New York's best heart surgeon, runner up...

The surgeon in S.F. sure did a great job. But New York Magazine just gave kudos to the guy that would have done the job here in New York, Dr. Adams. I never met the guy, but I sure talked to him a lot from outside the hospital in S.F. He was good at phone consulting. And *very* chatty. Uh, doc, thanks... but I gotta go... my wife is in the hospital...

http://nymag.com/health/besthospitals/24095/index3.html

HEART SURGERY
New York–Presbyterian Hospital

RUNNER-UP: Mount Sinai Medical Center is headed by one of the grand old men in cardiology, Valentin Fuster, and New York newcomer David Adams, considered a major catch when he was lured from Harvard five years ago.

No readers! A joy.

So nice to see that nobody looks at this blog anymore.

Zora is doing well.

Maybe I'll post another picture of her scar, just as an excuse to show more skin.

Telogen Effluvium

Anonymous writes in a comment below:
The phenomenon [of hair loss] is called telogen effluvium, which i think is a cool sounding thing. During stress, the hair stops growing and stops falling out, about 2-6 months after a stressor, all of the hair that should have fallen out, falls out all at once.

Thanks, anonymous. Fascinating! For what it's worth, Zora's hair began to fall out at a normal rate about 4 months after her surgery. The same healthy amount of hair she would lose before she got sick last October.

(And I am a very good judge of this matter as I get to inspect the clump of hair that rises up from the bathtub-drain strainer every time I take a bath. And to think she thinks I'm just splashing around with my toy boat in the bathtub.)

6 Months Later All is Well

Six months after the heart surgury Zora got the result from the first follow-up echocardiogram. The news is good. All is well.

Clean bill of health... and a full head of hair

Zora saw Dr. Gumprecht for, inshaallah, the last time. No sign of anything bad. The Good Doctor proposed that it would be all right to see him again if we needed shots for our exotic travels. That sounds fair.

Zora is doing well.

As a weird side note, Zora is no longer leaving hair in the bathtub every time she takes a shower. I noticed the past few weeks that I didn’t have to fish wads of nasty hair out of the drain. I also figured the odds that Zora was more conscientious about removing her own hair were pretty slim. Indeed, all her hair is now staying in her scalp. There was more hair falling out when Zora was sick in October and November, but there was some hair in the drain all the time ever since she moved in here last summer. Fascinating... sort of.

Two wheels good

Yesterday Zora rode her bike for the first time since the whole blind-in-one-eye thing. She just zipped off to Tamara’s while I was still in bed. Didn't even put the mirror on or nothing. She said it was fine. And apparently nothing came at her from the left. Or at least not that she saw.

Saw the cardiologist, barely.

Another relative all-clear. Except I thought I would have a nervous breakdown before I got to see him.

Up till now, insurance has been relatively smooth sailing. I get lots of things that say "this is not a bill" and "total to be paid: $0.00." Great. A huge relief. My insurance even approved my visits to the ID doc, even though he's not in the network. How beneficent.

So I thought it would be a cinch to see a cardiologist who really was in the network, the cardiologist who'd seen me at Mt. Sinai and who works with the ID doc. I'd gotten a visit to him approved back in January, but then the referral expired while I was busy having surgery and losing half my vision. "No problem," said my primary-care doc. "I'll just refax the first referral."

I didn't think about it again till I got to the appointment, and the receptionist said she didn't have the referral. And that there was no way to see the doctor without it.

Is that even legal? I'd even just signed some random piece of paper that said I was responsible for the bill if my insurance didn't cover it. Which I pointed out, but it didn't carry any weight with this by-the-book gatekeeper.

So I had to spend the next hour on the phone--largely on hold, usually on the brink of tears due to infuriation at the gross unfairness and indignity of it all--with insurance people and the imperious little guy who's my PCP's assistant. Everyone involved was hostile, defensive and unsympathetic.

Turned out, I think, that the assistant had refaxed the referral as promised, but hadn't bothered to change the dates, so it essentially arrived expired. And no one in the cardiologist's office had the imagination to appreciate that if HIP had approved my visit to the doc before heart surgery, it surely would be merited after surgery as well. Also, a faxed copy of the re-re-faxed referral, with dates corrected, to show the process was in the works, simply would not do.

I felt like tearing off my shirt and pointing at my scar and throwing a tantrum, but crying real tears had drawn nothing but an exasperated sigh from the receptionist, so I didn't want to risk her having me carted off by security. Instead I just went to the bathroom and blew my nose and splashed water on my face and took many deep breaths. Reading the New Yorker helped too.

After another twenty minutes, during which some manager talked directly to HIP about my impudence, the receptionist came over and said, "Fine. It's approved. But just this once. If you ever want to see the doctor again, you have to get another referral." Like I'd pulled a fast one on them, but they were on to me.

I can't help but think this might've gone a little more smoothly in California.

A Taste of California

I posted over on Roving Gastronome about this shipment of citrus we just got from California.

Oo-ee. It is good and life-giving. It makes me feel that my sojourn on the West Coast was not all just a fantasy of the Easy Life. And I certainly will not get scurvy.

Docs' update: Got blood cultures drawn on Tuesday, but I'm not clear yet: one more ID visit in my future, in a month, then I can be considered germ-free. Cardiology next Tues. Ophthalmological angiogram next Wed, followed by three or four more monthly checkups to make sure I'm not getting glaucoma. The day I have no more doctors' appointments scheduled, then I'll feel normal.

The skin post!

There hasn’t been much news here recently, which is really good news overall. Zora continues to recover nicely. I really do have better things to do than keep Flappy up-to-date. I look forward to the day when I can officially close out Flappy. But Zora still thinks it’s a bit early for that. And we wouldn’t want to jinx anything. And there’s still the adventure of preparing and cooking chicken brined with left-over saline-filled syringes to document. And for the pictures, Zora just happens to have a spare lab coat (“Of course I have a lab coat,” she says. Uh, of course?)

Zora saw some ophthalmologist last week. But there’s no real news there. The doc warned that glaucoma is more of risk in the blind eye (what’s a good analogy, like warning that the barn-door hinge is rusty long after the horse escaped?), so she’ll have to get checked for that regularly.

I’ve learned from fashion mags that nothing sells like sex. And I’m not too proud to resort to a little skin when desperate for material. So to reward the hardy reader, here are the healing scars. Maybe next time I’ll let the cat out of the bag and tell you the 30 things to please me that I’ll never tell you.



To remind you, here’s the old shot of her scars after about 1 week.



And here’s Zora eating her chocolate heart, curtsey of Adrienne.

It says it’s life sized and anatomically correct, but it’s only 1 1/2 inches deep and flat on the back! And imagine my disappointment when I claimed dibs on the mitral valve only to discover that on the inside, the damn thing is solid milk chocolate. Harrumph.

Today's the Day!

According to my post-surgery recovery schedule, today is a landmark day. Six weeks after surgery, I am able to engage in such activities as:

Using my riding lawnmower
Bowling
Bowhunting

I'm sure all other middle-aged-white-guy activities are approved as well.

Bills? We all got bills.

Hey, what about my hospital bill? Where is the interest? Where are the contests? Hello?! Perhaps some lucky reader wants, uh… a framed print of the bloody post-op pinky?

Well, I’ll just cut to the chase: One infected pinky; successfully lanced in the Emergency Room; about a two-hour visit: $1,943. Covered by insurance.

Interestingly, that works out to about the same hourly rate as Zora’s stay. But I didn’t get meals or cocktail service.

Perhaps they could keep health care costs down (or at least speed up the waiting time) by having a meter running at a steady clip of about 25¢ a second. Or maybe 5¢ a second while waiting and $2.50 per second when a doctor is attending.

Here's a treat for the Us Weekly crowd...

Karine got me a custom welcome-home present. I'd been a little out of the gossip loop, so as she gave me the gift, she had to bring me up to speed on such essential items as the latest cover story in Vanity Fair.

Here I am enjoying my morning tea, in glowing soft-focus, with Karine's extremely thoughtful gift.



Hey, what's that picture on there? It looks familiar... Let's zoom in a little:



And it looks like there's some writing on the other side. What does that say?



It's like, yeah, motherfucker, I'm fine.

Ah, the immortal words of Lindsay Lohan. Who knew she was so wise?

PICC-free and Proud!

We're getting very close to The End of Flappy. The post-op impediments are dropping away: I can sleep more comfortably, I can lift my arms up to hug people, I'm done with antibiotics and all the other drugs but the Pacerone. I have a couple more follow-up appointments, including what will surely be a weird encounter with my primary care doc tomorrow. If she said "Oops!" last time I saw her, I can't imagine what she'll do when I show her my scar and ask for a referral to an opthalmologist.

But really much more important, I dropped by the ID guy's office today to get my PICC line removed. Seeing how I'd already seen it done once, I'm sure I could've handled the job myself, but I know that's Not Allowed.

It came out in one tidy whisk! Those savvy Californians: This PICC line had little centimeter measurements marked all along it, so the doctor didn't have to do what my nurse had done with the first one, which was to, with his clumsy gloved hands, try to match the sticky, blood-splotched thing up with the flimsy folded paper tape measure that comes in the dressing packs. So it was clear that all 41 centimeters that went in came back out again. That's almost twice the length of my first one. Also, in California they used much thinner thread on the sutures, so they didn't get stuck in the bandage every time it got changed, and they got yanked out much less painfully.

Dr. Gumprecht asked me if I wanted it, but I declined. That seemed kind of like keeping your wisdom teeth in a jar, or, as one guy I dated did, a parasite that's been dug out of your back in the Bolivian rainforest. (Actually, that was kind of cool.) Gumprecht looked pretty keen to send me home with it, especially when I said Peter might want to see it. "I'll put it in a bag," he offered. I felt like I was turning down some particularly choice leftovers. (Hey, maybe I could've sent it as a consolation prize to a Guess-the-Bill competitor?)

Anyway, now I have clusters of almost symmetrical little spots on the inside of both arms. Which is secondary to the fantastic shower I will be able to take tonight, using both arms equally, and lifted almost all the way above my head.

And the winner is...

Wait, I’m sorry—that phrasing is insulting to all the losers. I should say:

And the Vicodin goes to...

Tamara.

This sounds fishy, I know, given the photographic evidence of her looking at the bill. Here are the numbers:

Bill total (all 12 pages):

$161,076.91

Winning guesses, in order:

Tamara: $179,346.87 — off by $18,269.96
Naomi: $141,257.32 — off by $19,819.59
“Anonymous”: $132,000 — off by $29,076.91
Joanna: $198,357.92 — off by $37,281.01

Due to (A) the slightly sketchy circumstances surrounding Tamara’s bid and (B) the huge amount of Vicodin I have left over and (C) the closeness of the first two entries, I’m going to split the Vicodin winnings. Check your mail for opiates, ladies!

Wait, now that I think of it, Tamara is allergic to opiates too. That means I should get a cut if she sells them to anyone.

And Joanna officially gets bumped up to 3rd place due to the modesty of “Anonymous.”

And thanks to everyone else who entered—if you bid high, yes, you clearly do love me more!

On to the bill itself!

The fascinating thing is that it’s fully chronological, so I can relive all the highlights of my stay as they happened: Ooh, DOPAMINE40MG—those were the days! (That dose was just $8.54, for the record—a relative bargain.) And I got an awful lot of Fentanyl right after the operation ($3.70 per dose).

It’s also broken down by category at the end:

Pharmacy totaled $13,240.73—and that’s even higher now, after finishing my antibiotics, considering that a daily dose of ceftriaxone costs about $617.73 (lots more when administered in the OR). On the low end, a tab of Tylenol costs $.46.

The operating room and supplies cost $24,959. I don’t think that includes the bill straight from the surgeon, however. But all those cannulas! (Cannulae? At any rate, they range in price from $206 to $655.) My replacement annulus (no leering), a little Dacron-coated metal ring that holds my valve in place and shows up in X-rays now, was an even $5,400. A bargain at twice the price, considering it means I didn’t have to get a complete valve replacement.

A night in intensive cardiac care goes for $10,983. My ginormous private room was $3,269 per night. In the regular hotel world, only the Saudi royal family pays similar rates.

My dual-lumen PICC line was $676, and the expert insertion only set me back $207. Not bad when you cost it out per use. By contrast, the albatross of a cardiac monitor that I had to keep around my neck the whole time cost $1,221 per day to run—that’s one high-toned 9-volt battery!

And, hey, on Jan. 17, I see I got charged for a BRAT PACK: $2,517. Does that mean Judd Nelson was “scrubbed in” at the OR?

Home Sweet Home!

Astoria here we come!

We fly back to New York in a few hours. Hopefully we’ll get bumped up to first class. I can’t even imagine how they’ll service me in the front of the plane!

My suitcase is laden with lots of produce from yesterday’s farmers’ market. Tangerines, mandarins, tomatoes, green tomatoes, and, of course, artichokes. It’ll be nice to have a little bounty of fruit when we arrive in coldest darkest winter.

Sunny Californ-eye-aye

All’s well in California and we’ll be back in New York soon! Zora looks great. It is always kind of exciting to see two weeks of improvement in one fell swoop rather than the barely noticeable daily incremental improvements.

Because of the crowded quarters here (parents, brother, his wife, and their kids), my parents are putting Zora and me up in a hotel around the corner. That also means we’re not being awakened at uncivil hours by jet-lagged little ones. Zora must get her rest, now.

Despite Zora saying how much she likes California, I’m still not sold. But Zora’s done well by California. ...Except, of course, the left eye thing.

I’m looking forward to being back home. Six very long weeks after we left on our two week vacation.

More on Monday. Including the official winner of the Guess-the-Bill contest.

The votes are being tallied.

Actually, I know who has won--I just forgot to bring the bill with me to the computer, so I can't dazzle you with the precise figure just yet. Peter brought it with him yesterday, and I made about the same face Tamara did, even though I knew the bottom line already.

So, yes, Peter's here, which is very nice. L.A. is colder than I thought it might be, which makes it even more of a functional airlock for NYC. Beverly is enjoying herself, and went off to the Getty Villa today.

I still can't sleep really well on my side, as it causes this pain in my chest that I'm sure is in a muscle but is uncomfortably close to where my heart actually is, so it's not a pain I want to be feeling in the dark, in the middle of the night. But I'm not as exhausted as I used to be, so I wake up after about four hours of sleeping propped up, and then toss and turn, delicately, for a couple of hours, until I'm good and tired, enough to tolerate the sitting-up sleeping again. At least after this I'll be very, very good at sleeping on airplanes.

Which reminds me, Peter and I are flying back business class--and not only that, it's paid business class, so I don't even have to dress nice and fly standby. The very thing that galled me about American Airlines, and made it pointless to achieve my fabu "gold elite" status, was that they'd reduced the biz-class fares to the point where there were never any empty seats left to get bumped up to. But now I'm actually benefiting.

Yes, even on my sickbed, I have been keeping track of my frequent-flier miles.

Last chance to enter.

The judges will convene at midnight tonight, PST. Get in your guesses about my hotel bill's bottom line in the comments section here.

And now I'm in LA. Mysteriously, it's colder than Santa Cruz. Santa Monica is sort of like the airlock before my return to New York: more cars, more energy, more people to talk to (all of the Moskoses are convened--or will be, when Peter arrives later today) and, luckily for Peter, more non-white people who don't ask you if you need help. If I'd had to fly straight from Santa Cruz to NYC, I think the culture shock would've been too extreme, and I would've had to double up on my anti-arrhythmia drugs.

Which reminds me, for all you pharmaceutical watchers, the Vicodin stash remains untouched but I'm back on the amiodorone, the drug that keeps my heart rate steady and makes things taste funny. (It also can turn your skin bluish-gray, and I've been noticing that on my legs. Creepy.) I was sitting in bed one morning last weekeend, minding my own business, when my heart suddenly went patpatpatpatpatpatpatpat for about five seconds, then went back to its usual drill. I'm jumpy about a lot of aches and pains right now, but that was pretty clear-cut: it was not supposed to be happening. It also made me realize that some feelings of "boy, is my heart rate fast, but I guess I was just up walking around the living room" from the week before might've been related.

Apparently it's a relatively normal thing to have happen, though, and now I have something in common with that poor lawyer guy in Texas, whom Cheney shot in the face.

She sure is purty

And I can't wait to see her.