Walking (…and walking, and walking some more)

About 10 weeks ago, I became a man on a mission. I decided, come rain or shine (an easy promise given that it rains about 3 teaspoons a year here in San Diego), I would take a vigorous walk for a full hour each day. It turns out that at the pace I walk, I end up putting in a bit over 3 miles in that hour.

I became motivated by a visit to a cardiologist after I was diagnosed with atrial fibrillation, or A-fib, which means that occasionally (turns out to be very occasionally) I get rapid and irregular heartbeats. It’s one of those conditions where the doctor tries to be reassuring and threatening at the same time. “Lots of people have it, and we’re not sure what causes it exactly, and by itself it’s not particularly harmful, except that it could possibly cause a stroke that could kill you.”

Huh. Well one symptom it causes is that I’m suddenly aware that there are dozens of TV commercials for medications for people with A-fib (mostly blood thinners) that show people my age being happy, healthy, and active while the voice-over cheerfully recounts the dangers of A-fib and the equally damaging potential side effects of the wonder drug they are hawking. I never noticed these ads before.

So, to stop the stroke that I might get if I continue to have fits of A-fib which might or might not happen, doc wants me to reduce caffeine intake (to 8 ounces daily), my beer consumption to no more than one a day, and to increase exercise.

Eight ounces of coffee is not even enough to start my heart in the morning. I have a 20 ounce cup of coffee from Starbucks every morning and 0 caffeine the rest of the day. To ease into the reduction, I now ask for “room for crème” when they remember to ask. I figure that cuts two to three ounces. Hey, it’s a start. I’ve cut my beer consumption by about 20%, and I figure I’ll get to his limit around the time it just becomes too hard to get out of my chair to get a second one in the evening.

So as much as I tend to respect authority figures, I refuse to let them take away my reasons for living. To paraphrase Mark Twain, it’s important to cultivate some bad habits so you’ve got something to give up when you contract something really serious.

However, I have embraced “the walk.” It is one of my favorite times of the day. Because I have a high tolerance for boredom, I take virtually the same walk every day. I drop down from my street into a nearby neighborhood and fall into a loop that my wife and I discovered years ago, and make that circuit five times. I return home sweaty and feeling self-righteous. It is often the hour that goes by the fastest every day.

There are a multitude of things that keep it from being the “same walk every day.” Knowing that the sidewalk and street is banked, I decided one day to reverse course after three laps and walk the route in the opposite way. I discovered it was (for a while) an entirely different walk! Nothing looked the same. All of my familiar markers were gone. I nearly missed one of the turns because everything looked so different.

And then there are the people.

I have walked as early as 4:30 AM (insomnia is a great way to get an early start) and as late as 10 PM and everywhere in between, and I’ve discovered my route has patterns and rhythms that are as compulsive as I am. At that early morning hour, the soul of the street is dead. I was completely alone for a full hour and missed the camaraderie of the people I’ve come to know.

I’ve begun to feel like the unofficial mayor of “the loop.” People I don’t know smile and wave at me as they drive by. A nice, retired couple that I have spoken with several times asked if I’d “keep an eye on the house” for them when they were leaving on a long RV vacation. I helped calm some commotion at one end of the street when a lady discovered a snake peeking its head from a lawn drain and was frantically keeping people away. I took a look at it and reassured her it was a harmless king snake and nothing to worry about (sure hope I was right). I’ve stopped to help a lady load up a file cabinet into her truck and then guided someone who was having some trouble parallel parking a gigantic truck.

Over time, some individuals are becoming more distinct to me. Since summer hit, I miss the harried parents who are stuffing their children into the car to get them to school. The kids are amazingly friendly and enjoy greeting me and clearly have not been taught about the dangers of talking to strange men. If I walk a little later in the morning, I am likely to see Spring Valley Dude emerge, usually on his phone, dressed only in a swimsuit with long scraggly hair smoking a cigarette, trying to get over his hangover from the night before. I always stop to trade gardening tips with Tera if she is out working in the front yard vegetable garden that she and her husband built, creating 6 raised beds for a wonderful growing space. I sometimes cross the street if I see this young, intense walker headed my way. He moves very slowly and wears way too much clothing for the hot weather we are in, and smokes while he walks. I’m pretty sure he is a serial killer.

I’m sure in another 5 or 6 months, I’ll start to get bored and either change the route or start having to drive somewhere to vary my routine. However, I’m terribly habitual and in this case my habit is making me healthier. Besides, my people need me. I have to keep an eye on things for them, help them park, save them from snakes, and keep an eye out for serial killers. I take my responsibilities seriously, especially the ones I don’t really have.

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Oh, the Bitter Pill of Irony

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So, it ends up that four hours after I posted my previous piece on the pitfalls of hypochondria, I ended up in the emergency room with chest pains.  It was the perfect storm of chest tightness, occasional pain, a raised level of blood pressure, with a touch of vertigo thrown in that pushed me to my 6% threshold of uncertainty and led me to ignore my own certain wisdom and call the Kaiser “advice nurse.”

Once I got on the line with her, she prepared me for the 150 questions she was about to ask me, but I already knew there was only one that was important:  “Are you experiencing chest pain?”  The rest of the questions were all relevant but unrelated to my immediate future.  I was going to the emergency room.

9 PM on the Tuesday night after the Memorial Day weekend and it was SRO in Kaiser emergency, and a lot of these people looked profoundly uncomfortable.  In fact, just being around them made me feel more sick than when I had come in. “Chest pain” used to get you right in the door and into a room, but once they established I was stable, I was sent back out to the waiting area.  In fact, I half expected one of the nurses to come out and look at my chart and yell at me, “Your pain level is a 2?!  You call that pain?!  I’ll show you pain, mister!!  Man up and come back when it actually hurts!”

Sitting, watching the waiting room slowly empty out until almost midnight began to re-define the entire concept of an “emergency” for me.  Once, my name was finally called, I was ushered into a very nice, private observation room where the hospital protocols kicked in and in short order blood was drawn, my chest was x-rayed, and a series of nurses and doctors stopped by to ask me the same, exact questions, over and over again.

It took until 4 AM for them to decide that I was going to spend the night, although that ship had clearly already passed, and that I was going to stay with them until I got a cardiac stress-echocardiogram done, hopefully in the morning.

Somehow the word “hopefully” got past me.  My weary and long-suffering wife left me to go home, and I passed out, finding it easy to follow their orders to not eat or drink anything before it was time for the test.  By mid-afternoon, when they decided they could starve me no longer, they broke the bad news that there were no openings for the procedure and I would have to be admitted to the hospital to spend yet another night eating hospital food and watching re-runs of Law and Order SVU.

Around 9:30 PM a bed finally opened up in the hospital, and I was transferred out of my fairly comfortable private digs to a regular room, a room that came complete with a roommate.  After ten minutes in the room with him, I became convinced that the only reason the bed had become available was that the previous occupant had begged to be removed, offering to sleep in a closet or to be taken off life support—anything to get away from this guy.  A nurse came in to ask me my list of questions again and then threw in a new one.  “Do you ever have thoughts of harming yourself?” she asked.  “Not until just recently,” I deadpanned.

He was in pretty bad shape and hard of hearing so the nurses had to repeat everything they told him, loudly, and he talked loudly in return.  And he loved to talk.  Every nurse’s visit prompted a new story about his wretched physical condition or his adventurous life.  He had been a musician his whole life and owned hundreds of musical instruments, had traveled the world, and spoke lovingly of his wife. He veered horribly close to insulting both a Hispanic and Pilipino nurse and somehow managed to re-engage them, turn on the charm, and became nothing but grateful for their help.

I was almost starting to like him somewhere around 11:30 PM when he suddenly began trying to cough up a lung.  He hacked and spat and swore and then started all over again.  In deference to me, he went into the bathroom to hock up the other lung, but it was impossible.  I could hear everything.  I decided to give up on sleep for the night as he settled in to watch some late-night TV which turned out to be the perfect tonic. Before I knew it, I was sound asleep.

The new day brought an introduction to new modern miracles of medicine.  By 7:30 AM I was being whisked away for a 4-hour chemical stress echocardiogram.  This involves having pictures of your heart taken at rest to create a baseline and then injecting you with chemicals which stress your heart so they can take more pictures to see if your heart is functioning efficiently.  It seemed somewhat counterintuitive to me to mess with such chemicals, but since I was not feeling the whole treadmill thing, I went for the drugs.

When I was ready for them, I was taken into a room with a treadmill and lots of monitoring equipment.  I was told that I was going to get a “lexi-walk” which was a combination of actually getting me started on the treadmill and then administering the drugs that would give me the jolt.  I started my stroll on the treadmill, but couldn’t get the term “lexi-walk” out of my head.  I’m sure it was my sleep-deprived state, but it kept conjuring two competing images in my brain.  In one, I was strolling down the beach with an adoring young thing named Lexi on my arm, and in the other I was being forced to walk someone’s annoying poodle, whose full name was actually Alexandrika.  The images faded quickly when the nurse pumped two injections into my IV and suddenly I felt like I was running a marathon–badly.

After more pictures, it was back to the room.  My roommie had vacated temporarily, and my nurse was kind enough to have the nutritionist come in and let me make a special order for my lunch.  Oooh, the salmon sounds good and of course I want the mashed potatoes and gravy, and broccoli–not those nasty canned green beans from the night before.  How nice, I thought.  Personalized service! Peace and quiet!

Within the hour, my lunch arrived:  chicken, undercooked carrots, and a bread roll made from sawdust (gluten free, I’m sure).

The only thing remaining, besides getting over my disappointment over lunch, was the visit from a doctor to tell me the results.  He was effusive.  “A model heart!  Your heart sets the gold standard for how we’d like these tests to come out!  Yeah, we have no idea what was causing your pain or discomfort, but you seem to be feeling better, so you are good to go!!”

40 hours.  40 hours to hear that despite all of the symptoms and a bucket load of worry, I was just fine.  Better than fine.  A model that other 61-year-olds should aspire to.  It almost made me wish that nurse had come out and yelled at me 40 hours earlier.  “Call that pain?!  You come in hear and bother us with a level 2 pain complaint?!  You don’t know the meaning of pain!  You ain’t even coughin’ up a lung like that poor old guy in 5011B.  Now, that’s an emergency!”

 

 

“So, Hypochondriacally Speaking…”

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I’m not a hypochondriac.  At least, I don’t think so.

But at 61, I have several chronic conditions (TMJ, upper neck and back pain, anxiety) and then other issues that make guest appearances from time to time (vertigo, extra heart beats, random muscle pain and spasms). I go to the doctor if something seems unusual, or if I suspect they might have some treatment that will improve the chronic ones but other than that, I just try to enjoy the fact that basically, I’m pretty healthy.

However, if several of these symptoms show up at the same time, say vertigo, a restless heart, and a little chest tension, then, of course, my anxiety shoots up and I start getting worried—which makes everything worse.

I’ve had enough false alarms that I’m wary of rushing off too quickly to the doc. I have learned not to call the Kaiser “advise nurse” because no matter how benignly I might describe my symptoms, her solution is always to send me to emergency room hell. I also NEVER Google a symptom. There is no quicker way to be sure that you are dying of some heinous disease, than to plug in a couple of symptoms and let a multitude of websites guess at what you might have.

Because the neck pain drives me crazy, I take ibuprophen every day. I’m confident (because I’ve read the warnings on the side of the extra-large bottle) that eventually my stomach will explode because of it. So when I started to develop a chronic pain on the right side of my abdominal area, I decided to go in to see my doctor. I explained my concerns about the ibuprophen destroying my stomach, and he told me straight out that that was not the issue since my stomach is on the left side. The right side contains the pancreas, liver, and spleen. Great, I thought, now I’ve got three critical organs to worry about.

After reviewing my blood work and doing a physical exam, he told me that he was pretty sure I had something called “abdominal wall pain” which sounded like something that doctors say when they have absolutely no idea what is wrong with you. He reassured me that he had eliminated 95% of the “really bad stuff” and that this diagnosis really did make the most sense. To eliminate the other 5%, he could order up an MRI and blast me with lots of radiation. I decided that I was OK with 95%.

During the exam, though, he introduced me to an interesting bit of doc-speak. He told me that he understood my concerns and my desire for him to be thorough, and that every doctor has to evaluate his patient’s “tolerance for uncertainty” in making a diagnosis. I now know that my “tolerance for uncertainty” is 5% or lower. If I’m 6% uncertain, I’m going to want to full monty of tests, radiation be damned.

However, my tolerance was sorely tested on Christmas Eve this past year. After our usual wonderful meal and as the family celebration was continuing, I excused myself to go to the restroom. Imagine my surprise when I discovered my urine had turned pink. Blood in the urine! This can’t be good. Either my stomach had finally exploded or something was surely wrong with my pancreas, liver, and spleen now that I knew for sure where they were.

I could not rush off to the emergency room on Christmas Eve even if it meant having my kids watch their dad slowly bleed out as we drank beer and watched “A Christmas Story.” I calmly told my wife, and she agreed that I should monitor the situation and as long as I wasn’t in pain, we could get it checked out later. By noon the next day, the symptoms were gone and all that was left was that nagging worry that at any moment, I could go critical again.

I waited until December 26th to go in to see an urgent care doctor and recounted the series of events and my various theories, all of which he kindly discounted. In fact, he seemed intent on assuring me that he was in far worse shape than I appeared to be. He asked me a long series of questions, none of which led to a conclusion. Finally, he paused and asked, “Did you eat anything unusual?”

Beets. Mary had made a beet salad from fresh beets and I ate it to be polite and because I read somewhere that purple food is good for you. I don’t even like beets. No one had ever told me that fresh beets, eaten in large enough quantity, will color everything that passes through your body for about 8-12 hours. Sure, ibuprophen has warning labels, but not beets.

So, am I a worrier—yes. Possessor of a 5% tolerance for uncertainty level—absolutely. Anatomically ignorant—check. Hypochondriac?—Hmmm. Still not sure. I think I’ll wait until the next time I’m nearly killed by a vegetable to decide.