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.

MON. & TUESDAY — saved by a cold wind

John had an annual medical physical scheduled for Tuesday at 2 P.M. and then the return drive from Cle Elum.  We might have gone for a short physical therapy walk up the driveway but with him on his return he brought the infamous Valley wind – from the northwest and off the snow covered Cascade Mountains.  When he got home the temperature was 63o F and an hour later it was 53o F with sustained wind at 37 mph and gusts to 46 mph.  He (John) bundled up and went out to give the horses hay.

We didn’t go for the short walk up the driveway as on previous days, and that was fine with me.  Monday’s trip was a bit much.  The first 40 yards of the driveway is up a slight grade, not much, but noticeable.  I didn’t take the walker and so used John as support but that meant I didn’t have a place to sit and rest as we went.  While I can walk, fast and far are not part of the descriptors – slow and exhausting fit.  In the Rehab physical terror room they monitor my heart rate and when it passes 85 bpm we stop, it drops, and we start again.  I tried to mimic this routine but without a continuous monitor I was going just be my sensing my heart rate.  I made it to the road (about 100 yards) and back.  That was enough to do me for two days.  I was saved by the cold west wind today.

Much of my time these two days was taken with routine and not so routine computer chores.  I wasted a lot of time repairing access to Safari on my university account.  First, before finding out I had been denied access because of more than 3 attempts to get to my account with the wrong password, I took the advice of the Help Desk and deleted Windows Explorer 8 from my system, added Vers. 7, and then had to download and install all new XP security updates.  What a pain.  When that didn’t help I then learned of the 3-bad-tries-and-you-are-blocked rule.  I did NOT have to go through all the other at all and I’m back to having an old version of Explorer installed too.  Bummer.

Much of the rest of Monday was spent learning again how to put a web page out on my site – I use a server in Texas.  I wanted to upload information John collected and photographed for the weather station and include air photos taken by a friend.  I was busy for several hours getting the package “just right” and going back and forth with a couple of friends on the procedure – including clickable thumbnails to link to the large image files.  Soon this info will join over 1,000 others in a weather station atlas for the country.   http://www.surfacestations.org/

We had a call from the doctor’s office that my insurance provider approved the out-patient physical therapy from the place where I was.  I only have till March 31, to complete those.  It will also require a co-pay of $25 / visit.  Once I am more sure of myself and things I should be doing, it might be cheaper to join a health club for a few months.  We’ll see.

WEEKEND — keeping up, keeping track

By week end my 4-wheeled walker is still the borrowed one from the PT folks at the rehab facility.  There was no word from the approved provider that was going to see about one with 7.5 inch wheels. Likewise, there was no word on my request of a review of the “approved for a new PT place” so that too is still on hold. Timely apparently is not part of the concept of health care recovery.

Late-week mail brought two interesting items.

1. Back on Dec. 14 & 16 (Nancy is in the ICU) something was done by the cardiologists and described as “Subsequent Hospital” and billed for $120 each time.  A statement arrived dated Jan. 29 indicating the insurance would not pay for these two things and we should send $240.  John tried to call but got a phone-tree and so he wrote a letter stating his understanding of the insurer’s denial to pay for something “Subsequent Hospital” when the patient was still in the hospital.  Now we have a new statement.  This one seems to indicate that the bill was resubmitted to the insurer and they then paid $99.60 which settled the 12/14 debt of $120 but left the other untouched.  Again, there is no explanation of what these charges are for nor why if the insurer can get by with paying only $99.60 of $120 we still have to pay the full $120.  Also, were these things the same (the code of 99232 and description and cost is the same) and, if so, why didn’t the insurer pay both of them?  We are still left wondering what we are being asked to pay for and why.

2. In response to a self-serving survey form from the insurer about a Case Management nurse calling program (talk-talk-nurse program) John wrote a letter.  A couple of weeks ago we were called by a nurse from Spokane.  She was the expected replacement in October for a nurse that called occasionally from Kennewick who was booted out of the process by the insurer when she didn’t agree to move to Spokane. This new talk-talk-nurse, in a response to a question from John, referred us to our EOBS.  John slowed her down, stopped her, and had her back up and explain what our EOBS were.  When the company pays a bill, or doesn’t pay, they then send a printout to you with the title “Explanation of Benefits.”  This is an EOB. The talk-talk-nurse was surprised we didn’t have any EOBs.  Because we did not have any we had no idea about the cost of Nancy’s long hospital and rehabilitation stay.  The nurse promised to alert the company’s computers and have our EOBs printed and sent.  A packet of about 40 arrived on Saturday.   The $$ amounts are frightening.  We will summarize them for you later.  One item, the blood for the open heart surgery, exceeded $10,000.

Change of topic:  Saturday we did go to a retirement community and I walked in with John’s help, my pillow, and him with my violin .. and took a chair I could get up from.   We had a great turn-out and most everyone joined in singing many songs (the Irish ones, we provided words for).  We went home for an hour, and then off to the Children of Chernobyl fund raiser with a dinner, program and silent auction.  We got in at the front of the line with my walker and proceeded along the buffet with servers adding small dollops of things to my plate that was riding on the seat of the walker. I managed to eat a good meal, encountered many friends and enjoyed the program.

Now today, Sunday, is a non-event day.  We have been resting and doing computer email.  I was able to write a letter of recommendation for a former student from Thailand that I had in an Intro GIS (Geographic Information Systems) class two years ago.  He is applying to graduate school in Texas and California, and, via computer, I contacted both places today.  Until ex-students settle firmly into careers these sorts of chores crop up.

With no outings planned, after lunch we walked up the driveway and back, for my daily exercise. There were lots of small birds at the feeder including a small woodpecker, a Downy, we think. Tomorrow we’ll take the camera, walk farther, and see more.

Nancy

THUR-FRI — feeling better

Our life is slowly morphing into a different form.  Two things are driving this.  One is that I am feeling better.  I sleep a lot, but eat and do little, but I can and do – do things. The second thing is that I no longer have a schedule, what with my release from the rehab facility and the falling apart of the insurance supported out-patient rehabilitation.  So, as I gain the strength to do more – I don’t have to do anything.  How strange is that?  Yes, we have much to do but that isn’t the same as having to do something.

In keeping with this notion, today was a slow day until afternoon and evening.   We went to the Rehab center to play music (this is the place I spent so much time after Jan 20th and where they taught me to walk again.  It is always special to go back there to entertain.  Also, tonight was the second night of final presentations for Intermediate GIS. This too was a real treat.  I went because I could, not because I had to.

We will probably not have any news till Sunday, because nothing much is happening tomorrow, except for calls about insurance and maybe my walker will be delivered.  We’ll see.  Saturday will be so busy that we likely won’t get a blog written till Sunday.  We are going to play (music group, Kittitas Valley Fiddlers and Friends), at a retirement community, for their St. Patrick’s Day celebration.

Tentative play list (with Irish music mixed into our normal fare), is below:

1. WHEN IRISH EYES ARE SMILING; 2. IN THE GOOD OLD SUMMERTIME; 3. RAKES OF MALLOW, COTTON-EYED JOE, SKIP TO MY LOU; 4. MY WILD IRISH ROSE; 5. WILDWOOD FLOWER/BUFFALO GALS; 6. TUR-A-LUR-A-LURA (IRISH LULLIBY); 7. REDWING; 8. IRISH WASHERWOMAN; 9. MOLLY MALONE; 10. LEAVES; 11. JUST BECAUSE; 12. BELIEVE ME IF ALL THOSE ENDEARING YOUNG CHARMS; 13. GARY OWEN; 14. THE GIRL I LEFT BEHIND ME/DOWN BY THE RIVERSIDE; 15. YOU ARE MY SUNSHINE; 16. DANNY BOY.

Saturday night we are attending a Children of Chernobyl fund raiser with a dinner, program and silent auction.  http://www.chernobyl.org/pages/hosting.htm

Look for a return on Sunday.

Nancy

WEDNESDAY — back to school

[written Wed. evening]

I made scant progress getting approval for physical therapy.  Maybe tomorrow.  Maybe never.

Most of the rest of the day was uneventful and I didn’t do all the exercises I should have, but at 4:45 we drove to the University so that I could participate in the final presentations of Intermediate GIS.   I was scheduled to teach this class and had signed in many of the students from previous classes – before I went missing.  My replacement kindly invited me to return.  It was nice to be there and see a few familiar faces and to view their projects.

Although I can walk I didn’t want to sit in the classroom chairs as they would be hard for me to get up from, so, I followed my walker into the building and up the elevator.  I discovered two problems.  The seat of the walker is a fine idea poorly executed.  Comfortable it isn’t – even with a cushion.  And the second problem is that I no longer have the built-in padding I’d learned to live with. But this is a condition I do want to learn to live with so I’m not complaining – just stating a fact. Did I mention it was a 90 minute class?

It was also my first time back on campus since before Thanksgiving.

Nancy

TUESDAY — doubly amazing today

[Tues. was the 9th; this was posted on the 10th]

At noon we left for Yakima Regional Medical Center to visit the fine folks of the ICU.  I was simply amazed. As we entered the parking lot John spotted the nun that floats around the wings, wards, and operating rooms offering support to all.  She showed up in the operating room just before my open heart surgery to see me off.  I couldn’t get out and run so John had to maneuver around rows of cars, other visitors, and a few in wheelchairs and caught up with the lady just as she was crossing a grassy strip and leaving the grounds.

Then, back at the front entrance, John dropped  me off, unloaded the 4-wheeled walker, and left to park the car.  I made it through the large double automatic entry doors to the front desk and there found the young woman that delivered all the e-cards ya’all sent.  After she paged the ICU Director for me I turned and encountered 3 of my caretakers. One had just delivered a patient in a wheelchair to a family’s van; the other two were just passing through.

Before we made it to the elevator we met my early morning blood drawer – she showed up and poked a needle in me most mornings at 5:30 and so John had never met her.  We had an elevator cage to ourselves but when I stepped into the hall we got an echoing “hello” from way down the hall from the mom  of one of my former students.  She is the nutritionist that keep me fed via a tube for many days and then kept after food services to see that I was served proper meals.  At the phone outside ICU where one has to call to get “buzzed in” a male nurse was pushing through the doors on his way out. He had been with me for many 12 hour days when I was in my worst condition and was always cheerful and helpful.  He meant so much to John and me through the stay.

Finally we made it through the doors.  This is a difficult place to “just visit” because every bed is occupied by a very ill person and those on duty are committed to keeping them alive.  Knowing this, we were amazed to find folks squealing with glee to see me walking again.  I got many hugs, and even John did.  It was a special day.  The on-floor doctor was about the only person that did not know me and he seem amused at all the fuss.  Nurses came out of several of the rooms, gave me a hug, and quickly went back to their patients.  We stayed no more than 15 minutes because we didn’t want to take folks away from caring for those needing the care as I got while in there.

Back in the hall we headed for the elevator.  A person had just turned into a door way, backed up, and addressed me with —  “Nancy, is that you?”  Well, I was in street clothes, up right, and walking – none of which she had seen from me before – and it has been 6 weeks since I was there, and still she knew me.  We met another nurse outside the big doors with a freshly emptied wheelchair and a flipped over name tag so I couldn’t see her name.  She knew me though and gave me a hug, remarking how good it was to see me walking.

Off to grab a milkshake for me and a hamburger for John, and then on to my surgeon’s last check up on me after the Dec 29th surgery.  It was another great meeting when my progress was noted as “exceptional”.   I think the surgeon and the nurse are exceptional too, but they are professionally through with me.   They will now pass me back to the cardiologist – that visit is for April 14th.  After that I should be released to our family doctor (in Cle Elum), also known as my primary care provider.

Finally, we hit the road for home with no further events, except a stop to get some lemonade for me.  Arrived home just about 4:00 p.m.

There I had a phone call reminding me about a play date, so we left for town again at 6 for me to play music with The Connections.  It is mostly singing (& playing) religious music, plus sing-alongs by the residents with anthems from a book that has the words.  Tonight someone chose The Old Rugged Cross, and Leaning on the Everlasting Arms, and others.  I still do not have a singing voice, but the others did fine and have strong voices.  I played my violin on all songs.  It was great to be back.  We ended with Amazing Grace.

Nancy

MONDAY — Nancy says . . .

Today was a most frustrating day all day from the initial contact with my insurance company until 5:00 p.m. with another call to them to check on what supposedly had been changed on the referral to Physical Therapy.

I’m not allowed to use the words on the blog that emanated from my mouth several times today.  I’m sure this is a test of my stress level and I guess I passed it.  I’m still alive.  I do not know how truly “sick” people deal with the system.  It stinks big time.

Started at 8:00 a.m. with a call to my principal insurance provider about an incorrect facility in the referral for outpatient physical therapy.  I was put on hold for 20 minutes while the agent checked on it to be sure, after I asked if a new referral with the correct place needed to be sent from my doctor.  She returned to say that it was the only facility they would pay for because I was no longer a resident of the Rehab center.  She said my doctor could request a change but it would likely be denied and the appeal process would take 30 days.  I won’t need it after that, most likely.

Then I called my doctor’s nurse to explain what happened.  The accountant in charge of such things called my provider and put in a changed location for the provider.  I didn’t hear until 4:00 p.m. today that it was approved, but we have nothing in writing, and only an authorization number.  I called the insurance company again and gave them the authorization number and was told it was still to the old facility.  So back on the phone to my doctor’s office and the woman who had just called to report nothing had changed.  I wanted to know before I made another appointment at the Rehab center that I would have to break.  She called again and found the paperwork had apparently not been updated in all the right places.  Now we await verification.

Let’s see .. what else today?   I spent loads of time on the computer responding to folks all over.  John took the 3 horses to get them their flu shots.  The wind started blowing again, fiercely all day, but that did not affect his getting them into our trailer and taken down for their appointment.

Oh, another call this morning to the HEBB (health benefits for the state), satisfied them that our wedding date was indeed July 12, 1969.  I never heard the other date they had.  He actually said the correct one before I had to tell him.  Also they were asking for his and my Medicare cards, which we thought had been submitted with the application.  Sure enough, they were in the file.

Finally, I made another call to the provider of my 4-wheeled walker which may not get delivered until I no longer need it.    They didn’t have any in stock with 8” wheels but no one thought to call me since last Monday when I refused to accept the 5” wheeled version.  First, the person contacted today said 2-3 weeks and he’d have to order; then he found they had one with 7.5” wheels and perhaps I will get it as late as this week.  Wow.. more frustrations.

Did I say ?  Something is wrong with this system, and I wonder how others are treated.  Certainly they don’t get any better “customer” service than I have experienced.

Actually, there is good news with my eating ability.  I managed to eat ½ piece of pizza john made for himself for dinner.  That was before my bowl of soup.  So I’m improving a little.  Not fast enough for John’s wishes, however.

Nancy

[from JFH:  Have you ever noticed how things seem troubled when the wind blows?]