Nannie: News

Yesterday we visited Dr. M again for the first time in a year. After Nannie's many reactions to cortisone in several forms (injections, orally, and in eye drops after cataract surgery) the spinal injections were abandoned. Dr. Will asked her to go once again and discuss the possibility of a nerve stimulator implant, which can be "sampled" for one week outside the spinal cord. The procedure requires a process. 

1. View a DVD of all the devices, procedures, and risks

2. Evaluation, required by Medicare, by a psychologist who determines if the patient is cognitively able to program the device that controls the stimulation

3. Assuming the evaluation goes well, an appointment is made with Dr. M, who surgically implants the temporary trial unit.

4. If the trial is successful, meaning that the stimulator improves the pain in the leg significantly, then the next step is to meet with a surgeon and make an appointment for permanent implantation.

The catch is that the stimulator will have NO affect on spinal pain or arthritis pain in other joints--only the nerve compression. 

After much prayer and several telephone visits with wise friends, Nannie has decided to move forward with the psychological evaluation. I made the call for the appointment and the assistant responsible for those appointments is out of town. We are clearly on a new journey and the first step is on "pause". 

Bag of Sunshine

My Daddy, Dubbie, dearly loved candy of all kinds. Hard candy was a big weakness and he had the dental work to prove it. In the category of hard candy, his very favorite was Lemon Drops. I don't remember too many days when the candy dish was empty of them when I was living on Mulberry Street. Since he is living in heaven now, and not on Mulberry Street, the candy dish has been empty. But our friend Mindy decided to do something about that. Yesterday she brought Nannie a GINORMOUS bag of lemon drops. It was like sunshine to Nannie's soul. Thank you, Mindy.

Neurology Report

Today’s visit with Dr. T, who is a former violin student of mine, was good. He let Nannie talk, checked her limbs—reflexes, strength, mobility and flexibility, and scheduled a new MRI. The last MRI is almost a year old, which is obsolete in neurological years. He is specifically looking for all the troublemakers in her spine, although the pain indicates that her spinal cord is not involved. The pain in her leg and also in her spine indicates that the problem is below the area of the spinal cord. Dr. T did not subscribed 100% to the idea that the L2 nerve is the sole culprit in producing pain. Rather, he wants the new MRI to look at all the evidence.

Dr. T’s position is that her spine is old and worn out. Not a very nice thing to say, but something that happens to most of us, because the alternative is, well, not being alive, if you know what I mean. So he used a model and explained vertebrae, discs, the cord and nerves, fluids, etc. He had studied her previous MRI’s and x-rays and was thoroughly informed through her records and visits with Dr. Will and Dr. M, who administered the injections that gave her some temporary relief. I was impressed. He was kind and respectful and totally changed the subject when she began to complain about two previous doctors, one of them a neurosurgeon. When she persisted he politely shut her queries off by saying that it was not in his job description to know another doctor’s reasons for his decisions. He made no offer of surgery, but on the contrary, suggested that depending on his discoveries in studying the MRI, an implanted nerve stimulator could be a good option. Dr. M would do a procedure that would allow her to "test drive" it. Dr. T would do the surgery to implant.

The MRI is scheduled at 7 a.m. Thursday. The follow-up visit with Dr. T is Election Day. The MRI is exactly where Nannie wanted to go and does not interfere with her shampoo and set appointment. YES!

Tomorrow

We are told in God's Word that tomorrow holds enough trouble of its own and that we should not worry about tomorrow.
Matthew, Chapter 6: 34Therefore do not worry about tomorrow, for tomorrow will worry about itself. Each day has enough trouble of its own.

Tomorrow is an important appointment for Nannie. She will see a neurosurgeon concerning her spine, which is causing her great pain. Several years ago she received a diagnosis of degenerative disc disease, untreated scoliosis, stenosis caused by arthritis and osteoporosis--all resulting in nerve compression. Last week she was walking through a store and felt a slight snap and felt almost debilitating pain immediately. Her prescription pain medication and a massage today helped her through the resulting week of pain.

Our prayer is that this new doctor will see some minimally invasive procedure as the answer to the nerve compression. She is still a very alert and relatively active 87 year old woman who drives, runs her own errands, and helps many people in need, as the pain allows.

Some of my friends had a precious Mom who died a couple of years ago from pneumonia. The pneumonia was a secondary problem beginning with spinal stenosis, arthritis and degenerative disc disease. Fractures appeared in her spine, resulting in horrible pain and nerve compression, and she was finally unable to move freely, spending her last years in a nursing home reading books. Sometimes just reaching for a book would cause a fracture. The pneumonia was a blessing.

But, tomorrow, having enough trouble of its own, also has victory of its own. It is that victory I am seeking for Nannie.

Two long days

Last February, I was diagnosed with a slipped disc in my lower back and three herniated discs in my neck. After lots of therapy and lots of prayer, the discomfort is mostly under control and frequently absent all together. However, after a weekend of rehearsals, a week of teaching and practicing, and another three days of teaching, I decided Wednesday evening to take one, not two, muscle relaxers after lying in bed for 45 minutes and not finding a comfortable position. The drug did its stuff and I was sleeping like a baby, planning to do so until late Thursday morning, the first day I had the chance to sleep a little later and not be at an early event.

One hour after I took the muscle relaxer, the phone rang. I don't remember much, but found myself sitting up in the bed, trying to find the source of the music (ring tone is set to Vivaldi) and had the light turned on. I intercepted the call during the message phase and it was a friend of my Mom's, who had driven Mom to the ER. She told me that she had severe stomach cramps and they were already in the exam room, seeing a doctor and an IV was inserted with something for pain. I remember saying that I was afraid to drive at that moment and would be there as soon as I could. After about 45 minutes (normally a 10-15 minute trip) I arrived in a sorry mental state to find Mother groaning in pain with a great nurse who informed me that the IV had pain killer, anti nausea, GI cocktail, and saline. Mother's friend left when the blood work labs returned and nothing showed up.

After forcing her to drink dye for a CT scan, which revealed a badly distended bladder and led to testing for a urinary tract infection, she was catheterized and in about 2 minutes 1600 cc's of urine flowed freely, which the nurse and the doctor thought would eliminate the pain. It didn't. She was released with a prescription for an antibiotic and orders to follow up with Dr. Will, given one Levaquin, and after 5 hours we came to my house. She slept for two hours, woke hurting again, and the pain was worse this time. I tried to call Dr. Will off and on for 2 hours, reaching the answering service too many times and leaving too many messages. I could not leave her alone long enough to get the medication at the pharmacy.

At 11:30 a.m. Dr. Will's office asked to have her admitted to the hospital and managed to reserve a room. We were at the hospital 20 minutes after receiving the call, but the admissions office was backed up terribly and working short handed. An hour and a half later, while waiting in the car with a simple grain bag I had heated in the microwave at my house, the pain stopped. Then admissions called my cell phone to say they were ready for her.

It was 9:30 p.m. when I finally left the hospital to come home. My almost-brother, GW, was with Mother for hours and stayed with her while I taught a group lesson without my violin. The labs, scans, and tests showed nothing unusual and she was given a ham sandwich to eat at about 7 p.m. , which she tolerated very well. Nothing unusual happened this morning after she ate breakfast, which was delivered very late. Lunch was on time, but she wasn't hungry yet. Dr. Will visited after 1 p.m. and she was released, which took over 2 hours to accomplish.

Late today at her home, Mother received a call from her friend who drove her to the ER. The friend's daughter commented that the pain Mother experienced seemed much like hers when she had a blockage due to adhesions. It was a light bulb moment. Mother had very serious surgery removing 18 inches of colon six months following a ruptured appendix about 23 years ago. She also had a complicated removal of her gall bladder resulting in an 18 inch incision, and that was 12 years ago. We never thought about adhesions. I don't intend to think about them much--just pray that they dissolve and break down.

About 30 minutes after driving Mother to her house, Muffin and I were overwhelmed with fatigue. That two hour nap was the best medicine dispersed in two days.

Change in the Wind

Tonight there is a change in the wind. Yesterday the wind came from the East and was hot. Today it was from the South and was warmer still. Tonight we have a North wind and tomorrow the forecast is for gusts up to 40 mph and coolish temperatures--low 80's. In Texas this time of year we call that a cold front.

Today is Nannie's 87th birthday. I called her this morning and she had already had a visitor. By tonight just before 9 p.m. she had a steady stream of calls and visits with gifts, complete with flowers, offers for free lunches, and a massage. She also decided that she wasn't feeling so poorly after all the exercise last night and will meet me at the gym in the morning for the senior class. Like I said, there is a change in the wind.

Hallelujah!

Foiled Again

Age has its perks—senior discounts (not old enough yet), respect and reverence (waiting on that one, too), wisdom (put my order in a long time ago). But today was not one which offered the perks.

Felt every bone in the body early on today, probably because it’s been 3 days since I worked out. Would do that tomorrow but I begin teaching for the fall semester and that will be for 8 hours and 45 minutes, with a short break for lunch.

Age is not in my favor with Nannie. She had agreed to meet me at the gym and consider my advice to spend one, two, or three days a week with the trainers who teach Active Living for seniors. However today she overdid her time on the stationary bicycle at her home and has now decided that she will not try anything new that might cause her to hurt.

Scratch that idea. It was primarily to help her get involved with new people in a new place where she had not built an album of memories with Daddy. But, no deal now. It may hurt.

However, the day was not lost. Upstairs is ready for the next visit. Muffin made the yard look fabulous. Reunion group was great, with lots of good prayer taking place. The Cheesemyhead family is coming to visit later this month. Most of what I need is in place in the studio for tomorrow’s first Fall lessons. Downstairs carpets are cleaned with foil still under the table legs. Foiled again in more ways than one.

Nannie: Medical update

Today Nannie’s appointment with Dr. Munton was at 4:30, but she wanted to be there at 4:00. I pulled into the drive at 3:58 and she arrived about 4:10. They called her in right at 4:30. He had read her chart before entering the room and asked how she felt today. Answer, “Hurting”. It was 5:20 when we left and she did most of the talking about matters unrelated to health, but it makes her feel better to talk, which I hope this office understands by now. They had clearly had a long, perhaps difficult day, and were very tired, but listened to her until she really got off the subject. Dr. Munton reins her back in very nicely and helps her focus on the subject at hand. I’m so grateful to him for that.

His consensus is that the injections are only giving her short term relief now and are causing more side effects than long term benefits. The spine is such a mess, but from the previous success of the injections they know for sure that it is the L2 nerve that is causing her the most unbearable, burning pain down her right leg. He asked her which surgeons she had seen in town and completed paperwork to send to a new one, faxing records and test results. It may take up to 2 weeks to get the appointment when the Labor Day holiday is factored. The surgeon is Talmadge Trammell, a former violin student of mine, who is a neurosurgeon. Dr. Munton’s theory is that now that he knows the L2 nerve is the pain center, perhaps a disc can be removed that will alleviate the pressure on the nerve and the resulting pain.

This is how Dr. Munton narrowed the options:

1. No longer having good long term results from injections, plus reacting to the cortisone
2. Reactions to medications are unsatisfactory and complicated (Lyrica and Cymbalta did not work, causing some side effects. Pain patches unsuccessful and are very powerful medications which require careful withdrawal. Only med that gets results is hydrochodone, which is causing side effects such as loss of appetite, weight loss, sleeplessness. Keep taking the antidepressant.)
3. Back brace may help by compressing the nerve into a comfortable position. He wrote a prescription for that.

Nannie really balked at the idea of surgery and began to voice many objections. He stopped her and asked first, if she objected to pain and suffering, then asked what she feared most about surgery. She began to cry and told him she feared losing her independence if surgery resulted in paralysis or further injury. He told her those are valid fears, but that her quality of life is pretty low now. He also told her he wished he had a magic pill, injection, or procedure that would take away all the pain and leave her happy, but he does not. I so appreciate his honesty and compassion toward her, and his willingness to continue trying to find a solution. He told her that when her body protests and she can’t move her body to help her get past the pain of missing Daddy, that she needs to use her mind. She cried more and explains that when she hurts really badly she can’t concentrate to crochet or remember what she reads.

Please pray for Dr. Trammell, for Nannie, and for pain free days and nights. She is very tired, and some of her strong will is broken. We’re giving thanks for Dr. Munton tonight.

Nannie update

She had two “episodes” while we were in AZ with heaviness in her chest and pain in the chest area. The EKG on the day of the spinal injection showed some irregularities. The episode yesterday was severe while she was in church. Upon arriving home after midnight last night, I made some calls this morning, but she had beat me to the punch and made the appointment herself. However, GW told on her to me during our drive home, so I had information she was willing to withhold from the family doc today. Namely, that the pain with these episodes is severe enough that she has considered calling 911. She spends too much time crying on his shoulder and too little time giving him specific symptoms and information, in my opinion, but Dr. Will is extremely patient with her and always blesses her. She told him the only thing wrong with her is that her heart is broken since Daddy died.

Bottom line is that today’s EKG was compared with last week’s and one from 4 years ago. They were very similar. Her “normal” heart rhythm is that every 3^rd or 4^th beat is abnormal. But that’s consistent.

Last week’s episode was followed by taking a sample medication, Lyrica, prescribed for nerve compression pain. She gave it back to Dr. Will, saying she was sure it caused the heaviness in her chest. He doesn’t think so. Neither do I, because she had a mild episode in the office today, following the EKG. I think this is an anxiety attack, but she takes an antidepressant already-- in a low dose.

Prescription for today included nitroglycerin tabs, in case this is a heart problem that is masked. If she has other episodes he will likely do a stress test and/or CT artery scan. The injection is doing its workout and her pain level is considerable reduced. We’re very thankful!

Update on Nannie

Yesterday at 2:40 p.m. she received another spinal injection and experienced a great deal of pain late in the evening. GW stayed with her for the remainder of the afternoon to be sure that she had no adverse reactions, did not bend or lift. He took care of Scooter, who is there to take care of Nannie. Go figure. (Scooter somehow got an infection, quit eating, got very lethargic, had a bad blood test result, and is taking meds three times a day.)
Anyway, she had a rough evening, taking lots of pain meds, but today is better. Boo talked to her and heard some of the nursing home stories again, but her symptoms are manageable today, her legs are not hurting, and her back pain is responding to the regular pain meds. She has decided to not take the newer sample med again since it made her so sleepy. Prayers always appreciated.

Update

Nannie saw Dr. Will on Monday. She is still losing weight because she is nauseated most of the time. He prescribed a new pain medication for her, even though she has an appointment in 2 days for another spinal injection. Hopefully she will not need as much of the original pain medication and will be able to eat more. She still struggles with side effects from meds, with some depression (she's taking an antidepressant), and with thoughts of Dubbie's personal items which are remaining in the house. JB is in town for a couple of days, working and staying at our house. I praying that he will be good medicine for her. She wants so much for him to be able to wear my Daddy's handmade boots--says she cannot bear to give them to someone who did not know him.

At 2:30 CDT on July 24, please pray that she will experience no ill effects or reactions from the injection. Thank you.

Nannie, Part 2

Perhaps it is because she sat mostly idle at Dubbie’s bedside for 2 weeks. Perhaps it is because she likes to be active. Perhaps she is remind too poignantly of his absence by looking at his personal belongings. For whatever reason, Nannie is in “purge mode”. She gave more items to two of the granddaughters today before they left town, and sent some with them for me and for the great-grandchildren.

For both of us the most difficult day of the sum of difficult days was his admittance to the nursing home. I wrote this on that day, almost exactly one year ago.

Wednesday, June 20, 2007

I am home. Just downloaded Chris Rice’s “Short Term Memories” so I can hear Come to Jesus and cry while I’m alone. It was so good to see Daddy cognizant and alert again today. Last Friday morning at 2 a.m. on the way to answer my parents’ call for help when Daddy fell for the fifth time in two days, I heard the Lord say we were on a journey that wouldn’t be all unpleasant. Yesterday I asked you, Father, that Daddy would regain his dignity, peace and reasoning. Thank you. Thank you for victory in this journey. Today I ask that Mother, Daddy, I and all my extended family will regain our joy. Abigail is asking what we will do without Dubbie. It breaks my heart to hear it spoken. I want him to fly to you, Father. I want his only visions and dreams to be of your kingdom and your power and dominion and glory. I want Him to be familiar with your realm before leaving this one. Thank you for giving what we ask. I receive it for him.

So, I thank you, Father, that my mom is moving, not stagnant, and moving forward, not backward, and that she is thankful even in loneliness. You are good. The journey was not totally unpleasant, and there has been wonderful, beautiful music. Amen.

Nannie

Nannie 6_17_08

The title of this post is very strange looking. We have always referred to my parents as Nannie&Dubbie--one word. Without him her name looks incomplete. I know she feels incomplete after 661/2 years of marriage. The past year has been "practice" in staying by her self at the house, in attending church alone, in driving alone around town to errands. There have been places she simply has not wanted to go without him--concerts, visits, some functions even at church. I cannot blame her at all. She didn’t want visitation to be at their church because she didn't want to remember the casket at the front of the church. Thankfully, we had the burial ceremony prior to the service. "Taps" played as the VFW Post representatives quietly folded the US Flag, knelt, and presented it to my Mom, along with a Bible, "on behalf of a grateful nation in thanks for his service to our country."
Today, Nannie said farewell to the TX coast relatives, then called Kak and Joy over to help her sort through personal belongings. She sent all Daddy's ties, suits, jackets, knives and a few other items home with them. They brought some of Nannie's things too-yarn and crochet hooks, wall plaques, my Grandmother's engagement bracelet. It is almost as if she wants to erase the part of her that aches in remembering. I'm concerned that she is making too many changes too quickly, but I also understand her desire to move forward. Three weeks ago, moving forward was too painful because the alternative to watching Daddy as he lay struggling to breathe was unthinkable. After 13 days at his side night and day, my mom deserves to move forward, however slowly or quickly she chooses. Since I have always been more like my Daddy, I do not expect to grieve as my Mother does.
She had plans tomorrow to bake with Abigail, who is in high demand at her Tae Kwan Do studio, preparing to leave for an exhibition trip. Baking day is postponed. Joy and Kak may take her to lunch before they leave town. They drove her to the cemetery today, and reported that she cried a little, but stayed strong. That's our Nannie. My Mother has always been strong in making decisions, following through, standing courageous and enduring pain. I am confident that will not change.

Muffin drove back to work tonight. His first appointment for PT on his shoulder is Friday morning. After he left this evening, I consolidated the remaining food, washed dishes to return to generous folks who have provided meals for our family, swept the walk and porch until I realized another storm is brewing, and vacuumed my carpets. Our girls are watching old movies. These things too, will not change.