5/26/2026

 Tuesday, May 26, 2026

1945 US dropped fire bombs on Tokyo

1966 Buddhist setshimself on fire at US consulate in Hué, South Vietnam

2004 NY Times published an admission of journalistic failings, claiming its flawed reporting and lack of skepticism during the buildup to the 2003 Iraq War helped promote the belief that Iraq possessed large stockpiles of weapons of mass destruction

2018 Ireland voted to repeal their 8th amendment to allow legalized abortion, 66.4% vote yes

In bed at 9:05, up at 4:20;  0430 126/68/32 ### 204.3; 61/80/61, cloudy.

Morning meds at 8:20 a.m.,  and half-dose of Bisoprolol at 8 a.m.

Started the day with a CT scan of thoracic and lumbar spine at the VA at 6:45 a.m.  The scan went well, at least in terms of efficiency.  I was in and out of the VA and back in my car by 7.  The bad news is that it's become clear to me that the symptoms of my heart condition(s) have gotten worse, the SOB and exhaustion from even slight exertions.  I came close to having to sit down in a chair in the entryway to the medical center, as I did the day I was admitted to the hospital for 5 days for low BP and heart rate.  At that early hour, I was able to park in the first row of spaces in the handicapped parking area right in front of the hospital.  The walk to the hospital entrance could hardly have been shorter, yet I was wiped out by the time I reached the check-in area, wondering whether I could make it to the elevators without resting first.  Not a good sign.  I had the same kind of experience walking from the general waiting room of the Radiology Clinic to the smaller waiting room outside the CT scan room.  Then a bit of a struggle getting onto  and off of the scanning table.  Not good.  On top of that, my lower back and right flank were (and are) hurting.  Am I becoming a bona fide invalid?  Or should I be using the present perfect tense, "have become," rather that the present imperfect or present continuous?  My recollection is that NP Maggie Angeli said that I was a Stage 2 od CHF when we met on Februray 23rd.  It's 3 months later and I'm clearly in much worse shape now, with 5 days of heart-related hospitalization behind me and the catheter ablation ahead of me.  I am thinking again of Ezekiel Emanuel's article in The Atlantic about "American immortals" and when to let Nature take its course.  Who does one talk to about such things, in addition to one's spouse?  Or is this the sort of thing on which we are, ultimately and inevitably, on our own?

The catheter ablation is 20 days away.  If I am to cancel, I should do it soon, to permit another vet to take my slot.  I asked ChatGPT:  "Describe the typical recovery from a catheter ablation for ventricular tachycardia and what can go wrong. What is a difficult recovery, especially for an 85 year old?"  The response:

A catheter ablation for ventricular tachycardia (VT) is usually considered a major but minimally invasive heart procedure. Recovery varies a great deal depending on:

(1) the person’s age and frailty, (2) underlying heart disease, (3)how weak the heart muscle already is, (4)  whether the VT is “simple” or related to scar tissue from prior heart attacks or cardiomyopathy, (5) and whether complications occur.

For many people, recovery is fairly manageable. For an 85-year-old, however, the recovery can sometimes be significantly harder and slower, even if the procedure itself is technically successful.

Typical recovery

During VT ablation, catheters are threaded through veins or arteries (usually from the groin) into the heart, where abnormal electrical tissue is mapped and cauterized or frozen.

A typical course might look like this:

First 24 hours: (1) Several hours lying flat to prevent bleeding from the groin puncture sites. (2) Continuous heart monitoring.  (3) Fatigue, groin soreness, bruising, and mild chest discomfort are common.  94) Many patients stay overnight; VT ablations often require more monitoring than simpler rhythm procedures.

First week: (1)Tiredness is very common. (2) Some irregular heartbeats may still occur while the heart heals. (3) Walking is encouraged, but no lifting or strenuous activity. (4) Many people can resume light activities in a few days to a week.

First 1–3 months: (1)The heart tissue continues healing. (2) The arrhythmia may improve gradually rather than immediately. (3) Medications may still be needed. (4) Follow-up visits and ICD checks (if the person has a defibrillator) are common.

What can go wrong:  Most procedures are completed without major complications, but VT ablation is more complex than many other ablations because the patients often already have significant heart disease.

Potential complications include: (1) bleeding in the groin or internally, (2) blood vessel injury, (3) infection, (4) stroke or blood clots, (5) perforation of the heart causing bleeding around the heart (cardiac tamponade), (6) worsening arrhythmias, (7) heart block requiring a pacemaker, (8) anesthesia complications, (9) worsening heart failure, (10) kidney injury from contrast dye, and  (11) rarely, death.

One feared complication is cardiac tamponade — accidental perforation causing blood to collect around the heart. It can require emergency drainage or surgery.

What makes recovery especially difficult at age 85:  Age alone does not automatically make VT ablation inappropriate. Some studies show carefully selected elderly patients can do reasonably well.  But in practice, an 85-year-old is more vulnerable to difficult recovery because reserve capacity is lower.

A difficult recovery might include:  (1) Profound fatigue and weakness.  (2) Older adults may take weeks rather than days to regain strength. Even anesthesia and a long procedure can cause marked exhaustion. (3) Delirium or confusion  (4) Hospitalization, anesthesia, sleep disruption, and illness can trigger temporary or prolonged confusion in older patients.  (5) Loss of mobility.  Even a few days in bed can lead to major decline:, trouble walking, falls, need for rehab, loss of independence,  (6) Heart failure worsening. If the heart is already weak, the procedure stress can temporarily worsen shortness of breath, fluid retention, or low blood pressure.  (7) Kidney problems. Contrast dye and blood pressure fluctuations can injure kidneys, especially in older adults with preexisting kidney disease.  (8) Bleeding complications. Older blood vessels are more fragile, and many VT patients are on blood thinners.  (9) Longer hospitalization.  Instead of going home the next day, some elderly patients require: several hospital days, ICU care, rehabilitation facility placement, temporary oxygen,  or home assistance afterward.  (10) Persistent arrhythmias. Sometimes the VT is reduced but not eliminated, or another procedure is needed.

The larger question doctors usually consider at age 85 -Electrophysiologists generally weigh: (1) how dangerous the VT is, (2) how often ICD shocks are occurring, (3) quality of life, (4) overall frailty, (5) other illnesses, (6) cognitive status, and (6) what the patient values most.

For some 85-year-olds, ablation dramatically improves life by stopping repeated ICD shocks and hospitalizations.

For others — especially those with advanced heart failure, frailty, dementia, severe lung disease, or multiple illnesses — recovery can be very hard and may not restore previous function.

A key distinction is often:

a robust 85-year-old who is active and independent,

versus

a frail 85-year-old already struggling physically.

Those are very different risk categories even at the same age.

I sent this journal entry to NP Maggie Angeli as the concluding part of this message:

Please direct to NP Maggie Angeli. Thank you.  I have an appointment with you on Thursday and don't know whether this message will get to your before then, or whether you will have the time to read it, but it seems to be worth trying.  I am scheduled for a caatheter ablation by Dr. Singh on June 15th.  I am considering whether I ought to cancel the procedure.  I realize that the responsible thing is to cancel enough in advance of the scheduled date to permit another patient to be scheduled in my stead.    I am copying herewith my personal journal entry from this mornning that describes the thought process I am going through and some pertinent information I gathered from the AI source, ChatGPT.   I hope to be able to discuss this matter with you on Thursday.  Thank you. 

I wish I had added that it's not clear to me whether there is a relationship between the CHF and the arrythmia that would be addressed by the catheter ablation,   What effect, if any, would a successful catheter ablation of the arrythmia have on the CHF" 

Geri read the journal entry also this morning and we had another serious discussion about the "big issue."

Dr. Cheng called with the result of this morning's CT scans.  It turns out that as expected I do have significant deterioration of my mid-spine and arthritis in two places, T4-T5 and T9 (if I'm remembering accurately.). There is a narrowing of the foramen in T9 that would account for the recurring pain between the bottom of my rib cage and top of my pelvis on the right side.  What can be done about it?  Basically, nothing.  Learn to live with the pain.  I took two 650 mg. Tylenol 8 Hour tablets this morning  and they're not helping at all with what I'll problebly now call my T9 pain in my right flank.

Nurse Lisa from the Cardiology Clinic called me around 4 this afternoon, wanting to talk about my secure message to NP Maggie.  We spoke for about 30 or so about my various concerns, which I felt better about after our discussion.  She said she has been in the Cardiology Clinic at Zablocki for 12 or 13 years and seemed to be very knowledgeable about Dr. Singh and about catheter ablations, the kinds of patients on whom it is generally performed, and the risks (mainly bleeding from the thigh).  After speaking with her, I felt more inclined to go ahead with the surgery and told her that, in any event, I would let them know within the next few days.  My arrythmia, PVC or premature ventricular contraction, is pretty substantial, at 30%, based on more than 3 days of wearing a Holter monitor. 

I had to laugh at one point in our conversation, when Nurse Lisa mentioned that in her years in the Cardiology Clinic, no one had died from a catheter ablation.  I apologized and explained that, at my age, I'm never afraid of dying under full anesthesia in an OR, realizing that there are SO MANY ways dying that are much more challenging.  What I fear, rather, is surviving a surgery but coming out WORSE than I was before the surgery, e.g., from the effects of a stroke, etc.

On the other hand, I've been thinking much of the day about that sacred cow, or should I say, that meaningless cliché, "informed consent."  According to Wikipedia, 

Informed consent is an applied ethics principle that a person must have sufficient information and understanding before making decisions about accepting risk. Pertinent information may include risks and benefits of treatments, alternative treatments, the patient's role in treatment, and their right to refuse treatment. In most systems, healthcare providers have a legal and ethical responsibility to ensure that a patient's consent is informed. 

Has there ever been a time when I truly gave my informed consent to any medical procedure or to taking any number of medications that have been prescribed by a physician?  I don't think so.  That word "informed" imposes a duty on the docs to make reasonably sure that their patien reasonably understands what he or she is 'consenting' to, including especially the risks, the 'downsides,' the potential costs if the statistically unlikely happens.  Do they routinely ignore this supposed duty?  I think so.  Informed consent comes up only when the unlikely actually occurs, and a legal claim is made.   Too bad, but in the real world of medical practice, it's not surprising and indeed undeerstandable. although I think for something as significant as any kind of invasive heart surgery, even so-called 'minimallly invasive' catheter ablation, a lot more 'splaining' should be done.

Weird weather.  We had the wettest April in recorded history here in SE Wisconsin.  Now we are in line for the driest May.