May 29: Regular stuff

Up in NY, Lyle turned 18. Tonight is the surprise party. He's still totally clueless, so hoping we can carry it off he walks in the room. I've been having great fun with this: the mild form of cloak-and-dagger. Sneaking around, co-ordinating, coming up with cover stories. John and Emma just left for Target, and then they'll head over to the restaurant by 6:30. Right now Lyle is taking a nap, he got very little sleep last night because he was in a magic card tournament (it's some kind of card game that came out of Dungeons and Dragons?) until about midnight, then was up to go to work this morning at 6:30. This may work out perfectly, because then I'll just wake him in time for us to go to dinner and get at the restaurant at 7pm, the specified hour.. Still will be shooting from the hip as to why we should go to this one particular restaurant....

Hands continue to improve, although typing for long periods of time causes the left hand and forearm to ache. But the amount of time is growing and is definitely improving.

This afternoon Emma and I took a walk down to the Hudson River. This would not normally be cause of mention, but the reason we went was because there is a very steep hill to walk down and up. We walked down and back going very slowly up the hill, stopping frequently to rest, but I made it! I'm trying to walk at least five days a week, am now up to 45-60 minutes. Not breaking any speed records, but the best I've done in years. As long as I keep my heart rate below a 100 my stamina is pretty good. Having made one goal to climb the Tor (see Oct 15, 2009 post) my next goal is to climb the mountain up at camp. The family vacation is first week in August, so still lots of time to 'train'. I haven't been able to climb since July 2004, right before things really deteriorated.

It's good to have a goal.

The kitties and I are enjoying the household being back to normal without Oreo. Zerla is getting around amazingly well. She walks a little funny, almost like her hind end is a bit higher, but she gets around quickly and is jumping up on the windowsills without using anything. Since Oreo picked on her she seems to be particularly happy for the return to normal, frequently next to me on the couch. KC goes on these 'tears' in the house, usually the evening. The three other cats and I will be on the couch, watching TV. All of a sudden the thunder of pawsteps will start in the dining room, through the kitchen, past us, followed by a flying jump through the window and out to the porch, circling the porch, another flying leap back through the window, living room, etc. This is repeated at least once more. Apparently it's his daily exercise. After this he settles on the kitchen table and naps, always staying as close to the food as possible in case the feeding schedule changes.

Finally had to break down a couple days ago and use the air conditioner. I don't tolerate heat well. The other member of the household who doesn't like the heat is Chester--he can take even less. I discovered this at the old place: he would stop eating, be very lethargic; then as soon as it cooled down he was back to normal. He had been just laying on my bed the other night, but his head went up when I turned the window A/C unit on. He immediately jumped on the sill in front of it, blocking off the majority of the vents. After cooling down sufficiently on the one furry side, he turned around and put the other fuzzy side against the vents. After about ten minutes he appeared very satisfied, and settled down on the bed, lying at the corner where the air hits. Stupid animals my a__!

Have a probably tenant, but a few snags. She is on disability and gets a housing allowance from the county. So we're waiting for them to go through all the red tape. Once it's official I'll say more.

Thanks for checking in, Laurie

May 24: Full story and why so concerning

Today is the first day without my left hand hurting. There is still some tenderness at the first and second knuckles, hurts with pressure. But the right thumb, which didn't seem to be improving, is now almost completely normal. The skin looks slightly different but, again, is almost normal. Of the various cat wounds there are only faint traces.

Explanation: Oreo had been more stressed of late, pooping outside of litter box for the previous 2 weeks, which is always behavioral. I'd increased pressure on Eileen for help, was doubting at this point that John and all should take her in case the nine months of unhappiness left her personality changed. Chester's consistent bullying probably didn't help, although I've never witnessed more than rough play on his part with her screeching like a wimp. On Saturday, after picking up her poop (which is easily disposed of and cleaned up after) I noticed the towel on the top of my favorite antique upholstered stool was bunched up. Oreo had defecated there before and, as is natural for cats with a burying instinct, then pulled the towel over it. On going over to inspect this was not the case, instead she had urinated right smack in the middle of the fabric then pulled the towel over. I went ballistic. Anyone who has smelled cat urine will totally understand. She was calmly sitting on the porch. I grabbed her by the scruff of her neck and carried her, dangling and complaining, to the stool, then rubbed her nose in it. Her protests became louder, screeching and screaming, Tabitha and Chester came running in, getting right up in Oreo's face. She lashed out. I tried to hold her down, still wanting to punish her, as Tabitha really got in her face. Oreo bit and scratched both hands and the right wrist. It went through my head "Let her go, it isn't worth it.", at which point I threw her away from me towards the open window, Tabitha hot on her heels. I closed off both windows, then went to the porch to find Tabitha (the only cat who has been declawed!) being so ferocious that Oreo was cowering in the corner. I picked Tabitha up, brought her into the house and left Oreo out on the porch to calm down.

My hands were bleeding a fair amount at this point. On testing my INR the night before it was perfectly in range at 3.1 (my range is 3.0-3.5) which is substantially thinner than most people on coumadin. The biggest danger with puncture wounds is infection, because of the penetration into the skin and tissues. So I held my hands in the bathroom sink and let them bleed. After several washings I then put on a strong antibiotic cream and bandaids, called my primary care doctor's office for an antibiotic. Cat's mouths are more bacteria-laden than either a human's or dog's bite. While cat scratches occasionally get infected, almost every cat bite will become infected.

For those who are not aware, there are two major issues for people with mechanical valves. The most common problem is the formation of clots on the valve, which then flip off and get lodged in nasty places like kidneys, eyes and--most common--the brain, leading to a stroke. For this reason, every person who has a mechanical valve has to be on coumadin and aspirin to decrease the chance of clot formation. With the blood thin come other problems: injuries, trauma, surgery. Anything that causes bleeding then becomes a risk for more blood loss and uncontollable bleeding is a significant factor in death and disability in coumadin patients. So a fairly minor accident takes on a whole new set of fears, any surgery has to be delayed while coumadin and aspirin are stopped and another drug, heparin, is started. Heparin can only be administered by needle,has a much shorter action in thinning the blood and can be timed very precisely. Surgery is then timed for when the blood is normal. After the surgery the blood thinners are re-started with the hope that no clots formed during the time of surgery but also taking the risk that any place that was cut during the surgery doesn't start bleeding uncontrollably. It's a delicate balance. But uncontrollable bleeding is a high cause of death and disability in coumadin patients.

As if that wasn't enough to worry about, the other major risk is infection. Anytime a person has any foreign material in their body they have an increased chance of it getting infected. But, obviously, an infection in the middle of your heart is more severe than in your knee replacement. If any bacteria travel through the bloodstream to the mechanical heart valve things go very, very badly. Infective endocarditis on a mechanical valve is critical. Untreated, the mortality is 100%. Treated, mortality drops to 40-50%, which obviously still not great. Not infrequently antibiotics aren't enough and the valve needs to be re-replaced. I'm at greater risk because of the number of surgeries and resulting scar tissue, which attracts bacteria because it's different. Additionally, there is the repaired tricuspid valve as another site of bacterial seeding.

For the record, the above issues are the reason why the goal was to repair the valve rather than replace. This is why they tried three times during the first surgery and Cohn's first time in (my second surgery) was again a repair. Especially in a younger patient who will have more years to develop serious problems.

So, rapidly starting on antibiotics is critical for me. After the call to the primary's answering service was returned the next call was to the vet. My wish was taking Oreo to the SPCA for euthanasia but the vet tech talked me into bringing her to the office and boarding her for 24 hrs to calm down. I chose the latter if for no other reason than the vet office is less than 5 mins away and the SPCA , which I've never been to, about 30 minutes drive.

I started the pills within about two and a half hours of the bites. My hands were very swollen and painful. My thumb on the left was OK, the fingers on the right weren't bad, but then one on the right wrist was pretty painful. The pills were prescribed for 3/day, 1 very 8 hrs but I took 3 in a 12 hour period. When I went to bed there was discoloration, which I was hoping was blood collection since bruising is a way of life with any trauma while on coumadin. But when I woke Sunday morning the areas that were bad eight hours before were all worse, red and hot. While it appeared to be cellulitis (infection of the layers of skin) and wasn't streaking up the veins (much worse) there was no doubting IV antibiotics were needed. Off to the hospital.

Eileen took me; she had told me the day before she was available to help and the two other people I called weren't able to help. Just in the first two hours she was with me the redness moved almost 2 inches further up my left wrist. With the above information you now understand the conversation with the ER doctor. Fortunately the infection was contained and responded to the stronger IV antibiotics, there was no infection in the blood.

The danger is over, things are fine. I now go back to living my 'new' normal life of the last few years. But it's a reminder--for everyone in my life--how quickly things can change.

By the way, Eileen's ex-boyfriend took Oreo. She had sent out a feeler to him through mutual friends and he had gotten back to her Friday night. She couldn't find my phone number to let me know. Oreo is now an only cat and reportedly very happy. My four and I are happy to have a spat-free house back. But the stool will probably need to be re-upholstered, which there isn't money for right now.

Time to start typing and rest my hands. Will update other things later. Besides, the Flyers are leading 3:1 and a win will mean going to the Cup Playoffs.

Thanks for checking in, Laurie

May 18: Brief because it hurts to type

Saturday, May 15, Oreo the foster cat bit & scratched me on both hands. Story later. Let everything bleed until it stopped (to flush out bacteria), used strong antibiotic cream. Left Oreo at vet's, started antibiotics within 3 hours. Swelling, both hands left worse than right. Thought it was blood collecting under skin. Sunday am clearly cellulitis despite pills and cream. To Paoli Hospital. Really started spreading rapidly: 1.5 inches up wrist in 2 hours. After nurse in triage got history and saw my hands things moved rapidly: 90 second evaluation from ER doc (who looked about 15 yo). She came in almost immediately, just after I'd changed into the wonderful hospital gown and before nursing staff had gotten into the room.

ER Doc: "You have a St. Judes's valve in?"

LB: "Yup, 2007. After 2 failed mitral valve repairs."

ER Doc: "And you got bit by a cat? Did it have immunizations?"

LB: "Yup, I took her for them less than a year ago."

ER Doc: "OK, let's see them."

LB holds up hands. One second later:

ER Doc: "OK, you're admitted."

IV antibiotics incredible. Hospital room the nicest I've stayed in. Food really good. Nursing staff great. Out after about 24 hrs.

Hands dramatically better but still some swelling. Left hand a little tight, right thumb & middle finger still painful. Very tired. Two different antibiotics for a total of five times a day. One giving me reflux, but oh, well.

More later when typing a little easier. Laurie

May 3: General updates

Maybe I just needed to get back in the habit again. Appreciate Kevan and Deneen's comments. If a handsome Canadian Mountie showed up right now I'm sad to report that my first thought would be to get him to put the air conditioners in! And sometimes my lack of writing is that I just don't feel like being particularly introspective.


Kind of stunned when reviewing my posting before last it was March. So, what's been going on....

Audi sale went through without a hitch, although not as early as anticipated because of the seller waiting for financing. I've gone out of my way to put stuff in the empty bay in the garage so it's not quite as gaping an area. I've actually been pleased at how little it's an issue now. The actual release was the hardest, but now that it's over it's just over. There have been a couple times I've wished for it, but on the whole the Camry is just fine.

Working on refinancing still. Mom generously gave me some money, put some IRS refund money in, sold some things; actually have the home equity line monthly payment down so much now that it might not be worth the cost of the re-fi, especially with the aspect of having the Camry, re-doing the rental unit and Zerla's surgery being paid off for 15 years. Asked the bank how long the house appraisal is good for, may try to push back a few months and see if I can continue to get the principal down. With the prospect of disability in a few years it will be comforting to have as little debt as possible.

Tenant still an issue, and a major round tonight. He still hasn't paid me on time, his fees are mounting, at this point equal one month's rent, plus May. He's begging me to give him another month. Offering to hand over his paychecks to me for me to take a portion out and give him the rest. I told him I have to think about it. Someone else has approached me about renting, which may have a definite impact on my decision. He accepts that he has screwed up, but the biggest thing he did wrong was lie to me. If you know me then you know that lying is the one thing that I just refuse to tolerate. I've pretty much made up my mind to terminate the lease at the end of the month, but we'll see.

On the subject of the rental unit, let me address Deneen's comments from before. The house is separated into the first floor and second floor. While I'm doing the stairs with much more ease, there is no way I could live on the second floor and do them daily. They are quite steep, and it would mean hauling up groceries, cat litter, etc. Additionally there is the issue of just how much the market will bear. For this area, with it not being an entire house, it would probably only rent for $200 a month more. That's not enough to pay off the mortgage or do anything major about finances, certainly not worth the difficulty of dealing with the second floor. Also, the upstairs won't support a washer and dryer (the pipes are too small), so that would be laundry up and down. The kitchen in the first floor was beautifully re-done by Bidge and includes an apartment sized stacking washer/dryer, which allows for basic laundry without stairs. There are full sized units in the basement as well. So many reasons why the current arrangement is still, by far, the best and most realistic.

Oreo is still with me, but my cousins in NY are going to take her. The delay is that Emma has to find a home for the guinea pig first. Meantime, my lack of sociability may be affected by losing my meditative place to Oreo. She's out in the general population during the day but has to be separated at night because Chester finds it too irresistible to resist picking on her in the early morning hours. The hissing and yowling is not conducive to sleep. While I can put her in the enclosed porch for my quiet time, it still means having to set up everything, making the whole process seem more laborious. It's a production to set up the relaxing picture of the moon relflected in the water, the chalice and candle, special stones from Glastonbury and my CD player with meditation music, book of contemplation....yes, it's a rather extensive ritual. But during the deep breathing phase last night it became evident that incense needs to be coped with as well because the scent of cat litter is just not conducive to a deeply relaxing medatative state. Damn cat.

Tomorrow is Martha's birthday. John's comment tonight was that he just didn't know how he felt. Nothing seems right, not doing anything seems wrong, but he just feels like denying the whole thing. Lyle and Emma apparently feel the same. Making the timeframe more difficult is that Mother's Day is this Sunday. I had offered to go up, if only for a diversion, but it's on hold for now. My comment to him was that his instincts have been perfect through all of this, he would know tomorrow the best thing to do--or not to do.

An interesting note (possibly) on a reaction of John's which might offer some insight to others: he finds that he can't deal with her family. As he expressed it to me it's not that he doesn't love them, it isn't that he doesn't want to be a part of their lives anymore, it isn't even that he doesn't want them in his life anymore. He gets along splendidly with all of them, is very fond of her relatives. It boils down to not being able to react to their loss. His/my family is, of course, mainly concerned about him and the kids, regardless of how close any of us were to Martha we are still the in-laws, her loss is more indirect. This is much different from Martha's parents, siblings, nieces, nephews, friends....who are grieving Martha's death and how it directly affects them. This gave me perspective on the death of a couple friends in the past which lead to a loss of contact with the spouse. It isn't because the people who were primarily close to the lost loved one aren't important to the remaining family , but rather the need to insulate from other's grief. Hope he doesn't mind my sharing this and that it might give someone else an explanation for a similar situation.

Chrissy is now home, but in a lot of pain. The first surgery was done laproscopically (sp?), she was home the following evening. The next morning, Thursday, she used the toilet, and while turning to flush caught her foot on the bathroom rug. She fell, unable to react fast enough to protect anything, and landed directly on her stomach. This caused the incision sites to open up, to the extent that at least one of them had a small loop of bowel protruding--never a good thing. Idiot that she is (I actually used stronger terms when speaking to her today) instead of calling 911 she had her daughter drive her back to the hospital. This lead to the second surgery, having to open up the abdomen to correct the herniation of bowel, etc. She feels absolutely horrible, hasn't pooped in 9 days. So after telling her to eat pineapple tonight (contains enzyme that really helps with this) in addition to the three other medications for these issues, my stern instructions for tomorrow were that if there was not significant improvement she was to go back to the ER--there are times that an enema is really your best friend.

On that happy note I will sign off. Thanks for continuing to check in, Laurie