Comcast Holiday Spectacular

Quite A View!

This is the view from the terrace of Steve Martin's home in St. Barthelemy. The house is for sale for something like $9M. The view is looking west toward St. Martin. You can see the St. Jean bay and the airport runway down below in the distance.

The Impressive Hospital Complex At The University Of Pennsylvania

At HUP Radiology

Picking up the disc of my chest cat scan from last week.

Philadelphia's Christmas Village

The Christmas Village at Love Park was busy over the weekend with post-holiday shoppers crowding the aisles.

My Little Model Train World

It's relaxing to spend some time enjoying my favorite hobby.

St. Vincent Official Trailer #1 (2014) - Bill Murray, Melissa McCarthy C...

Really good movie...must see!

Holiday Portrait

A Germantown Christmas

At our good friend's house in the Germantown section of Philadelphia. Our gracious host is Paul Jablonsky.

Our Holiday Display 2014

Our Holiday Tree 2014 and the trains running underneath.

At The Hospital For Tests

At The University of Pennsylvania hospital for a CAT scan.

The Holidays At Our House

Holiday Concert

One of my favorite seasonal events in the Harriton High School free concert at Liberty Place in December.

Holiday Tree: City Hall

Nice to see the tree return to City Hall courtyard after a few years.

Back In The Groove...For Now

At one of my Starbucks haunts...made my appointments yesterday to see two different surgeons. I have medical appointments tomorrow and next Tuesday but I'm also determined to enjoy what's left of my favorite season. After coffee and lunch there is a free holiday music concert I want to attend at Liberty Place. That will be fun!

Getting Re-acclimated

Home at last...trying to get caught up on everything after a week in the hospital. I received excellent care, nevertheless, I'm still in recovery mode. It'll take some time to get back on my feet. Photo shows the view from the 11th floor of HUP looking towards downtown Philadelphia.

Day VII: I'm Being Discharged From The Hospital!

Hooray! I'm being discharged this afternoon with a recommendation for surgical aortic valve replacement. My cardiologist, Marty Keane, was formerly at Penn but he is now at Temple. He has recommended a surgeon that Temple just lured away form the Arizona Heart Institute, Gray Wheatley. Marty also gave me another name at Penn, Wilson Szeto, so I'll meet with both of them. I have time because I have to wait for any neurological damage from last week's incident to heal. It looks like my surgery will be around late January/early February, I feel good about everything and I feel good physically so I just have to stay healthy until I can get rid of the bad valve that is causing the problem.

I Made It! No Coronary Artery Disease!

This photo shows the new-style air bladder pressure dressing applied to my wrist at the cardiac catheter entry point just to the left of the green dot. Using the wrist is far better than the old-style groin entry because recovery is so much faster and far more comfortable for the patient.

I had both the TEE and the cardiac cath this afternoon. The staff here at the Hospital of the University of Pennsylvania is so expert that I got through everything easily with no discomfort or pain, contrary to my fears. While I do not have most of the results of the tests, I did find out that I do not have coronary artery disease validating my own prediction. Tomorrow I'll meet with my doctors and hopefully get the full test results as well as find out what the plan is to address my heart valve, and mini-stroke/heart attack issues.

Day VI: Heavy Duty Testing Day

Today will be extremely challenging because I am scheduled for two difficult, highly invasive tests: a trans-esophageal echocardiogram first, followed by a cardiac catheterization. If I can get through these challenges the up side is that I may have answers to what is causing my heart stress and mini-strokes.

Day V: The Plot Thickens Yet Again

This morning one of my cardiologists, a resident named "Mike" came in early to fill me in on the planned course of action for the coming week. Since the films from last weeks barium esophageal X-Ray series were negative for any TEE contraindications, I will have the TEE first on Monday. If the TEE does not reveal any contraindications for a heart catheterization, then that will happen second, either on Monday or Tuesday. Then there will be a pause of two days to allow contrast media to clear my system. Next, probably on either Thursday or Friday I will have a full chest contrast CT scan. One of the purposes of this is determine what the surgical options are for AVR. It may be possible for me to have a TAVR procedure but this is yet to be determined. HUP does the most TAVR procedures in the Philadelphia area and they are making the procedure available to populations other than the initial limited elderly and ill who are not candidates for OHS.

Update: I am NOT eligible for TAVR...it has not been approved for bicuspid valves, and it is not being done here as widely as the resident led me to believe. Nothing like getting your hopes up and then having them dashed within a few short hours.Also, the chest CT scan is needed to help in the evaluation of my dilated ascending aorta, however, it is uncertain whether or not it will be ordered based upon the results of the cath, etc.

Room With A View

Looking west from the eleventh floor cardiac intermediate care unit (CICU) University of Pennsylvania hospital.

Day IV: Information Finally!

l had my much anticipated visit by my attending physician Dr. Litwack and his associates. I was prepared with written questions. Here are the answers: My esophagus is normal. The troponin level peaked so there is no longer any need to track it. I experienced a combination heart attack and stroke. This is not uncommon. I will probably need aortic valve replacement. I can inspect my chart. The plan for Monday is to try for both the TEE and the cath, both of which will help with the diagnosis and treatment plan.

Day III: Stuck In The Hospital

Remember when you took your car in for one repair, and they tell you, oh, by the way, this is broken and that doesn't work, etc., etc?

So I wait all day today, Friday for the heart catheterization, they prep me, take me down to the cath lab and....STOP. Because the brain MRI yesterday showed that I have suffered multiple minor strokes (!!!!) to be safe we need take a closer look at your heart valves to make sure there's nothing that can dislodge during the cath and cause a serious stroke. So I need a type of echocardiogram called a "TEE"...a trans-esophageal echocardiogram, where you get high then you swallow (gulp!) the transducer and they look at your heart valves internally. What fun! So if that wasn't bad enough they ask me questions about my esophagus...no problem until the question about swallowing...any problems? Well, I've had swallowing problems for years caused by who knows what, maybe my dilated ascending aorta? Anyway, that put everything on hold. No TEE, No cath...instead I had to go down to radiology and swallow a half gallon of barium while they x-rayed my esophagus! The other tests are on hold until Monday, MONDAY! So I' m stuck here all weekend with the prospect of the nasty TEE to look forward to before I can even get to the cath. Who knows when I'll ever get outta here!

Thanks friends for reading all this and for your love and support.

Jim

Another Hospital Room Selfie

Day II

Thursday, December 11... I found out that, while the CT brain scan was ok, neurologists wanted further detailed evaluation of my brain so MRIs were ordered. I finally spent 45 minutes in an MRI machine in the afternoon under sedation due to my claustrophobia. No further tests that day so I was able to have a nice salad for dinner courtesy of Louise and chocolates that Dan bought for me. In the morning Dan and I were able to speak with the attending physician's substitute and his team. We asked various questions about troponin levels, why was Lipitor prescribed (ad a precaution,) the cath will evaluate the coronary arteries and the aortic valve. A post release plan will be provided. If the aortic stenosis is believed to be the cause of my episode, options include scaled back activity or AVR. Options were not discussed in the event of coronary artery disease.

Oh well...

Still ticking anyway...

Day I: Wednesday 12/10 In The Hospital

Tuesday evening, December 9 I was in the basement in our home on Aspen Street in Philadelphia working on my model trains. I was not exerting myself. At around 5 pm an episode of chest and throat tightness and palpitations came on me. I began to feel poorly. I stopped what I was doing and decided to try a short walk outdoors with our dog to see if the air and walking might help me feel better until the episode passed. However, I still felt bad after returning from the walk. In addition to the chest and throat pressure and malaise, I noticed some problem with the peripheral vision in my right eye. I sat on our sofa and alerted Dan that I was in distress and that I felt it advisable to go to an ER that specializes in stroke. We discussed the options in terms of hospitals. We opted to take a taxi cab to HUP, the hospital of the university of the University of Penn Pennsylvania, since we are familiar with it. Upon arriving at the ER I explained my condition and I received immediate attention. I was in significant discomfort but a nurse provided me with two Nitro-Glycerin pills. These made me feel much better. A blood sample was drawn and I was placed in an observation room for the night. Wednesday morning, December 10 at 4 AM I was admitted to the hospital and given a room 1169 in the CICU (Cardiac Intermediate Care Unit) on the 11th floor of HUP. I was put on a variety of anti-coagulants including an IV Heparin drip, and Plavix and Aspirin orally. Blood tests had revealed a level of Troponin, an indicator of heart muscle damage or stress. Weary from the episode and lack of sleep, I tried to get naps whenever I could. I was scheduled for tests including an echocardiogram, which I got Wednesday morning, and a heart catheterization. Being out of my room for most of the day, I missed the visit of the care team and so I was lacking information about my condition. Later my nurse told me that my troponin levels were trending up. In the afternoon I was taken to the cath lab and prepped for the procedure. However, when my attending Cardiologist, Dr. Witlack, learned from me about my vision abnormality that I reported as happening at the same time as my cardiac episode, he decided to have the vision issue evaluated prior to the heart cath for safety in case there could be loose embolisms floating somewhere. So the next test I had was a CT scan of my brain. That ended the tests for the day so I was finally able to eat a small meal, my first solid food since Tuesday mid day.

Longwood Gardens At The Holidays

We had a great time Sunday afternoon at Longwood Gardens with our friends Chad and Franklin from Baltimore. We sang carols and listened to the wonderful organ, enjoyed all of the holiday lights and flora, and followed up our visit with cocktails and a nice dinner in Kennett Square.

La Provenca St Barth (Formerly Wall House)

One of our favorite restaurants on St. Barth, Wall House, has changed hands. The new owners have made extensive renovations. Hopefully, the food will be just as reliably good!

How To Survive An Encounter With Police

Too bad it's come to this, but everyone needs to be very careful when dealing with law enforcement. The following advice is attributed to a policeman:

My 5 tips on how blacks and others can survive an encounter with police are very simple and if you stop and think about it make a lot of sense: 
1.Do NOT under any circumstance ARGUE with police out in the street. You cannot win an argument with police out in the field. 
2.2. Do NOt raise your voice, but stay cool and calm. Do NOT make any quick or aggressive movements. Remember the police officer does NOT know you and will react to protect himself or those around him. 
3.Police know that hands kill, so always keep your hands in plain sight. Before you move your hands ask permission, officer I need to go into my back pocket to get my ID, is that OK with you? 
4.NEVER run from police even if you are innocent. When you run you create a heightened sense that something must be wrong here. 
5.DO NOT resist arrest – if you do one of three things is going to happen: 
a.You are going to get beat down till you stop resisting 
b.You are going to get injured or accidentally killed 
c.And you are going to have charges taken out against you.

Longwood Gardens

With friends to see the holiday exhibits.

At Longwood Gardens

With friends Chad and Franklin from Baltimore.

At Knock, Downtown Philadelphia

Having a Martini...waiting for Dan and three friends.

Swan On The Schuylkill

I can't remember seeing a swan on the Schuylkill River before. Dan and I saw this one this morning during our walk.

Philadelphia Orchestra Concert Excerpt

Tuesday evening the Philadelphia Orchestra gave a free concert in conjunction with "Giving Tuesday." All seats were occupied and for the encore from Tcahikovsky's "Nutcracker" ballet our conductor Yannick Nizet Seguin encouraged audience members to record the excerpt and share it widely. The aim is to promote attendance at orchestra concerts.

Thanksgiving Holiday Photos

Photos from the Philadelphia parade, and our dinner at home with friends.

Macy's Light Show Fans

People enjoying Macy's noon holiday light show line the grand court inside the John Wanamaker building.

Great NYC Restaurant

At 93rd & Amsterdam on the upper West Side of NYC.

Holiday Trees For Sale

Outside of Starbucks on Columbus Avenue.

MTA Work Train

At 34th Street on the 123 line...all locals running on the express track. NYC is always interesting.

Holiday Light Show

At Macy's in the historic John Wanamaker building located in the heart of downtown Philadelphia.

"He Did Not Deserve To Die"

A Canadian commenter writing on the New York Times observes:

Observing all this from North of your Border I can't help but have a sick feeling for the future of those who must face daily life on the streets of your cities. Based on the explanations provided via the Prosecutor I can understand why no charges will be brought against Officer Wilson. But it only makes sense in the context of a US gun culture that has spun out of control. Where firing one's gun is always a first option. Had this scenario happened in England or Scandinavia or Australia or Canada where gun culture is restrictive, I doubt that this young man would have been killed. Make no mistake about it, Mr Brown was acting like a punk. He deserved to be arrested. He did not deserve to die.

Police officers are highly trained and paid a comparatively high salary. They are supposed to use good judgement in protecting the public. They are not supposed to be armed vigilantes acting as judge, jury, and executioner on our streets. Laws that authorize the police use of deadly force against unarmed citizens are bad laws. An encounter between an armed policeman and an unarmed citizen that leads to the death of the unarmed citizen falls outside any acceptable scenario for a civilized society. Our so-called justice system is broken when the perpetrator of police violence walks away unaccountable after causing the death of a citizen. Riots are what happens when powerless and desperate people are pushed against the wall of hopelessness by a broken system that sets free uniformed murderers. Police forces must be DE-militarized. Police must wear body cameras. The laws must be changed to make the use of deadly force a rare event, not a routine one.

Holiday Tree

Always one of my favorite holiday displays...the tall tree at Liberty Place, Philadelphia.

Horseshoe Curve!

A Nice Evening Out

With opur long time friend Louise and her neighbor Brian at Doma Japanese restaurant on Wednesday evening.

A Pretty Rose Color

This bouquet came from our local Shop-Rite store. I love the color.