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EASTER — Celebrating; now where’s spring

We bought a rib roast and took it over to our neighbor so she could cook it in her new oven, thereby saving us the trouble of cooking, making gravy, and carrying a cumbersome and hot carton of things 300 yards down the road. Nancy is supposed to take a stomach motivation pill about 30 minutes before she eats. So we arrived a bit early and engaged in neighborhood news with the extended family members. After a time Nancy rose out of her chair as though she had been poked with a sharp stick. We were shocked – shocked, I tell you! She had forgotten to take that pill and dinner time was fast approaching. We were shocked that she would be so forgetful and threaten the timely serving of the food, for the rest of us would not have tasted a thing until her recalcitrant stomach was primed for the event. Shame on her.

We haven’t written in a couple of days, but it’s because we have been busy, visiting doctors, physical therapy, and checking out some horses in the lower valley. Nancy anticipates riding this summer and needs a calm and responsive horse. We found a Tennessee Walking Horse mare 10 years old with experience around guns, dogs, people milling about, birds flying from under foot and so on. Namely, a birddog field trial horse. She has a 6 yr. old half brother. We will pick them up next weekend.

Nancy drove to town Friday – her first such activity since before Thanksgiving. And also, except when we know she will want the attached seat, she leaves the 4-wheeled walker in the car. All signs of progress.

John participated Saturday with our youngest horse in a workshop put on by our horseback trail riders club in the Kittitas Valley. The weather outside was frightful. Friday we had 3 to 4 inches of snow, and it snowed here a little Saturday. I stayed home and was able to speak by phone with my maid of honor at my wedding… 40 years ago. That was quite special.

Also, Saturday afternoon we went to a friend’s house and watched 4 kids color Easter eggs. It’s much different from what I remember as a kid. Then we ate a wonderful dinner and played around afterwards on the piano.

Monday starts another busy week. One of the companies with Nancy’s retirement money gave us the wrong forms a few weeks ago so new ones have to be completed, signed and stamped by CWU’s benefits administrator, then resubmitted. We have to turn in campus keys, go to physical therapy, go to the hospital lab for another blood draw for tests—never stops, and threatens to make me anemic again ! (ha ha )… not so funny. Wednesday evening there is a presentation on the great ice age floods that swept across what is now eastern Washington State carrying blocks of ice, rocks, and all sorts of debris to the Pacific Ocean via the (now named) Columbia River Gorge. This is a favorite topic of many retired earth science types we have known for years and, as such, we will see a lot of friends last seen months ago.

We know some readers are experiencing lovely spring-like weather. And from the winter you had, you deserve a few nice days. Not us. We had a mild winter. Here, this past week has been more winter-like than winter was. With new horses coming, John has preparatory work to do. Where’s spring?

THURSDAY — April Fool’s Day

John and I are writing this the evening before but because of a time zone thing it will post after Midnight and will show up as being posted on April 1^st. What a hoot. We graduated from high school in 1961 and it was repeatedly pointed out to us (a) that 1961 reads the same up-side-down, and (b) as you go forth into the real world you will learn that your H.S. days will be the happiest days of your life. Not true, but we heard that.

We started college the same year and “retire” was something old folks did and then sat in a rocking chair and waited for the USSR to vaporize our country with nukes. Neither the prospect of retirement nor being vaporized was something we worried much about. We never got nuked but, can you believe, we did retire. The golden years are here.

Under John’s vigilant care, Nancy (with a major contribution by the State via CWU) has been stashing money away in mutual funds at 3 major companies. One might think it would be simple to reverse the process by turning in a form saying “I retire” and the money, instead of going, would return. You would be wrong in that thought.

There are boxes to be checked, forms to be filled in, signatures to be signed, witnessed, sealed, and delivered. Do you want to keep funds with company A or transfer them to B, C, D, or . . . Do you want it returned to you all at once or in significant gobs or little dribbles? Shall you have a check sent to you or maybe via the flow of electrons to your bank; and would that be a checking or savings account? And if you are hit by a big truck or fall out of the air from 33,000 feet in a silver sardine can – what then? Truth is your retirement troubles begin before you retire.

Regarding medical/health/recovery issues:

The Good; The Not So Good; & The Bad:

The good news – – Nancy is back working with a physical therapist and had an active 45 minute session Wednesday afternoon. Being the latest person to sign on (and the need indicated by the dearth of time slots) the next session is not until next week. Then two a week.

The not so good news – – was another episode of food moving up when it should be going down. The help-it-go-down medicine is a dangerous thing (both too much and too long have serious possibilities) so the doctor’s recommendation is to switch out a heart-regulator for a different one. Someone (to go unnamed but she knows who she is) suggested ordering a 3-month supply of the meds, which we did. Can one sell Amiodarone on E-Bay? The new med is generic “metoprolol” and is also sold as Toprol-XL®.

The really bad news – – is that these drugs come with concocted names no one can remember, spell, or pronounce and 2 pages or more of small print “patient counseling” instructions.

Retire. Enjoy life. Read. Right!

MONDAY — So far,

It looks like the current plan is working, namely, one new pill before eating and a short walk after eating and as little salt as pragmatism permits.

I think of the new medication as the pump-priming-pill. It tells the stomach to get ready to process food so when the food arrives 30 minutes later the muscles are not caught dozing. They are ready to pump it on through to the next sequence in the digestive process. Since last Thursday’s supper this seems to be working.

We’ve taken several short walks each day. Usually we head out the back door and pass through a gate into a corner of the horse pasture. When the horses are near one or more will come over for a little TLC. So far we haven’t take carrots or other treats because they can get a little frisky under such conditions. At this stage we don’t need frisky! We circle through a bit of the pasture and past the small barn and the water trough and so we can keep track of the water level. Our other path is out the front door and up to the mail box. Either trip is about 150 yards. Today was wet and cold and Nancy had a blood draw scheduled so after that we went to the grocery story and walked and shopped. On Sat & Sun the walks followed the eating but today it didn’t work that way and the pill, food, stomach things still seem to be working.

The low salt aspect is more difficult. The grocery makes a nice chicken salad and so Nancy has had cereal for breakfast and chicken salad for her other meals. To break the monotony I simmered thick pork steaks with chopped onions and a can of chopped tomatoes until the meat was very tender. With this she got sliced peaches and mashed potatoes. We trekked through the grocery store to the deli counter to buy another pound of chicken salad only to find an empty larder. So, … The rotisserie lemon-chickens were on sale.

Using telephone and e-mail, we have spent much time over the weekend updating and getting updated about our lives and that of others from our past. Some of you will remember that I (John) used to write a somewhat convoluted Christmas/New Year’s story and mail it out. Then the internet arrived big time and the frequent back-&-forth with some led to a decline and then cessation of mailings. Nancy’s troubles have generated many reconnections and catching-up. We expect to keep at this. With Nancy’s time not being consumed by teaching duties and other university (insert four letter word here), we no longer have an excuse for not keeping up with friends from other times and places.

Well, she just told me she took that pump-priming-pill (P³) 10 minutes ago so I’ve got just 20 minutes to not disappoint that stomach. Bye.

FRIDAY — more

“More” is the word of the week. More exercise. More pills. More paperwork. More attention to details.

Nancy has been evaluated at the other physical therapy facility and we have scheduled two (45 min.) days a week. There was paperwork to fill out and as she switches to Medicare as prime provider next Thursday this will continue – the paperwork, I mean. We were encouraged to do lots more at home – exercise, not paperwork. Once each hour – out of the chair and chase the chickens around the yard. (I’ll have to round up some chickens – we haven’t had any for about 17 years.)

The diagnosis of gastroparesis, although based on Nancy’s history and occasional emptying of stomach contents, and not on the high tech test has resulted in an additional med, namely “metohkloepramide” (sounds as: met–oh–KLOE–pra–mide). What’s one more, at this point!

We learned carbonated drinks encourage water retention. Bad. As does just about anything one eats or drinks – salt or sodium is hard to escape. That will be the “attention to detail” part. And all the labels just get more complicated and seemingly smaller print size every year.

Yesterday a letter came inviting me (John) to serve the community by appearing for jury duty in May. Fill out the form and return in 5 days or less, they say. What are they going to do? Come and knock me around for 5 minutes or so? I’ll have to see if they will postpone the request for a few months. More paperwork.

THURSDAY — Home; out of the CCU

The local hospital refers to where Nancy was as a Critical Care Unit. If I figure out how that differs from and Intensive Care Unit, I’ll let you know.

It is now 7:30 P.M. and we have been home about 15 minutes.

Nancy was discharged earlier this evening with instructions for a very low salt diet and continued exercise. The consensus is that her entry into the hospital on Monday was a result of her heart not being vigorous enough to do its work because of too much salt, too much liquid, and lack of movement. They don’t call it congestive heart failure for nothing.

The stomach issue is thought to be a result of too little stomach activity over the last 3 months but the test today did not reveal any severe problem. A medication to improve the physical flexing of the stomach has been started and a prescription written. The idea is to encourage the stomach to force food along its intended pathway and not let it just hangout there. Reading material provided indicates that this problem should lessen with appropriate food preparation, medication, and exercise.

A physical therapist had to check her out before the hospital would release her. He was from the place the insurance company approved – associated with the hospital – for outpatient visits. We will visit at 9:30 on Friday morning and plan on therapy visits starting next week.

Nancy ate at the hospital after taking one of the new meds. I have horses, dogs, and me to feed – and the dishes need washed.

I’ll add more about this week’s events for Friday’s post.

WEDNESDAY — Enough already !

A visiting doctor thought Nancy might be experience gastroparesis. This translates to stomach paralysis. Test will be on Thursday.

Here is a link and the first paragraph there from:

http://www.gi.org/patients/gihealth/gastroparesis.asp

>>Gastroparesis literally translated means “stomach paralysis”. Gastroparesis is a digestive disorder in which the motility of the stomach is either abnormal or absent. In health, when the stomach is functioning normally, contractions of the stomach help to crush ingested food and then propel the pulverized food into the small intestine where further digestion and absorption of nutrients occurs. When the condition of gastroparesis is present the stomach is unable to contract normally, and therefore cannot crush food nor propel food into the small intestine properly. Normal digestion may not occur.<<

Today’s events: All was progressing well today until after lunch. I had been talking to the nurse about having Nancy do more than just be in the bed. Could she walk around some? Was there a 4-wheeled walker around or could I bring one in? That sort of thing.

There was a CWU EMT student there for the day so the nurse agreed to more exercise after she and the young man checked Nancy’s vital signs as she moved about – sitting, standing, in and out of a chair. That all went well. So after a little exercise she got back into bed and I started to leave. At that point she expressed some stomach discomfort – like she had to burp. I urged her to sit up straight and do so. It was more than a burp. It was all the liquid she had consumed at lunch. She has learned to keep a pan handy and so all the mess was contained.

Shortly thereafter the visiting “hospitalist” came in and talked to Nancy and the others that had witnessed the event. She was less than surprised and based on Nancy’s long stay in bed before and after surgery expressed her opinion that this would not be uncommon.

She wanted Nancy to eat (mostly liquid and soft food tonight) and then nothing until they start the examination tomorrow. They will give her food with ingredients that will show on an X-ray and then over several hours and several pictures determine if the food stays in the stomach overly long.

We will learn more tomorrow.

TUESDAY — Not pneumonia !

Pneumonia was not confirmed. No fever and no sign of the right germs or whatever it takes in one’s coughed-up material, which there was almost none of anyway.

A couple of weeks ago with Nancy seemingly stable the diuretic was eliminated from the drug arsenal. But as she was not eating the right stuff, combined with the less than robust heart function, she began to retain fluid again. To Nancy, currently, the ideal food is Lipton or Campbell noodle soup with a fake chicken aroma and lots of salt. Sometimes she even eats the noodles.

I can’t hardly buy anything she will eat that isn’t loaded with salt. I guess the next thing is to buy a grinder and get pieces of things small enough that she will swallow them. The local hospital calls this a soft mechanical diet. Think of a chicken salad sandwich without the bread. Such pureed foods are sold, I think, in the grocery store under the heading of baby food. That probably won’t do.

Before they kick her out of the hospital tomorrow I will have to have a plan in place.

MONDAY — pneumonia !

The past week and weekend were busy and the night’s not very restful. By Sunday evening late Nancy’s heart rate and pressure were going up and her breathing a bit ragged. This morning Nancy called the doctor’s clinic and talked to a nurse that knows her. The nurse, based on the sound of Nancy’s voice and the above mentioned symptoms, suggested bypassing the clinic and going to the ER. Off we went.

Sure enough, after listening to chest sounds and looking at the chest X-ray we were well on the way to being admitted to the ICU – again. That occurred right after a massive IV of the combo-antibiotic Zosyn®. The ER nurse was new to Nancy but the ICU nurse called her by name – not having seen her since last June. She was the nurse on duty the night Nancy had a big fluid build-up and was sensing an on-coming heart attack. She initiated the move from the normal hospital bed to the ICU. Today was just her fourth day of being an ICU nurse.

I spent the initial ER time with Nancy and then ran out to get food. I was beginning to think they would have to admit me too. I got back just as the initial Zosyn-IV finished dripping into her arm. Then I helped with (or got in the way of) the move between ER and ICU.

The expectation is that Nancy will be there two days. Assuming an improvement the norm will be for discharge (Wednesday?) with oral antibiotics and related follow-up.

I came home about 4 P.M. and missed a lengthily visit by an ICU doctor. I’ll add more information here as soon as I can. It is now 5:30. I’ve got dogs and horses to feed and then I’ll head back into town. I likely won’t get home before 8 or 9.

Pneumonia is covered here:

http://www.medicinenet.com/pneumonia/article.htm

FRIDAY — John thinks . . . (by John)

. . . the country is becoming more dysfunctional by the day.

Reason One: I report this because we need to make a modem and wireless network change and if it doesn’t work we may be out-of-contact for a short while. We got fed up with the phone dial-up connection in the summer of 2008 so before the CWU term started we agreed to unload a bundle of cash and signed on with the local phone company for a high-speed (DSL) connection. Most everyone I talk to seems to have a bit of a problem with dropped connections and we have been no exception. The problem has gotten worse. About six weeks ago the cute little red light on the modem started coming on every time a national politician said or did something that was stupendously stupid. This finally initiated a response.

Last week we called the Company’s customer’s service line, and this being a national company got someone in North Carolina (we think). The nice lady looked at our digital records and agreed that the connection was dropping frequently. This I had just told her. She said she would write up a ticket on it. We said “Thanks” thinking this meant someone would do something about it. By this Friday we hadn’t heard a word and began to wonder what “writing up a ticket” actually meant. I now think it means that if their caller-ID shows it’s us – no one is supposed to answer it.

This morning I wrote a friendly letter addressed to “internet guru” and carried it into the local office – passed it through a hole in a glass barrier – and left. I wrote about the mysterious lady from the East Coast “She then told us she would write up a ticket. We don’t know what that means. The only tickets we have ever gotten were concert tickets or speeding tickets. What is a DSL/modem ticket? When should we get it and what do we do with it once we do get it? ”

An “internet guru” called a few hours later and suggested our modem was likely worn out – “they only last about 18 months”, she said — and if I would stop by she would have a new one at the front desk for us to install. “Great,” I yelled as I headed for the door.

Reason Two: I’ve mentioned a bill we’ve gotten. There were two charges for $110 each. A month ago, I wrote a letter. It was a nice letter. I ended with: “I will send a check upon hearing from you if these are charges I should pay now.” This week a new billing arrived. One of the two charges was settled by the insurance company paying $99.60 but they still wanted $110 from us for the other – no explanation included. Nancy called this morning. That charge had now been settled by another payment by the insurer and our balance was $0.00. “Great,” I said, “will you be sending us a statement saying so?” Does it not seem logical that if they have billed us for $110 but now we don’t owe anything at all that they would tell us. Oh no. They don’t send out statements like that. Nancy shut me up before I got to ask what they would have done with my check for $110, the envelope, and the cancelled 44¢ stamp. Nancy has an appointment in that office in April.

Reason Three: Mail. Forms. Rules. Reports. Okay, that’s four things. We signed up for Social Security in October and Medicare shortly thereafter. A flood of mailings followed. Some make sense. Some are unnecessary. Some are undecipherable. Each one has a cost. To the government. And to us. If we can’t determine what we are supposed to do, then it takes a phone call (more cost to them). One letter this week came and a phone call revealed that in the fine print on page three (or was it page 4) it stated that we could ignore this form (page one said respond in 10 days) if Saturn, Jupiter, and Uranus were all aligned ten degrees right of Pluto on the day it arrived. Who could have guessed?

Oh, Nancy was back at the hospital for another poke with a needle today and as she sat in her walker the doctor that saw her in the emergency room and instigated the “find the bacteria” blood draw way last year appeared and greeted her as though he’d treated her yesterday. He is what they call a “hospitalist” and confirms our belief that these folks (all the medical professionals) – are amazingly good at what they do. She was pleased that she got to relate her ongoing story to him because she thinks of him as the first of the life saving professionals in her life.

WED. & THURSDAY — fine & otherwise

It is late Thursday evening, and I’m happy. Why? Well, tonight’s food – clam chowder and lemon meringue pie – went down easily and has stayed down. We established contact with a personal representative, for us, from one of the big mutual fund companies where a third of my retirement funds have been invested and she helped us complete the forms to begin taking out money instead of making deposits. And, the Kittitas Valley Fiddlers and Friends made some music this afternoon.

About the not so fine things: Minor irritations with the insurer regarding approving physical therapy continued. On the phone I alternately got yes and no, then absolutely not, and today a letter came that seems to say yes. Still, the month is about over – so what does it matter? I haven’t heard a peep from the 4-wheeled walker company – another stain on the health care system. Some of the issues are like weeds.

John and I had blood drawn on Thursday. He had to fast for a cholesterol test so we went from the hospital directly to one of EBRG’s finest fast food establishments. We brought burgers home and about 2/3 of the way through mine – it reappeared. Enough, I said and called both the pharmacist and my doctor to ask about the meds I’m on and if something might be causing this rapid regurgitation. We made some adjustments. One of the things I’m on is Amiodarone (used to correct abnormal rhythms of the heart) and is known to have side-effects and interactions with other drugs – with digoxin, for instance, and I’m taking that. (Just for reference I’ll have another blood draw for the digoxin level tomorrow.) Big doses of iron also can cause issues. As reported above, tonight’s meal was not a problem but that was luck or circumstances. For one thing, Amiodarone builds slowly and stays long in a person’s body so just deciding to reduce the dosage, and having not yet done so, shouldn’t have any effect. Do you think?

The oddest thing that happened this week was that my phone at CWU mysteriously quit working. The deal was to be that the number and messaging system would stay for some months as previous students might be calling and asking for references and such. The paper work was very clear about this but someone saw my name and the word “retirement” and the dastardly deed was done. It took several phone calls and some sleuthing by the head-phone-lady to track this down and fix it.

Speaking of sleuthing, John learned that Amiodarone is a drug that emergency medical personnel need to know about. I’m in the process of ordering a medical-alert bracelet and, so, along with heparin that one will have to be listed too.