An ICD storm and a positive spin to slowly dying in Canada

When I was in California in the summer of 2010, I had a V-tach event. The heart reaches a frighteningly high, but very inefficient, heart rate. I needed medical help within ten minutes to prevent permanent brain damage or death from occurring.

Taken to emerg, the medical staff took my pulse, they got a reading of 300 beats per minute. They immediately placed defibrillator paddles on my chest and hit me with 200 joules of electricity. The jolt put my heart back in normal sinus rhythm.

In emerg in Marin County General in CA.

From the emerg in a hospital in Sonoma, California, I was taken by ambulance to Marin County General. I was kept overnight and given a number of fancy tests. Although no cause was found for my V-tach event, the cost of treatment reached almost $30 thousand U.S.

The battle to save my life was easy compared to the fight to have my insurance company cover the cost of my treatment. It was the better part of a year before the travel insurance provider provided the coverage for which they had been paid.

Yesterday I had another V-tach event at about seven in the evening. My ICD, implantable cardioverter-defibrillator, hit me with an electrical jolt that caused me to tumble from the bed to the floor. Wow! When I regained my composure, it was off to emerg for an EKG.

No heart damage was evident on the graph and the flutter which had plagued my heart for the past few months was gone. I'd had a successful do-it-at-home cardioversion. In no immediate danger, I was sent home with instructions to contact the hospital's cardiac unit as early as possible the next morning.

At midnight I had another V-tach event. I was not knocked out of bed but the jolt left me unnerved. I had a hard time getting back to sleep. Two events in just under five hours. Not good. Just one more jolt and I would be in the midst of a full-blown ICD storm.

At seven thirty the bedroom phone rang. It was the hospital. They wanted me to come in for eight thirty. At the hospital they downloaded the memory records from my ICD. It confirmed my two V-tach events and added a turbo event at three thirty in the morning. In the so-called turbo event, the ICD gained control of my heart without resorting to a full-blown electrical jolt. Once in control, the ICD paced the heart down.

Three events in about eight hours, this was getting serious. I was in the midst of an ICD storm, defined as 3 or more ICD jolts in 24 hours or less.

The doctor and nurse, working together, reprogrammed my ICD and the doctor upped my daily dose of sotalol by fifty percent. Sotalol is the drug I take to keep my runaway heart in check. Clearly it wasn't working at the former dosage.

I am now back home, my heart is again beating at its usual, sluggishly slow, mid 50s bpm and my blood pressure is also down. I seem to be out of danger for the time being. I see a cardiac specialist on the 23rd of this month to discuss my meds and next month I touch base with the ICD department of the London Health Sciences Centre.

I must rest today and tomorrow. I can't do anything strenuous. I have been left with one big question: How much would all this health care cost in the States?

In early 2003, I had robotic surgery to correct a failed mitral heart valve. The DaVinci medical robot used to perform this medical miracle is not cheap. I have a very small scar despite having had open heart surgery. The government health care system has a very big scar from where it must have bled big bucks paying for my excellent state-of-the-art care.

In mid 2010 the search for the cause of my V-tach event in California commenced. The American doctors failed to find a cause but then they had less then thirty hours to search. It took the Canadian doctors months to track down the cause. Eventually it required a high-tech, oh-so-expensive, experimental 7T MRI to suggest the cause and it took genetic testing to pinpoint it. My heart is breaking down because of a relatively rare genetic condition. The disintegration of my heart muscle is disrupting the heart's electrical system.

My ICD is similar to this one.

In early 2011 an ICD was implanted in my chest and a wire screwed into my heart muscle. I understand the ICD, a Medtronic Protecta XT VR, is among the best on the market. It didn't come cheap. The hospital doesn't say what they paid for this baby but I have seen figures indicating it might have set the government back about $26,500.

Since having the implant, I must go to the hospital ICD department every six months. They download the ICD memory and modify my treatment as seems reasonable.

My drugs are expensive. Luckily for me, unluckily for the government, I'm a senior. I pay only $4.11 for my prescriptions, but there is a once a year $100 deductible. The drug benefit is a perk of being old in Ontario. To keep costs down the government has certain restrictions and sometimes one is forced to take a cheaper alternative to what may have been the doctor's drug of choice. I say the government is paying the bill, at least most of it, I'm not going to bad mouth them for trying to get the most bang, or should I say the most drug, for the buck.

One reads a lot of bad stuff about the government health plan in Canada and Ontario. There are problems, no argument. Still, if I lived in the States would I still be alive? Would I have had the ICD implanted or would my insurance have been canceled after the incident in California? If all my recent health expenses had fallen on my shoulders, I could never have afforded the necessary treatment.

In the States, I would have been out of money after the first 24-hours of treatment. Those first doctors in California would have picked my financial bones clean.

Sometimes it is wonderful to be living, and slowing dying, in Canada.

Hey, ReThink London: This is no way to treat our spaceship

Is this sprawl? If it is, are North London and South London also sprawl?

It was 1963 when Buckminster Fuller's Operating Manual for Spaceship Earth hit the bookstores. Fifty years later an updated section on the design of the ships's accommodation is desperately needed. For years the ship's crew have been extending the living quarters into the food production areas. This simply cannot continue. Spaceships have limits and spaceship Earth is no different. Buckminster Fuller wrote:

"Our little Spaceship Earth is only eight thousand miles in diameter, which is almost a negligible dimension in the great vastness of space."

Unfortunately, as Fuller points out, our ship is so well designed that those on board are not even aware they are on board a ship. Their lack of awareness leads to some incredibly foolish conduct. The ship's oxygen generators are being destroyed, the ship's stores of fresh water, called aquifers, are being depleted and the factories that supply the spaceship with food are being demolished to enlarge the living quarters.

Since 1971, in Canada alone, expanding urbanization has built over an area of farmland almost three times the size of Canada's smallest province, Prince Edward Island. About half of Canada's urbanized land was once some of the country's most productive farmland, according to Statistics Canada.

Randy Richmond, in a London Free Press article, refers to London as the "poster child for suburban sprawl." Richmond gives us too much credit. Sprawl is as Canadian as peach pie made with canned peaches from South Africa.

Abandoned orchard. Homes and not fruit soon will grow here.

Actually, it's lucky we can get peaches from South Africa, asparagus from Peru, potatoes from Idaho, and strawberries from California because we're paving over our own farmland and closing our food processing plants.

When it comes to frozen vegetables, some of our Europe's Best brand frozen vegetables come from China. I remember when frozen corn came from fields south of London. Today that London Green Giant plant is closed.

Are there any solutions to sprawl? Yes, but you won't find them in any of the planning suggestions being bandied about by ReThink London. The solutions cloaked in the ReThink mantra are not solutions at all.

The city has put forth three scenarios for future growth in London: The compact scenario, the hybrid scenario and the spread scenario. Only the compact scenario doesn't require more farmland to accommodate the city's population in the near future. City planning director John Fleming calls the compact scenario "extreme."

Extreme is continuing to build on our precious farmland. Extreme is paving over our future food lands. The water table in Peru where they grow our asparagus is dropping. Here is a link: How Peru's wells are being sucked dry. The Washington Post reports, "A 2011 lawsuit against the Whole Foods grocery chain alleges that frozen vegetables sold at its stores are made by prisoners in China and irrigated by a polluted river. . . . "

John Fleming tells us Londoners don't want sprawl. Fleming also warns us that London will need to annex more farmland in the future. He does seem to hold out much hope for the compact scenario that his own planning department put forward.

Fleming insists London needs Smart Growth. What is smart about paving over Canada's best food producing lands? This is no way to treat our spaceship.

I had another TIA (Transient ischemic attack)

When I have a TIA the vision in my left eye is affected.

If you are here because you have had a serious visual disturbance, if, at anytime, you decide you may have had a TIA, get to emergency. Quit reading and get to the hospital. You must consult a doctor as soon as possible.
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The first time I had a transient ischemic attack (TIA), I watched with a mixture of horror and amazement as the vision in my left eye slowly disappeared. At first, I thought both eyes were affected; I thought I was going blind. But, it was almost immediately obvious that only my left eye was affected.

I closed my right eye and watched a very dark grey curtain with a rather jagged edge slowly rising in my left eye. The curtain was completely opaque. When about 95 percent of my vision was blocked the rising curtain stopped and began to recede.

As the curtain receded, the opaque dark grey turned somewhat translucent in places. The curtain was breaking up. Soon what remained of the tattered curtain had dropped to the bottom of my vision field and disappeared; My vision was restored. The entire episode took a minute -- maybe two. I went to emerg at the local hospital. I felt like no one would believe me when I told them what had happened. I felt like this could be an event fit for an episode of House on TV. It wasn't.

The doctors in emerg diagnosed my problem as a TIA. TIAs can be thought of as mini strokes. They may last a minute or two, sometimes as long as an hour. According to the Mayo Clinic, an extremely long one can last as long as a day but if the disturbance lasts too long, one has most likely suffered a stroke and not a TIA.

The signs and symptoms of both a TIA and a stroke in the early stages are very similar, but a stroke leaves the brain with lasting damage while a TIA doesn't or at least the damage is not immediately evident. Both come on suddenly and hit the victim with dramatic and very frightening affects. The TIA disturbances disappear quickly but one should still go to emerg to be checked out by a doctor.

A TIA is a warning that you are in danger of suffering a serious and debilitating stroke. According to the Mayo Clinic, about 1 in 3 people suffering a transient ischemic attack eventually has a stroke. About half of these strokes occur within a year of the attack. See a doctor!

Some of the signs of a TIA are:

• Sudden double vision
• Sudden blindness in one or both eyes
• Sudden dizziness, loss of balance, loss of coordination
• Sudden weakness, numbness or paralysis in your face, arm or leg. This often only affects one side of the body.

I have had at least three TIAs. All have been related to a serious heart arrhythmia. Today, my heart is in a constant state of flutter. This increases my chances of suffering a stroke -- a brain crippling stroke. Strokes are blood clots that travel to the brain, blocking off the all-important blood supply to a section of the brain. To prevent this from happening, I take an anticoagulant: Pradax.

It is quite possible that thanks to Pradax my clots break-up quickly, dispersing into my blood stream. The poorly formed clots no sooner block the blood flow in my brain than they begin disintegrating.

Transient ischemic attacks may last less than a minute (like mine) or, according to the Mayo Clinic, as long as a day. Most signs and symptoms disappear within an hour. The signs and symptoms of TIA resemble those found in the early stages of a stroke and may include:

• Sudden weakness, numbness or paralysis in your face, arm or leg, typically on one side of your body
• Slurred or garbled speech or difficulty understanding others
• Sudden blindness in one or both eyes or double vision
• Dizziness, loss of balance or coordination

After your first attack your condition must be evaluated. This is very important. I had both a CT scan and an MRI performed on my brain. While TIAs themselves are not dangerous, always keep in mind that after an attack one is at increased risk of stroke.

Medline Plus warns:

TIAs are a warning sign that you may have a true stroke in the coming days or months. More than ten percent of people who have a TIA will have a stroke within three months. Half of these strokes happen during the 48 hours after a TIA. The stroke may occur that same day or at a later time.

As I said at the beginning of this post, if you found this because you are seeking information on TIAs, having just suffered a stroke-like event yourself, stop reading and get to a hospital.

ReThink London: Higher goals get more attention

ReThink London is all about communication, or so they say. As you can see from the image above, I've now communicated and the ReThink computer has replied, very politely I might add. Now I'm waiting for the human contact. Wonder how long I'll have to wait.

Now, to today's post: It is easy to be a critic. I am under no obligation to come up with solutions that can actually be put into place. That said, I do try to find answers with a practical bent. I like to find stuff that is being done, stuff with a proven track record and then reference that stuff. I post links. I do my best to avoid pie-in-the-sky. I try to leave the dreaming mostly to others.

In the '70s I insulated an older home London home. I also had new windows installed that, from a distance, looked like the old '20s windows I replaced. When I was done, these simple and quite obvious upgrades slashed my home heating bills dramatically.

An Eifehaus energy efficient European home

At the time, I watched new houses going up that didn't appear to give a lot of thought to energy use. These homes cleared the bar set by the code and that was it.

If London wants to be known for urban leadership, maybe London could encourage the construction of suburban homes meeting the best of the world's energy efficiency standards. In London, green could be more than just a buzz word.

The passivhaus movement is spreading throughout Europe and has made the leap across the pond. There are passivhaus homes being built, or planned, in a number of communities in Canada.

London's Sifton-built solar heated home fell into disrepair.

There is no point in me rewriting what can already be found online. So, here are some links. The first link is from Great Britain and discusses the passivhaus energy standard. This is a tough standard. It is one even Mike Holmes might respect.

The next question is "What can you tell me about passivhaus homes, or even extreme energy efficient homes, in Canada?" The answer is "Lots." Read the linked article from The Tyee -- Step Inside the Real Home of the Future: Passivhaus.

If London wants to lay claim to the word exceptional, a dream ReThink seems to be chasing, then London has to do more truly exceptional stuff. The present goals being set by the ReThink group don't strike me as too exceptional. Sorry.

Sprawl: May not be exactly what you think

Reading The London Free Press the other day I came across a story with "Sprawling out" as the headline above the story. It was an article looking at the recent release of the first discussion papers by ReThink London.

I had read the discussion papers and was not impressed. Considering the time spent assembling the information, it was rather poorly presented. So poorly presented, in fact, that report Randy Richmond got some of his figures wrong by a bit more than ten percent. When a professional cannot even decipher the information easily, quickly and accurately, there is a problem.

I found myself thinking about the term "sprawl." I've been to Los Angeles and there is a place that certainly seems to sprawl. Yet, that community is rated the densest urban area in the entire United States.

I don't have time to write a post on this today. My time is spoken for. But here is a link to a University of California article: What Density Doesn't Tell Us About Sprawl, by Eric Eidlin.

Cheers,
Have a good weekend.

ReThink London: smoke and mirrors

[I've posted this but I don't have a copy editor. I believe my figures are all correct but if you notice an error please leave a comment. I will not be insulted if you correct me. Thank you.]

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ReThink London is falling flat. If you are looking for new thinking, move on. You won't find anything new at ReThink London.

After months spent investigating what Londoners want from their city, city planning director John Fleming can do no better than spout truisms. Londoners want quality infill he says. Did he think they wanted poorly done infill? Londoners want compact growth. This is a surprise? Did he expect a lot of folk would tell him they wanted sprawl? Londoner want great public spaces. Of course, they do. Who dreams of poor public spaces?

I read the ReThink London discussion paper, Building a Mixed-Use, Compact City, very carefully. It left me puzzled. I had lots of questions.

Soon this will be housing. Suburbia is but a short walk away.

The report tells us in 1961 the city annexed large tracts of land in order to sustain growth. Byron and Oakridge were just two of the areas taken over by the city at that time. A decade later, the 1971 official plan determined London could accommodate a population "in excess of 500,000" thanks to those annexed lands.

Yet, by 1992 the city was in annexation mode once again. Almost the entire Township of Westminster found itself obliterated by the expanding city. According to the ReThink discussion paper, today we’ve developed all of the '61 land—all of it! We're expanding into the '92 territory and yet the population of London is only at 366,151 (2011 census). We didn't even come close to housing 500,000 before we ran out of land.

• What kind of plan misses the mark by such a wide margin. A damn poor one I'd say. 
• If the plan wasn't poor, it certainly wasn't followed, not even remotely. We need to know more. 
• Who was responsible for the screw up? If it was the city planners, did they make some basic math error? It is important for us to know. We don't want this happening again.

Moving on, let's look at some of the facts, figures and forecasts contained in the recently released discussion paper. The planning department presented Londoners with three scenarios illustrating three different approaches to London's future growth in the next 50 years.

The planners see London with an additional 190,000 residents. An increase in London's population of 54.6 percent. My math tells me that this works out to a population of 556,151. Now, let's look at the scenarios.

The compact city

• 30% single detached houses
• 35% townhouse and mid-rise
• 35% high-rise
• city covers 420.57 square kilometres (Today's figure.)
• population is 556,151

Hybrid pattern of growth

• 50% single detached houses
• 23% townhouse and mid-rise
• 27% high-rise
• city covers 420.57 square kilometres plus additional 10.98 sq. km for total of 431.55 sq. km.
• population is 556,151

The sprawling city

• 70% single detached houses
• 15% townhouse and mid-rise 
• 15% high-rise
• city covers 420.57 square kilometres plus additional 64 sq. km for total of 484.57 sq. km.
• population is 556,151

The report didn't calculate the population densities for the various scenarios but allow me.

 

Persons per sq. km.

• Compact: 1322.4
• Hybrid: 1288.7
• Sprawling: 1147.7.31

So what does this tell us? If you are like me, you have nothing to compare these numbers to. Let's do a little research. Let's look into the densities being achieved in the popular communities in the GreaterToronto area.

 

Persons per sq. km.

• Toronto: 4149.5
• Mississauga: 2,439.9
• Brampton: 1967.1
• Richmond Hill: 1838
• Kitchener: 1602.1
• Waterloo: 1542.9 
• Markham: 1419.3
• Oakville: 1314.2

Tower in Mississauga.

If our city planning department was willing to emulate Oakville, London would not require more farmland. Oakville is said by many to be one of the finest places to live in Canada. The compact city density doesn't sound out of line at all.

If our planners took an approach more like Mississauga's, London could handle better than a million residents. This is more than twice the population our city planners have set as their goal.

What is going on here? What am I missing? When planning director John Fleming chatted with The London Free Press he talked of compact growth. So where's the compact growth in these figures?

ReThink assures us that our future will be "exciting, exceptional and connected." Did you actually expect to be told that the city planners were guiding London into a dull as dish water, unexceptional and disconnected future? Check out the apartment tower on the left. That apartment building is Mississauga's exciting, exceptional future in the flesh. It is one of The Absolute World Towers, known 'round the world as The Marilyn Monroe Towers because of their sensuous curves.

London's wild dreams bring back memories of another time and another place where civic puffery took centre stage and facts be damned. Where? Detroit! In the mid '60s Mayor Jerome Cavanagh made a short film promoting his withering city, once the fourth largest in the United States, Detroit was already about 15 years into its decline. The film was called: Detroit, City on the Move.


London: exciting, exceptional and connected. Only in ReThink London's dreams. It may come to pass, but it may not. At the moment, ReThink London talks a good line but that's it. Until the planning department and the city council get on the same page, this long trip, as John Fleming calls it, may end badly. If you doubt me, think of Wonderland Road South—the new gateway to the city.

Nothing threatens good dreams for tomorrow like bad moves today.

In some cities, apartments are found above stores like the above. Not in London.

If you think I am being too hard on the ReThink London process, I find myself thinking along the same lines. I want to pullback, go a little lighter. And then I look at the picture below showing one of the new developments in London the planning department finds praise worthy. I look at this picture and I know I am hitting the mark. 

What an awful structure. Nothing exciting or exceptional here. Now, move down the street a few metres and all that changes. Or look across the street at the restored pottery guild building. The structure shown above is a stain on London's urban fabric.

In keeping with the conversational aspect of ReThink London I contacted them and e-mailed them the following message:

My recent blog post has been getting more than the usual hits. It is a criticism of ReThink London. I'd love to hear your defence. Hey, this whole thing is about conversation, right?

http://rockinontheblog.blogspot.ca/2013/05/rethink-london-smoke-and-mirrors.html

Cheers.
p.s. I'm posting this message at the bottom of my post.

Maybe ReThink London should Remember Detroit

Recently I read a very positive take on a new building in town — a four story condo. According to the author, the new units are selling very well — so well that the developer has applied to the city council’s planning committee for permission to begin construction of the second phase. This is ahead of schedule.

The Nuvo Condos promise luxury living.

 
I drove by the building to have a closer look. It is actually quite nice. I think it looks much better in the flesh than in pictures. Yet, I still didn't like it. It is not the building itself that turns me off but the company it keeps. The new structure is sitting on the edge of an absolutely massive highrise housing development, possibly the largest, densest grouping of tall apartment buildings in all of the London area. When seen from some angles I call it a taste of Hong Kong.

This is the neighbourhood Nuvo in which Nuvo finds itself.

Please don't misunderstand, I am not against highrises. I loved the highrise in which I lived forty years ago in Toronto. That building was sitting in a neighbourhood of private homes, near parks, near the Danforth, near the subway. Almost all parking was underground.

For the most part, these tall London buildings sit apart, divorced from the surrounding city. Walk out the front door of one of these monoliths and walk into a parking lot — acres of asphalt cover the neighbourhood. Cars are parked around the buildings, in low-level parking garages nearby and probably underneath as well.

It is all very practical. Truth is folk prefer to park above ground that brave an underground parking garage. But that fact doesn't make all the acres of parking visually pleasing. But, I must begrudgingly admit, these buildings do seem to work. The do a yeomanlike job of providing a roof over people's heads.

I can't fault critics for saying these look like "the projects."

Some folks see these and see what are known as "the projects" in the States. These are not the disgraced projects. Furthermore, the projects did not fail because of architecture despite the prevailing mythology.

I do not like these buildings, successful or not. One must be careful not to equate success with good. People for the most part are good and good people need affordable housing. Clump a lot of these good people together in decent, clean, practical housing and you may well have a successful development. But, and it is a big but, this does not mean it could not be done better.

To learn how this is done, one need look no further than Detroit and its Palmer Park Heritage Apartment District. This was an area I knew well as a young man back when I was going to art school in Motown back in the mid '60s. This was one cool place to live. It was a stigma free high density neighbourhood

Palmer Park Apartment District: Photo by Andrew Jameson

I used to visit friends living in Palmer Park. The neighbourhood was very walkable with ice cream stores, hamburger joints and beer and wine stores nearby. Every thing a student could want.

Actually, the walk could be a little long, depending upon where in the area one lived, but the area was just so interesting: Moorish arches, art deco buildings, lots of stained glass. As an art student I was in heaven.

And when one tired of strolling the apartment lined streets, there was Palmer Park itself, with its fountain, tennis courts, miles of biking trails and Palmer Pond for ice skating in the winter. And Woodward Avenue was right there. It was a quick trip to some of the best shopping in the world.

 Read what the United States National Park Service says:

From 1925 to 1965, 40 buildings were constructed, with the majority built in the 1920s and 1930s, to accommodate middle-class and upper middle-class tenants. The Palmer Park Apartment Buildings reflect the latest concepts and technology in multiple-family housing unit design from the time and are excellent examples of various exotic architectural styles such as the Egyptian, Spanish, Mediterranean, Venetian, Tudor, and Moorish Revival styles. 

Today, sadly, the district has fallen on tough times. This is no surprise as this is Detroit. Detroit has lost tens of thousands of high-paying jobs and hundreds of thousands of residents. Detroit's neighbourhoods are deserted and decaying not because they were bad but because there were no people left to live in them. The exodus of jobs and of people left no one to buy the homes offered for sale, even when the asking price was but a fraction of their former value.

Keeping the above in mind, let's take a Google Street Views tour of the Palmer Park Historic Apartment District.

The entrance to the district off Woodward Avenue at Merton Road.

Proceeding down Merton Road but still close to Woodward Avenue. 

As interesting inside as out: Cool doors, hallways, lots of wood, stained glass.

Porches on this Manderson Road apartment were popular gathering places.

Not all the apartments were massive. Note the two on the right.

Covington Drive apartment faces Palmer Park itself. Note good condition.

Parkview Apartment on Covington Drive is simple but still stylish.

The district had more than apartments: Churches, stores, parkland, schools . . .

The Woodward streetcar line may be long gone but there are plans to bring it back, bigger and better. The U.S. Department of Transport has announced a planned $137 million dollar M-1 Rail project to revitalize the Woodward Avenue Corridor.

The J.L. Hudson flagship store is gone and closer to Palmer Park the rows of business which once lined Woodward are also just memories. On the plus side, the Fox Theatre and the new home of the Detroit Tigers are both on Woodward Avenue. Even Palmer Park has had a revival of sorts. I've seen pictures of the fountain in the park, forgotten and sprouting trees in its empty pool. Today the fountain has been cleaned up and looks rather welcoming.

Palmer Park, not as grand as it once was, but still a very nice urban space.

 If you found this interesting, you might like to mark this date on your calendar: Friday, October 4, 2013. This is when the Third Annual People for Palmer Park Historic Architecture Tour will be held. You can visit Detroit and view the work of some of Detroit’s finest architects. For tickets and more information, click on the following link: Tour.

I just wish I could interest the London planning department and the London city council to visit the Palmer Park Historical Apartment District. We don't have to build Moorish style or art deco looking apartments but surely we don't have to build so many filing cabinets for people either.

Maybe ReThink London should remember Detroit.

An apartment complex even Le Corbusier might hate.