WEDNESDAY — taking stock

Nancy and I went to Yakima today for a visit with the cardiologist.  He reviewed her history and records from the time she entered Yakima Regional Hospital with an on-going heart attack on the Friday morning after Thanksgiving.  This was interesting – his view – but it was not new material.  He reviewed all the medications and recent tests and suggested some adjustments and a substitution.  He also made a referral to another doctor in the practice, this one is an implantable device specialist.

One med problem is that the desired action of Coumadin (Warfarin) as an anticoagulant isn’t being maintained with the 2.5 unit dose and creeps up with the 5 unit dose.  Thus, until there is a 3 unit dose we are back to taking the larger dose about every third day.

He is recommending stopping the Lisinopril and substituting Telmisartan at its lowest dose.  These meds are to help maintain blood pressure in an appropriate range and one advantage of the new med is that it lasts longer in the body than the other.  Deciphering all the other differences of these types of drugs will involve more reading than I want to do tonight, so no more about them now.

The referral to the implantable device specialist is to get an opinion on whether or not one of the modern gadgets would work for Nancy in controlling heart functions.  There may be benefits with some implanted device but there is also the problem of her reaction to heparin such that any procedure would be more problematic.  That appointment (about 2 weeks off) has yet to be scheduled, so again, there is not much more to be said tonight.

MONDAY — just catching up

Nancy says to get a new posting on her blog and she sent over a jumble of happenings, mostly written on Sunday.  The theme of all these things is that she is feeling better, growing stronger, and doing more everyday sorts of activities.  Anyone want to go to garage sales with her?

Our trip to bring the new horses home took about 4.5 hours.  For a potty stop, we exited the interstate highway about 15 miles short of our pick-up destination.  This short time coincided with the arrival of about 100 black leather-jacketed gents and ladies on motorcycles, upon questioning, Nancy found they were assembling to ride in a funeral procession for a local solider killed in Afghanistan.  The Yakima paper carried the story the next day.

We loaded the three horses and returned home, only Nancy left an hour later to play music. She puts it this way:  Yesterday I turned around and went to town to play music at the Retirement Center where they are able to get up and dance and are in good shape.  They always feed us too.  Yesterday it was homemade potato soup, best I’ve ever had, by a resident.  These are apartments – where folks are living –  not a care-center.  They do their own cooking and have their own apartments.  We entertain them and them us every second Saturday of the month, at 2:00 p.m..  It is really a rewarding experience for all involved.

On the way home yesterday from playing music, I stopped at a yard sale and got for $2.00 total the best deals of the century !!   —  Donation of a large roaster (to our riding club for baking beans); 3 pieces of clothing.  A nice blue denim shirt for John and a reversible yellow vest (looks brand new) [made of waterfowl feathers and parts and a little down] we both can use, and a great corduroy coat for me, with new quality too, and big brown buttons probably worth more than $2 paid for all.  Good day at only one yard sale that was on the way home.

Sunday a.m. we snuck out the back door (dogs out the front) and walked to the new horses and fed them and then out to the others past the barn and fed them, and then walked up through the woodlot to the road for the paper, and on the way there, we encounter 11 deer.  I did not have my camera along – too bad; but, really, we have dozens of deer photos and while some individuals are recognizable to us, they basically look like the deer that were here 10 and 20 years ago.

We walked back down the driveway.  That was probably six times as far as my original 1/2 trip up the drive with my walker a few weeks ago.  I am definitely improving, and no longer using the walker except in the grocery store.  Not in the pasture nor even holding on to John.  I’m on my own.  Well, I did take his arm to cross the small creek north of the barn, and while stepping on the edge of the plank to cross the irrigation ditch.  That’s where the older horses are getting their water now.

This morning John worked with the new mare, Cheyenne, in the round pen.  She had a halter on – we usually don’t have them on except as necessary – and she would not stand for him to take it off.  After 15 minutes going round and round – with many stops for reflection – her lungs convinced her brain that standing still makes good sense and then she got turned loose in the pasture.  The young gelding, Breeze, allows us to approach him with only minor apprehension on his part.  He is very curious – only 4 years old.

THURSDAY — “knocking on wood”

It is early and Nancy is still sleeping.  This week’s first three days have gone well.  At PT on Tuesday she worked hard and has sore muscles to show for it.  Her heart rate and blood pressure behaved properly and have remained so.  We have remained active by walking inside buildings such as the grocery store and others.  Outside – not so much.  Literally, the weather is frightful.  Just west of us, in the Cascade Mountains, a major snow storm is adding to the snow (aka – late season irrigation water for Yakima Valley fruit growers).  Here the little snow we are getting is going sideways – headed to Idaho, I think.  The sustained wind is in the mid-30s and gusts are expected as high as 50 mph.  Today is a music play-day for Nancy and friends so she will be active (upper body) and happy.  The new Physical Therapy place and Medicare came up with a 4-wheeled walker on day one.  She can walk nicely without holding on to it but it provides a seat for an occasional rest.  We returned the borrowed one and thereby made a return visit to the folks that got her off her back, out of bed, and mobile – they are now an important part of our memories.

We dropped our horse-trailer-pulling truck off yesterday so she had to drive, and will again, when we pick it up today.   Following open heart surgery one is warned not to do things that might stretch or pull on the stitches, such as whipping the steering wheel around and sliding through a hairpin turn.  However, because she was very ill in addition to the operation, by the time she could walk and move around those potential post-operative issues no longer were issues.  So my concern about her being alone while driving was more about the possibility of the car quitting.  She is good about taking her cell phone along, so there is less concern about this sort of thing than there once was.  Still, new and nearly new autos we have owned in the past have mysteriously stopped in the middle of nowhere and such are not fun to deal with even when there are no other worries.  (With a life involving field trailing, horses, and expanding our geographic knowledge and photo collections, we frequently have found ourselves in the middle of nowhere.)

The deli at our favorite grocery store makes a good chicken salad.  For Nancy they are now providing some with slight adjustments, namely they hold out onion and green peppers, package a pound for her, and then they continue with their makings.  At home I add hard boiled egg and a bit of shredded cheddar.  Okay, it’s not as good as a grilled steak but it’s not too bad, and most importantly Nancy eats it.  Is it too soon to claim this eating issue solved?

An interesting take on “knocking on wood”:

http://query.nytimes.com/mem/archive-free/pdf?_r=1&res=9801E2DD1E39E633A25756C1A9649C946596D6CF

And for expressions around the world:

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

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 1st.  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: metohKLOEpramide).  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.