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Friday, June 8, 2018

Aspiration Pneumonia: When What You're Eating Arms Your Biggest Nemesis

There’s not a lot of things I’m scared of in this world… heights, attics, expressing the L word for the first time, grizzly bears, another Yankee dynasty, driving in DC traffic, having nobody in my life, being misunderstood, being forced to spend time hanging out with the Real Housewives of anywhere (especially Lisa Rinna) and the wrath of my wife if I dare do something to upset her stand out (just kidding on the last one – she’s one of the kindest people I know).
And while there are things that make me nervous about Parkinson’s, only a few things scare me above that level of being nervous.

#1) Losing my mind and ability to process / express information.
#2) Giving up my interests due to Parkinson’s side effects to the point that my ability to exist beyond inside of a sterile facility is gone, and I am no longer me.
#3) Aspiration pneumonia (from here on out known as AP).

In the world of things that might kill Parkies, AP and falls top the list. If I were a betting man, memory-affected reaction incidents and hallucinations would also cause a few themselves, but they’re not on top.
Having held AP’s hand of death, while sitting down to dinner with it, I realize that I have met my killer. Knowing this scares the tar out of me.

Like a twist on Jonathan Edwards’ “Sinners in the Hands of an Angry God,” a sermon from 1741, which makes the rounds in classic American lit books (and a lot of my supernatural / paranormal writing), I find AP to be a vengeful and punishing master. Replacing GOD in one small section of Edward’s “self-help” book, you get:
That the Reason why they are not fallen already, and don’t fall now, is only that ASPIRATION PNEUMONIA’s appointed Time is not come. For it is said, that when that due Time, or appointed Time comes, their Foot shall slide. Then they shall be left to fall as they are inclined by their own Weight. ASPIRATION PNEUMONIA won’t hold them up in these slippery Places any longer, but will let them go; and then, at that very Instant, they shall fall into Destruction; as he that stands in such slippery declining Ground on the Edge of a Pit that he can’t stand alone, when he is let go he immediately falls and is lost.

Let’s just say that Mr. Edwards wasn’t the Kevin Hart / Will Ferrell of the party.
Not finding fault with Edwards’ overuse of capitalization, we see a preacher trying to warn his people of the danger of evil. With that, let’s do the same as above and skip to the end.
Therefore let every one that is out of Christ, now awake and fly from the Wrath to come. The Wrath of almighty ASPIRATION PNEUMONIA is now undoubtedly hanging over great Part of this Congregation: Let every one fly out of Sodom: Haste and escape for your Lives, look not behind you, escape to the Mountain, least you be consumed.

Here, my fear comes back to the mechanics of aspiration pneumonia. We eat food. It goes down to the intersection of the trachea and the esophagus. Normally, the body sends it down the esophagus. If “stuff” happens, and in the midst of a chaotic system, it does, the body has a failsafe system called the epithelial lining of the trachea. This creates mucus to suck up debris that gets in by mistake.
If something mistakenly gets into the trachea after making it past the “bodyguards” at the gate, we have a problem, much like Henry Rollins did in 1993, when I led a group of friends and British people back to his dressing room at the Cambridge Corn Exchange. Rollins was non-plussed to say the least. I get it. If you’re reading this, Henry, I’m sorry. I mean that. The kid with glasses in the picture was a jerk.
Anyway, like Henry’s hostility at everyone in the room, especially me, when the trachea’s protective system fails, crap happens. Rollins had to sign autographs after he performed a 2-hour show, when all he wanted was some serious decompressing time. As for the body, the food that gets trapped in the lungs creates aspiration pneumonia, when all it wants to do is breathe easily.
Some food / liquids that kind of hovers at the point of deciding what road to travel just kind of chokes a person. Thoughts like this make me want to train every member of my family in the Heimlich maneuver, to include my 4.5 year old nephew Dylan. He might not be able to get his arms around me, but at least he could bang on my back a little bit.
Methinks he would enjoy that.

Now I’ve been to the hospital twice for respiratory stuff. I’ve been to 2 additional pulmonary visits to get medicine when my chest felt like the citizens of Salem were turning me into a latter day Giles Corey (“more weight!”). Being in the 80% O2 saturation phase sucked. I can only imagine how bad it felt for my friend’s father who had serious COPD issues when he recently died after a long battle with breathing issues.
The first time I went to the hospital for aspiration pneumonia, I didn’t know what it was. I didn’t even know what I had (they called it septic pneumonia). All I knew was hot and cold flashes, like a bad version of Tom Jones, Katy Perry, or Big Bad Voodoo Daddy. Nearly 3 days after being released, I came to understand how pneumonia was more than just “souped-up bronchitis.”

This stuff can kill.
When I went back in the hospital a month and a half later, I knew what it was. I was well aware of what it was capable of. Being pushed back into the CAT scan machine felt like going into a mausoleum in New Orleans. Only here, the techs were talking to me while I waited around wondering if this was the really messed up health / death test verdict. A part of me wondered how many bags of bones were in here with me.

I mean, everything these doctors have looked for, they’ve found.

1)      Parkinson’s – check.
2)      Lyme disease – check.
3)      B12 deficiency – check.
4)      Sleep apnea – check.

Now you’re looking for aspiration pneumonia! Oh, hells no!

Fortunately, I only got a hypoxia verdict time 2, but still, the search was on. AP had been sighted, and Detectives Mills andSommerset were on the case.

The search went on until yesterday. In addition to the fact I looked like Luke Skywalker in the medical center in Empire Strikes Back (on my way to becoming Darth Vader), the doctors were curious about asthma history. Now, I don’t have that (or do I?), but I’m currently suspect and under investigation (I have Ventolin and Breo inhalers, and I need them today since my throat is whistling again).

Now, the concept of being under investigation for AP / asthma / respiratory issues is like being under investigation for tax fraud / colluding with the Russians / accepting campaign donations from the Chinese. The microscope is powerful and everyone wants a shot at examination. This is definitely going to be a big deal on the news.
When it comes to contemplating medical testing from a patient perspective, we need to confront the “objective” doctors with the “subjective” patients. In writing class, I would present this thought to freshmen:
¨  When they know what tests to order to quickly and cheaply get to the problem, we’re happy.
¨  When they order many tests that come up negative, we get angry since it feels like a waste of time and money.
¨  When they fix our problems and we return to health, we feel good about having to go to them since they “did their job.”
¨  In a conspiracy kind of way, other people feel predisposed to dislike doctors and feel like they’re doing expensive tests that put patients in pain because it’s an opportunity for them to do these things (experience and money). As medical professionals, how can we help patients and their families to understand that the tests and procedures are good things to go through?

Now, as medical professionals, we know how to rule out X to find Y. However, patients don’t, so we need to put it simply, comfortably, and appropriately so A gets the right treatment, not just a huge bill.
For instance, we know that if my lactic acid level is high, there’s a reason for this. It basically means low oxygen levels in the body in the case of a person like me who was in respiratory ugliness. Thus, the “evil witch doctors” and their heinous sidekicks “Big Pharma” are not trying to hurt a Parkie in overload mode when they try to put a 2nd IV in (should we need to go “bolus” and have to open up 2 fluid ways to, you know, SAVE MY LIFE).

Fortunately, the IV they weren’t able to get in didn’t matter. Additionally, the waiting to see if my lactic acid levels would ever lower came and passed, as I did go lower. Eventually, I got to leave the hospital, even if it wasn’t as soon as I liked because “what I think doesn’t matter.” It only matters what I know and can find out. If my life is on the line, it doesn’t matter if I’d be more comfortable at home. My job is to listen to doctors and the CEO of My Brain (my wife), as well as the Board of Trustees of My Brain (my parents). There’s time that too much free will and decision making is dangerous. Trust me; I’m living proof.

Nevertheless, as my follow-up swallow study came up yesterday, angsty Dan (the old guy who was a jerk before he started learning to be a better person) started to feel like not wanting to go since it was a waste of time and money (AKA, I did this in the hospital as a visual test AND I didn’t want them to find what they’re looking for since they find everything they’re looking for in me). Then he realized he blogs about his medical condition, and this would be a terrible example to set, as well as a potential opportunity lost to be fixed if something is upon him.
So I went, because, you know, I need to know – not think.
The gals at the hospital in Lebanon, Pennsylvania, (pronounced Leb-Nin – like the bologna) were top notch. They were professional and friendly. They didn’t make me eat a banana, but I did do solids, liquids, and apple sauce, all coated in barium to light up my throat.

Let me tell you; if you’ve never seen your throat lit up and swallowing on a black and white screen, you’re missing something. It’s kind of like never having seen the original Star Wars.
“Who are you?!!!”
But I digress. In the end, I was OK, though I have food / liquid in indecision state at that intersection of 2 roads (though it makes the right choice, even if I shall be telling this with a sigh Somewhere ages and ages hence: Two roads diverged in a wood, and I— I took the one less traveled by, And that has made all the difference). Thus, I have to relearn that the Air Force basic training rule of “eat all of your food in 2 minutes or so or starve” needs to go on the extinction list with the stegosaurus (BTW - that was back in 1990). Here, I don’t want some of it forced down the wrong track since I’m swallowing a whole pork chop at a time. I want to be healthy and alive since I have things to do yet in my life.

Which brings us back to having dinner with a serial killer.
There are 5 or so options for us every time we Parkies with dysphagia eat (the fancy term for difficulty swallowing, which we get because of bradykinesia). Though the chances aren’t 20 / 20 / 20 / 20 / 20, this is what our nemesis AP asks us when he sits across from us eating his broccoli, Brussel sprouts, cauliflower, and other vegetables (since they are a sign of evil, unlike pizza, fried chicken, cheese steaks, hot dogs, burgers, fries, and chocolate iced donuts).
Ø  Will we enjoy dinner?
Ø  Do we cough a little, a lot, or start to choke?
Ø  Do we quietly and slowly find the food seeping down into our lungs and building up to a nastiness that will mess us up?
The choices generally fall to enjoyment. We don’t constantly think about dysphagia causing us to turn colors as we lose our breath. Why would we? People generally don’t envision their death or think of themselves as already dead (Cotard’s syndrome).

But what if we did see ourselves in a way that was not only going to die, but to be murdered outright? What if we saw AP as the medical equivalent of the Carter Brothers (a pair of New Orleans killers who thought they were vampires – executed in the early 1930s)? Would we take it more seriously? Would we wield a stake 24/7 to slam it through the monster’s heart, if it should dare appear? Would we go quietly and let it feed off our blood, making us one with it? Would we avoid entering into situations where it exists? Would we live in fear?

Or would we recognize the face of evil and still live life to its fullest by taking a few simple precautions (slowing down, not using a straw, letting others know about the problem)?
Besides, Dan, Godzilla and King Kong could rampage tomorrow, and their ability to level society via city-level destruction trumps John and Wayne Carter any day.

I’ve been working on my new paranormal book. This is just a rough draft, but it starts with the Carter Brothers tale. For those who might be interested in tales of the supernatural, this might be for you. If not, you can stop here. While it's not done yet, this is the first walk through. It will change over time. The book itself is in a series. It's not about these vampires, but rather a group that is a mix of the XFiles meet the Navy SEALs to save the world from cryptids and the people who consort with them for terrorist purposes. It's more archaeology and history / character building, though I do have action scenes. My purpose is not the gory stuff, but rather the sense of eerie. Think M. Night Shymalan (Sixth Sense / Split / Signs) instead of Halloween or Friday the 13th. If you like that, many of my other non-Parkinson's writings are HERE.

New Orleans 1932
Trying to hold back the onlookers so that the ambulances and police could get in, Patrolman Petit felt absolutely overwhelmed on what normally would have been a routine shift. No matter what he and the two fellow officers that he was working with did to push the denizens of the French Quarter back, it wasn’t working. It was like they couldn’t make headway against an avalanche of rock sliding down a mountain to crush them. Only here, instead of stones and debris, it was the sweaty hordes trying to live in a city that was built on a swamp.
“Maybe we should get the firehoses and thrust the mighty waters of Lake Pontchartrain at them,” he declared to the patrolman on his right.
“If only the professionals would arrive,” the second patrolman said. “Then we would get to leave this unholy mess.
Looking at his watch, he realized that it had been thirty minutes since the first officer, Martin, came upon the girl. The other men who arrived on the scene followed her back to where she said she escaped from. The suspense of what was coming was palpable, but it was nothing like what was going on in the second floor apartment building.
Petit knew that whatever it was represented all that was gory and unholy, but he couldn’t imagine what it might be. Was it like the scenes of carnage his uncle spoke about from the time he was stationed on the Western Front? Maybe it was bad like that, but he couldn’t envision it. Even in bar fights that got bloody or the few random deaths by pistol shot, he knew what death was when it stared back at him.
Nevertheless, this situation must have been far worse since two policeman left the scene well after gazing on the image of her pale flesh and bloody wrist. Yes, something they saw in the apartment was much worse.
This scared Petit senseless.
Moving off to the side, he reached in his pocket for a cigarette as his fellow policeman held the line for him. As he stood there smoking, he tried to calm down, but it was no use. He could see the goosebumps on his arms grow goosebumps, while all the while, his sweat froze to his skin.
Of the two officers directing the crowds back, the one man who had responded to Petit was wearing his Catholic cross out. The other was blowing his whistle, which he held with his left hand, while his right hand squeezed the grip of his revolver.
As the men wrestled against people trying to look down the road to sees what was going on, a tall, muscular man in a suit and coat appeared at the line. Looking out of place with the suitcoat on, he pushed through the grubby families to speak to his fellow officers.
“Officer Laurent, we’re glad you’re here. They’re up in the second floor of the apartment on Chartres Street,” Petit responded.
“Do you want us to come with?” the man whose hand was on the pistol asked.
 “Whatever is up there doing this to that woman requires someone a lot stronger and committed than our Patrolman Petit,” he said as he sneered at the youthful patrolman on the side. “Are you ready to pull your club and start swinging if you run out of bullets?”
“I’m asking if you are ready to put down the po boys and help me put a hurting on something more than a drunken no goodnik.”
The man smiled with a devious bloodlust that said he was.
“Well then, go find me some other members of our police. We’re going to wait for these men to return, and when they do, we’re going to put a hurting on them.”

New Orleans 2016
Despite his military history, Bart Doherty blended in well with the crowd taking in the haunted New Orleans tour. While he was physically in better shape than all of them, even the youngens, he was still overwhelmed with the heat and humidity of June in the Crescent City.
The twenty-something crowd, mostly straight out of the bars, were looking for highlights of NOLA’s paranormal past. When the tour guide couldn’t offer the attention-grabbing stories, the drunken profane bursts of the summer tourist crowd mixed with their profane desires to get loaded on hand grenades or whatever hard alcohol combination could be served to them in goldfish bowls or sexually suggestive containers.
Normally, Bart would have relished the sights of the 24/7 party world that is the French Quarter, but today, he was unwinding in the reconnaissance mission that was him taking in a tour known as The Devil’s Footprints. He had been promised vampires, witches, demons, ghosts, and other cryptids, which might seem like a goofy way to spend the day for a man of his military discipline, but Bart was actually looking for tips into finding stores that traffic in black magic as something more than curious books and random bits of pretend debris passed off to tourists with no inclination how to use the real stuff.
It wasn’t like Bart wanted to perform this ritual. No, if truth be told, he wanted to make its brokers vanish from the face of the city. First, he would need to know what they knew about the situation with the death of Earnest Swanson and all of those other men. The fire that took out a good part of Ursulines Avenue was still being investigated, and now that he was back from General Bannister’s funeral, he had to do what he could to stop things from getting really bad.
Well, he had to do that if it wasn’t too bad already.
Looking across the 600 block of St. Ann’s Street the guide talked about John and Wayne Carter’s handiwork in a time before the street took on its new moniker. After nearly 80 years, the number of dead bodies would change depending on who gave the presentation, though it was almost always 14. Nevertheless, it could go higher. There were also 4 people who would survive after they were rescued from the house of horrors. This included the gal on the street, who alerted the police with her shock and bleeding wrist. Of the 4 survivors, one other man would become a vampire serial killer himself. It seemed like John and Wayne had some serious abilities at possessing the souls of their victims.
Additionally, the number of cops who had to take on the middleweight brothers would change as well. The more cops that the brother could resist as they made their incredible getaway to freedom, the tougher and more otherworldly that they became.
Now, in every story that was told about them, they were also dumb as dirt, since they showed up the next day for their job on the docks. Having jumped from the third floor and escaped, someone might think that it was time to head for Mobile or Baton Rouge, but alas, the next day was business as usual.
Once again, lots of police officers showed up, and despite taking a bruising, they managed to subdue and capture the brothers, so they could be taken on trial. Once again, the police injury list was significant, but they outlasted the brothers eventually.
After lots of sensational news reports, the good people of New Orleans were filled with that mix of emotion that is paranoia and bloodlust, so John and Wayne received a one-way ticket to the gallows. As soon as it was over, both men found their way into caskets where they were dropped into the ground without hesitation. After a period of time, be it short or long, the coffins were exhumed and found to be empty.
Apparently, the vampires had escaped.
Doherty is not impressed. He’s heard the story before. It’s been told the same and differently. At the end of each time, there is a story of how the Carters come back to New Orleans or go to some other city in search of blood. It’s all part of the package. Pay your money and get a scare.

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