The blood test that was done on Monday afternoon, the results are shown below:
Jan 06, 2025 1:46 pm
Thyroid Stimulating Hormone (TSH)
1.95 uIU/mL
0.27-4.200 uIU/mL
Jan 06, 2025 1:46 pm
Vitamin B12 Level
886 pg/mL
239-931 pg/mL
Seems that the values were within the normal range; so, nothing obvious there.
On Tuesday I had an EEG which seemed to go OK. I haven’t been able to find any results on the web site but the nurse administrating the test seemed satisfied with the results.
This morning, I had an MRI (Magnetic Resonance Imaging). Lindsay had these done on a regular basis. I was in and out in 40 minutes the first thing in the morning. The results are already posted on the website by this afternoon, but I don’t think there is an easy way to import them into this webpage. I have gone through them and although I obviously don’t have MS (none of the artifacts of dead areas), I’ll have to wait for the doctor to evaluate them.
I got a call from Dr. Santiago’s nurse to see about scheduling a follow up with him. I discussed not having completed the Lumbar Puncture so she said she would check with the doctor to see what he wanted to do.
Shortly thereafter, I got a call to schedule the Lumbar Puncture on Friday, but the scheduler discovered that the PA who did the procedure was out on Friday, so it is scheduled for Tuesday Morning. You have a two-hour observation period after the procedure, so I won’t get out until about 11:00 or so. Jan or Mike will drop me off, and (hopefully) pick me up afterwards.
Also, on Tuesday afternoon I have my Echocardiogram, for the other issue, poor circulation in my lower legs and feet. Thats a follow up to see what is causing poor circulation.
Today I had an appointment with the Neurology Clinic (accompanied by Jan, as always you can have whispered conversations about me). We had a wide-ranging discussion about my history and development of my “issues”.
One big thing I noticed is that there is a new (to me) category called MCI, Mild Cognitive Impairment, between normalcy and dementia. I think that that describes me much better. See the posters below.
One of the things discussed are activities to keep the mind agile and engaged. Things like puzzle books, Wordle, classes at Casper Community College, etc. etc.
I brought up what Sis told me about the longitudinal studies of dementia at Mayo Clinic. He was familiar with it and the local status is that the spinal tap for protein fragments was established last year. The blood serum test should be available in February or so, but so far they haven’t got the correlations available to evaluate the results. (probably next year it will be widely available). If you have the protein fragments they follow-up with a PET (Positron Emission Tomography) scan.
So, the plan of treatment is:
1. Get a blood test at the doctors office (dropped in this afternoon 2. Get an EEG at the Neurology Office (tomorrow) 3. Have a spinal tap (lumbar puncture) at the hospital downtown (waiting for scheduling to call) 4. Get a MRI at the hospital downtown. Scheduled for Wednesday Jan 8th.
From the above schedule you can see one of the attractive items about Wyoming health care – 3 out of the 4 items, that were identified this morning, have been scheduled this week. Picture if this were in California or Portland, OR.
I will provide an update to this towards the end of the week to provide more information.
Twas the night before Christmas and etc. etc. etc.
I have a brief update on my various medical issues. I have 3 issues currently: 1-Sleep apnea 2-Veinous issues/lower limb circulation 3-Alzheimer’s/memory issues. Monday I had two appointments with updates to issues 2 and 3. My sister, Jan, accompanied me so if you doubt my interpretation you can check with her.
On the sleep apnea front use of the CPAP machine tends to be a surprising lack of drama. I use it and it seems to be working.
A report from the myAir app on my phone. I haven’t really noticed any improvement in my health, but the website says it takes a couple of weeks to see it.
On to circulation issues in my lower extremities. The consultation with the Casper Medical Imaging was not particularly satisfying. The bottom line was from the lower limb ultrasonic exam and the abdominal CAT scan was nothing remarkable found. We discussed my history, familial issues (dad’s heart attack and Sis’s heart issues) and other topics. The bottom line is that since there are no obvious issues they need to look elsewhere. We discussed it with my PA at the afternoon appointment and we discussed getting an ElectroCardioGram EKG and a blood test. The accomplished both of those in the office at that time. The next step is a stress test, ultrasonic imaging of heart while on a treadmill. I had done one of those years ago and it wasn’t a big deal. That will probably be done after the holidays.
Now the biggie, my memory issues. I had an afternoon appointment with my PA. We discussed the issue at some length. I mentioned that Sis was in a longitudinal study of Alzheimer’s with the nuns at the Mayo clinic and mentioned the blood test for protein fragments. Jen Wagy mentioned that there had been some talk last summer, but she didn’t think that the FDA had released the test yet, but that she would check.
She gave me a manual test of my orientation, the date, the fact that I was in a doctor’s office, etc. and administered a manual test that was surprisingly comprehensive. Having me recall 5 random words, and then about 5 minutes later, after doing other things, having me repeat them (I only got 3 out of 5) coming up with all the words I could that started with the letter F (excluding names) and counting down from 100 by 7’s. (basically doing mental subtraction). I did surprising poorly at that. I wound up getting a referral to a Neurology consult with Dr. Angelo Santiago. I got a call this morning to schedule it for January 6th. So, we will continue exploring that as we go.
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.
Since spring, the increase of mosquitoes has been annoying and I have been researching countermeasures. One that I have found is bats and I have discovered that I have a nearly perfect environment for them.
Bat houses (like the ones HERE) are best located about 15′ high, on a wall with a Eastern or Southeastern exposure with early morning sunshine and within 800 feet or so of water.
Facing East, 15′ high
Turning around you see this:
Pond 100-300 feet away
I’ve ordered a Bat House (See HERE) to mount under the eaves under near where the “SLSW” is stenciled (to avoid guano collecting on the solar panels). I’m not sure if the local bats are migratory or not, but we should have bats moved in by next spring.
The box should be in the shade after about 1:00pm so I don’t expect them to get overheated. We will see how it fares.
I’ve started prepping for Jon’s arrival (July 2nd +/-).
We’ve pulled the trailer out of the (garage/Storage unit/C-Cans.
AT disconnecting the roof compressor
First, we had to disconnect the mini-split unit, bleed down the compressor, and disconnect the components on the roof. Then we pulled the trailer out a couple of feet to disconnect the skirting around the back of the trailer and carefully pull it out.
Trailer out baking in the sun.Need to clean out for Jon.
At the family meeting last Saturday Jon asked me to take some pictures of the power pole behind the trailers. I went out to do that on Sunday and discovered the problem below.
Before mowing
The wet, wet spring we are having has resulted in a burst of growth of the undergrowth. Need to get the weed-eater out.
A couple of hours later the results are shown below.
After photo
What follows are close ups of various pieces.
Close up
Below is the PVC pipe emerging from the ground and entering the box below the Meter. Appears to be 3 inch PVC.
Input piping, 3 inch PVCMeterInside breaker box Left of the Meter.Output of breaker box that runs to back of C-Cans
I am getting underway for the cruise with Jen, Patrick, Charlotte and Kate for a cruise from Vancouver, BC up into Alaska. I flew into Vancouver yesterday, after United Airlines squeezed the timing to be unable to make the connection in Denver.
I learned a lesson and next time I won’t try to save some money by relying on third party reservations. It is about 1:30pm and we are already on board waiting to get underway about 5:00pm. This is more a placeholder to see how posting will work.
A quick review of the completion of the front deck.
Adding deck ramp
First is the completion of the ramp along side the west side of the front of the house. We moved the ramp from along side of the trailer down to the house. The ramp turned out to be much lower slope than when servicing the trailer.
Front Deck Railing Section
This is the first of two sections of the front desk railing. It was rediculously expensive pre-fab sections but does look very nice when completed.
Front deck Ramp
This is the finished front ramp and deck. The ramp railings are slightly different and designed for stairs and slopes. There is a slight gap (about 1 ft) between the sections that I’m still noodling on.
Looking Westward up the stairs and down the ramp
This is looking Westward, up the stairs and down the ramp.
Close up of the solar lights on the deck posts. They are only
