IEEE Consultants' Network of Long Island

Rising Bubbles - John Dunn, Consultant, Ambertec, P.E., P.C.

I've always been a little bit curious about those really small bubbles that are dispersed in tap water, especially during the summer, and which rise so slowly to the top.

These pictures were taken at roughly ten second intervals. It took over a minute for the bottom most bubbles to rise only four inches to the top. Larger bubbles blown through a soda straw rise through that vertical distance almost immediately.

Why are the smaller bubbles so much slower than the larger bubbles?

Fourth Heart Attack, Part 11 - John Dunn, Consultant, Ambertec, P.E., P.C.

More about breathing:

The occupational therapist who was working on me noticed something. I had spoken of feeling a tendency to faint when rising from a chair. I never actually fainted, but the effect was there. Her observation about that was that I was rising too quickly and that I was holding my breath for a moment when doing so. That needed correction.

When rising from the chair, I was instructed to rise slowly and to not hold my breath at all. I tried to conform to this directive in the next few days during which I noticed that if I were to inhale while rising, the impulse to fainting became worse, but I were to exhale while rising, the impulse to fainting became less.

The occupational therapist was surprised by my reporting this, but later, the visiting nurse had something to say. The nurse told me that what I had discovered is a well known issue. Weight lifters, I was told, are trained to only exhale while lifting heavy loads.   

I was told that when I am about to get up from a chair, I am to first inhale through my nose and then while rising, to exhale by blowing air out through my mouth as though into a straw.

I've since been following that instruction and things are indeed better.

Fourth Heart Attack, Part 10 - John Dunn, Consultant, Ambertec, P.E., P.C.

Breathing:

A breathing tube had been inserted during my surgery and when I came out of anesthesia, my windpipe was super irritated. Apart from a feeling of sheer rawness, trying to take a deep breath would induce a very painful spasmodic cough. They told me that was a good thing.

My lungs were full of fluid which needed to come out. The spasmodic cough would accomplish that removal and was quite necessary for that purpose, even though it was painful. That red, heart-shaped pillow they'd given me was to be pressed against my chest wall while coughing to diminish the pain. To some extent the pillow helped, but there was a lot of pain anyway.

I was also given this device with which to do breathing exercises.

The patient inhales at the mouthpiece which causes the blue plunger to rise along the calibrated main column. At first I was only able to make the plunger rise to 2000 mL, but today I am able to get it up to 3750 mL. The limiting factor was always that painful, spasmodic cough but that is definitely on the mend.

A cautionary note: If you want to visit a heart patient such as myself, do NOT go if you have even the slightest of respiratory illness yourself. If what you have transfers to that patient and sneezing or coughing starts to happen, that patient will be put through hellish pain, over and over and over again.

I would say that the phrase "the tail end of a cold" is absoluteley the STUPIDEST phrase to which anyone can be subjected. If you've had a cold and the symptoms are in decline but are still there, it doesn't matter how mild those symptoms have become because you are STILL CONTAGIOUS so stay away!!!!

Fourth Heart Attack, Part 9 - John Dunn, Consultant, Ambertec, P.E., P.C.

A couple of additional aspects of having returned home:

 

Heart rate:

My doctor's instructions were to take my medicines at eight hour intervals in the prescribed doses. For one medicine though, I was to take it or not to take it depending on my systolic blood pressure and my heart rate.

Post surgery while in the hospital, my heart rate was in the one-hundred-thirties, way too high above anything normal. I was told that those numbers were the result of atrial fibrillation and needed to come way down before I could be discharged. The heart rate stayed stubbornly high for several days which I think was beginning to cause some concern and then, one magical morning at 10:30 AM, the heart rate was seventy-one.

Subsequent readings were in the seventies as well so I was discharged.

At home, I needed to track my numbers too. I measured heart rates of 78, 80, 76, 69, 73, 76, 73, 84, 68, 72, 71, 68, 73, 68 which is just where they should be and then one night at 11 PM, I measured a very scary heart rate of 118.

Did that jump in heart rate mean I was lapsing back into atrial fibrillation?

I called my doctor and he told me to take my medicines as usual, then measure myself in the morning and call him to report the result whatever it may be. I did. The morning heart rate reading was 69. Good!!

On the night of that elevated number, I had been watching "The American Experience" on PBS television about the early days of NASA and the space program. It was part one of three. That first program had ended with footage from the Kennedy assassination to which I felt myself react. I asked my doctor if the elevated heart rate could have come from that reaction and the doctor said it might be so. 

During my next visit from the visiting nurse, I related this story and she said that what had happened to me was not at all unusual. Stresses of most any kind can produce results like that. She told me that when she arrives at a patient's home, she always takes the "vitals" measurements first thing before discussing anything that might evoke a stress response.

I felt better.

 

Egotism:

With Judy, it's always been possible to discuss a multitude of topics. We talk about the grandsons, what's in the news, about the house and the yard, but with everyone else, it's sometimes hard to do that.

Through all this heart trouble, I have conversed at length with other family members, with friends, with doctors, with nurse practitioners, with nurses and with therapists. The discussion topics have covered the range of me, myself, me personally, yours truly, this kid, number one and numero uno. I'm buoyed up by the words of concern and encouragement that have been addressed to me, but also, that diverse range of topics has had the effect of making me feel guilty of becoming some kind of prima donna.

It just isn't comfortable. I am getting very impatient to be well.

Fourth Heart Attack, Part 8 - John Dunn, Consultant, Ambertec, P.E., P.C.

A few aspects of having returned home:

I learned quite quickly after coming home just how helpless I was. Every move, every gesture, no matter how small was an effort. I survived this part of the experience because of the fantastic care and the help I got from my wife, Judy. I could not have successfully fended for myself while under the duress of recovery. I  would have to have been institutionalized.

My household chores fell onto her; washing dishes, taking trash and recyclables out to the curb, doing my own laundry and so forth. All of that fell on her while she coped and still copes with medical issues and pains of her own.

"In sickness and in health" the words go and that has certainly been the case.

My medication regimen is complex. Once Judy managed to sort out all of its details, I transferred them into a spreadsheet which I still use to keep track of what I have taken and what I have not taken, when I did the taking and what my blood pressure and heart rate were each time. When the visiting nurse first came to the house, I was able to present that info for rapid understanding. It would have been impossible trying to keep track of it all simply by memory. 

Medicinal side effects were and are a problem, especially with dizziness and balance. Adjustments needed to be made and thank heavens, my doctor's colleague was on call when I needed him. My inquiries to their office were returned in mere minutes. I was listened to very carefully and corrective instructions were given to me quite clearly. I very much derived a sense of security from that.

However, in spite of the wonderful care, in spite of all the words of encouragement from doctors, nurses, loved ones and friends, mental stability can still be a problem.

What I have endured doesn't rise anywhere near to the horrors I keep reading about in the news. I fully know that and I can't even begin to imagine what continues to befall the victims of those horrors.  Even so, after almost one month (not such a long time, really) since the heart attack itself happened, I fell into a deep sense of despair.

I went to my bookmarked YouTube URLs and went after every upbeat song I could find. I listened to "Click-Clack" by Dickey Doo and the Don'ts, "Love is like A Butterfly" by Dolly Parton, "I Got Lucky" by Elvis Presley, "Honeycomb" by Jimmie Rodgers, "The Martian Hop" by the Ran Dells, "Twenty Six Miles" by The Four Preps and "Maid In Japan" by Buck Owens.

It helped a little bit but I still need to work on keeping a positive attitude. It isn't easy.

Fourth Heart Attack, Part 7 - John Dunn, Consultant, Ambertec, P.E., P.C.

My surgeon wanted me to be transferred when I was ready, from that second hospital to a rehabilitation (rehab) facility before being sent home. On Tuesday, June 25th, I was transferred. At 5 AM on Wednesday, June 26th, I telephoned my doctor's office and left a message that I could not abide that place and that I absolutely MUST be sent home at once.

That evening of June 26th, there I was at home in my dining room with my wife and with everything I could possibly ask for at hand but with the thought of what another night in that rehab facility would have been like generating substantial upset.

It was a glimpse of PTSD.

There were two beds in the rehab room, but the other man there was quite out of it. There was a four foot long fluorescent light fixture above the head of my bed which had four settings of off, low, medium and high although the light levels of low and medium were the same.

When I turned that light off, the room went totally black. There couldn't have been a stray photon there. Since I had to get up now and then, total darkness in the presence of unknown objects and obstacles struck me as unsafe so that light needed to remain on.

Across the room from the foot of my bed was a television screen from which the fluorescent light reflected directly back at me. During the passage of the night, I couldn't shut out that reflective glare which gave me one nasty headache.

There was an HVAC unit that was vey noisy, especially with low frequency rumbling. As I tried to get some sleep during the night, I repeatedly woke up shivering with cold or else panting for breath in the heat.

I got up and looked at the HVAC controls and as I rotated the temperature setting knob, I could hear the compressor start or stop. The problem seemed to be that whichever side of that threshold the setting was at, the compressor stayed there way, way too long which was resulting in extreme swings of temperature.

I went along with some prescribed occupational therapy after breakfast that morning and things went well. Although I insisted on leaving and did indeed do so, perhaps to my long term recovery's detriment, the rehab environment I'd been through at night was too horrid to let be repeated.

 

 

Fourth Heart Attack, Part 6 - John Dunn, Consultant, Ambertec, P.E., P.C.

This matter came up later as I was being discharged to go home, I'm not sure if from the second hospital or from the rehabilitation facility (a topic to come), but it too was a communication issue.

The list of medications, their usage schedule and in one case their conditional usage instruction came embedded in the fine print list on the left. To me, it was quite difficult to interpret.

The SIG, as I find on line, is shorthand for the Latin, signetur, or "let it be labeled". What that means to the patient is "Here's how and when you are to take this medicine.", in short, the usage directions. Should I have been able to see that? Yes. In my befuddled state, did I see that? No.

Judy unraveled this mess for me and then I organized a small spreadsheet to help me reliably follow the doctor's instructions.

Here again, why this can't have been presented plainly and clearly lies beyond my comprehension.

Fourth Heart Attack, Part 5 - John Dunn, Consultant, Ambertec, P.E., P.C.

This suction tube device was in use at that second hospital. It is called a "Yankauer" and its purpose was to rapidly remove the nasty stuff that was coming up from my innards. It worked.

"Yankauer" is a trade name, but it is also the word that nursing staff used as a noun in referring to it. It is furthermore a word which I did not know, a word of which I had never heard and a word of which I had at first absolutely no idea of what it meant.

Amidst all of the bedsheets, things would often get lost. Picture trying to find the "call" button when I needed help. This thing would get lost in the cloth too and not knowing the y-word, when I asked for help to find the "suction tube", many of the nursing staff had no idea what I meant.

Once I learned the noun, communications issues were resolved, but how this could have been a problem in the first place is beyond my comprehemsion.

Fourth Heart Attack, Part 4 - John Dunn, Consultant, Ambertec, P.E., P.C.

The tem "hospital food" is an almost universal cliché for something unpalatable. This concept has long been the stuff of cliché comedy.

However, when we get into the realm of disgusting, revolting, repellent, repulsive, sickening, nauseating, nauseous, stomach-churning, stomach-turning, off-putting, unpalatable, unappetizing, uninviting, unsavory, distasteful, foul, nasty, obnoxious, odious and vomitous, we leave the realm of comedy and enter into a topic of medical importance.

The food that I encountered at the second hospital would in my opinion be worthy of every one of the above adjectives. Supposedly "steamed" broccoli florets came coated with some kind of dreadful sauce that made them inedible. A "green bean medley" was so foul tasting that I thought the beans must have somehow rotted before being cooked.

As bad as that was, the meat in one dinner of sliced turkey and the meat in a different dinner of sliced beef were so extremely salty that neither one of them was edible. I ate no dinner at all those two times which cannot have been a good thing for my health while I was trying to recover from surgery.

I asked one doctor about this. I'd had it made clear that sodium intake was of medical concern for me. Why then was there so much salt in those two meals? Wouldn't that corrupt attempts to achieve my medical goals?

The appalling reply was that the doctor had no control over the food service. The same question put to a nurse practitioner and to various nursing staff always elicited the same response.

I've been hospitalized several times in recent years at other institutions where the food service was quite good. I do NOT accept the cheap cliché that what was happening this time was in any way par for the course.

I do not know what the remedy for this might be, but I hope someone finds that remedy soon.

Fourth Heart Attack, Part 3 - John Dunn, Consultant, Ambertec, P.E., P.C.

HVAC in the second hospital is air ducted. Airflow out of any vent is of extremely low humidity, even in the Long Island summer. My bed was positioned in the hospital room between a hanging curtain and a vent grid located just above the room's window to the outdoors. With that set-up, the airflow around my hospital bed was as follows.

One could see that with the hanging curtain drawn, the fabric of that curtain was billowed out toward me by pressure from air coming in from the direction of the room's doorway to the hall. The curtain blocked that pressure pretty much completely.

However, when that curtain got left open, I got into some very serious trouble.

As I lay in the hospital bed with the curtain open, I could feel a strong flow of air coming down directly on top of me. Not realizing that there was any danger, I fell asleep face up and with my mouth wide open.

The result was sheer horror.

I awoke with a stabbing pain in the back of my throat. I spat out gobs of the most horrible blood carrying goo. In only a few minutes, the downward flow of low humidity air had desiccated the back of my throat to the point of tissue injury.

After getting the pain down to a manageable level by rinsing my throat with a lot of water, I let nursing staff know I wanted to talk to a supervisor. A hospital representative whom I will refer to as "H-Rep" came and a discussion began which I will try to summarize as follows.

The H-Rep response was silence.

Later that day, I was looked in on by a surgeon, a colleague of the surgeon who had operated on me. He asked me how things were going and I told him of the above incident. His reaction was to become enraged with me!

How could I say such things? He had seen this happen hundreds of times before and he spat out a rapid fire string of medical vocabulary as to what the cause had been in consequence of my surgery. His intent seemed to be to impress and intimidate, not to inform.

To me, this was clearly a deliberate case of a deaf ear. If he had seen this happen hundreds of time before, why haven't steps been taken against such things? What ever happened to the oath to "Do no harm"?

There is more to tell and I will be telling it.