My big pacemaker adventure

My pacemaker model

This post documents the lessons learned en route to getting a pacemaker, along with some lessons learned after the fact. – updated 7/26/2022 with section “6-Week Checkup”

I often use FutureMe.org to send myself an email at some future date — for example, to document some worries or concerns (so I can learn whether such worries or concerns are warranted), or to predict what will happen or how well I will do something (so I can compare my actual experience with what I expected without letting hindsight to adjust my memory of what I expected — the “Yes, I knew that would happen” response), and so on.

[I learned in a business context that it is a good idea when presenting findings — of costs, profit, overtime, late delivery, or whatever — to first have people write down what they expected the findings to be (and perhaps write on the board a few of those expectations) before I revealed the findings. If I failed to do that, I found that people would say “Yeah, we already knew that” even when (especially when?) they had no idea. — You could even take the average of the guesses. Often the average will be close to the actual finding, but if it isn’t, it might indicate a problem in information flow and availability within the organization, which might be worth checking out.]

This post is, in effect, a letter to PastMe — it’s represents an email I wish I could have received two years ago to tell PastMe all that I’ve recently learned. 

The beginnings

In July 2020 I began having brief episodes of blacking out. I found difficult to describe the sensation. I would lose consciousness of my surroundings and of myself, aware only that something was happening. My vision didn’t work (thus the “black out” part), and during the episode I felt I was just hanging on, trying to recall where I was and who I was and what was happening. I was aware of time passing, and of my effort to understand, but was aware of nothing else.

The best description I could offer that I was experiencing brief periods of intense wooziness. These episodes initially happened while I was sitting in my chair. A second or two before an episode I could tell from how I felt that an episode was about to occur, and —  after once spilling a bowl of salad I was holding —  I used that warning to set aside anything I was holding.

Once in the parking lot, as I was taking trash to the dumpster, I had an episode. When I got the warning sensation, I stopped and bent forward, and then fell a little onto my outstretched hands. No damage, and when I got up after I came out of it, I realized that when I got the warning sensation and I was standing, I should immediately sit or lie down (if a chair or bed was at hand) or crouch low to floor or ground so that any fall would be more like rolling onto my side. 

I decided to keep a record. Here are the beginning entries I made:

7/10/2020 10:05 am Brief, before breakfast, in my chair

7/21/2020  3:00 pm  Again brief, mid-afternoon, in my chair

7/26/2020 4:16pm After one drink and some cold-smoked fish. This was fairly extended. I felt confused.

Then I decided to use my pulse oximeter after an episode.

8/1/2020 7:40am Pulse 48 O2 96% Brief but focused. Couldn’t recall immediately what to do (i.e., record event, pulse, O2)

8/2/2020 6:08am Pulse 72, dropped right away to 58. O2 96%. Fairly intense: not knowing where I was or what was happening, just focused on internal sensations.

8/6/2020 6:32am Very brief. Pulse 54. After feeling a strong surge of emotion.

8/7/2020 6:29am 96% oxygen, pulse 60. Started shallow but deepened. duration probably around 1 minute. Not unpleasant. I felt like I was exploring it — it had a dreamlike quality.

8/9/2020 6:06am Pulse 60 O2 95% A fairly lengthy episode, and not unpleasant but still. “Fairly lengthy” means about 45 seconds to a minute, I would guess. — 7:23 Another one, more intense. They seem to be happening more often. I don’t quite pass out but I am pulled inside and not really aware of the external world.

8/11/2020 – I seem to be able to forestall episodes. I can feel one starting to form and somehow I can redirect my attention so that it does not happen. Need to confirm by letting it happen

8/14/2020 10:18am – brief but intense. Quick onset, quick ebb.

8/15/2020 5:55pm – another brief and intense: quick onset, quick ebb.

8/15/2020: 10:20pm – intense and fairly lengthy

8/17/2020 7:15 sam – fairly long and intense and I kept trying to figure out how to characterize it.

9/6/2020 None since the one above, though a few times I felt close, but no actual episode — just a precursor.

9/7/2020 10:04am Just had another, fairly lengthy — about 30-45 seconds. Fairly intense.

The duration estimates are just guesses, and for the longer durations, inaccurate guesses, I think. I was aware of time passing, but not how much. Recovery was very quick once an episode ended. There would be an instant of confusion, and then I was “back,” knowing where I was and what I was doing.

I naturally talked to my doctor, who said it sounded like a blood pressure problem. He ordered a 24-hour ambulatory blood pressure test, but that didn’t show anything. I would bring it up off and on, and a year later, I got a referral to a neurologist, who ordered an MRI — getting the test done took some months, in part because of the strains on the medical system. The neurologist later requested an EEG, but I never got that because the actual cause became clear. 

More recently in the record of episodes:

5/19/2022 3:55pm On walk. Enough warning to lean against a telephone pole, but then went completely unconscious and did not at first know where I was when I came out of it. Not sure of duration, but I think around 30-40 seconds. Passerby saw me fall and helped me up. It was toward the end of a 1.6 mile walk.

5/26/2022 Two intense seizures of some duration, both while sleeping. One at 6:45am and one at 7:45am. They were strong and confusing because they were mixed with dreams. I got up after the 7:45am episode, and then as I sat on the bed, I got a few waves — 3 or 4 — of “almost seizures”: the sensation that I was sliding into a seizure. I’m afraid to walk today. — And again 5/26: At 6:00pm I had a strong effort to have a seizure, then fought it off; then at 6:05pm I did have a seizure, brief but definite. And now it seems to be trying again a few minutes later. — 7:35pm:  yet another, very intense toward the end. Was Facetiming with J so she saw it. She said it was about 8-10 seconds. — 7:52pm A slight one, but a real one.

5/29/2022 6:45am — very brief one; 10:50am – another very brief one.

6/4/2022 3:30pm — half a seizure: it started (enough that I put down my glass of tea before it took hold) and then it stopped.

The episodes continued, and because of staff changes at my clinic, I saw a different doctor. My wife described to him the episode she saw during the Facetime call: My head slumped, my eyes rolled back, and I started breathing harshly. She said my name a few times and asked me what was happening, but I didn’t respond. Then after 8-10 seconds the episode ended, and I quickly (within a second or two) remembered where I was and what was happening and was back to normal. 

The doctor said it sounded like a seizure. I had already been referred to a neurologist, who ordered an MRI. This doctor ordered a CT scan. 

Because the episodes, though intense, were not painful and didn’t seem to do much harm, I was patient. I did have a couple when I was asleep in bed, and those were unpleasant because they were more confusing: I truly did not know what was happening. 

I had one while I was doing an exercise walk, and that made me wary of taking a walk.

Barking up the wrong tree

A fair amount of time was spent pursuing false leads. I mentioned the referral to a neurologist. Another false trail I returned to repeatedly was that the episodes were the result of something in my diet.

I had eliminated sodium from my diet (that is, I did not cook with salt or add salt to food, and of course did not eat highly processed foods, generally high in salt), and I wondered if I had too little sodium. So I began adding just a little as I cooked. 

I had seen on Cronometer that my potassium was low (and potatoes, an excellent source of potassium, impacted my blood glucose, so I did not eat them at all). I started taking a potassium supplement. I thought it was safe because I had read that the body can easily rid itself of excess potassium, but then I got worried and cut that out, and then also cut out the zinc supplements I had been taking(another mineral I thought I was low in) — and I learned that calcium supplements turn out to be a bad idea anyway. So I discontinued all those supplements, but no change in episodes.

Then I thought about hibiscus tea. I had started drinking it when I switched to a whole-food plant-based diet because in How Not to Die, Michael Greger MD had noted that it was beneficial for blood pressure. I drink a pitcher of hibiscus tea every afternoon and evening as iced tea. (That’s a little less than a quart: 30 oz instead of 32 oz (a quart).) Maybe that was it? It certainly didn’t seem to be helping blood pressure because for the past year or so my systolic pressure was running 135-139 — that’s high. I was worried enough about that to buy my own blood-pressure monitor. My morning blood pressure was even 140/90. So hibiscus tea was not working anyway, and maybe it was causing seizures? So I quit hibiscus — that was just a week ago. (The odd thing about the blood pressure was that three months after switching to my whole-food plant-based diet in May 2019 and discontinuing any added salt, my blood pressure was 120/71. But for the past year so, my blood  pressure has consistently been  high.)

Update 23 Oct 2022: My blood pressure reading probably was high because I was not following a good protocol when measuring it. I read carefully the manual for my blood pressure monitor, and I now take two readings a few minutes apart, and I wait at least 30 minutes after eating or drinking coffee or exercising. I take my blood pressure while lying on the bed, and I lie quietly for 5 minutes before taking my blood pressure. After 16 readings over a week (one day I took readings both morning and afternoon), my average is 120/72 with a pulse rate of 62. This is good blood pressure, according to the American Heart Association.

Thursday, June 9

Late in the afternoon last Thursday, I noticed that my left leg, which had been going to sleep (because I prop it over my right leg to hold my computer in place), did not wake up after I walked around on it for a while, as it usually did.

I will also note that over the past couple of weeks, the momentary dizziness I felt on standing up from a sitting position seemed more intense and longer — I would have to stand still and wait until the dizziness and feeling light-headed passed. That would take 5-10 seconds. 

But the persistently numb leg was new, and of course I searched the internet and decided that if my leg were still numb/asleep the next morning, I would call my clinic for an appointment.

Friday, June 10

The numbness was still present in the morning, so I called my clinic, the James Bay Urgent and Primary Care Center. I got an appointment for 5:00pm Sunday, June 12.

Saturday, June 11

I decided that it had been too long since I walked, so I got my Nordic walking poles and set out. I had planned to walk several blocks — up to Menzies, over to Dallas, down to Boyd, and back home ​​— but I was barely able to walk ust around this block, and even then I could walk only slowly and twice had to stop along the way to rest. The chart for that walk is below on the right, and you can see the two rest periods.

I had experienced a blacking-out episode during my walk on May 19, and had done only one walk after that (on May 21). I was just fearful of blacking out again while walking. On that May 19 walk, I felt the episode warning signs, moved off the sidewalk, and grabbed onto a telephone pole in a grassy strip. The next thing I knew, I was prone on the grass and a guy was asking me whether I was okay. 

I said I was — as usual, when the episode was over, I quickly felt okay — and he helped me to my feet and I walked the short remaining distance home. I did only one walk after that, quitting because I feared a fall.

Below are some charts from the iPhone app for my Amazfit Band 5. On the left is the May 19 walk. You can see toward the end of the walk a period where my speed was 0mph. That was while I was lying on the ground. 

There are some other oddities in the May 19 walk. Look at the heart rate: irregular, but fairly flat (as a trend line) right until the end of the walk, even though for the first half of the walk I was walking at a fairly brisk pace uphill, as shown in the chart below.

Despite walking briskly uphill, then back downhill, my pulse really doesn’t change all that much until I blacked out at the very end, which made me think the Amazfit was getting poor readings. But maybe the readings were accurate — perhaps the problem was not with the exercise tracker but with my heart.

Below the altitude data at the right are cadence data. You can see where my blackout pretty much wrecked the cadence.

On the right above is my walk of June 11. I could manage only 2.3 mph, and even that required two stops to rest and breathe. I was feeling very feeble indeed, and I could not figure out why.

The heart rate chart for that walk (shown above) is also weird. My heart rate increases — sure, I’m exerting myself — but then for no real reason it drops off.

Sunday, June 12

I needed some things from the grocery store — fruit, mainly — so I got my little grocery cart (which I seldom use, but I felt weak) and walked there (about two blocks) and back. Again, it seemed to require a lot of effort; I simply had no energy..

At 3:05pm I was making a new batch of tempeh when I had an episode and blacked out in the kitchen. I had crouched quickly, and when I regained consciousness, I was sprawled on the floor with my legs a bit twisted.

I straightened myself out, scooted over to bed to get up; sat on the edge of bed, and blacked out again. When I came to, I moved to my chair to record the episodes and passed out again — this was at 3:18pm. Then, before I could get up from the chair, again at 3:29pm. The appointment at the clinic was at 5:00, and I asked my wife to take me. (The clinic is about 4 blocks from here, but I was just weak and worried about passing out.)

As she drove me there, I passed out in the car. As we talked to the doctor about my numb leg, I mentioned also my problem in passing out — something I had been to the clinic about before — and then I passed out sitting in front of him.

The doctor, who had asked quite a few questions about what had been going on, immediately had a nurse do an ECG. My pulse was 30 beats per minute. 

At this point, the doctor had a diagnosis. I had an atrioventricular block (AV block): the electrical signal traveling from my heart’s upper chambers to the lower chambers was impaired. Normally, the sinoatrial node (SA node) produces an electrical signal to control the heart rate. When there’s an AV block, the SA node’s signal is dropped.

The doctor told me to go immediately to the hospital ER, and he would phone them now to expect me. I needed a pacemaker and would almost certainly get one before I was sent home.

The Wife drove me to the hospital, and while she parked the car, I walked into the ER and signed in. I noticed a price list (see photo at left) posted for non-residents. The prices don’t apply to me, since I am a Permanent Resident, the Canadian equivalent of the US Green Card. But it was interesting to see an actual price list, given that hospitals in the US often refuse to reveal their prices.

Seeing the sign reminded me that I also didn’t have to worry about a common practice in the US where hospitals will staff ERs with out-of-network doctors so the hospital can charge (much) higher prices than the insurance company allows for in-network doctors. (See “Their Baby Died in the Hospital. They Had Good Healthcare Insurance. Then Came the $257,000 Bill.“, for example.) 

I feel sure that in the US my hospital stay would have been a noticeable financial hit even if I was insured, just from the usual co-pays, plus I would have the hassle of wrangling with the insurance company over pre-authorization and afterwards over what they would and would not cover. (See “She expected to pay $1,337 for surgery. She was billed $303,709” for a prime example.) And if I was not insured, I imagine it would be a financial disaster. (And, surprisingly, many in the US continue to say that the US has “the best healthcare system in the world.”) — Update: See also “Sick and struggling to pay, 100 million people in the U.S. live with medical debt.” Two words: indentured servitude. Update again: Two identical surgeries in the US, same insurance: one patient was billed $204, the other $4,057.

After signing in, I moved to the next desk to be admitted, and there was another, more detailed price list for non-residents (click to enlarge). Note that the units where I stayed would cost a non-resident CA$11,600 per day — 3 days bring that to CA$34,800 for my stay, and that’s just the room charge, never mind the fees for surgery, the pacemaker itself, the tests, and so on.

I was moved (via wheelchair) to a private room in the Cardiac ICU. I changed into a hospital gown, got into bed, and was immediately hooked up to an intravenous drip that delivered a medication that helped regulate heart rate — not a long-term solution since the body adapts to the medication, and the medication will stop working.

It was too late for the evening meal, and I was allowed only ice chips in case surgery would suddenly be required. (If the med didn’t work, there was a temporary surgery that could be done to keep me going until the pacemaker could be installed.)

Monday June 13

I got no food for breakfast because it was possible my surgery would happen that day. Instead, I breakfasted on ice chips. My fasting blood glucose was 8.3 mmol/L! (150 mg/dL!), the highest reading I’ve had. I imagine the high reading was due to stress and possibly something to do with my irregular circulation. 

My average for the previous 3 months (and previous 30 days and previous two weeks) was 6.2 mmol/L (112 mg/dL), and in fact the previous Thursday my fasting blood glucose had been 5.8 mmol/L (104 mg/dL). 

This morning (Thursday, June 16) my fasting blood glucose was 5.4 mmol/L (97 mg/dL), which in the “normal” range. I wonder whether my fasting blood glucose will now drop to normal levels. Time will tell. — 20 June 2022 Time is telling, and the answer is , “Yes, blood glucose levels will drop.” Last couple of days fasting blood glucose has been 5.7 mmol/L (103 mg/dL). Week’s average: 5.8 mmol/L (105 mg/dL).

When the surgeon stopped by to tell me what to expect, I asked whether a general anaesthetic would be used. No — pacemaker surgery is done under a local, and I would be (and was) conscious the entire time. That’s a good thing, I think. General anesthesia has risks, including cognitive impairment (brain fog).

The surgery took place from (roughly) 1:30pm – 2:30pm. One good thing about living in a city with a fairly large elderly demographic is that surgical teams and hospitals are well practiced in (among other things) installing pacemakers. The operation struck me as efficiently and effectively done, with everyone involved calm and practiced in what they did — very reassuring to a (conscious) patient.

Tuesday, June 14

After some sleep in the early part of the night, I woke up at 1:30am and remained wide awake and alert until 7:30am. I was thinking of recipes, of blogging, of what I had gone through, and — of course — of why I was so awake and alert for 6 hours in the middle of the night. One obvious reason was a recent change — namely, the pacemaker. I got thinking about what it does. Combining what I knew with what I had learned:

My heart’s right atrium takes in blood that has traversed my body and arrives exhausted and full of waste — lacking oxygen and burdened with CO2. The right atrium — thump! — sends that blood into the right ventricle, which then contracts — THUMP! — to push the blood to and through the lung’s capillaries. My diaphragm works steadily, day and night, moving up and down to pull air into my lungs and then pump it out. As blood moves through the lungs, it quickly ditches the CO2 it carries and grabs as much oxygen as it can before it flows out of the lungs on its way into the left atrium.

The left atrium contracts — thump —  sending blood it received from the lungs on into the left ventricle, which then contracts — THUMP! — and ejects the blood to surge out through the aorta and flow throughout the body, bringing oxygen to the cells and carrying out their trash (CO2).

Thus the heart rhythm: thump-THUMP!, thump-THUMP!, thump-THUMP!; and so on, slower or faster as needed.

When the atria contract, they send an electrical signal to a way-station, which then sends a signal to the ventricles that they should now contract. My way-station was defective: it sometimes did not send along that signal. If the ventricles don’t get the signal, they don’t know when to contract, but they have  a fail-safe fallback: if no signal shows up, the ventricles will eventually contract on their own, and that will get whatever blood they contain on its way. Their default pulse rate (in the absence of signals) is about 30 beats per minute. That is not enough for good circulation — thus the black-outs: insufficient oxygen to the brain.

The pacemaker takes over the role of the way station. A wire with a threaded tip is inserted at the appropriate point on the right atrium (RA in the photo of the pacemaker) to capture the signal. A second wire, also with a threaded tip, is inserted at the appropriate point in the right ventricle (RV in the photo of the pacemaker) to pass the signal along to tell the ventricles to contract.

The threaded tips keep the wires from easily pulling out once the tissue has healed — that is, once scar tissue develops to securely grip the threads and keep the wires in place. (I noticed hospital staff preferred to talk to me about “healing” rather than “scarring,” but in this case the scar tissue is important.)

So after the surgery, I have to restrict the range of motion of my left arm — not raise it above my head or pull it back — and not lift anything heavier than 10 pounds with my left arm for a period of 6 weeks (for me, until July 25). For the next few weeks, my model is Spencer Tracy in Bad Day at Black Rock (excellent movie).

The pacemaker includes a computer, which is programmed to meet patient requirements. In addition, the pacemaker’s algorithms monitor signal frequency and timing and can correct for problems like atrial fibrillation and arrhythmia.

Before the pacemaker, the monitor in the ICU I was attached to showed that my heartbeat was highly variable, even with the intravenous medication. After the pacemaker was installed, my heart beat was totally regular but The Wife said that the pacemaker line on the display was active, jumping up and down as it swung into action or applied corrections — it was on the job.

Bottom line: my body was now getting the feast of oxygenated blood that it required and that had previously been in short supply. No wonder I felt so awake and alert. 

My pacemaker battery will (at the level I’m using it) last 11 years. If they have to ramp up the output to a higher level, the pacemaker will run out of energy a little sooner. (When I go to Pacemaker Clinic Services for my regular appointments, they will scan the pacemaker and get a full report and readout, including remaining battery life. (For details on my pacemakers capabilities and reports, see this PDF.)

When the pacemaker’s battery runs down, another surgery is used to replace the pacemaker altogether. (Pacemaker batteries, like batteries in, say, the Kindle, cannot be replaced, but in the case of the pacemaker, surgery would be required to replace batteries, so replacing the entire unit makes sense.)

Microwave ovens are no longer a problem for pacemakers (or so I’m told), due, I imagine, to improvements in pacemakers and microwave ovens. However, I cannot carry my iPhone in my shirt pocket, right next to the pacemaker. And induction burners, with their strong magnetic fields, will confuse the pacemaker.

I use an induction burner for cooking, and I was concerned about the effects, so I called Boston Scientific and talked to a patient services tech about my particular model of Boston Scientific’s Accolade MRI EL DR Pacemaker (model L331). He told me that if my pacemaker gets within 12 inches of an induction burner in operation, it will pick up the magnetic field as a signal and (in effect) say, “Okay, I don’t have to send out pacing signals,” and so it will quiet down for my heart do its own pacing. As soon as the magnetic field is gone or distant, the pacemaker notices that the absence of signal, and it resumes its programmed operation. [Note that this comment concerns the particular make and model of pacemaker that I have. Pacemakers vary, so don’t assume that what’s true of the Boston Scientific L331 is true of another model.]

So, basically, no problem. I can just stand back a little with my right side toward the pan (and burner and its magnetic field) — and, luckily, I am right-handed — and cook, knowing that even if I move in close and my heart must resort to its own pacing for a few seconds, the pacemaker will resume operation as soon as burner is off or I move away. And I normally don’t stand all that close anyway, plus I can move my portable induction burner farther away, toward the back of my cooking space. That will easily take care of it with the only downside being that I’ll just have to reach a little farther.

Moreover, according to what I’ve read, the effect of the induction burner’s magnetic field is minimized if (a) a large pan is on the burner (sopping up the magnetic field), and (b) the pan is centered on the burner. An iron or carbon steel pan, or a magnetic stainless steel pan that works on an induction burner, captures and channels the energy of the induction burner’s magnetic field, using that energy to make eddy currents that heat the pan. As a result, the field beyond the pan is minimized and has little range.

So I moved my portable induction to the back of my cooking area and close to a wall on the right. The presence of the wall already moves my left side away from the burner (and, as noted above, I’m right-handed, so the location is not at all awkward). Putting the burner toward the back in itself increases the distance sufficiently. So far, there’s been no problem. When I use a small pan, I’ll just take care to stay distant. 

Around 2:00pm on Monday, shortly before the ward nurse came to dismiss us, I felt the effects of staying up most of the night and took a nap. The room was pretty bright, so I used the face mask the hospital provided (for when I was moved through the corridors) as an eye mask. It worked well, in fact.

Aftereffects 

1. I felt some soreness after the operation, but nothing Tylenol could not banish. By today, the soreness has gone. Today I also removed the bandage and took a shower — a great pleasure. At the end of this post, below the fold, is a photo of the wound.
2. My familial tremor, which had become much worse in the last few days before the operation, pretty much went away. I think again that having a better supply of oxygenated blood was the cause of the improvement.
3. The numbness in my leg went away, presumably (once more) because of better circulation. Also, I can now stand without experiencing any dizziness or light-headedness — again, presumably because of better circulation.
4. My systolic blood pressure increased to 136-139 over the past couple of years, even though it settled at around 120/72 shortly after I switched to my whole-food plant-based diet. (I also (a) cut out salt and (b) started drinking hibiscus tea afternoons, as iced tea). But when I got my blood pressure checked after the episodes became a regular occurrence, it was — to my mind — way too high. Immediately after the pacemaker was in and working, my blood pressure dropped back to normal: 116/70. (See Mayo Clinic’s chart of blood-pressure ranges.)
5. My mind was racing from 1:30am to 7:30am and I believe it was again due to improved circulation: my brain (and muscles) were suddenly getting better delivery of oxygenated blood. Over the past couple of years, I had adapted to mediocre oxygen delivery, so I very much noticed the change when that improved. A contributing factor to my feeling of energy probably was a great sense of relief.
6. (5 days later) My sleep — nighttime and just now a nap — is much deeper and more restful. I would bet defective blood circulation kept almost waking me or actually awaking me. This improvement in my sleep — more deep sleep, for example, and in blocks instead of scattered, fewer periods of wakefulness — shows up in the Amazfit Band 5 app on my iPhone. As with the Amazfit’s heart rate detection, I had assumed that the poor showings in the charts was due to the Amazfit not being very good, not to its detecting actual defects in me (heart rate, sleep pattern). I should have paid attention.
7. Already noted is the change in my average fasting blood glucose. Prior to surgery, my average reading, both short- and long-term, was 6.2 mmol/L (112 mg/dL). After the surgery, a week’s average was 5.8 mmol/L (105 mg/dL). I’ll update this after I resume walking and also have a longer timeline to average.

I suspect the odd heart rate readings my Amazfit Band 5 detected were not (as I assumed) due to poor performance by the product but because it was reflecting defects in my heart rate.

The antibiotics I got (three doses during hospital stay: before, during, and after surgery) and the Tylenol I took doubtless decimated my gut microbiome, but I have a good supply of vegetables I’ve fermented. Eating that will help my gut microbiome recover — plus whole plant foods (such as fresh fruit) are probiotic in themselves (as well as prebiotic, dietary fiber being the foodstuff of the microbiome).

At the right is what the surgical site looked like after my morning shower. Before the shower, I removed the bandage that covered the wound. What are left are steri-strips that will fall off in a few days or can be removed in a week.

6-Week Checkup

This morning I had my six-week checkup. I told the tech who was looking over the pacemaker records (which he downloaded to a console via a wireless connection) that a few times I had felt that I was about to have a dizzy spell, but then did not. He asked for an example of when it had happened. “Yesterday,” I told him, “on my walk.”

“Around 8:00am?” he asked.

“Wow. Yes,” I said.

“8:12am, in fact.” He could read that from the record.

He worked away at the console for a while, and I asked whether he had an update on expected battery life. He did: 12 years, as of now.

He had question for his boss, who came and worked with him a while at the console, then asked whether I would like a remote monitor. That would sit beside my bed and every night ping the pacemaker to get most recent readings, which it would transfer to the hospital so they would be alerted to any anomalies. The monitor is a passive receiver: gets information from the pacemaker but doesn’t transfer anything to it — for example, no adjustments. For those, I would go to the pacemaker clinic at the hospital. But the monitor would let them know whether such adjustments are needed.

Pretty cool, and I have it now. It took a fair amount of time to get it initialized, because when you plug it in for the first time, it phones home and downloads and installs software updates. That took probably 10-15 minutes. It’s now all initialized and will be sitting beside my bed, quietly checking each night how the days has gone.

Cognitive effect

The Wife mentioned today that she only gradually because aware of it, but my cognitive reflexes are noticeably snappier after the pacemaker was installed: I pick up on things more quickly, respond better — much as I used to before the heart problem manifested. I thought that was interesting.

Going home After PacemakerDownload

Pacemaker Clinic ServicesDownload

40 Years On – The Lessons of the Falklands War

Interesting post on the importance of preserving institutional knowledge and experience, by “Sir Humphrey” (of Yes, Minister and Yes, Prime Minister fame, in which Sir Humphrey was the prototypical civil servant) in The Thin Pin-Striped Line:

40 years have elapsed since the Falkland Islands were liberated, and the local population were freed from dictatorship to choose their destiny again. This short, bloody and wholly unnecessary war was started by dictators, and finished by the British Armed Forces. Even now, four decades later, its lessons continue to resonate and must be considered.

In a series of tweets, the French Navy Chief of Staff has set out thoughts on the enduring lessons of the war, and why it still matters. Many others have done likewise – it has been a period to reflect on why, even many years later, the war still has something to teach us. This article is a short reflection on what the author believes are five enduring lessons we must continue to reflect on.

The first and most simple lesson is that time and again we end up fighting the war we didn’t expect to fight, but we succeed because we keep the skills alive to do so. In 1982 we planned to conduct high intensity armoured warfare in Central Europe for 7 days before the literal end of the world was nigh. Little thought was given to expeditionary warfare at long distance, beyond the amphibious reinforcement of Norway. Naturally we ended up fighting an amphibious war many thousands of miles from home with no anticipation. In 1991 we still expected (just) to fight in Europe, and we ended up fighting the desert, just in time for expeditionary operations to become central to our doctrine, only for deterrence in Europe to come into vogue again in 2022 – in short, we prepare for one, and often end up doing another.

While this may sound familiar ground, what we fail to take into account all too often is that . . .

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Conserving de Kooning: Theft and Recovery

Here’s more on the theft and restoration.

The inflation rate has been declining for the past year

The graph above shows the PCE core chained index (the PCE measure of inflation excluding food and energy) and is from a post by Kevin Drum, who writes:

. . . I’m not saying this is the inflation measure everyone should put on their front pages. Overall CPI inflation is a good measure of what people see in their daily lives, which is why it’s the one that shows up in headlines.

Still, for analytic purposes the Fed claims that PCE core is a better measure of underlying inflationary pressure in the economy. And if that’s the case, it’s been on a downward trend for the past 12 months. Hell, even CPI core inflation has been going down for the past couple of months.

So why the widespread panic over inflation? Why doesn’t anyone pay attention to the PCE core metric? And in particular, why doesn’t the Fed seem to pay much attention to the very metric they say is the best?

At last I shave again — and what a great shave!

I think that Yaqi brush’s loft is a little low, but still: a great lather (Phoenix Artisan’s CK-6 formula) with a fragrance I very much like. The iKon stainless slant, here with a DLC coating, more commonly now with a B1 coating, is a terrific slant (if used with the correct angle and light pressure). Here the head is mounted on an Above the Tie handle.

A Derby Extra blade works for me quite well in this razor but has a short lifespan. After the shave I replaced the Derby with a Swedish Gillette from my stash. A good splash of the aftershave, augmented with a couple of squirts of hydrating gel, and the job was done and I’m feeling very good. This morning was my first shower since Sunday morning, so very welcome. 

The tea this morning is Murchie’s Anniversary Blend: “To commemorate our 125th anniversary (1894 – 2019) we’ve created a tea founded on the heritage of our oldest and best-loved blends. The combination of Assam, Keemun, Ceylon, Yunnan, and Gunpowder single-origin teas produces an expansive cup with light briskness, full mouth feel and a rich amber hue.”