So, I have received the CPAP machine ordered by the Otolaryngologist and spent yesterday reading the documentation and setting it up. They say that it takes a month or so to adapt to the machine and become comfortable with it. Yesterday was day 1.
This is me trying on my mask and adjusting the straps to get a good fit.
My Sleep Number bed collects data on the soundness of sleep, restlessness, and brief bed exits. Below is the data from two nights ago, Dec 16-17.
I stayed up too late, went to bed at 0103. The good news is that it only took 4 minutes to fall asleep and I got 6 hours of restful sleep. The large 78 is the overall score (out of 100).
Below is my first night using the CPAP machine. The overall rating of 75 is only slightly lower that the previous night.
I got to bed much earlier, at little before 23:00 and apparently fell asleep wearing the CPAP without issues. I experienced some discomfort about 05:00, possibly due my throat drying out. I gave up and got up about 06:00. I’ll see how it goes tonight.
I just got a call from my doctor’s (actually Physician’s Assistant) office. It turns out that she is coming back a week sooner than I had expected. I have an appointment on Monday, Dec 23rd at 1:00pm to discuss my concerns about Alzheimer’s Disease.
Earlier that morning (at 10:00am) I have the consultation at Casper Medical Imaging about the Veinous Insufficiency issue that I have. So, it looks like I should have some of the answers to my path forward early next week.
Below are copies of the CT Scan and Venous Mapping reports. At the risk of head softening, you can read through them, but the bottom line in both reports is that there is no obvious explanation for my observed issues. It will be interesting to see what they say next Monday.
Below is a copy of the report of the CT scan.
CMS MANDATED QUALITY DATA - CT RADIATION — 436
All CT scans at this facility utilize dose modulation, iterative reconstruction, and/or weight based dosing when appropriate to reduce radiation dose to as low as reasonably achievable.
FINDINGS: CT venous angiogram examination of the abdomen and pelvis was performed in multiple contiguous axial sections with the use of intravenous contrast enhancement. Sagittal and coronal 2-D MPR were obtained.
Contrast: Visipaque 320 150 mL Used 0 mL Discarded
Lung: The visualized lung bases are clear of active disease.
Liver: The liver is homogeneous without biliary ductal dilatation or enhancing mass.
Gallbladder :The gallbladder and gallbladder fossa are within normal limits.
Adrenal glands:Adrenal glands are symmetric and unremarkable.
Spleen: The spleen is homogeneous and unremarkable.
Pancreas: The pancreas is unremarkable as visualized.
Kidneys: The kidneys are perfuse symmetrically without evidence of obstructive uropathy. There are bilateral renal cysts. There dominant on the right,
Bowel:The small and large bowel are normal in course and caliber. There are few scattered diverticuli without evidence of acute diverticulitis.
(Ed. note: Turns out there is a new (as of 2012) organ in the abdomen) Mesentery: There is no gross free air, free fluid, or other gross mesenteric abnormality.
Reproductive: The prostate gland is heterogeneously enlarged causing mass effect on the posterior bladder.
Soft tissues:Soft tissues are unremarkable without abscess or subcutaneous gas.
Venous: The IVC is normal in course and caliber throughout its abdominal and hepatic course. The bilateral iliac veins are symmetric, widely patent without significant stenosis or compression.
Bones:Osseous structures are unremarkable. There is no focal pathologic bony lesion.
IMPRESSION: 1. No evidence of venous thrombosis or stenosis. 2. No acute abdominal process. 3. Diverticulosis without evidence of acute diverticulitis. 4. Prostate enlargement. -Electronically Signed By: Ryan Bonifield -Electronically Signed On: 11/27/2024 3:40 PM
HISTORY: 74-year-old male with bilateral leg swelling and bulging venous varicosities.
TECHNIQUE: In both the supine and standing positions the superficial and deep venous systems of the right lower extremity are evaluated with grayscale, color Doppler, and spectral Doppler sonography without and with compression.
COMPARISON: None
MEASUREMENTS: The report below indicates reflux exceeding one half second (500 milliseconds) occurring in the venous branches charted below.
RIGHT DEEP VENOUS EVALUATION:
DVT: No
Deep reflux: No
Common femoral vein: No wall thickening, endoluminal thrombosis, or luminal narrowing.
Femoral vein: No wall thickening, endoluminal thrombosis, or luminal narrowing.
Popliteal vein: No wall thickening, endoluminal thrombosis, or luminal narrowing.
Posterior tibial veins: No wall thickening, endoluminal thrombosis, or luminal narrowing.
LEFT DEEP VENOUS EVALUATION:
DVT: No
Deep reflux: No
Common femoral vein: No wall thickening, endoluminal thrombosis, or luminal narrowing.
Femoral vein: No wall thickening, endoluminal thrombosis, or luminal narrowing.
Popliteal vein: No wall thickening, endoluminal thrombosis, or luminal narrowing.
Posterior tibial veins: No wall thickening, endoluminal thrombosis, or luminal narrowing.
SUPERFICIAL VENOUS EVALUATION:
RIGHT
VEIN DIAMETER (mm) REFLUX REFLUX (ms) SFJ 6.8 mm no REFLUX ms PROX GSV THIGH 4.9 mm no REFLUX ms MID GSV THIGH 4.6 mm no REFLUX ms DST GSV THIGH 4.4 mm none REFLUX ms KNEE GSV 4.1 mm no REFLUX ms PROX GSV CALF 3.9 mm no REFLUX ms MID GSV CALF 3.2 mm none REFLUX ms DST GSV CALF 3.7 mm no REFLUX ms AAGSV 3.7 mm no REFLUX ms SPJ 3.6 mm no REFLUX ms SSV PROX 2.7 mm no REFLUX ms SSV MID 1.4 mm no REFLUX ms SSV DST 2.3 mm no REFLUX ms GIACOMINI mm REFLUX ms PERF 1 mm REFLUX ms PERF 2 mm REFLUX ms PERF 3 mm REFLUX ms PERF 4 mm REFLUX ms DOM VARIX mm
LEFT
VEIN DIAMETER (mm) REFLUX REFLUX (ms) SFJ 8.4 mm no REFLUX ms PROX GSV THIGH 4.3 mm no REFLUX ms MID GSV THIGH 4.3 mm no REFLUX ms DST GSV THIGH 4.7 mm no REFLUX ms KNEE GSV 4 mm no REFLUX ms PROX GSV CALF 3.9 mm no REFLUX ms MID GSV CALF 2.9 mm no REFLUX ms DST GSV CALF 3.3 mm no REFLUX ms AAGSV mm REFLUX ms SPJ 1.4 mm no REFLUX ms SSV PROX 1.5 mm no REFLUX ms SSV MID 1.6 mm no REFLUX ms SSV DST 2.4 mm no REFLUX ms GIACOMINI mm REFLUX ms PERF 1 mm REFLUX ms PERF 2 mm REFLUX ms PERF 3 mm REFLUX ms PERF 4 mm REFLUX ms DOM VARIX mm
FINDINGS:
Right greater saphenous vein: Competent.
Right anterior accessory greater saphenous vein: Competent.
Right small saphenous vein: Competent.
Left greater saphenous vein: Competent.
Left anterior accessory greater saphenous vein: Competent.
Left small saphenous vein: Competent.
IMPRESSION: 1. No evidence of deep venous thrombosis. 2. No evidence of deep venous reflux. 3. No evidence of superficial truncal venous insufficiency. 4. If there is concern for central venous obstruction in the pelvis, recommend CT venography abdomen and pelvis for further characterization. -Electronically Signed By: Charles Bowkley -Electronically Signed On: 11/13/2024 5:10 PM
Welcome back. It’s been about 15 months since I’ve last posted. What prompted me to restart this blog was a life-altering event that occurred yesterday. Before I get into what occurred, I want to emphasize – “DO NOT PANIC AND IMMEDIATELY CALL ME!” (I’m looking at you, Kate and Jen.) I am (mostly) the same as I was last week, last month, last year.
I intend to continue posting at least weekly, that will document what’s going on in Wyoming, and specifically how I’m doing.
Over the past several months I have noticed occasional gaps where I had momentarily trouble picking the word I intended, or the specifics about the place we were going, street names, etc., but they were transient and momentary. I attributed this to general aging and not being particularly significant.
I am currently dealing with two issues as a fallout of my physical in early November. First is the issues with circulation in my lower legs. I’ve had veinous mapping of my legs and a CAT scan of my abdomen to try to find the source of the issues. I have a consultation with Casper Medical Imaging Dec 23rd to discuss the results of the tests.
The second issue is my sleep apnea that I had intended to ignore, but various family members have persuaded me to at least explore some of the options.
Poster that was on the wall behind me during my physical, which tended to undercut my plan to ignore Sleep Apnea.
I had a consultation with the Otolaryngology Clinic in November to discuss my options. The bottom line is, for Medicare to fund something like Inspire you first have to try a CPAP machine and document a failure to effectively use it. There is also a BMI restriction, that I am on the ragged edge of. I plan to get down from 240lbs to 220lbs over the next couple of months for other reasons so that shouldn’t be an issue.
So, the first step was to have the Doctor order a CPAP machine from Apria Direct. So yesterday, while I was driving home, I received a call from a very nice lady to discuss the CPAP that was ordered. Of course, I was using the hands-free telephone option in the truck, so there were no safety issues. She reassured me that they had made advances over the last 10 years (since I had last used one previously). She also explained that when I receive it, I can bring it into their local office for fitting, etc. They needed a physical address for UPS to deliver the machine. So, I started to rattle off my address – 7401 … and drew a complete blank for the street. Disconcerting. I knew empirically there had to be a street name, but I was drawing a complete blank. And it wasn’t a momentary thing, it was gone.
Fortunately, I explained to the nice lady that I was on a car-phone and in traffic and to wait just a moment. I pulled over and grabbed my iPhone and pulled up my address. As soon as I saw Geary Dome Road it all snapped back. I gave her the address and expect to receive it next week.
Drawing the blank on my address is what I consider the first definable mark of possible Alzheimer Disease. PUT THE PHONE DOWN, KATE!!! I TOLD YOU NOT TO CALL ME. REMIND ME TO BRING IT UP ON THE FAMILY CALL THIS SUNDAY; YOU CAN CALL ME AFTER THAT.
The first question is, is this really Alzheimer’s. I will be asking my doctor this, as the website above mentioned pre-clinical stages with pathological biomarkers. Hopefully they can identify if this is indeed a disease or just forgetfulness. I have talked to Sis and she says that a number of the nuns at Mayo Clinic are in a longitudinal study and that various markers are available in blood work (and via spinal taps).
The next big question is: If this is indeed a marker for possible Alzheimer’s, what is the slope of the curve? If it’s shallow, it will be a race between it and general decrepitude over the next 20 years or so, and probably not be much of an issue. If it’s steeper, the I anticipate it will be a wilder ride and will require some lifestyle and other changes. Watch this space.
