Valentine's Day, 2015

To my wife, Bobette...Happy Valentine's Day, baby

For my dear cousin, January Elizabeth who inspired me to write this Valentine's Day Message

   To me there is nothing more pleasing than the woman I love snuggling up to me in our bed at that moment when I am most relaxed and slipping into the twilight stage of early sleep. I lay on my left side as she spoons her way into the recesses to take up all the spaces between us. She strokes my arm and lays her head on my back near the shoulder. When she first started this she would gently pat my thigh in time with my heart beat. If she knew I was awake and aware she would often say how slowly and strong it sounded within me. I would feel her count out the rhythm and figure the average beats per minute. Fifty five to sixty was usually the range. Like all things couples do to each with acts that comfort, they drive away any thoughts of the little dramas and issues that cloud our days. Sometimes, though, there is exists a fine line that can make even the most intimate gestures of affection into being an annoyance. There was a night when she came to me slowly and insinuated her hand over my arm and started keeping time as she had so many nights before. I wanted sleep more than anything else and tried my best to be diplomatic when I asked her to please stop though I did enjoy her touch. However, this night, something was different. The taps on my thigh were twice as fast as nights before. She asked me if I felt okay and did I feel any different with a heart rate that went from about sixty beats per minute to one hundred twenty. I told her I felt fine, but there was insistence to get up and take my blood pressure and pulse. Sure enough, the monitor showed a rapid heart rate with an elevated blood pressure. We both agreed it was time to see our doctor to discuss this occurrence and made an appointment for later in the week.

   The next day I had an appointment with a testing clinic to have a Doppler ultra sound test on my legs and feet. For some unknown reason a peripheral neuropathy had manifested itself giving me points of deadness in some area. Having diabetic wife I have learned this is a sign of concern and to have my blood tested for signs of this disease. Not once has it shown me to be on the path to this life changing illness and curiosity lay in the amount of circulation of my lower extremities. An order to get the test had been arranged that put me into a testing room with a series of pads and wires placed on my legs and feet. As the technician went through his test procedures I could hear the activity of my heart beating through the speakers on the testing console. "Is your heart beat usually this irregular, sir?" was the question and all I could answer was no. "You better have that checked out." I told him I was seeing my doctor in a few days to discuss a rapid heartbeat. He urged me to have this conversation sooner rather than later. That afternoon I gave the results of the Doppler test to my wife and we were both relieved to hear that I had good circulation in my legs and feet and that the neuropathy remained a mystery. However, the irregular heartbeat took front and center when I told her about what both the technician and I heard. I called our doctor's office and we managed an appointment that same day.

   As I sat on the examination table noting mentally that the paper used as a clean surface had not really changed very much throughout the years. It was still as crinkly and uncomfortable as ever as my mind imagined a testing lab where some technician was standing in front of his boss wringing his hands in secret while the big man decided to keep or scrap this latest run. Was is worthy of the thousands of butts that it would serve? I asked my wife the hypothetical question regarding quality control of such a product and was immediately told to stop being so silly and pay attention to the issue at hand. "Yeah, I guess so."

   My doctor entered the examination room in her usual manner full of smiles, hugs and positive energy. In the years we have known her she has become almost a member of the family familiar with the many secrets we keep within ourselves. I was told by my mother, a registered nurse herself, that it's necessary to establish such a bond with your internal medicine care giver. Many times she has proven herself worthy and we accept her advice almost without question. She has taken the position of quarterback of our health care. My wife took the lead and started recounting the story of her snuggle and my suddenly increased heart rate. The blood pressure measuring cuff came out and she quickly inflated and slowly deflated it watching the mercury and listening with her stethoscope. Her face went from its usual happiness to something a little grayer as concern started to crept into her mind. "You have something going on in there and we've got to find out what it is." She called for the EKG machine and one of her internists brought in an A/V cart with a large machine placed on the top shelf. I was hooked up with simple electrodes and sat still as it ran through its test procedure. The graph showed the irregularity as well as the increased rate. She quickly scribbled out a referral prescription for me to see a cardiologist immediately or else face an extended stay in the hospital as tests were run. The hospital is the most expensive hotel in town and it was the last place I wanted to spend a week of medical confinement.

   The cardiologist's office responded with a quick appointment date and my sentence to serving time at the hospital was lifted. I nervously spoke with my wife making note that he, too, had the same kind of paper on his examination table as our doctor's. Sure that I would be once again admonished for not taking things seriously I was saved by the doctor's nurse arriving with another EKG device in tow. She officiously and expertly placed a number of sticky electrodes on my chest, back and legs. Once on-line the device quickly printed out about a yard of data on paper which was given to another nurse for delivery presumably to the cardiologist. The electrodes were pulled off and the nurse left the exam room as fast as she arrived. I looked at my wife and said, "Busy woman." She responded with, "I guess so." We returned to silence as I looked about the room always looking for the models of organs that drug companies give to medical professionals extolling the virtue of their wares. These are usually well made models with much detail and eye catching colors. I am certain there are a number of sand sculpture artists that are paid well for these reproductions of heart valves, sections of intestine and lung tissue. My interest was quickly diverted as the doctor entered the room.

   We made our introductions at which time I mentioned he shared the same name as one of my favorite jazz bassists. He acknowledged my reference with a smile and asked me to remove my John Deere hat. When asked why he said that his father was a McCormick Farmall dealer and that John Deere logos were banned from his office. I explained it was nothing more than a "gimme hat" from my place of work, Home Depot. That didn't matter. It had to go. Okay, I can deal with that.

   Pulling out the EKG data strip he went into his explanation of what my heart was doing, but had no clear cut answer as to why. He asked me if I snored and did I have sleep apnea. I answered yes and I don't know. He then wrote out a prescription referral to have a sleep study performed to determine if apnea was present in my nightly slumber. Then he pulled out a piece of blank paper and started to draw the human heart and explaining how it works highlighting both plumbing and electrical functions. He did this quite well as expected and I had a clearer cut idea what was happening in my chest. He asked me if I noticed my heart racing and again I said no and that I had no idea anything was wrong. Further discussion on the subject of apnea revealed a number of symptoms that I have noticed singularly, but not as a group totaling up to a real problem. Was I tired most of the time? Yes I was. Did I wake up refreshed or dying for that first cup of coffee? No, I can't say that I've woken up to refreshment and yes, coffee was important as life, itself in those early moments. The questions and answers started adding up to more than I ever thought about and I suddenly became very interested in this sleep study business. Apnea kills. It can cause strokes, weight gain, and heart issues such as heart failure, irregular heartbeat and heart attacks. It can also effect mood and actually give depression a stronger foothold. I had to press on and find out more. Apparently, my life depended on it.

   I've always had issues with falling asleep. I firmly believed it took me anywhere from thirty minutes to an hour to fall asleep. So, to counteract this I was able to convince my caregivers into writing a prescription for Ambien, a drug along with others that were introduced to me during the initial stages of my recovery from alcoholism. I went the chemical route rather group therapy or support organizations. That story is arduous and better left for another time. With its ability to put me to sleep mid-sentence Ambien became a close personal friend and one whose company I enjoyed for many years. Typically, though, I assumed the grogginess I always felt in the morning came from a bit of hangover from the drug.  In actuality, Ambien's half-life is about 45 minutes to an hour, so, the hangover I felt was not exactly the result of it knocking me out quickly and soundly. Something else was leaving me groggy. Ambien eventually became a subject of more than a few discussions with my wife about what it would do to me once taken. There are many documented stories of people doing strange things under its influence. People have been known to act out with aggression, attempt to drive a car or other dangerous activities that require a sober approach. Mine was hunger and I paid dearly for it. I would take my dose and stay up way too long while it took effect. Sooner or later I would find myself in the kitchen making a sandwich or other dish using either the microwave, toaster oven or the gas range. It became a matter of safety since I would often leave the gas on slightly after cooking my snack. I loved the idea of sneaking around and hiding the food from my wife. Like most people who engage in addictions it's the adrenaline rush of the escape that matters then most. In reality I was hungry. Ambien made it so, but, it was the act of her not catching me that satisfied that little demon inside my head even more. I am a known quitter in my head. I have quit cigarettes and booze. I have walked from people and relationships without regard to the consequences. I made up my mind for the last time to give up Ambien for good and away it went onto the trash heap of expended addictions.

   I went into my interview with the sleep specialist with many questions. He corroborated many of the things I had learned about apnea prior to meeting him. My first sleep study was recommended after he listened to my heart and countered with several key questions of his own. My first sleep study was scheduled. I arrived anxious to learn about what goes on when I struggle to go to sleep. I was also interested in a recent phenomenon that I had developed known as Hypnic Myoclonia, a brief, involuntary twitching of a muscle or a group of muscles that would wake me up furthering my sleep frustrations. Again, I was missing the entire explanation focusing instead on individual symptoms to my sleep deprived experience.  He basically dismissed that subject with a wave of his hand as if it were just another complaint from a sleepy head. The date for my first sleep study was set and we left to go home, work and wait for the date when all would hopefully be revealed. Secretly, a little voice in my head was asking for a prescription for Ambien. It would be easy. Just open my mouth and let the words fall out as easily and successfully as all those other times. I knew I would never get away with it, though. My wife's expectant anger at such a request was more than I wanted to entertain. We left with my Ambien demon child screaming for attention.

   I arrived late into the evening at the sleep center determined to get some answers and some serious sleep. I was walked into a basic bedroom with little adornment other than a flat screen television and an ominous looking camera pointed directly at the bed. Yes, there were several sophomoric thoughts that went through my mind, but they were quickly dispelled and I got down to business. A multitude of sensors and lead wires were affixed in strategic locations on my body a sensor stuck to the base of my nostrils, a very ticklish spot for me. I can go crazy with frustration if an errant mustache hair decides to go north and I do suffer the malady of long black hairs growing inside my nostril. If you don't have them you will. Take my word for it. Wired up and ready to go I lay down and instantly felt the need to entertain my hosts with a few Hypnic jerks for effect. Computers and video were set to task measuring my temperature, my brain waves and all other manner of information given off by the body. This information was eventually written up into a report that told me I do not sleep, but I do fail asleep faster than I ever thought. There are four stages of sleep with the fourth being the deepest and the most beneficial. I managed to get as far as the second level, but would soon fall back to the first because I would actually stop breathing. My brain then said, "Hey, man. Wake up. You're not getting any oxygen. So, I would wake up enough to inhale and thereby sending life giving oxygen to my blood that was then pumped through my body. This happened as often as 59 times a minute, but sat more along the lines of 19. No wonder I was always tired. My weight and age had contributed to a small flap in my throat closing off an air entry that would make me snore in some positions and stop breathing in others. The answer was CPAP or Continuous Positive Airway Pressure, a machine that I would be tied to for a long time to come.

   The CPAP machine came within days and I set about the task of making this thing work and getting better. I didn't realize that it can sometimes longer than a year to fully adjust to it. It blows a significant amount of air into your nose and opens up that little flap that causes so much damage over the long haul. Think about it. Those that you know that are overweight ask them if they snore or have issues with waking up many times at night. If they answer yes then you should get them to a sleep study right away. I have now gone through the usual frustration of having this mask on my face that I dream is suffocating me. I am doing my best to embrace this chapter of my life since I know it will be of great benefit in the long run. It took a while, but I did manage to get over the embarrassment of my appearance in bed in front of my wife. She loves me and wants me well a little more than handsome at this stage. There are many more things that can be said about my CPAP adventures, but they are also best left for another time.

   My last visit to the cardiologist lead to a discussion for a medical procedure that would help with my rapid heart rate and irregular heart beat. I was diagnosed with an atrial flutter. It's where the SA node on your heart beats twice as fast as the answering node that creates that ever familiar heart beat known as "lub dub." The procedure is known as ablation. A small incision is made in your groin near a large vein and a catheter is introduced all the way and into your heart. A dye guides the way for the surgeon who is more electrician than heart doctor at this point. My electrician was a young guy who looked more at home on a fast Japanese motorcycle rather than an operating facility. I read about his background and his reviews were rated number one. He was the first pick by my cardiologist to perform the procedure. The ablation occurs when he zaps the node on the heart and thereby cancels its ability to emit an electric signal. Simple, right? What's the worst that could happen if I'm told that angioplasty? They're pretty common, right? Are they?

   I checked into the Heart hospital ready for the trip to normalcy in happy heart land. I was ushered into a receiving room where I was given a southern exposure hospital gown with impossible tethers that are very frustrating to tie. I figured my apron tying expertise would come in handy, but I still managed to flash my butt at more people than I really wanted. I signed the papers and joked my way through the set up process. The doctor showed up, shook my hand and told me he was ready to rock this ablation. I was more than ready as I was fitted with an IV. I was wheeled through the halls into the operating room where there were many cool looking machines that did a variety of things like beep and flash lights. I was slid onto a table beneath the shadow of a very large flat screen monitor. This is where the ablation would play out with all of its technological and medical wonder. I looked over at one of the nurses as she broke out a hypodermic needle and injected it into a port on the IV stand. I woke up several hours later in my hospital room with my wife standing guard duty. Nurses were in and out introducing themselves and wrote my name and their contact numbers on a white board. And, my chest hurt. Not my heart, but rather a spot above my heart just below my shoulder.

   I was now the possessor of pace maker. Huh? I didn't sign up for this and I don't remember agreeing to it. My wife filled me in on what happened. I performed well during the ablation procedure and all was right. As always, I am baffled by the claim that anyone does well when that have an operation. Doing well equates to not dying I suppose. Apparently, while I was doing so well I went beyond doing well into doing too well. My heart rate had dropped to 40 beats per minute along with a much lower blood pressure. I would have lived with those numbers, but how well was the question. My heart rate did not rise. The doctor approached my wife and explained how well I did (again) and said that I would be best served with a pace maker in my chest that would feed life giving "normal" heart rate signals to my heart. I was told that I agreed with this in a conversation I had with the doctor in the operating theater. However, I have no knowledge of this happening since I was given an amnesia kind of drug where I would not remember the twilight sleep I was getting form the anesthesia. My wife took everything into consideration and signed the consent form to proceed. 

   After getting over the shock, and it was a shock, of seeing this thing in my chest I started to settle in by rationalizing my new status in life. From this point going forward I would be tied to this little computer in my chest for the rest of my life. It would always be there and I would have to advise many people both known and unknown of this fact. Traveling becomes interesting in that I will have to be inspected separately from the rest of the crowd in airports. I will have to advise all doctors both future and present of my status. I will have to avoid certain situations where magnetic fields could affect my device and throw it off kilter. I've had major concerns that my guitar pickups might interfere with it. Paranoid or just careful? I am researching to see if electric guitar pickups with their Alnico V magnets can affect the device. Jokes are running rampant about such inquiries, but it is a serious question to me since I still try to play every day.

   The bruising has been monumental and the pain is slowly ebbing. I know it's only a matter of time before I fully settle in with this and go about my life. So far, I have noticed that I am sleeping better because of it and my wife says I have never sounded as good. She was startled the first time we spoke and was very impressed with the clarity and presence of my voice. She said I haven't sounded this good in years. Time will tell me if I am to expect even more favorable results such as a lowered blood pressure, loss of weight and a possible end to my neuropathy. I am waiting to see what the combination of CPAP and the pace maker have to offer. I may be on the verge of a great healing recovery. I hope it is so.

   This all occurred as a result of my wife's love for me. Her gesture was heartfelt and genuine. When she noticed something was wrong she spoke up and put this process into motion. If she had not I may have had weeks, months or maybe just a few more years of life when either a heart attack or stroke would take me off the playing field. She has given me more than her love and support. She has given me the best Valentine's Day gift a man can receive.

Dave Tongay aka "Ironman"