Something new coming soon... just not here!

 In the first part of 2020, the world (as we know it in the USA) changed, at least temporarily (and so far ongoingly). Suddenly our church (Faith Family Fellowship) was unable to meet in person for services, and we started doing online services instead, recording the praise portion with a limited praise team and the sermon portion separately, then editing the video portions together into a single worship service video. I volunteered to assist as I had some limited prior experience doing video editing, and enjoyed the task as well (both prior and current). I also had a video camera that we could use for a second angle, and was able to edit the footage together with some pans and zooms added in post-production - for example, this service (or here on Facebook) - despite all the pans and zooms apparent in the praise portion, this was entirely shot with unmanned cameras on tripods. It was a huge effort (for me - probably like 5 minutes' work for someone with skills and experience), but I enjoyed it.

Then, suddenly, the ban on gathering in person was slightly lifted, and our church started meeting in person, with restrictions on gathering size, social distancing requirements, and additional cleaning requirements. However, our church decided to also begin live streaming our services as we started meeting in person, so that those who couldn't or didn't want to meet in person (due to the Coronavirus) could still "meet" with the church family and worship. The first live streamed service wasn't great (shot from a single phone down front in the sanctuary, unfortunately in a location where audio was very, very bad - essentially live video with a bunch of white noise for audio), but, as we'd already been in discussions about live streaming, I had already begun configuring a computer for the church to use for live streaming from some older leftover components that I'd upgraded in my own personal rig to use for the video editing. I got the system finished before the second week, and, along with a USB audio input box purchased by the church to allow a line from the sound board to the computer, things were much better. We continued to improve both the computer configuration and the live stream hardware (such as eventually adding PTZ cameras), and now it's in a pretty decent shape for live streaming our services (note: we don't currently pan/zoom live, but we do use presets in the PTZ cameras for changes in scenes). It's been a fun, occasionally frustrating, and overall satisfying experience, and it isn't over, as I'm still interested in doing live streaming as a side hobby/business. (I did a live stream for a friend's blacksmith shop, for instance, and while it didn't necessarily go as planned, or even great, it was adequate, I think, and I learned a lot of what not to do. His shop is really cool, by the way - you should definitely sign up for a class and go make something! They offer gift certificates, as well, so you can buy someone a gift and schedule a class later.) 

Having gone through this over the last year, I've decided to start a second blog/website devoted to live streaming. That's what's coming soon, on a new domain. Hopefully it will provide some resources and information to others who may be interested in setting up a live stream system for their own use, whether that's for a church, for a business, for your own hobby or entertainment, or whatever else you might want to use it for. I'm slowly getting it ready, and I'll let you know when it (really) goes live (the domain is live, but there's nothing really there, content-wise, yet).

As to me, I'm still kicking, although cardiac rehab won't let me push it too much (for instance, they told me I can't get on the rowing machine or the elliptical yet, as I tended to really get the heart rate up on those). And we're still doing the DASH diet thing, and my wife is still making delicious, low-sodium, low-saturated-fat meals. Life is good!

Cars, cars, cars...

 So, my son's 2009 Mazda 6 shredded its serpentine belt a few weeks back. It looked something like this:

After pulling the belt off, we found that the tensioner wasn't spinning, which was what was shredding the belt. So we pulled that off, and it looked like this:

Pretty sure that outer circle should be concentric with the inner one, not offset. That's a lot of rust, too. So, we ordered these parts:

Now, my son had to go out of town, so we borrowed my parents' van, which he took to a D-Now that he was leading. That Saturday, with a little help from my wife, we put the tensioner and the new serpentine belt back on, and everything seemed to work great! I also installed the replacement washer fluid reservoir, to replace the one that was damaged in an accident last year. During that process, I had to hammer a little of the steel back into place that had been twisted during the accident. I managed to clip my thumb at one point with the hammer, through the glove I was wearing and across/under the thumbnail. Do you recall that I'm on a dual anti-platelet treatment? Here's the result:

A week and a couple days later and it's still looking pretty much like that (just waiting on the under layer to heal and push the dried blood blister out). Still, I got it done, got the car put back together, and all seemed well. Took the car to get a couple new tires (as two of them were quite worn; it needs an alignment pretty badly) and filled it up with gas, too. It was a good, productive day. We even replaced some of the black tape with red tape after reinstalling the passenger headlight (which we removed to 1) replace the washer fluid reservoir; and 2) make it easier to get to some of the areas where the serpentine belt went). The red tape isn't a perfect match, of course, but it's nicer, I think, than the black (which is still present on the front, as we didn't replace all of it yet), and looks something like this:

My son got home that Saturday evening, and took his car to church the next day... and it was making an awful rattling sound (which it hadn't made the day prior). After we got it home, I made this recording:

After sharing with a few mechanic friends, it's pretty much been determined it's rod knock. My only question for my friend Murphy is why it couldn't have started that knock the day prior, before I filled it with fuel and put two new tires on it or even before we put the time, effort, and money into replacing the serpentine belt and tensioner (close to $200 for just the tires, well over $200 with tires, fuel, and the new tensioner and belt). That was an irritating day.

But, we still had the borrowed van (my parents were out of town for a couple of weeks), and that was quite useful in the interim. Since then, the boy has bought his first car on his own,  2021 Hyundai Kona. Looks a little like this:

He really likes that car (but got a nail in the left rear tire sometime yesterday; he did get that patched today, as it was cleanly in the tread). Also, it was a good experience at Allen Turner Hyundai in Pensacola - highly recommended if you want a new Hyundai (or Genesis, as they also sell those). Or perhaps a Chevy at their dealership in Crestview which is where we bought our Chevy Volt a few years back. I've also heard good things about Terry Thompson Chevy in Daphne, which is where we get our Volt serviced (the reason we went over to Crestview to buy the Volt is because of the fact that, when we bought it, they had both 2016 and 2017 Volts on the lot there, and the one 2015 Volt at a significant discount - in fact, it was the same price new as a used 2015 Volt with 10 or 20 thousand miles on it, and the new one was a Premiere model (uplevel) vs the base model used one, and the used one was also in Pensacola, whereas Terry Thompson didn't have any Volts in stock at the time we were shopping).

Anyway... anyone want to buy a 2009 Mazda 6 i Grand Touring - that probably needs a new engine, but has two literally brand new tires on it? It has all the goodies - heated leather seats, automatic dual-zone climate control, sunroof, blind spot monitor, automatic HID headlights, automatic rain-sensing wipers, heated auto-dimming side mirrors, etc.

Hmm... the drug post

I've recently discovered that there is a potential negative interaction between Proton Pump Inhibitors (omeprazole - AKA Prilosec or Zegerid, esomeprazole - AKA Nexium, etc.) and Clopidogrel (AKA Plavix), which is an anti-platelet drug typically administered post myocardial infarction (heart attack), especially after coronary stent placement. Specifically, the proton pump inhibitors reduce the effectiveness of the anti-platelet drug, which probably isn't a great thing for someone depending on the anti-platelet drug to minimize likelihood of a recurrent myocardial infarction. Now, the studies, such as noted in this article (from 2010), are mostly retrospective studies, and there are some other studies which indicate there is not an interaction. At any rate, the current FDA info on Plavix (Clopidogrel) indicates that proton pump inhibitors, especially omeprazole, reduce the effectiveness of the anti-platelet drug. For those needing clopidogrel, a good recommendation would be to switch from omeprazole or esomeprazole to something like famotidine (Pepcid) or ranitidine (Zantac), although ranitidine is now subject to a voluntary recall due to potential cancer causing agents.

So, why am I blogging about this? Because I had a myocardial infarction, and was prescribed clopidogrel, and also have gastro-esophageal reflux disease (GERD), which I have been over-the-counter treating with Nexium (esomeprazole) for many years. I included "daily Nexium" on my list of medicines, both at the hospital when I was having my heart attack and stent placement, and at my primary care physician at the post-heart attack follow up visit (and it was already in my records there, too), and at my cardiologist when I started seeing him at my first cardiology follow up visit. None of these (nor any of the three pharmacists where I've filled the clopidogrel prescription) gave any warning of interaction between esomeprazole and clopidogrel. I only just found out about this interaction this week. Now, my GERD has been quite severe at times (I'll spare you the rather nasty details from occasional bouts of really bad reflux), and I've (mostly) managed it with the daily Nexium (over the counter dosage, not prescription dosage). 

Probably at least a portion of my GERD is a result of my poor dietary habits and my growing waistline. Both of these have been significantly improved since the heart attack; starting on the DASH diet once we left the hospital (with a stent in one of my coronary arteries) has helped on both fronts (along with tracking both my nutrition and my overall intake via My Fitness Pal) has reduced both the frequency and intensity of my reflux. With that in mind, it seems that a switch to a less potent acid reflux medicine, such as Pepcid, would be a viable thing to do, especially in light of the fact that I'm currently taking clopidogrel to minimize the likelihood of another heart attack (especially related to the stent, which the platelets might otherwise want to adhere to, I guess). 

I'm just wondering why none of the doctors suggested switching away from the Nexium to something that doesn't have any demonstrated negative impact on the clopidogrel. All the doctors had a full list of the medicines I routinely take, and all knew that I had a stent placed, and all knew that I was taking clopidogrel to minimize the risk of having another heart attack, or stroke, or adverse reaction to the stent which opened up my right coronary artery from 95% blocked to less than 10% blocked. Interestingly, in the hospital two weeks ago, they gave me Pepcid to combat any acid reflux instead of Nexium, so someone knew something. But they said nothing, and sent me home to continue taking both the clopidogrel and the esomeprazole. Until I came across this info on my own (and while actually looking for something else, looking into the drug interactions of clopidogrel, and saw omeprazole and esomeprazole on the top of the drug interactions list; then again, perhaps I should have paid more attention to the drug facts sheet from my first filling of the clopidogrel prescription, but I was also recovering from a heart attack, and the prescribing facility, although new to me and I to them, knew of my daily OTC dosing of Nexium, as well as any other medicines I took on a regular basis, so I didn't think I had any reason to need to question the prescription of the doctors there).

I guess the moral of this story is: don't take anything new for granted, especially when it comes to medicines. Be sure to read the whole pamphlet, and/or research the drug online, especially interactions if you're taking anything else (or want to take anything else). I suppose it should go without saying that illicit drugs shouldn't be included in any collection of medicines you're considering to take. But, there, I said it. And I'm about to go order some Pepcid on Amazon.

Another day, another doctor visit, another deductible... and a joke!

Since our last installment, I've had two doctor appointments: one with my primary care physician, and one with my cardiologist (who is part of the cardiology group that was involved in my treatment at the hospital last week). Neither visit was particularly revealing; in fact, both seemed more a waste of time and money (deductible) than informative and useful. That said, I probably would do both again if this happens again (at least in part because the cardiologist, while saying he didn't believe any additional tests were needed at this time, said that were it to happen again, he would order additional tests, likely to include a 30-day (or longer) heart monitor). I think perhaps my primary care physician was overbooked, as it seemed she had a lot of patients come in all at the same time as my appointment (she's usually pretty good, but it seemed quite rushed this visit).

Since those visits, however, I did a little research on my own, and I believe that what I experienced last Monday (that is, Monday of last week) is "post exercise syncope" or "post exertion syncope" - as can be described in this article (an interesting read, where a pacemaker was eventually implanted to prevent post-exertion syncope in the 29-year-old case study) or this article. I don't think what I experienced was "exertion syncope," as can be found in this article, which describes both post-exertional syncope and during-exercise syncope:

Post-exertional syncope frequently occurs when exercise is stopped suddenly and reduction of lower extremity muscle pumping results in less cardiac venous return and cardiac output. In such a circumstance, an acute increase in myocardial contractility can lead to activation of the cardiac depressor reflex inducing concomitant paradoxical bradycardia. As a result, the athlete may develop acute loss of postural tone, hypotension, and therefore transient global cerebral hypoperfusion – this is termed the Bezold-Jarisch reflex. Contributing factors likely include dehydration and reduction in plasma volume. Syncope immediately post-exercise which occurs when the subject is still standing, is usually less concerning than syncope during exercise.

Syncope which occurs during exercise raises concern for structural heart disease and can serve as the only symptom that precedes sudden cardiac death. The differential diagnosis for life-threatening causes of syncope in athletes includes hypertrophic cardiomyopathy (HCM), anomalous coronary artery, arrhythmogenic right ventricular dysplasia (ARVD), ion channelopathies such as Long QT Syndrome (LQTS) or the Brugada Syndrome, myocarditis, and even previously undiagnosed congenital heart disease such as noncompaction cardiomyopathy. Although not necessarily associated with underlying native structural heart disease, commotio cordis is an important cause of syncope and is characterized by sudden cardiac death attributable to cardiac contusion from trauma to the precordium. Heat stroke or hyponatremia must also be considered in patients with exercise related syncope.

Although my "symptoms" seemed to start during exercise, it wasn't until I'd stopped exercising (and some small amount of time later, in particular, after stopping all movement altogether and sitting in a chair to rest) that the syncopal episode occurred. That said, given that I had a myocardial infarction (heart attack) just over two months prior, it's still cause for concern, although apparently not really to the cardiology group (having observed my ECG over two days in the hospital and performed a tilt-table test prior to discharge). But it was concerning enough to the cardiac rehab center that they didn't want me to return until they had direct confirmation from the cardiologist that I was approved to resume cardiac rehab. In general, it seems the cardiac rehab team are more concerned about the episode than the cardiologist group; in fact, it turns out, they had been monitoring my case remotely throughout the day on Monday after I was taken to the ER via ambulance. A short, expensive ride (although the ambulance claim hasn't been submitted to my health insurance yet). Also, there was a period during the syncope of bradycardia, which can be quite alarming; for about 24 seconds, my heart rate was about 20 beats per minute. That's one beat every 3 seconds. And it dropped to that from over 100 bpm very quickly; and after about 24 seconds, just as quickly rose back up to over 100 bpm. But, near as I can tell, I think that's not necessarily uncommon with vasovagal syncope, but it is a bit disconcerting when you see it on an ECG (I was being monitored at the cardiac rehab center at the time of the episode).

All that said, overall, I think I'm doing well. We'll see Monday how it goes on my return to cardiac rehab; I do plan to take it a little easier than I had last week, and will follow whatever guidelines the cardiac rehab staff want to put in place. I can tell you this: I will be tired Monday morning, even before the exercise begins, since Daylight Saving Time starts this Sunday, so Monday will only be day #2 in the "earlier to rise" setting (so, doubly-early: earlier than I used to rise before starting cardiac rehab, and earlier than the prior week by an hour due to DST). I think I may end up in bed much earlier Monday evening than usual.

As for the deductibles, I really wish preventive appendectomies were a thing. I would sign up the whole family. And maybe go ahead & take out anything else that might be a future issue waiting to happen: gallbladder, one of the kidneys, a tonsils if they haven't been done... let's get all the things done while it's on the dime of my insurance instead of me. After all, the Dec 31 timing of the heart attack meant twice the deductible in early 2021 (because of starting and finishing 2020's deductible all on the last day of 2020, to be paid in 2021). Fortunately, it's better than the $63k that was billed for the initial heart attack, along with the over $6k for the episode last week, and the more than $5k for cardiac rehab (when all is said and done). We'll be OK, and surprisingly, we've managed to get some of our credit paid off over the last year plus. Eating in seems to be a lot cheaper than eating out (not to mention much, much healthier!). Also, I promise you, my wife is going to be blogging about all of this in the not-too-distant future, too; she's very busy recently (what with caring for a cardiac patient, learning about cooking low sodium and low saturated fat and all the other things, attending cardiac rehab three days a week as my "heart mate" - at a much lower cost than my own attendance, and going to school to study elementary education with an eye on becoming a teacher in the future... she's super-busy! but she's been noting things down, and considering plans, and we'll get her a blogging address set up for her to put to the public everything she's learned, tips and tricks, helpful suggestions, and general encouragement for those in similar situations).

So... did you hear about the butcher who accidentally backed into his meat grinder? He got a little behind in his work.

Later, all...