Word of the week – hectic

I’ll start by mentioning that my sister had a medical hiccup on Thursday. I guess she is okay, but it is hard to know because in her best interest she was taken from a smallish ER clinic to a monolithic hospital. Therein cell phones do or do not connect with the outside world depending on cosmic rays, sun spots, or the concrete/steel/electromagnetic frailties of the structure. She called me last night, and a cousin today. My call tonight did not get through.

Friday morning I carried boxes of tax related papers to an EBRG CPA. I have to get a power of attorney signed so he can talk to the IRS about things. So, slow moving on that front.

Today, the three horses went to a new home. They were purchased early in Nancy’s recovery 10 years ago but we were advised that she could be hurt and bleed internally, so she and I stopped riding. They were lovely animals so we kept them until today. I did not have much success in Kittitas County with moving them to new homes. Friends from the west side thought they could adopt them. I have worked with the horses a dozen times in the past few weeks. Now they would come to a small area (known as “home”) and be handled, haltered, and led around – mostly well mannered. Far from a finished ground-work graduate. Still they loaded into a trailer for the two ladies that are taking them west – and by 5 o’clock they were gone.

The horse activity was interrupted because I have been looking for a simple pickup truck. The Subaru dealer was going to take my truck (F350), Nancy’s Forester, and my Crosstrek – but they could not find anything close to what I wanted. Neither could the local Ford dealer.
Last night a used truck dealer in Yakima posted just such a vehicle and friend Kathy was searching and found it – 6 hours after its posting. When she came for the horses this morning she had the listing, photo, and dealer’s number on her cell phone. I called and told them I wanted to look at it. So Kathy’s husband, Francisco, and I left after I put halters and lead ropes on the 3 horses.
At the truck place I was about to write a check for one truck when Francisco noticed another newer one out a side window. We hopped in that one and took a short ride. Meanwhile, Jennifer, the brains of the operation noticed that Nancy’s name, above mine, was on the title of the Forester. Jennifer said we would need Nancy’s signature. Oops!
However, if I had a death certificate the sale could go forward. Francisco called Kathy and I gave her directions on where to find said form. Francisco and I went for lunch, and got back to the dealer just as Kathy showed up with the necessary document. We cleaned out the Forester – Kathy found $22 to add to the $390 she found in the house last week – and we were soon headed back to the Naneum Fan and the horse situation.
The new ride is a white 2019 F150, 4×4, 8 ft. box, low mileage, and a full bed liner.
At home the ladies (Kathy & Janelle) prepared for horse loading. Francisco and I went inside and he wrote checks for the Crosstrek [purchasing for daughter Maraya ] and for the F350, for his own use. About the time the car dealing was coming to an end, there was a Whoop and a Wahoo! from outside as the third horse hopped into the trailer. Did I mention they had not been in a trailer since Nancy and I brought them home 10 years ago. Further, today was the day they were introduced to Horse Whisper Janelle.
With Janelle and the horses headed west, we cleaned out the Crosstrek of my stuff, and loaded a few things Kathy and Francisco decided to add to their stuff.
They will be back Sunday for the F350, more stuff, and the better of the two horse trailers.
Nancy and I bought our first horse, a Quarter Horse named Captain, in 1978 or ’79. We were up to 5 a few years ago. Now Zero.

Change is sometimes slow – sometimes rapid.
Uff da!

From the Naneum Fan
John

Memorial Day (long weekend)

My long awaited phone call with a Social Security clerk came at a little after 2 pm on Monday. I sent a note to friend Dot, who visited the DeKalb County court house to get the certificate of marriage.
That note follows.

I had my phone call with Victor of the Yakima office of the Social Security Administration on Monday afternoon. I either had to drive to Yakima (100 miles round trip) or mail the certificate of marriage.
I have no other reason – just now – to go there, so I mailed it on Wednesday.
The talk was as expected, except he asked if I could read small print. Maybe if I said no I’d get a large print version of whatever he will send to me.
It is also odd that a surviving spouse or child may receive a special lump-sum death payment of $255. This payment has bedeviled congress and the SSA since the beginning.
The amount of $255 was set in 1954, but with price increases since then the amount today would be $2,532.
I will ponder the use of my $255 as I await its arrival in my bank account.
I’m slowly making credit card and other changes as I figure them out.
A tangled web, as you know.

The last line is a reference to the things that followed the death of Dot’s husband Bill over a year ago.
– – – –
SATURDAY
Five of Nancy’s friends and I spent hours sorting and packaging stuff, mostly clothes, from a bedroom, including from on the queen sized bed, from closets, dressers, floor, and hanging on doors. Mid-morning Sunday two of the kind folks will be back for more of the same.
I’m too exhausted to write more tonight.
I should have spent more time over the past few weeks doing some of this, but not being in that frame of mind – and knowing help was coming, I didn’t do much.
A further distraction this past week was serious work on the last major project of the house remodel. Namely, concrete and joists for the deck were 95% completed. Photo #1 below. Photo #2 is the nearly finished entrance sign. This pulled the workers away from the deck; my choice.
However, the entrance structure and sign have been a goal of mine, and I wanted it to be there to greet some long-time friends.

The Nordic horse is a symbol of welcome (Välkommen, Swedish, or Velkommen, Norwegian). This one was painted 35 years ago in Troy ID.
On this Memorial Day (long weekend) spend a few moments remembering those who served.

I’ll put flags out Sunday and Monday.

John
from the Naneum Fan

Stuff happens

NOON Friday update:

3rd trip to bring computer health –
Most problems (see below) solved, but the default router-to-computer connection is assumed to be a cable. I need WiFi.
Old box and the new are back in town to see if the wifi of old will fit in the new. If not, I’ll have to buy a new one. Most components are smaller now than 7 years ago.

B e l o w:
The good: I just figured out how to use WordPress on the Dell laptop Nancy used — and I dislike bigly.

The bad: The computer I used (large tower, 2 monitors, wireless mouse and keyboard) went to the Great Trash Heap. I brought a refurbished Dell home but it doesn’t recognize the mouse or keyboard, and only 1 monitor appears.
I’ll call in the morning, but I may have to go back in with all the parts to get help.
Other than that it was a nice day.
John

March update #2

I knew there were issue a week ago but I’ll just start with Tuesday; that’s the regular blood draw day.
We started in the door (auto sliding) and made one step inside.
A man was coming from our right – the direction we needed to go.
Nancy started to pivot that direction, and I took another step forward. Oops!
Her feet tangled and she went down – I had her hand and kept it from being a hard fall. With the man’s help we got her up, and the receptionist rushed over with one of the tall chairs. A rest, and then on into the real waiting room.
I told Kim (phlebotomist) she need not draw a vial for the clotting index INR but could use a finger-prick. She did better, taking a drop from the vial being sent to the lab. INR this way is immediate.
We had little to do in town, so went home and had lunch.
Not long after our “doc” Chelsea called and reported the Potassium level had spiked into critical level and we should think about going to the ER. I questioned whether or not we could just walk in. So she called the ER, then called us back to say they were expecting us.
Indeed, they were – so no waiting. The ER doctor and about 6 or 7 others fussed around Nancy, and the hospital doctor of the day came in also. He came to talk serious stuff with me, and then arranged the transfer from ER to the Critical Care Unit (CCU).

To digress some – Nancy was mentally confused – this I knew, but also knew I was going to talk to Chelsea on Tuesday, so did not call her Monday. Nancy’s “sleep study” was scheduled for Wednesday at 8 PM, and I was sure that would be disaster in her condition. On the way to the ER (about 17 minutes), I called the Sleep place and cancelled.

The ER doctor asked Nancy about name, time, date and where she was. She knew all the answers. Then in an instant she would say something very odd. She heard the conversation when we cancelled the sleep study but then told a nurse she needed to get out for the study. At some point she told me someone in the hospital was going to take all my clothes and I would have to walk the streets of Ellensburg naked. (That happened the next morning, I guess; but she was behaving strangely.) She was trying to remember the words to the “doxology” song and wanted nurses and aides to sing with her.

At this point her Potassium was recorded at 6.5.
According to the Mayo Clinic, a normal range of Potassium is between 3.6 and 5.2 millimoles per liter (mmol/L) of blood. A potassium level higher than 5.5 mmol/L is critically high, and a potassium level over 6 mmol/L can be life-threatening. {Last year, mine was just 4.0.}
They gave her a cocktail of chemicals to bring that down while still in the ER. By Wednesday Noonish it was down to 5.5, and Thursday to 5.1. That’s good. Not so good is that she has retained a weight gain of 20 pounds since early December, and that hasn’t responded. With weak muscles from a year of inactivity, this complicates simple movements, such as getting on and off of a regular chair (think commode). I’m trying to locate a high and wide bedside unit.
As that dropped, her mental condition improved. To me the result was stunning. For the time we were there the CCU doctor was a retired man but working at least a few days a month at regional hospitals. He too (along with nurses and aides) were impressed with the rapidly changing (improving) mental state. I was told on Thursday to expect a discharge on Friday.
Had a short visit with a Physical Therapist and a long visit with a Social worker, Polly. They were (did) to set in motion actions to get help at home with in-home things. On discharge, I was told folks would be in touch Monday. Polly also arranged for Nancy’s 2nd Covid shot to be brought out to the house.
On Thursday I ordered a powered hospital bed for home, and borrowed a walker from Hospice Friends. The bed was to arrive at 11 am Friday, so I visited Nancy at breakfast, then went home.
A young man named Dylan came with the bed. This is his #2 job. Number 1 is with the EBRG Fire and Rescue folks, where friend Sara is an EMT. The bed has 3 small electric motors and the gear to (1) raise the entire frame, (2) put a kink under the knees and (3) raise the head & shoulders section.
#3 was dead on arrival. A metal piece had been drilled with two holes too close to the end that attached to the drive shaft from the motor. Those holes (metal) tore, leaving a sharp edge like on the lip of a just opened tomato can. Dylan and I tried to fix this, but could not make it work.
Otherwise the bed was fine, so he left it and will bring a new one Monday. My work-around is shown in this photo.

Once Nancy was in the bed, she thought it needed tilted more. I rotated the plank. I’d already taken the photo; a new one seemed unnecessary, but the height is now about double what you see.

Diet instructions were given to me. That is, a list of high, medium, and low K foods is provided. I managed to dress up a mushroom soup, with a side of pears. I will only note that this is going to be a problem. For example, when on the blood thinner Coumadin there are things one is to avoid. Of course these seem to be low in Potassium. Also, there are a few things Nancy will not eat – Watermelon! Butternut squash (she likes) is a no. Summer squash (sorta doesn’t like) is fine.

I guess that is it for now –

Remember to change clocks this weekend!

John

Not so Nasty News February 26th

Item #1: Parma Street Clouds

Left photo by my sister in NE Ohio.
Right image from here: Cloud Streets

Various sites claim that “cloud streets” typically form fairly straight lines over large flat areas such as the ocean. Ohio isn’t an ocean but the area next to Lake Erie (or parts of) is flatter than an ocean under a good breeze.

While in the region, there are some nice photos of Niagara Falls at this site: Ice is nice

Item #2: Vaccine
We went for the 1st dose of the Pfizer Covid vaccine on Friday afternoon. Two hours later I cannot (feel) tell where the needle poke was. I was talking to one of the volunteers and not looking. Maybe I got just a skin-pinch for some sort of test.
Our entry was at 3:30 and the folks had give over 400 shots.
There is a second site in the County. Hope the Saturday morning paper will provide information. We ought to be near half vaccinated.

Somewhat related is the number of times we keep having to give our e-mail, phone #, address, and more in a county where we have a “medical portal” that’s is supposed to keep track of health records. If this sort of stuff is what is being designed into self-driving cars – the lack of connectivity and intelligence, I mean – such cars should have a bright orange, with black skulls, paint job. We’d know to pull to the side when one is spotted.

Item #3: Snow

Washington is having a snow season. Snoqualmie Pass, 70 miles west of us has an accumulation of about 33 feet. There is 37 feet at the pass north of that. Farther north the road has been closed since last November 13th.
Many people are pleased with this. Others, not so much. Spring melt will have some flooding, so that is already being discussed; in the local paper early in the week. There has been 2 or 3 feet of new snow since then. We got about 5 inches.

To prevent snow coming down on traffic the roads are often closed, say from 4 AM to 6 AM. Various means are used to bring the snow down, then they clear what hits the road. Travelers need to stay informed and prepared.

And that, for this week, is the not so nasty news.
John

Not so Nasty News February 19th

North from our driveway and Naneum Road. Hills were covered with fire and smoke during August, 2014. {2/19/2021; by John}

Item #1: A new national zoo

A wise owl wrote about all the odd things our nationally elected politicians do when they are not busy taking our money. Seems they put some fencing up. Where or how much, or how much it cost, I have no idea. Then the person connected the dots – – odd behavior + fence = Zoo.Item #2: A weather rhyme

Some wag said that history doesn’t repeat, but it sometimes rhymes. Search for “River Thames frost fairs” for stories and images. Painters made nice works, as the one below left shows. Ice on canals; one of many reports:
the Netherlands 2021

Item #3: Into the snowbank

The Washington Department of Transportation moves quickly to close the State’s important highway (I-90). After the first half-dozen vehicles spin into the snow, barricades stop traffic at Ellensburg and North Bend. After conditions improve, the traffic can move again.
Last week in other parts of the country, snow, ice, and fog brought a couple of massive (100+) piles of vehicles. I don’t want to discount the injuries, but I also wonder about the total costs accumulated from such an episode. I considered making a list of things but decided there were more than I had time to bother with. Hint: I see guardrails being replaced frequently. They are not cheap.
Anyway, regardless of the truth shown in the photos below, I got a chuckle.
Item #4: What heat wave? This is the January 19th look-ahead forecast for Feb. 2021 on the Weather Channel (see small box, upper right).
Grade: FAIL !

Item #5: Back in the real world

We have managed to get scheduled for Pfizer 1st Dose vaccine.
County Health opened the web page for next week with appointments for three people every 10 minutes during each day.
My attempt got me scheduled for Thursday afternoon. I tried to schedule Nancy for the same time slot, but the software would not allow a second name using the same e-mail address. So I called the phone number they gave, and after about 5 attempts (every 10 minutes) got to talk to Joe. By then all the Thursday slots were filled.
We went to Friday and Joe entered Nancy and me for 3:30 at the County Event Center – Teanaway Hall, in EBRG. Same place I took neighbor Kenny last week. Then Joe cancelled my Thursday appointment, so someone else can get in there.

And that, for this week, is the not so nasty news.
John

Not so Nasty News February 12th

Item #1: Big Cold

The map below is available here: http://wxmaps.org/pix/curtmp.png
The time is from London, so 01Z is 1 AM there and here in WA we are 8 hours behind. As I write, 6 PM has just passed. Parts of Canada and the United States are shown. The dashed line across Texas is where it is freezing, to the north. Austin is 30°. Ask in search for a conversion from Zulu (Z) time for your location. The nasty news – there is the clash between Gulf air (moist) and the cold air from the North. That brought icy roads, a major multi-vehicle pile-up, and at least five deaths.
In central Washington, it is colder, there is little moisture in the air, and not a lot of snow at our elevation. Even at the elevations of the major highway passes, there is just normal winter driving conditions.
Higher elevations will get more snow as winds shift and begin coming from the west. Monday will be a transition day to temperatures 10 to 15 degrees warmer. Hallelujah or maybe just Yaa’HOO!

Item #2: Confusion

Thursday: Neighbor Kenny was scheduled for a vaccine, with a brother planning to drive him to town. Brother’s daughter has a water issue about 70 miles east, so I took him.
While in the building (fairgrounds) I had a greeter find a person that could answer my questions about getting an appointment. Interestingly, the person – Trinity – knew Nancy from years ago at one of the summer fiddle camps. Her mother and Nancy were in the same class for about 8 years in a row. Trinity, then just a youngster, would come and play with the older group when she wasn’t with her own age-class.

I explained to her about me getting on a web site and getting an “eligibility card”, but she said that was a State thing and not really useful. We needed to be on the County Wait List. She took our names, phone #, and e-mail info, and signed us up. She said we might have to wait a few weeks, but if people didn’t show up and they had vaccine thawed out we could get a call any time. From call to getting there had to be fairly quick – I said it will take an hour, and she thought that would be fine.
I’m going to guess it will be the first week in March.

Item #3: moving snow

I usually use a push broom to get pathways cleared, and often the driveway. Our snow is mostly light-weight so 3 or 4 inches is easily moved.
This morning, with about 5 inches and more on the way, I guessed there would soon be a big John Deere tractor working on the driveway. (There was – neighbor Allen.)
After feeding horses and quail, I pushed snow away from things and into the edges of the driveway. I anticipated doing more, but on the back side of the house I broke the handle. It was like on the left here.I think the attachment is cast Aluminum and there is no support to keep from twisting. 14° temperature might have contributed. I had a couple of things to do in EBRG today, so I bought one that is similar to the right image.
I have another nice pushbroom that has a glued-on handle. I left it in the pickup with the load of “composting” horse manure. I think the heat expanded the metal-tube handle and it came off of the attachment fixed into the horizontal piece. If I can fix those two broken ones, then I’ll have 3 good ones (and a 4th not so good).

And that, for this week, is the not so nasty news.
John

Not so Nasty News February 5th

Item #1: Little bottles

Years ago we visited the Corning Museum of Glass (CMOG), assuming that is what it is was called then. The pieces of carved and blown, and all the rest is worth a look. The web site is
CMOG

The photo here is of a worker inspecting a small glass bottle or vial. If you have just guessed this has something to do with the millions of doses of vaccine being shipped around the world, you get a gold star.
Corning’s Valor glass

Item #2: What is going on?

Assume you have been in a coma since 1995. Now you wake and look at the woman. What would you think?
Correct. Society has gone kooky.

Item #3: From great to cranky

Last week our county was highlighted on news reports. Why? Because Kittitas County was doing better than any place in the USA with respect to its vaccination roll out. This past Monday there was a glitch. There was a surge of registrations reaching 100,000. The County’s population is about 50,000. The wait-list is temporarily closed. There was not a bunch of folks from other counties. There was an error in the system. Apparently there were a few other problems, thus they will use this opportunity to conduct additional troubleshooting before re-opening.

Item #4: We are eligible

While we can’t register for an appointment we can still get a cute form saying we are eligible.
There are no checks on one’s answers, so this seems pointless. Note, it uses the word “now.” We can’t get the shot now, but we are eligible now.
As of Friday, the shut down is still in effect.
I think the person that designed the message has a financial interest in an ink supplier. I’ve snipped about a third of the blue, and Nancy and I each have of one of these messages.

Item #5: Seattle

Sometime I’d like to show good news from Seattle. However, all the news from Seattle is nasty, but I have hope.

And that, for this week, is the not so nasty news.
John

Not so Nasty News January 29th

Item #1: Really Old

Sister Peggy celebrated 80 this week. Photo was the summer of 1963, I think. Two of the 4 kids had red hair.
Neither of our parents did, but there is red hair on both sides of the families.
Brother’s wife, Kit, also had a birthday, but is a decade older.
Happy Birthdays to you.

Item #2: Calving season

On Thursday I noticed several Bald Eagles in the trees, about 5 miles south of home. How they know when the calves are about to arrive is a mystery to me. I haven’t seen any calves or eagles closer to home. Then again, we haven’t been out and about much.
Will try for a good photo this year. We have several but none of high quality.

Item #3: Candy floss ice

That’s the English term. Here in the USA some call it “hair ice.”
Candy floss

Or:
Hair ice

Item #4: To wait, or not to wait?

We will see about signing up in a week or so. We likely won’t see more than 5 people in the next 5 days. Under 6 feet? Tuesday when Nancy gets blood drawn.
Being in a small population rural county, the Covid Panic of 2020 has had moderate impact. Never made the news.
Now that vaccines have started to flow, the County made national news.
Fun with numbers

There it says:
ELLENSBURG – Kittitas County is making national headlines over its ability to administer all its vaccination doses.

Read down and the numbers are not so stunning. There are two places where shots are being given – the goal is 215 per day at each.
They actually did better with a bit over 250 at each site. Eat your hearts out, you with a population of a million or several million residents.

The county folks claim dealing with wildfires has given folks experience coordinating multi-agency activities. So all that you need to do is have more wildfires to make giving Covid shots efficient.

And that, for this week, is the not so nasty news.
John

More than you want to know – Nancy

Hi Folks,
John writing. Not much new here, as of Saturday morning.
I’m late with this, so this one is just a marker.
I need another hour, and then will post on this simple link below.

http://rocknponderosa.com/

February 27th
FIFTH OF UPDATES More than you want to know – Nancy

Tuesday was a blood draw with INR and K both within range.
Getting a plump vein to tap has been a problem. Conversations with others suggest diet and fluid intake need an increase. Looking back, I think she drastically cut Powerade (sports drink) along with total removal of Ensure protein drink (about the highest Vit K item in her diet – still not real high).

As a substitute I’ve been making what I call “blurpies”. If you put fruit, ice cream, and yogurt in a blender the first sound produced sounds like “blurp.” Well, it does to me. She uses Almond Water (COSTCO brand) to dilute coffee, so we also add that to the Blurpy.
So, we are working in this.

COVID SHOTS
Friday at 3:30 we went for the 1st dose of the Pfizer vaccine. We were met in the parking lot and handed a 2-sided survey – filled out in the car. I took those to the greeting table. We were escorted inside and passed off to person #3. We asked for a high chair for Nancy. Most chairs were of the folding metal type, and 10 inches lower. (More of the higher chairs are needed in this world.)
Because Nancy is on a blood thinner (question was on the survey) we were visited by a Nurse (#4), who explained possible bruising from a shot. Nancy showed her a few, and she was satisfied we would not be startled if such happened at the site of the poke. (Without a mirror we can’t see that spot.) The nurse summoned #5 who led us to a table (with a high chair) where #6 was waiting.
We wore short sleeve shirts and warm vests without sleeves; and a warm winter coat. Remove the coat, and there is the bare arm ready for the shot. Next we were off with person #7 to the waiting area. Chest tag had the time 1551 (24 hour clock) at which we could leave. About five minutes into the wait, person #8 arrived with a computer on a high rolling cart. For maybe the forth time we gave names, birth date, address, phone number, e-mail.
Person #9 appeared and we asked to short-circuit the longer exit route, pass through curtains, and exited where we came in, about 30 feet from the car. We thanked all the outside greeters as we passed.

Our 2nd dose was scheduled, but she could not alter the 21 day period. We want to stagger those by 3 days. Some folks can feel a bit off (symptoms vary) as the body’s immune system ramps up after the 2nd dose. It is not likely that both of us would be impacted, but that is possible, and easily prevented. We just have to call the County Health folks and reschedule. I had to call to get us in the same time slot on Friday. The computer system tossed me out when I tried to fill a second slot from my computer.

Saturday morning and into the evening we can feel where the shot was given, only if we put a hand on the arm. Otherwise, it is not noticeable.
That’s it for now.

February 20th
FORTH OF UPDATES More than you want to know – Nancy

We started off the week with a haircut, just around our rural block, from Nancy’s long ago (in EBRG) “find” – – Celia Winingham and husband Bob. He was cleaning snow from the driveway as we arrived. I passed her off to Celia at the door, and then I came back home where a couple of workers were working under the carport. Forth minutes later I went back and picked her up.

Tuesday was the blood draw – INR and Potassium were within range.
Kidney function remains an issue with a high marks for “blood urea Nitrogen” (BUN) and Creatinine. No surprises.

Wednesday, with nice weather and dry roads, we visited with Dr. David Krueger, cardiologist in Yakima (50 miles). He was pleased with the lowering of swelling in feet and legs. We talked about how to ease the pressure on her heart – see the section under the red stars, below, Saturday January 30th. Lots of protein can be an issue, but her intake of meat protein is low, so I don’t see a lot of help via diet. He is also thinking the CPAP (sleep study day is March 10th) apparatus will help. Next visit with him is March 31st, after CPAP or whatever. We also need a new “pulse Oxygen meter” (oximeter). The one we had quite working. $20 for a simple one; $100+ for a recording one, but I haven’t figured out if our WiFi will work (no smart phones here).

General: cast is off unless we are out-&-about. Sling isn’t needed in the recliner, and she has use of her right hand for laptop use. That makes things easier.
An elderly local lady is reported to have had a serious reaction to the 2nd Pfizer Covid dose. I don’t think that means Nancy will have an issue, but on Monday we will ask about this. Our 1st dose shots are scheduled for next Friday.

For now: “That’s all folks!”

Saturday February 13
THIRD OF UPDATES (2nd follows, then 1st at the end)

Not a lot happened on the health front this past week. The Tuesday trip to town allowed her to walk a few hundred steps in the grocery store. Much more exercise would be good.

I had removed the wrap that enclosed her thumb and wrist late last week. Swelling on the back of her hand/thumb/fingers did not increase after that, and maybe went down a bit. Feeling and color were normal, so that is how we left it.
Thursday, after 3 weeks, we did go to Cle Elum for cast removal and a follow-up X-ray. That seems to show normal healing. We were instructed to replace the cast if out & about and, also, take the arm out of the sling a few times a day and do mild exercise of that arm. After 2, days the swelling is now gone, or almost.

I had hoped to get her outside and walk for more general exercise, but the cold air mass seeped into the area – a rare event. Thursday evening we got snow, about 4 inches and a morning temperature of 12 degrees F. The snow and the cold continue. Outside exercise is cancelled.
Neighbor Allen cleared the snow from the driveway. That was the first for this year. He commented that with much more in our forecast he was making sure the equipment {John Deere tractor} was working. As expected, snow continued. He came back just before Noon today and cleared it all again. I need to clean up around the edges.

Drawing blood on January 26th was a left arm affair, and even then had to be from the back of her hand. Both INR and Potassium were in range so we didn’t do them this week. Next week they can go back to the right arm. That’s Tuesday.

On Wednesday (2/17) there is a cardiologist visit in Yakima. Previously an interim meeting (1/20) with his assistant, Buffy Sawyer, provided a “maintenance” status. This will be a more thorough and important exam.

Nancy may add a few notes tomorrow, but that’s all I have for today – 2/13/21.
John

Saturday, February 6th
SECOND OF UPDATES (1st follows below)

ZOOM to sleep [Tuesday, 2nd]
A consultation with a person at Memorial Sleep Specialists (Yakima) had the expected result. Nancy has to go for a sleep test. This may be later in February, with cast off, but maybe not the sling.
The ZOOM experience was horrendous. Lighting on their end was poor and the audio was worse. We understood enough of the words (2/3) such that we did not have to use another method. A phone call would have been better. An in-person consultation preferred.
The doctor that we dealt with in 2014 has assumed higher level administrative duties so the contact was with Allison Morgan, about whom we know zilch. She read the letter I wrote about Nancy’s non-apnea results from back then. Nancy’s issue is, apparently, hypopnea, or shallow breathing that results in reduced Oxygen in her blood.
However, Nancy – on Dr. Kim’s strong urging – lost weight, enough so that a new test is called for. Something about properly prescribing and calibrating the equipment.
Nancy and I thought her CPAP equipment was less than stellar, and not highly advanced in the sense of being tuneable to a particular situation. Have these things gotten better? We can’t find that they have with respect to Nancy’s needs.
We’ll see.

Moving on to COMPRESSION: I wrote earlier:
“Meanwhile there was significant swelling in the legs, below the knees. Not good.”

I intended to explain our encounter with (think of a mad Badger) compression socks. One soon learns of the lies photos tell. Below is the evidence.
First, nothing so colorful seems to be available in EBRG. We bought the largest size (white) at BiMart. Doc Chelsea showed us how to put these on. She is young, with nimble fingers, and experienced. Still it was difficult. She suggested getting a “sock donner” and that we did. Cost was $45 and a second set of stockings ($10.00); also White. A friend offered a pair of black socks. From “all colors” to no color – great!
Notice the enticing look in the left photo above. Note also the legs are not swollen. Same thing on the right. No swelling. Easy-peasy.
We are now experts at sock donnering. Meaning, with significant effort on my part and great patience on Nancy’s the mad Badger has surrendered – each leg gets donned. The amount of Lasix {LAst SIX hours} is doubled, so Nancy is wearing out the carpet in the hallway.

Next: arm wrap
In this image the cast is in light blue. That is dressed with a Velcro closure elastic wrap; horse owners will recognize this. Also, I bought a dozen rolls and carry a few in my backpack. I took one out over a 10 year period. That was on a trail repair workday at Mt. Rainier. A tourist fell and our best trained crew raided my pack, then went to help. The roll was not used so I still have it. I digressed there.
Note where the hard cast and the wrap end. Well the back of Nancy’s hand, and fingers, became swollen. We’d been keeping Nurse Lacey and Chelsea informed, and on Wednesday (the 3rd) I wanted to either go to the Clinic, or release some of the pressure.
About 10:30 AM, with Lacey having heard my latest concern, and having consulted with Chelsea, we cut the wrap away from the hand and back to the yellow line.
I also realized the hard cast came out to the carpal bones (pisiform bone?) [Yeah, I looked that up.] The cast will have been on for 2 weeks on Thursday the 4th and it immobilizes both elbow and wrist.
We’ve been advised that the cast can be removed for an hour or so if Nancy is a good girl and doesn’t move the elbow much. If we do that, I think I will take about 3 inches of the end – red line above.
Not only has the exposed part of the hand puffed out a bit, but she has complained of it being cold. With slowed circulation out to her fingers, I suppose that’s not a surprise.
We’ll see if we can fix that.
Saturday afternoon we have keep the cast on.

End of 2nd update (1st post follows)

Saturday January 30th

A few years ago the computer place in Ellensburg shut down and we had to create our own domain name. We either lost, or just can’t find the early editions of the writings about Nancy’s health. For any new acquaintances, I will briefly summarize. Skip to the red stars line below if you like.
Nancy, the child, had rheumatic fever. Heart valve damage is a complication. This isn’t a big deal, until it becomes so. For Nancy that started in 2009.
She began that year with a slight persistent cough. No one thought much of that except me. However, either from a dental procedure or bad luck, she contracted “Endocarditis”, a life-threatening inflammation of the inner lining of the heart’s chambers and valves (endocardium). That was taken care of, then followed with a visit to an amazing (we agree on this) cardiologist, in Yakima, WA. Dr. Anatole S. Kim is responsible for Nancy being alive. Next in that sequence is Dr. Baljit Sharma, heart surgeon. But I just jumped ahead.

Early Friday morning, after Thanksgiving Day in 2009, Nancy developed an artery blockage that took us to EBRG Emergency and then on to Yakima and a Cardiac Catheterization unit to remove a blockage in an artery across the front of her heart. From home to removal of the blockage took about 4 hours, enough time for some heart muscle damage. Not good, but not a catastrophe either. Then a sudden calamity. An anticoagulant, unfractionated heparin (UFH), was given to prevent clotting. Most people do not have a problem with Heparin. Nancy was unlucky. By Saturday afternoon she was experiencing a reaction that makes red blood a target of immunological response, resulting in the degradation of platelets, which causes thrombocytopenia. In simple words, her red blood cells were dying. The shorthand for this is HIT, for Heparin-induced thrombocytopenia.
She was sedated and put on life support for 8 days. When I got to the intensive care unit, I was advised that she might not live. She surprised them all.
Over the next few weeks we learned about the intra-aortic balloon pump (IABP), a mechanical device that increases myocardial oxygen perfusion and indirectly increases cardiac output through afterload reduction. A computer-controlled mechanism inflates the balloon with helium and so on. Wow. Look it up. A typical yard-stick leaned against the bed. Among all this high-tech (science fiction like) stuff, a wooden stick was used to make sure the heart and pump controller were at the same height. [Clarke’s third law: “Any sufficiently advanced technology is indistinguishable from magic.” Arthur C. Clarke, Profiles of The Future, 1961]
With a bit of time and prodding by Dr. Kim, the surgical team went to work on December 29th, cut Nancy’s chest open, fixed two arteries, replaced her native Mitral Valve with one from a pig, and used fractionated heparin with low molecular weight to finish the day.
Whew!
Eleven years later she is using her second implanted cardioverter-defibrillator (ICD). Actually, the ICD is there, but not used. The first was used once, shortly after being implanted when she was, again, ill with Endocarditis. The “pacer” part is almost never used, but it is there too.Late last year (2020) a routine blood exam [Basic Metabolic Panel; BMP] showed a spike in Potassium (K). We cannot identify dietary or other reasons for this, so a few tweaks in medication and dropping Ensure from her diet have followed. (Ensure has K, but not all that much.) One med was dropped, a second was cut by a third, just this week. The test on Tuesday was still high for K, but not as critically high as a few weeks ago.
Meanwhile there was significant swelling in the legs, below the knees. Not good.
We visited, on the 20th, with Buffy Sawyer, the Cardiologist’s assistant and will see Dr. David Krueger in February. Our “doctor” is Chelsea Newman (physician assistant, certified) at the Cle Elum Clinic. Nancy’s favorite drawer of blood (Kim) is in EBRG, where her blood is most often tested. Chelsea’s nurses are Lacey and Summer. A great team – we like all.
A recent echocardiogram (echo) was not a whole lot different than in previous years, although the pulmonary artery pressure was higher, causing swelling of legs (edema), and Tricuspid Regurgitation – backward leakage through an intended one-way valve. Not good.
Images have “exploded” views on the lower left of each heart.
On the left image, blue arrows show flow of blood in open & closed positions. The right side image has a red arrow showing back-flow or regurgitation through a valve that does not completely close.

The hypothesis is that improvement is possible if the cause is Hypoxemia – oxygen deficiency in arterial blood. This can be caused by slow breathing and heart activity while sleeping. This is undesirable because the amount of Oxygen in the blood drops and the organs have an insufficient supply. An exam in a doctor’s office now (for us) includes using a Pulse Oximeter to discover the peripheral capillary oxygen saturation (SpO2). When the heart and lungs do not send sufficient oxygenated hemoglobin to your finger, the rest of your body suffers. A good reading is shown in the image below, along with the pulse.

Low readings, say near 88, are seriously low.
However, when the saturation drops by 3%, say from 97 to 94, that’s not good either.
Nancy used breathing apparatus (continuous positive airway pressure) (CPAP) and an Oximeter for about 4 years but lost a few pounds and seemed not to need it. Now stopped for about 4 years.
Our issue with CPAP was/is that it is designed with stopped breathing [obstructive sleep apnea (OSA)] in mind, rather than shallow breathing – and there was no way to record the SpO2 monitor readings with the rest of the (cumbersome) setup.
Nancy will likely return to the CPAP, maybe with a newer and better technology. Consultation will be by ZOOM, on Tuesday February 2nd.

NEXT (problem):
Nancy goes to Kim (phlebotomist) almost every Tuesday for a blood draw to check clotting time [international normalized ratio (INR)], and now for the Potassium level. When INR is stable she is only tested about once a month. The spike in K changed the routine.

Heading for the medical building, On January 19th, Nancy was turning to get into our Crosstrek and fell. She landed with her right arm between her body and the ground. Ouch!
This resulted in a “closed fracture” with a tiny bit of movement, about where the blue line is in the diagram.
This shows on the X-ray, but we can’t get to that via the medical portal, and Chelsea would have had to use a cell phone camera to send us the image. It was not worth the effort.

She got a modern-day splint, with arm in sling. Photos below are not Nancy.
They put a cotton sleeve on first. The photo does not show the first cotton sleeve.
Then a mixed fiber/plaster (wet first) “splint”, and then wrapped with an outer fabric.

The right photo shows the fiber/plastic that quickly hardens.
Left photo shows the outer wrap, that can be loosened if more swelling (not expected) occurs. Why? Because the fracture happened on Tuesday, we had the visit with cardiologist Buffy Sawyer scheduled on Wednesday, and didn’t get to Chelsea and Racine until Thursday, the 21st.
Because hers is the right arm, and the left shoulder is the one that is bad – the next 8 weeks will be a pain – literally and figuratively.
Chelsea (our “doc”) sees very few fractures, so Racine, who has worked in a special ortho (bone) clinic came to help. She was a pro, so Nancy got all fixed up like a high performance downhill skier. Neither elbow or wrist can move.

They also fitted her with a nondescript black sling, very un-photogenic, unlike in the photo here. I’d add some decorations, but who’s to see?
The restraining cast is due to come off about noon on Tuesday, February 11th. I think Chelsea said the sling should be used for at least a month after that. Maybe Nancy will have enough allowed movement to use the right hand on the keyboard.
The sleep/breathing issue will be addressed starting on the 2nd of February.

Better news:
Nancy has been using a 40 (?) year old recliner, sleeping beside a monitor that sends nightly updates to the ICD folks. It uses the plain old telephone system (POTS). The chair’s lift system died, or the buttons did. We ordered a new chair, but there is a two month wait. So, Korbie, a former student from 16 years ago gave us a very new chair (dog chewed the right side arm and left a hole), used briefly by her father-in-law. I gave her 10 pounds of home grown onions. What a deal! When Nancy’s new one arrives, I’ll move the given one into the converted (new) room.

That’s it for now.
Updates to follow, when things happen.
Such will appear at the top of the page.
Thanks for the good wishes being sent Nancy’s way.
Typing is hard for her, but you can call:

1-509-925-3304