Even cyborgs need periodic battery replacements

I’ve been recovering from heart surgery since Feb. 16. It was Valentine’s Day Week and it seemed like a good time for it. Heart surgery has an ominous sound. Thoughts go to quadruple bypasses and aortic valve replacement. I just needed a replacement generator in my chest to stop any signs of ventricular fibrillation which can lead to death. The gadget is filled with microchips and wires that connect to leads that snake down into my heart. I got my first one ten years ago after a widowmaker heart attack that almost did me in. Because it took too long to get help for my stopped-up heart, it sustained some muscle damage which in turn made my heart less effective. Up until January 2013, my heart had been very good to me. In high school, it pumped like a champ as I ran down the basketball court or when a girl looked at me in a certain way. Got me through my adult years until I hit 62 then BAM! Damn…

So the first one wore out and I needed a new one. I am on Medicare and have secondary insurance that pay for the $23,000 gizmo and attendant expenses such as doctor’s fees, OR fees, nursing services, etc. I am lucky to have health care insurance that keeps me ticking. Health insurance is a right and should not be optional. I see that our esteemed GOP state legislators have once again torpedoed Medicaid expansion that would insure thousands of Wyomingites. A widowmaker strikes and you need help? Tough luck, buddy. For the GOP it’s all about the cruelty. They didn’t used to announce their cruelties for all the world to see and hear. Now they shout it from the rooftops.

Back to my trip to the operating room. It’s called the CRMC Cath Lab and it’s where the electrophysiologists work their magic. I was under conscious sedation, like the kind you get for your colonoscopy. In this case, the surgeon applied a topical anesthesia and then pumped me with Fentanyl but not too much. He then cut into my chest, removed the old battery and in with the new. Then he sealed me back up. Before you know what’s going on, I'm being whisked off to recovery.

So how does my electrophysiologist keep track of the signals beamed from my Abbott Laboratories ICD? I used to have a Merlin Home Transmitter the size of the big black phones you used to see in 1940s movies. It sat by the side of my bed and beamed my readings to the CRMC Device Clinic. My new monitor is a Samsung device, smaller than a smart phone, that I can take anywhere. Pretty slick.

My new machine should last 5-7 years, according to the pamphlet that accompanied it. I plan on lasting at least that long. Seven days post-op and I’m doing fine.

Thank you, modern technology and surgical expertise. 

Two years ago I reviewed a nonfiction book about ICDs on WyoFile. It's "Lightning Flowers" and written by Wyoming author Katherine E. Standefer. She needed a device while still in her 20s and then set out to find the its origins. A great tale, whether you're a cyborg or not. 

Night of the Widowmaker, ten years on

Ten years ago on these pages, I regaled my readers with stories of my heart attack. It was an exciting misadventure. Nobody in my family had heart issues and neither did I. I was struck down in the middle of a working day. The scientific name for my affliction is anterior ST-segment elevation myocardial infarction or STEMI. It’s commonly known as “The Widowmaker.”

I didn’t hear the term from a cardiologist until I was recovering in my hospital room. Such finality. It seemed so 19th century. "Night of the Widowmaker" could easily be the title of a thriller novel. Its shock value was too tempting for a storyteller to ignore. I used it hundreds of times in place of heart attack. When I took the time to describe it in detail, tossing in an encyclopedia of medical terms, I could see my listener’s attention begin to wane. Simply described, the left anterior descending (LAD) artery gets blocked by a clot or plaque and the heart reacts.

The signs are there should you pay attention. Chest pain, shortness of breath, excessive sweating, jaw pain. Mine was a belly ache. Since it happened during norovirus season, I figured I was getting ready to blow chunks and/or get the runs. I got neither. It was Dec, 17, 2012, and the eve of my birthday number 62. I might have to lay off the cake and ice cream. I was off work for two weeks so I could lie around and see what happened. After a week, I went to my GP and he thought I might have pneumonia so sent me for an X-ray. He had a perfectly good EKG machine out in the hall but that never entered into the conversation. The X-ray showed congestion and the doc prescribed an antibiotic and bed rest.

On Jan. 2, I headed to work but only made it as far as my front door. I couldn’t open it. I called my wife. She decided to come home and take me to the ER. When she arrived, she saw I was in pain so called 911. The EMTs got there quick, took my vitals, and said I was having heart failure. They bundled me onto a gurney and sped, sirens blaring, to the hospital. Tests and X-rays showed the heart attack and also congestive heart failure. Dr. Khan wanted to get me to surgery right away but held off because I couldn’t breathe. So he stashed me on the telemetry floor and prescribed Lasik to rid my body of fluids. The next day, I had an oblation which opened the LAD and I began to recover.

Then I started telling my story. My heart, left to its own devices for two weeks, lost some of its pumping power. They filled me full of drugs, sent me home with orders for several rounds of cardiotherapy. Six months later, I got the bad news that my heart had only partially recovered and that I was a prime candidate for Catastrophic heart failure. To avoid further drama, I needed an Implantable Cardioverter Defibrillator or ICD. So I got one. Its battery eventually ran down, so this last Thursday, I got a new one.

The ICD lasts from 7-10 years. I pushed mine to the end so Medicare and my insurance company would agree to foot the bill. Medicare reimbursement for an ICD is 23 thousand and change. That doesn’t include hospital and physician and other associated fees. That will quickly eat up my deductible so my out-of-pocket costs will be manageable.

Someone with a heart condition shouldn’t have to worry about affordability. Someone with breast cancer – my wife – shouldn’t have to worry about treatment costs. My son and daughter, both with mental health and medical needs, shouldn’t have to up their angst to find affordable treatments. Alas, that’s where we are in 2023 in the United States of America.

Next time, I'll explore the status of my heart ten years on.

For some of my ruminations on the widowmaker, put "heart" in the blog's search bar.

What does it cost to save a life?

I am pleased that WyoFile published my review of Katherine Standefer's nonfiction book, "Lightning Flowers: My Journey to Uncover the Cost of Saving a Life." In it, the author recounts her diagnosis of Long QT Cardiac Syndrome and how the cure can sometimes be as daunting as the ailment.

Standefer walks Planet Earth with an implantable cardioverter defibrillator (ICD). It's a high-tech device about the size of a Zippo lighter (remember those?) that surgeons implant in a cardiac patient's chest. If that person's heart experiences irregular rhythms or stops, it shocks it back to life. As one research center noted: "It is like having paramedics with you at all times." 

Tiny paramedics.

Standefer playfully calls this intricate medical device her "titanium can." When we met online in November, she said, "Welcome, Cyborg." 

Surgeons installed my ICD in July 2013 when I was 62. Read my blogs about it here and here. 

Standefer is at least a generation younger than me. However, her cardiac problem is genetic and is a killer. 

In 2009, she was a 24-year-old college grad living in Jackson. She busily balanced outdoor jaunts, a budding relationship, several jobs, and performing in a local band. In what Standefer calls "the last morning of my first life," she passed out in a parking lot and was rushed to the hospital. After tests, a cardiologist said she had Long QT Syndrome and needed a defibrillator implant. If she didn't get one, she was vulnerable to Sudden Cardiac Death which is as final as it sounds. Problem is, she had no catastrophic health insurance for a procedure that could cost as much as $200,000.

This is when Standefer's saga began. 

“Lightning Flowers” explores two questions, Standefer told an audience during a Nov. 18 Zoom reading co-sponsored by Jackson Hole Writers Conference and Jackson Hole Book Trader. The first is: What happens to a 24-year-old who passes out in a parking lot and tries to access proper medical care? And the second: What does it cost to save a life?

First things first. Wyoming residents without means have few options for procedures like this. She found out that Colorado had an indigent care program for state residents. She made the decision to leave her life in Jackson behind and move back to Colorado so she could get the life-saving operation. She did, but there were complications. Once in recovery, she wondered about the second thing: what is the true cost of modern medicine? Her journey takes her to the California lab that made her device and the Mayo Clinic in Minnesota. She traveled to Madagascar and Rwanda. She interviewed miners and the impoverished people who lived with the poisonous byproducts of modern medical engineering. And then it was time to write the book.

The U.S medical establishment does one thing very well: research and development. New life-saving gizmos come online all of the time. I have an ICD and artificial knees. My diabetic wife is equipped with an insulin pump. During the Covid crisis, Moderna and Pfizer and others used new technology to develop a vaccine in record time. I received my first injection two weeks ago. I had a passing thought about all the materials the nurses used at the hospital. Syringes, vials, the medicine itself. Where does it all come from and where will it go? 

"Lightning Flowers" prompted me to ponder this question. Last night, the nightly news reported that people in developing countries are less likely than those in developed countries to get vaccinated against Covid. Some countries are raising holy hell about it and I don't blame them. It doesn't take much imagination to conjure a world war caused by lack of access to a cure for a plague. Countries that have vaccine supplies (looking at you, U.S.) are having a difficult time getting it into people's arms. One-percenters fly to places to get vaccine intended for the 99 percent, as in the recent case where a white couple traveled to the Yukon to get vaccine intended for elderly indigenous people. Capitalism at its worst. 

I am a First Worlder with insurance and access to miracle drugs. Millions of others do not have such an advantage. I aim to find out why and report what I find.

Meanwhile, read Standefer's book to trace her journey of discovery. Order a copy from your local indie store. Click the JH Book Trader link above. 

Next time you survive a heart attack, try to fine-tune the description

What action verb best describes a heart attack?

Most times, the past tense of have serves the purpose. Dad had a heart attack. That's so bland. You can "have" a heart attack, just as you can have a cup of coffee or a bad day. But it doesn't really get to the heart of the matter.  Something happens when you have a heart attack, something profound. The muscle that keeps you human stops working. It is an experience of a lifetime and, often, the last experience, your deathtime. It deserves a better description.

The heart attack should be the subject of the sentence. A heart attack killed father. A heart attack claimed his life. You can add an adverb: A heart attack almost killed father. Most of us survivors are fond of adverbs such as almost or nearly, Our lives depended on those adverbs. You could also stay with the action verbs and say something like this: Dad beat the reaper. Or, if you prefer, "Don't Fear the Reaper" with jangly guitars and cowbell, always more cowbell.

Heart attacks deserve better treatment, language-wise. They define what comes after, whether that be finality or life's new chapter. I was lucky and got the latter. I paid a price for neglecting the telltale signs. I wear an ICD in my chest wall that sends signals to a hospital monitoring station. I remain confident that Russian hackers will never find the frequency. But please alert me if I ever start saying nice things about Donald Trump.

My widowmaker heart attack on Jan. 2, 2013, nearly killed me. I lived. During my year of recovery, I went through rehab and ate right and exercised and continued not smoking (I quit in 1985). Some things I did not do. I did not read and entire novel. I wrote very little, although I blogged a bit about the widowmaker (links here and here). The experience took a piece of my heart, my soul. I never thought I would write fiction again. I told my wife Chris that I would never write another book, not even in retirement. She was having none of that. I started a novel the day after I retired in January 2016. I'm 30,000-some words into it. Hard work, this novel-writing biz. Better suited for a young man. Now I have experience but not the stamina. Life plays mean tricks. It entertains us with surprises.

How did the term "heart attack" get started? The heart does not attack. It protests. Dad ate too many Big Macs and his heart is mad as hell and is not going to take it anymore. Bam -- your heart seizes up like an engine low on life-giving 10W-40. My original diagnosis was Acute Myocardial Infarction accompanied by Congestive Heart Failure. I could also call it a Coronary Thrombosis. These terms aren't nearly as colorful as Heart Attack. That's what I will continue to say. And will continue to find better ways to describe that thing that disrupted but didn't end my life.

Strong mind, strong body -- take your pick

Just added to my reading list: "Blue Dreams: The science and the story of the drugs that changed our minds" by Lauren Slater. I will tackle it once I finish "Lincoln in the Bardo" by George Saunders.

"Blue Dreams" is a non-fiction account of psychiatric drugs and their effects by someone who is both a patient and a psychologist.

"Lincoln in the Bardo" is a novel that explores something that seems a lot like severe depression and PTSD in Abraham Lincoln, who is mourning the death of his 11-year-old son, Willie, in 1862.

Would Lincoln have benefited from a regimen of Prozac or other SSRIs? Perhaps. Maybe he would have recovered from his dark moods more quickly with a couple hits of Molly or LSD.

We'll never know. But psychedlics figure into Slater's book. Party drug MDMA (Molly) has been tested on those with PTSD. It has shown some remarkable and lasting results. As Slater recently described it on NPR's "Fresh Air:" those who take Molly and relive their trauma are able to shift that experience into another section of the brain, possibly the prefrontal cortex, helping remove it from the "fight or flight" amygdala. They can then get a handle on a horrible memory without degenerating into bouts of anxiety or self-harm, even suicide.

Slater wonders if this experimentation may lead to another golden age of drug therapy. The previous golden age brought on by lithium and Prozac may be nearing its end. Slater testifies that medications have helped her stay sane, raise a family and write books. They also have shortened her life.

That's the trade-off. So goes the old witticism: "Sound mind. Sound body. Take your pick." After five stays in psychiatric facilities between the ages of 13 to 24, Slater's doctors discovered Prozac. In a rush of Seratonin-laced good will, she finsihed finished her education, married, had two children and embarked on a writing career.

Then came trouble, in the form of the return of depression  and the start of her use of Zyprexa, which caused her to gain weight and lose her libido.

We patients are guinea pigs. Researcher still don't know the inner workings of these drugs. And their long-term effects. If you are in the midst of a severe depression, you want immediate help. Doesn't happen. Prozac or Zoloft may alleviate the symptoms eventually. Studies have shown that two-thirds  of those with depression would recover just as well with a placebo. That's depressing enough. Add side-effects into the mix and you have to wonder what in the hell we are doing.

I have been taking antidepressants for almost 30 years. I feel better, go off them, and crash. One of my psychiatrists once lectured me: "You have to stay on these the rest of your life. You have depression."

That made an impression. Unfortunately, I don't always listen. I went off my Zoloft six years ago and the walls came crashing down. I was out of work for a month. My psychiatrist at the time, who fled Wyoming for Hawaii one winter and never came back, tried a return to Zoloft and then several other meds. We finally went back to Prozac with a nighttime dose of Remeron. Several months later, I felt better but also was back exercising on a regular basis and eating right, which helped. Also, I was in talk therapy with a therapist and regularly saw my psychiatrist. Still, that summer I was still experiencing bouts of depression interspersed with anxiety. It probably took a good six months for my moods to stabilize.

Six months later, on Jan. 2, 2013, I had a heart attack. I recovered quicker from a "widow maker" than I did from depression. Got more help, too. Add an inept mental health care system to the fact that the docs know so little about the drugs and the human mind. That makes for a killer cocktail of ignorance. At least I have both Medicare and private insurance which enables me to navigate the system without going broke.

But I am not only here to complain. I am here to critique books. "Lincoln in the Bardo" is a wild ride and I'm only on page 98. This is how an award-winning short story writer writes a novel. Truly unique. I am a short story writer working on a novel. I find encouragement in Saunders work.

I have ordered Slater's book. I, too, would like to know what happens with long-term use of these drugs. My life depends on it.

I do not believe Sen./Dr. Barrasso when he says he is "passionate about ensuring that patients are able to get the care they need"

Wyomingites call John Barrasso a U.S. Senator.

Before turning to politics, he was Dr. John Barrasso in Casper. An orthopedic surgeon, like the very capable docs in Cheyenne who replaced both of my knees, operations covered by Medicare and my supplemental insurer, CIGNA. I give a lot of credit to CIGNA for its service. I also pay the company more than half of my retirement income to provide necessary coverage for me, my diabetic wife, and my mentally challenged daughter. My knee docs are not in the Senate. Not yet, anyway. They may have noted how much money Barrasso is raking in as as pal of the Koch Brothers and other right-wing funders. And the senator has great hours and plenty of vacation days. He hardly works at all! 

I'm not sure what to call Barrasso. A physician would not demean his profession the way he does. Lately, he's been up to no good in the U.S. Senate, working to deny health care to thousands of Wyomingites. 

So I write letters and postcards. They are cordial but insistent. I do no name calling or cursing. I don't want to get on the Senate's Shit List, which I hear is getting longer by the day.  

My senators write me back. This afternoon I received an e-mail response from Sen. Barrasso. A laugher, if you're into dark humor. Read it and weep or laugh, the choice is yours. You can get your own response, suitable for framing, by writing to Sen. John Barrasso, 307 Dirksen Office Building, Washington, DC, 20510. Get a full list of his mailing addresses and phone numbers in Wyoming by going to http://www.barrasso.senate.gov

Dear Michael,  

Thank you for taking the time to contact me. It is good to hear from you. 

There are serious challenges facing health care in our nation. As a doctor, who practiced in Wyoming for over twenty years, I am passionate about ensuring that patients are able to get the care they need. Right now, Congress is in the middle of an important debate about the future of Obamacare.  

For the past seven years, patients have experienced the impact of this law. The people I talk to in Wyoming tell me they are facing higher premiums and fewer choices. According to the Department of Health and Human Services, premiums in Wyoming are up 107% since 2013. We also have just one single insurance company willing to sell Obamacare policies.  

This law cannot continue in Wyoming or across the country. This is why I voted to repeal Obamacare and will continue to support this effort. Patients need relief from the law’s mandates and taxes that are making health insurance unaffordable for so many families. Importantly, we can do this while still ensuring that people with serious medical conditions continue to have access to insurance coverage.  

The repeal of Obamacare is just the first step. We need to make changes that ultimately lower costs and improve quality of care received by all patients. In particular, this means letting states decide what works best in their local communities. This is especially important so places like Wyoming can meet the needs of residents in our rural communities.  

Michael, thank you for contacting me. I appreciate hearing your thoughts and comments about this important issue. 

John Barrasso, M.D.
United States Senator

In which Sen. Enzi tries to calm this heart patient's fears about the Senate's health care bill

I am always impressed how quickly Wyoming Sen. Mike Enzi replies to my letters, postcards, e-mails and phone calls. I am just one of his many constituents. I am a registered Democrat and never voted for him. Of all the GOPers objecting to Pres. Obama's ACA, Enzi, at least, had some of his own common-sense proposals. 

But like the rest of the GOP, the Trump-era Enzi has gone off its rocker. He and his pal, Sen. Barrasso, helped craft the nastiness that is the Better Care Reconciliation Act (BCRA). The goal should be to provide universal health care. Instead, it deprives millions of coverage in order to give tax breaks to the rich. 

So I complained. Enzi's response was predictable. I like to publish them online. You have to read between the lines to see what it actually says: "We destroyed the ACA and now want to replace it with something much worse. And you can't do anything about it."

So here's his response: 

Dear Mike: 

The Affordable Care Act (ACA) has caused skyrocketing health care premiums, imposed mandates and taxes, and is collapsing individual insurance markets. Millions of Americans and thousands of Wyomingites have demanded we take action on these issues. One proposal in the Senate, the Better Care Reconciliation Act (BCRA), would address these problems and help ensure the most vulnerable among us get health care.

There are people suffering under the current health care system created by the ACA and more will follow suit if we do nothing. The health care status quo is simply unsustainable and changes must be made. The recent vote on the motion to proceed provides us with an opportunity to improve our health care system. I will continue to work to find the best way forward while keeping in mind the health care needs of Wyomingites.

Thanks for contacting me.

Sincerely,
Michael B. Enzi
United States Senator

When Ike had his heart attack in 1955, coronary care was still in the dark ages

Building 500 on a January afternoon.

Coronary Q & A

After a short visit to the eighth floor of Building 500 on the University of Colorado Anschutz Medical Campus in Aurora

Q: If you had a heart attack in 1955, what was the likely outcome?

A: Death.

Q: You're kidding, right? I said 1955, not 1855, or 1755.

A: I kid you not. The most common nickname for a garden-variety heart attack in 1955 was "the widow maker."

Q: "Widowmaker" is what my Syrian refugee cardiologist called the heart attack caused by a total blockage of the Lateral Anterior Descending Artery or L.A.D. The kind of heart attack I had to welcome in the new year of 2013.

A: Times change. So does the language.

Q: In 1955, what was the most common prescription for the usual heart attack symptoms such as chest pain, numbness in the left arm, shortness of breath, chronic gastrointestinal problems?

A: R & R. Some time on the beach. A few rounds of golf. A relaxing day fishing by a bucolic Colorado trout stream. That was for men. Women? They didn't have heart heart attacks in 1955. It was probably hysteria. Or penis envy. Freud was in vogue.

Q: Forget Freud. Didn't doctors use electrocardiograms in 1955?

A: Not often. In 1955, President Dwight D. Eisenhower complained of chronic gastrointestinal pain. His doctor, U.S. Army Major General Howard McCrum Snyder, conducted a month-long physical of Ike without once doing an EKG. He told Ike to relax by going on a vacation and play some golf.

Q: What did Ike do?

A: He flew off to Colorado and played some golf.

Q: Why Colorado?

A: Ike's wife, Mamie Doud, was from Denver. She and Ike usually stayed at the Doud family home in what is now the Seventh Avenue Historic District. He had a heart attack on Sept. 23 after playing 27 holes of golf at Cherry Hills Country Club. According to the Encore newsletter I picked up at Building 500, once known as Fitzsimons Army Medical Center, Ike "complained of chest pains, but but continued to play, assuming it was heartburn."

Q: But it was a heart attack?

A: Right. One of the symptoms the American Heart Association warns you about.

Q: So he went to the hospital?

A: He went back to the Doud's home. "He awoke the next morning at 2 a.m. from chest pains that were not subdued by Milk of Magnesia."

Q: Even I, a layperson and not a doctor, can see the difficulty of subduing a full-blown widowmaker with Milk of Magnesia.

A: Exactly. It wasn't until that afternoon that the Fitzsimons docs administered an EKG to POTUS and "announced that Eisenhower had a coronary thrombosis condition that would be best treated at Fitzsimons."

Q: Don't docs now say that "minutes means muscle," that time is of the essence in the treatment of any heart attack?

A: They didn't know that in 1955.

Q: What did they know?

A: From Encore: "While the American Heart Association was founded in 1924, little was known about heart disease. Doctors knew that death could occur, but provided no causes, symptoms of treatment for coronary thrombosis.... Since the 1920s, heart disease has continued to be America's number-one killer."

Q: That's progress. So the President of the United States, the man who whipped the Nazis, received no treatment for his heart attack? No oblation? No stent? No blood thinners? No pacemaker? No bypass? No weeks of painstaking rehab on the treadmill and weight machines?

A: Those were all treatments of the future. The good news is that the president's seven weeks of rehab in Denver alerted the world to a dangerous killer. When you had your heart attack, the medical establishment had almost 60 years of research behind it.

Q: I could have died.

A: But you didn't. You walk around with a machine in your chest that regulates atrial fibrillation (A-fib) and will shock you back to the present should you ever experience catastrophic heart failure.

Q: One of my earliest memories is from Aurora, Colorado. I was four. We lived in the neighborhood across Colfax Avenue from Fitzsimons. My father pointed out the lights of Room 8002 and announced that the President of the United States was recuperating from a heart attack in that room. Memories are funny things. I'm not sure why I remember it. It's possible that my father told me about it later. He was a good storyteller.

A: When you were in Denver last week, did you get to tour Room 8002 at Fitzsimons, now known as The Eisenhower Suite? It's been lovingly restored by the University of Colorado Hospital, an entity that obviously cares about history and science. It now looks like it did in September of 1955, when the leader of the free world and his wife and a secret service detail lived there.

Q: It was a quick visit. I was in town to take my daughter Annie to some medical appointments. But I will be back. It may have led to my own recovery from coronary artery disease. In Eisenhower's Heart Attack, Clarence Lasby, M.D., states: "The eight floor became, in a way, the nation's first coronary care unit... where shifts of cardiologists, nurses, technicians, medical corpsmen, dietitians, cooks, and security staff were present on a 24-hour basis to serve the patient and his family."

A: I love historic sites and museums. I'm curious. Alive and curious. Thanks, Ike.

Four years after the Day of the Widowmaker

It began with a hallucination.

Flashback, I thought, after-effects of my misspent youth.

My vision lit up with sparkles and crinkles, as if I was being wrapped in silver Christmas wrapping paper. Me, a present for someone, or maybe for myself. It should have been the ER, but I didn't realize that yet.

I had been having these visions for weeks. They didn't appear as I climbed the steps to my office and the downtown parking garage. I did have some shortness of breath but I ascribed that to lack of exercise and the ritual packing on of holiday pounds. I'm going to get back to the Y at the first of the year, I told everyone. Really -- I mean it.

Four years ago today I sat at my desk. The crinkly vision subsided, replaced by a horrible stomach pain. Uh oh, I thought. The dreaded cruise ship virus that was a plague in Cheyenne that winter, even though very few cruise ships dock at Port Cheyenne. My boss had said she'd returned home a few days earlier to find her husband curled up on a ball on the floor. He had a stomach ache. Rita got him to the car and then the ER. The docs pronounced norovirus. Sure enough, at home two hours later, the symptoms exploded in living color. I didn't have to ask for details.

My stomach ache led me to the restroom several times but no explosions. I decided to go home. I had plenty of sick hours. I was off the next day for my birthday. I didn't want to be sick for my 62nd birthday.

I was. Went to the doc. He said I had the norovirus and gave me a shot for nausea. The EKG machine was right outside his office. He could have put that to use and found the problem. But I had no history of heart problems. And a stomach ache was not one of the symptoms usually described in American Heart Association literature. I stayed home, nursing my stomach ache. The day after Christmas, I revisited my doc and complained of congestion. He sent me to X-ray. The pictures showed congested lungs. Pneumonia, he pronounced, and sent me to the pharmacy to pick up a supply of antibiotics.

A week later, I was in an ambulance screeching its way to the ER. After an EKG and series of X-rays, the results were in. I had -- and was having -- a heart attack. The cardiologist said I had a blockage of my left anterior descending (LAD) artery. I am an educated person, curious to a fault, but I didn't know that I had such an artery. The artery, of course, knew about me. Later, after surgery, I discovered that an LAD heart attack is happily referred to as "widowmaker." The surgery came two days later, after the docs and drugs took care of my congestive heart failure that had looked like pneumonia, at least to one practitioner.

Widowmaker. I was lucky. Blessed, too, as Widomaker is very efficient at its task of killing you. Once my lungs were decongested, I received an angioplasty and a big stent at the junction of my LAD. Six months later, I was the proud recipient of an ICD -- an implantable cardioverter defibrillator -- due to damage sustained by my heart muscle during my two-week-long heart attack. A bedside monitor keeps track of my rhythms and arrhythmia. I lost weight. I exercise. I eat sensibly. Take my meds. All the things I should have been doing before my very expensive heart attack.

I retired in January. I have had many fine days to write and travel and garden and read. On warm summer days, I sit on my back porch, look out over the garden, inhale deeply and thank God and medical science that I am still here.

When AFib comes to town

The Cheyenne Regional Medical Center Telemetry Lab staffer called me Friday. She wanted to know how I was doing. I said "fine" but knew that this wasn't a courtesy call. The Telemetry Lab monitors my Implantable Cardioverter Defibrillator (ICD) remotely. I have a home transmitter at the side of my bed. It picks up my heart signals and transmits them to the lab, which then takes a look to see if I am in sinus rhythm, which is what we want, or in atrial fibrillation (AFib), which we don't want.

The lab said I was in AFib on Thursday morning. "Did you feel anything?"

"Yes," I said. "I was light-headed all morning."

"Anything else?"

I had to think about it. "I just felt weird all morning. Had a hard time at physical therapy, was tired and out of sorts all afternoon."

The Telemetry Lab person (sorry I don't remember her name -- blame it on the irregular heartbeats and lack of oxygen to the brain) told me that I needed to be aware of these symptoms as a long-duration AFib is dangerous. "Next time you're feeling that way, please send me a manual reading from your monitor."

"OK," I said, feeling a bit scared. I tend to ignore my heart difficulties most of the time. I exercise, take my meds, maintain a good attitude, am kind to animals, etc.

She made me an appointment with my cardiologist. She is able to access my MyChart files at CRMC which shows a calendar of my appointments. She puts me down for a March 15 appointment with Dr. Nienaber. As long as I'm dealing with a CRMC physician or group, my records are online and we can carry on these types of conversations. It's a bit spooky, all this electronic data-keeping and accessibility. My fiction-writer self thinks of all the ways that this system can be abused. Let's say a U.S. politician has an ICD with a bedside monitor and someone, say, an ISIS terrorist, wants to murder that politician. He hijacks the signal and causes the ICD to shut down. Even scarier, he causes that ICD to activate its defibrillator. Bam! -- a big shock to the heart to get it back into rhythm even when it doesn't need it. And another shock and another and pretty soon, the heart gives up. Remote-control assassination. Because I am postulating this as sci-fi means that the possibility already exists and the U.S. or the Russians or even ISIS may be preparing an attack.

For me, though, right now, the threat is more from AFib than it is from some shadowy hacker. AFib can cause strokes, blood clots, heart failure. My heart attack of three years ago created the cardiac scar tissue that sometimes misfires as AFib. My pacemaker activates to get me back into rhythm. If catastrophic heart failure threatens, the defibrillator will kick in with a debilitating jolt. This has never happened to me, and I hope it never does.  I could be driving down I-80 at the time. Or I could be napping. Anything is possible.

A big thank you to the CRMC Telemetry Lab. A big shout-out to the researchers and engineers and technicians who put these gizmos together. I freakin' love science.

To watch AFib in action, go to the American Heart Association web site. You can compare an AFib animation to one of a normal heartbeat. My heartbeat was normal for 62 years. Cholesterol and inflammation and stupidity led to my heart attack, which almost killed me. I was pulled back from oblivion by EMTs, cardiologists, surgeons, and nurses. I'm 65 now, retired, someone who knows how blessed he is every day. Or almost every day.

Never too late for a wellness class

Chris and I are attending a wellness class at the YMCA.

The class uses a text entitled "Living a Healthy Life with Chronic Conditions." It outlines self-management tools based on "an ongoing series of studies conducted at Stanford University School of Medicine." Stanford, founded by robber baron Leland Stanford, is known for many things. It helped spawn the computer revolution, trained numerous NFL players and sponsors a kooky marching band (go you Cardinal!). And I have nothing against robber barons -- with them we wouldn't have Stanford's Wallace Stenger poetry fellowships, the many Carnegie libraries that taught generation to love books, and Grand Teton National Park (thanks Rockefeller family). Our current crop of high-tech billionaires seem to be trying to follow in the footsteps of their elders, although our grandkids will have to judge their legacies.

I'd be lying if I said the book's Stanford connection didn't impress me. There are some elitist bones in my body. But the book is a good and helpful and logical. We all need self-management skills when it comes to our health. Too often, we don't sail our own ship, health-wise, and that leads to many problems down the line -- heart disease, arthritis, diabetes, asthma and, as the book notes, "other physical and mental health conditions." Notice that latter term -- mental health conditions. The book stresses links between physical and mental health. Very important. You really can't have one without the other.

Pages 8-9 lists the management skills recommended for an array of chronic conditions. Categories include pain management, fatigue management, breathing techniques, relaxation and managing emotions, nutrition, exercise and medications. Notice that "medications" is last? I did. I take a boatload of meds for my heart disease, but also pay attention to the other categories, especially exercise and nutrition. I would like to wean myself off some heart meds. This is a challenge, as the drug lobby is adamant we use its products and never get off of them. Out docs are complicit in this strategy. They may also need this wellness class.

The series of six classes are led by two women who were trained in the process. Each class involves note-taking and brainstorming and action plans. We often choose partners to work on action plans. Our workshop leaders call during the week to check up on our progress, or lack of it.

Is the class worth it? Not sure, as I'm only halfway through. I probably will miss the last two sessions, as I'm getting a new knee Feb. 3. Takes a good month to get back in the action. But wellness is important and I wish that I'd taking it seriously sooner. At 65, I have several chronic conditions: heart disease, arthritis, depression. A better lifestyle would have spared me the heart condition. Arthritis and bad knees show the wear-and-tear of time, and many years of basketball and running. Depression runs in the family.

I'd like to sum up by saying something memorable about living life to the fullest. Must be a gazillion quotes and thousands of memes on the subject.

Here's one: "Be here now," coined by writer/philosopher Ram Dass for his book of the same name..

Here's another: "One day at a time," something I heard once or twice at Twelve-Step meetings.

"So it goes" from Kurt Vonnegut.

Low-sodium chili could be the key to turning Wyoming blue

On or about Jan. 2, 2013, I began considering sodium.

Didn't pay particular attention to it until my heart stopped functioning properly.

"Cut down on the salt," the cardiologists said.

"I don't put salt on my food," I replied.

They told me that salt is everywhere. In processed food -- all that stuff in the center aisles of your local grocery store. Frozen foods too.

"Frozen foods?" I asked. "Pizza and TV dinners and lasagna don't need salt."

"Check the labels," the docs advised.

Due to my wife's diabetes, I check labels for sugar and carbs. Sodium hadn't been a big concern. Until the widowmaker brought me to the ER and the attention of the cardio unit.

They halted my congestive heart failure and installed a stent. Put me on a cardiac diet. For a week, the nutritionist in the hospital kitchen told me what I couldn't have more often that she agreed with my dietary choices. Once I was out and about again, wandering the aisles of King Soopers, I read some amazing horror stories on food labels. Hormel Chili with beans, one of my faves, contained 990 mg. of sodium for one-cup serving. That meant that a can of chili, warmed up in the microwave and served during the Broncos game, gave me almost 500 mg of sodium more than the 1,500 mg. daily intake recommended by cardiologists. Throw in some "saltines" and cheese and beer and soon I was at the average of 3,400 mg. of sodium ingested daily by Americans.

That was a shocker. But prowling the frozen foods aisles was really enlightening. Those big pot pies are one of my guilty pleasures. I loved them as a kid. But they are loaded with sodium. Why? Freezing preserves the food, so salt and MSG are not necessary. One can only assume it's for the taste. We Americans love our salt! And what about the salt lobby? Is there some branch of The Illuminati that loads us with salt, making us compliant, water-logged, obese drones ready to do the bidding of this secret cabal? Get on this, Dan Brown!

Face it, our industrial food system is still stuck in mom's 1955 kitchen. Our families were so happy to be rid of the Depression and the world war, that we would do anything to have three squares a day. Salt was a celebrated part of the Great American Diet. Hell, the East Germans and the Chinese were starving. We got all Henry Ford on our food system. Mom and Dad showered us with mac and cheese and rump roasts and hot dogs and Wonder Bread and Hostess Twinkies.

Do I blame them? Hell no. All my mom got for Christmas during the 1930s was an orange and a handful of walnuts. Was she concerned with a little bit of salt? Hell no. She was happy to be feeding her kids -- all nine of them. They all grew up to be strapping lads and lassies, me included. I kept eating as if it was 1955 right up until my LAD artery got clogged and I went in for a Roto Rooter job.

So what is a 64-year-old American man supposed to do about food? Eat less. Eat right. Exercise more. Nothing I didn't already know. Then I didn't really, did I? I opted for the easy solution. Pizza and Big Macs and those big plates of food they serve you at every restaurant, especially here in Wyoming and my other home places in the South. I love all that barbecue and chicken-fried steak and burgers and ice cream. But I want to stick around for awhile. That doesn't mean that I, as a creative cook, can't come up with solutions.

Taste my chili -- please! I make a low-sodium chili that is not bad. I am not going to win any prizes at the chili cook-off. But I don't care about that. I just want it to taste good and get some appreciation from my friends and colleagues. You will not unduly tax your heart when eating my chili! I can make that boast.

I'm making a batch today in my slow cooker. I made some last week for the Broncos game and the chili was better than the game, especially when you consider the lackluster performance by Peyton Manning. I kept some as a starter dose for this weekend's chili/salsa/dessert fund-raiser put on by the Laramie County Democrats, which is Sunday, Oct. 25, from 6-8 p.m. Wyoming Democrats must pay attention to our longevity. There are so few of us that we can't stand to lose anyone to heart failure. I'm doing my part by cutting back on the sodium. A lowered heart rate might allow us to once again clinch a majority in both houses of the state legislature by 2050, the year I turn 100. Combine longevity with an influx of young immigrants eager to make their way in Wyoming's very creative atmosphere, and you have Democrats galore. You say that you can't move to Wyoming due to too many right-wing dingbats in the legislature? They can't live forever, especially when you consider the average Wyomingite's salt-laden diet. Be patient.

Today, low-sodium chili. Tomorrow, the world or, at least, WYO.

BTW, do I have a recipe? Not really. My only goal is to keep the sodium content below 350 mg. per one-cup serving, which is what nutritional guidelines recommend for all foods. That is approximately one-third of the Hormel Chili variety I referenced above. It's about one-half of the levels in Hormel low-sodium chili with beans.

That's progress!

Wearing red -- and happy to have the past two years

Wear Red Day for heart health. 

A new study shows that many people would prefer to die sooner than take a daily pill. From the Atlantic Magazine Online:

In a study published earlier this week in Circulation: Cardiovascular Quality and Outcomes, a journal of the American Heart Association, researchers from the University of North Carolina and the University of California, San Francisco, surveyed 1,000 people on what they would be willing to give up to avoid taking a daily pill—one without any cost or side effects—to protect heart health. 

Here’s what people were willing to trade: 

• More than 20 percent said they would pay $1,000 or more; around 3 percent said they’d pay up to $25,000.

• Around 38 percent of respondents said they’d be willing to gamble some risk of immediate death; around 29 percent of the people surveyed said they’d accept a small (lower than 1 percent) risk, while 9 percent of them said they’d accept a one-in-10 chance of immediate death.

• When the question changed from risk of death to certain death, around 30 percent said they would trade at least a week off their lives, and 8 percent were willing to give up a full two years.

Eight percent were willing to give up a full two years?

Yikes. I wonder how I would have answered had I been surveyed three years ago? Would I gamble some dough, risk immediate death or trade a couple of years?

Not sure. Maybe I’d accept a small risk of immediate death (less that 1 percent) or trade at least a week. That is a bit unreal when you haven’t faced death, especially cardiac death. Once you do, well, it becomes all too real.

I experienced a heart attack two years, one month and 18 days ago. I had a pain in my stomach. I saw the doctor but he didn’t know what it was. Two weeks later I was in the ER with congestive heart failure. My life was saved, through little effort on my own. I received a stent at the juncture of my Lateral Anterior Descending artery or LAD. Its nickname is “The Widowmaker.” A few months later, I returned to the hospital for an ICD, a combination defibrillator/pacemaker. In the two weeks that I didn’t get help for my heart, it sustained blood loss and permanent damage. I now take ten pills a day to forestall another heart attack. Is it a pain in the ass? Yes. Do I wish I didn’t have to take them? Yes. But do I want to live two more years? I already have….

Today is #WearRedDay for heart health. I am wearing red. I took my pills this morning. I went to work today and tonight, my wife and I are going to a party to see our friends, many of whom visited me in the hospital two years ago. I am glad I had those two years. I wouldn’t trade them for anything.

Wyoming Democrats respond to Rep. Cynthia Lummis's comments about the Affordable Care Act

This was posted on the Wyoming Democratic Party web site today:

Yesterday during a hearing about the Affordable Care Act in the House Oversight Committee, Wyoming Representative Cynthia Lummis suggested that issues enrolling in the Affordable Care Act were partly to blame for her husband’s death.  

The following is a response from Pinedale's Ana Cuprill, Chairwoman of the Wyoming Democratic Party: 

“Wyoming's Code of the West reminds us to be “tough, but fair” and to “know where to draw the line.” Representative Lummis missed the mark on both accounts yesterday. Rep. Lummis voted more than 50 times with her Republican colleagues to repeal Obamacare. The real consequence of those votes is time and effort wasted by the administration defending the law instead of addressing “glitches” that would make the process of enrolling go more smoothly. I will agree with Rep. Lummis that there is no time to be glib about the problems with healthcare. Now is the time to find solutions that will have real impact on people's lives. While we are sorry for the tragic loss of Rep. Lummis’ husband, we are glad for the thousands of people in Wyoming and millions of Americans with access to quality, affordable care. We’re relieved for families who no longer face bankruptcy, can’t be dropped from coverage when they get sick and don’t face lifetime maximums when a sick child needs care. We’re still concerned for the thousands of people in Wyoming who make important health decisions based not on the best available care, but whether or not they can afford to have any care at all. We believe using her truly unfortunate situation to attack the Affordable Care Act was disingenuous and call on our Congresswoman to join us in finding ways to improve the Affordable Care Act."

Well said, Ana Cuprill. And amen.

Some final words about Mental Health Awareness Week

I could not let Mental Health Awareness Week go by without commenting.

The week, promoted by the National Alliance on Mental Illness (NAMI), was a week filled with a flurry of social media posts, including a series of images (see one above). Thursday, Oct. 9, was National Depression Screening Day. I’ve already had mine – several in fact -- and depression was located in various regions of my body – my heart, my celebral cortex, my Islets of Langerhans. I take meds for it, see my psychiatrist every six months and my therapist every week. I work out at the YMCA every other day and eat right.

Last weekend I made chili for the Broncos game. This is not a recommended treatment for depression. Following the Broncos may even cause depression – the jury’s still out. I make my own chili because I love chili and the store-bought variety comes with tons of salt. Too much salt causes my heart to work harder to get rid of fluid build-up. An overworked heart negates the medication I take to keep it calm and reliable. An overworked heart may go into a fatal arrhythmia and would cause my ICD to kick in which, in turn, would cause me to flop around on the floor like a fish. Depression would follow, as would stares of passers-by.

Homemade chili, you see, can ease both heart disease and depression. Mine features lots of pepper slices and tomatoes, our planet’s super-food. No-salt-added tomato sauce. It’s meaty with the lowest-fat hamburger I can find. Flavoring is a problem that no amount of Mrs. Dash, cumin, and chili power can remedy. Our taste buds are primed for salt and lots of it. We need some salt as our body’s origins are in the briny deep. I’m still working on that part of the chili challenge.

It’s not that easy to get the same attention for mental illness as is given to heart disease. I’m pleased that heart disease gets lots of attention and much funding. I might not be alive if that were not the case. I am pleased that my local hospital has a spiffy new cancer center and that October is Breast Cancer Awareness Month. Everyone wears pink, even NFL players and cowboys (at least they do every summer at the CFD Rodeo's "Tough enough to wear pink" day). As for the NFL -- those were some bitchin’ pink cleats that the Houston and Indy players were wearing on Thursday Night Football. Good game, too.

I didn’t spy many green ribbons or green shoes this week. As I said, social media lit up with references to depression and schizophrenia and bipolar. USA Today did a series on mental illness and suicide. Nice job – I read it all. Shocking stats revealed that 40,000 Americans killed themselves last year. It’s shocking enough that an average of 22 military veterans take their lives daily. But to really be shocked, you have to read their stories. Many don’t get any help at all, or the right kind of help. But many do and still kill themselves. Many civilians with mental illnesses don’t get any help at all, or can’t afford it, or don’t get the proper treatments. They jump off bridges or shoot themselves or OD on pills with alarming regularity. Does that mean it’s hopeless? No, but people who feel hopeless may not get help because of the stigma attached to mental illness or the “cowboy up” mentality that we have in Wyoming and other western states. “Cowboy up” is not a helpful response to someone who needs help. “Tough it out” or “lighten up” – also not helpful responses. But you can’t really blame people. If they haven’t experienced a mental health challenge themselves or with a friend or family members, they may be clueless.

I walk around with an Implantable Cardioverter Defibrillator in my chest. My wife Chris walks around with an insulin pump on her hip. We often get into lively discussions with people with heart disease and diabetes. We compare experiences and devices. Growing old, it seems, is filled with these types of conversations. Having a heart attack gives you carte blanche to bore everyone silly with your story.

Want to stop a lively conversation in its tracks? Bring up mental illness. Chris was at a community gathering this week and was having a good old time talking to old friends about her meter and my ICD. Lots of people have encounters with heart abnormalities and blood sugar levels. But when they asked about our daughter -- let's call her Margaret -- and Chris told them she was in a mental health treatment center, the conversation stopped. Crickets chirped. Tumbleweeds rolled through the room. The friends excused themselves and Chris was left standing there, an intriguing story hanging from her lips.

Too bad they didn’t stick around to hear the story. Margaret has received a variety of diagnoses. Bipolar. Borderline personal disorder, with and without bipolar. Severe depression. She’s a cutter too, you see, which usually freaks out the uninitiated. It freaked me out when I first found out about it. She’s used knives, box cutters, razors and even broken glass to carve a topo map of scars on her arms and legs and stomach. It’s a constant reminder of her traumas. It will always be a reminder to her as the challenges she faced as a teen and young woman. She may arrive at a place where she can live with her mental illness, maybe even outgrow the worst symptoms. But she’ll always have the scars. When she’s 63 as I am now, her grandchildren may ask, “Grandma, where did you get those scars?” She can tell any story she wants, as grandparents do. But I have a feeling she will share the truth. That may help them somewhere down the line. This mental illness runs in our family, you see, and DNA has a funny way of replicating itself. Science may come up with answers. Better, more targeted drugs with fewer side-effects. Better and more widely available therapy. Less stigma. Empathy breaking out all over.

Meanwhile, there are social media images to post and blogs to write. Chili warms on the stove. Life is a series of little treatments, tiny steps, unexpected laughter. Sorrow awaits you around every turn. Be aware.      

Fill in the blank: "_________ should not be a debt sentence"

Sign seen at the Medicaid Expansion rally held Thursday in Cheyenne:

"Cancer should not be a debt sentence."

You could customize that in a number of ways:

"Heart disease should not be a debt sentence."

"Diabetes should not be a debt sentence."

And so on. Plug in the malady that may be afflicting your family. I have heart disease and my wife is a diabetic. We have insurance. Still, my health care costs topped $200,000 in 2013. I ended up paying several thousand dollars out of my own pocket. Heart disease may have been a debt sentence, or possibly even a death sentence if I wasn't able to afford a stent and an ICD and a two trips to the hospital and rehab and many medications, some of them pricey.

Some of the people testifying at Thursday's rally face debt sentences for hospital bills they can't afford. Fate decrees that the insured and the uninsured alike keel over from heart attacks, wreck their cars, contract horrible infections, slip on the ice and break a leg, get a Big C diagnosis, etc.

We got news on Friday that two Medicaid expansion bills made it out of the Joint Labor, Health and Social Services Interim Committee for consideration during the legislative session.

"I think it is the responsibility of this committee bring it forward for a full discussion," said committee chairwoman Rep. Elaine Harvey, R-Lovell. "I would hate to think that 12 people would decide for the whole state to not do any kind of Medicaid expansion at all." 

Sometimes it seems that there is just one person one person on that committee who wants to deny health coverage to everyone in the state. This from Saturday's Wyoming Tribune-Eagle:

Co-chairman Sen. Charles Scott, urged the committee Friday to table the pending Medicaid expansion bills. He said the federal government's proposal to Medicaid brings out the worst in the American health-care system.

"It encourages excessive utilization of health-care services to the extent that they're not good for people," Scott said.

Wonder what Scott considers "excessive utilization?" Preventive care? Taking your kids to the doctor when they're sick? Riding in the ambulance to the emergency room when you could walk there on the two good legs the Lord gave you?

Sounds to me as if Sen. Scott is arguing for government oversight of what is "excessive utilization" and what isn't "excessive utilization." He wants to be the sole arbiter who decides if 17,000 uninsured Wyomingites get health insurance coverage under Medicaid expansion, a plan that will save the state $50 million, according to Wyoming Health Department Director Tom Forslund.

What is good for people and what is not -- and who decides?

Next thing you know, Sen. Scott will be advocating for death panels.

Maybe he already is.

Sunday morning round-up

Anyone out there had norovirus, gastroenteritis, the intestinal bug, stomach flu, the cruise ship curse? It's all the same thing. Unpleasant but fast moving. I should be fine by start of work on Monday. Last year at this time, I was told by my doc that my stomach cramps were the onset of the bug. He gave me a nausea shot and sent me home. Meanwhile, my heart kept revolting and I didn't get help until the new year. Yes, I keep bringing this up. And no, I won't stop. Not because I blame my doc. But because heart attack symptoms can be almost anything. A pain in the ass? That's probably something else, such as watching too much Fox TV or spending too much time with that Tea Party relative. But unexplainable pains in the stomach, side, arm, head, back? As my old Wyoming pal Dick Cheney says: "When in doubt, check it out." That doesn't go for weapons of mass destruction in a troublesome foreign country whose initials are I-R-A-Q. But it does for the H-E-A-R-T.

The Broncos play in Oakland today.  Normally this would be a cause of great drama, but the Raiders are only a shadow of their former selves and the Broncos have Peyton Manning. This used to be one of the greatest rivalries in the NFL, but you almost have to go back to the John Madden days for that. Howard Cosell belittling the Broncos on Monday Night Football. All those crazy fans in the rickety south stands of the old Mile High Stadium. The fans used to get on Madden, but he has said on national TV that he and his team would always get revved up to play in Denver. Madden, now a video-gaming gazillionaire, probably has softened with time. Those games could be brutal. Gradishar and Alzado and Jackson and Hayes and Stabler-to-Biletnikoff and Morton-to-Moses. My late brother Pat, the only one of us five brothers to play football in high school, was a Raiders fan. He liked the Broncos, too, but only when they weren't playing the Raiders. Wonder what he'd think of the present-day Raiders? I'll think of you today, Pat, when I'm watching the game, especially if (when) a fight breaks out.

I hear that Florida will soon bypass New York as the third most populous state. Not surprising, considering that millions of New Yorkers have deserted Syracuse and Buffalo and Albany for the Sunshine State. I spent about half of November in Florida and experienced first-hand that population boom. Orlando traffic is crazy. A commuter line, SunRail, is being built by Canadians (the original snowbirds) but even that may not help alleviate the congestion. I'm going to central Florida in a couple weeks for my niece's wedding. The difference this time is that I'll be driving instead of leaving that to others. Wish me luck. I live in a small city, one where drivers think nothing of stopping in the middle of the road to chat with neighbors. Our new two-lane roundabout has caused apoplexy in some old-timers who see it as a commie plot against the all-American tradition of streetlights and running those very same lights to cause horrible crashes. As I said, wish me luck.

Have a happy and healthy new year.

And when in doubt, check it out.

Year in Review: The Big C

My year can be summed up in one word: heart. Cardiac may be a better term, as my year was filled with issues related to the parts of the hospital with the other C-word in their names: Cardiac Lab, Cardiac Rehab, Cardiology, etc.

The condition of my heart first came to my attention on Jan. 2. The pain in my belly that was first diagnosed as intestinal flu and then as pneumonia, became a full-fledged heart attack on the day after New Year's Day. I related the story in my blog here and here. These blog posts came after the fact, as I was busily being ill for the first two weeks in January. During recovery, I had plenty of time to bemoan my fate and to ponder it. After generous doses of meds and rehab, I went under the knife again in July for an Implantable Cardioverter Defibrillator, a device that goes by the initials ICD. More recovery and exercise followed. Finally a clean bill of health was issued by my docs in the fall. They don't issue an actual Clean Bill of Health, although a cardiac patient is issued a dazzling arrays of bills for service.

The Cardiac Year.

The original Big C -- cancer -- played a big part in my year. Not for me, but for three of my siblings and several of my friends. Cancer runs in our family. My mother died of ovarian cancer at 59 and my father from prostate cancer at 77. My eight siblings and I all have been diagnosed with various forms of skin cancer, the legacy of growing up Irish on Florida beaches. My brother Dan was diagnosed with melanoma in his early 50s, but the docs caught it in time. Same with prostate cancer, which was treated and dismissed a few years later. Then leukemia came calling. This is the big leagues of cancer. Dan received big-league treatment at Houston's MD Anderson Cancer Center. But it came to naught, as Dan passed away just a few days shy of his 61st birthday. I wrote about this, too, but the words do not seem to assuage the pain. Some farewell posts for my brother here and here and here and here.

The Cancer Year.

Amidst the pain comes humor and its first cousin, politics. I had some fun with our conservative opponents this year. They are such easy targets, especially in this age of viral videos that reveal to all the world their knuckleheaded intentions. I had a great time documenting the comments of the legislature as it discussed a civil unions bill. You can revisit that event here. No aircraft carrier bill on the docket this year, but we can always look forward to 2014.

Some attempted humor on other topics here and here.

The Year of Living Crazily.

To sum up, Cardiac, Cancer and Crazies. The year of the Big C.

Wants the facts on the ACA? Go to the sources

Keep a few things in mind when trying to understand the Affordable Care Act.

Go to the correct sources for information. The main web site is http://healthcare.gov. That's where you find out the facts, ma'am (and sir). In Wyoming, look up Enroll Wyoming at http://enrollwyo.org. If you prefer talking on the phone, call 2-1-1. That's what smartphones are for.

Enroll Wyoming has a batch of navigators spread around the state. Three of them were at the town hall meeting in Cheyenne on Monday night. Their director said that she and her crew had given more than 30 presentations last week in Laramie County alone. At this point, there is probably no question that they haven't heard.

A crowd of 40 or so people heard a panel of experts spell out the ACA details at the Monday meeting.

In Wyoming, we are bombarded with misinformation from Know-Nothings. If you want to know the facts, avoid any comment or communique from the Republican Party. Don't read Rep. Cynthia Lummis's e-mail missives about Obamacare. Senators Barrasso and Enzi are no help either. Neither are state legislators with an "R" after their names. They all are so blinded by hate for our president that their lies never cease.

And Medicaid expansion? According to Phyllis Sherard, Cheyenne Regional Medical Center Population Health Officer, who was at the meeting, the Wyoming Hospital Association has spelled out the four main objections to Medicaid expansion and refuted each one. Go to http://wyohospitals.com. Here are some highlights of a recent press release from the WHA:

There are at least three key reasons that legislators should support the full expansion.   

First, the full expansion is good for Wyoming’s patients. One of the surest ways to improve overall health and control costs is for patients to receive the right care, from the right provider, at the right time. 

Providing coverage for more than 28,000 Wyoming citizens – often described as the working poor – will provide that access to care. We know that patients who receive preventive care, or who receive care earlier, tend not to be as sick when they do need care.

Second, the full expansion could save the state $47 million over six years, according to a study released by the Department of Health. These savings can only be achieved, however, if the Legislature supports the full expansion of the program. 

Finally, the full expansion will help ensure that Wyoming’s providers can continue to provide care for our vulnerable populations. In 2011, Wyoming hospitals provided about $200 million in uncompensated care – up from about $126 million in 2007.  At the same time, federal assistance for hospitals that treat large numbers of low-income and uninsured patients has been slashed. The impact of both the dramatic growth in uncompensated care and the reductions in this federal assistance would be significantly offset through the full Medicaid expansion.,

Who cares about hospitals? We do. Every community wants its own hospital so its citizens can be close to quality medical care. This isn't possible in Wyoming with its low population and great distances between centers of medical care. Casper currently is discussing the wisdom of adding a third hospital to its ranks. Cheyenne Medical Center recently added a cancer center and a state-of-the-art ER. Meanwhile, hospitals in Colorado and Montana and Utah beckon us with slick ads and promises of big-city medical care just a short drive over the border.

Medicaid expansion, it seems, is one way to ensure that our home-grown hospitals stay solvent and able to treat our rapidly aging population. I spent a fair amount of time and treasure this year at CRMC. As is the case with many in Cheyenne, I cast a dubious eye on our local hospital. I had a heart attack in late December and on January 2 had to be rushed to CRMC. I could have gone to Fort Collins or Denver but "minutes mean muscle" as those alliterative cardiologists say. The longer a heart patient goes without treatment, the more heart muscle can be lost. It's important that good care is close to home especially when it comes to the beating heart. I discovered that the Kardiac Kids at CRMC run a tight ship and make minutes count. There's a fine cardiac lab and a top-notch telemetry unit for recovery and a whole regimen of rehab.

I spent several hundred thousand dollars on my heart. I was lucky as I have insurance that I (and the State of Wyoming) has been paying into for 22 years. Some of those payments go toward paying some of $83 million over the past three years that CRMC has written off in uncompensated care. That shortfall has to come from somewhere. I've done my part and I'm not sorry. I could resent those "freeriders" that I paid for, but that wouldn't be very Christian of me, would it?

So get on with it, Wyoming Legislature, and expand Medicaid.

Hacking the heart signal

Imagine this....

You're the vice president of the United States. You have a heart attack and are fitted with an Implantable Cardioverter Defibrillator or ICD. At your bedside is a monitor that pulls readings from your ICD at 2 every morning and sends them to a computer at your cardiologist's office. An enterprising terrorist discovers a way to hack those signals. He sends a rogue signal to the Veep's ICD causing it to generate a massive shock that stops the Veep's heart and kills him.

I didn't make that up. It was a recent plot on the Showtime series Homeland. I read about it in this morning's edition of the Wyoming Tribune-Eagle. It was part of a story about former V.P. Dick Cheney 's Friday stop in Cheyenne to promote the book he co-wrote with his daughter Liz and his cardiologist about his long battle with heart disease. The book is Heart: An American Medical Odyssey. 

Cheney received an ICD in 2007. When he discovered its remote signal, he had the technicians disable it, stymieing any attempt by a hacktivist to hijack the signal and transform Cheney's main muscle into a bleeding heart. That's not the way he put it. But that's the way this bleeding heart interpreted it. He did have them disable the signal, which shows an active imagination and more than a little bit of paranoia. But any politician that started two interminable wars and considered waterboarding a patriotic act has a right to his paranoia.

Thinking back, it would have been keen to attend the noon book-signing and talk yesterday hosted by the Cheyenne Chamber of Commerce. Tickets were $50 apiece and that included a copy of the book. The last time I attended a book-signing by a conservative stalwart was in 1995 when I waited in line for hours to get Newt Gingrich's Restoring the Dream. It was a present for my conservative father. I would have done almost anything for my conservative father, including buying a Gingrich or Cheney book and even running for the U.S. Senate in Wyoming. Alas, my father passed in 2002 and has no more need of books or Senate seats.

Dick Cheney and I share a few cardiac traits. He had his first heart attack in Cheyenne, the first of five. I had my one and only heart attack in Cheyenne. He has an ICD and I have an ICD. As far as I know, none of my foes in the right-wing blogosphere has tried to hijack my signal, but that's only as far as I know. Cheney and I both have a daughter, although mine is not running for the U.S. Senate. He has another daughter, too, a married lesbian with a nice family. That daughter is not running for the U.S. Senate, although it's OK with me if she moves back to Wyoming and runs against her right-wing sister. That's not going to happen.

I have to hand it to Dick Cheney -- the guy has been through the ringer, health-wise. Heart attacks and heart transplants and ICDs. Now that I'm a heart attack survivor, I appreciate his struggles. He is right when he says about symptoms: "When in doubt, check it out." He is shouting out the news that heart disease is still the number one killer in the U.S. He praises good ol' American know how when it comes to heart gadgets and surgical techniques.

I do find it odd that the most heartless of contemporary U.S. politicians has had to face mortality via a faulty heart. Literally, he is not heartless.