Some good news and some bad news.

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Some good news and some bad news.

Postby owleye on July 18th, 2014, 9:37 am 

First the good news. The problem I'd been complaining about over the past couple of years and I'd been suspicious about for longer than that has been found. it was finally detected in a routine visit to check my blood pressure. And the bad news is the problem they found. Apparently I'd been suffering from atrial fibrillation that had occurred only in the presence certain patterns of exercise, notably following attempts to run, then jog, then periodically trot as my age has advanced. For the last six months or so, I'd been reduced to only walking, and now merely walking my dog on a daily basis, though the heat and mosquitos become a nuisance. Stress tests, e.g., with treadmill had failed to show a problem. I'd been taking medication for hypertension for the last twenty-five years and this may have contributed to it. Sort of a can't-win thing.

It was finally detected in the usual way by the routine check using a stethoscope, with a confirmation from an in-office quick EKG. Don't know what triggered it, but as everyone knows, those deep breaths that are part of the routine cause the heart to start beating a little faster and stronger, so this is what my doctor linked it to. In any case, I'm now in a waiting state while she (my doctor) contacts my busy cardiologist who comes to our main hospital/clinic on Fridays, traveling some distance from St. Cloud to Wadena, as part of his route. Wadena itself is a half an hour away from us. We have hopes he can squeeze me in on short notice today, but if not, then next week, where in the meantime I await instructions on whether there is a need to start me on Cumadin, the purpose of which is to lower the risk of a stroke. No clot was detected and it appears I have some tolerance built up to such a condition, as I hadn't detected it myself. A drop in blood pressure is how I notice it and indeed, I was a bit surprised when my bp reading showed 127/83 even as the appointment was late in the day. It makes me wonder whether the condition I had in the office is now more of a permanent condition.

So, why am I telling you this? Well, I'm now getting news that puts me closer to my demise and though I don't yet know what my prognosis is, I'm now paying more attention to what I need to do to help my family deal with my condition and my eventual absence, which includes my obligations to this forum, one that is part of my life and wish to make a proper good bye when the time comes, thanking all those from which I've found inspiration.

James
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Re: Good Company

Postby Faradave on July 18th, 2014, 10:57 am 

James,

I always enjoy your posts and if for any reason you are unable to continue as moderator, I hope you will continue to drop by with words of wisdom.

There are many thousands of people going around with chronic a-fib, lots of whom don't even realize it. A-fib is not a desirable condition as it is associated with increased risk of coagulation events. Normal, organized atrial contractions flush out the atria before blood can coagulate. A fibrillating heart shivers rather than contracts and so doesn't empty as well. It may thus contain regions of relatively sluggish flow. There are a number of blood thinners (anti-coagulants) available today which greatly reduce the risk. Coumadin (warfarin) being generic, is the least expensive and has the most experience but requires careful adjustment to the right dose and there's a list of medications, such as aspirin which must be avoided because it interferes with coumadin's effects.

Nevertheless, millions of people manage quite well for years and years with a-fib and on these medications. My mother (88) has been fibrillating for about 10 years now and is on Plavix (clopidogrel), another blood thinner. I spoke to her last night (like you, she enjoys scientific and other academic discussion) and she fully expects to break the century mark.

I wish you well and expect we are far from hearing the last of you.
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Re: Some good news and some bad news.

Postby BioWizard on July 18th, 2014, 12:35 pm 

I'm glad to know the problem was finally diagnosed so your doctors can begin to manage it properly. And you'll be with us for a very long time :)
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Re: Good Company

Postby Marshall on July 18th, 2014, 1:16 pm 

Faradave » Fri Jul 18, 2014 7:57 am wrote:James,
I wish you well and expect we are far from hearing the last of you.


I very much concur! James, I read the wikipedia article Dave linked to. It's a good article I think.
http://en.wikipedia.org/wiki/Atrial_fibrillation

In the epidemiology section http://en.wikipedia.org/wiki/Atrial_fib ... idemiology it said that atrial fibrillation affects about 8% of the population over 80 years of age.
My aunt (after she retired) lived with chronic fibrillation for some 15 years. She had been a nurse (I think she knew as much as the doctors but was tactful about it) and she was fortunately able to avoid the dangers both of stroke and of bleeding caused by anticoagulant medication.

Dave, I liked your explanation why fibrillation increases risk of clot formation, and thus of stroke. It's intuitive and makes sense.
There are many thousands of people going around with chronic a-fib, lots of whom don't even realize it. A-fib is not a desirable condition as it is associated with increased risk of coagulation events. Normal, organized atrial contractions flush out the atria before blood can coagulate. A fibrillating heart shivers rather than contracts and so doesn't empty as well. It may thus contain regions of relatively sluggish flow. There are a number of blood thinners (anti-coagulants) available today which greatly reduce the risk...

Nevertheless, millions of people manage quite well for years and years with a-fib and on these medications. My mother (88) has been fibrillating for about 10 years now and is on Plavix (clopidogrel), another blood thinner. I spoke to her last night (like you, she enjoys scientific and other academic discussion) and she fully expects to break the century mark.


Starting from the main article you linked to, I found this side article on management of the condition. I looked at it but didn't find it as understandable as the main article, or your explanation:
http://en.wikipedia.org/wiki/Management ... brillation
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Re: Some good news and some bad news.

Postby CanadysPeak on July 18th, 2014, 2:09 pm 

owleye » Fri Jul 18, 2014 9:37 am wrote:First the good news. The problem I'd been complaining about over the past couple of years and I'd been suspicious about for longer than that has been found. it was finally detected in a routine visit to check my blood pressure. And the bad news is the problem they found. Apparently I'd been suffering from atrial fibrillation that had occurred only in the presence certain patterns of exercise, notably following attempts to run, then jog, then periodically trot as my age has advanced. For the last six months or so, I'd been reduced to only walking, and now merely walking my dog on a daily basis, though the heat and mosquitos become a nuisance. Stress tests, e.g., with treadmill had failed to show a problem. I'd been taking medication for hypertension for the last twenty-five years and this may have contributed to it. Sort of a can't-win thing.

It was finally detected in the usual way by the routine check using a stethoscope, with a confirmation from an in-office quick EKG. Don't know what triggered it, but as everyone knows, those deep breaths that are part of the routine cause the heart to start beating a little faster and stronger, so this is what my doctor linked it to. In any case, I'm now in a waiting state while she (my doctor) contacts my busy cardiologist who comes to our main hospital/clinic on Fridays, traveling some distance from St. Cloud to Wadena, as part of his route. Wadena itself is a half an hour away from us. We have hopes he can squeeze me in on short notice today, but if not, then next week, where in the meantime I await instructions on whether there is a need to start me on Cumadin, the purpose of which is to lower the risk of a stroke. No clot was detected and it appears I have some tolerance built up to such a condition, as I hadn't detected it myself. A drop in blood pressure is how I notice it and indeed, I was a bit surprised when my bp reading showed 127/83 even as the appointment was late in the day. It makes me wonder whether the condition I had in the office is now more of a permanent condition.

So, why am I telling you this? Well, I'm now getting news that puts me closer to my demise and though I don't yet know what my prognosis is, I'm now paying more attention to what I need to do to help my family deal with my condition and my eventual absence, which includes my obligations to this forum, one that is part of my life and wish to make a proper good bye when the time comes, thanking all those from which I've found inspiration.

James


James,

Been there. Done that. It's right darn confronting. Go with my best wishes for a good outcome. Cumadin is a PITA, but it really helps. If you get on it, go to the drugstore and ask for a product called Wound Seal (there may be similar ones with similar names). If you wind up in the hospital, ask 'em if they have a local Zipper Club. That's a bunch of old farts like us who've been through this and can help you deal with the changes that might come.

Be well,

Tom
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Re: Common but varied condition

Postby Faradave on July 18th, 2014, 4:46 pm 

Marshall wrote:...side article on management of the condition. I looked at it but didn't find it as understandable as the main article...


Though a-fib is a common condition, treatment is individualized to the patient. The good news here is that the cardiologist is very familiar with all the variations and family doctors are also quite adept at managing according to the established plan. Every practice will have several such patients.
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Re: Some good news and some bad news.

Postby Braininvat on July 18th, 2014, 6:47 pm 

Hope you can manage this and feel better, James. I'm not an old guy yet, but sometimes the ticker will go ka-chunk or flutter oddly for a moment (I was born with a slightly off-brand mitral valve) and it reminds me to get on with my life and carpe as much diem as possible.

all the best,

paul
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Re: Some good news and some bad news.

Postby owleye on July 18th, 2014, 9:04 pm 

I cannot begin to thank all of you enough for your kind thoughts on this condition. I've learned a lot in the last couple of days and welcome all of your observations. As it happens, I did manage to see "my" cardiologist (which in fact was a different one that I'd previously seen, though out of the same office). There was a late cancellation, so I was able to get his full attention. I tend to make a quick judgment of doctors based on how they present themselves and I confess I concluded that I'm neutral over this one, but I follow the advice of doctors, so I don't believe I will be affected by such a judgment. In any case, after determining that I'm one of those who are now among those having this condition, he put me on Coumadin, ordering it from Rightsource, for those of you who know who they are. When it arrives, I'll be getting some lab work done to establish the regimen I'll be using (assuming that I'll adapt to it). In the meantime, I'll be taking aspirin. In addition, because he also found the symptoms present while I was with him, he has me strapped with probes the purpose of which is to record the signals from my heart just to see how often I go in and out of it over the next 24 hours.

And, I'm told, that with Coumadin, the chances of a stroke (according to the doc) are reduced to 1%, so if I'm a good patient, unlike in the case of one of my (ex-)relatives, I should be able to weather this condition and continue to have a rich and fulfilling life ahead of me. Even so, of course, I suspect my relationships with others will be altered and I'll have to change some priorities. I even understand that changes in my diet are in store, so I'll have to think more carefully about what I eat.
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Re: Some good news and some bad news.

Postby mtbturtle on July 19th, 2014, 7:29 am 

James,

Glad you are figuring out what the problem is and on top of treatments.
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Re: Some good news and some bad news.

Postby owleye on July 19th, 2014, 9:52 am 

mtbturtle » Sat Jul 19, 2014 5:29 am wrote:James,

Glad you are figuring out what the problem is and on top of treatments.


Well, maybe, but not entirely. I understand that my odds of having a stroke may be reduced, but the atrial fibrillation may have other effects as well. I may in fact be in need of a pacemaker. The heart itself in order to be useful might have had to become stronger as a reaction to the inefficiencies due to the irregularities in heart rate and the occasional loss of synchronization between the atrial and the ventricle chambers of the heart and over time, its had to change its beating patterns to compensate, as well as hardening the cellular walls because of that beating. Over a lifetime of exercise, my resting heart rate is somewhat low. I've even had readings that are as low as 38 bpm. However, when more oxygen is needed, the heart quickly adjusted and my pulse jumped up quite rapidly. If the a. f. that I'm now in "at rest" is my new norm, I'm just not sure what's going to happen. Already my resting heart rate is generally higher, I think.
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Re: Some good news and some bad news.

Postby BadgerJelly on July 19th, 2014, 10:02 am 

I hope the good outweighs the bad for you whatever you do.
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Re: Some good news and some bad news.

Postby Natural ChemE on July 19th, 2014, 2:50 pm 

owleye » July 18th, 2014, 8:04 pm wrote:I should be able to weather this condition and continue to have a rich and fulfilling life ahead of me.

Ah, good! So the forums won't be suddenly getting dull.

Gotta admit, though, the 38 beats per minute thing? Jeeze, that's impressive! What were you doing, running a marathon every weekend?
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Re: Some good news and some bad news.

Postby owleye on July 19th, 2014, 9:57 pm 

Natural ChemE » Sat Jul 19, 2014 12:50 pm wrote:Gotta admit, though, the 38 beats per minute thing? Jeeze, that's impressive! What were you doing, running a marathon every weekend?


I don't know. Maybe it's a symptom of something else. I used to run a lot (maybe forty miles a week was an upper limit), and enjoyed the 12-17 mile Saturday morning runs through the foothills of the Santa Clara Valley when I was much younger. I did get around to running a couple of marathons, but was never fit enough to run it straight through. I probably managed to be able to do 20 miles of running at a pace of 6 1/2 min/mile, but I can't say I was ever competitive. It's the one physical thing I love to do, and I've now reached an age where I have to let that go. (There are folks who in fact can be runners at an advanced age -- even up to 100, I guess, but I'm afraid that's not me. Note that in age-group racing, the last category is 75 and above. More power to those in that category, but though I used to sign up for them while up to the 70-74 group, by the time I got to 74, I was reduced to going so slow that I can't really say I was actually in it.)

For the most part, my heart rate was in the low to mid fifties, though there were periods when it was in the forties. Somewhere along my decline, I think it began to rise into the 60s, but I'm not sure, as I didn't really think much about it. When it showed 76 while in this atrial fibrillation condition "at rest", I realized something must be happening that isn't usual for me.
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Re: Some good news and some bad news.

Postby Hendrick Laursen on August 26th, 2014, 3:38 pm 

Well, I don't know much medicine, just I can say I hope you win your health back.
Take good care, James.
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Re: Some good news and some bad news.

Postby owleye on August 26th, 2014, 7:07 pm 

Hendrick Laursen » Tue Aug 26, 2014 1:38 pm wrote:Well, I don't know much medicine, just I can say I hope you win your health back.
Take good care, James.
Hend


Thanks for your message and sentiment. Things are a little more routine now. Taking Coumadin religiously and have been told the heart, while seemingly confused (my BP readings using a new BP measuring device seems to go crazy on me. I'll have to (work with my doctor to) figure out how to deal with that. I don't feel worse for the wear, except of course being in a state of old age, I, like many, suffer from all sorts of old age infirmities. I advise not getting old. The cardiologist, which at this point I don't have a whole lot of confidence in, seems to think that except for having a higher heart rate at times and a lower heart rate at other times, I'm ok. Apparently Aphib isn't all that big a deal. I don't need a pacemaker, according to anybody and I'm glad to hear that. I confess I do read all the obits.
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Re: Some good news and some bad news.

Postby CanadysPeak on August 26th, 2014, 7:23 pm 

owleye » Tue Aug 26, 2014 7:07 pm wrote:
Hendrick Laursen » Tue Aug 26, 2014 1:38 pm wrote:Well, I don't know much medicine, just I can say I hope you win your health back.
Take good care, James.
Hend


Thanks for your message and sentiment. Things are a little more routine now. Taking Coumadin religiously and have been told the heart, while seemingly confused (my BP readings using a new BP measuring device seems to go crazy on me. I'll have to (work with my doctor to) figure out how to deal with that. I don't feel worse for the wear, except of course being in a state of old age, I, like many, suffer from all sorts of old age infirmities. I advise not getting old. The cardiologist, which at this point I don't have a whole lot of confidence in, seems to think that except for having a higher heart rate at times and a lower heart rate at other times, I'm ok. Apparently Aphib isn't all that big a deal. I don't need a pacemaker, according to anybody and I'm glad to hear that. I confess I do read all the obits.


James,
I'm darned glad it's settling out. I'll go out on a limb (I do that every few hours, don't I?) and advise you that, if you have no faith in a doctor, change doctors. It's bad enough having your life depend on some guy you see for 12 minutes every 6 months, so you gotta be comfortable with him, and especially with the office staff. It's good to read the obits. You're at an age where you need to start going to people's funerals, else they won't come to yours.
Cheers.
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Re: Some good news and some bad news.

Postby owleye on August 26th, 2014, 7:55 pm 

I have confidence in my primary doctor. She, of course, will refer me, as needed to specialists. The team of cardiologists are located far away and as part of their coverage area, come every so often to our area, of which I have to travel some 30 minutes or so to meet with them. The doctor I saw first was ok and signed me up for cardio testing, where nothing abnormal was found, however he was busy with this latest episode, discovered by my primary doctor, and the referral went to his partner (in the legal sense) and who put me on Coumadin, though this was by then expected. I'm not sure how much control over who I see, and I'm not reticent to give my opinion about who sees and has sees me, but what I find is that my local physician in town is very knowledgeable anyway and reads the same reports the cardiologist reads from, so I'm not all that worried.

Let me say that with a long history of trying to find out how everything works, I've resigned myself to going with doctors advice, with the proviso that I'm aware that it's all very complicated anyway, even for doctors, and also that I need to be very wary of elective surgeries.
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Re: Some good news and some bad news.

Postby BioWizard on August 26th, 2014, 10:28 pm 

Wait a minute. James. Did you say you could run 20 miles at 6.5 min/mile pace?
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Re: Some good news and some bad news.

Postby owleye on August 27th, 2014, 8:49 am 

BioWizard » Tue Aug 26, 2014 8:28 pm wrote:Wait a minute. James. Did you say you could run 20 miles at 6.5 min/mile pace?


Well, yes. But that now feels like so long ago that it's almost impossible to imagine. I can't ever say I excelled as a runner, but I did have a passion for it and gave it a fair amount of priority during those years. As I began to decay my mind holds on to the idea of improvement, yet at some point I had to realize that the decay rate exceeded any possible rate of improvement. indeed, muscle loss is so rapid that any weight loss (even due to exercise) becomes a loss of strength, not a loss of fatty tissue. It's probably the advertising world, but the younger set doesn't actually get that things are different in old age. Advertising makes it seem as if we are all just like the exceptional who think we can all be like them if we do what they do.
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Re: Some good news and some bad news.

Postby Braininvat on August 27th, 2014, 1:19 pm 

Yes, I've been mildly amused at the idiotic tv ads (back when I watched broadcast tv) that depict some 80-plus year old snowboarding or break-dancing, and then peddling some health product with the suggestion that every old person can be like this if they just take the right supplements or put a massaging spray head on the shower or whatever. Snowboarding 80 year olds are outliers, to borrow Malcolm Gladwell's term, and usually have been exceptional athletes with exceptional genes and formidably strong joints.
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Re: Some good news and some bad news.

Postby owleye on November 17th, 2014, 4:22 pm 

Apparently over the past three weeks my body has undergone further deterioration. Results of tests (which I'm about to take) are not in, but my doctor is very concerned. I had attributed my symptoms to a change in diet, but she noticed a jaundice condition. And this means that my liver (or even my pancreas) is not functioning well and may be impeded in its functioning by a growth (i.e., cancer). We'll see.
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Re: Some good news and some bad news.

Postby AllShips on November 17th, 2014, 6:29 pm 

Owleye,

I just noticed this post. I'd like to wish you well with your health challenges. From reading your posts here over the last year or so -- many of which go way over my head -- you strike me as a person of uncommon knowledge and wisdom.

So you'd better stick around. We need you.

Warmest regards.
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Re: Some good news and some bad news.

Postby owleye on November 17th, 2014, 8:10 pm 

AllShips....

Thanks for your support on this matter and the kind words as well, which I'm afraid I'm not able to live up to. In any case, I hope you can remain in contact with this board and put the successes of science in their proper context. There are a number of philosophical camps that have taken science to task. And there is at least one camp which thinks that the philosophy of science is philosophy enough. I think the assumption is that all other topics that philosophy attends to have already been subsumed within science and that philosophy should just beg off. That may be, but I'm guessing that science isn't prepared to take on that responsibility. Jn any case, it will your keen sense of understanding that will discern science oversteps its own status.

I'll leave off now as I have further info on my condition that I want to pass along.
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Re: Some good news and some bad news.

Postby owleye on November 17th, 2014, 8:31 pm 

Ok. The results of the two catscans (chest and abdominal area) are in. The radiologist apparently wants to do another exam, because what's blocking the tiny bile duct isn't visible. My doctor, however, wants to consult with an oncologist before administering more tests. There are a number of possibilities, the best being a simple inflammation, the worst being a cancerous growth. She will be giving me a prescription to alleviate swelling just so that if this is a factor it will help with the symptoms: (itchy skin, bad hacking cough (note lungs are actually ok), gout (which recurred), changes in stool and urine, jaundice, loss of appetite and taste, weight loss).

For those interested in my atrial fibrillation, you know that the blood is tested regularly to make sure the dosage of Warfarin provides an INR reading of between 2.0 and 3.0. (Normal is under 1 for those not with this condition.) Over the last several readings, my reading has been 2.5 or 2.6 on 2.5 mg dosage per day (well every day but Wednesday, when no Warfarin is taken). That's as it was three weeks ago. This time, however, the tester failed to give a reading after three trials and my blood had to be sent to a lab that could make a reading. The assumption my doctor made was that the reading would be out of bounds on the high side. She was right. It turned out to be over 11. So, I'm off warfarin and now on Vitamin K (which should correct it, but only gradually as is desired).

In any case, we'd had plans to travel (back to WA) next week, so at this point that's up in the air. My doctor is working overtime to tackle this condition and I have great confidence in her.
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Re: Some good news and some bad news.

Postby mtbturtle on November 17th, 2014, 8:35 pm 

Fingers crossed for you James. Let me know if there is anything we can do for you.
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Re: Some good news and some bad news.

Postby owleye on November 18th, 2014, 9:33 am 

Thanks mtb....

I'm still in limbo, trying to get a night's sleep. I hope the anti-inflammation drug works. I think the oncologist is being consulted because my doctor thinks the best hope is to obtain a definitive picture of the blockage. And that this will require an invasive procedure to get the best perspective on it. Unlike for the colon, it probably won't be easy to couple this with scissors to extract a polyp, if it is found. One may hope that other alternatives exist to isolate it and even cause it to crumble, say using radiation, but I'm out of my depth here.

And, though not specifically mentioned, there is a possibility that it's a virus that is affecting the liver (or other digestive organ) and at this point my doctor may not be keenly aware of the entire panoply of possible viruses that might be considered. Right now, however, she thinks it's a growth. Note that gallstones are more often considered here, but in my case they have been ruled out on the basis that I'm not in any pain. My guess would tend to run that if it is a growth it's exterior to duct(s), not interior. However, this theory wouldn't make a lot of sense unless there was a hard surface on the other side of it that would enable it to be pinched off and, unlike in lung cancer, where the rib-cage could be that surface, I'm just not sure how fixed these organs are.
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Re: Some good news and some bad news.

Postby owleye on November 18th, 2014, 2:38 pm 

Ok. New status. The oncologist didn't want to advise on the invasive procedure at this time, so instead it was agreed that a new test would be needed to gather more info. An MRI/MRCP (qv) is scheduled for Thursday PM, a follow up with the oncologist (a Dr. Swenson, out of the Mayo Clinic), the following Tuesday. Our planned trip (as well as other events we counted on) are now cancelled. I've started the Prednisone that should/could alleviate the symptoms.
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Re: Some good news and some bad news.

Postby Marshall on November 18th, 2014, 4:39 pm 

AllShips » Mon Nov 17, 2014 3:29 pm wrote:Owleye,

I just noticed this post. I'd like to wish you well with your health challenges. From reading your posts here over the last year or so -- many of which go way over my head -- you strike me as a person of uncommon knowledge and wisdom.

So you'd better stick around. We need you.

Warmest regards.


Amen to that! Hang in there, James. We're rooting for you. Doctor sounds smart and engaged. I'll look up "MRI/MRCP". With luck, she and Dr. Swenson will figure out how to eliminate the blockage.
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Re: Inflammation vs. Obstruction

Postby Faradave on November 18th, 2014, 6:15 pm 

It sounds as if your liver was having a hard time metabolizing the warfarin, so it built up in your system giving you high levels. Its a blessing that it was caught and reversed with vitamin k or it might have led to serious bleeding.

That sounds more characteristic of a general liver malaise, as you suggest with virus, such as hepatitis. I'm sure they're checking this. Obstruction, such as by tumor or gall stones (which can also be like sand or sludge) is a possible cause but I think, less likely as it is more local. I would expect them to have seen dilated bile ducts on the scans if there was a down stream blockage.

In any case, I join the others in wishing you well. As I am among those who pray, consider yourself on the list.
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Re: Some good news and some bad news.

Postby Dave_Oblad on November 18th, 2014, 8:24 pm 

Hi James,

I too hope for the best for you. Hang in there and keep us posted.

Best wishes,
Dave :^)
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