Communion Of Dreams


And then one day you find ten years have got behind you*

Another progress report/follow up to my previous two posts.

As of Thursday, I had passed the week-long “don’t exert yourself” mandate following the cardiac stents installation. There wasn’t any worry about how my heart would do, just that I needed to let the puncture in my femoral artery heal completely.

And as I resumed my normal activities, I realized that things had, indeed, changed. Significantly. For the better.

Which was a little confusing, initially. Because as I had noted, I wasn’t feeling particularly poorly or limited prior to the procedure. In fact, as I said in my previous posts, there were no real indications that I had much of a problem. That was because overall my heart was very strong, and was perfectly capable of dealing with the blood demands of my body in almost everything I had wanted to do. It wasn’t until the very upper end of the stress echocardiogram that there was objective evidence of a possible blockage. The ultrasound imagery showed that the lower part of my heart wasn’t doing much work — the upper 2/3 of the heart did almost everything. That was because of the 95%+ blockage of the lower part of the RCA.

But what has become clear to me in the last few days, as I upped my exercise activity significantly, is that having 2/3 of my heart handle all the work of the whole heart meant that it was working harder all the time, if only just to push enough blood into the lower heart muscle to keep it alive and healthy. And now it no longer needs to do that.

The result is I feel a lot more energetic, and less tired at the end of the day. I feel, already, like I am ten years younger. I suspect that as the virtuous cycle continues to build on itself, that even that situation will improve. Exercising (walking every morning, doing yardwork for 60-90 minutes several times a week) takes less effort, and is more productive — which will help me lose weight and strengthen the muscles in the rest of my body. I recover from those exercise sessions faster, and can get more accomplished overall.

While I didn’t realize it while it was happening, I had been increasingly constrained and drained of energy. That constraint is now largely gone. Amazing what a couple of inches of steel mesh tubing can do in the right place.

 

Jim Downey

*Again, of course.

Advertisements


Everyday miracles.

This is a follow-up to my previous post.

I just sent the following message to my primary care doctor:

Dr M,

I wanted to take a moment and thank you. Your recommendation that I take an echo stress test likely saved my life.

You’ll probably get the cardiac cath results from Dr W, but it may not include an observation he made when he first examined me: that had I come to his practice for a routine exam, presenting the same symptoms I told you, he probably would not have suspected such a serious condition. But the echo stress test clearly demonstrated that there was a major problem. And that the cath procedure showed just how bad it was: 95-99% blockage in the lower part of my RCA.

The seriousness of that condition was masked by my overall/otherwise heart strength. But it could have *very* easily resulted in a serious M.I. or even death. Had you not picked up on the subtle indications we discussed, and taken the prudent step of recommending the echo stress test, my true heart condition may not have been discovered until it was far too late.

So, thank you. Your intelligence, education, and experience probably have added decades to my life.

Why am I sharing this?

Because I got extremely lucky. And I want others to benefit from that luck, and my experience, if possible.

As it turns out, the overall condition of my heart is remarkably good. The strength and efficiency of that muscle is at the very top range for normal healthy people, or at the lower end you’d find in a serious athlete. Furthermore, there are no other indications of atherosclerosis or plaque build-up.

However, due to either a genetic or developmental defect, the lower part of my RCA is badly kinked/convoluted, creating a situation where eddies in the blood circulation form, and allowing what plaque I do have in my system to accumulate, like a sandbar will develop as a result of a bend in a river. In my case, that accumulation had progressed to the point where just the slightest additional clump of plaque could have closed off the artery completely, allowing a part of my heart to die. That’s a classic heart attack, folks.

But the strength of my heart overall was such that it almost completely masked the condition of my RCA. It wasn’t until I was up to about 90% of my heart rate maximum while taking the stress test that indications of the problem surfaced. And even then, just how bad the situation was wasn’t fully known until the cath procedure was done. But when the cardiologist went in and directly observed the condition of my coronary arteries, he saw the problem. And with about 90 minutes of hard work, corrected it with a couple of long cardiac stents.

That was just three days ago. I actually left the hospital the next morning, and have been playing catch-up on things since then.

Think about that: for 90 minutes, a team of medical professionals were playing roto-rooter with the inside of a major artery of my heart. I was completely awake and unsedated through the whole thing. The next day I left the hospital, walking on my own without difficulty. This morning I got in my usual morning walk of a mile. For about another week I have to take it a little easy, to let the puncture site in my femoral artery completely heal, and for the next year I need to take blood thinners, but otherwise I don’t need extraordinary care.

That’s pretty miraculous, in my opinion. One of the everyday miracles which surround us, and which we seldom give due consideration. Stuff that not too long ago would have been considered science fiction.

Anyway, here’s my advice, though you’ve heard it before: pay attention to your body. Don’t succumb to toxic masculinity. Or, if you’re a woman, to the illusion that you’re immune. If you think that something is going on, get it checked out. A little embarrassment at being wrong beats dying.

 

Jim Downey



Shorter of breath, and one day closer to death.*

“Well, I’d hate for you to have a heart attack,” said my doctor. She was standing against the wall in the small exam room, arms folded in a classic body language message of being skeptical about what I had just said.

* * * * * * *

I wrote this in September 2007:

And as I stood there at the sink, washing the dishes, thinking favorably on the option of having a heart attack, it sunk in that I was done. I mean, I’d been considering that a heart attack might be the best solution to my problems. Yeah, a heart attack. Hell, at 49, I’d probably survive it. It’d come as no surprise to anyone, given the kind of physiological and psychological stress I’m under. No one could blame me for no longer being a care-provider for someone with Alzheimer’s. Hey, it might even get someone to think about noticing my writing, since a tragic character (whether alive or dead) always gets more notice as an artist than does someone who has their life, and their shit, together.

That was a few months before our care-giving journey ended, and Martha Sr passed away. For those who don’t know the story, I was able to re-center, and continue with my role as a care-provider the next day. The following year was spent recovering from the stresses of that role, and getting my shit back together. Because in spite of the perspective indicated in the final sentence of the passage above, my hold on things wasn’t nearly as solid as I thought at the time.

Such is often the case. I think it’s a defense mechanism, with more than a little toxic-masculinity.

* * * * * * *

Did I say toxic-masculinity? Why yes, I did. Such as in this timely article:

Men, in short, are less likely to seek preventive care than women and more likely to put off seeing a doctor when in need of medical care. They also prefer to seek out male doctors, but they tend to underreport pain and injuries to male doctors, thereby compromising the chances of receiving optimal care. And all of this, it should be said, is particularly true among those men who prescribe to masculine ideologies.

“Masculine men tend to not go to the doctor, and when they do, they tend to pick male doctors whom they then underreport their ailments to,” Sanchez said.

* * * * * * *

We recently had a change in our financial situation, thanks to the sale of some property we owned. That, combined with the protections of the ACA which mean you can’t be as easily penalized for a pre-existing condition, made it a lot easier for me to make the decision to having something checked by my doctor.

Howso? Well, our income has never been huge. In fact, it’s always been pretty modest, though in recent years it has gotten better and become more stable. But still, if I had something turn up which required me to miss a significant period of work, or which came with a large insurance co-pay for treatment, we would have lost what progress we had made. And not having to worry about having a documented ‘serious health issue’ mess up my insurance coverage in the future is a huge relief.

In other words, I’m financially stable enough to get sick. Hell of a system, isn’t it?

* * * * * * *

“Well, I’d hate for you to have a heart attack,” said my doctor. She was standing against the wall in the small exam room, arms folded in a classic body language message of being skeptical about what I had just said.

Which was that I was reluctant to go see any medical specialist, since the way the system works it’s almost guaranteed that they would find something which needed ‘treatment’. After all, none of us are walking perfect models of health. And, as the old adage goes, never ask a barber if you need a haircut.

But I nodded my head, sitting there on the exam table.  I had my shirt back on after they had done the in-office EKG, which showed that everything at present was OK, but that there were possible indications of problems in the recent past. And the very mild symptoms I had recently were possibly indicative of a coronary arterial blockage, and it runs in my family on my father’s side. “Yeah, me too. OK, go ahead and book me for a stress test.”

She nodded, we chatted some more, and she left.

I had the stress test last Friday. Got the call with the results yesterday.

No complete blockages. But some constrictions which need to be addressed. So yeah, sometime soon I’ll be seeing a cardiologist, and we’ll discuss options from there.

It’s not good news. But it’s not horrid news. After all, this is one of the most common medical problems around the world. So we’ll see what happens.

But I’m glad that I’m lucky enough to be in a position to have it found, treated (to whatever extent possible), and not worry about it completely ruining our financial situation. And I’m also glad that I’m not quite macho enough to think that I should ignore the classic symptoms, as mild as they were.

 

Jim Downey

*Of course.

PS: if you feel the need to post a political comment related to the ACA … don’t. I’ll just delete it.



Get lucky.

“I’d rather be lucky than good.” — Lefty Gomez

* * * * * * *

In a fairly soul-baring piece by Emily Gould about the reality of struggling to be an ostensibly ‘successful’ writer, this should give even the most optimistic person pause:

In 2008 I sold a book-in-progress for $200,000 ($170,000 after commission, to be paid in four installments), which still seems to me like a lot of money. At the time, though, it seemed infinite. The resulting book—a “paperback original,” as they’re called—has sold around 8,000 copies, which is about a fifth of what it needed to sell not to be considered a flop. This essentially guarantees that no one will ever pay me that kind of money to write a book again.

 

* * * * * * *

In a discussion over on MetaFilter, successful Science Fiction author Charlie Stross had some thoughts on the above-cited essay. Here’s an excerpt from his comment:

In 2001 I had a gigantic stroke of good luck: I acquired a [good] literary agent and sold my first novel. It was about the tenth novel or novel-shaped-thing I’d written since 1990, on my own time. The advance was, eventually, $15,000 for US rights (a good first book advance in SF/F) and £3500 for UK rights. Note that a new novelist can’t get follow-on book contracts until their first book has proven itself in print — to justify the advance money the new contract will cost the publisher — so I had to keep up the freelance journalism for a few more years.

 

* * * * * * *

“A gigantic stroke of good luck.”

But Stross is a good writer, right? I mean, doesn’t he deserve his success and popularity? The meritocracy of the marketplace and all that?

Perhaps. From an NPR story the other day:

Several years ago, Princeton professor Matthew Salganik started thinking about success, specifically about how much of success should be attributed to the inherent qualities of the successful thing itself, and how much was just chance. For some essentially random reason, a group of people decided that the thing in question was really good and their attention attracted more attention until there was a herd of people who believed that it was special mostly because all the other people believed that it was, but the successful thing wasn’t in fact that special.

Salganik came up with a clever experiment, one which allowed a large number of teenagers (30,000) access to several dozen songs by promising but as yet unsigned bands. The way the experiment ran created 9 different iterations of ‘reality’, to see whether the same song would become the most popular one in each test run. They didn’t. In fact, the results were wildly divergent:

“For example, we had this song ‘Lock Down’ by the band 52 Metro,” Salganik says. “In one world this song came in first; in another world it came in 40th out of 48th. And this was exactly the same song. It’s just in these different worlds, history evolved slightly different. There were differences in the beginnings, and then the process of social influence and cumulative advantage sort of magnified those small, random initial differences.”

Now obviously there are many different things that have an impact on success and failure — money, race and a laundry list of other things — and after this work, which one person in the field described as a seminal paper, Salganik went on to do similar studies with parallel worlds that suggest that quality does have at least a limited role. It is hard to make things of very poor quality succeed — though after you meet a basic standard of quality, what becomes a huge hit and what doesn’t is essentially a matter of chance.

 

* * * * * * *

Another comment a little after Stross’s in that MeFi discussion offered a different perspective that’s worth considering:

Emily Gould’s example is crucial because she is the primary example of a writer who had succeeded. She did everything she was supposed to do: came to NYC, produced a ton of successful content for a big brand website, then continued on her own to create a huge internet presence, and then branched out into conventional media (the NYT piece) and eventually a six-figure book deal. If you think of the thousands of writers who are racking up credit card debt writing for free or almost on free all those websites we read every day, they are trying to become Emily Gould. Regardless of what they might think of her work itself, that’s the approximate career path they’re trying to follow.

So when people are glibly like, “Oh, she lived in a one-bedroom apartment in Brooklyn, there’s your problem,” what they’re saying is: the pinnacle of this career is one in which you will never be able to afford to live on your own, never mind have kids or financial stability or even a regular writing paycheck, the end. And that should really give us pause.

Because, sure, you can say “She should never have come to New York, she should always have kept a full time job in a different profession, etc. etc.” But to work for Gawker, she had to come to New York. To gain the kind of name recognition she has, she had to work full time posting and networking and Tweeting and, basically, working for free. And when her book failed, it didn’t fail because it was “bad” – because she wrote, in the book, the exact same way she wrote online. For better or for worse, that was what people liked. The real, applicable lesson is that the book failed because the people who read her stuff online didn’t care enough to pay for it in print.

 

* * * * * * *

“I’d rather be lucky than good.” — Lefty Gomez

I used to think that this was wrong. In fact I was quite confident that my intelligence, hard work, and focus could overcome any barrier. And there’s absolutely nothing wrong with any of those things.

But I’ve seen too much life to still believe that. Yeah, I’d rather be lucky than good.

Back to work.

 

Jim Downey