When KISS isn't

So, KISS is an acronym for Keep It Simple Stupid.  When you hear your aging parent screaming that the expensive programmable thermostat is an elephantine pile of dung (in not so nice terms) you realize that even though your impulse was KISS -- all she has to do is switch from heat to cool as the seasons dictate -- that is not enough.  First of all, you forgot she can not see the symbol that means the AA battery needs to be changed even though it is very obvious and plain to see because she doesn't expect to see such a thing on a thermostat.  Secondly, she expects that she has to turn it up and down because that is the way thermostats have worked all her life and has completely forgotten that all she has to do is switch from heat to cool or the reverse because you made it easier for her.  Sigh.

Newfield Memorial Service for 9-11-2001 includes callery pear

The service in the grove was low key and hopeful.  Children from the local parochial school sang a song expressing wishes for peace around the world.    The local business alliance planted a callery pear, which is the same variety of tree as the 'survivor' tree located at the 9-11 memorial site in New York City.

Personal consequence of 9/11/2001 morning

I used to be an watcher of TV news and listened faithfully to NPR during my drive to and from work each weekday.  But since that morning I can no longer do either.  The heartbreak of 9/11 is etched into my visual and aural memories of news programs in either media.

What happened was this:  Every weekday I would take a shower than wander into the kitchen to snap on the tv to hear the weather and fix my breakfast just before 6am Seattle time.  If it was a lucky day, Mt Rainier would be visible and start off my day with a smile.  Now you are saying to yourself, why would she watch the weather when it is always raining in Seattle -- temperature baby, temperature.

Anyway, that day was the tv picture came into focus I see this building burning and what appears to be airplane wreckage.  I say to myself, I don't remember any disaster movies coming out soon wonder what that is and my it looks realistic.  Then I hear a voice over talking about NYC and how a plane hit one of the twin towers.  I think to myself was there some horrible glitch in the cockpit software (hint: I was software engineer for Boeing)? 

I dash to my bedroom and don a pair of slacks and pullon type top suitable for the casual work environment of the Boeing Space Center and rush back to see this plane I recognize as a Boeing plane impact the second tower.  That image is seared on my brain.  To see a Boeing plane hit the tower.  I knew then it was not an accident or glitch but a hijacking.

I rushed the rest of my morning routine and started my commute to work.  I don't even remember finishing breakfast so I bet my cat ate the milk and cereal.  I snapped on the radio, which was always tuned to NPR to listen and catch what ever was being reported.

I am almost to work and have been listening to a reporter live from the Pentagon when what happens but he is saying "we're hit"  and a couple of seconds of silence and then the studio reporter takes over.  I snapped off the radio and have never listened to NPR news again. 

When I reach work a few minutes later, the gates are still open and I park inside.  Less than thirty minutes later, the gates will be closed for several years with guards checking badges.  The office administrator I had known for fifteen years has a small black and white tv she is using to provide us information during the day.  There's no tweeting or wide spread texting to spread the news then.  We had no idea if there were more targets only this time the West Coast.  The admin reported about the plane going down in Pennsylvania.  People who were on vacation far from home called in to say they would be driving rather than flying and hence not back when expected.  The atmosphere was not just somber but wary.

My daughter asked me later why I had even gone to work that day.   I replied I didn't know what was going to happen but I thought I might be able to help, no matter what it was.  So, I guess I am one of those whose impulse is to pull together and do whatever needs to be done to get all of us through the crisis.  I know I am not alone in this and many, many people did that following 9/11.   I salute them all.

Today, in Newfield there will be a ceremony in the grove (some towns have a square, Newfield has a grove) in remembrance.  Local volunteer fire companies will attend and local churches are supporting.  Newfield has four - hopefully the one that always sets itself apart because of religious doctrine will bend and participate but I wouldn't bet on it.

Just like I wouldn't bet that our congress critters will bend from their doctrinal positions and put the good of all the citizens as their first priority rather than re-election, but I can always hope.  Congress needs that spirit of pulling together that 9/11 evinced.  Heck the whole country needs to remember and act on that feeling.

Hurricane Irene aftermath as of 8am Aug 28th

Here in town the aftermath is mostly water in basements, which the local volunteer fire company pumps out.   My mother's house is one of them.  Also, from my house all I can see is minor branches down, no major trees and we still have power as of 8:17 am EDT.

This is not the first time this month that the firemen have been pumping basements in town this year.  We have had a very wet summer with about 10 inches of rain locally just in August.  The water table is very high, so when they mention possible flooding of area streams that means water in basements from underground streams too.

Hurricane Irene is not completely gone yet but the storm could have been so much worse already.  There are still winds around so not safe from trees coming down yet.

Earthquake centered in Virginia caused house to shake up here

It was a shallow one centered in Virginia with magnitude 5.9.  Made the house shake and creak here in South New Jersey but no damage.  Curious to me is that it was more of an adventure that scary.  I think that is because I experienced the February 2001 earthquake in Seattle that was was more severe (8+), lasted longer (40-45 seconds), and was as loud as if a train was speeding directly at you from less than a hundred feet.  By that I mean the sound of the other earthquake was not only loud but had a lot of deep harmonics that you felt as well as heard.

Everyone is safe here and no damage to buildings.  Just another adventure.

It's Copper River Salmon time

Oh I was so tempted to purchase fresh Copper River Salmon fillets in my local Costco.  But since it is an hour from there in Delaware to back home in NJ, I resisted.  It has been two years since I have eaten any because the season for the fresh version is short even in the Seattle area.

So I count on my friends and family in the Seattle area to devour some and tell me how good it was.  And then I remember even the smell as it is broiled or planked in Chinook's at the Fishermen's Terminal in Seattle.  Oh, now I am hungry.

Cleared for driving and intake of caffeine, alcohol, and ibuprofen

So, I have had an echocardiogram to see how my valve is working.  The gradient (pressure across the valve) was 15 and the size of the opening was 1.86 square centimeters, both of which fall in normal ranges.  Before the replacement, I fell into the critical category with a gradient above 70 and an opening that was only 0.5 square centimeters.  I call this success.

I had a post-surgery visit with the cardiac surgeon and other than a small stitch in the incision that had not dissolved properly, I am in good shape.  The physician's assistant snipped the stitch thread and pulled it out.  Felt pretty strange to have the thread tugging through my skin, I have to say.

I asked if I could drive, drink alcohol and caffeine and use ibuprofen instead of acetaminophen.  The answers were all "yes" just not at the same time, of course.

Today was my first venture out as the driver of the car.  It feel great to be that free again.  I only went as far as the post office and bank but now I can drive the 9 miles to the grocery store.  I am still restricted as to weight I can lift to between 5 and 10 pounds as it can take 3-4 months for the bone they had to break to complete heal at my age. 

Pain from swelling still an every day visitor

I wish I could drop the acetaminophen and switch to ibuprofen to reduce the swelling because that is the source of my pain mostly.  As I jar or move my chest muscles in any way there it is.  I was hoping to drop pain medication during the day and use it only at night by now but no go as my body is slow to get rid of swelling on its on.

So its every 4-5 hours preventively especially if I know I will be in a car or just doing light household chores like laundry or filling/emptying the dishwasher.

3 weeks post surgery

I continue to improve - less pain, less coughing, more energy for activity.  I had a small set back on pain last week when shoulder muscles become less swollen putting more pressure on incision, but continuing Tylenol on 4 hour basis has worked.

Now if it would just get over 50 degrees here (we are being unseasonably cold) I could try walking to the end of the block and back again.  I want to see the daffodils and other spring flowers that have sprung despite the temperatures.

Taking stock, 14 days post surgery

All indications are that I am doing very well:

• The incision that was superglued closed has healed up well without ugly wormy look and the external bruising has disappeared
• I am down to taking 1 acetaminophen every 4 hours as I sleep so my pain is almost gone
• All fluid is staying off
• I can dress myself and take a shower which means I have no problems lifting my arms over my head
• My appetite is fair but that is ok
• I have no problems doing the exercises that the physical therapist recommended
• The cardiologist gave me ok today to start taking vitamins and fish oil again
• I am able to do crossword puzzles again which means I have thrown off all the fuzziness caused by the pain medications
• I get tired but not as easily as before the operation, part of that is the ferrous sulfate I am still taking

So, I credit the wonderful doctors and nurses and all the good thoughts and prayers of family, friends, and acquaintances.  Thank you all.

Feeling connected

I didn't realize how much I feel tethered to family and friends with my iPhone until I didn't have it until Wednesday evening after my surgery.  My sister and nephew brought it up and I breathed a sigh of relief.  I had tunes; I had text messaging to my daughter; I had email; I could read BOOKS.   

My fingers were still swollen and stiff with fluid making it awkward to use the keyboard but not impossible if I held it in landscape mode and swiping thru books was easy.  My sister had brought my iPad too but I had her take it back home as it was too heavy for me to hold for long periods.  Fortunately, Penn Presbyterian Medical Center had a guest WIFI network so I was in business and connected again.

There was a TV in the room that I could have used for a small daily fee but I never turned it on.  I had NetNewsWire to get news and I was glad that in the cooler medium of print I could read about the tragedy as it unfolded in Japan.  As it was, even reading about it was upsetting enough and invaded my dreams, which was not conducive to getting healed.

My only complaint about using the iPhone in the hospital was that the cord for recharging was really just six inches too short.  As the battery got low, I could have the staff scoot the reclining chair back sufficiently to go on reading but that didn't work for the hospital bed.  I am sure I could have purchased a longer one if I had thought of it ahead of time, but I didn't.

Someone else's hero

Penn Presbyterian is a teaching hospital, which means that on weekends, nursing students from area schools get to practice what they learn in the classroom.  I had one student nurse on Saturday and a team of two on Sunday.  They all made me smile. 

It turned out that I had a personal link to their supervisor so I got VIP treatment.  In the seventies and eighties, my Mom had gone to college and taught as school librarian/media specialist at a rural school in  a farming community in Cumberland County NJ that had may be 100 books when she started.  She established the library as a real part  of curriculum for that elementary school and brought in computers (the first were Commodore 64s).  An addition was added to the school and it included a dedicated library where each class had some time each week with my Mom, who supplemented their course work or added books that answered their questions.  The nursing student's supervisor was one of those students - now with a PhD and lots of responsibility for a nursing educational program.  And, he credits my Mom with (direct quote) "making me what I am today" by opening his mind to broader ideas and possibilities than following the expected career of becoming a farmer, to which he is totally unsuited.  It would have been a waste of an inquiring, caring mind.

So, it was a week of identifying heroes (more properly heroines) with my son writing a  sweet tribute about me and my encountering someone whose life had been deeply touched and improved through my Mother's dedication to being a librarian who made a real difference that ripples still through many others' lives.

On medications

In the hospital, some of the medications are administered intravenously and others by mouth.  The diurectic, which was removing all the excess pounds of fluid, was given intravenously.  Fortunately, they had inserted the intravenous portal before any surgery as my veins are small and - "nurse tech talk here" - they roll when you try to put a needle in them.  I, of course, knew this as I have had blood taken since I was 17 and had appendectomy.  I also knew they were really terrible because once I tried to donate blood - my type is semi-rare being A negative - and after 4 attempts to fill a pint bottle, the Red Cross people told me never to come back again.

So, the medications I was taking meant they had to test my blood sometimes twice a day, potassium loss from the diuretic being a biggie.  This was a trial because the workable veins are hard to find in the beginning and with all that fluid they seemed to disappear.  I still have many bruises in my arms and hands from failed and successful attempts.  The worse part was after 4 days, they need to put in a new intravenous portal to prevent infections and clotting.  There were numerous attempts by the "best" nurses and only 8 hours after the "due" date, one nurse succeeded.  Of course, I was still losing fluid which made it possible though still difficult.

One evening I started to feel like I was about to hiccup - it was my heart doing an atypical rhythm called afib for short.  The heart monitor told the nurses it was happening and they immediately came to administer intravenously something to get me back to normal sinus rhythm.  I am still taking medication for it at home.  The doctor calmed any fears by reporting that 40% of aortic valve replacement patients have this occur, which is why patients have to wear a heart monitor throughout the hospital stay.  Fortunately, I will not have to take this pill forever as it makes me a bit woozy.

At home, I am taking less prescribed medications but, after discussing it with the medication nurse specialist, I added back in some things they were giving me in the hospital and my allergy medicine now that I am home with the cat.  The meds I continued that were not directly prescribed are a stool softener, an acid reducer (Pepcid in particular), and Cepacol throat lozenges.  My stomach throws a lot of acid back up my throat (acid reflux) in reaction to medications so the Pepcid helps it not be so corrosive and the Cepacol soothes my irritated throat.

The biggest medicine topic for me is that since I chose a tissue rather than metal/plastic valve, I do not have to take Coumodin (warfarin).  Clumsy as I am, this is a big plus not to have to be careful about bruising, falling, or worrying about blood draws not clotting.

The only thing I will have to take is an antibiotic before any dental work or cleaning.  I can easily adapt.

warning - plain talk of poo and pee

The nursing staff has smelly, disgusting work as each patient recovers from their major surgery and the anesthesia.  Anesthesia shuts down the digestive track and sometimes has to be shocked into working correctly.

The excess fluid in my body made me very clumsy and unable to work my fingers very well. So the first time the foley bag was out and I peed into the cup (urine output has to be measured), I couldn't even blot myself.  That was embarrassing to say the least, but the nurse assistant was so gentle and took it all in stride.  Another day, he was back just to see how I was improving and put his hand softly on my shoulder - it felt like a healing touch and reminded me how often my father would put his hand on your shoulder just like that to say he was there to help if you needed it.  Thanks, Delmar.  It meant a lot.

So, for a couple of days, I needed assistance to get in and out of bed just to pee and they would often have to unhook me from the oxygen and the leg cuffs that massage to keep circulation and muscle tone up.  I did get able to blot after a couple of trips to the toilet, thank goodness.

The fluid pervades everywhere including into your lungs and so you have to breathe into this contraption that encourages you to expand your lungs (ouch) 10 times an hour when you are awake and it encourages you to cough up the fluid.  Well, about Thursday, I had plenty of bowel tones and smelly, smelly gas but no action so they gave me laxatives twice along with the stool softeners I was already getting.  The stool softeners are because they are giving me iron as ferrous sulfate and that causes constipation.  So I am getting lots more gas and just as I was getting ready for bed, we had success with a bowel movement on the toilet.  The nurse and I thought all was good, and I feel asleep.

A couple of hours later I woke to a coughing spell and promptly pooped all in the bed before I could ring for the nurse.  What a mess!  Cleaning me off was problematic because the ferrous sulfate makes the poo green black and sticky and the stool softener make the poo soft enough to get in the nooks and crannies that women have.  It must have taken half and hour to clean me off and remake the bed.  This time they put a diaper liner under me just in case.  That was a good thing, because it happened again closer to morning.  At least this time, there was a diaper to dispose of instead of all new bed linen.

Fortunately for me, they removed the drain and cat whiskers on Friday and I was able to take a shower.  It felt heavenly.

I was still retaining too much fluid as they increased the dosage of diuretic each day but on Sunday, I finally peed out more than five pounds of fluid and my weight was back to normal.  This was key to going home.

My chest sprouted cat whiskers?

Before I left ICU on Tuesday, they had to remove several things: (1) inter venous line feeding me fluid and food and (2) Swan-Ganz catheter.  However, they left in several long wires that they could have used to regulate my heart rhythm if needed.  I looked down and it seemed I had sprouted cat whiskers.  They also left in place a drain bulb that was collecting excess fluid from the pericardium - the sac containing the heart.

Removing the Swan-Ganz catheter started me down a slope of pain and acute nausea, which wouldn't completely clear up until Thursday.  I consumed unsalted top crackers so I could take my medications.  Most of the nausea was from pain medications.  After morphine, Percocet (oxycodone and acetaminophen) is normal but I can't take it without feeling sick.  Next we tried acetaminophen with codeine but that just made me sleepy and slightly sick so that food smelled and tasted awful.  I needed to be able to eat to get my strength back.  And, I needed to relieve the pain from the deep bruising etc to heal.  It's been proven by studies in the 1980's that if a patient is spending all their effort to ignore and deal with pain, they don't improve or heal as quickly.

Finally on Thursday, one of the nurses suggested moving me to Motrin (Ibuprofen) because I was still so swollen around the incision.  And, voila, nausea was gone.  Unfortunately, it made me more of a pin cushion as the ibuprofen had to be monitored relative to my kidney function but for me, it was a better choice.  

Waking up after surgery the pain was horrendous -- in my thumb!

The last thing I remember was the anesthesiologist telling me not to panic if I was still intubated when I awoke again as they taped a surgical cap to keep my hair off my neck.  I was still intubated (breathing assist tube down your throat) as I awoke to the sounds of the beeps in the ICU so I could not tell the nurse of the awful pain in the thumb on my left hand.  Half an hour later they removed the tube and I could complain but that was a long half hour.  Turns out, they had taped the pulsimeter (measures heart rate and amount of oxygen you are breathing in) to my thumb at such an angle to activate the arthritis pain I have in the joint at the base of my thumb. 

Soon after giving me a chip of ice to ease the soreness in my throat, they got me out of bed to do two things, sit up for awhile and most importantly, weigh me.  They had weighed me going in and were weighing me know to find out how much extra fluid the heart-lung machine had left in my body.  Turns out I was an overachiever at 20 pounds.  This excess fluid was what so distorted my face that my sister didn't recognize me when they let her into the ICU before she had to go back to NJ.  This is common but a friend of mine told me that the ICU nurses often don't warn family that their loved one will not look normal because of the fluid as it happened to her when her father had a mitral valve repair.  She said, "you are sure this is my father?", as she checked his wrist identification band.  Interesting that we hide more as we "fatten" than as we slim down.

So I sat up for several hours as the morphine wore off and they tried to give me some food and water and other pain relief.    Close to midnight, I was transferred to a room on the surgical recovery ward.  The ICU nurse had let my daughter know so everyone family wise breathed a sigh of relief.

Home is where the heart is now

I survived the surgery, which went very well, now just making one day at a time through the long recovery procedure.  I want to thank the superb staff at Penn Presbyterian, who work well as team and individually to make the patient experience as positive as possible.  As complicated as recovery is from heart surgery, they had an answer for every contingency.

In following posts, I will let you in on what happened but here is a little tease.  How come my own sister didn't recognize me a couple hours after the surgery?

Got my final instructions for surgery on Monday Mar 7th

The scheduling nurse just called.  I need to be in there at 6am.  I go into Penn Presbyterian at the Cupp Building, then follow the signs to the Wright Saunders building.  Then I take the elevator to the third floor and find the Heart and Vascular Unit.  I am to bring no valuables or cash.  The clothes I wear in will go home with my sister as I will not be able to have anything in the ICU after surgery.  That means I will have to pack a bag with going home clothes for her to bring in later in that week.

I am not to eat  or drink after midnight nor take any pills.  No brushing of teeth or swilling of water in my mouth.  I hate morning mouth, oh well.

Surgery moving to Monday March 7th

The surgeon has emergency surgery to do on the 28th that bumps me one week. 

Feb 28th Penn Presbyterian Medical Center is date and place for surgery

It will be a minimally invasive procedure because indeed, there are no aneurysms.  I already stopped taking my fish oil daily capsules as these may thin the blood to make it clotting of the incisions slower.

So far, I am scheduled to be first in the OR, so I have to be there by 6am.  I will know for sure sometime on Friday. 

My sister's best friend from childhood will be driving my sister and me up to Philadelphia.  She has no problems with Philadelphia traffic and is somewhat familiar with that part of town. I am glad she will be there to keep my sister company while they wait for me to come out of surgery and anesthesia.

ABC's "Gray's Anatomy" recently aired an episode that showed the full open heart surgery and my niece was watching and realized why I was hoping not to have that procedure but the minimally invasive one.   I am sure there were horrible complications in the tv show that made it worse than real life.  Still, I am very glad medicine has advanced to the point my valve can be repaired without that.

Preliminary reading of CT angiogram shows no aneurysm

I had two tests today as preliminary for the surgery. 

The carotid doppler looking for blockages was simple enough, you just lie there as they run the ultrasound sensor over your neck after applying gel.  I do not have the results yet and no hints either as the technician was not up to hinting.  They are not supposed to so that is just fine.

For the CT angiogram they have you lie flat on bed that moves in and out of a doughnut after they inject a dye to make it easier to see your blood vessels.  No pain with this one either.  There is often a feeling of warmth from the dye as it circulates within your blood.  For me it was as if I had come in from a very cold winter's day and then soaked up warmth by sitting on a radiator.  This time, the technician could tell me that no aneurysms were seen as they watched the test in real time.  If there are, they are very small and might be found in the final analysis.  Me, I all for being positive and believing there are no aneurysms.

The good, the puzzling, and the OOPS!

Oops first:  Just like Group Health and Virginia Mason in Seattle, Penn Medicine is an alliance of hospitals (University of Pennsylvania Hospital, Children's Hospital of Pennsylvania, Penn Medical Center), clinics in Pennsylvania and New Jersey, and associated satellite practices in Pennsylvania and New Jersey.  So when I called the patient registration office back to clarify where I was going, they said, "The Hospital."  Due in at 7am, with an hour's drive ahead, we left at 5:30am to ensure we could get there on time despite the freezing rain storm that had occurred overnight.  Having never been there,  it took a bit of maneuvering in the dark to actually find the entrance to the parking garage but I made to the hospital admissions office before 7am.  They didn't have me listed.  They asked what I was having done and sent me across the street to the Heart and Vascular Center. 

No one was in yet because of the storm but just before 8am, that receptionist showed up and I wasn't listed for a procedure there either.  That's the center that does heart transplants.  Turns out I was supposed to the at the Penn Presbyterian Medical Center, which is about 8 blocks away.  The receptionist, Patrick, was very helpful and thoughtful.  He called over and told them I was coming and then wrote out directions for us because of the one-way streets around the hospital.  He even escorted us to the parking garage to point out the streets and to validate the parking so we wouldn't be charged.

By 8:30am, I made it to the Heart and Vascular Center for outpatients of Penn Medical Center, which is nothing more than a makeshift nurses station in what is an older Federal style brick building as you often see in down-town Philadelphia.  What an adventure when you are hungry, thirsty (I had been fasting since midnight, no water either), and sleepy.  Who sleeps well anticipating a medical procedure and worrying that the alarm won't go off?

Puzzling next:   There are two puzzles actually. One, do I have the tissue or the plastic/metal mechanical valve? Two, what is causing the subtle finding of lower oxygen content between the aortic chamber and the aorta blood vessel itself?

Regarding the first puzzle, I am in a gray area with respect to the AMA and FDA guidelines because of my relative health and age.  If I choose the tissue valve, it will wear out in ten to fifteen years and need replacing and so I would face another major surgery.  Of course, the procedure may have improved dramatically by then and not be so difficult.  Just think how heart vessels by-passes have changed over the last twenty years.  If I choose a mechanical  valve, I will need to take Coumadin (warfarin rat poison) for the rest of my life to prevent clots.  By take, I mean faithfully the same time every day, no skipping for forgetting.  The Coumadin will also make me prone to bruising from my clumsiness and make any other surgeries including dental somewhat tricky.  So, the surgeon told me the decision was mine to make.    So, I have some research ahead of me.

Regarding the second puzzle, the surgeon who did the heart catherization told me that the finding could mean I have a benign blood vessel that is connecting the aorta to my heart or that there is an aneurysm that needs to be repaired before it blows out causing a stroke or heart attack.  I will be having a CT angiogram to help the surgeon determine what is the cause.  If there is no aneurysm, the valve will be replaced with a minimally invasive procedure without cracking open my chest.  If there is an aneurysm, I will have the full blown surgery so they can effect a repair.  Of course, I am hoping for the first case as the other one is just plain scary.

The good:  Everyone - the nurses, nurse practitioners, and surgeons were so nice, thoughtful, competent, and worked as a real team.  That gave me confidence I am in the right place for this work.   For example, when the nurses moved me from the gurney to the operating table, I piped up and said I had had a back operation and I would need a pillow under my knees, the response was "coming right up" and the anesthesiologist piped right in with "Then I will give you more pain blocker and less sedation to prevent any back spasms."  Just picture a surgeon with a long piece of metal wire in your heart trying to find the hole formed by a valve and then the person's whole body spasms from a heavy duty back pain.  And to show their thoughtfulness and competence, all my pre-op testing (chest x-ray, ekg, blood and urine samples) was completed before I left the hospital yesterday.  When you live an hour away, that is a huge time and hassle saver. 

Secondly, the test showed that the aortic valve opening is very small and there is no question that I need the replacement.  The other valves operate normally.  So, no hassles with insurance for 2nd opinions or justifications.

Thirdly, the blood vessels of the heart are all clear so there is no need for any stents or other work such as a bypass.  This keeps my odds of dying during or right after the surgery in the 3-5% range.  I will take those odds any day.

7 am at University of Penn Hospital Wednesday Feb 2nd

That is when I have to arrive for the catherization testing.  The procedure should take about an hour and then I will have 4-5 hours recovering before I can go home.  There is a slight chance I have to stay overnight but it isn't likely.  Hopefully, I will meet the cardiac surgeon who will be doing the final procedure.

I am not to eat or drink anything after midnight but that is not a hardship.  So wish me rain instead of snow over night so everything goes as to getting there and back.  I am confident that the procedure and recovery will go well.

here's where to read about the test I am having

1st test scheduled for Wednesday, February 2nd

So, U of Penn Presbyterian Hospital just called to schedule my catherizations for Wednesday, February 2nd.  The nurses will call the day before for the exact time that I have to be there.  And, they will provide other instructions like fasting after midnight then too.

still in limbo

Meet today with the cardiologist, Dr Ross Zimmer, from Univ of Penn Medical Center who coordinates cardiac care for all heart operations among various south Jersey cardiac medical practices.  He treated the appointment mostly as a second opinion.  He does agree I most likely need the valve replaced and selected a cardiac surgeon for me by the name of Dr Wilson Szeto.  The next step is catherization both sides of heart blood vessels.  This is an outpatient surgery unless they find something demanding immediate treatment during the procedure.  I do not know when this will happen but should get a call about the appointment in the next week.  Hopefully, I will meet with Dr Szeto either before or after the procedure.