Just Back Home after a Serious Event.

[TLS Guy]

Glad to hear you are still amongst the living.

Any idea what caused all of this; age related, diet or ... ?

An idea but not certain. Yes, clotting events do get more common as you age. However I do have a risk factor, and have had some unusual clotting events over the last few years.

The risk factor has been my hyperparathyroidism which was an issue over the last years. I had one parathyroid gland removed from my neck a few years back, but had recurrence. Now hyperparathyroidism raises the ionic fraction of calcium in the blood. Among being a crucial ion in polarization and repolarization of nerves, muscles and brain function it also plays a crucial role in the clotting cascade. So high ionized calcium tends to make harmful clotting more likely. Two years ago I had a serious DVT in my right leg, largely involving the popliteal and superficial femoral veins, but not the common femoral vein. So I was on extended anticoagulation but the veins did not recanalize.
Now the second parathyroid tumor was elusive, and it took a recently developed isotope test developed by Mayo to find it. In February I had a thymectomy via mediastinoscopy. The parathyroid adenoma was 10 times the size of a normal gland. My blood total and ionized calcium levels returned to normal in 20 minutes, and have remained normal since.
Now an ultrasound showed early recanalization of the superficial femoral vein in March which had increased slightly on the ultrasound done Wednesday. My anticoagulants were discontinued six weeks post parathyroidectomy.
So the vascular medicine specialist raised the possibility that since the balance between clotting and thrombolysis had moved towards, thrombolysis then this thrombolysis may have been responsible for this embolus. But this of course is highly speculative.
In a month, I will be carefully evaluated at Abbott Northwest Hospital in Minneapolis, where there is a world renowned specialist in these matters, and works in close association with the UC medical center in San Diego, who are the world leaders in this problem. They are the only center as far as I know that have a good track record of dealing surgically with saddle emboli causing, or likely to cause chronic right heart failure, known as Cor Pulmonale.
So for now, I just lay low for the next month.
My wife worked as NP on that heart failure/transplant unit for 12 years. I know the physician I will be seeing. As it happens he is an avid audio enthusiast, and heard my system when it was installed in our lake home on Benedict Lake. We used to host summer parties for that team at our lake home.

 

[Jeepers]

In February I had a thymectomy via mediastinoscopy. The parathyroid adenoma was 10 times the size of a normal gland. My blood total and ionized calcium levels returned to normal in 20 minutes, and have remained normal since.

Thanks for the explanation...although I am not a doctor and English is not my native language.

Nevertheless a thymectomy (thus the removal of the thymus gland); isn't that performed in case the thymus is working again and therefore resulting in your immune system being too strong and thus attacking your own body.
Was your thymectomy done because you have issues with your immune system ?

 

[TLS Guy]

Thanks for the explanation...although I am not a doctor and English is not my native language.

Nevertheless a thymectomy (thus the removal of the thymus gland); isn't that performed in case the thymus is working again and therefore resulting in your immune system being too strong and thus attacking your own body.
Was your thymectomy done because you have issues with your immune system ?

At my age the thymus is completely non functional and can be removed with impunity.

In any event trying to remove the parathyroid without removing the thymus would have been very dangerous and involved difficult and risky dissection up against the great vessels of the mediastinum. The surgeon's judgement was absolutely correct and still would have been, even in a younger patient.

 

[lovinthehd]

At my age the thymus is completely non functional and can be removed with impunity.

In any event trying to remove the parathyroid without removing the thymus would have been very dangerous and involved difficult and risky dissection up against the great vessels of the mediastinum. The surgeon's judgement was absolutely correct and still would have been, even in a younger patient.

Just how old are you, doc? Wasn't your specialty nutrition?

 

[AcuDefTechGuy]

1st, glad to hear you are doing better. Scary as heck. Old age sucks.

Most PE start out as DVT in the legs or other parts (caused by injury or surgery) and require tPA 100 mg IV to dissolve the clot (thrombus).

Did you receive tPA or just anticoagulants (Heparin/Warfarin/Apixaban)?

 

[TLS Guy]

Just how old are you, doc? Wasn't your specialty nutrition?

Yes, I did run the nutritional support service. In fact I set it up, and it was among the first hospital support services in the country. It involved support of individuals who could not eat, mainly as a result of major surgery and complications. So I worked closely with the surgical service. It also had a small bowel rehab program for those who had suffered catastrophic small bowel resection. I was also one of the three on the critical care service for those years. There was myself, our pulmonologist and our nephrologist, who was my close friend Phil, who you have probably heard we refer to. We sadly lost Phil 18 months ago. I am 76.

 

[TLS Guy]

1st, glad to hear you are doing better. Scary as heck. Old age sucks.

Most PE start out as DVT in the legs or other parts (caused by injury or surgery) and require tPA 100 mg IV to dissolve the clot (thrombus).

Did you receive tPA or just anticoagulants (Heparin/Warfarin/Apixaban)?

Old age only sucks, if you let and want it to. Just Heparin and I am now on Rivaroxaban. tPA is controversial because of complications in this situation. The main issue has been severe fatal cerebral hemorrhage. At Mayo they have only used it for those circling the drain, and they have had a very significant incidence and fatal cerebral Hemorrhage.

 

[ryanosaur]

Old age only sucks, if you let and want it to

This!
And i’m not even “old!”

But we have the choice to let “age” be an excuse. I could curl up and die if I do choose, but that is not what I want!
And do I don’t.

 

[AcuDefTechGuy]

Old age only sucks, if you let and want it to. Just Heparin and I am now on Rivaroxaban. tPA is controversial because of complications in this situation. The main issue has been severe fatal cerebral hemorrhage. At Mayo they have only used it for those circling the drain, and they have had a very significant incidence and fatal cerebral Hemorrhage.

What I mean is that when we were 18 years old, we likely would have never even gotten a DVT, much less a PE.

Yeah, I don’t see our hospital using tPA (reperfusion) for PE unless we absolutely have to.

 

[TLS Guy]

What I mean is that when we were 18 years old, we likely would have never even gotten a DVT, much less a PE.

Yeah, I don’t see our hospital using tPA (reperfusion) for PE unless we absolutely have to.

The problem is that in these clots even if you use catheter ablation, the total tPA dose ends up being the same as the systemic dose. So catastrophic cerebral bleeds are common. A recent study showed the mortality of the catheter infused dose for catastrophic PE and giving it systemically was the same. So this situation remains problematic. So reserving it for catastrophic PE does make sense. Opening a coronary or cerebral artery with tPA is a different matter as the targeted catheter dose is below the systemic dose.

 

[Dan]

It seems as though our interventional radiology folks uses mechanical thrombolysis rather than tPA for saddle PEs these days.

I think it may be time to change your ranking name. Just sayin…

 

[TLS Guy]

It seems as though our interventional radiology folks uses mechanical thrombolysis rather than tPA for saddle PEs these days.

I think it may be time to change your ranking name. Just sayin…

I know. I think the problem for Mayo here, is that Rochester is a very small city with a huge multistate referral area. So that means they do not see as much serious acute disease as institutions in large metropolitan areas. This is also a huge problem with recruitment now, especially after IBM pulled out of Rochester. So if a medical staff are recruited there is limited employment potential for a spouse, unless they are also medical.
Mayo and Rochester are starting a new drive to attract businesses that require skilled and higher paid staff. It is the new "Destination Med' initiative. I suspect it will be no more successful than previous somewhat similar endeavors. Despite this, Mayo has a huge catchment area. In the parking garages, you see number plates from pretty much every state in the Union. So they have just announced a multibillion dollar expansion for Rochester. I know for a fact though there was a lot of debate, whether it should be in Arizona or Florida. There were rumors even of pulling out of Rochester. However I can't imagine them walking away from the colossal investment they have in Rochester.
The problem remains though that unless you work for Mayo your options are pretty much lower paid service jobs, unless you are a professional like a lawyer or accountant for instance.
Even the only fine dinning establishment closed in Rochester, and now there are only chains. The reason being so many visitors coming to Rochester are NPO, or have very early morning appointments!
How they keep it all organized though amazes me. In the huge two lobby floors of the Mayo and Gonda buildings there are crowds bustling through all day by the thousands. However, almost all appointments are dead on time, and anything other than a five minute delay unusual. In the clinical areas there is never the faintest whiff of hurry or stress. That is one to the features that staggers me most about Mayo.

 

[davidscott]

Glad you're still with us. This site wouldn't be the same without you.

 

[McC]

Just a few years ago I woke up one night feeling agitated and flushed. Thinking little of it I went back to bed. Following that I felt quite puny getting winded easily and being generally weak. After about 3 weeks I was able to see my Cardiologist who ordered an Adenesene Stress Test. Once the nurse had connected all the ECG leads she asked when my heart attack was. I was shocked and said I hadn't had one. She insisted that I had. The next thing I know I'm on the table in the Cath Lab as the Cardiologist is feeding a catheter through my wrist and into my heart. Unfortunately, he was unable to push the wire through the blockage in the artery and it remains occluded. Fortunately, I have sufficient ancillary vessels in my heart that I didn't die. I had always thought that a completely blocked artery in the heart was certain death. I am glad to be wrong about that.

Congratulations on surviving!

 

[Dan]

I had a similar experience in Rochester as a patient. It is an amazing place and they way they run the outpatient side is incredible. Smartest docs I’ve ever seen. I know some of the radiologists in Scottsdale and Jacksonville better, they are all brilliant. But I could never work in Rochester. I need outside interests and there wasn’t much else I saw in Rochester that would interest me. Five years since I went there and the docs I saw will still offer help via email whenever I ask. I have calcium issues too but bone loss and renal stones. Not hyperparathyroidism however.

 

[Trebdp83]

Feel better. Maybe stay away from any Audioquest threads for awhile.

 

[TLS Guy]

I had a similar experience in Rochester as a patient. It is an amazing place and they way they run the outpatient side is incredible. Smartest docs I’ve ever seen. I know some of the radiologists in Scottsdale and Jacksonville better, they are all brilliant. But I could never work in Rochester. I need outside interests and there wasn’t much else I saw in Rochester that would interest me. Five years since I went there and the docs I saw will still offer help via email whenever I ask. I have calcium issues too but bone loss and renal stones. Not hyperparathyroidism however.

Yes, Rochester is a one horse town. Rochester was selected by the Mayo brothers, because land was cheap, it had the railway, and it had good transport to a lot of major cities. That was around 1880, and they founded the world's first multispecialty clinic. They had the Catholic nuns staff the hospital since they were Irish Catholics.
They had a pal from Ireland come over the build a big hotel for families and patients to stay. That is the Kahler and it is still there. Unfortunately it has been wantonly mucked about in recent years. When I first new it fifty odd years ago, it was very much as it always was, with the Victorian grand staircase and dining room.

Mayo was founded very much on monastic principles, and actually still has that feel. The physicians often refer to themselves as men of the cloth. We did that often in the Grand Forks Clinic which was on the Mayo model.

Mayo has always had an interest beyond medicine, especially vehicles. In the early days of motoring Mayo did research on automobile maintenance. I attended a lecture from their chief librarian some years ago, and he had slides of a lot of the documents. It was absolutely fascinating. This tradition continues as they have a department developing autonomous vehicles.

I took this picture of one some years ago when they were experimenting at night.

These vehicles are now picking patients up from the Mayo building and taking them to their hotels and St. Mary's Hospital.

 

[cpp]

Yes, Rochester is a one horse town. Rochester was selected by the Mayo brothers, because land was cheap, it had the railway, and it had good transport to a lot of major cities. That was around 1880, and they founded the world's first multispecialty clinic. They had the Catholic nuns staff the hospital since they were Irish Catholics.
They had a pal from Ireland come over the build a big hotel for families and patients to stay. That is the Kahler and it is still there. Unfortunately it has been wantonly mucked about in recent years. When I first new it fifty odd years ago, it was very much as it always was, with the Victorian grand staircase and dining room.

Mayo was founded very much on monastic principles, and actually still has that feel. The physicians often refer to themselves as men of the cloth. We did that often in the Grand Forks Clinic which was on the Mayo model.

Mayo has always had an interest beyond medicine, especially vehicles. In the early days of motoring Mayo did research on automobile maintenance. I attended a lecture from their chief librarian some years ago, and he had slides of a lot of the documents. It was absolutely fascinating. This tradition continues as they have a department developing autonomous vehicles.

I took this picture of one some years ago when they were experimenting at night.

These vehicles are now picking patients up from the Mayo building and taking them to their hotels and St. Mary's Hospital.

As a Mayo patient in Jacksonville since Feb 2020, actually I have an appt at 2:25 this afternoon for a CT, I don't have any negatives. They have always met my expectations with their medical care and patient interaction.