Pulse Pressure

Pulse pressure is defined as the difference between your systolic (high number) and diastolic (low number) blood pressure readings. Idealy, you want your pulse pressure values to be between 40 to 60 mmHg. A pulse pressure less than 40 requires evaluation by a cardiologist. A wide pulse pressure, that is readings above 60 mmHg, is also bad. These are my pulse pressure readings from 2023 (I had done 89 readings). As you can see, I am about 68% good and 32% bad, that means I need to improve next year (it is on my new year resolutions list). A handful of my pulse pressure readings were below 40 mmHg (2.5% of the readings were below 36 mmHg), and my average (standard deviation) is 57 (11) mmHg for 2023 pulse pressure, just below the cutoff point of 60. Seventy-Five percent (75%) of my pulse pressure readings were below 63 mmHg, and 90% of them were below 71 mmHg; my pulse pressure range was between 32 to 100 mmHg, or a 68-point spread (idealy, it should be a 20-point spread). 

Merry Christmas 2023 from BMP Blog

 

Happy 15th Birthday BMP...This Blog was born on Christmas Eve 2008

 

Total Thyroidectomy Surgery: What to Expect?

I had total thyroidectomy surgery on December 4th, 2023. Today was my 16th day following this surgery. I had this surgery at a top hospital in the US. As a preparation for the surgery, I met with the surgeon and his nurse practitioner first during an office visit. I saw each one of them separately, first the NP and then the surgeon. I had had prior to this visit a CT scan, so the visit with both of them consisted of discussing the CT scan and the reason I should have the surgery. I did not have cancer, but I had a very enlarged goiter that was pressing on my windpipes and making it hard for me to breathe. My surgery was scheduled at 12:10 p.m. I was told not to eat anything solid starting at 10 p.m. the night before, but I could drink liquids (like plain coffee) up to 9 a.m. on the day of the surgery.

When I got to the hospital on December 4th, I was told to get there by 10 a.m. After initial check with the receptionist, I waited about an hour to be called in to prepare for the surgery. Having gowned and layed down on a hospital bed, the nurse took my vitals, weight, and asked me the routine questions from meds I was taking to when I stopped eating the night before. The anesthesiologist and her intern checked on me. The surgeon stopped by to place his initial on my neck signifying that he was the one to do the surgery. Then, I was given a pill to "calm me down" before I was taken to the OR.

I entered the OR fully awake. I said good afternoon to the tech staff that were preparing for my procedure. Then I was transfered to a surgical bed, and the anethesiologist and her helpers began giving me "oxygen" by a mask place over my mouth and nose. The surgeon was not in the OR at that time. He came in after I was totally gone. I looked at the clock in the room, and it said, 12:20 p.m. That was the last thing I remembered before I was waking up in the same OR bed, looking at the clock stating 3:20 p.m. A three hours operation, and I remember saying to one of the guys in the room, "it took one hour only!" He replied, "it was more like three hours," smilling. I remember the aneshesiologist removing the breathing tube while I was awaken, with her saying, "don't let him cough." But, I coughed.

In the ICU, I as fully awake chatting with my wife and the nurse in charge. I was given some spray to ease the hoarseness in my throat, and tylenol + narcotic (low dose). I experienced very little pain, if any, after the operation. The only bothersome was the irritated throat due to the breathing tube I had during the surgery. This feeling completely gone after 24-36 hours from the time of the operation.

I stayed at the hospital overnight and was discharged by 10 a.m. the next morning. I did not need to take any narcotic med, and the single dose of pain killer I took was tylenol on Tuesday. While I was at the hospital, they applied ice packs over my neck to ease the swelling. The assistant surgeon came and saw me before my discharged. He was very assuring. I also saw a hospitalist who checked on me twice when I was still at the hospital. Making sure I was not bleeding. The nurses did that too. The assistant surgeon told me that the risk of bleeding almost goes away after 6 hours from the surgery, and it is only less than 1% of the cases that experience any bleeding. By the way, I did not require to have any blood during this operation.

At home, I continued applying the ice packs for a week. My neck started to appear normal by the 5th day, except for the incision which healed pretty fast (I was told the wounds in the head heal fast within 10 days).

In terms of meds, I started taking Levothyroxine  (137 micrograms), once daily, the first thing in the morning, on an empty stomach. In fact, nothing should me taken with this med for 30 to 60 minutes. Avoid coffee for at least 2-3 hours, and any calcium (milk or dairy products) too. They combine with the drug and reduce its availability to get absorbed.

I drunk a lot of iced water. I drunk like 2-3 liters of iced water daily to keep hydrated and it is good for the throat to heal. Today was my post-op visit with the surgeon. All appears to be normal. He removed my entire thyroid, but kept the parathyroid. The latter is important to control calcium. I was told to take Tums chewing tablets, three in the morning and three in the evening until Christmas. The surgeon checked my parathyroid functions today and also my calcium level. Both were normal. The nurse in the ICU did the same thing, and they were then within normal as well.

The only thing left is some mild pressure where the surgery wound is located (middle lower neck area). My surgeon said this feeling would subside in a couple of weeks. Another thing, I am still unable to sleep flat, and I got used to sleep sitting with my feet elevated or my bed is slightly elevated. This too will get better in a couple of weeks, by the end of this year. By the way, if you have allergies, get a couple of good HEPA filters devices to your home. You can get each for about $100. They are life saving. They help eliminate allergens from your home, and help you breathe. They are worth every dime.

All is good. If you have to do it, just do it. It is an easy surgery from the patient point of view. Very little pain, if any. The wound heals fast. And the throat area heals within 4-6 weeks. Make sure that your surgeon is specialized in this procedure. It does require great skills to do it, but we are blessed in the US that we have great thyroid surgeons.

P.S. Excuse my bad English. I wanted to deliver this message to those who are considering to have it. I wish you all the luck, and hope you will have it as easy as I did. Oh, by the way, the regular size thyroid is 25 g. Mine was over 350 g, reaching down to my chest area. Another thing, they put me on a low dose methimazole (5 mg weekdays; no weekend doses) for a couple of months before my surgery. This was important in order to shrink it and get the chemistry within normal.

NASA Images-Mars

 

Iraq's Stamps: Scott # AP4-C13; Dec 1, 1965; Trident 1E jet planes