Category Archives: Health

Recovery Now

Spring                                                                          New Shoulder Moon

20180401_0632072
this morning

The new shoulder moon has gone from new to full and over the course of its transition Kate’s new shoulder has begun to heal. Still a long road ahead but her pain is better, her overall spirits, too. She still has some nausea, which is tough for her because it makes her very uncomfortable. On the whole though her recovery is on track after those first four days post-op.

The routine of caregiving has become easier. I’ve learned how to alter my routine so it makes things simpler for her and for me. I even did two loads of laundry yesterday. Now, this may not seem like much, but Kate is a laundryhead and as a result it’s something I’ve done only rarely in all our years of marriage. Before we were married, yes, but she likes laundry. General picking up, cleaning up, something we might both do, is now my responsibility so I just do it. Cooking and shopping are mine now; as is doing the dishes, though I hope our very expensive dish drainer will actually wash the dishes, too, after Monday.

Kate’s has two post-op appointments this week, the one I mentioned on Monday at Panorama Orthopedics and Wednesday with Dr. Gidday. By the time the new shoulder moon wanes her recovery will be well advanced.

 

OMG

Spring                                                             New Shoulder Moon

anxietySurprising, sophisticated, jawbreakingly awful sign on a conservative church sign board: “Anxiety is just unbelief in disguise.” If you live in Christworld, there is a certain sense in which this appears to be true. If only your belief were strong, you would need have no worries. Look at the lilies of the field.

However, assume for just a moment that your metaphysic is wrong. Then, this sentiment is cruel. It doubles up the anxiety for those of us who are anxious, a whole big bunch of us*, by adding weak faith to the angst we already feel. And, even if God is watching out for you in a way totalizing enough to assure you in every situation, punishing anxiety as weak faith is not going to move you closer to faith. The opposite. It will push you deeper and deeper into the slough of despond.

Now, what’s funny is that I saw this sign on my way to The Happy Camper, the dispensary just over the Park County line near Bailey. Picking up our regular supply of thc, a sleep aid we’ve been using for a while now, is a monthly or so trip. Why do I need it? Anxiety is a bitch goddess who demands sacrifice as soon as my head hits the pillow. Has been true to a greater or lesser degree since high school.

Anxiety is not as much of a problem now as it has been, but the long established habit of chewing over the day once the lights are out has become a regular time for my brain to turn on, consider relational or political or philosophical matters. A habit I’ve been unable to break.

sleepFriend Tom Crane sent me a book, he does that every so often, “Why We Sleep,” by Matthew Walker. This is an excellent review of the latest in sleep science and daunting as a result. Sleeplessness has drastic health ramifications, enough to make the favorite yuppie mantra, “I’ll sleep when I’m dead.” ironic. What I can’t understand, and Walker says the same, is the lack of attention the medical profession gives to sleep. Many of us are desperate to get to sleep. And by desperate I mean desperate. Yet the help offered is often better sleep hygiene, a good idea, I practice it, doesn’t do the trick for me though. If help is offered at all.

I hate to add this idea to all those others out there, but this is a NATIONAL CRISIS. Especially for those of us in the third phase when sleep becomes harder for a variety of reasons.

SleepDeprivation3We have elaborate protocols for people with pulmonary issues like COPD or emphysema, cardiac issues of many nuances, joint replacements for tired and painful knees, shoulders, hips; but, what do we have for a part of our lives that constitutes a third of our time use each 24 hours? Yes, there are sleep centers, but they’re not on offer often and besides it seems that cognitive behavioral therapy is the current gold standard. Problem is not many CBT folk specialize in sleep and we’re certainly not referred to them anyhow.

It’s enough to make a guy lose sleep.

 

*Anxiety disorders are the most common mental illness in the U.S., affecting 40 million adults in the United States age 18 and older, or 18.1% of the population every year. Anxiety disorders are highly treatable, yet only 36.9% of those suffering receive treatment.  AADD

Recovery under the New Shoulder Moon

Spring                                                                           New Shoulder Moon

recovering-please-waitKate has slept well, mostly, her first two nights home. She’s controlling her pain with tylenol and the occasional tramadol or vicodin. She had a bout of nausea yesterday; but, unfortunately, that’s not really unusual. Her weight is up, thanks, she thinks, to good intravenous hydration in the hospital. Prior to surgery she’d had trouble keeping water down. She’s on the mend.

Can’t say the same for our *%$!!** dishwasher. Not the drain pump. Maybe the sump pump? Nope. So. Computer boards. 1 of 2. We have to order them, can’t get them by Wednesday. Oh. That means, due to 1 Stop (ha) Appliances mountain schedule, Mondays and Wednesdays only, that we’ll not see a working dishwasher until April 2nd which is the date of Kate’s post-op appointment with her surgeon. Grrrr.

10002012 05 01_4261Snow. While the rest of the nation east of the Rockies has been pounded with storm after storm this land of ski resorts and mountain passes has been dry, one of the 14 driest winters in the state’s meteorological history. Last night though, maybe 9 inches of heavy, wet fire dampening snow! Welcome.

Our little hippie dog Gertie has recovered from her long, strange trip over Sunday with her usual resilience. Tail wagging and happy. Gertie is a good role model for how to handle adversity.

The view out the window here in the loft shows snow covered solar panels, flocked lodgepole pines, a white Black Mountain, and a pastel blue/white sky. Peaceful.

 

 

Finally

Spring                                                                            New Shoulder Moon

dictionary.com
dictionary.com

Finally. Kate’s home. An iatrogenic problem. Squared. The surgery was the first culprit, of course. A surgeon cut into her. An anesthetist put her into a drugged sleep. New, unfamiliar elements got installed, in her body. Lots of insults. Why surgery is not ever to be taken lightly.

Recovery, then. In the newer, fast paced, get’em out of the hospital mode, the gold standard is one night, then back home or wherever. Knock back the pain. Make sure the gut’s working, pass gas and you win the prize, get some discharge instructions and Bob’s your uncle.

However. If the pain is bad, so are the drugs. In this case dilaudid. A powerful narcotic it apparently upset Kate’s sensitive stomach. She couldn’t keep food or water down. But the pain. More dilaudid. You see the problem here. This is the second iatrogenic cause.

homeostasis concept map
homeostasis concept map

Sometimes, the treatment can rival the presenting complaint as a source of pain and discomfort. Medicine is as much art as science, a truth not always palatable to consumers who want certainty in matters critical to life. I know I do. But, it’s a fool’s desire. The human body is far more complex than we understand. Just look at all the new information about gut microbes as an example.

To my non-medical mind the biggest issue is the interdependency of all the body’s organs, systems. Poke one, many respond. It’s like trying to repair a car while the engine’s running. So, I’m grateful that the folks at Ortho Colorado stayed in the messy and confusing twists as Kate’s body tried to recalibrate. It did. Joy, to mention a word from a few posts ago.

Suspended

Spring                                                               New Shoulder Moon

Still not home. I went over yesterday after lunch only to find Kate struggling to eat a bite of a bacon sandwich. She couldn’t keep that down, water either. Extremely unpleasant for her. Kate hates nausea.

ok, maybe not this quiet, but still...
ok, maybe not this quiet, but still…

When I went in yesterday, the busy M-F buzz of the hospitals had disappeared. There were fewer cars in the parking lot, a guard at the concierge desk, the Ortho small cafe closed. Nobody bustling about guiding patients, taking preop folks back, people with canes or walkers stayed at home. On the third floor, patient rooms, only a scattering of folks remained, three that I counted on Kate’s wing.

It’s disconcerting to have Kate in a place that feels emptied of its vitality, just when she’s having trouble. Being in a hospital over a weekend is not something you choose.

Meanwhile, after a full Sunday of lying around stoned, looking pretty damned unpleasant, Gertie’s tail wags furiously (normal) and she ate. Back to normal after a trip to the late ’60’s. Kep sniffs Kate’s side of the bed.

20180323_075536_001On Thursday, the day of Kate’s surgery, I left Rigel and Gertie outside while I was at Ortho Colorado. Staying outside that long, several hours, is unusual for them. When I let Rigel inside, she ran to the couch, jumped up on it, jumped in the air a couple of times, then flopped down into her usual position. Ah.

(Rigel yesterday hunting for voles.)

I hope Kate comes home today. Having her in the hospital, uncomfortable, makes this whole process feel suspended. When she’s home, I know her shoulder will be recovering, right now its her system adjusting to the insults of surgery. Not where we wanted to be right now, but what is.

Relieved

Spring                                                                             New Shoulder Moon

Update. Just spoke to Kate. Feeling much better. Home after lunch sometime. I’m heading in around noon. Relieved.

Kate Still At Ortho Colorado

Spring                                                                            New Shoulder Moon

Kate, costumed for Purim
Kate, costumed for Purim

Kate had break through pain yesterday and nausea that they couldn’t control well. So, she’s still at Ortho Colorado. Plenty uncomfortable, but problems that seem, at least to me, manageable. Unpleasant sequelae from the meds and the cutting. I imagine she’ll come home today. Still convinced this was the right thing and that her care has been very good.

A strange sense of exhilaration with all the changes occasioned by Kate’s surgery. I find myself whistling on the way into the hospital, generally feeling good. It’s as if the additional load is something I needed. Weird, eh?

As also happens in these situations, often enough to be predictable, a lapse in the daily routine led to Gertie consuming a substantial number of Kate’s thc edibles. My fault. Gertie is, right now, pretty stoned. We had a similar incident with Kepler a couple of months ago and he slid down the stairs, looking confused. Apparently all mammals have a cannabinoid system and cannibis receptors. Gertie seems very unhappy, I imagine because her left leg makes her unsteady to begin with and the mary jane? Adds to it.

Beloved community dr-martin-luther-king-jr-quote-beloved-community-09.16.15-v2-1800Beth Evergreen has reached out to us in several ways. Individual members have offered to bring food or otherwise help. Leah, the executive director, called, wanting to know if we needed anything. Several folks from our mussar group responded to my e-mail on Thursday with love and concern. For both of us. A thought that keeps going through my mind: beloved community. Christian churches aspire to this, Beth Evergreen achieves it. I’m proud to be a member of the congregation.

One other thing I noticed. Both Kate and I were worried about her dying during surgery. Why? Well, it happens. Rarely, but it happens. Jeff Glantz, a member of Beth Evergreen, had a successful operation to remove a malignant brain tumor, then four days after surgery, he died. This was a couple of weeks ago. Jeff’s situation was on our minds, too.

I mention this because neither of us owned up to this concern until the surgery was over. By not talking about it before, by letting the death taboo keep it hidden, we lost a chance to console each other, to go a little deeper into our relationship.

 

 

Rituals of the Medical Kind

Spring                                                                               New Shoulder Moon

ritual
Ritual, an album by Yeti

No Kate in the bed last night. Kep was there, though. Medical procedures upend regular life in so many ways. Kate had to stop most of her meds, use special cleansing soaps, sleep on clean sheets (yes, that was a requirement), stop eating. Then we have to leave our home, drive in to the hospital early, always early. Once there the ritual of checking in and paying, followed by pre-op disrobement, placing of iv’s, lots of conversation about medical history, warm blankets, lying in hospital bed on your back connected to various machines with many different numbers: O2, blood pressure, heart rate among others.

This is a gradual relinquishing of control that culminates in anesthesia and allowing someone, paying someone, to violate one of the most persistent taboos in our culture, the literal integrity of your body should not be disturbed by another. The surgeon cuts into the skin, goes inside where we never see, into the most private and intimate of spaces. And, in this case, takes out bone and cartilage, sets aside nerves, and installs titanium in a location known before only to flesh and blood.

Portrait of Dr. Samuel D. Gross (The Gross Clinic) Thomas Eakins
Portrait of Dr. Samuel D. Gross (The Gross Clinic) Thomas Eakins

The process begins to reverse in the recovery room as questions about nausea and pain depend on your answers for treatment. Modest control returning. Once in your room you begin to eat again, determine your pain medications, walk, use the bathroom. Finally, if no complications arise, the wheel chair ride to transportation home. Even at home the post-op plan governs a lot of your life. How much and how long of course depends on the procedure. Not sure quite what this looks like in Kate’s case yet, we’ll learn that today.

We agree to all this because we trust, more or less, the institution of medical care and the people who make it work. Of, if we don’t exactly trust, then we realize our options are few if we want the painful right shoulder to stop hurting, become useful again.

resilience-Disaster-risk-reduction-Climate-Change-Adaptation-guide-english

As a physician and a former nurse anesthetist, Kate knows the parts of surgery usually invisible to a patient due to anesthesia. This is, as the Bible says, a blessing and a curse. It’s a blessing in that there are fewer unknowns to give anxiety, but a curse in that surgery does not always go well and she knows that from personal experience.

I look forward to picking her up today, bringing her home and helping her through recovery. As Schneider’s interviewee said, then she can live on and give on.

Under the New Shoulder Moon, a New Shoulder!

Spring                                                                     New Shoulder Moon

The new shoulder got placed this morning in a procedure that started at 9:30 and ended before 11. “Easy peasy,” said the surgeon, David Schneider. A good guy. In an interview for a book Schneider’s writing an informant told him he wanted those who benefited from his device to “Live on and give on.” Schneider added, “My new hip allowed me to do just that.” Very refreshing to meet a doctor, especially a surgeon, who sees his work as people’s bettered lives. May he live long and prosper.

Kate was a bit nervous, helped down from a lot nervous by conversations about Sjogren’s and all of the medical team taking her concerns seriously. I came home right after talking to Schneider because I wanted to feed the dogs and let them out. Headed back to Ortho Colorado in just a bit.

We’ve been heading toward this for quite a while and I’m relieved the surgery is over. Hopeful it will give her a painless shoulder, aiding sleeping, her right hand and her stress level.

 

 

Resilience

Spring                                                                    New Shoulder Moon

stephen-hawking-albert-einsAs one of Dr. Agronin’s youngest informants said, even when physical decline and losses restrict one’s options, there remains the capacity to appreciate and approach each day with a sense of purpose. “It’s all about how you frame what you have,” she told him.

He cites the concept of “positive aging” developed by Robert D. Hill, a psychologist in Salt Lake City, that is “affected by disease and disability, but not contingent upon avoiding it.” Rather, it is “a state of mind that is positive, optimistic, courageous, and able to adapt and cope in flexible ways with life’s changes.”  Finding Meaning and Happiness in Old Age, NYT, March 20, 2018

The third phase of our lives, the one that we enter when career and creating a family have faded in importance, or ended, has a mental image for most of us past 65 of decline, of a gradual decrease of abilities and agency. This image comes from our childhood when retirement was predominantly of the finish line sort, work was over, now we wait. That waiting often wasn’t long with heart disease or stroke or a bad fall ending it.

resilenceHopefully, our children, the millennials among them, will look at us and come to that phase of their lives with a different image. My hope is that they will see that aging is the accumulation of years, not a time of diminished hope and diffuse fear, but life continuing. If that image can become dominant, it will look like the diverse approaches people have to their first and second phases. In other words the third phase will have as many distinct trajectories as there are people who enter it. It will not be dormancy, or a pause before dying, but life itself.

Is the third phase the same, then, as the first two phases, just creakier? No. Like the first two, when education dominates, when building a career and raising a family dominates, it has its distinctiveness. Perhaps its most salient characteristic is open endedness. In the third phase there is, at least now, no culturally limned outline; perhaps that will change, I don’t know, but right now, thanks to the old finish line model of retirement, the third phase has no particular flavor. Or, perhaps, it has a negative flavor as I indicated above, of decline and loss of agency. Even that negative flavor though leaves the third phase open.

That very undefined nature daunts a lot of people. If your life counted on work for self-definition, if your family, with children or not, made your life worthwhile, the thought of years, maybe as many as 25 or thirty, with no such hooks for meaning can make the future look bleak, as if you were entering a time when life flows on around you, in spite of you, even without you.

positive-agingI like Robert Hill’s definition of positive aging: (It’s) “affected by disease and disability, but not contingent upon avoiding it.” Rather, it is “a state of mind that is positive, optimistic, courageous, and able to adapt and cope in flexible ways with life’s changes.”

The idea of resilience has gotten a lot of play recently. My sense is that is key to positive aging.

A telling article on resilience in childhood from the Harvard Center for the Developing Child has some hints for us third phase folk. For instance, here are some factors that enhance resilience in children:

  1. facilitating supportive adult-child relationships;
  2. building a sense of self-efficacy and perceived control;
  3. providing opportunities to strengthen adaptive skills and self-regulatory capacities; and
  4. mobilizing sources of faith, hope, and cultural traditions.

ResilienceNot only in children, I think. Resilience can allow us to accept the changes of the aging body without losing hold of the power of our own lives. With a resilient personality even ALS will not cause us to stop growing. Just look at Stephen Hawking.

As we enter the third phase, or as we cope with its vague demands, focusing on enhancing our resilience will help us adapt, remain flexible. Perhaps resilience is nothing more than following the tao, finding the energy and flow of the universe no matter what externalities are present in life. I’d like to think so.