JimFormation

At my heaviest, I weighed just north of 190 pounds. When I went to my first cardiology visit after my heart attack, I weighed around 165 pounds. He said he wanted me leaner. A lot leaner.

The doc wanted me to get down to my high school weight, which was about 145 pounds. Lately, I bounce around between 141 and 144 pounds. It only took me 6 months to shed that other 20 pounds. I can’t say it was easy, but I will say that it was not unpleasant.

I was going to write a big, long bit about how I lost weight. My first draft was almost 1,000 words and was still growing — it was too much.

Losing weight, in my opinion, comes down to four things (and two of them may be superfluous):

1. You have to be motivated. For me, being a mere 45-years-old, having a heart attack, and not wanting to have another, was motivation enough. (Mind you, when I had the heart attack I was somewhere around 170 pounds — not a fat tub of goo by any interpretation.)
2. Reduce the number of calories you consume. Eat less! Duh. We all understand it’s that easy, but who can eat just a couple of pretzels (see #3 below).
3. Eat food. But here’s the rub: You have to know the difference between food and edible food-like substances. Maybe I’ll write about this one day, but I’ll give you a hint — the following are not food instead are edible food-like substances: soda, candy bars, birthday cake, bagels, your stupid tofu, beef barley soup (the beef is okay though), low-fat cheese (really any cheese), peanut butter, jelly, jelly donuts, any donut, you get what I mean.

   A lot of your edible food-like substances make you hungry to eat real food, but instead you eat more edible food-like substances. And then you fall face first into the problem that vexes Rule #2 (see above).

4. Move your body. A lot. And with vigor.You’re not going to lose weight simply by exercising. You need to burn an extra 3,500 calories to burn up (lose) a pound of fat. A brisk walk burns about 400 calories in an hour. How many hours of brisk walking are you going to have to do to lose 10 pounds? I was going to have you do the math, but the answer is pretty close to 88 hours. Good luck.

Six months ago, I had a heart attack.

I started writing about the experience, but then stopped. It’s not your fault. It’s not that I’m sensitive about it. It’s just that I stopped writing. Whatever.

Here’s the short story to get you caught up:

I was transferred from Community Medical Center to Deborah Heart & Lung hospital via ambulance. I asked if I could drive myself or have my wife drive me. I was laughed at.

The ambulance ride was uninteresting other than the fact that the driver was an EMT and my attendant was a flight nurse. The nurse, a dude–for what it’s worth, assessed me before we left. He looked in my mouth.

“I know why you’re doing that,” I said. “In case things go horribly wrong, you want to see what you’re going to have to push your endotrachial tube through.”

He smiled. The EMT-cum-Driver made a joke that is lost in time.[pullquote_left]There, in front of my wife, a round, African-American woman shaved off my pubic hair.[/pullquote_left]

At Deborah things went quickly. Maybe a bit too quickly for comfort as one of the first things that happened is that a round, African-American woman told me to take my pants off and lay down. There, in front of my wife, she shaved off my pubic hair.

I’m not even certain I was told why. I know why though. They wanted unencumbered access to my femoral artery, which happens to run closest to the surface of my skin just starboard of my twig and berries.

Now let me slow down a bit: Ever since I learned about people sticking catheters into other people’s femoral arteries in nursing school, I’ve had a healthy fear of it. Never did I want anyone to ever, ever stick me in the femoral artery with a needle. Ever.

It gives me the willies.

But, guess what? I had no choice. I was going to get a cardiac catheterization and that was that. And the only way to get that done was through my groin. Through my femoral artery.

Good thing for me (and I was hoping this was going to happen), they gave me goofy pills (Valium and Benadryl) about a half-hour before going to surgery and a goofy shot (intravenous Versed — wonderful!) just before they “accessed my femoral artery.”

So there I am — on the table, naked but for a light sheet — all goofed up. There are a bunch of busy-bees in scrubs and clogs moving around medical equipment. I was comforted that they had with them the machine that goes ping!

They are very friendly. So friendly that they even laughed at my jokes. (I think they’re paid to do that.)

Several wide-screen televisions are set up floating over me when I hear someone yell, “Time out!”

The room goes quiet and still.

Someone asks my name. I tell them. Someone else checks my wrist band and nods. A clipboard is checked.

Someone asks why I was there. I said, “I was hoping you knew.” No one laughed. I told them why I was here. The person with the clipboard nodded.

They went through the rest of their checklist but the audience participation part was over so I went back to goofy-land. While in goofy-land I vaguely remember people busy all around me and asking me questions that I’m pretty sure I answered.

If I had any State secrets, I’m sure I gave them up.

And then the Top Doc woke me up and pointed to one of the televisions. I don’t remember exactly what he said but it was something like this:

Dude! You need to see this! Check this out. This was just a couple of minutes ago. See that blank area. It’s not supposed to be blank. Watch what happens when we opened the stent!

Cue angel music.

Do you remember those over-the-city shots when they turn the power comes back on? The whole city lights up? That’s what the television screen looked like. My lights were turned on.

“That was your circumflex coronary artery, dude. It was 100% occluded. It’s one of the three main arteries in your heart and no blood was going through it. It supplies blood to the back of your left ventricle. If we didn’t put that stent in, you were fucked!”

Okay, he didn’t say, “You were fucked!” and he probably didn’t call me “dude.” But he was young enough to say both.

Let’s get back to my femoral artery: A team of surgical-types have been using it as a freeway for all their nasty little surgical-type tools. I was sent back up to my room with the tubes still stuck in there.

The nurses told me to lay flat and to stay flat for a very long time. “Don’t move or your femoral artery will open up and there will be blood everywhere. Or worse, you’ll get a massive hematoma that will get so large it will form its own gravity and eventually implode in on itself in the form of a small black hole. It might take the whole hospital with it.”

A nurse took the tubes out in the middle of the night. First she gave me morphine and waited a half-hour. Then she came in, pulled the tubes and pressed all her weight on the site for at least five minutes. But she wasn’t done yet. Nope.

Then she took out a humongous C-clamp and clamped me to my bed. The business end of the C-clamp was positioned directly on the dressing that the nurse just put on.

And then she brought more morphine.

And there I lay, pinned to my bed, for the rest of the night.

In the morning, they sent me home. No pomp. No circumstance. Just, “We’re done with you just like we were done with the thousands that came before you. Move along. Nothing to see here.”

The only instructions were:

1. Take these pills;
2. Slowly resume normal activities and;
3. Don’t bend at the waist (they didn’t want me to “bleed out” from my femoral artery or form that very large hematoma).

See you in a month.

The one month check-up included an intensive cardiac ultrasound. The doc said that there was no damage to the cardiac muscle at all. None. Zippo. Nada.

He said the blocked artery was probably due to faulty genetics. I picked the wrong parents. Double whammy. Cardiac disease on both sides — a massive heart attack killed my mom’s brother when he was my age, and my dad has a bunch of stents in his heart in his early sixties and his doc wants him to get bypass surgery.

He said, “You shouldn’t be standing in front of me as a cardiac patient. You’re young (45-years-old). You’re in shape. You’re not too heavy. Your blood pressure is not too high. Your cholesterol is not too high. But here we are — I’m a cardiologist and you have a stent in your chest, and I know about it.” He went on to outline what needs to happen so that I don’t have to repeat the procedure on another coronary artery.

The approach is three-fold:

1. We have to get my blood pressure as low as it can go (“caveman low”, he called it and then barked off two ungodly low numbers),
2. We have to get my bad blood cholesterol (LDL) as low as it can go (under 70) and the good blood cholesterol (HDL) as high as it can go (over 50) and,
3. I have to get as lean as I can.

“I’ll take care of the first two with medications. But you need to the third,” he told me.

“How lean do you want me to be?” I looked down at my belly, which wasn’t big. “I only weigh 167 pounds.”

“What did you weigh in high school?”

“About 145.”

“That’s where I want you to be.”

At my three month check-up he called me the perfect patient.

A couple of weeks ago I went to my six month follow-up. Again, I came back smelling of roses. To take his points one-by-one:

1. Blood pressure: I said, “When I stand, I get dizzy.” He asked, “Have you passed out?” I said, “No.” He said, “Then I have you perfect.”
2. LDL = 64, HDL = 55. The doc said that he was surprised by how good my numbers were.
3. Weight: 145 high school pounds.

I don’t have to go back to the doc for another six months. He said that he would have made it longer than that, but things change in medicine quickly and he wanted to be able to advise me or change my medical regimen to meet current medical thinking if he wanted.

So that’s that. You’re now up to date. I can start blogging regular again.

For a couple of weeks I’d been dreaming of putting together something sweet and hot. What kept jumping to the front of my head was, “Pineapple. Jalapeno. Pineapple. Jalapeno.”

Finally, I did it. My wife posted the results on her TwitPic account:

The result was a little sweeter, a little waterier, and a not as hot as I wanted.

I’m not one to follow a recipe. I made most of it up as I went along. Here’s my recipe (excuse my unique measurements).

Pineapple-Jalapeno Salsa

Ingredients:

1. One pineapple, cut into chunks;
2. Three jalapeno peppers, de-veined with the seeds removed;
3. Three green onions (scallions);
4. Some cilantro, chopped;
5. A squeeze of lime;
6. Pepper, a few turns;
7. Salt, a few pinches.

Preparation:

1. Put everything in a blender and pulse it a few times;
2. Set aside in the fridge for an hour or so to allow the ingredients to combine;
3. Put it on something (I chose chicken, but you could use it on fish or even beef);
4. Eat.

Bonus Mini-Recipe

I hate putting a half a lime or lemon back in the refrigerator. Here’s what I do:

1. Fill a glass with seltzer water;
2. Squeeze the shit out of a half a lime, lemon, orange, grapefruit, or whatever into the seltzer water;
3. Drink.

Like I said, my recipe wasn’t hot enough. I think next time I make it, I’ll replace one of the jalapenos with an habenero pepper. As it was, I wound up putting some hot pepper flakes on mine just to crank it up a notch.

As far as the wateriness, maybe I’ll spin the pineapple chunks in a salad spinner next time.

The sweetness? Hell, I’ll just have to deal with it.

I accept suggestions.

Last we spoke I’d just gotten into the emergency room …

The most remarkable thing about being a 45-year-old heart patient in an emergency room is the amount of whizzing about that goes on around you. Within moments, someone had taken my blood. Another person a chest x-ray. Yet another an EKG. A nurse started an IV — well, she didn’t start an IV; she accessed a vein and put a heparin lock in just in case they needed to start an IV or push some medications into my veins.

I told a half-dozen people that I really wasn’t in any pain — maybe a little discomfort behind my shoulder blade. Maybe a little along my jawline. Maybe.

I’d given a history to that half-dozen people too.

They hooked me up to a telemetry machine (cardiac monitor), a continuous pulse oximeter (to record the levels of oxygen in my blood), and a blood pressure cuff that took my blood pressure every 15 minutes.

Most of my emergency room entertainment came from guessing what my blood pressure would be once the machine kicked into action. And watching as emergency room workers avoided eye contact with me.

My oxygen saturation was 99%, meaning the oxygen pumping through my arteries was completely oxygenated. Still, they put oxygen on me.

“What’s this for?” I asked.

“It’s oxygen. To perfuse your cardiac muscle.”

I looked back at the oxygen saturation reading. “How much better than perfect do you want me to get?”

The nurse looked at me. I put the oxygen cannula in my nose. When she walked away, I took it out.

This started a series of discussions with my wife that really rankled her — my wife worked for years in critical care nursing, including cardiac care. “Doesn’t anyone assess the patient anymore? Don’t they make decisions on those assessments anymore?”

Every time I got a shot of lovenox to thin my blood or nitro paste to help more blood get to my heart muscle, she wondered if I really needed it or if it was just part of the cardiac clinical pathway. Again, you have to understand, I felt fine — I was having no pain, no shortness of breath, no nausea, nothin’.

Clinical (or critical) pathways are predefined interventions for patients with targeted diagnosis and a predictable clinical course. Think of them as a pilots pre-flight or emergency checklist.

I was on the Acute Coronary Syndrome Pathway or, perhaps, the Myocardial Infarction Pathway. Either way, there is a set routine that must be adhered to regardless of how the patient presents him or herself. This includes everything from blood pressure every 15 minutes to continuous oxygen administration to the use of nitropaste and lovenox, and the like.

They say they made clinical pathways so that nothing is missed in patient care. I think the lawyers gave us clinical pathways.

As a patient, you get sucked into the clinical pathway and the vortex is so strong the only way out is refusal of care.

I continued up on the floor — I was put in the Surgical Intensive Care Unit (SICU) as the Coronary Care Unit had no available beds. The SICU has some of the sickest people in the hospital. Everyone of my fellow patients on that floor was on a ventilator. The staff laughed when I was brought up and jumped off the gurney and into my bed. “Patients here just don’t do that,” I was told.

And there I languished for two-and-a-half, almost three, days (Friday evening through Monday morning). My cardiologist was off that weekend and the covering doctor just, well, covered. He wasn’t really willing to discuss my prognosis or my future. Well, he did say that I had a “tiny” heart attack. I like hearing “tiny” and held onto that word whenever I explained my situation to people.

He also said that, even though it took me a week to get into the hospital and get care, “taking that aspirin when you initially had chest pain may have saved you.” See! I did something right!

My cardiologist showed up on Monday morning. “Jim, you had a heart attack. We’re going to give you a cardiac catheterization this morning and see what we should do from there.” I was a little taken aback because he spoke to me as if he’d never seen me before — I’d been going to him once or twice a year for five years. I mean, he has a lot of patients, but c’mon!

“Listen, Doc. If I have to have a cardiac cath, I’d like to go to Deborah,” I told him.

“Why? We can do it right here.”

I happen to know that they just started doing cardiac caths at that hospital and aren’t yet allowed to do any interventions like angioplasty or stent placements. I didn’t want to be the 100th person the hospital cardiac cath’d; I want to go to Deborah and be the millionth! Also, I didn’t want to be cath’d twice — the first time for diagnostic purposes and the second time at some other hospital for an angioplasty or to get a stent. Once is good enough, thank you.

“Oh. We can do interventions here. We are allowed to do emergency interventions and we’re involved in a study where on a limited basis we can do routine interventions too.” He explained to me that the study included doing a cardiac cath on a patient, determining if s/he needed intervention and, if s/he did, calling some number while a random algorithm decides if you can be fixed there or somewhere else.

“A lottery! Thank you, no. I’d rather just go to Deborah.”

My doc got pissed. I’m the perfect candidate for their study. If I needed an intervention, I’m probably going to live. Not only that, I’ll probably make it the year or two or five that they’re looking for to get the thumbs up to do interventions via cardiac catheterization into the future. Not only that, in the short run he personally can’t bill for the procedure nor the extra day or two that I’m going to be in the hospital.

He tried to talk me into it one more time. When I declined. He abruptly cut the conversation short and I didn’t see him again. Not a handshake. Not a “good luck.” Nothin’.

Fuck ‘em. I’m going to Deborah.

Last I’d left you my wife got in touch with me and told me that I needed to get to the emergency room ASAP. She spoke to my doctor who said that my cardiac enzymes were elevated that I’d had a heart attack.

So I drove past the hospital on my way home.

I wasn’t nervous. I had no real chest pain. Just some vague discomfort.

At home, I packed a small bag (mostly with books, one of them a book on Brazilian Jiu-Jitsu techniques — how’s that for optimism?), made sure I had clean underwear on, peed, kissed the children, and told them that I was probably going to be admitted into the hospital for some tests.

Nothing that happened after that was much of a surprise.

On the way to the hospital my wife and I talked about what was going to happen next. “You know that they’re probably going to want to do a cardiac cath. I don’t want to be cath’d there. I want to go to Deborah (Heart and Lung Hospital).”

Our local hospital only recently started doing cardiac caths, and then only for emergency and diagnostic reasons. If I needed angioplasty or a stent or some other sort of other intervention I’d have to be transferred to a different hospital (like Deborah) only to be cath’d again. No one needs that.

My wife agreed. She spent much of the summer taking her father back & forth to Deborah. He had a couple of cardiac characterizations, each requiring a stent. My wife is a tough nurse and she couldn’t have been happier with the professional and courteous care he received there. So that decision was made before my first EKG was even ordered.

Truth be told, I tried to get direct admitted to Deborah before even leaving my office. My doctor’s office manager said that she’d tell my doctor of my request, but advised that I go to the emergency room. I called my cardiologist, they said the same thing. Phooey.

I get to the emergency room. They knew I was coming. They took my information and had me sit in the waiting room.

My wife and I sat just long enough for me to acquire my complimentary USAToday when a overly-young female transporter tried to get me to sit in a chair that was several times larger than my hips. I stuffed the USAToday in my bag, “I’d rather walk,” I said.

“Are you sure?”

“I’ll walk.”

The three of us walked into the recently refurbished cardiac section of the emergency department. It was so bright and shiny I was tempted to shade my eyes. Everywhere there were machines that went “ping.” Those machines were largely ignored by the emergency department personnel.

Those same employees desperately avoided making eye-contact with me (or any other patient). This is a skill learned early by people who work in hospitals, perhaps they pick it up in orientation. If you make eye-contact with a patient, that patient may ask your for something — like a glass of water or, perhaps, a urinal to pee in. The presumption is that if someone needs help desperately enough, he or she will scream. At which time they immediately administer medications that will stop the screaming.

I was brought in front of a gurney. A nurse appeared out of nowhere, closed the curtains around us, told me to strip down to my waist and put a gown on. Moments later, they all showed up …

Someone who has had a heart attack will have damage to the heart muscle. Elevated levels of troponin I in the blood stream are indicative of damage to the heart muscle.

Blood levels of troponin I in people without cardiac damage is, essentially, zero. Seven days after having chest pain, the troponin I level in my blood was 1.87. According to some graphs I’ve seen on the internet, the day after my heart attack, my troponin I levels may well have been over 100.

The number, however, doesn’t matter. What matter is that they found troponin I in my blood. And that is always bad.

The last we talked, I’d just been to my doctor being followed up for chest pain that I’d felt several days before. The chest pain had been getting less and less, halving itself every day. I’d convinced myself that my chest pain was gastrointestinal or bronchial in nature.

Tuesday, 8 December 2009

I called X-Ray Associates while simultaniously making only reservations at Quest Labs to get my blood tests. The earliest I could wrangle all these together was Thursday–three days after my doctor’s appointment and a full week after having chest pain.

Feeling better after seeing my doctor, I went about my business as usual. That evening I help teach the Kids Brazilian Jiu-Jitsu class and returned to take the Advanced Class.

During “live training” at the Advanced Class, I got winded after only one round (5 minutes) of fighting. I sat in a chair beside the mats to catch my breath. My good friend, Richie, called over to me, “You okay, Jim?”

I assured him that I was. I figured my low endurance was a product of just getting over a cold. “Just winded, Richie. I’m fine.”

Unconvinced, he asked again but this time slowly and starkly, “Are you okay?”

“Just winded.”

Normally I catch my breath and get right back on the mat. Tonight, I put my gi in my bag and go home.

Wednesday, 9 December 2009

I wake up alive. Everything else is secondary.

Thursday, 10 December 2009

At 8:15 AM I arrive at Quest Labs to get my blood drawn. Within the series of tubes is blood destined to be separated into a piece of lab equipment that scores troponin I levels.

By 9AM, I’m at X-Ray Associates. First, I get a  gallbladder ultrasound that has become the focus of attention for my physician. “Do you know why you’re here?” the ultrasound tech asks.

“To get a gall bladder ultrasound.”

“Do you know why?”

“Not really. I assume to rule out gallstones, but I have no pain and no tenderness. I think my doctor felt something that she didn’t like during my physical.”

After the test, the tech says, “I can’t give you the results, but you have nothing to worry about. If you know what I mean.”

Oh. I had plenty to worry about, but none of it had anything to do with my gallbladder.

Then a chest x-ray and home with wife. I take the day off. We eat soup and sandwiches while waiting for our youngest to return from kindergarten.

That evening, I help teach the Kids Jiu-Jitsu class. I also help teach the Beginners Class–leading them through warm-ups, assisting the instructor, and drilling out the techniques with a white belt.

For some reason, I decide not to take the Advanced Class. I go home and have dinner with my family.

Friday, 11 December 2009

I wake up alive again and go to work.

Fast-forward to 3PM. My wife calls me at the office. “Your doctor called. She wants you to go to the emergency room. Your troponin I level is elevated. She thinks you may have had a heart attack.”

… to be continued …

In David Letterman’s last interview with the dying Warren Zevon, Letterman asked:

From your perspective now, do you know something about life and death that maybe I don’t know now?

Zevon answered:

Not unless I know how much <pause> how much you’re supposed to enjoy every sandwich.

And here I sit preparing to eat a sandwich made almost thoughtlessly, but ever-so-caringly, by my wife. She doesn’t realize the symbolic importance of this sandwich.

Two weeks ago, I had a heart attack. Maybe I should bring you back there …

Thursday, 3 December 2009, 8PM

I’d just finished jiu-jitsu class. Brazilian Jiu-Jitsu classes usually end with several rounds of live training. Sparring. Fighting against a fully resisting opponent. This night was typical. And, as typical, it was exhausting. My gi was soaked with sweat.

I was feeling weak as I left and grabbed an apple, which I ate quickly, hoping it would up my energy level. I drank a full bottle of water.

On the ride home, I had pain in the center of my chest. Substernal chest pain. Bad, and getting worse.

“Maybe I shouldn’t have eaten that apple and guzzled that water,” I thought.

Thursday, 3 December 2009, 9:00PM

I complain to my wife about my worsening chest pain. I’m getting concerned, but like most people having a heart attack, I’m wishing it away as indigestion or gastric reflux. “Honey, do we have any Maalox or Tums?” “No.”

Thursday, 3 December 2009, 9:30PM

The pain is worsening. I’m in bed lying near my wife. “If this pain gets any worse, I’m going to have to go to the hospital.”

“If you have to go, then go.”

I wait and hope for the pain to go away. I go downstairs to drink a little milk, hoping that it will ease the pain. It does, but only as the cold milk slides past my heart. As soon as the coldness subsides, the pain returns.

I should go to the hospital, but don’t. Instead I go to Target to pickup antacids.

In Target, I’m in a near panic. The pain is that severe. There are people in front of me. Slow people. Christmas shopping. I need to get to the pharmacy aisle. Now! I need my antacid. This pain is too much. These people need to get out of my way. Please, people. Please.

On the way out of the store, I pop three, four, five, six tums. I suck on them hoping that they’ll go down slowly, coat my esophagus, and ease the pain in my chest. Nothing.

On the way home, I pass two EMS ambulances waiting outside a house. I think, “I can just stop there. They don’t need both ambulances. Two responded; they only need one. The other will take me to the hospital.” I don’t stop.

And then I think, “Just drive straight to the hospital. Call Sandi from the emergency room. Tell her you couldn’t take the pain anymore.”

I don’t. I go home. Take a couple of Tylenol and go to sleep.

This is the third worst pain I’ve ever had:

• The second worst was when I “burst” (orthopedic’s surgeon’s word, not mine) my fibula while sliding into home plate.
• The first worst was when I essentially had a vasectomy without anesthesia.

This is up there. I described the pain as an eight on a scale of 10. (10 being the time some schmoe cut into my nutsack without properly numbing it first.)

Friday, 4 December 2009, 7AM

Luckily, I wake up alive.

The chest pain from the night before is still there. I figure it’s about half as bad as what it was. I convince myself it was the apple I ate and go to work.

Still, I call my doctor and try to get an appointment for that day. She can’t see me, but I make an appointment for Monday. I can’t go first thing in the morning because I have work obligations. We make the appointment for 1:15PM.

Satuday, 5 December 2009, 8AM

Once again, I’ve woken up alive. I didn’t think anything of it. Again, the chest pain is half what it was the day before.

Saturday, 5 December 2009, 9AM

I help teach the childrens no-gi Brazilian Jiu-Jitsu class. Several of the older kids (14-years-old or so), take a shot at the title. I defeat them all handily.

Saturday, 5 December 2009, 11AM

I take the advanced Brazilian Jiu-Jitsu class. For most of the live training, I do what I call “hiding in a hole.” I get in a defensive posture and wait for my opponent to make a mistake. It conserves energy. Even with that, I am completely wiped by the end of class. I attribute it to getting over a recent cold.

Sunday, 6 December 2009, 8AM

Again, I wake up alive. I still don’t realize the importance of this.

Sunday, 6 December 2009, 11AM

It’s cold. Mid-30s Fahrenheit.

I join my wife on her daily 2-mile walk through Cattus Island Park. I almost immediately get a sharp pain in my chest. I attribute it to the cold air going down my trachea. Bronchospasm, I figure. It’s normal. Especially after getting over a cold.

Only I know better. I’ve worked and played out in the cold my entire life. I never get chest pain. I never get short of breath. This walking, I try not to admit to myself, is getting me out of breath.

I ask my wife to slow down.

Halfway through our walk, which she usually does briskly and often with a jog in the middle, I ask her if we can explore the bay beach. We do. She keeps asking if I want to sit down. I don’t. I tough it out.

The walk back gets me nervous. I don’t tell her. It’s the first time I admit to myself that something’s wrong. I’m scared.

I wanted to spend the afternoon putting up Christmas lights for the kids. I don’t. Instead, I lay on the couch. Vegging. Watching football. Wondering why I feel so exhausted after such a simple walk and praying that my chest doesn’t start hurting again.

It doesn’t. But I feel like a lazy jerk for not putting up lights for the kids.

Monday, 7 December 2009, 7AM

I wake up alive.  Again, I don’t know how lucky I am.

Today I have little, if any, chest pain. Maybe some discomfort, but no big deal.

I figure the acid reflux or esophageal damage I did while eating my apple is healing.

Monday, 7 December 2009, 9AM

I arrive at work, as usual, and have more things to do than I can ever pray to get done. Just a regular work day.

Monday, 7 December 2009, 1:15PM

I arrive at my doctor’s office and tell her my story.

I am now, essentially, pain free. She does a routine check up on me as I haven’t had one in almost two years.

She prescribes some tests, including a chest x-ray and routine blood work.

“I think your chest pain is probably GI,” she says. “Maybe you tore something when you ate the apple. Maybe you have an esophageal ulcer. Maybe reflux.” She recommends I go see a GI doctor.

But before I leave she takes the prescriptions back. “You know, because of the chest pain, I’d like to add a troponin level to your blood work.” This will eventually change everything.

Continued: Enjoy Every Sandwich, Part II

By now we all know that Tiger Woods’s wife chased him out of the house with a golf club. As he was trying to leave she busted out the windows of his Cadillac Escalade. This resulted in Tiger bouncing his car off a fire hydrant, into a tree, and knocking him silly.

We all also know that Tiger’s wife went on this tirade because she discovered that he was having sex with other women without her permission. (Tiger probably didn’t seek her permission because he knew she’d say “Get the fuck out of here.” At least, that’s what my wife would say.)

Turns out that Tiger has been banging women that aren’t his wife since 2007 or so. Not surprisingly, that’s the year Mrs. Woods had her (and Tiger’s) first child.

Now the entire world knows Tiger Woods’ personal business. We know he enjoys the club scene. We know he enjoys, ahem, sexting (texting in a sexually indiscreet manner). We know he likes to shag floosies.

He likes a little strange on his hang-low.

This has me wondering, “Was it worth it?” And by “worth it”, I mean what it’s ultimately going to cost him financially. What will it cost Tiger Woods, per act, to have sex with women other than Mrs. Woods.

I’m going to assume that Tiger had sex with trollops and assorted comfort women on at least 78 occasions. Here’s my math:

1. Since 2007, Tiger Woods has played in 52 professional golf events. I’m going to assume he had a chickie-poo in half those events: 26.
2. Each golf event is 5-6 days long including practice rounds and Tiger will have to get a room for those nights. Let’s assume he has sex at least half those nights. I’m calling it: 3.
3. 3 sexual encounters at 26 events equals 78 sex acts.

Let’s assume that his marriage is going to end because of his indiscretions. His wife reportedly has a $300 million prenuptial agreement.

At that, it will have cost him $3.85 million per coital communication. ($300 million/78 sex acts = $3,846,153.80 per fuck).

But I’m not going to stop there. Tiger makes a cool $100 million per year in endorsements. I’m going to assume that he’s going to lose 10% of said endorsements. That’s $100,000,000 over ten years.

If I’m right, in 10 years it will have cost Mr. Woods $5.13 million dollars per roll under the hotel sheets. ($300 million prenup + $100 million dollars lost endorsement revenue / 78 sex acts = $5,128,205.10 per fuck.)

That’s my math. You can disagree and use your own figures if you’d like.

Regardless, I think we’d both agree that it would have been much cheaper for Tiger if he’d developed the unhealthy habit of snapping his zippy to cheap hotel porn.

We’re just past the half-way point of 2009 and it has already been known as The Year Celebrity Deaths.  So far there have been a bunch of notables:

Ricardo Montalbon, Paul Harvey, Ron Silver, Natasha Richardson, Bea Arthur, Dom Deluise, David Carradine, Ed McMahon, Farrah Fawcett, Michael Jackson, Billy Mays, Karl Malden, Walter Cronkite, among others.

But here are some notable people that died in the first half of 2009 that you probably missed:

• Pat Hingle, Commissioner Gordon from the Batman television show;
• Bob May, The Robot from Lost In Space;
• Clarence Swensen, A munchkin from the Wizard of Oz movie;
• Altovise Davis, Sammy Davis Jr.’s wife and oft used punchline;
• Dom DiMaggio, Pro baseball player and brother of Joe DiMaggio;
• Wayne Allwine, voice of Mickey Mouse since 1977
• Dallas McKennon, voice of Gumby.

Oh, and on February 27th, Alan Landers became the third cigarette company manly-man model to die of lung cancer. He was the “Winston Man”; the other two were “Marlboro Men.”

Watch how I do this:

The United States army has carried out forced disappearances, acts of torture and illegal raids in pursuit of insurgents, according to documents and interviews with victims, their families, political leaders and human rights monitors.

All I did was substitute “United States” for “Mexican” and “insurgents” for “drug traffickers.”

Here is the original from the Washington Post.

The Mexican army has carried out forced disappearances, acts of torture and illegal raids in pursuit of drug traffickers, according to documents and interviews with victims, their families, political leaders and human rights monitors.

Neat trick, huh?

Oh. The United States is threatening to withhold up to $100 million of anti-narcotics assistance if Mexico doesn’t straighten out their act.

After all, we did.

Right?