the guarantee of the need for a new valve in 7-15 years (and increased risk of complications or death associated with second surgeries). The more I ponder those questions, the less I worry about WHEN I get the surgery.

Experiences, thoughts, advice welcome from all quarters.

Oh, and I see a bike ride (slow, with my kids) in the very near future.