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November 8 to 24
written November 9+
Dear Diary, Friends, and Families,

I ended the last diary describing Marianne's victory over the pacemaker implant side effects: chest pain,  headache and inability to sleep the night.  Friday morning, after she had slept the whole night, I said: "I'll take that as very encouraging".  And it was.

When she did get up on Friday, Marianne was a changed person, full of cheer and energy and we jumped into catching up with normal activities.  One saga for some time has been our car situation.  We are still driving the eleven-year-old Audi we brought back from Germany. A bad economic decision, but that's a different story.

The plan has been to replace it with a "biggish" SUV, something to use exploring America.  We looked at the various General Motors offerings, but could not get enthusiastic.  We also considered a couple of Japanese SUVs,  but decided they were just too simple for our Grand American Tour.  Finally, we decided on a Jeep Grand Cherokee, biggish, but with a surprisingly fuel efficient diesel engine.

A few months ago, we even went through the process of buying one that the local dealer had in stock, only to renig on the deal the next morning when we recognized they had sold us the car they wanted to sell, not the one we wanted to buy.  The solution was to order one just like we wanted: red, tan interior, diesel engine, and almost all the extra gadgets. 

Unfortunately we had chosen a car that was not being made quite yet.  The diesel engines come from Italy, the 8-speed transmissions from Germany, and none were currently available in the Detroit factory.  It took almost two months for the situation to change and allow our order to be processed.  It has been another two months since then, and we still have no confirmed ETA.  Rumors at the dealership are that manufacturing is starting "soon", but meanwhile, the old Audi needs a transfusion of new parts every few weeks, so this waiting is particularly painful.

To make sure we have enough buyer's discomfort, we also decided to go ahead and buy car #2.  In this case, it would be a "nice", smallish car.  This time we stuck with German cars, because that's what we know, I suppose.  I wanted the VW (Golf) GTI, a peppy small car more commonly bought by young drivers.  On the second test drive, Marianne was finding enough things wrong that it was clear that the GTI was not in our future.  We moved on to the Mercedes Benz GLA250, the deluxe brand's low-end SUV.  A nice car, but this time I objected, partially for the relatively high price and secondly just because old people buy MBs.  I'm not ready for the stereotype.

In the end, we looked around the Audi-Porsche dealer on one of our repair visits.  What we REALLY wanted was a Porsche.  How about this one?:

For about a million dollars, one can get on a three-year waiting list for a Porsche 918.  Our local plumbing supply dealership owner did just that and, for a few days, he allowed us mere humans to look at his 900-horsepower hybrid - a Prius sort of.
No, instead we settled on an Audi Q3, another smallish SUV.  Once again, we wanted a version not currently in stock, so we placed yet another order.  This time, delivery was estimated at three months.  (Engine from Hungary, car from Spain).  No problem.  We are patient buyers.  I just hope the old Audi stays adequately reliable.  We'll see.

Meanwhile, how is Marianne doing?  She was wonderful on Friday (7th) and had the energy to finish buying the Q3, take Mamo to dinner, and sleep peacefully through the night.  Saturday morning, just after breakfast, the underlying heart arrhythmia problem reared its ugly head and it was trip #6 to the Kaiser Emergency Department, by ambulance this time.

d141109_02_visit.jpgBy now, we know the ED (ER) staff and they know Marianne enough that testing for problems she does NOT have were skipped.  Because her heart rate would not settle down, she was sent upstairs to a regular room "for observation". On Sunday she got a change of heart regulation drugs, but I think Gabby's visit did more for her heart than the new chemicals.

Monday and Tuesday are a bit of a blur (I am writing this a couple of days later, but it seems like a week.)  The cardiologist explained options and, after considerable thought, we chose a path forward.  First, the doctors will try to reset Marianne's heart rhythm with a procedure called "cardioversion", where a shock is administered to momentarily stop the heart and, in over 90% of the cases, the heart restarts in normal rhythm.  We wanted this done ASAP, but nurses at Kaiser went on strike Tuesday and Wednesday, so the medical team preferred to delay.  As of Thursday morning - 13th, we have no date, but we have emphasized "ASAP" and we expect to hear today.

The second step will be a procedure called atrial ablation, an operation where misbehaving heart circuits are ablated (burned) into submission.  This is a fix that should be permanent, although in the medical world it seems nothing is guaranteed.  Marianne needs to be on blood thinners for 4 to 6 weeks before it would be done, so that preparation period sets an ablation schedule for mid to late December. 

We'll see, maybe in early 2015 we will have one or two new cars and a newly-refurbished heart.

Stay tuned.

John and Marianne

ps:  Yesterday (12th) I took a break and wandered around the yard and neighborhood.  Our roses are looking great, after almost dying in the summer heat, and the local trees are showing their fall colors.  As we watch winter settle in east of the Rockies, I think we have it ok here in Fresno - so long as the health-thing works out.

pps:  Marianne update (Morning of Nov 22)
Nine days after the last entry and what's been happening?  We received a schedule for the heart re-set, December 5, that we thought was much later than "ASAP".  Nevertheless, it was at least planned.  As with most of our plans, that's not what happened.  Thursday night (19th) we sent an email asking if the cardioversion procedure could be moved up, because Marianne was remaining weak and in some pain.  Friday morning, she was too weak to stand and, again, we dialed 911 and the ambulance took her off for her seventh visit to the Emergency Department.

d141120_02_drill.jpg(I followed, but got to the ED in the middle of the hospital's "Ebola training".  While I had to wait, I asked the drill manager if Fresno Kaiser has ever had anyone answer "yes" to the now-ubiquitous question: "Have you traveled to West Africa in the last three weeks".  "No", he said, but the drill is useful for any sort of contagion outbreak, I suppose.)

When I was allowed back to ED room 3, Marianne was better, or maybe just less bad. The ED team went though all the normal routine: EKG, iv, a bit of oxygen, some fluids.  At some point, we checked email (it's what one does nowadays) and discovered that the cardiologist had indeed answered and said that the only way to move up the cardioversion was to show up in the Emergency Department.  So, we answered that we were there already, Room 3.

The procedure went quickly.  By 10:20, all was set up around the emergency room bed (cardiologist, anesthesiologist, ED nurse, echo cardiogram tech, and the red bag with the electric leads to connect to two pads  Marianne was now wearing.)  I left, the professionals did their jobs, and I was back in 30 minutes to see Marianne's nice, regular heartbeat on the monitor. Less than two hours later, we were home and updating  relatives and neighbors about the day's events.  It looked good.

On Monday (Nov. 24), Marianne had a phone consultation with the doctor who should perform the ablation procedure down in Santa Clara.  We learned a lot about the condition "atrial fibrillation" and the various means to control the condition.  Currently, Marianne's heart rate has been restored by shock, and is being kept regular chemically.  "Over control" by the drugs (ie: slowing the heart too much) is prevented by the new pacemaker. 

The next level of control will be "ablation" or destruction of heart nodes and circuits that cause irregular and fast heart beats.  The Santa Clara cardiologist specialist answered our questions and defined requirements before the procedure could be done.  First, the inflammation around Marianne's heart needs to go away.  That could take weeks or months.  Second, the pacemaker leads need to "age" another couple of months, until they are more firmly anchored.  Finally, the Santa Clara facility has a two to three month waiting list.  All this points to an operation date sometime in March or so.

We will keep family and friends up to date, but for now we will concentrate on other matters (I hope!)


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