Thursday, September 4, 2014

What Else Has Changed

This, not New Years, is my time of year to pause and reflect. School starts, another birthday looms, milestones like Medicare - last year - and Social Security/ retirement - this year - mark the emotional calendar. Some years nothing changes noticeably. That's not the case this year.

The biggest thing is not that I am retiring later this month, years earlier than planned. The big thing, the thing changing my world view, is why.

Last year the big thing was getting health insurance again - finally. I got lucky, slipped through the holes in coverage periods with nothing major happening to bankrupt me. Now there wasn't just coverage but affordable coverage. Some call it an entitlement program. Yes, I'm entitled, having paid into the program for nearly all of my working life, just like I'm entitled to withdraw my own funds from the bank or be compensated by my auto insurance or homeowners insurance when something happens. Qualifying by age for that coverage lifted a burden of fear from my future, nebulous as it was.

And just in time. I spent last year's birthday in the hospital. There've been medication adjustments after each of the following ER visits this year for the same thing. There have been tests finding little, lists of dos and dont's which pretty much haven't changed my life any since I already don't smoke, limit caffeine, get plenty of sleep, don't do drugs like coke, get moderate exercise but not heavy, etc.

It's all come with a cost, and I'm not just talking about the after-Medicare bills that keep showing up. I'm talking about how I see myself and my future.

I used to look at my folks and judge my lifespan by theirs. Since Mom made 90 and Dad made 97, the thought was that I was likely to have a similar lifespan. True, medical issues are creeping up, but medicine has advanced. It might be a wash. Or at least close. I planned on having to save for a long retirement, and as soon as the kids were grown, I did. Being a single parent without financial help post-divorce put a crimp on those savings plans, but I did what and when I could. I invested conservatively, avoiding the ups and downs of stock markets for the security of smaller but guaranteed investments. The only devaluing that occurred was in home value, but that doesn't count when you're not selling until the market recovers anyway. Plus you can't be underwater when the mortgage is already paid off.

The one thing that bit was when the company I contract with dropped everybody's commission percentages. Because they could. I was busy eliminating that pesky credit card debt until then. My inability to keep doing that as quickly led me to adjust retirement age to 70. It was going to be a sacrifice, spending winters away from Steve, but I'd be much better set for retirement.

Then the heart problems started. Each time another episode of A-Fib hit, I lost a bit more optimism, a bit more ability to stay in denial. And they kept hitting. Everything I read, internet to ER handouts, said to seek medical attention, and since I was always away from home, on the road, inconvenient to anything but an ER, that's where I went. It gets costly. It shouldn't be how medicine is practiced, especially with insurance. Tests showed little. Everybody just said to me, "Learn to live with it."

Nobody said how, exactly. Coping seemed like just another revision of my life expectancy downward. And again. Plus piling the bills upward. And of course, facing my need to get out from behind the wheel. A little investigation after bout two left nothing but pessimism about any chances to pass another DOT physical. Retirement, then, ready or not, at the end of my grace period before the next physical was due. The last round left me calling Paul to come meet me at the ER, pick up my last package, and deliver it for me. I did of course clear it with dispatch, but she was just grateful she didn't have to try to track down an available driver in the Forest Lake area late on a Friday night. Luckily the drop was a regular one, and I could describe to Paul just where to take it.

Each time it happens, my meds get changed, the metoprolol dose gets doubled, in hopes of stopping the next time. Obviously, that is not working. The last time added in the complication of what they call paroxsysmal A-fib. That means throwing in a flutter of rapid heartbeats every so often. My pulse would go dub dub du-du-du-du-du dub dub ... dub dub.... dub du-du-du-du dub and so on. I could feel it in my chest, besides getting light-headed from improper oxygenation. But the road I was on had wide paved shoulders, allowing me to pull over a couple times to allow the light-headedness to pass, and continue till the next time, until I pulled into the ER parking lot. And yes, if you must know, no matter how bad I was feeling, my first stop inside the door was the bathroom. No need for another complication, eh?

The treatment in the ER was, as usual, more IV doses of metoprolol. After three, and no conversion to normal sinus rhythm, they decided to send me to the ICU overnight. The nurse I had then started showing me what nobody else had bothered to yet: ways to maybe stop the A-fib myself.

Wow! What? Something I can do besides take daily pills and wait for the next bout? First was abdominal pushing, like if you had constipation and needed to force a bowel movement. Of course, you didn't actually have one. Just kept pushing. No dice.

Then there was coughing. I had hopes for that, because sometimes I've felt a single little flutter, now that I know what that feels like, and I involuntarily cough and it goes away. Only now I was to cough-cough-cough-cough fast and with many repetitions. Alas, again no dice.

Another option is dunking the face or head into icy cold water. We didn't actually try that. She got busy with a trauma patient, other staff popped in and out, and somewhere in there, about three hours after walking in, I converted.

It was noticed. I was informed that they would keep me another couple hours on the monitors, so they could tell for sure that it was going to take. Then I could go home instead of to the ICU. One nurse asked me what I converted to? Was I now Jewish? Catholic? I just told her cheerfully that this as a free country and I didn't have to tell her. Luckily she had the right sense of humor. Doubly so in that I was struggling to keep mine.

No longer able to keep in denial, I made my appointment to start with the coumadin clinic, something I've found excuses to avoid for nearly a year. The side effect of A-fib that everybody keeps warning me about is stroke. The blood pools when the heartbeat is wonky (technical term, eh?) and can clot, making stroke likely. Blood thinners are standard as preventative, but need monitoring regularly for the rest of your life.

My annual physical was due a week later. I decided I had questions. Just what was "live with it" going to entail? Were there any other options? Was this going to kill me in a year or two? How did I stay out of the ER? Since they dosed me with metoprolol, could I just stay home, pop extra pills myself, and wait for it all to go away again?

My primary doc listened and decided I needed another visit with a cardiologist. Only this time I got sent to one down in Edina, primarily because the move is coming up and time was to short to get an appointment with the guy I'd been seeing.

I got really lucky, starting with an appointment the very next morning. But it got better. I found out that even cardiologists have sub-specialties. This guy's expertise was in the electrical system of the heart. In other words, exactly what I needed. And, boy, did we talk.

I could, next attack/s, just stay home, relax with my feet up, and ride it out. Not driving was a good idea for the duration. As to dosing with extra metoprolol, that was a bad idea. Really bad. It slows down the heartbeat, potentially useful with the fast flutter, but too much slowing down is, well, just way too much. (I had noted that my new pulse rate on the increased dose was 54 the day before. Not bad for a prime athlete, perhaps. Not so good for an out-of-shape geezer.) He thought it likely I converted despite the ER meds, rather than because of them.

He added a new med and halved the metoprolol. The combination would do a much better job of controlling the A-fib. I just needed an EKG in a week to make sure  my rhythm was doing what it should, and note whether side effects like headache or skin rash occurred.

And long term, there is a possibility of a surgical procedure called abladement (I think) where they send a catheter up a vessel to the heart and cauterize/kill the cells that are sending the wrong signals to the heart as to when to beat. It sometimes needs to be done twice, but is about 90% successful.

WOW! HOPE! I left the ER the week before completely discouraged. I left his office optimistic again. What a change in such a short time!

Oh, and what else has changed, is the retirement date got moved up a day. When I cancelled my commercial drivers policy, I told them I would be working through the 19th. They cancelled it on the 19th. My new AZ policy starts the 20th, so I've got one day uninsured.

I won't be driving.

There'll still be packing to do.

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