Another Medical Problem

I've been in the hospital the last couple of days, was mostly irrational a few days before that. I'll probably be here at least a couple more days. The side effects from taking the antibiotic Clindamycin started bad and got to the point where I was in constant severe pain in my gastro-intestial track. One small swallow of anything would amp the pain to writhing in bed for 30-60 minutes. I'll explain more later.

FMD Update 5

What a nightmare. I developed a bad toothache a few days before going to see the specialist in New York. I had put off going to the dentist for a couple of years because I was so disappointed with my last experience... my dentist had put in 2 crowns in the back on the same side and they were too short, ruining my bite. Well, this toothache was bad enough that I couldn't procrastinate any longer, but I found a new dentist. He gave me several options, and I chose to have him remove this tooth in preparation for a snap-on-smile. I could always get an implant later, if I want to.

Well, the root of a tooth is normally inside the jawbone, but in this case the jawbone had an indentation and the root was outside the jawbone. So, when the doc pulled the tooth, he mixed some of my blood with some bone graft material and spackled it in the gum and sutured it up. It was supposed to hurt for a day or two after the Novocaine wore off. It didn't. So the doc put me on penicillin in case there was an infection. It felt a little better for a day, then got worse and worse. I was hurting a lot when it was time to leave for NY, but I didn't want to postpone that trip. The trip was very unpleasant due to my gum.


Well, on the trip, Dr. Olin, the FMD specialist, had trouble reading my angiogram. The software on the CD for showing the images does a poor job of cacheing, so it was very slow. He said he'd review them later on a faster computer. Based on the images he did see during our visit, he said that the stretch of right renal artery looks very much like FMD. However, he didn't see any other arteries that looked like they had FMD, so that's a puzzle since FMD normally affects more than one short section. There is, however, a test available that I had not heard of, one that combines an angiogram and ultrasound, and gives the most accurate picture possible of an artery. Since my case is still a mystery, a friend of Dr. Olin's down here in DC may do that test.

So, I get home from the trip, and my mouth is killing me. I call the dentist in the middle of the night and leave a voice mail. He didn't call back right away, so I went to the emergency room. All they could do was put me on a stronger pain medication (hydromorphone) and tell me to go back to my dentist. Actually, the ER doc, who did not examine my mouth at all, said that I needed a root canal on the jaw where the tooth had been. I asked if there could be an infection that might be resistant to penicillin, and he said no, there was definitely no infection. I get home and talk to the dentist (cells phone signals are suppressed in the ER). The dentist walks me through some steps while I look in the mirror, and I push on my gum and some whitish-yellowish liquid comes up out of a hole in the gum. He says it's definitely infected and obviously resistant to penicillin, so he tells me to stop the penicillin and calls in a scrip for clindamycin.

My blood pressure was highly erratic all this time, but my temperature had always been normal. After starting the clindamycin, my temperature started going up and down and the pain got worse. Finally, last night, my fever came down to stay, and the mouth pain has diminished significantly. Just in time for the onset of severe heartburn, a side-effect, apparently, of the clindamycin. Another call to the dentist, who called a pharmacist, and he called and told me to use Mylanta to deal with the heartburn. It doesn't get rid of it, but it makes it a little more tolerable.

Oh, I almost forgot one thing. One afternoon after a trip to the dentist, with my mouth full of Novocaine, I felt no pain anywhere, my blood pressure was great, my mind was clear (well, you know, as clear as my mind gets...), and I was full of energy. That was extremely delightful. Perhaps my mouth has been part of my blood pressure problem. If so, that should be remedied soon.

I see my dentist tomorrow morning, and my general practitioner tomorrow afternoon.

Update

FMD update delayed due to dental emergency...
Pain and blood pressure out of control. Don't feel like writing...

Mortgage Meltdown, Addendum

Here's another idea that seems obvious I forgot to put in the previous article.

It's normal, when a homeowner defaults on a mortgage, that the lender evicts the homeowner and sells the house. Normally, however, there's not a tremendous glut of houses for sale at very high prices, so houses are sitting on the market for very long periods of time. For example, the house at 100 Main Street, the owner gets evicted, and the house sits empty for a year before the bank can get it sold. Say the original mortgage amount was $2400 a month, so the total revenue to the mortgage company was $28,800 for one year. Instead the bank's revenue for that period of time is $0.

Mortgage companies, and especially mortgages backed by FHA, Fanny Mae, and Freddie Mac, instead of evicting homeowners, ought to try to work out a deal that lets the homeowner stay in the house and pay some amount of rent. Suppose the homeowner can pay half the amount they were paying in mortgage payments. If they can pay half, then the lenders' revenue will be $14,400 for the year, instead of $0. They can still try to sell it while it's occupied, but they also have the option of selling it as a rental unit that is already rented.

:typed and edited by Promise Lambert

Mortgage Meltdown

I don't feel like writing a lengthy treatise, but I have to say something about the mortgage crisis, since our political leadership doesn't seem to see what I think is an obvious technique to improve the situation. None of them will see this, probably, but at least I'll get it off my chest.

The Federal Government should pay off 2nd and 3rd mortgages up to 20% of the value of primary residence and take a 25% ownership of the property, if the 1st mortgage is a stable fixed-rate loan and this restructuring will enable the family to keep up with payments after the change. The valuation should be based on the valuation at the time of the last mortgage, not the current valuation.

The Fed is going to pump many billions of dollars into the mortgage crisis somehow. This method allows families to stay in their homes if they can afford it after the deal. They are lightly punished by losing slightly more home value than the percentage of financial assistance they receive. This punishment is appropriate because they bear responsibility for knowing what they could afford long term, and a deal that does not punish them is unfair to those who were more responsible with their finances. Yes, the homeowners were probably deceived by lenders pushing them into houses with payments larger than they could afford in the long term. Criminal charges should be pursued against lenders who misrepresented affordability to home buyers or misrepresented the quality of the loans to mortgage bundlers (for the mortgage resell market). This would minimize foreclosures, which will keep the maximum number of families in their homes and stabilize national home values as much as possible, contributing to a more rapid recovery of housing values than we'll otherwise have.

Thanks to all...

I haven't been keeping up with email, which makes me feel guilty, but I'm probably not going to do better unless and until I can get my pain significantly reduced.  I'm takng a lot less Vicodin than I could in order to avoid getting addicted and to avoid my body becoming so used to it that it doesn't work as well. Unfortunately, that means I hurt more and feel like doing very little, and it makes it hard to sleep until I'm exhausted. That means I've been costing Carla a lot of sleep also.

I've been surprised at how many people have emailed encouragements, even strangers from around the world. Wow. So if I haven't replied to an email from you, please know that I read them all, eventually, and I really do appreciate them.  -- John

FMD Update 4

Well, it was a long, but interesting two weeks, with lots of pain, lots of high blood pressure (measured as high as 195/110) and several new developments.

First, I met with a local interventional radiologist who recommended that he go in and angioplasty my right renal (kidney) artery and look around at all the other arteries in the area, but he wanted to discuss it with my kidney specialist (nephrologist) first. So, I got a call later from an assistant of the radiologist who told me the radiologist talked to the kidney guy, and that the kidney guy wants to see me before the radiology guy does the plasty thing, so I should call the kidney guy right away to get an appointment. So, I call the kidney doctor's office, and they tell me I already have an appointment in 6 weeks. Yes, I explained, but now there's a more urgent matter so I need an appointment right away. Okay, they put me through to the doctor's assistant and I left a voice mail. The next day the assistant called me back and I explained everything, and the assistant said she would talk to the doctor and call me back. That was over a week ago, and they have not called me back. Grrr.

Okay, so the first instance of a major symptom immediately prior to the eventual discovery of FMD was on Sunday, July 13, with lots of abdominal pain, which later localized around my right kidney. I tried to tough it out and went to work as usual on Monday, but the became intolerable and I left after working 7 hours, feeling pretty lame that I couldn't hack just one more lousy hour. Monday night was horrible, and I didn't sleep much, and went to my general practitioner (GP) first thing Tuesday morning, and it didn't take long before she called an ambulance to take me to the hospital. They checked me for kidney stones and gall stones and junk like that, which were all negative. They found a suspicious wedge shaped thing in my right kidney that would need further investigation, and gave me pain meds and sent me home. It wasn't until July 30th that I finally ended up getting an angiogram that revealed FMD in my main right renal artery for sure, and showed a complete blockage in a smaller renal artery that had resulted in the death of 5% of my right kidney, and another partial blockage right next to it. However, no one mentioned the FMD to me, with the possible exception of the radiologist right after the angiogram while I was still stupid from the drugs. Stupider than usual, that is.

Well, this last paragraph is to give you dates, so you can fit this in: In the first week of August, I started noticing a pain in my right shoulder, and it kept getting worse and worse. So I went to my GP about, and was referred to an orthopaedist for a possible tear in my right rotator cuff muscle. Except how could I have torn a muscle? I hadn't been doing anything! Well that led to some big news this week. The ortho doc said all the symptoms fit a tear in the right rotator cuff muscle, gave me a shot in the shoulder and told me to come back in 3 weeks. Did that, and my shoulder was hurting worse, and that wasn't all. The shoulder had only hurt when I moved certain ways. It hurt really bad when I moved it those ways, but when I was a good boy and didn't move it those ways, it didn't hurt. ["Doctor, when I do this, it hurts." "Okay, don't do that."] But in the meantime, my right bicep had started hurting, all the time. So ortho doc sends me for an MRI of my shoulder and I have to wait until yesterday to see her and get the results. And... there's no tear. That's good, right? There's clearly some tendinitis in my shoulder, and some fluid around the joint, and the MRI doesn't show down my arm. The problem is that the tendinitis doesn't explain the severity of the pain.

Now, there's this version of FMD called intimal fibrosis that occurs in less than 10% of FMD cases, but it can cause problems in any artery anywhere, like in a shoulder. I had thought of this a few times, but the odds were really, really tiny. Until I find out I've got no tear. Now those very tiny odds only seemed like tiny odds. The odds my have been tiny, but they were, like, moving in the wrong direction, you know what I mean? So I start thinking too much about it, pondering life without my favorite right arm, and so on. Then I woke up in the middle of the night with a better theory. A much more likely theory. A highly probably theory, that lets me keep my arm solidly attached to the rest of me. Very Tense Muscles. Just hold on, it'll make more sense in a minute.

I went to my GP early this week for a comprehensive review of The State of John, with all the test results, trips to the emergency room with high blood pressure, etc. And as part of the catalog of complaints, the doc noticed my muscles were very tense. I said they had been that way a long while, and I knew it, I just hadn't been able to successfully convince my muscles to relax. It's apparently a reaction to the pain. Or possibly space aliens, but I'm going with pain as the primary culprit. So doc suggests some muscle relaxing drugs. Hey, I'm a basket case, what's one more drug to test? Well, I started taking methocarbamol (generic for Robaxin) "as needed" and pow -- it knocked my blood pressure way down, and reduced my average pain significantly. I hadn't realized just how tense my muscles were!

Now back to the shoulder theory. Tendinitis and tense muscles -- muscles acting like they were constantly doing isometric exercises. What's the treatment for tendinitis? Rest. Don't use the muscles, dummy! Except my muscles were using themselves without permission from the rest of me. So instead of taking the muscle relaxer only when my blood pressure goes high, I'm going to take it regularly for while and wear a sling to remind me not to do anything with my right arm (other than blogging), and I fully expect my right arm to thank me in a week or two. One less source of pain would be a very good thing.

By the way, I had been down to a thyroid medication and pain patches for my feet as my only medications when my kidney blew up. Now I'm on the those, plus 2 blood pressure medications, pain pills, blood thinner, and muscle relaxers. Phooey. By the way, at home, I take the generic version of Vidodin for the pain. They gave a script for Percacet, which is supposed to be stronger, but it does nothing for me. Not only does it not help the pain, it doesn't even give me the intoxicating effect that most people get. Tried it 2 weeks apart, just in case the first time was an anomaly. This, I have no explanation for. Yes, I still have an almost full bottle of Peracet. No, I won't sell it to you. You'll have to get your own malady for that.

For now, it's 11 days and counting until I see Dr. Olin.

FMD Update 3

I haven't mentioned it before, but the reason I'm posting my story of learning about FMD is in the hope that it might help someone else learn about it. Since it's rarely covered on the evening news. And even if it were, people rarely watch the evening news these days.

So, on with the story. I had a duplex Doppler ultrasound of my carotid arteries Friday morning, then Carla dropped me off at the train station and I worked about 4 hours, but on the way home I started hurting a lot worse. On Sunday, my left kidney started hurting, but not as much as on the right side. My blood pressure was bouncing around, going as high as 145/105, even though I'm on a blood pressure medication.

I had an echo cardiogram this morning (Monday), then went to the office, but it didn't turn out well. The train ride increased the pain a bit, and that apparently triggered my blood pressure to go up again. It kept going up despite a double dose of blood pressure medicine. The building I work in has a health clinic, and a nurse there put me in a dark, quiet room and called my doctor. After awhile, my BP stabilized, then went down to about 135/85, which is still too high. Then my family picked me up, and my BP went up again on the way home. After a few hours in bed, it's finally back down to the safe range: 120/80. Unfortunately, I didn't get much work done.

FMD Update 2

Worked all day today for the first time in almost 2 months. I was tired and hurting a bit, but I worked the whole day. Even walked to the train and back home. And I got an appointment with Dr. Jeffrey Olin on October 1st. He's the director of vascular medicine at Mount Sinai School of Medicine at Mount Sinai Medical Center, and has written more about FMD than anyone else. So, I should have a lot of news after that.

FMD Update

Talked to my kidney doctor yesterday and saw my general practitioner today, and they both concur that it's a good idea for me to check with a doc who deals with FMD a lot. I spoke to an assistant for the doc who's written more on the subject than anyone else, and have emailed him my medical history. He's supposed to look it over and his assistant will get back to me regarding one or more appointments. In the meantime, I'm waiting for results of more blood tests, and I have duplex ultrasonography scheduled for my carotid artery and an echo cardiogram just to make sure those things are in good shape. And I now have written permission from my general practitioner that will allow me to go back to work, since my company wouldn't accept a note from my kidney doctor. I still have moderate abdominal pain, but work isn't supposed to make my condition worse, so I'm hoping to last the whole day. Work is good!

Fibromuscular Dysplasia

Well, it turns out I may not have had a kidney infarction after all. There had been continuous confusion amongst the many doctors involved as to whether I had an infarction (from a clot) or an infection (from unknown cause) in my right kidney. The key thing I understood at the beginning was that I had one small kidney artery that was completely blocked, killing 5% of that kidney, and another small artery right next to it that was partially blocked. The blockages were either from a clot of blood or cholesterol or from an infection. An angiogram showed no sign of an existing clot, so if that was the cause, it had dissolved by then. I was put on an antibiotic in case I had an infection, but that didn't change anything. The early prognosis was that I would be fine with such a small loss of kidney tissue, that I would take an anti-coagulant the rest of my life to ward off any more potential blood clots, continue to watch my cholesterol levels, and the pain should be gone in a few weeks.

Except the pain never left. It subsided for awhile, then got worse a while, then better, and so on, but never left. I was out of work that whole time, as the pain was generally more than enough to require medication that interfered with my ability to think, which is what I get paid for. Had I not taken the pain medication, the pain would have been too much to think, so either way, I wasn't much good for working. Last week the pain improved to the point that I thought was ready to resume working and I got a note from my kidney doctor allowing me to return. At that visit, my kidney doctor reviewed with me everything he knew from all the tests. That included something I hadn't been told about before: there were some partial blockages in the main artery feeding my right kidney, and it was determined (by their size, shape, location, etc.) that they were caused by Fibromuscular Dysplasia (FMD). The kidney doctor still didn't know what caused the full and partial blockages in the smaller arteries, as things didn't quite fit the normal characteristics of either infarction or infection.

Then I found out my company and the insurance company require a note from my general practitioner, so I had to wait until next week. Then a couple of nights ago, the pain got really bad again, and my blood pressure went high (around 160/110) and stayed there. Although the pain backed off a little, the BP stayed up, and my kidney doctor called in a prescription for Diovan to bring my BP down. After a day or so of that, my BP is back down. In the meantime, I've been studying FMD.

FMD is a rare disease. Really. There's actually a list of rare diseases, and FMD is one of them. And there's a support site on the Internet run by doctors and patients, and information from FMD doctors indicates that FMD is not well recognized or understood by doctors. Patient stories support the idea that most doctors are not familiar with it.

Basically FMD results in some cells in the walls of arteries growing larger than they should, constricting the flow of blood through the artery, eventually blocking it off altogether. No one knows what causes FMD, though genes and hormones both seems to be factors. There's no cure, but the symptoms can be treated with anti-coagulates and angioplasty. Most people who are familiar with angioplasty have heard of it because they know someone who had it to open up an artery around their heart. That common usage means someone gets an angioplasty once every few years or less often. Some people with FMD get angioplasty several times a year. FMD can effect any artery in the body, with the kidneys being the most common, and the carotid arteries being the second most common.

So, I've come up with a theory, which I wrote up and faxed to my kidney specialist yesterday. He called me late last night to tell me he had been in hospitals all day and had not had time to read the letter yet, so I'm hoping to hear from him next Tuesday. I have an appointment with my general practitioner on Wednesday, and I'll discuss this with her then. My theory is that I had neither an infarction nor an infection, but that both are the results of FMD. There is a form of FMD called intimal fibroplasia that comprises less than 10% of FMD cases, but it appears to me it fits perfectly with the full and partial blockages I have in my smaller kidney arteries. It seems to me to explain everything, including my continuing and fluctuating pain, and I really like understanding things. If I'm right, however, it's bad news, because this form of FMD is the most aggressive.

Well, as Bill Gates famously said, it's good when bad news travels fast. That's because the sooner you learn of something bad, the sooner you can do something about it. So, I have FMD. I may have the most aggressive kind. Since I know, my doctors and I can more aggressively monitor my arteries and intervene with angioplasty as often as necessary. And that could give me months or years more than I might have left if we hadn't figured it out.

Whenever I have more news, and feel like posting, without being to unintelligent due to pain medication, I'll post followups here.

Big Setback

I was sure my next training run of 5k was going to be the first time in over 20 years I'd be able to run that distance without having to stop and walk part of the way. I was just a day or two away.

Then I had a kidney infarction and lost 5% of my right kidney. That was weeks ago, and I haven't stopped hurting yet. Quit doing everything, including eating, and have lost 20 pounds, so I'm down to just over 130 pounds. Haven't weighed that little since high school.

Well, two weeks ago I start walking again, very slow, very short distances. I got to where I can walk to the Metro station again, and took a short test ride. Subway trains are way bumpier than cars, if you didn't know, and the shaking is really tough. Since then I've ridden all the way downtown twice. It made me hurt worse for awhile, but within a day it got back to the same level of hurting it was at before the train ride. I sure am looking forward to running again. And working again. And doing other things again. Especially running.