Today is 3-14 the annual celebration of Pi day. (Mmm, pie)
By a happy coincidence, my daughter-in-law Irene’s maiden name is also Pi, so she gets a shout out too.
In my post a couple of days ago I mentioned that Kate and I would be traveling to the Aulani Disney Resort in Hawaii in April. Sis replied asking if I would be there over my birthday (April 21st) and reminiscing about being stationed at Naval Airstation Barbers Point back in the mid-70’s. She closed with “I wish I was going with you!”
I answered her “No, we’re going for Apr 9 through 11. I remember coming out to visit you at least once at Barbers Point. Any chance you could get sprung? We could cover your costs if you could go AWOL.”
Less than 10 minutes later I received a Facetime call from Sis. After confirming that I was serious we discussed how we could meet up in Denver for our noon flight. I then called Kate to alert her about the change. I got on the United Airlines website and booked another ticket and changed our seat locations. By 10:00pm we had booked and changed our travel arrangements.
Since we are looking at checking out the changes in Barbers Point and elsewhere on Oahu, I decided to spring for a rental car. It will also make it easier to get over to Aulani from the airport. Looking at Google Maps there are a lot more freeways, but some things look the same. Kaena Point is still unpaved and labelled as a hiking trail. It was unpaved in the early 70’s but mostly passable for the adventurous, but if you got your vehicle stuck it would have cost thousands to get it out. Nu’Uanu Pali still overlooks the Kaneohe Marine base and the Northeast side of the island.
One of the issues from my physical in February was my weight (and subsequently A1C). So I’ve gotten back on the intermittent fasting wagon. I’ve also gotten back on the water walking. Like today I got up at 7:45am or so and went immediately to Casper Aquatic Center and walked a mile or so and came back home for a cup of coffee and breakfast. I cut off eating about 4:00pm or so and just suffer through the evening. So far, I have lost about 10 pounds since my high of 253.6 at the end of February. My goal is to get down to somewhere in the vicinity of 220 by May when the PCP wants me back in for and A1C check.
It has been a month since my last update and things are winding down back to somewhat normal. I will try to update you all my current state.
I got definitive proof that I do NOT have Alzheimer’s Disease (at least as of now). I had a lumbar puncture (Spinal Tap) to look for specific proteins that leak into the spinal fluid and the result was negative. Sometime later this year or the next they will have a blood test for the same kinds of protein to monitor it on an ongoing basis. It made last quarter an exciting period of time but I’m glad that it’s over.
My right ankle has healed from spraining it (stepped in a hole in the back yard of the C-cans). When I went in for a Podiatry appointment about two weeks later and the doctor expressed concern about increased blood flow that added to the swelling and the perception of warmth in the ankle. The concern was for Charcot Syndrome which results in your ankle collapsing. The correction was to finally start wearing knee high compression stockings. Lindsay had worn them (thigh high) for the last several years for the same circulation issues. Two or three days later the swelling was down significantly and the follow up with the podiatrist went great. From the 6 page full report:
Assessment & Plan Problems 1. Diabetic foot E11.8 2. Type 2 diabetes mellitus with hyperglycemia, without long-term current use of insulin E11.65 3. Polyneuropathy associated with underlying disease G63 4. Generalized edema R60.1 5. Nail dystrophy L60.3 6. Tinea unguium B35.1 7. Sprain of anterior talofibular ligament of right ankle, subsequent encounter S93.491D Plan Diabetic patient with right ankle sprain concerning for potential Charcot event with improvement in temperature and swelling from prior visit. No changes in right ankle compared to left side today. Recommended continued monitoring. He will continue to limit his activity. He will continue with compression socks. Discussed follow-up in 1 month with repeat imaging. He will follow-up sooner if recurring swelling or heat to the ankle. He will continue with good blood sugar control. He will monitor and follow-up. All questions answered.
A week later I had a rather uncomfortable conversation with my PCP at my regular 6 month physical. Jen Wagy had been gently advocating for compression stockings for the last year that I had been ignoring. All of a sudden, I showed up in compression hose and there were several axes of contention – Male Doctor vs Female Nurse Practitioner, etc. We left it as it is good that I am using compression hose.
Other than that, things are generally good with the signal exception that my A1C has crept up to 6.5 along with my weight. She expressed that maybe it was time to go back on medication (metformin). I expressed confidence that if I got my weight back down to 230-220 lbs from the current 252 lbs that the A1C would go down. She agreed to let me try, but set the deadline at May 28th, a couple of days after Memorial Day. So I am back to intermittent fasting, restricting my eating to mostly protein between about 9:00am-3:00pm. I am also going back to water walking at the Casper Aquatic Center three days a week. For those of you who want to dig into the ugly details, the actual report is below:
One thing Jen suggested was getting a DexaScan to measure bone density. It’s of more concern for women, but good to get a baseline for elderly gentlemen. Again, a couple of days later I went into the Radiology Clinic on the first floor, and it was 20 minutes in and out. The report is below:
Kate visited from Feb 23rd-Mar 1 and we actually got some significant things accomplished. First up was the stairs up to Jan & Mike’s house:
The ties are actually 8′ lengths of 4×4″ plastic cut into thirds. After placing they are staked down by 3′ or 4′ sections of 1/2″ rebar. I added the lights I had hanging around and the finished work is as shown below. The plan is to let the spring rains settle the earth on the slope and when Jon comes out this summer add the handrails (set in concrete) and pea gravel.
Contrary to what was alleged, the second step was not set to intentionally trip Jon’s OCD.
The other major project was to get some 2×3 sections of shelving from Menard’s to help clean off the island. It and the table had accumulated misc tools, liquor bottles and assorted stuff. We set up first one, then went back to Menards to get the last one in stock to finish off.
They are set up on the wall across from the island in the putative dining room. A view of the cleaned off island is below:
The last project we accomplished was replacing the UPS system that protected the Starlink system. It tripped off a couple of times while Kate was working here. It was easy to reset, but Kate offered to split a replacement from Best Buy. We went down and bought a slightly updated one of the same kind that we had. It went in with no issues, but the instructions showed how to remove/replace the 2 12vdc batteries. I checked Amazon and they were $81.00, but I checked at Batteries & Bulbs in town (on Second St) and got the last two in stock for $78.95. I brought them home and installed them, so I now have a UPS for the laptops in the office.
That resolved most of the medical issues I had. Next month I go back for a repeat set of X-rays of my feet and ankles and in May I have the follow up on my weight/A1C. Also, next month Kate and I are going to Hawaii for 4 days to visit Disney Aulani Resort. It’s to burn off a few vacation points that will otherwise expire. It’s located over by the former Barber’s Point Naval Air Station so it will be interesting to see the changes from the early 70’s.
Since today is February 18th, I would like to wish both Sis and Jon a happy birthday. Jon was Dawn’s 10th birthday present.
So, while the temperature plunges (today – High – 15 deg Low – 0 deg) I had my semi-annual diabetic podiatry appointment. In addition to the standard foot poking, we discussed my sprained ankle and the bruised big toenail.
I will summarize the above for those who don’t want to noodle through the whole thing. The foot poking went about like last time, some loss of sensory perception but no worse than before.
The right big toe has been bruised under the nail ever since the Foreigner concert on October 1st. The doc examined it and started carving around it with the big old nail clippers he had. After he had exposed about half of it (with no pain or discomfort) he remarked that the nail had started growing underneath it. He kept whacking away at it until it was down to the quick of the nail and stopped. He said that it should thicken up and get harder over time.
The ankle he was a little more concerned with. It was still swollen compared to the left side and was considerably warmer. What he was primarily concerned with was the possibility of a Charcot event (see which is Neuropathic Arthropathy). When you have a persistent inflammation, you can get an elevated blood flow (hence warmness) which can lead to lead to bone scavenging until your ankle collapses (generally considered not to be a good thing). He decided to get some X-Rays for both the right ankle and foot and one of the left foot to establish a baseline for longer term issues.
It just so happened that the Radiology department was next door so I walked over there and checked in. Five minutes later I was ushered into the X-Ray office, and they took a series of X-Rays of my feet and right ankle. I walked back in and was reseated in the office and ten minutes later the Dr. was back in and we discussed the X-Rays. I hadn’t broken any bones in my foot or ankle and there were no gross abnormalities.
For the short term he recommended wearing a compression stocking to improve circulation flow. I was familiar with these as Lindsay wore them for the last 10-15 years. I picked them up at Walgreens and am wearing them now. I have a follow-up appointment in two weeks to check my right ankle.
Tomorrow, I have a follow up appointment with Wyoming Otolaryngology Clinic to see how the CPAP machine is working for me. I don’t expect any problems, I’ve had string of 90% or better scores since Dec 11th of last year through last night; except for one night that I didn’t use it at all (Mike’s hospital adventure) and last night which was only 79%. That event was caused by power running down at 3:17am due to the heater running continuously (low temperatures).
Tomorrow afternoon I have an appointment at Greiner Ford to get my oil changed, filters, and tire rotation. Again I don’t expect any issues.
We had the follow-up appointment with the Neurologist, Dr. Santiago this morning. I was accompanied by Jan, so, as always, contact her for the minority opinion. It started off slowly, with the blood pressure, pulse rate, O2 sats, etc. The nurse, Sherry, was frowning as she checked the paperwork, checked a couple of things out of the room and came back, still frowning.
The Doctor came in shortly and apologized for the fact that they still didn’t have the results of the Lumbar Puncture. He reported that it was the third time recently that they had problems getting the results. We talked about me being local, as opposed to driving a couple of hours to get here, and we were preparing to have to come back.
There was a knock on the door and someone, presumably Sherry, handed in a couple of sheets of paper (see below). She had presumably broken through barrier and gotten the results.
The Dr. then shifted the tone and delivered the good news.
The key information is on page 2 under the block labelled CSF. The “Beta-Amyloid Ratio” is reported as 0.092 while the Reference Range is “>or=0.073”. Therefore, I do NOT have Alzheimer’s Disease (or at least not yet).
Jan pointed out that at the bottom of page 2 that the test was performed by Mayo Clinic Laboratories. Thanks Mayo!!!
As we talked about the results the Dr mentioned that Sherry could be quite fierce over the phone and attributed the ability to get this done to her. After I got home, I called a florist (amazingly located on 2nd street) to order a flower arrangement to be delivered to her at work today to thank her. I just got a phone call from her thanking me; I think I made her day.
Aside for persons of XY gender. Many years ago, before my first patrol on the USS Sam Rayburn, the COB (Chief of the Boat) took aside all the people making their first patrol. He laid some facts on us as if they were handed down from Jehovah himself. The bottom line was people with XX chromosomes are queer for the sexual organs of plants. As an XY you don’t have to make sense of it, or even understand it at all – just accept it as a given. So, if you accept it as a given, go to a florist and make arrangements to send your wife/girlfriend the sexual organs of plants (flowers) once a week, or every two weeks, or for you cheap bastards at least once a month. Just do it, don’t analyze it, just do it. I took his advice and have never looked back. It really is true. In addition, I had them delivered at work so that all her co-workers could see that I loved her.
I’ll write more later this week on what my plans are moving forward.
Brief addendum. I see that I have inadvertently confused some of you. I mentioned sending flowers to Sherry as a sign of my appreciation for her tenacity in beating an answer out of the people we were depending on for answers.
I wrote the last paragraph over time, and revised it a couple of times, in order to reveal to some men, the truths I had discovered. In the last sentence I was referring specifically to Lindsay and the fact that I was sending flowers to her at work while I was deployed. I certainly did not mean to suggest any nefarious interest in other females.
Just a couple of new items, some mentioned on the family call.
First of all, Jill sent me a text that power was off in the C-Cans, so I went up and futzed around a bit and discovered the breaker at the power panel was tripped. So I reset the breaker, and while turning around I slipped and my right foot slipped into one of the several holes that I have neglected to fill in since we worked on the power last year. I got out and my ankle felt a little sore, but didn’t seem to be much worse for wear. I got the power all reset and heat restored to the C-Cans
Over the next 6-8 hours my ankle swelled up and I determined that I had definitely sprained my ankle. I wrapped it up in one of my collection of Ace Bandages. I can walk on it and although sore I don’t think I broke anything. Next week I have the 6th month appointment with the Podiatrist, Dr. Murdock, for the semi-annual foot stabbing to assess my neuropathy, so if my ankle is still swollen, I will ask him about it.
On Monday, as I promised on the family call, I called the office of Dr Santiago, the neurologist, to ask about the follow up. We reviewed the test results they had, and she hadn’t gotten the final result of the Lumbar Puncture. She said she would call them and get back to me.
On Tuesday she called back and said they had the results and wanted to schedule the follow up. We decided on Tuesday February 11th (the twin’s 42nd birthday). I also got a Webster’s Large Print dictionary from Amazon to crib words-starting-with-F so I can ace the cognition test if they give it to me again.
I still haven’t had the Influenza-A, which Mike was diagnosed with, that I might have been exposed to while taking Jan to the hospital. I came home and dosed myself with Vitamin-C, Zinc, and Ivermectin. I appear to have been successful in avoiding the infection.
Well, it’s been a week since my last post but I really don’t yet have any answers to post about my afflictions. So I will update you on what has been happening around the old homestead.
The CPAP machine has continued to be a huge non-issue. I am using it nightly with good results. My sleep, as reported by my Select-Comfort bed is better and less restless. I have a follow up appointment with Wyoming Otolaryngology on the Feb 19th that I expect will confirm that I am satisfied with the treatment.
We had some excitement earlier this week. Late Sunday Jan called me to say don’t be alarmed by ambulances rolling up, as she had called them for Mike. (If this is news to you, bitch at Jan, not me.) I suited up and walked up to Jan & Mikes to give her some moral support. After about an hour they packaged Mike up and carted him off to the hospital. Jan and I followed in her truck. The good news is that they didn’t go code-3 and drove leisurely to the ER.
After a couple of hours at the ER, they decided to admit Mike, based on diagnosis with Influenza A (no COVID), with an early catch of pneumonia. We hung around until they got him settled in a room and made sure they had all the admin stuff handled. We got home about 2:00 AM (there is an amazing lack of traffic at that hour; we didn’t see another car, in either direction, all the way home.)
Once I got home, I broke out the Ivermectin and took some additional Vitamin C and Zinc. I have maintained that regime this week and haven’t had any symptoms.
Mike reportedly came back last night and all seems over.
I have been getting some nuisance calls, all reportedly from cities around Portland, reportedly scam calls. I screwed up the first couple of them and answered, with “Yes?” rather than “Hello”. Got no answer or a hang-up but apparently the call got triggered as being answered. I started getting a flurry of them (4 or 5 per day) so I dropped back to not answering them and letting them go to voicemail (most don’t leave it). I have been blocking the number each time and the calls are trailing off. I haven’t gone yet to blocking all calls except from my call list, but I’m getting close. The good news is that I’m also blocking calls from scam sites offering to get me out of my Trend-West time share that I haven’t owned for a couple of years.
Well, that’s most of what has been going on here in Wyoming.
I think a brief review of the bidding would be in order. The medical issues I am dealing with are: 1. Circulation issues with lower legs being addressed. 2. Sleep apnea identified late last year which I agreed (under protest) to seek treatment for. 3. MCI (Mild Cognitive Impairment) or Early Alzheimer’s Below I will address the status of each of these.
Lower leg circulation. We have been slowly examining the circulation issues from the bottom up. We started with Venous Mapping of my legs. That was a group of ultrasonic examinations of the veins in my legs looking for leaks, valve issues, or other things. They didn’t find any of the obvious issues.
The next step was a cat scan of my abdomen, looking for any circulation issues that would cause the problems observed in my lower limbs. That also did not show any abnormalities.
The last thing to look at was an Echocardiogram of my heart. That involved using ultrasound to reflect off my beating heart and measuring various heart valves and chambers to evaluate blood flow. This last was done yesterday afternoon and I haven’t seen the results yet. I didn’t notice anything wildly out of character from one I had several years ago. If the heart isn’t the issue I don’t know where that leaves me.
My next appointment is next month, on February 25th do I will add it to the list of discussion points.
Sleep Apnea Sleep Apnea has evolved into a non-issue. After discussing with the Otolaryngologist last November, the decision was made to try the CPAP machine and if it was as uncomfortable as the one I tried several years ago, then we would seek trying out the Inspire surgical implant.
Well, I got the new and improved CPAP machine and tried it out and have had zero issues. I don’t know if the CPAP machines are better or if I have improved, but from day one I have been sleeping just fine. I am up to 23 days of usage with the score of 99-100% on the iPhone app.
I think my sleep quality is improving, looking over my Sleep Number bed results in general I see fewer restless periods during the night. The next follow up appointment is on the 19th of next month. I will talk it over with the doctor, but right now I think I will stick with the CPAP machine.
MCI/Early Alzheimer’s This has literally been a whirlwind of activity. I had an appointment with Neurology on January 6th. I don’t think I had the doctor’s report the last time I posted.
Note: One correction, I remembered the address, not the Street names; other than that, it’s correct.
Since then, I have blood work, an Electroencephalogram (EEG), an MRI, and a Lumbar Puncture/Spinal Tap. I was able to examine the MRI, but other than determining I did not have MS (Lindsay’s MRIs had prominent scars in the MRI that documented the progress in the disease) I didn’t see anything obvious. The spinal tap was a big nothing. Lindsay had one in the mid 1970’s, and it was fairly traumatic. This one was easy, good local anesthetic, a local X-ray to guide the needle in, extracted the spinal fluid, and put a band-aid on the site. They then wheeled me into a recovery room I vegetated for two hours and then walked out. (Mike and I had lunch at Johnny J’s, since we were downtown anyway.)
I expect that I will have a follow up appointment with Dr Santiago to discuss the results over the next couple of weeks.
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.
