Wednesday

I started the day by nearly fainting after breakfast. It was a 40 minute long dizzy spell featuring black spots before my eyes if I stood up. The nurse threatened to call 911, but I put her off. I gradually felt better and went upstairs with a staff member at my elbow. In my room, I took my blood pressure - ERROR - the meter wouldn't read it. Wait a minute, repeat - 85/64. I'm sure it was much lower when the spell was really underway. After I got to where I could think, I remembered my blood pressure meds. I'm supposed to take 2.5 mg a day of the Lisonipril. But I have 10mg pills, and I never got the right ones. So I try to quarter the stupid triangle shaped pill with variable results. I think the variation was on the "too much" side last night. I called my cardiac doc today and asked her to fax a prescription to the local pharmacy for the right amount. I don't know if she's done it, so I made sure I took less than a quarter pill tonight. We'll see how it goes tomorrow.

I visited my new psychiatrist today. He's an older fellow with an old dog planted on the couch. So the cliche of the Freudian analyst talking to the couch bound patient won't work in his case. He listened to my extensive psychological and medical history, scribbling notes rather frantically I thought. He seems like a nice guy who doesn't patronize. That's a rare and precious quality in a shrink.

I also went and had my blood thinning tested. Around 5PM I got a call from the coumedin nurse at my doctor's saying that she wanted me to stay on lovenox and increase the coumedin dose. Since the latter is managed by Atria, I handed her off to the local nurse. This worthy was insisting on a faxed order for the dose change, which I guess they worked out. I never did find out what my INR (thinning index) was, which is annoying. I like to know things like that. It seems to me the coumedin nurse wants me to discontinue the lovenox two days hence without testing, assuming that the higher coumedin dose will kick me into therapeutic range by then. I'm not comfortable with that. She specializes in getting people into the right coumedin dose, of course. So she's probably right about how long it will take in this case. But as long as I'm at increased stroke risk, I'm going to insist on whatever it takes to keep me anticoagulated. I'll call her tomorrow and discuss this with her.

At lunch and dinner, I spoke with Dick, the guy with liver cancer. He has been desperate for someone to talk to. He keeps telling me how relieved he is to have me around. I'm glad to help. He's a nice guy. I'm a little worried about being his only lifeline though. I'm also facing a choice of whether to befriend a dying man, with all the sadness and perhaps horror that could entail. There's actually no question that I'll jump right in, but the morbid thoughts do occur to me. On the plus side, he has two nice looking daughters. :)

I tried going to the see the movie tonight. It was "Labor Pains," which was a chick film par excellence. Call me dense, but I didn't get that from the title. It was mildly funny, but the subject matter didn't speak to me. I left with apologies after 15 minutes.

Tomorrow I start the outpatient program. I'm a bit nervous, but I'm sure it will work out OK.