--- /dev/null
+## Zachary Vance - Patient Information
+Aged 32, born 1988
+Height 71 inches
+Weight 166 pounds (73.6kg)
+
+Known health issues:
+- Repeated ankle sprains and injuries in both ankles
+- Developing cataract in right eye (from eye trauma)
+- Hemorrhoids (usually internal, external rare). internal is doctor's guesswork, not verified.
+- High cholesterol
+
+Past, corrected issues:
+- Pronating ankles
+- (self-diagnosed) general inflammation
+
+###Common Questions
+- **Current medications**: Atorvastatin, 40mg daily
+- **Current supplicants**: 100mg magnesium daily, daily multivitamin, occasional B-2 supplement, occasional vit D/vit C supplement.
+- **Past supplements**: 0.5tsp piracetam daily, 1tsp choline bitartrate daily, 200mg magnesium daily
+- **Medical Allergies**: No known medical allergies, although nitrous oxide has nearly no effect
+- **Standard Allergies**: Mold, Dust mites, Sesame
+- **Vaccines**: First COVID-19 (Pfizer, 2021-04-16), typhoid (2014), japanese encephalitis (x2, 2014), rabies (x3, 2014), tdap (2014), DTaP(x5, 88-94), Hib (90), IPV OVP (x4, 88-90), MMR (x290-00), TD (03), no varicella (had disease), Hep B (x3, 98-99), Hep A (x2, 98-99), PPD (94)
+
+###Family history
+Sister - Ovarian issue (cyst?)
+Sister/Brother - alive, no major health issues
+Mother - Healthy
+ Mother's mother - alive, some heart arhythmia, unknown add'l problems
+ Mother's father - alive, quadruple bypass
+Father - Pretty healthy. Parkinsons, overweight.
+ Generally father's side of the family are smokers and overweight. Lung cancer, heart problems, diabetes common but I don't know who's related by blood.
+ Father's father - dead at young age (30-40) from medical problem, don't know what
+ Father's mother - dead, lung cancer (smoker)
+
+## Zachary Vance - Medical History
+All tests, labs etc should be attached.
+
+Childhood: Standard vaccines. Grew up in military bases abroad so somewhat more vaccines than usual, unsure which.
+2002-2004: Ankle surgeries on both ankles to correct pronation. Screws inserted in both
+?: Tonsils removed
+?: Dental surgeries to remove baby teeth
+?: Dental surgery to remove wisdom teeth
+2007-01-10: Blood donation
+ heart rate 100bpm
+ blood pressure 130/70
+2014: Adult vaccinations due to Vietnam trip. Typhoid, Japanese Encephalitis, Rabies, Tdap
+
+...
+
+2018-10-17: Got in a fight, eye injury. Glasses lens popped out of frame and hit eye.
+(2018): Treatment for eye injury (trauma). Dignosis of glaucoma, emergency surgery. Recovered fine, still seeing optometrist twice a year. Developing cataract in one eye.
+2019-03-29: Began physical therapy for ankle issues (repeated sprains)
+2019-04-15 End physical therapy for ankle.
+2019-05-07: OneMedical Doctor appt.
+ blood pressure 122/88
+ heart rate 92
+2019-05-14: OneMedical Doctor appt. Topics were heart palpitations, longstanding finger injury.
+ height 71 inches
+ blood pressure 126/88
+ heart rate 83 bpm
+ weight 183 lb
+2019-05-19: CBC w/differential/platelet; metabolic panel; lipid panel, hemoblogin A1c (all attached)
+2019-05-19: ? hospital. Finger x-ray
+ Finger x-ray showed no fracture
+2019-06-18: Allergy panel (environmental)
+2019-06-24: Allergy panel (food)
+2020-12-10: First heart racing
+2020-12-09: Began new exercise program. Previous had started laying down 20-22 hours a day during quarantine. Instead started sitting all day, using standing desk at least an hour a day, eating more veggies, etc. Still going as of 2021-04
+2020-12-12: Confirmed heart is racing for no reason (90-130bpm, for half hour to hour), feeling of it being 'exhausted' outside those periods. Some B-2 and riboflavin supplimentation. Symptoms disappeared a few weeks after this.
+2020-02-05: OneMedical Doctor appt. Subject was chest pain a few days earlier. Diagnosis was not a heart or lung abnormality (best guess was muscular). Prescribed 40mg atorvostatin daily due to two past blood tests, years apart, showing high cholesterol.
+ EKG normal
+ blood pressure 118/78
+ resp rate 14 bpm
+ heart rate 112 bpm
+2020: Self-diagnosed chronic (whole-body) inflammation. Went away when I fixed my ankle problems in early 2021.
+2020-12-21: Very bad ankle sprain. Couldn't sleep much or even sit up for a week.
+2021-?: Fixed ankle problems after resuming physical therapy on my own.
+
+2021-03-24: Current symptoms begin (see "symptoms" and "recent timeline")
+2021-04-05: Telemedicine (phone) appointment with Dr. Rahoul Ahuja.
+2021-04-16: Highland Hospital cardiac tests. EKG. Echocardiogram TTE. (attached)
+2021-04-16: Highland Hospital blood tests. CBC w/auto differential; comprehensive metabolic panel; lipid panel; hemoglobin a1c; tsh w/reflex to ft4 if abnormal (attached)
+2021-04-16: Highland Hospital, first COVID-19 vaccine (Pfizer)
+
+## Zachary Vance - Symptom Timeline
+### Non-recent, heart-related
+2019-06-04: Retired (became more sedentary)
+2020-01-23: **"Skipped" or hollow-feeling beat** (first heart palpitation). At colorado airport (high-altitude), on some caffein.
+2020-05: Gradually reduced and stopped caffein consumption, which reduced heart palpitations.
+2020-10-09: First **heart racing**
+2020-12-09: Began new exercise program. Previously had started laying down 20-22 hours a day during quarantine. Instead started sitting all day, using standing desk at least an hour a day, eating more veggies, etc. Still going as of 2021-04.
+2020-12-12: Confirmed heart is racing for no reason (90-130bpm, for half hour to hour), feeling of it being 'exhausted' outside those periods. Some B-2 and riboflavin supplementation seemed to relieve "exhausted" feeling. Heart racing and tiredness symptoms disappeared a few weeks after this. I stayed on occasional B-2 but not riboflavin.
+### Recent (complete)
+The first time a symptom appears, it is **bolded**.
+
+I've had two distinct kinds of lightheadedness--ask me about it. The first kind was the usual kind--like when you stand up too quickly. It usually got better or went away if I sat or laid down. The second I don't know how to describe, but it seemed to be hard to focus, and it was correlated with feeling like blood was pooling in my head.
+
+2021-03-24: Had a short **episode** where I felt like I increasingly wasn't getting oxygen (but could physically breathe fine). Checked using a pulse oximiter--blood oxygen was 96%, but pulse was 120 and rose to 180 by the time I grabbed my roommate to keep an eye on me. Went back down within a couple minutes. Legs/arms were clenching on their own. Had a glass of water and an ibuprofen. Heart rate was relatively normal (85-90) an hour later so didn't go to the ER. Episode was about 2 hours after a stressful falling-out with a stranger. Trouble sleeping.
+2021-03-25: Try to relax. Feeling ok.
+2021-03-26: Center of **chest tender**.
+2021-03-27: Fine.
+2021-03-28: Fine. **Muscles twitching**. **Bottom of throat feels lightly choked**
+2021-03-29: Fine. Muscles twitching, esp chest. Choking feeling.
+2021-03-30: Muscles twitching. **Throat feeling 'pinched' and closed up**, choking. **Green poop**. **Possible heart racing episode.**
+2021-03-31: **Lightheaded**. Choking feeling absent.
+2021-04-01: Chocking feeling returning. Lightheaded when standing. At night, **mechanical trouble breathing**, especially face down or face up. In evening, **throat swollen, irritated feeling in chest**. Worried I was stopping breathing when falling asleep--body felt like it just wouldn't bother with the inhale. Moved to living room to sleep, had roommate watch me a bit. Sleep apnea also worse than usual.
+ Developed theory that the cause might be environmental (ex. allergy) and stayed in living room for several days to test.
+2021-04-02: Living room. Made Doctor's appt at Highland Hospital. Breathing fine in morning. Lightheaded in evening sitting down (worse standing). Throat closing up in evening. **Blood pooling in hands** in evening.
+2021-04-03: Living room. Throat slightly closed up. Chest, right side twitchy. Short of breath just sitting. Throat closing up in evening. Chest tight/sore. Just **right half of throat swollen**, **feeling of something stuck in throat**. While laying on floor nearly asleep, sudden huge **spasms on one side of chest (forget which)**--whole lower chest rapidly compacting and releasing. checked heart rate right after, 160bpm. I seemed fine, so went back to sleep about 5-10 minutes later.
+2021-04-04: Living room. **Cold sore.** Quick heart race, felt hard to breathe. **Heartbeat looked irregular** while standing (and checking pulse). Trembly, flushed, lightheaded sitting after. Throat swollen+lightheaded in evening.
+2021-04-05: Living room. Cold sore. Lightheaded.
+ Telemedicine visit
+2021-04-06: Living room. Cold sore. Internal hemmorhoid starting? Poss irregular heartbeat.
+2021-04-07: Slightly lightheaded. Out of breath from things like drinking water. Left leg 'pulsing a little'. **Feel heavy** / trembly. Feeling of something caught in throat. Slight **feeling of having inhaled water**, like down nose.
+ Swapped air filter in my room.
+2021-04-08: Feeling of something stuck in throat. Slightly out of it. Lightheaded. Dizzy. Poss vertigo+panic at night.
+2021-04-09: Cold sore gone. Internal hemmorhoid starting? Something stuck in throat. **Heart rate extremely low at night (50s, dipped below once)**. Monitoring heart rate. Felt/saw like heart stopped (unclear if true), then sudden fast heart rate (50 to 160). bpm ~59 after this.
+2021-04-10: Stressed. Short of breath. More weird-beat palpitations than usual.
+2021-04-11: Lightheaded when standing. Head feels weird and intense when standing, like **blood pooling in my head**. Feeling of **hearing shutting off** in one ear.
+2021-04-12: Head weird and floaty. Blood in left leg twitching. When nearing sleep, a **whomp of blood vessels tightning or releasing or something for 2-3 sec**? Trouble sleeping.
+2021-04-13: **Feeling of all the blood suddenly rushing from my head** while sitting there. Up until then, had felt some pressure/extra blood in head. Dizzy for a minute or two after, like room was swaying a bit. Heart went a little fast (95-120). Blood rushing to head slowly while falling asleep. Trouble sleeping.
+2021-04-14: Lightheaded. Blood suddenly rushed to/from head. **Face slightly numb**, sweat. Minor acid reflux. Heart went a little faster for a bit. Trouble standing even a few minutes. Trouble sleeping.
+2021-04-15: Feeling of blood pooling in face/head. Very lightheaded standing. Trouble standing even a few minutes. Did not sleep.
+2021-04-16: Hospital visit. Feeling much better, can walk around and stand. Became lightheaded around 3pm in hospital. Lightheaded and a little dizzy. Head feels heavy. Slept. Rapid shallow breathing, felt fine. Extra sleeping. Floaty/dreamy. Tilting my head past vertical feels weird. Acid reflux. Trembly arms. Palpitations, feel dizzy.
+ Got lightheaded in the hospital with a mask on--some evidence this is not environmental.
+2021-04-17: Worrying about stroke because of headaches/blood pooling in head. Called 911 in the morning, thought I had a transient stroke--woke up or was almost asleep when I suddenly head a headache and couldn't move or call out. Was probably a false alarm--EMTs decided I did not need to go to the ER. Feeling heady, especially head, like gravity is turned up.
+2021-04-18: Pretty good. Heart races in morning (5-15 sec), felt a surge of adrenaline when waking up for 1st one. Lightheaded and dizzy. Head heavy.
+2021-04-19: Feeling good. Head heavy, dizzy.
+2021-04-20: Feeling good. Heart a little fast, somewhat stupid.
+2021-04-21: Feeling good. Heart a little fast, somewhat stupid.
+
+
+## Zachary Vance - Measurements (at-home)
+### Pulse Measurements
+| Date | Morning (sit) | Stand | Sit | Lay | Exercise
+|------------|---------------|---------|---------|-------|------|
+| 2021-03-19 | 80 | 105 | | |
+| 2021-03-20 | 81 | | | |
+| 2021-03-21 | 100-105 | 80-95 | | |
+| 2021-03-22 | 72 | | | | 144 |
+| 2021-03-23 | 90 | | 80-85 | |
+| 2021-03-24 | - | 120-180*| 110-167*| 78-90 |
+| 2021-03-25 | 95-105 | | 82-105 | |
+| 2021-03-26 | 75-97 | | | |
+| 2021-03-27 | 80-92 | 100-135*| 86 | |
+| 2021-03-28 | 80 | | | 78 |
+| 2021-03-29 | 80-90 | 85-100 | | 55-60 |
+| 2021-03-30 | 62 | | 81-110 | |
+| 2021-03-31 | 83-76 | | 75-130 | 60-78 |
+| 2021-04-01 | 95-110 | | | | 150-160
+| 2021-04-02 | 71-100 | | 80-95 | |
+| 2021-04-03 | 67-75 | 80-100 | | 70-80*|
+| 2021-04-04 | 75-95 | 85-103 | 65-100 | |
+| 2021-04-05 | 80-90 | 98-108 | 78-100 | |
+| 2021-04-06 | 88 , 97% | | 65-85 | 60 |
+| 2021-04-07 | 80-94 | 107-115 | 81-100 | 63-70 |
+| 2021-04-08 | 77-90 , 94% | 85 | 87-105 | 72-90 |
+| 2021-04-09 | 74-81 , 96% | 102-112 | 75-90 | 49-90 |
+| 2021-04-10 | 85-90 , 98% | 127 | | 57-73 |
+| 2021-04-11 | 90-110 , 96% | | 70-107 | |
+| 2021-04-12 | 79 , 97% | skipped | skipped | skip |
+| 2021-04-13 | 95-105 , 95% | | | |
+| 2021-04-14 | 85-90 , 95% | | | |
+| 2021-04-15 | 90-93 , 93% | | | |
+| 2021-04-16 | - | | | |
+| 2021-04-17 | 79 , 95% | | | |
+| 2021-04-18 | 88 , 96% | | | |
+| 2021-04-19 | 80-95 , 94% | | | |
+| 2021-04-20 | 82-90 , 97% | | | |
+| 2021-04-21 | 80 | | | |
+Notes: I take my morning pulse and sometimes my standing pulse as a regular thing. Other measurements are sporadic, so they may ex. have been because I thought my heart was going fast (very biased). I frequently write a measurement as a range (highest and lowest stable number seen). If there are multiple measurements in a category, I've combined the ranges. A star indicates this measurement might be unusual for some reason.
+Measurements are with a "ZacVrate" pulse oximeter
+
+### Blood Pressure Measurements
+| Date | Arm | Blood Pressure | Notes
+|------------|-------|-----------------|
+| 2021-04-04 | right | 125/91, bpm 87 | First time using pressure cuff
+| 2021-04-04 | right | 121/88, bpm 92 |
+| 2021-04-07 | right | 115/83, bpm 93 |
+| 2021-04-07 | left | 112/81, bpm 92 |
+| 2021-04-11 | right | 120/83, bpm 86 |
+| 2021-04-11 | right | 104/81, bpm 82 |
+| 2021-04-11 | right | 154/107, bpm 82 | may have adjusted cuff
+| 2021-04-11 | left | 100/74, bpm 82 |
+| 2021-04-12 | right | 104/81, bpm 82 |
+| 2021-04-17 | right | 110/87 |
+| 2021-04-19 | right | 126/96 | just sat down
+
+Measurements are with an "Intellisense" cuff that goes near your wrist. Generally I try to take them after sitting for at least 5 minutes, with my arm around heart level, as per the included instructions.
+My measurements do NOT seem to match a doctor's office measurements.
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