Oh No, Back in the Hospital

These strokes are capricious things...they sneak up on you, often without warning. On the other hand, sometimes there is ample warning...and that's what happened this time.

For the last several weeks, there have been warning signs that another stroke is possibly looming in the future:

• A couple of episodes of double vision.
• About five episodes of numbness of the left arm from shoulder to finger tips, lasting a minute or two.
• A persistent headache just behind the right eye, sometimes lasting for more than a day at a time.
• On Sunday a large island of numbness in the right side of the face.

During a visit with Bettie's nutrition counselor on Tuesday, these symptoms were all discussed and he said it was time to see just what was going on...NOW. So off to the emergency room once again, this time at Valley Medical Center. We choose VMC for a couple of reasons:

1. They are a little better equipped for this kind of stuff than Auburn.
2. They have all my medical records.

That's right, MY records. You didn't think this was about Bettie did you? She's coming along OK, this time it is my issue.

Being male and basically invincible, I've been noticing the issues mentioned above and, because none of them (except the headache) last for more than a minute or so, pretty much ignoring them. But when the facial numbness occurred on Sunday, I realized that this could be pretty serious. Since I was scheduled for a visit with Bettie's nutrition coach on Tuesday for my own issues, I mentioned everything to him.

So here I am, blogging from a hospital bed at VMC while they poke, prod, scan, and otherwise make like doctors. I had to stay the night Tuesday and may have to Wednesday as well, simply because of the number of tests they want to do.

Meanwhile, Bettie is being cared for by our son Rick.

It is nice that I have access to the web from bed here, but it is very difficult logistically. The monitor is across the room and the controls to type and edit are unfamiliar. I'll post this now, and then edit it tomorrow when I get home, assuming nothing serious is found that precludes it. (Talk about serious...a few minutes ago the nurse came in and said I had flat-lined...she quickly discovered that one of my heart monitor cords had unplugged. Whew, that was close.)

__________ Update __________

I did, in fact stay both Tuesday and Wednesday nights and had a good going over. I had my head in a scanner three different times...you'd think they could find something in there with all of that, wouldn't you. Also had blood work and a echo analysis of my heart for half an hour. I'll revisit some of the specialists soon to get the fine details. But for the most part, everything checked OK. I need to be taking asprin every day as a cheap, effective blood thinner, and of course, no more having secret issues that I keep to myself. It turns out that I am not invincible...imagine that.

The Results Are...Underwhelming

At least so far, there does not seem to be a great deal of difference between Bettie's pain with walking today, versus yesterday and before. On the other hand, this is just about the time the doctor at Auburn Diagnostic Imaging (where she had the shot of Depo-Medrol on Tuesday) said the effects of the injection would begin to show...if they are positive.

For the first time in a couple of weeks, a home care therapist (Renee Morgan, physical therapy) came to work with Bettie. As usual, these people see improvements that the family misses, being so close daily. That is encouraging in itself.

Other than an afternoon trip to Costco for another "driving" excursion up and down the aisles, an uneventful day. This time we didn't run into any old friends...or anyone else for that matter.

Bettie Has Been Shot!

Right on (the revised) schedule, Bettie has had an imaging-directed injection of Depo-Medrol in the right hip ball joint. (Our hope here is to give Bettie a few months of pain relief while she gains enough strength to cope with a future hip replacement.) I had thought that she was going to get something to lubricate the bone-on-bone condition there, but that's not what this stuff does. It turns out to be a pretty effective anti-inflammatory drug...most of the time.

Like the investment caveat "Past performance is not a guarantee of future results", so it is with this treatment. The doctor who did it says its effectiveness can be from no pain relief at all, to complete pain relief for many months. Most patients have good outcomes, and the injection can be repeated up to three times. But for now, it is wait and see.

An anaesthetic was injected first and that will wear off later today. When it does, we should not expect any improvement today, as the Depo-Medrol takes 24 to 48 hours to begin its magic. Thursday...that's when we hope to see her resurrection, so to speak. Hopefully I'll have a good report on how things look Thursday evening.

Don't Ask, Don't Tell

For going on three months now, we've had a closer relationship with the medical community than anyone should ever want. However, it has been generally as positive and professional as one could hope for. But I suppose it is inevitable that an occasional bump in the road should occur...and one did on Monday.

That was the day Bettie was to have an injection in her hip to relieve arthritic pain, and hopefully free her up to make more progress toward normal walking. When we arrived at the imaging clinic to check in, I mentioned in passing, that Bettie was on a blood thinner (Coumadin), just in case that was an issue. It turns out to be a big issue, and they can't do the injection until she has been off the thinner for at least four days.

This was my third contact with the clinic, the previous two being by phone, confirming the appointment, etc. In neither of those calls did they ask about her medications, nor did I think it important to tell them. In addition, the appointment was set up by a referral from another doctor's office and that office didn't tell (although they knew), nor did the imaging clinic ask. Maybe I'm just making excuses for myself, but it seems like if there is a restriction on a clinical procedure to be performed, the performing clinic should ask if that restricting condition exists, at the time the appointment is first set.

The result of this lapse is a reschedule of the appointment for next Tuesday, eight days later than it would have been. Eight days of additional pain...all because no body asked, and nobody told.

If it Isn't One Thing...

Right... it's something else. And the something else turns out to be arthritis.

A couple of weeks ago Bettie had a follow-up visit with Dr. Sultana, the director of the Acute Rehab Center at Auburn Regional Medical Center. While going through the standard stuff: "What is your name...show me two fingers...point to your nose" etc., he asked her to take a few steps. He noted that she had a slight limp, which the rest of us just thought was stroke related. "I want that right hip x-rayed" he said, "There's something going on there".

He was correct. The subsequent x-ray shows that she has moderate to severe degradation in the right hip joint and is a prime candidate for a hip replacement...but not in her present condition. She needs to be stronger and just generally more stable, medically speaking.

So it appears that the pain in the right side resulting from the gall bladder drain tube has indeed been subsiding, but the pain from bone-on-bone contact in her hip has been increasing. Because of her inability to be very specific about just what hurts, it was easy for those of us close to her to assume the right side pain was a continuation of the drain issue. In fact, it now appears to be mostly, or maybe even entirely, hip pain. It always hurts when she walks, and always stops when she lies down. In hindsight, it is not so hard to diagnose.

So, what to do? Here's the plan: Monday she will have an imaging-directed shot of Cortizone (or something like it) injected directly where it will (hopefully) do the most good. This should give her two weeks to a month of freedom from pain. The shot can be repeated a limited number of times. This buys time for her to gain strength and weight so that we can seriously consider hip replacement.

Though there is still pain in her life, and it is still limiting how much progress she can make with some of the physical things like walking, it is a relief that the issue isn't some mysterious internal problem with the gall bladder, gizzard, or whatever, in her insides.

Since she can't get on the treadmill just yet, I asked my son Tim to move the weight bench into our master bedroom so she can start working on strength training. She realizes the need for "getting in shape" and is taking to it very well. She can do leg lifts without hip pain. She's up to thirty pounds, and climbing. And that's not all.

Bettie is driving again!

Yesterday, for the second time in the last week or so, we made a trip to the Fred Meyer store in Covington. For the convenience of handicapped customers, they have drivable electric grocery carts. She got one one, and off she went. The only thing she found difficult was getting off when it was time to leave. When we finished at Fred Meyer, we went (practically next door) to Costco. There she quickly mastered the Costco cart, which naturally had a much bigger basket.

Having these electric carts for free use by customers is a great boon to caregivers like me. It is a big help in my new role as the primary grocery shopper, because she knows where everything is, what brands, and sizes we use, etc. It is good for her to get out and do something meaningful and fun. It also gives her an informal opportunity to get comfortable interacting with people.

And to prove this last point, in both stores we ran into people we knew. Ah, let me change that...we bumped into...no, no,...we saw, people we knew. That's better. Anyway, in Fred Meyer, it was Dora Darby, the woman I sat next to in church last week. In Costco, it was Bobbie and Chuck Stocton, old friends from the church we attended previously. Both interactions were warm and supportive...just what she needs.

Simple Pleasures

We are still dealing with some pain in Bettie's right side, though it is somewhat intermittent. It seems to be aggravated by movement, and is often better or gone in the afternoons. It is, however, greatly slowing her progress in most areas.

This week we visited the nutritionist, Raven, at Dr. Heide's Clinic and she gave us some good tips for altering Bettie's diet to minimize the work the gall bladder has to do, just in case that is causing some of the pain. We also had a couple of trips to the anti-coagulation clinic at Valley Hospital to monitor Bettie's coumadin level, to hopefully thin her blood enough to prevent future strokes.

Otherwise, we take things day to day. When she is feeling good, Bettie is lots of fun and we work together very well. Sure, being a caregiver is lots of work, but so is being a stroke victim. But it isn't all negative and we simply try not to dwell on the parts that are. From the beginning, I've leveled with Bettie about what happened: "I know this isn't what we wanted to happen, but it did, you had a stroke. You can't talk very well, and stuff is hard. But I'm here and we'll get through this together. The family is here and we all love and support you."

So she knows what the score is, and is not fighting it. There are lots of frustrating times, but overall, she has a resigned but cheery disposition (provided she doesn't hurt). While stroke is not a funny issue, we find lots of stuff to laugh about. Sometimes...well, actually a lot of times, she starts to say something and then can't find the right word and just rolls her eyes as if to say: "Oh brother, there I go again". Other times I'll say it: "Oh there you go again with one of your stroke words" and then I'll repeat which ever one of the dozens of new words in this language of hers that she just used, and we both laugh at it. (I wouldn't do this if she didn't laugh too, but it seems like it helps us both to cope.)

Another thing we like do is make funny faces, just to see who can make who laugh. We usually both succeed. Yea, simple pleasures, but you find 'em where you can.