And it's here...  The Coronavirus...

So, Friday afternoon Leena was just out and about, running errands.  She saw there was no line outside the nearby urgent care clinic by our apartment and just went in to ask how quick it is to get a COVID-19 test and if it's free.  It was, with our insurance, so she scheduled one for Monday afternoon.

Monday afternoon she went out for her 3pm test.  She described it as a terrible experience.  She checked in and was put into a stuffy exam room.  And nothing happened.  Nobody came, she just waited.  Finally when she opened the door to ask someone if she could wait with the door open, someone realized she was in there.  

The test itself was quick and easy, if mildly uncomfortable.

Then Monday night, after I went to bed, she developed a stomach ache, a sore throat and a fever.

Tuesday morning I got up as usual to begin my workday and she felt horrible.  She had some Tylenol and went back to sleep.  The rest of Tuesday she was clearly sick.

Around 3pm on Tuesday she got an email from the urgent care clinic that she had a 5pm telehealth call with the clinic's doctor, which made no sense as she hadn't requested one and she was afraid they'd charge us hundreds of dollars for it.

Then she saw she also had an email with the test results...  In big bold red letters it said the coronavirus was "DETECTED".  Then I guessed that the 5pm telehealth call was probably required by the doctor to discuss the positive test with her.

We put together a list of questions to ask the doctor about Leena's condition, about what we should do to take care of her, about what I should do regarding my own upcoming doctor visits, and so forth...

Only at 5pm we got into the telehealth website the email linked to, and waited.  And waited.  And waited some more.  By 5:20pm the doctor never signed in and Leena gave up.  She's less patient than I am, and she was sick.

After that she called the clinic and gave a rough overview of the situation to the receptionist who said she'd get a doctor on the phone.  And Leena waited and waited and waited, for nearly an hour on hold without ever getting the doctor.  So she gave up.

Today she's feeling much improved, talking with a lot more energy.  I think her sore throat is mostly gone, and the fever is more mild than it was yesterday.

I've scheduled a test for myself for tomorrow morning to see if I might have it, since I've definitely now been exposed to it as we live in a tiny apartment.

-- --

Follow up Friday afternoon...  I got my test results: Negative.

And I keep thinking of the band W.A.S.P. with their Live... In the Raw album.  It's got a short sequence in the song I Wanna Be Somebody where Blackie Lawless leads the crowd in a bit of "audience participation".  They do a bad job so he admonishes them, "What, are you guys sick or something?  I'm supposed to be the sick motherfucker around here."  Well, after all my heart related exams and appointments recently, it's not Leena, it's me, "I'm supposed to be the sick motherfucker around here," not her...

 An Apple a Day Keeps the Doctor Away

Over the years I've found this cliche actually works out to be true.

For years I've eaten an apple a day as part of breakfast.  Not because the cliche, because they're healthy and I like sweet apples.  In India I ate ones that tasted like sweetened apple juice, which may have been imported from China.  Here in the U.S. I eat Fuji apples, which are pretty similar.

After I had my high blood pressure crash & burn that landed me in the emergency room in 2014 I set myself up with a primary care physician, Dr. M who we really liked.  The day of my first appointment with her was her first day at that practice, so she had a lot of time to spend with us answering questions and what-not.

And a few years later she moved out of New York City, leaving the large practice where we went.

They assigned me a new primary care physician, Dr. Z and I went to her a couple of times.  While Leena never joined me and didn't meet her, I liked her, she seemed like a pretty good doctor.  But then she moved out of New York City.

Following Dr. Z's departure I continued to eat an apple a day as part of breakfast and didn't go see a doctor at all, not wanting to start over all my history again with a new one.  Better to just skip the whole thing.

But last autumn Leena had an urgent need to see a doctor.  So, thinking back to when I first went to Dr. M, I remembered another doctor at that clinic who Dr. M used on billing and referrals until she was completely set up in their computer system, Dr. A, I set us up with Dr. A as our primary care physician.  Leena went to Dr. A and really loved her, recommending I go to see her about my long running high blood pressure.

Great.  I prepared some notes and how to introduce myself to Dr. A for my own appointment with her.  I told her I picked her at that clinic because she was the one Dr. M used for billing and referrals when she was still too new at the clinic to be set up in their computer system.  Dr. A acknowledged that and we continued on.

And now we recently got an email from the clinic that Dr. A is leaving in a couple of weeks.

I have to wonder, back at my first in-person appointment with her, when I told her why I chose her as my new doctor, did she already know she was on her way out?  Or did she get a new opportunity at some point after that...  

Thinking back farther, back in India, sometimes when we'd make a plan to go see Dr. S for whatever reason, Leena would usually tell me to eat something before we go.  Sometimes, I'd eat an apple, and then Leena would call the doctor's cell phone to confirm (Leena was an old school friend of the doctor's wife, also a doctor) and he'd say something like, "sorry, I'm stuck in Mumbai on some work," and we'd have to postpone, cancel or maybe go see Dr. P instead...

My only conclusion is that eating apples regularly somehow repels doctors.

Maybe it's time I switch to a pear a day...

A picture of Fuji apples I snagged off the internet...  (not my apples, not my photo...)

The Heart of the Matter

So, in November last year I finally went to a new primary care physician to discuss my long-running high blood pressure issues.  I'd been putting it off for a few years because I didn't want to get into things with yet another new doctor after my previous two both left New York City...  

But Leena had gone to her for a skin issue and really liked her, so she talked me into going.  I actually picked this doctor because I knew her name at the clinic since she was well established there when I first started going for another doctor in 2014.

So, Dr. A. talked to me, took some blood and later when we followed up via video call (coronavirus pandemic, you know...) she changed my high blood pressure medication and put me on a statin for cholesterol, which she described with "sky rocket".  The new medications were giving me headaches, but as they were lowering my blood pressure she didn't want to change them without my seeing a cardiologist first.

When I saw the cardiologist, Dr. T. he didn't believe me that the medications were causing the headaches, which started the day after I started those medications, but was willing to change the prescription to ease my mind at a minimum. 

Dr. T. was concerned about my state of health, my long running high blood pressure, that I got out of breathe when I was active, and my family history, since my father had a heart attack and quadruple bypass at 64 years old and one of my grandfathers died of a heart attack at 62 (granted, he'd been a lifelong smoker, which wasn't my case).  Dr. T. said things like my father's heart attack usually started showing signs about fifteen years in advance, and that puts me easily into the beginning of that 15 year range compared to my father's heart attack...

Dr. T. also scheduled me for a CAT scan, a "CTA Coronary Artery" at the hospital for a week and a half ago.  I went for that, which involved spending an enormous amount of time waiting my turn, and then feeling like I peed my pants when they injected me with the radiocontrast dye (I didn't, it just felt that way when the warmth spread through my body, getting to my crotch region...)

And Monday last week I met with Dr. T. at his office where he reviewed all the images from the CAT scan and some other ultrasound images done that morning.

He then told me that the scans of blockage scored me in the 89th percentile for men aged 51.  Um, ok.  I had to ask if that meant 89th percentile good, or 89th percentile bad.  He then clarified that it was bad.  So, these are like golf scores, a lower number is far better...  It turns out I have more blockage in my heart's arteries than 88% of men aged 51.

Well, I figure that's trivial to beat.  Later this year I'll turn 52, invalidating the whole statistic.  

Dr. T. recently uploading the results to the MyChart system so I could read it and here's an excerpt of the key parts.

1. The calcium score is 119 in the 89th percentile for age, gender and ethnicity.

2. There is no calcified aortic plaque.

3. Normal LM. 

4. 25-50% stenosis of the proximal LAD due to mixed plaque with a high risk feature of spotty calcification. Normal remaining LAD.

5. 50-69% stenosis of the ostial to proximal large high D1 due to mixed plaque with a high risk feature of low attenuation plaque.  50-69% stenosis of the mid D1 due to non-calcified plaque. Norma distal D1. Normal branch of D1. 

6. <25% stenosis of the proximal LCx due to non-calcified plaque.  Normal remaining non-dominant LCx. Normal OM1.

7. Normal proximal RCA. Mid RCA is ectatic with 50-69% stenosis in the mid segment due to mixed plaque with a high risk feature of low attenuation plaque and spotty calcification. <25% stenosis of the distal RCA due to mixed plaque. Normal RPLA and RPDA.

I sent this to my wife with this description, including links to Wikipedia:

Here's a Wikipedia article that explains the arteries in question.  

And here's a grabshot of the vector drawing in the Wikipedia article:

Note that the picture is reversed, showing the patient's left side on the right and right side on the left.  This is because the picture is drawn the way a doctor would see it looking at the patient.

In the picture you can see the LAD mentioned in the doctor's #4 item.  It's on the right side of the picture.  This is 25-50% blocked (I'm not sure why there's a range that size, whether it's because different parts of the artery are blocked different amounts, or because that's as accurate as the scan can get).

His #5 item refers to D1, which is on the lower right side of the picture.  This is blocked 50-69%.

His #6 item is LCx which is in the middle of the right hand side of the picture.  This is blocked less than 25%.

His #7 item is RCA which is on the left middle side of the picture.  This is blocked 50-69%

For now Dr. T. has increased my blood pressure and cholesterol medications as well as including a new one, a beta blocker.  He suggested (was it a suggestion or an order?) a no cholesterol diet.  And I'm to follow up with him later this month to see where to go from there.

He talked about maybe scheduling another procedure to look closely at the blockages with a camera inserted up in there, and possibly inserting stents.  I assume it wasn't an immediate life threatening emergency or he would've done more than sending me home with some medication prescriptions for now.

Dr. T. also emphasized my need to get a sleep study from a sleep specialist.  I was lazy about scheduling that, with the idea that it would be a lot less stressful to deal with one specialist's area of my body at a time.  

At home we're trying to deal with my diet.  I need to be more careful about not cheating as much, since now the damage that's doing is more concrete and less abstract.  But convincing Leena to change how she's cooking for me is harder because she doesn't want to believe she's been cooking food that's unhealthy for my heart as it is.  She wants to think she's been doing everything perfectly.

I also made an appointment with the sleep specialist for next week...