Survival of the fittest

This all sounds like good news to me - except maybe the hospital bill!

Not surprised about the bill (yay, insurance!), but I'm encouraged with how confident they are that you will make a full recovery.

Walking is a great recovery activity, so you should do it as much as you can, as long as you're not walking up Mt. Hood.

Rehab sessions in Bend?

Overall, a great report. Keep up the good work!

Yea on no bad news!

I'd be curious to know how much heart damage you have, as a percentage?  And how much of a heart is repairable (lots of variables on that question)?

As far as insurance, your claim not only is out of network, it's out of state.  So, I'm real curious on how this shakes out, as are you, Nancy.  If this was an in-network claim, that 6 figure bill would be reduced to a ridiculously low figure.

I'd read up on how to make an out of network, out of state insurance claim work better for your pocketbook.

And don't worry about reporting in on Friday, as I can't make a story out of the remaining emoticons.

Yes, I'm not disappointed with any of the news I received at the orientation on Friday.  I'm making progress...not as fast as I'd like but it's noticeable progress. 

They indicate and I agree that walking...or at least that level of activity...is better for my recovery than a hard workout.  I intend to walk as much as time (and energy) allows.  No walks on Mt. Hood planned although this weekend was the weekend Katie and I had scheduled to summit Mt. St. Helens.  Marty is taking my place.  It will be a nice (but warm) father/daughter trip.

Mark...Dr. Beckerman would have loved me to attend rehab at Providence in Portland but realized that a 5 1/2 hour round trip three times a week wasn't feasible.  Madras and Redmond don't offer anything.  I'm going to St. Charles in Bend.  I can make it in an hour if I don't have traffic issues.  That's my best option and it's doable.

I read some discouraging information on the internet about heart muscle damage being permanent.  I mentioned this and she assured me that the heart figures out ways to work around the damaged muscle and can/should return to the former capacity.  The echocardiogram in Boston indicated I had Left Ventricular function of 55%.  That did not sound good to me but they explained that normal is 55%-70%.  (Some extend the normal range down to 50%.)  So I'm at the low end but still in a normal range.  My heart function was not tested before the event we aren't sure where I was.  I will have another echo on July 13th and they expect to see improvement.  They are pleasantly surprised that I don't experience any angina (pain) when I exercise.

As far as the bill and the insurance goes I have done some research and my understanding is that I will have to pay 100% of costs until I reach my $6000 deductible.  At that point they would pay 80% of in-network costs or 50% of out of network costs.  I'm responsible for the remainder but I would only pay a maximum of $5900 additional if all my service were in-network.  Since it is not my maximum out of pocket cost (in addition to the deductible) is increased to $11,800.  They don't seem to be concerned about the out of state or out of network care as it was an emergency and I did not have an option to us in-network providers.  So far the bills they have covered have been treated exactly as I expected.  They are waiting for some diagnosis info on the bigger ones but I'm not at all concerned about that.  I may be surprised at some point but for now the coverage is what I expected.  We have been putting before tax money away in a Health Saving Account and while it won't be enough to cover everything it will come close.  I'm just happy I'm still here to worry about the bills!!

I am a big supporter of HSA's. 

I had forgotten about the emergency aspect and how it positively affects who pays what.  THAT'S really good news.  I would imagine the in-network price will be really discounted deeply.  And for some reason, insurance companies have never been enamored with having ambulances covered.


And thanks for the info on the heart, too!

Those are good details on the heart exam. You were clearly at a good place when you had your "event."

The high deductible makes me cringe, but the HSA ought to help.

Glad to read that you are progressing...even if not as fast as you would like.  Hopefully you will get to compete in September.  Also, I am glad that you are here to worry about the bills.  The alternative would suck!!

Thanks all...it's hard not to get frustrated and depressed but I do realize how lucky I was/am!

So the update after today's rehab session...

It went really well.  The medical professionals and the other patients are all super friendly and encouraging.  By going in the afternoon I'm in a less crowded session and I think we get a bit more personal attention and everyone seems willing to share with the group.  There were 7 of us.  A couple were fairly old and frail but the rest were probably close to my age.  4 women and 3 men.  The lady next to me said it was only her second session...this time.  She'd been through this 10 years ago.  She didn't offer details and I didn't ask.  She didn't look to much older than me.

So out of the hour long session I managed to get in 38 minutes on the treadmill.  We have to wait till they put the EKG wires on and take our resting BP and then they turn us loose.  We have to start slow but I ended up getting up to 3.5 mph and 1.5% incline for the last half of the session.  Then they make us cool down, get a drink and we do some stretches and relaxation while sitting in a chair.  They monitor us continually and also come around and start conversations to make sure we can pass the talk test.  They were pretty happy with my HR and BP before, during and after exercise.  Her only minor concern was that my HR didn't recover as quickly as she would have liked.  She suggested we do another session on Monday and she'll call and discuss everything with Dr. B on Tuesday.  I'll know what he says when I go back in on Wednesday.  I almost get the feeling they are playing good nurse, bad doc...  I think she's concerned that if she asks to soon and he's not comfortable with allowing me to do more yet then I may have to wait even longer.  Frustrating but better to be conservative.  I don't want to start this process all over again!

I did ask more questions...the info that I've been reading indicating that heart muscle damage is permanent is correct.  BUT she indicated that even though the muscle that has died can't repair itself, the heart usually figures out how to work around it and function just as good as it did before the muscle damage.  She said she expects my EKG and heart function to return to normal...it just may take some time for the heart to figure out how to reroute things and do it with the remaining healthy tissue.  AND the reason I can't do to much to soon is because I need to allow the heart to do this remodel job before I ask it to work to hard.

To hot to walk any more this afternoon.  I don't have to bale hay in the morning so I plan to get out early for a walk while it's still reasonably cool and try and go a bit longer.

That sounds like a great session, and an even better nurse! Very encouraging.

I never cease to be amazed at just how durable the human body is -- and how adaptable it gets making compensations when something goes wrong. Life finds a way.

Good report.

I think you should monitor your HR after a walk at home.  Mimic what they are measuring at the clinic.  If you keep track at home the stats they do at the clinic, they get a better picture of how you're doing and you do, as well.  You'll know by keeping track that you're getting better and the rate.

That could help to explain why it's tougher to walk two days in a row.  Think of when you have a pulled hamstring or other muscle.  It takes a while to rebuild the muscle cells, fibers, etc.  So, it takes a while to get back to your baseline.

I have no idea how long it takes to grow heart muscle cells.  Statistics will rule the day.

Thanks for the update, Nancy.  The human body is certainly remarkable.  My FIL had a stent put in a few yrs back when he was 85 (he is now almost 90) and his arteries had grown a path around what was blocked before he had an episode.  They said it had been that way for a long time.

Good suggestion Doug.  I keep my HR monitor on for a few minutes to watch my HR but hadn't thought about logging how long it takes to recover.  I'm already logging my blood pressure twice a day, my exercise, my steps (they sent us home with pedometers)...

4 miles on Saturday morning.  2 miles on Sunday.  Rehab again today.  It went well.  They make me take my pace up slowly but I got up to 4 mph at a 2% incline.  It felt a bit harder but not bad.  They laughed...there were 6 of us there today and the other 5 were in pretty bad shape.  2 were on oxygen.  One had MS.  The other 2 just seemed to wander from one machine to the next but never got much exercise.  One of the head cardiologists stopped in today.  He introduced himself and asked what my story was.  He said they don't see people like me there very often.

I've been pretty cautious at home because of the heat.  Most of my walks have been 17-18 minute miles.  It felt good to get up to a 15 minute per mile pace.  They are going to update Dr. Beckerman tomorrow.  Hopefully they'll have good news for me on Wednesday.

It's supposed to be in the high 90's and low 100's for at least the next 10 days.  It's going to be a HOT 4th!

Heat does a number on us whether we walk or run.  Humidity just adds insult to injury.

With as much as doctors love statistics, they love graphs even more.  If you remember at what time increments they look at your HR after exercise, then maybe have a separate graph for each (or a couple) of those increments, even if it's just a sheet of paper with dates on the X axis and HR on the Y axis. 

If you don't remember the time increments, pick at Zero (when you finish), +1 minute, and +5 minutes.  They will LOVE you for it and you receive immediate feedback at home on how your heart is doing without waiting for a doctor's interpretation.  If the numbers go askew more than once, then what did you do different?  Hillier?  Stop for a quick rest break during?  Longer distance?  Make notes for the anomalies. 

In addition, you become a partner in your treatment because if they say something the graphs do not support, then you can say the trend over the past X weeks do not support what the doc is saying.  Some docs will enjoy your engagement in your treatment, while other docs that think they're God's gift to cardiology won't like being shown up by a mortal.  Screw 'em, it's YOUR heart.  If you think their response is a stock response, say so.  It'll make them up their game a bit.

Doctors are NOT gods.  That's why they practice medicine.  YOU are your BEST advocate for YOUR heart.  I've had a doctor accuse me of claiming he was guilty of malpractice.  I said, "If the shoe fits."  Now, if you like the doc, then maybe not go so far as I.  I didn't like that doc.

Very quick update while I wait for the dew...if we have any...to settle in.

These 16 hour days and I are not getting along very well.  I'm exhausted.  I've been napping during any spare time I do have so exercising has been minimal.

I did walk the 5K on the 4th.  My daughter and niece walked with me.  It was nice to visit with everyone before/after the race.

Dr. B still hasn't released me to do more.  Partially because he was out of town and couldn't look at the EKG readings they faxed over but primarily because he didn't want me to overdo it in the heat...probably wise.  I'm hoping he's back and they'll have an update from him when I go to rehab this afternoon.

Tired of the heat.  Tired of dodging thunderstorms.  Tired of waiting for the dew.  Come to think of it I'm just tired.

nkrichards wrote:Very quick update while I wait for the dew...if we have any...to settle in.

These 16 hour days and I are not getting along very well.  I'm exhausted.  I've been napping during any spare time I do have so exercising has been minimal.

I did walk the 5K on the 4th.  My daughter and niece walked with me.  It was nice to visit with everyone before/after the race.

Dr. B still hasn't released me to do more.  Partially because he was out of town and couldn't look at the EKG readings they faxed over but primarily because he didn't want me to overdo it in the heat...probably wise.  I'm hoping he's back and they'll have an update from him when I go to rehab this afternoon.

Tired of the heat.  Tired of dodging thunderstorms.  Tired of waiting for the dew.  Come to think of it I'm just tired.

Gratz on the 5K!  So, I guess this is your race recovery week?  Be nice to your heart and rest this week, I would think.

Sorry about the heat and humidity as I know you guys are not used to the combo out West.  I'm lucky enough now that the heat is mild as compared to GA or TX (where Doug is) so I'm adapting every day.  Yesterday was the warmest run that I've had in weeks and it was only in the high 60s, but the humidity was 94%.  This morning it was the same humidity but back down to 57! - boy it felt cool, almost cold.  I'm sure the heat will be back as it is odd for us to be so cool into July.  Funny as it was close to 90 everyday back in early June before I arrived here, and NE Oh is experiencing the same cool down.  I just know it will be back in time for the half we run every summer on the 18th!

Take it easy and be patient.  I know that is hard for us all, but it is more important this time than ever.  You can do it!!!

Keep up the good work, Nancy! I think your doctor might be afraid to give you too much, knowing that -- unlike the guy who wanders from machine to machine -- you're going to squeeze every last iota out of whatever workout you're allowed.

Cooler weather may be on the horizon. Dare we hope for an early autumn?

Yes, that's right...I got to jog today!!!!!  I'm released to jog, bike, and swim as long as I'm cautious and avoid the heat.

After a nice warm up I cranked the rehab treadmill up to 5 mph.  After 5 minutes they checked my blood pressure and said it looked good as did the EKG.  I did a couple more 2 minute intervals with some walking in between before I ran out of time.  Not fast and not much but boy did it feel good.

I'm going to try and bike and/or swim for a few minutes tomorrow depending on how things go on the farm.  I have rehab again on Friday and will do some jogging again.  They'll send a report to Dr. B on Friday.

I may have been a bit excited....they laughed as all the other patients toddled around trying to get out of working to hard.

nkrichards wrote:

Yes, that's right...I got to jog today!!!!!  I'm released to jog, bike, and swim as long as I'm cautious and avoid the heat.

After a nice warm up I cranked the rehab treadmill up to 5 mph.  After 5 minutes they checked my blood pressure and said it looked good as did the EKG.  I did a couple more 2 minute intervals with some walking in between before I ran out of time.  Not fast and not much but boy did it feel good.

I'm going to try and bike and/or swim for a few minutes tomorrow depending on how things go on the farm.  I have rehab again on Friday and will do some jogging again.  They'll send a report to Dr. B on Friday.

I may have been a bit excited....they laughed as all the other patients toddled around trying to get out of working to hard.

And you survived!  WOOHOO!!!  You blew out any skepticism they had.  Further, their report will not look normal for a cardiac patient when the notes say "Pt ran at 5 mph pace for 30 minutes with no effects."

As a joke, ask them when they're going to discharge you from Cardiology because you're fixed.

Good job.  Now, get out there and walk 4 miles.  Chop chop!

Boy do I have news!

I've been to the pool twice.  It was a bit scary the first time but all went well.  Today I was able to catch up with my swimming friends.  I spent as much time talking as I did swimming but that's OK.  I got in 1000 yds...all easy of course.

I've also been out on my bike twice.  Just a nice easy 6.5 mile loop with minimal hills.  The first day was pretty awkward but it felt better this afternoon.

I haven't managed to get out on the roads for a jog yet.  I've been in the tractor in the morning when it's cool and I'm not supposed to run in the heat yet.  I did do another session on the rehab treadmill and that went well.  I'm hoping to get in a short run in the morning before I head in to rehab in the afternoon tomorrow.

AND....   I had an echocardiogram in Portland yesterday.  When I left Boston my Ventricular Ejection Fraction was 55%.  Most of the doctors consider 55-70% in the normal range.  Yesterday my EF was 65%!  Dr. B and I are both quite pleased!  Some evidence of heart damage is still showing up but nothing that Dr. B seems at all concerned about.

So...the hay is baled and stacked so I'm not working such long hours.  The thunderstorm that blew through yesterday dropped .7" of rain on us in 10 minutes...a nice irrigation with no significant crop damage.  It's fair week...the grandkids have lambs and cooking exhibits entered...we'll have time to watch them show their lambs and socialize a bit.

7 1/2 weeks till the MacDash.  I'll be slow but I'll be able to participate.

nkrichards wrote:Boy do I have news!

I've been to the pool twice.  It was a bit scary the first time but all went well.  Today I was able to catch up with my swimming friends.  I spent as much time talking as I did swimming but that's OK.  I got in 1000 yds...all easy of course.

I've also been out on my bike twice.  Just a nice easy 6.5 mile loop with minimal hills.  The first day was pretty awkward but it felt better this afternoon.

I haven't managed to get out on the roads for a jog yet.  I've been in the tractor in the morning when it's cool and I'm not supposed to run in the heat yet.  I did do another session on the rehab treadmill and that went well.  I'm hoping to get in a short run in the morning before I head in to rehab in the afternoon tomorrow.

AND....   I had an echocardiogram in Portland yesterday.  When I left Boston my Ventricular Ejection Fraction was 55%.  Most of the doctors consider 55-70% in the normal range.  Yesterday my EF was 65%!  Dr. B and I are both quite pleased!  Some evidence of heart damage is still showing up but nothing that Dr. B seems at all concerned about.

So...the hay is baled and stacked so I'm not working such long hours.  The thunderstorm that blew through yesterday dropped .7" of rain on us in 10 minutes...a nice irrigation with no significant crop damage.  It's fair week...the grandkids have lambs and cooking exhibits entered...we'll have time to watch them show their lambs and socialize a bit.

7 1/2 weeks till the MacDash.  I'll be slow but I'll be able to participate.

That IS some excellent news!  Way to go!!  That bouncing emoticon at the bottom of the post made me think that you're chomping on the bit to get going.

I do have one question that you may have covered in earlier posts.  Did any of the docs have an idea of how long the heart damage had been going on and what caused or contributed to the muscle damage?

Git back on that tractor!

Fantastic news!!!!!

Weird question for you.  Not sure if you remember Mary Pat from the Boston dinner (the woman that Nick and I ran with, my friend from Philly), but she has two friends who have outfitted a van (for living) and have been driving all over the country picking up odd jobs basically in exchange for the experience and meals.  They worked at some "pig and chicken" farm outside of Austin and some other farm in Iowa.  They will be here (in western NY) in a couple of weeks to visit MP (and I and others) before they head out on another adventure,  And that is when I thought of you, and wondered if you need some help during harvest - again in exchange for meals, experience and a place to park (and board) for the weeks they might be needed.  Just a thought as I really have no idea what it takes although I expect it may be colossal and it might be fun for you all.  Anyway think on it and let me know if there is any interest remembering of course that nothing might actually materialize if they are set (they were not as of last week).

nkrichards wrote:Boy do I have news!

I've been to the pool twice.  It was a bit scary the first time but all went well.  Today I was able to catch up with my swimming friends.  I spent as much time talking as I did swimming but that's OK.  I got in 1000 yds...all easy of course.

I've also been out on my bike twice.  Just a nice easy 6.5 mile loop with minimal hills.  The first day was pretty awkward but it felt better this afternoon.

I haven't managed to get out on the roads for a jog yet.  I've been in the tractor in the morning when it's cool and I'm not supposed to run in the heat yet.  I did do another session on the rehab treadmill and that went well.  I'm hoping to get in a short run in the morning before I head in to rehab in the afternoon tomorrow.

AND....   I had an echocardiogram in Portland yesterday.  When I left Boston my Ventricular Ejection Fraction was 55%.  Most of the doctors consider 55-70% in the normal range.  Yesterday my EF was 65%!  Dr. B and I are both quite pleased!  Some evidence of heart damage is still showing up but nothing that Dr. B seems at all concerned about.

So...the hay is baled and stacked so I'm not working such long hours.  The thunderstorm that blew through yesterday dropped .7" of rain on us in 10 minutes...a nice irrigation with no significant crop damage.  It's fair week...the grandkids have lambs and cooking exhibits entered...we'll have time to watch them show their lambs and socialize a bit.

7 1/2 weeks till the MacDash.  I'll be slow but I'll be able to participate.

Extremely fantastic news!!!

Despite the evidence of damage, everything indicates that you're recovering well, and quickly. That you're able to make such strides while enduring 16-hour days of farm work says a lot, too. Sure, you're tired, but what you've done would have put most people on their fannies.

Yes, Doug...I'm chomping at the bit...but learning that I need to make sure I don't get to excited.  I do still get tired if I do to much.  But the definition of to much is changing daily so that's good.

I'm still learning but my understanding at this point is that I didn't/don't have the type of plaque that comes to mind when you hear of Cardiac Artery Disease.  Normally the plaque is full of calcium and bulges from the walls of the artery narrowing the artery and limiting the blood flow to the heart muscle.  My plaque is a thin layer of softer plaque that doesn't show up on normal tests and it doesn't narrow the artery...hence no symptoms prior to my cardiac event.  Apparently this type of plaque is more common in women and also more vulnerable to breaking loose and causing trouble.  So I had no symptoms and no problems at all until marathon day when the plaque broke loose.  When it did the platelets rushed to that area to heal the injury (ie blood clot).  Because I have an extremely large artery and was running I was able to push the blood past the clot for quite some time.  This became more difficult as the clot grew larger and my pace slowed more and more as the blood flow was restricted.  The last 3 miles I have very little memory of the race course and I had very little feeling in my hands and feet.  When I stopped running the artery blocked completely and a portion of my heart muscle was not receiving any oxygen.  This portion died before they could get the artery opened back up and restore the blood flow.  The damaged area is fairly small but it is damaged permanently.  But the heart is figuring out ways to pump more efficiently and work around this non-functioning portion of muscle.  I'm on anti-platelet medication to help slow/prevent clotting in the future, statins to lower cholesterol while helping with inflammation that might cause another piece of plaque to break loose, and a beta blocker to slow my heart rate and lower my blood pressure while the heart learns to work around the damage.  I am also at risk for irregular heartbeat as the electrical impulses are confused by the dead muscle.  The beta blocker also helps with this risk factor.

No tractor work for a few days but I am headed to the local fair where we'll buy a lamb in the 4-H/FFA Auction to support the youth in our area.

Michele \"1L" Keane wrote:Fantastic news!!!!!

Weird question for you.  Not sure if you remember Mary Pat from the Boston dinner (the woman that Nick and I ran with, my friend from Philly), but she has two friends who have outfitted a van (for living) and have been driving all over the country picking up odd jobs basically in exchange for the experience and meals.  They worked at some "pig and chicken" farm outside of Austin and some other farm in Iowa.  They will be here (in western NY) in a couple of weeks to visit MP (and I and others) before they head out on another adventure,  And that is when I thought of you, and wondered if you need some help during harvest - again in exchange for meals, experience and a place to park (and board) for the weeks they might be needed.  Just a thought as I really have no idea what it takes although I expect it may be colossal and it might be fun for you all.  Anyway think on it and let me know if there is any interest remembering of course that nothing might actually materialize if they are set (they were not as of last week).

Michele...we'd be glad to host Mary Pat's friends for a couple days.  Harvest is all done mechanically.  The labor intensive part of our operation is planting which takes place for a couple weeks in April so we don't have work available.  Carrot planting is a pretty tough job.  Other than our family we haven't had a non-Hispanic worker last a full day yet!  They might be glad we don't have work.

We're a bit off the beaten track...Bend is located closer to the more popular recreation areas.  That said we aren't to far from Lake Billy Chinook and Smith Rock.  If they are interested in a place to park for a couple days we'd be happy to accommodate them.