I’m Baaack!

It has been quite awhile since I last posted here. I’ve been posting on my other blog, one devoted to reading and writing, not health, wealth, and all that makes life better than the alternative. But August has been a tough month and has brought me back here, to celebrate what’s better than the alternative.

At the end of July, my husband wasn’t feeling well. I suggested we go to the urgent care clinic closest to our house where he was diagnosed with an infection. Something minor. Something easy to treat. Or so we thought.

He did have an infection. I had had the same infection a few months back, the reason I recognized his symptoms. In my case, a quick test confirmed the infection and a trip to the pharmacy to pick up an antibiotic, followed by a long nap, was all I needed to get better. We expected the same would apply to him.

But he didn’t get better. In fact, he got worse. So much worse that when he saw his primary care physician a week after that trip to urgent care, the doctor sent him straight back to urgent care, this time at the hospital our doctor is associated with.

The doctors there discovered his blood contained a very high level of potassium. They ordered an EKG to see if his heart was in trouble. It wasn’t.

 

But his kidneys were.

After I had hung around the urgent care intake rooms for hours, the doctors and nurses urged me to get something to eat and reassured me they would get him into a room while I was away. They told me to come back once I had eaten.

When I returned, they gave me his room number–Room 15 in the ICU. ICU. That’s Intensive Care Unit. Not exactly what I had expected when they said they would get him into a room.

My first reaction was to wonder if the hospital was so full they could only find space for him in the ICU. That’s the denial phase. He couldn’t be so ill that the staff needed to monitor him 24/7, could he?

It turns out, he was that ill. His kidneys were no longer functioning. The culprit, the doctors were 95% certain, was the antibiotic he was prescribed for that minor infection. The same antibiotic I was prescribed for the same minor infection eight months before.

Apparently, he is allergic to that drug. At any rate, we’re going to consider him to be allergic because we don’t want to repeat the exercise to confirm it.

The first week of August centered around his treatment in the hospital. They did a biopsy of one of his kidneys to rule out more serious causes. You know, like cancer. The doctors said the biopsy results were good, indicating the problem was typical of an allergic reaction. But good is relative.  His kidneys were not functioning. He needed dialysis to help his kidneys do their work. And the kidneys need time to heal.

The next two weeks of August centered around dialysis and follow-up with doctors. Twice a week we made a thirty-minute trip to a dialysis center where we sat in a room for the three to four hours needed to filter his blood through a machine.

Along with dialysis comes a limited diet. Foods with high levels of potassium were not permitted. And you can be sure that everything he wanted to eat, now that his appetite was back, was on the list of foods with high potassium levels. Vegetables were particularly difficult to work into his meals. Vegetables low in potassium are ones that have little color and even less flavor: bean sprouts, celery, cucumbers, eggplant, mushrooms, onions.  And most things he wanted to add for flavor–salt, soy sauce, salsa–are also high in potassium.

At the end of the second week and after four out-patient dialysis sessions, the doctors concluded his kidneys are functioning sufficiently to eliminate the dialysis. But his need for a daily dose of strong medicine to help the kidneys heal will likely remain for several weeks, if not months. One doctor finally used words that made us both sit up and listen. “You’re not ill,” she told my husband. “You are very, very ill.”

He’s no longer on the dialysis diet. Now we’re on the more varied diabetes diet. The drug he needs to treat the kidneys elevates the level of blood glucose, making it necessary for him to watch what he eats as well as to take insulin since most medications to treat diabetes in pill form are not advisable when kidneys are compromised.

Have I learned anything from all of this?

First, I will always step up to the Consultation window at the pharmacy when picking up a new drug. I did when I picked up my husband’s medication and am so glad I did. Not because the pharmacist warned of the side effects my husband experienced. There was no warning. Kidney failure is not a listed side effect on any of the information available about that drug. So I know I didn’t ignore a warning. Had I not taken the time to wait to speak with the pharmacists about the medication, I would have wondered if I should have known to bring him to urgent care again.

And second, I will pay much closer attention to my husband’s complaints when he isn’t feeling well. He doesn’t get sick often. He usually just plunges forward in his usual day if he feels a cold or even the flu coming on. So when he stayed in bed for days at a time, I should have realized he was really not well.

In support of that second lesson, I am happy to point to the fact that married men are healthier and live longer than single men. This Harvard study only hints, in the final paragraph, that wives insisting their husbands see a doctor is a positive factor in the health of men. Personally, I think it’s the main reason.

cruising in the caribbean

Cruise ship - Radiance of the Seas by blmiers2, on Flickr
Creative Commons Attribution-Noncommercial-Share Alike 2.0 Generic License  by  blmiers2 

We are seniors. We have been for awhile. And taking cruises is something seniors do. In the winter, many of those seniors go cruising in the Caribbean, where the weather is warm and shopping is duty free.

I had been fascinated by the idea of taking a cruise long before I joined the ranks of seniors. I first wanted to take a cruise since before I joined the ranks of teenagers, in the days of that TV classic from the late 50’s, The Gale Storm Show: Oh Susannah. Finally, last month, my husband and I headed off for ten days on a cruise involving stops at six islands interspersed with three days at sea. I was so excited.

We were with two of my cousins and their husbands and were joined for evening meals and many other events by a couple my cousins had met before who have enough nights of sailing with the cruise line we were on to be five-star passengers. The six of them had been on many cruises before. But we were newcomers. There were so many things we didn’t know, even though my cousins and their husbands tried to fill us in.

Maybe the fact that we didn’t have to do our own research was part of our difficulties. My cousin’s husband had checked out the price, the route, and the time of the year, concluding that the price was great, the route would take us to lovely ports, and the time of year would guarantee us pleasant weather. He was right, but that wasn’t enough for our first cruise.

Here is what we learned from our experience.

  • Be prepared to experience motion sickness. No matter how big those ships are, the bow will be bobbing along in the water at some point and that motion can be difficult to adjust to. It is no surprise that the dining rooms are at the back of the ship, where the motion isn’t quite as extreme. Bring motion sickness medicines along. There will be some available on the ship, too, but those shops are like mom-and-pop shops everywhere, limited in what they offer and the prices are high.
  • Start from somewhere close to home. Our ten-day cruise originated on the east coast. We live on the west coast. So our first travel day was consumed just getting across country. And our first flight was delayed by hours because of mechanical problems, putting us at risk of not making our connection or arriving on time, not the carefree beginning to our vacation we had hoped for. And the return trip was even more stressful.
  • Start with a short cruise. This may seem counter-intuitive since it will cost a packet of money for a vacation and longer vacations always seem better than short ones. But we both concluded we should have tried a five-day, not a ten-day, cruise for our first one. Had we not been on the ship for so long, we would likely have enjoyed all of our cruise, instead of just the first half. That’s because. . .
  • Cruise ships are confined and confining places where it is difficult to get away from anything unpleasant. And what was unpleasant for us was the viral infections we both picked up. For the final five days of the cruise, we couldn’t take part in many of the activities we had been looking forward to because our coughing disrupted those around us. In addition, the virus robbed the food – the exquisitely prepared and oh, so plentiful food – of its flavor.
  • Remember that not everything comes with the cost of the room. Meals are included – and as I had expected, there was plenty of food at all the hours we were awake. But everything else beyond food comes with a price tag. It isn’t that the prices were all high – drinks were about what we pay for them back home. But we don’t go out to have cocktails ten nights in a row back home. On the ship, that’s what we all did. And the Love Boat series that included Dr. Bricker as one of the main characters never prepared us for the cost involved in visiting the ship’s medical center. For what we paid for our medical bills – thanks to my PSVT episode – we could have brought along another passenger or taken another shorter cruise. And it happened on the fifth day – what would have been our departure day had we opted for a shorter cruise.
  • Be aware that people on cruises – both passengers who have been on them before and the staff – speak a different language. We didn’t know what the Lido deck meant. Everyone else knew that was the top deck where the buffet and the swimming pools were. I checked what I thought was the right box on the form to arrange for our disembarkation but when we were advised to be ready to leave the ship at 7:30 a.m. while our flight out of town wasn’t until 5:00 p.m., I thought they had made a mistake. When I called to ask why we had been told to be ready to leave so early, the helpful man at the other end of the phone explained, seemingly with great pleasure, that we had been approved for the Luggage Direct program. I had no idea what that meant except that it required us to leave much earlier than we wanted to. We didn’t know the difference between Expedited Departure and Luggage Direct, so we showed up to disembark with the wrong group. I thought a 7:30 a.m. departure time was pretty darn expedited, but we had to wait for the expedited departure folks to leave first. Once we figured out the language of cruises, I realized that what people told us was accurate, but it was as if they had been throwing Finnish words into the middle of English sentences.
  • No matter what clothes you bring along, you’ll need different ones. I had bought three pairs of walking shoes to be sure I had good ones for walking around in port. The first pair bruised the top of my foot before I even set foot on the ship. The second one had decorative holes along the top – I thought it would be good to have shoes that could breathe. Each edge was the source for rubbing my toes, resulting in blisters. Thankfully I bought a pair of walking shoes on the ship – at a lower cost than any of the pairs I brought with me – that served for part of the time. I had to buy another pair when the blisters on my toes made it clear I was not going to make it back to the ship if I didn’t get out of that pair. And I hadn’t brought along dressy shoes for the three formal evenings. I made do with the third pair of walking shoes that could pass for ballet slippers.
  • Be prepared to pony up plenty of money for anything off the island. Sure, it was possible to just walk off the ship and walk around town – each port offering essentially the same shops, all duty free, all offering goods I don’t need and wouldn’t use – but anything beyond that came with price tags per person in excess of a couple of hundred dollars. The one excursion my two cousins and I took together was a slightly lower price and I can’t imagine that any of the other offerings could have topped it. We went zip lining across the jungle canopy of the Dominican Republic.
  • Check for where the smokers spend their time. On our ship, smoking was permitted around the outdoor swimming pool on the Lido deck – at the back of the ship – and on the verandas of the staterooms. Unfortunately, the couple in the stateroom just forward of ours were smokers. Every time we opened the door to spend time on our veranda, we heard one of them open their door. And then the smoke wafted from their veranda to ours. I wish we had asked to swap staterooms with them on the first day. I didn’t think of that until the end of the cruise.
  • Are we sorry we went on the cruise? Not at all. It was a wonderful opportunity to reunite with my cousins and their husbands. And we met other great people as well. Besides, it was on my bucket list.

    Will we go on another cruise? Maybe. But unless taking a cruise is the only way to get somewhere we really want to go, I think we’ll opt for an all-inclusive package where we can stay in one place or go out somewhere else as we want to, not according to the ship’s schedule.

shingles

If you have had chicken pox, the shingles virus is already in you.

You have probably already seen and heard those ads. So have I. In addition, I have watched people suffer from the inflamation, so when our internal medicine doctor asked if we wanted to get vaccinated, we both said yes. He wrote us prescriptions since doctors don’t give the vaccinations, at least not here in California. Pharmacists do.

We are both covered by Medicare which greatly simplified the process since Medicare covers the entire cost. It is possible to get a prescription at age 60, but it is very expensive and not all insurance plans cover all or even most of the cost. 

The vaccine is approved for use in people between 50 and 59, but the Center for Disease Control doesn’t recommend it for anyone under the age of 60. There are also conditions where the vaccine is not recommended at all. According to the Mayo Clinic, the shingles vaccine isn’t recommended if you:

  • Have ever had a life-threatening allergic reaction to gelatin, the antibiotic neomycin or any other component of the shingles vaccine
  • Have a weakened immune system due to HIV/AIDS, lymphoma or leukemia
  • Are receiving immune system-suppressing drugs, such as steroids, adalimumab (Humira), infliximab (Remicade), etanercept (Enbrel), radiation or chemotherapy
  • Have active, untreated tuberculosis
  • Are pregnant or trying to become pregnant

Since there are so many conditions that may make life in our later years less enjoyable, taking a step, one that cost us nothing but the time we had to wait at the pharmacy, seemed wise and prudent.

nursing homes and hospitals

My dad has been moving between the hospital and the nursing home, sometimes several times in a week, for the past six weeks. As a diabetic, he runs the risk of poor circulation to his feet, and that has resulted in two surgeries, one to remove two toes and the second to remove the remaining three toes on that foot. Those surgeries, the drugs that have followed them, and the movement from hospital to nursing home and back again are the context for my thoughts below.

I don’t know how our family would get through this without my sister-in-law, a nurse, serving as patient advocate for my dad. And the situation makes me wonder whether a patient who doesn’t happen to have a daughter-in-law who is a nurse can get an advocate to listen to the string of instructions and explanations the doctors and nurses provide to tired, confused, and often, if only temporarily, cognitively impaired patients. For example, my dad cannot tolerate a certain class of medications. Yet every time he returns from the hospital to the nursing home, my sister-in-law finds that the most recent physician has added one of the drugs in that class to the list of his medications. So the discussion occurs again. A phone call from the nurse on duty to the physician must happen to explain that my dad won’t take that medication. The result is that it is once again removed from the list of medicines.

My dad grew up during a time when there was only one way of doing most things. And he grew up in a small town where everyone knew everyone else and everyone knew what the only one way of doing things was. So he expects that he doesn’t have to repeat his wish not to be given drugs in that class to every new doctor. He thinks that information should be in his chart and that new doctors will review his chart before determining what is best for him.

Instead, it appears that doctors are treating his symptoms instead of treating him. And since his symptoms are treated with a number of drugs, including those in that dreaded class, the medicines are added to the list without reference to his history.

Thankfully, my family has a patient advocate in my sister-in-law. What do others in our situation do?

them bones

A bump on the head used to mean just that — a bump on the head. It might hurt for a few days, but then it’s gone. But with age, a bump on the head turns into pressure along the spine, lower back pain, sciatica, headaches, and all sorts of aches that I hadn’t thought were connected to my head.

The toe bone connected to the foot bone,
The foot bone connected to the leg bone,
The leg bone connected to the knee bone,
Now hear the word of the lord.

On the last day of 5th grade, I wanted desperately to play softball with the boys on the playground. When they weren’t willing to let me join them, I inserted myself between the catcher and the batter — I can’t for the life of me remember what I was trying to do. The result was that the batter connected the bat to my forehead which left me with a nasty bump on the head that lasted all summer long. The bump raised my bangs on one side, slanting them at a not-unfashionable angle for these days, but it was clearly unnatural for those days. The bump turned black and blue, gravity drew the purplish hue down over both of my eyes, and the bump slowly spread out and faded to a very unpleasant greenish gray. But that was the end of it. A bump on the head with a little discoloration for a few weeks.

Them bones, them bones, them dry bones.
Them bones, them bones, them dry bones.
Them bones, them bones, them dry bones.
Now hear the word of the Lord.

Anonymous

Last Sunday we went to Home Depot to pick up some plants for the balcony. On the way back to the car, I had to squeeze through a small gap at the entrance because a family was loading their purchases into a van right there. I didn’t notice that the van’s raised door didn’t quite exceed my height. Wham! A bump on the head. It hurt a little as I walked away. Pressure from my palm on the bump helped. But I hadn’t expected the lower back pain I’ve been experiencing since then.

Musculoskeletal pain is pain that affects the muscles, ligaments and tendons, along with the bones.

Web MD.com

I walk a lot slower these days. It just hurts too much to walk at my normal pace. And this afternoon when I caught the edge of the sole of my shoe on the floor as I walked down the corridor, causing a little footwork stutter, I had to refrain from calling out as the pain shot through my whole body.

I hadn’t expected this part of getting older. Wrinkles, dry skin. . .sure, they are in the commercials all the time. But I’m not ready for a cane or walker yet.

More on musculoskeletal pain from Web MD.