Saturday, August 6, 2016

Antibiotic Gut......

About six weeks ago I got a toothache.  It wasn't bad, initially - nothing a little Tylenol wouldn't kick - and since the tooth in question was up under a permanent bridge I just said a prayer and waited. But it felt suspiciously similar to the pain I've felt when I was working up to needing a root canal, and since I didn't have a thousand bucks sitting around waiting for a dental emergency I hoped for the best. Of course, it was a Sunday when it went from Tylenol-will-do-it to holy-crap-gimme-narcotics level pain.  I could feel some swelling, so I grabbed some amoxicillin (leftover from Maybelle's Lyme disease - yes, I took DOG antibiotics - don't judge me!) and called the dentist first thing Monday morning.  

An x-ray showed what I already knew - there was an infection.  But the worse news was that this tooth has already HAD a root canal, so in addition to it being permanently glued to a large bridge, it's already sealed shut.  So whaddaya do about that??

Well, you take antibiotics.  Amoxicillin is fine, but increase the dose and hang in for a couple of weeks.

Okey dokey.

I finished, as instructed.  And three days later the entire right side of my face blew up.  

This would not have been so bad, aside from the pain, except we were loading up for our annual mission trip the following evening. So I called the dentist again and explained that not only was I worse, but I couldn't come in to see him.  (Always what your provider wants to hear, I assure you.)

 "Well, how about we put you on some amoxicillin?"  How about not, since it worked so well last time?

"Clindamycin, then."  Alrighty.

I started it Thursday evening, and by the Friday night load-up I was at least 50% better, and off we went on Saturday to fix houses in West Virginia, an hour and a half from the nearest decent hospital (directions are always posted at the center, and every group has a copy): 


By Tuesday evening it was apparent to me that I was suffering from one of the rare side effects of this class of antibiotics:  A Mallory/Weiss tear of the esophagus.  there was no bleeding, but the pain when I swallowed was spectacular, and the heartburn was unbelievable.  I was inches away from vomitting but terrified to do so:  With a partial esophageal tear that is the VERY last thing you want to do.

And on Wednesday, the cramping started.  Nothing terrible, thank God, and our worksite had a functional bathroom.  But on Thursday, our center lost all of its water, so there were no showers on site, and very limited toilet flushing for our final two days.  You cannot imagine:  One hundred people, half of them teenagers....and I HAVE to go to the bathroom. At a dead run.  In the middle of the night. Three times.

I came back, returned to work, finished the antibiotic. The great news is that the tooth is 100% better.  The okay news is that my esophagus healed up by the time we got home.  The not good news is that the rest of my gut just kept getting worse.  I couldn't eat much, and I couldn't stray far from a bathroom.  The dogs got very short walks. I dropped three pounds. Then five. Then eight.

By Wednesday of this week I hit the "I want my mommy" point, and called my doc.  Thursday I saw the NP, who ran some tests.  The good news?  No dehdration and my sugar is awesome.  The bad (but hardly unexpected) news?  I have C. diff. 

Basically, we all have Clostridium difficile living peacefully in our guts.  Most antibiotics do NOT kill it, but they wipe out everything else that usually keeps this bug in control.  Once that balance is upset, the C. diff overgrows and produces a toxin.  It's the toxin that is the issue, causing cramping and diarrhea.  In fragile patients, this can lead to severe dehydration, perforation of the gut and even death.  

I'm not so fragile.  But there were moments yesterday when death made a certain degree of sense.  

So now I'm on yet ANOTHER antibiotic to make my gut settle down.  So far, I can't say whether we're winning the war or not, but I did manage to leave the house for a little while today.  I'm not allowed to return to work until the symptoms resolve.  

I try not to be too cavalier about the possibility of side effects of medications.  I know they happen - I've had plenty myself.  It's easy for doctors to forget or play down the suffering caused when this sort of thing happens.  But honestly, the alternatives were limited as well.  Dental abscesses are no joke:  I had a young patient have a stroke as a result of one that encroached into the carotid artery, and not too long ago the news had an article about a 12 year old who died from a dental infection.  

But I sincerely apologise to ANY patient who feels I didn't sympathise properly when they reported a side effect.  


Sunday, July 31, 2016

New Use for a FitBit....

Babygirl's most recent visits to the doctors were generally productive and reassuring.  Driving in the Philadelphia area during the Democratic National Convention, less so.  All of the trucks seemed....confused.

Nephrology had nothing new to say.  They scolded her for missing doses of medication (how does that even happen? I wake her up EVERY DAY and she has phone alarms.  It's the morning pills this time, two sets still in the boxes when she sorted.  UGH).  The kidney is doing well despite this, with a creatinine of 1.05, about average for her lately.  The headache medication still have her a bit too acidic but they decided that taking 14 bicarbinate tablets a day was about the limit.  Fourteen.  It's a lot of sodium, seriously.  So, lab work here in six weeks, and see you in three months in Philly.

Gyn had nothing new to add.  We were overdue by a couple of months there.  Dr Z of course took Babygirl aside alone to question her ("Why do they always ask me if I feel safe??" she asked me later.  "Be glad that question puzzles you," I replied.  "Oh.").

Neurology talked Babygirl into the full 31-injection set of Botox.  Watching this provider do the injections, compared to the CHOP provider, it seemed that she was more organized about her approach, or perhaps it was that she just talked more about the logic of the shot locations as she worked.  The really interesting thing was that I didn't need to order the Botox from our specialty pharmacy and have it shipped to Nemours/Dupont hospital ahead of time (copayment:  $300 each time CHOP had us do this!).  These folks just pulled the vials out of their fridge and gave it to her.  It will be part of the bill for that day, so it will be interesting to see how that plays out.  I did call our insurance company ahead of time to check on this, and they weren't sure WHY CHOP had us send the medication in like thay - they would have paid for it as part of the service.  Dr P, our new neurologist, tells me that they get the Botox for about $100/vial.  Since they use 2 vials for Babygirl's injections, the total cost MAX would be $200, so what the heck, CHOP? Could I have my extra $200 back?? Just one more reason that I'm glad we aren't going there anymore.

One of the big problems for people with migraine is sleep. Babygirl routinely reports poor sleep, so Dr P asked me to put my FitBit on Babygirl at night to see how much sleep she is getting, which is a creative approach to data collection. I've also made Babygirl commit to turning off all electronics at 11 PM whether she is having a hard time sleeping or not.

We are to update neurology in 2 weeks with a headache report and sleep data.  And then we'll see.


Saturday, July 30, 2016

Sure-Fire Paint Remover....

Some years ago when I decided to paint the fireplace bricks, I painted the cheap-looking ceramic tile hearth as well. (Painting With Brownie Mix) The tiles are bland beige squares, and the former owner must have gotten a deal on them because he used them all over the house on both sides, on walls, floors, counters - places where floor tile has no business being.  We've gotten rid of all of them, except these.

The ultimate goal is to install a gas fireplace insert, and when we do, we'll upgrade the sad little hearth to something pretty.  Poured colored concrete, perhaps, or quartz, or Italian tile, or ANYTHING but these sad, boring beige babies.

Painting them brown helped a little, but paint doesn't really stick too well to tile unless you rough it up a little first, so over the years it has chipped away.  I've convinced myself that it's charming.  It's either self-delusion or go find the rest of that can of paint and touch up, and THAT always sounds like work.


You can see the "charming" tile next to him on the floor, under his Sudoku book.  He's chill that way.

We've had him since mid-May, and he's been a perfect gentleman.  Or he WAS, until the Great Backyard Apocalypse engendered by our neighbors' July 4th celebration began.  Apparently setting off fireworks less than 30 feet from his head was more than he was prepared to take. And thus began Poopmaggedon.  It took us nearly two weeks of leash-walking the poor boy into the backyard every day to convince him no one was going to kill him.  And in the meantime, his guts were in a total, uncontrollable uproar.  His location of choice to let go?  The tile.

It could have been worse.  He didn't select the Chinese rug, and he (mostly) avoided the hardwood. And the tile is not in a path that anyone has to cross in the dark. But let me tell you:  Dogshit is fabulous paint remover. Every successive cleanup peeled larger and larger circles of paint off of those tiles, leaving the left side completely, well, unpainted.

If it weren't for the smell, there'd have to be a patent here someplace.  The supply appears unlimited, it's cheap to produce and probably not hard to package and ship if anybody needs some.  I'd be happy to help out.


PS Some crating, probiotics and regular walks have him set right.

Tuesday, July 12, 2016

Turning It Upside Down....

Once you have lost 80 pounds, you have a little....mmmm....slack.  Since I have about 20 more to lose to get anywhere close to a healthy weight, I have to live with this for the time being.  Dressing around this requires careful shopping and fitting, and if you all want to say you never noticed, well, then, I'm shopping pretty well, thanks.

But I'm enjoying this yoga thing, so I'm making a comittment in appropriate clothing.  I had pants, but they were purchased about 30 pounds ago.  Loose t-shirts do okay for cover up, but when you go into Downward Facing Dog, you get Upward Facing T-Shirt.  Not only can't you breathe, but everyone else gets a flashy show.  And the slack stuff?

Okay. Feel free to stop reading if you are faint of heart.  Or take a shot of whiskey or something.

It's bad enough that when I am moving quickly up a hill there are inexplicable squamous smackdown noises when my 'apron' meets my upper legs.  Turn that upside down and there's an almighty adipose avalance toward my ribcage.  To make things worse, I finally learned how to relax all my facial muscles when I'm upside down.  I'm thinking that perhaps Maybelle the hound-dog has been reincarnated in the result:  I can feel my jowls displace my cheeks, but that's okay because I think my cheeks have shoved my eyelids up to my hairline.  (Side note:  If I were truly intended to put my arse above my wrists, a merciful Father would not have let it get so big.)

Thank God for Old Navy.  They actually believe that Plus Size women exercise, and they make stuff that keeps your skin from sliding all over the damned place while you do it (well, except my face.  No fixing that in this life, I suppose), and shirts that stay DOWN without making you look like you are wrapped in an inner tube.  I wouldn't wear it to Walmart (although I've met people who would), but I'm okay for class.

So far this has had no measurable effect on headaches for either Babygirl or I, but I feel like my posture has improved, and I can tell my balance and upper body strength are better.  It's an easy place to meditate. And it seems nice to be in a 'sport' where the only competition is internal, and everyone cheers everyone on.


Sunday, July 3, 2016

The Downside of Fit....

Adding three 75-minute classes/week to a full schedule sucks some time out of your life, you know?  Not that the yoga hasn't had some very nice benefits.  Babygirl and I get to spend time together. We are getting in better shape.  We have some new life skills:  Breathe.  Be in your body.  Let your shoulders relax down your  back.

I no longer fall sideways everytime I stand on my left leg.  Babygirl is beginning shape up a nice plank.  Neither one of us has any real good news to report yet on headache improvement, but it's less than a month, so....

In other news:  Larry.  My sister-in-law (an animal savant if ever there was one) said, after one brief glimpse of Larry, "He's at least 10" despite the rescue's estimate that he was about 6.  Our vet saw him the other day, and she agrees with my SIL - he's probably about 10 years old.  Ah, well, we don't care, he's cute, and walking him has made him younger every day. Yesterday's walk had him leading ME the whole way.  He's so different from Maybelle. She selected a different route every day, and crossed the street as often as I would let her.  Larry is more predictable:  Go west until I won't go west anymore, then go north until I turn him toward home. Unless it's hot, then south to the river.  We've heard him bark only twice, once when another male dog tried to check out his sexuality and he let out a houndy, "Notgay!" and once in the middle of the night, when he bayed at SOMETHING outside the front window for long enough to wake us all up.

So life is pleasantly boring, but singularly lacking in free time.

Besides, it's summer. I have books to read, and grandkids to hang out with.


Sunday, June 12, 2016


Yesterday I went to a yoga class for the very first time.  Well, not counting some kind of yoga sort of thing that I went to once at our church where we lay down on the floor for an hour doing a progressive relaxation exercise in the dark for an hour (seriously - we never moved at all - it was a weird experience).  

To help you understand my experience a little, you need some background.

I grew up Baptist.  Now, I can't speak for all churches of this denomination, but I can tell you that I was taught that Satan had his hand in an awful lot of stuff.  Almost anything that came from anywhere outside of our home town was pretty suspicious, and a heck of a lot of what DID come from our home town was for sure hell-bound as well.  So the Catholics were doomed (they had statues in their churches, idols, doncha know! AND beer tents and BINGO!), and Mormons and Jehovah Witnesses for sure. The Methodists might make it even though they baptized BABIES for crying out loud, and the other Protestants might be okay.  I'd never even heard of a Muslim or a Buddist, honestly, but I knew that Hypnosis and Accupuncture and Iridology and Reflexology and most other non-traditional-medical-ologies were certainly dabbling in the Devil, and Yoga was certainly right up there as a doorway straight to Hades.  Namaste, y'all.

Clearly I had some things to work through in my medical training, as well as in my spiritual journey.

But Babygirl's new doctors have literally prescribed yoga three times weekly for her headaches.  So here we are, pushing through yet another rediculous cultural barrier leftover from childhood.  

"Namaste" literally means "I bow" but implies "I bow to the divine in you" as a recognition of the spark of the divine dwelling in all people.  Taken from the narrowest view of my childhood I suppose it could be interpreted as "I worship the divine in you" which would, of course, put this greeting right up there in the 'idol worship' (go straight to Hell, do not pass Go) category.  Taken as my heart has come to understand Christ's call to us all, I would interpret it as, "I recognize that you, as I, are equally created in the image of God, and I honor that image."  

We are called to love others as ourselves.  We are all made in the image of God.  The fact that I was taught to distrust my own theology if it came in a foreign language doesn't change my theology. Namaste.

The class was an hour and a quarter.  I was, somehow, not expecting it to feel like exercise.  This, it turns out, was a serious error in judgement.  My legs are pretty good from all the walking.  My abs? Not so much.  I rehabilitated my right leg after a foot fracture a few years ago so my balance there isn't TOO bad, but the left?  Let's not talk about it.

Before the poses requiring us to stand on one leg, the instructor kindly told the class that we were all welcome to move to the wall if we needed support for balance.  It wasn't until today that it dawned on me that she was actually only talking to ME, the new, grey-haired lady with zero yoga experience.  

We both had some perceptions to work through.  I didn't fall over because of my grey hair, and lightning didn't strike me for growing up Baptist and attending yoga anyway.  I think we'll all be okay.


Wednesday, June 8, 2016

Going to Medical School.....

Dear Class of 2020:

I'd like to introduce you to one of your new teachers.

Jerry was born there in Buffalo in 1934.  He moved to the snow belt with his family, graduated high school and married my mom at 19. He worked his whole life at the Ford Stamping Plant, had three kids, and died of Parkinson's Disease and COPD last summer at the age of 80.  An ordinary life, but....

When we were kids, he and my mom packed us up in an old station wagon and went camping all the way accross the U.S. TWICE.  We saw mountainous sand dunes in Indiana, glaciers in Montana, boiling mud in Wyoming, and trees so huge they beggar imagination in California.  We stood on four states at one time.  We stood in a massive cavern in New Mexico when they turned out the lights and let us see what it was like to be truly blind.  We went white-water rafting in impossibly challenging waters.

He built a two-story cabin in the woods, by himself with his own two hands. He taught me to handle a gun, same as my brothers. He hiked two generations of Boy Scouts up Mount Marcy.  He had bright blue Paul Newman eyes. He was an extraordinary man.

When I was 20 I became my family's first college graduate, with an associates degree.  A year later, a Bachelor's.  After three years of cancer research at Roswell Park I called my Dad to have my weekly 'tea-by-phone' conversation with him.  "I'm thinking about going to medical school, Dad."  It was a low-key conversation, discussing pros and cons, expenses and logic and career paths without pressure or judgement.  He was kind and supportive. "Either way, honey."  Ten minutes after we finished talking, his sister from California called in a state of total excitement and exclaimed, "I hear you're going to be a DOCTOR!!"  He was THAT proud.

When I graduated from NYCOM in 1987, he was there.  The day before the ceremony we went to campus to look around, and he specifically wanted to see the anatomy lab.  It was a brand-new building, barely finished in time for us to use it.  I told him about our first day; how we were all nervous and trying to not show it.  About the moment of silence honoring the people before us who had volunteered to be there to be our teachers, and the somewhat useless reminder for us to be respectful and reverent.  We then met our cadaver.

There were four of us on the team, and it took all our strength to raise her to table height.  She was short, she was round, and she was HEFTY.  We named her Addy, because she was very Adipose. I told my dad about that first disection: To get to the chest wall, one must remove the breasts.  Some of the construction workers who had just finished the building had asked to observe, so when our forceps proved less than adequate for the amount of tissue involved and we lost our grip (slapping a large, wet breast back down onto the exposed chest wall with a room-stilling THWACK!), one of them offered us a pair of pliers from his tool belt.  That was the end of any solemnity we had left in us.  We laughed hysterically, completely DONE with nerves, finished the dissection like pros and ordered Chinese from the lab with the scent of formadehyde still strong on our hands.

My father found this story hilarious.  My mom found it nauseating.  Dad asked to see a cadaver.  Mom fled.

As we examined a fully-dissected body, Dad and I talked at length about how the cadavers had taught us much that we would never have learned in mere books.  And despite the appearance of disrespect, when I spoke of how emotionally challenging it was for me to perform Addy's facial dissection, he understood that there was, and remains, a deeper connection to humanity both because of and despite what many would see as a very dehumanizing process.

I suppose I wasn't too surprised, then, when I discovered that Dad had sent himself to medical school upon his death. His lack of education never reflected low intelligence but rather lack of opportunity, and he took his opportunities where he could find them.

And here is my message to you:  I want you to know that Jerry knows you are going to laugh at the things you find as you dissect him, and both of us are okay with that. His pacemaker IS on the wrong side (he's a left-handed redneck - putting it on the correct side would have interfered with his shootin' arm). Lord knows, he has a million scars and they each have a story (the chain-saw wound on his thigh, the toe amputation due a run-in with the lawn mower, the extra belly-button-like mark from a power drill?  Feel free to make up a story.  I guarantee the real tale is funnier).  But I love that battle-scarred old guy, and I miss him, and I want you to remember he is there because even after a life well lived, he still had it in him to want to teach YOU.

Respect that.