Author: admin

[Written over several days this week.]

The infusions via the PICC will cease after Tuesday.  It would be nice to have a way of preventing infective endocarditis (IE) by these bacteria because of the damage they cause and because the treatment is long, involved, and a pain in the arm.  Having dental work, even flossing, is a risk factor and while there are antibiotics and oral rinses (Now using Chlorhexidine gluconate 0.12%.), The American Dental Association thinks that “. . . only an extremely small number of cases of IE might be prevented by antibiotic prophylaxis for dental procedures even if such prophylactic therapy were 100 percent effective.”  That’s not highly reassuring!

After Tuesday we wait two weeks and have blood drawn and cultured.  If Nancy’s blood is free of the bacteria, the PICC will be removed.  So while IE may be rare in the overall population, Nancy has had it twice.  Our response is going to be extreme vigilance, being on the watch for any of the signs of IE that we are now (unfortunately) too familiar with.

And speaking of rare events.  Last Sunday a storm cell hit Ellensburg just seconds after we entered Dean Hall on the CWU campus  — thunder, lightning, hail and wind, the storm swept right over the campus where we were going to the memorial service.  They took me in an hour early at the hospital for my infusion, and I was able to make it to the campus in better time, and got in the building right before the “bottom dropped out”.  Luckily, the major storm cell was 10 miles south of our house and the puppy and his dad, out in separate yards, were not exposed to the bad part.

We had gotten there early, so we stopped at Hebeler, a building two down from Dean where we were going, to clean out my locker from several years of teaching there in a computer lab.  We didn’t have a big enough box or a cart to carry away all the stuff, so we will have to return one of these days.  We loaded a small box, and two plastic bags, with books, paper, and things.

Then on to the other building, with huge drops of rain (and we had no umbrella), but we parked right behind it and went in the door before getting soaked.  We watched the storm from the 3^rd floor of Dean Hall, and we could see the other end of the valley north, and realized our house was not really in the storm.  In 30 minutes it had blown on to the east and the rest of the afternoon was exceptionally nice.  Many years ago we lived in places where summer thunder storms are common.  Not so here.

Monday found us on the road to Yakima to Costco, as we were out of lots of things we need.  Then Tuesday, visited my doctor, family physician.  I’m in much better shape than when I last saw him, in August.  We also got our flu shots, both of us, this visit.  Normal afternoon visit for antibiotic infusion.  Tuesday night I went and played music with “The Connections”.  They were all happy to see me back among the living.

Wednesday… was another busy day.  Had to be at the hospital for an Echocardiogram at 12:45.  There wasn’t time and I didn’t feel like starting my exercise class, so we went to lunch.  Ate well.  Then dropped by my class at the end to say hello and let them know I was alive, and in better shape than when I last saw them in August.  I wanted to thank them for the cards they sent to ICU Yakima in mid August.  On from there to the hospital for an infusion, after an ice cream cone for each of us.  McDonald’s has a good deal of a 50 cent soft serve cone, and I get it in a cup with a spoon.

Thursday.  Time to go play music, but all morning was spent either with the puppy or on the computer putting together a slide show of my students in action over the past couple of years, for showing at the retirement “party”, Saturday, Oct 2^nd, afternoon.  Then after music at Hearthstone, we went to the hospital and then home.  Today (Thurs.) was the day for the PICC line dressing change (once a week).  John is busy now, making a pecan pie and another for a scholarship luncheon tomorrow at CWU, Friday.

The Scholarship luncheon is a group at CWU of mostly staff members, who get together and someone fixes lunch.  Then the money for lunch goes into a scholarship fund at the Foundation, and is distributed to needy students.  I have been in this group since 1988, and a few of the people from the beginning are still there.    Now it is Friday, and we went and had a great garden salad and rolls.  The garden salad was all from Ruth’s garden, i.e., tomatoes, corn, (doubt she grew the black beans), onions, and a slaw of grated cabbage and carrots.  Yum.  On the way home, we hit a couple of yard sales.  At one, John found a Wrangler shirt in new condition, for $1, in the blue and yellow colors of Sweden. (Many web sites render the yellow incorrectly but the shirt gets if right.) I found a lovely western shirt for a buck, as well.  Then we came on back home, but on the way saw a long time friend in his yard splitting wood, so we stopped and visited for a nice visit, before getting home for a stop before going back for an infusion.

Saturday, brings more music at Briarwood (a retirement community).  They provide us with a free lunch for playing and singing.  This time, they are planning to feed us cabbage rolls.  I checked today, and will go a little late to my infusion, so I can participate.  I did and we had a great time.

John and I hit some garage sales this morning.  We didn’t get as much as usual, but did get some good things and deals.  John did not bargain on his major purchase, a set of 5 unopened packages of cedar wood thin pieces.  (John, please elaborate.  Okay – glue on panel replacement, 3.5 inches wide and a fraction thick.)  He also found a stuffed horse (2 ft. high) for $2.  At the same place I bought a brass giraffe and baby on a small stand.  It is for me to give to one of my nurses who loves giraffes.  It was only $1 and is about 6 inches high.  Then another place I found some moccasins that fit for $1.  I found a stack of various kinds of greeting cards to replace the stash I used the last of recently.  All plus some other stationery / cards for a quarter.  We did walk through some sales that had nothing to offer, or whose prices were out of line.  Another sale made us question, “Why bother?”  There was so little stuff.  At least I got some exercise walking around them.

Sunday, nothing is planned… to my knowledge, except for the infusion again.

The other thing I have been working on all week is a slide show (mostly of recent students and other things) to show in the conference room of Dean Hall during the retirement party.  It will just revolve through them without intervention.  I’m cleaning my computer and snagging smaller pictures of my students in action – for the past couple of years.  I have pictures of them presenting their map projects and GIS (Geographic Information Systems) projects in 3 different classes at the end of a quarter, in a University Poster session in the Science Building.  I have done that for at least 10 years.  I also have had my Urban Geography class do posters on their final term project.  As well, I have pictures from some of our Wine: A Geographical Appreciation class field trips.  There are pictures from different award banquets that I have nominated students for over the years.  Pictures of events during classes, such as orienteering on campus, or visiting the Map Library to learn about maps and research in Government Documents.  I have fun pictures, as well, of a Halloween pumpkin carving contest one year, when we shared a building with geology and physics.  Now we share a building with anthropology.

That’s it for the week.  Hope yours was good.  Stay tuned for next weekend, hopefully not before.

Nancy

. . . but not on the western horizon.  A major storm approaches and at this time next week western Washington (the Olympic Mtns.) is expecting a major wind and rain event.

Again a relatively quiet week.  Sunday, Monday, Tuesday were the same with infusions that worked well.  Actually, Tuesday, the Culligan Softener that broke was replaced and we added a reverse-osmosis system for giving us nice pure drinking water from our own well and our kitchen sink has a matching faucet from which it comes.  The company operating from a phone-hub in Spokane (3.5 hours away) has a sub-base in Yakima (50 minutes away).  There are glitches and this week’s was a requested “first in the morning” scheduling didn’t happen so by the time the installer arrived it was not possible for John “the driver” to perform that function and I had to get myself to the hospital.  Look out Kittitas County! – down the Naneum fan I went.

We returned to routine on Wednesday and added two new stops:  1-a haircut for Nancy; 2-another setup with a 24-hr Holter Heart Monitor, but this time from KVCH in Ellensburg.  This one was very nicely administered with care, and I will go back in the morning to have it tested before removing all the connections.  This is quite different from ripping off the contacts and pushing into a mailing envelope to return to the Yakima Heart Center (never heard the results from that one either).  Makes you wonder…. Hmmm.

Thursday was another busy day.  Back to the morning hospital removal of the Heart Monitor.  That went fast and John got to visit with a friend who volunteers there in Respiratory Services.  On to the grocery for donuts to take by another friend’s house on the way home.  Yum.  It was to talk about taking one of our horses, Myst, back to their house and round pen, and on Saturday, to a horse training clinic.  She needs exposure to different things, and we are too busy going to the hospital for IVs to take her ourselves.  One of their horses is lame so they offered, and we accepted, gratefully.

Once back home, John moved horses around, and they came and picked her up in their rig.  We went to town for me to fiddle with my “group” at a retirement center.  It went well and we had a good turnout, despite vacations.  From there, right away to the Out-Patient services for the IV of Rocephin.  They were ready with room #4 which is most often my room of the 12 there.  They had to change the dressing today on the PICC line (once a week).  They are so good and had my Chocolate Milk Shake with added Glucerna, ready for me.

Friday was less involved.  We played with the puppy, and went for the infusion.  No surprises. Hit two garage/yard sales.

We planned for Saturday to be morning garage sales and a search for paperwork for retirement.  We must have stopped midstream when my health went downhill and lost track of what we were supposed to be doing.  Then buried some papers.  There is no real harm done, it is just that the consolidation we were working on has been delayed.

Did not do the paperwork search, but did the garage sales for a couple of hours.  It was successful, and then home for a good nap, before going for the afternoon infusion.  Sale items, I can remember:  western shirt and knit shirt and pants, $2 for all; nice old axe with a new handle ($5), a couple of bags, just nice looking, and one full of plastic coat hangers, $1 each.  Then to another fun sale a few roads west, where John saw some boots (almost new, hiking type) that fit me perfectly, $1.  We also got tongs and a nice saw for $2 total.  John found a Louis Lamour paperback for a quarter.  Oh, a throw for the furniture to keep the dogs from eating the quilt, $1; and a nice sweatshirt for John, $1.

Then more–  A strange collection of CDs still packaged, one of Shelby Lynne for $1.  Then one with a hat over the ears such as John wears for .25.  On to two sales, one proceeds going entirely to the American Cancer Society, where we got John another sweatshirt for working around the place. $1.  Then we met some friends at a sale in an alley, and found a cute little girl selling her plastic horse collection for 50 cents apiece.  We gave her $2 and will put in the raffle at our trail riding club.  We might keep one that looks like our horse.  Another dust gatherer.  John found two nice new potholders, large, both for a quarter!

Still more.  We went to another at the SR. center where I was going for my exercise class before I ended up so sick in August.  There we found 5 glasses to match the 4 we packed away last week.  They are Christmas glasses which we were told came originally from Dairy Queen!  While there John found me a beautiful quality sweatshirt with inlaid hearts, $2, and the lady in charge gave me a hanger that holds 5 or 6 blouses.

On to the last one, after a stop for donuts at Super One and my medication mouth wash to try to prevent these bacteria from entering my system again!  There we found a leather jacket (a little small, although a large size, but I can wear with a light blouse beneath).  It’s cool and only was $2, and nearly in new condition.  John found a horse lead and rope halter there for $5 total.  Each alone alone costs at least $10 or more from the store… maybe more.  We haven’t bought either in awhile but will do a post-purchase check sometime.

Yes, I know this is not all according to my health, but I’m getting clothes that fit me in my new weight.  And, I get my exercise in walking around the sales.

The infusion today was in the Intensive Care Unit and I had a nurse who was the one who got me there last summer when I was going downhill from the bacteria and they thought I was having a heart attack.  Turns out my lungs were full of fluid from the bacteria loaded on my heart and causing the blood flow to decrease through my heart properly.  That time, in 2009 June, they pulled off 4 quarts of fluid from me.  Amazing.

Well, I’m much better now and able to navigate and might be up to exercise classes when they resume on Sept 20^th at the Sr. Center (oh, properly called the Adult Activity Center); no one wants to be politically incorrect.  What’s wrong with saying this place is for old people?  It is a nice provision the city has for its “seniors.”  They have trips planned and also lunch is provided for a reasonable fee every day but Friday and the weekend.

Sunday we go early for the infusion so we can get to a memorial service for an anthropology colleague who died from liver disease.  John will go ahead and post this Saturday night because it could be after 6 or 7 P.M. here on the western edge of the continent before we could return home and add Sunday’s news (or lack thereof).

Have a nice week, and we hope to talk to you next weekend, having gone through a nice normal week.  What a concept!

Nancy

Many of you were not expecting anything to be written this past week till today, but we sneaked some in on you when things starting happening.  The end of the week was less eventful, thankfully, on the health, antibiotic infusion part.  The rest of the time after the mess on Monday, was pretty smooth sailing.   Today had a funny note, but the infusion went well.

The Out-Patient services put in a standing order for me for a milkshake with boost of Glucerna added to chocolate ice cream, two scoops.  Yesterday went without a glitch and the kitchen provided my shake.  Something got lost from yesterday to today, and first they brought a bottle of Glucerna with a cup, no shake.  The people in Med-Surg sent it back requesting a shake.  What came next was the Glucerna in a cup with ice as the base.  Finally, the third time was a charm, but it was only 10 minutes before I ended for the day.  I drank a bit and took the rest with me for the trip home.  We’ll see if tomorrow the kitchen gets it right the first time.

The other nice thing that happened today was a visit with friends, now in Rockville, MD who we have known a very long time – since starting at the Univ. of Idaho as an undergraduate student, going on through to a Masters, and being involved with me while a GIS manager on the west side, by employing several of my students as interns.  He and his family flew to Seattle, rented a car, and were driving over to Spokane, when they stopped off for lunch and a visit with us.  We met them at the Deli at Super One in town.  That was a good choice because the town is inundated with rodeo and fair goers and all major restaurants probably were packed.

The rest of our last couple of days was filled with moving hay (John), and playing with the puppy, who has taken a liking to the sofa in the den.  He actually made it halfway through the night in the washroom, went out to “pee” at about 2:30, and spent the rest of the night till morning, happily sleeping on the sofa with his mom.

We do not have any special plans for labor day so doubt there will be any blogs till next weekend, but that’s what we said last week.  So we will not speak ahead and just keep you informed if anything big happens.

Much of my time this past week was spent on email, contacting former students and workers who employed my students to invite them to my retirement party.  If you didn’t get an invite and are interested, let me know by email (nancyh@ellensburg.com) and I will send you the invite, knowing you cannot come but might just be interested in seeing the celebration the Geography Department has planned for me, Oct 2, Saturday afternoon.

Former students have responded by email with some good memories that make my day.  There are comments from them about their connection to me (and John) that I would never have known.  There will be a memories book at the reception, for people to write in, and they also can send to our secretary, for her to include in the memory book.  I hope she will just print the emails and save herself  the effort of writing in the book, and just slip them in the back.  Otherwise it might be an impossible task.

Other things have happened this week, on the minor side, but major in my book.  John had planted some tomatoes, but our temps have been low and the winds high, so we had broken plants and not a lot of ripe tomatoes.  Yet, this week he has harvest a few small ones and they are wonderful, tasting like tomatoes.  What a concept !  [from jfh, We have had many clear-sky nights and at 2,240 feet elevation the night temperature will and has dropped well below 50^o F.  Tomatoes hate that.]

I’m sure I left something out, but not to worry, there is another week.  Thank you for your phone calls and birthday and get well cards.

Have a nice week, and we will try to do the same.  I still have till September 28 to go daily to the hospital for the infusions, which have decreased this week from two to only one – 30 min., Rochephin.

See you on the blog hopefully only next weekend.   Nancy

Have to report on my birthday (67) yesterday, Sept 1.  It was a good uneventful day.  I didn’t want John to make me a Chocolate Cake with Chocolate Frosting, but I did want two presents.  One was a squeaky toy and a rawhide chew for the puppy, Rhu.   He now has a name, and a neat toy hamburger he loves.  He can jump up on the sofa along with it and settle down for a nap with his mom, John, or an aunt.

John put in more time digging for the bottom of the stand pipe where the leak is suspected.  He then went to the pasture to mow old grass, roses, and other nasty weeds, and ended up getting a stick caught under the drive-belt.  Apparently the belt and the stick both fought gallantly until they both died. The mower quit moving forward when the friction and heat stretched the belt.  So, yet something else to fix.

Birthday afternoon at the hospital out-patient clinic was delightful.  They were all attentive and everyone on the staff came by to wish me a happy birthday.  They had a little snuggle bear on my pillow for me to have and take home.  There was a milkshake ready with extra protein and supplements.  All went well, and they changed the dressing on my PICC (has to be done once a week).  It is nice to be able to report nice things.

Today is Thursday and was another great day.  We got my other present I requested when John got a haircut from the lady who has done my hair cuts since I arrived in town in 1988.  I normally do John’s hair, but was unable in the past few months and his hair was beginning to look like Einstein’s.

Then I went to play fiddle and sing at a nursing home and had another good hour.

Finally, left there in time to get to my infusion, which again went smoothly.

That’s all, but wanted to give you some good news for a change.

[posted Tuesday, after John said no more reports till Sunday]

A continuation of the drip, drip epistle:  We’re good at prematurely speaking about successful activities.  For my blood draw and infusion today, at 3:00 p.m., we found that the the PICC line would not flow, unlike the water line at home that won’t stop.  There was not a drip of blood to be had because there was a clot in the line acting as a stopper and wouldn’t allow anything by or from.  The first saline solution seemed fine, but subsequent attempts to draw blood resulted in dry air.  This normally is just over an hour in and out for the antibiotic infusion.  Not today.

The problem would have been either a fibrin tail or an intraluminal thrombus.

These and other PICC issues are reported here:

http://www.medscape.com/viewarticle/508939_6 Here are quotes:

#1  “Fibrin also may build up on a catheter without completely enclosing it. In this scenario, a small piece of fibrin hangs off the catheter tip. This is known as a fibrin tail, which also represents a persistent withdrawal occlusion. These can sometimes be resolved with an infusion of low-dose alteplase over 2 to 4 hours, but this is not always successful, and the fibrin tail may develop again.”

#2  “An intraluminal thrombus forms inside the catheter and can result in partial or complete occlusion. It often can be dissolved with a small dose of alteplase, a fibrinolytic agent that is instilled for 30-120 minutes and then withdrawn from the catheter.”

~ ~ ~

When the PICC is to be used the first thing done is to apply suction until blood is seen.  When none shows up it indicates a blockage.  Fibrin is explained here: http://en.wikipedia.org/wiki/Fibrin

When fibrin attaches to the inner-end of the line or tube (lumen in hospital speak) it floats in the blood stream until that backward flow from the external suction causes it to be pulled into the open end of the tube. If the lump or clump (thrombus) is formed inside the lumen then the condition is called an “intraluminal thrombus” as in quote #2, above.

If you have a broadband connection, try this video for an explanation of these things and the solution.  (This is an ad-like video for the chemical used in my PICC.)  http://www.cathflo.com/media/cathflo_moa.mp4

The production of this stuff involves recombinant DNA technology, fermentation, and Chinese hamster ovary cells.  Why Chinese hamsters?  Who knows?  We didn’t even realize hamsters had nationalities!

Which ever it was, we had to go to plan B.  That meant an extra hour plus while we awaited delivery from the pharmacy of  Cathflo Activase® and its forced entry into the PICC line with turbulent motions.  Push, push, to get the fibrin broken up and the line unclogged.  Meanwhile, John retrieved me a warm blanket to try to get me comfortable.  Those 45 minutes seemed to last forever.  I called a friend on the cell phone to tell her my plight.

Finally, the time came to search again for blood from the PICC turnip.  It came!

First item on the agenda was to draw blood for an INR test, from the PICC.  Before that, one has to clean out the Cathflo Activase® and about 10 cc of throw-away blood.   (No wonder I’m anemic; they put blood in one week and take it out the next).  So we continue.  She draws a full vile of blood for the INR test, more than enough to be on the safe side.

I had started the paperwork over a week ago from my family physician’s office to put the INR on tap for being done by a nurse in the Out-Patient Services where I am every day except the weekend.  This is a great service that prevents being “poked,” but Lab personal cannot take from a PICC line; only a trained nurse is allowed.   When I came in, before she started the antibiotics I mentioned the need to do the INR test and that the paperwork was in place.  Normally, I have a standing order at the Lab, but nothing at the Out-patient Services.   This nurse couldn’t find anything in the records, so off she went to call my family physician’s office to request it before she could draw.  There was plenty of time while we waited for the fibrinolytic agent to work its dissolving wonders.

Once done, as mentioned above, the nurse could change the head on the PICC line (cannot use one through which blood has been taken, and infuse the antibiotics into my PICC.  I think it was 4:16 when this part started that usually takes an hour.  We were about on schedule, only an hour + later than usual.  So begins the drip, drip – one from each bag of the two antibiotics, combining into one tube headed into my superior vena cava — a large diameter, yet short, vein that carries deoxygenated blood from the upper half of the body to the heart’s right atrium.

http://en.wikipedia.org/wiki/Superior_vena_cava

I slept through the first 35 minutes, but by now my back was hurting, the pillows weren’t right, and I was a basket case for reclining in an uncomfortable set up so long.  Oh, I had made a couple more cell phone calls to friends in the set up stages when we were just waiting.

So, I mentioned my discomfort to the nurse.  I was in a special bed with remote controls to determine height of back raised and the same with knees.  I played with the controls and finally found a good position.

At some point I was really wanting a chocolate milk shake.  The nurse overheard me and said they could order one for me.  They did.

I managed to rest through the last hour of the infusion.  We didn’t walk (wheel) out of there until 6:30.  That was 3.5 hours for an expected 1 hour stay.  I was not a happy camper.  Except I was thrilled to see the double saline solution flushing with a turbulent short pushes motion to force the solution to the line with the hopes of breaking up any clots.  I surely don’t want a repeat.

~  ~  ~  ~

In the “for what it’s worth” department:  At home, the day started with nary a drip.  In order to prevent loss of water from the well John flipped the circuit breaker to the pump; turning it on only as needed to have running water in the house.

A Culligan man was due at 10:00 a.m. but was delayed ½ hour.  He got to the house and John explained the problems.  They determined the Culligan-Softener (21 yrs old was shot) and the Iron removal equipment was doing fine still. (Ours is ferrous iron that oxidizes in the lines and tanks.)  The Culligan-man and John discussed the pressure problem in the tank and decided there was a leak in the house or between the house and the barn somewhere.  Turns out it is between the house and the barn but John hasn’t yet located it.  He has to dig 4 feet down through alluvial fan material that has been refilled in a ditch for the buried water pipe.  He’s hopeful that the leak is in a frost free stand up faucet for the horse tank at the barn. While the exact location of the leak is sought, replacement equipment has been ordered to provide sparkling water inside the house.

Blood and water go drip – drip.  Money goes in clumps.  Ouch!

Life continues . . .

I think Nancy feels better today than she has in a couple of months.  A lingering question about the blood loss remains.  If not caused by the bacterial infection, then what?  The heart issues will be treated continually, so, while she is examined, tested, and treated appropriately for her finicky heart over the next few weeks, the anemic aspect will be watched.  Multiple exams ruled out many things, so with respect to this, we are in a period of watchful waiting.

She went to the local hospital for antibiotic infusion via the PICC line today.  The pharmacy folks indicated they were okay with both of the compounds going in at the same time.  That cut the procedure down to about an hour.  They fixed up a nice comfy bed for the duration and when I returned she was ready to go.

I hadn’t stayed.  That’s the “double dang” part.  One of my jobs yesterday was to clear out the hospital room.  Things such as un-opened fruit juice and the plastic pans for holding tape or other incidental items – these things all get sent home with the patient or tossed out. I cleaned up all these things into a couple of small boxes and a plastic bag.  A nurse brought a wheelchair, I went ahead and brought the car to the front door, and minutes later we were on I-82 heading toward home.

Big mistake.  Someone (me?) forgot to unplug two power supplies – one for her cell phone and one for the laptop.  Bummer.  Ensconced in a fluffy bed, Nancy recharged while I boomeranged from Ebrg-to-Yak and back.  Wind gusts today were nearly 50 mph and the passenger side of the car sometimes makes an odd woodwind sound when air begins passing over us at about 100 mph.  I got that a lot today along with the turbulence.  I did see a large column of dust coming from the lower valley south of Yakama and streaming into the area above the clouds over my route. That was very interesting.  On the ground these dust steams make for nasty driving, accidents and closed roads.

Now that Nancy has her computer back I will expect her to write on Saturday.

There is a potluck by and for the Kittitas Valley Fiddlers and Friends tomorrow evening, so, Friday will be an off-day for our communications.