It's Been a Blue, Blue Day..."

Arnold, is that really you?  This is Bob Bartlett, Robert was what you called me 50 years ago.  Fifsty years!  CAn  you believe it!  I could believe it even though I would never have recognizd the voicae or he speech patterns.  But last year during  a trip to Utah I had made a special effort to visi his brotherReed and share a dinner so graciously set by Reed amd jos wofe Afton.  Afton wasn't sure she remembered me even though and Reed had double daated  with me and my wife.  The boys had lived across the street from us all through grades k ==-12 and into collevge.  Reed was a ear older thab nem /rkbert a gear  younger.As often happens with threesomes, I was often tight with one while on the outs witiih the oher.



So begins the Country-Western hit by ____________  which describes a syndrome common in the higher latttitudesnbut not so well known closer to the equator - Seasonal Affective Disorder or SAD for short.  SAD is one of those mental illnesses that are difficlt to someone supervising a SAD oersib ti aacceot.  But trdrstvhrttd hsvr frrtminrf yhsy proplr who seasonally get less and less sunlight suffer depressioin,listlessness, .  And in many cases, streatment with light psrimarily blue spectssru , will find smany of these symptsoms decresing and even disappearing.

What is the treatment for seasonal affective disorder?

http://www.medicinenet.com/seasonal_affective_disorder_sad/page2.htm

In addition to being key in the prevention of seasonal affective disorder, regular exposure to light that is bright, particularly fluorescent lights, significantly improves depression in people with this disorder when it presents during the fall and winter. The light treatment is used daily in the morning and evening for best results. Temporarily changing locations to a climate that is characterized by bright light (such as the Caribbean) can achieve similar results. Light treatment has also been called phototherapy. Individuals who suffer from seasonal affective disorder will also likely benefit from increased social support during vulnerable times of the year.

Phototherapy is commercially available in the form of light boxes, which are used for approximately 30 minutes daily. The light required must be of sufficient brightness, approximately 25 times as bright as a normal living room light. Contrary to prior theories, the light does not need to be actual daylight from the sun. It seems that it is quantity, not necessarily quality of light that matters in the light therapy of seasonal affective disorder. The most common possible side effects associated with phototherapy include irritability, insomnia, headaches, and eyestrain.

Antidepressant medications, particularly those from the serotoninselective reuptake inhibitor family (SSRI) family, have been found effective treatment for seasonal affective disorder that presents during summer as well as that which tends to occur during the fall or winter. Examples of SSRIs include fluoxetine (Prozac), sertraline (Zoloft), paroxetine (Paxil), andcitalopram (Celexa). Common side effects for this class of medications include insomnia, nausea, diarrhea, and decreased sex drive or performance. As with any other mood disorder, psychotherapy tends to accentuate the effectiveness of medical treatment and therefore should be included in the approach to addressing this disorder. In individuals who are perhaps vulnerable to the development of bipolar disorder, either light therapy or antidepressant medication can cause a manic episode as a side effect.

Since stimulant medications like modafin

Three easy pieces

Reading others’ adventures sometimes makes me wonder if life is passing me by.  I decided that I needed to write a little just to remind myself that isn’t so.  Here are a couple of snippets of the most recent 10 days of my life in no particular order or importance:

Get Well!

When was the last time you got a Get Well card?   From your hospital?  Maybe even they are beginning to think I’ve seen too much of the inside  of our hospital  lately.   In any case I’m taking it at face value and consider it a class act.

Drop Your Pants

I’m told that members of our culture  have many dreams in common.  In one common dream we find ourselves naked or nearly so while family, friends, and relations around us are completely clothed.  Last week I went one better. 

Carolyn and I attended a “Broadway quality” production of “The Book of Mormon” in downtown Sacramento.  It was a rainy evening and we had used my little travel scooter too much.  It finally ran out of juice just as we reached the theater box office.  As Carolyn pushed the battery-dead scooter, we could see we weren’t going to have time for a last minute run to the restroom. **

The play, the sounds of rain outside, the excitement of the crowd all made it impossible to ignore the call of nature.  We were on our feet the moment the house lights came on for Intermission.  We and a few hundred others headed to the doorway for relief. Suddenly,  I felt a distinct draft around my knees and more difficulty than normal moving my feet.  Yup, you guessed it. My wardrobe (specifically my suspenders) had malfunctioned.  With only a slight delay, we adjusted our hand holds (remember we were trying to carry 2 umbrellas, a cane, and my pants) and dragged me to the nearest men’s room where I desperately tried to layer enough  cloth in the suspender clamp mechanism to keep my pants up for the rest of the evening. 

_____________________________________________________________________________________

The Book of Mormon

Speaking of “the Book of Mormon”, I think the Church played a P/R card that was as brilliant as It was unexpected.  In the past the church may have sponsored pickets, nuisance lawsuits, or blanket letters to the editor when something as potentially offensive as “the Book of Mormon” surfaced.  This time the Church ran 3 full-page ads in the program.  The face coming off the page in the first ad  says “I’ve read the Book’; the second ad, “THE Book is always better;, and the third “You’ve seen the play… now read the Book.” It looks as if the Church is partially sponsoring the play.

              I predict that t there will be as many opinions about the play as the number of people who see it.  And the ratio of people offended to those who weren’t  will be unpredictable.  If you are offended by street language and crude descriptions you’ll have trouble with this play.  If you feel that no one, even God, is beyond  criticism(see Fiddler on the Roof”) you will find much to agree with.   But in all cases you will get more out of seeing it than avoiding  it.  Sort of like reading the original ”Book of Mormon”.

Night at the (Wax) Museum

Thinking way outside the box, the Mission Elementary School put on a play adapted from the movie
“Midnight at the Museum” which was adapted from a children’s book of the same name.  The plot, in case you missed it, involves historical characters represented in the museum coming to life and doing battle (small skirmishes, actually) with some children from the present who happen to get stuck in the museum overnight.  The play/show/book avoids dry history by posing interesting questions such as  relative firepower of pirates versus renegade cowboys.

Some very talented local musicians adapted a musical score and the way it was adapted to the stage allowed for few cast members or dozens, singers or not, dancers or not.  And the kids had to learn history like it or not.  Great selection and wonderful performance. 

**A couple days ago, I discovered a useful word in the Urban Dictionary that seems almost made for my situation:

   ========================= 
|| bladderdash ||

   ====================

---

1.       a mad run and/or sprint to the bathroom before your bladder explodes.

2.      the quick sprint or ‘dash’ to the toilet due to the combination of excessive drinking and poor planning
Julia made a bladderdash after she drank a whole two liter bottle of soda.

Faith in Humanity

Faith in Humanity

Two recent incidents have reaffirmed my belief in the basic goodness of people:

#1

Downtown Sacramento, lunchtime, one of the busiest pedestrian intersections in the city.  I was carrying a wallet overstuffed with 9 credit cards, drivers license.ID and $400 cash from $20’ s to $1’s to provide tips on our anticipated trip to New Orleans.  Carolyn & I had attended an office fund-raiser and had left to return home without even noticing that my wallet was missing.

Shortly after getting home our phone rang.  It was our dentist’s office asking if I had lost a wallet.  The question was so absurd that I answered “No” before checking. I patted an empty pocket and immediately changed my answer. The dentist’s receptionist explained that she had gotten a call from a young man who had seen and retrieved the wallet and was now trying to contact the owner.   We immediately called the number passed to us by the receptionist and arranged a time and place.  I could imagine all he trouble we were going to have cancelling and replacing all the credit cards and the drivers license.  Trying to fly while getting new ID would be a real pain and absorbing the loss of $400 would not be insignificant.

When we got back downtown, the young man was waiting for us. He handed us the wallet and wished us a happy weekend. Without even looking at the contents of the wallet, we offered him a reward. He wouldn’t accept it.  We finally got him to accept $40 tor lunch.

As Carolyn drove us back home, I checked the wallet’s contents. I couldn’t see that anything was missing or even out of place. The man had been totally honest.

-----------------------
#2 

Two days later, original travel plans still intact; we boarded a plane for New Orleans.  This was a time-share trade that we would either have to “use it or lose it” .  Carolyn was anxious to start her “retirement travel mode” having spent the past two months doing all the little thins around the house that had been awaiting her retirement. 

I, on the other hand, was more than a little hesitant.  You might be aware that I have Parkinson’s Disease, one symptom of which is difficulty in walking straight. As tourists we would need to transfer from our tour bus to a small boat or trolley or swamp boat, etc.  Even if Carolyn helped me, I was going to look drunk.  At our first transfer the tour guide called out, “We need someone to help this gentlemen.” No fewer than 6 members of our tour group, all strangers until now, immediately stepped forward.  One young woman took two steps forward, placed my hand on her arm and introduced herself, “Hi, I’m Amanda and I’ll be your guide today.”  During the whole week, I always had plenty of help getting where I needed to go-usually from perfect strangers who live half a continent away from my home.

By the way, New Orleans is a great place to visit!

Retirement Planning

The Planning 

With enthusiasm and a willing heart, Carolyn undertook the task of moving her planned retirement date to 2015 instead of 2025.  What was "sometime in the future" was now "NOW".  Years shriveled into months, weeks or even days.

Coming to grips with such a goal change was not an easy task.  Carolyn had to change some internal goals about positions and responsibilities.  She would aim for and discuss those revised  targets.  She had to review long range plans with appropriate outside consultants to ensure  that they didn't have unrealistic expectations about her part in them past 2015.    Of course no one can guarantee their own future availability but groups can develop a sense of future direction.

Carolyn also began discussions with CalPERS to tie down dates and assumptions.  Although many employees find this activity exciting, for Caarolyn it meant making major changes in her plans, Carolyn  found it difficult.  But she perservered.  Fortunately things turned out close to revised expectations.  

I continued to hold my breath.  Not until Carolyn showed up with official retirement papers did I r\believe it was going to happen. Even at her retirement party, I had my doubts.

The Move

There's a certain finality in clearing out your desk and saying goodbye to your colleagues.  You expect them to say they'll be in touch and really mean it but they're not as interested in our opinion on a decisions as they were two weeks earlier.  Your (former) boss , your co-workers, your buddies, all now seem much busier than you.  You didn't need to plan for so much time to wrap things up as you had expected.

Moving into your home/office also goes faster than planned but you find that your husband and all the people you want to call have busy schedules and they want to move on.  You pull out your trusty smart phone and To Do List and start jotting down the three things you remembered in the last 10 minutes.  You'll find that moving home to retire is both quicker and slower than expected.

And frightening.

Changing

Everyone retires a little differently.  Many people take off a mandatory 30 days or 6 months then come back into consulting positions that look identical to the position they just vacated.  Others, like me, take on a whole different list of job duties, salary structure, and work hours.  Carolyn wasn't exactly sure of what her situation was going to be but we expected major changes.

For one thing, we wanted to spend more time together.  She can't spend 40 hours a week in the office.  For another, my care needs continue to escalate which reduces her availabilities.  'Third, the job she stepped out of will necessarily change making it more difficult for Carolyn to just slide back into place.  

Retirement? What's Retirement?

Oh, and just one other "minor " change between now and 20 months ago.  It may turn out to be the most significant.  Yup.  Carolyn has retired!

The Decision

Carolyn has talked "retirement" ever since she started working outside the home.   But her career consisted of several bis and pieces covering almost as many specialties as employers  It's hard to make long range plans when you have no long range investments.

But when I retired in 2011 Carolyn had finally gotten a toe-hold with the Department of Childhood Education,  Not only was she now a part of the mature and well-known California Personnel Employees Retirement System Cal-PERS) but she is now in a major, professionally run retirement program.  w vested, diversely invest and a projected .  Her earliest retirement date that would be within her lifetime.  Because PERS is a defined benefit plan she could, by working until 2015, have a retirement  of 20% of her salary.  And 10 years later she could count on 40% benefit if she continued working.  And part of her medical insurance premium wold be covered as well.  Carolyn was trilled at having this benefit and began mentioning it in our family long range discussions.  What I didn't notice was that as my retirement date of 2011 became firmer, her retirement date was becoming more 2025 and less 2015.  After all, the benefit was much better , she loved her job, and she had a future.  She had beaten cancer 3 times now so she was even a winner in that aspect.

With my increasingly fragile healh, I was  beginning to question our assumption of how long we colud enjoy retirement together.  Just when Carolyn was seeing after 2025 s as golden ones I was afraid that I would be dead or severely disabled b 2025.  After a couple of serious discussions, we both decided that an earlier retirement might be called for.  

Gamely shifting gears, Carolyn began  targeting 2015 for retirement.

Whatever happened to 2014 (and most of 2015)?

If you look at this blog in a sequential or linear way, you'll probably notice a laarge gap between this entry and the one before.  There are many reasons for that ranging from being way too busy to fearing that I may suffer from overexposure.  I'm at heart a very private person but I also like to share information , thoughts, and ideas with others.  That produces a bit of a contradiction.  What if people read my blog and treat me differently because of what they read?  I sense that could be a real problem in my DMV series.   I don't know if my case would have gone differently without my blog but there's every reason to believe it might.

But I'm rapidly reaching the point in my life when it won't matter.  Not having a paid job I can't be fired or have my salary cut.  After I stop driving it won't matter whether I have a license or not.  Perhaps then I'll be free to be more open once again.

--------------------------

First, I'd like to dust off the old resume and quickly bring you up to speed about my health situation.  The easiest way to do that is look at my condition on January 26, 2014 about 20  months ago.

My vital statistics, "measurements of life" haven't changed worth noting.  Its nice to know that my weight loss has remained but not so nice that bursitis has also.  I still have Parkinson's but its beginning to get on my nerves.  I can still drive but I'm more nervous about doing so.

My various responsibilities and "jobs" on the other hand, have changed considerably..  The biggest change is completely resigning from the regional center consulting.  It was beginning to get difficult for me to honestly claim that I was earning my fee.  Another responsibility was playing the piano for Sunday church meetings - a responsibility I added this year and have just resigned.  Finally, I realized that the church newsletter I was editing was getting stale and taking too much energy to publish even in a poorly rendered state.  I will soon no longer be in town enough to keep up the paper so it too had to go. dOn the increase side I have gotten more involved as a Support Group Facilitator and I am definitely doing more as the Treasurer for the local branch Friends of the LIbrary. Overall, I would say my activity level could be as much as 50% less tha2 years ago.

My chances of dying took a significant jump recently when I was diagnosed with atrial fibulation or incomplete and inefficient beating of the ventricular atrium.  Left unattended this condition increases my chance for a stroke by 2.5 times and by a hemorhage maybe double.  Of course that's all theoretical if I die from a heart attack.  We'll speak in greater detail about this in another post.

I think of greater concern to me is mental agility or dementia.  I had understood that it was a minor portion of Parkinsons patients which have to deal with dementia, maybe 10% or so, like the general public.  But now I'm hearing numbers like 70% and I'm beginning to see that happening in my own world.  Ending the regional center contract was primarily a matter of forgetting from week to the next what I was doing or how I did it.  I see more and more of that with other things I do on the computer.  I will analyze this in more depth in an upcoming blog post.

++++++++++
need to research % of PP folks with dementia
risk of death with a-fib
impact of Carolyn's retirement

State of the Self - February 2, 2014

Presidents give state of the Union messages, governors do state of the state.  It's only logical that I come out with a state of the self message.  Here goes:

As of January 26, 2014 and for a man in my condition I'm in great shape.  My weight is almost exactly where it should be although it’s not distributed quite the way I'd like.  My blood pressure, pulse, and most other measurements are with normal limits of normal standards.  I do have sporadic sleep apnea, edema of my left leg, bursitis in my left shoulder, peripheral neuropathy in my feet, receding gums, cluttered vision, stiffness in my fingers, GERD, 20% hearing loss.  Oh, and did I mention I have Parkinsons Disease?  That supposedly explains why I can't walk or stand without assistance, freeze while walking or moving my arms, garble my words or speak so softly that you can't hear me anyway, am impotent and slightly incontinent, and have spells when I fall asleep uncontrollably. 

On the other hand I can still safely drive a car under good weather and traffic conditions,

play the piano for congregational singing, cook a simple meal or bake a batch of cookies, can ride a recumbent tricycle 25 to 30 miles at an average speed of 10 mph, chair a patient support group meeting, maintain a small web site, keep the books for a branch of the Friends of the Sacramento Library, and publish a monthly church newsletter.

My chances of dying are only slightly elevated from an average man my age, the elevation coming from swallowing difficulties associated with Parkinsons. With my poor swallowing ability I could easily aspirate food or water into my lungs and drown within minutes.  They tell me that like most people my age I will live for several more years becoming less and less capable and more and more dependent, that my mental functioning will increasingly limit my ability to interact with and enjoy friends and family.  After I am finally, thoroughly, and obnoxiously dependent I will die, probably timing my death for maximum inconvenience for the family.

I had appointments with my GP and with my throat surgeon last Wednesday so this is about as up to date as it gets.

Let's all have a happy year, okay?

The DMV and Me, Part II

in which the author again learns that being good has its rewards...

The DMV & Me

Part II

I might as well admit it right away – this isn’t strictly about me and the DMV this time.  Unlike my first story about the DMV and Me this one has several more characters a part of the drama.  But it’s still “them agin' me”

It started on one of those dark winter evenings that you can only get in the northern half of the state, when the sun decides it can’t support more than half a day’s work and therefore leaves you in the dark before you’ve even started thinking about going home from your job.  We were running late for dinner and picked what has become too often our one-star restaurant S*M’s Club.  Great food as long as you like pizza and great pizza as long as you like cheese, pepperoni, all meat, or all variety.  I can’t even remember if we bought anything of significance that evening.  In fact, at the time we didn’t know anything of significance had happened that evening.

It wasn’t until two days later that one of my grandchildren called my attention to the little slip of paper under the passenger side windshield wiper.  I could tell immediately it wasn’t a flyer for the local church’s crab fest.  It was a note from the county sheriff’s office, parking division.  We had been ticketed for (and I quote) “Disabled Space Parked in Stall Space.”  Turns out to be code for “parking in a handicap spot without displaying proper handicap identification”.  My first thought was “we finally got caught doing what we shouldn’t .  This slap on the wrist will make us more careful.”  My second thought was “holy Cow:  $407!!!!  $407 is NOT a slap on the wrist. I was so mad, I was sick. I simply filed it away and worked on some mindless chore.   Tomorrow would  be soon enough.

The next day I carefully retrieved the ticket to assess the WPR Worst Possible  Result of this deal.   No matter how I counted it, it looked like $407 was the greatest damage.  This was the minimum penalty and we could pay that and forget the whole affair.  But we had to either pay the fine or appeal the ticket within two weeks of the fine would be doubled.  I also considered the minimum damage:$0.  An appeal cost nothing.  I could file it online so that postage wasn’t even a cost.  But again it had to be done within two weeks.  No problem.  It was still less than a week since we parked so carelessly.

Believing still in bureaucracy, I composed an appeal  letter using the logic that we might have forgotten to hang the placard (and they had good photographic proof of that) but since we had a placard we would have taken the spot anyway so we didn’t displace anyone from his/her parking spot.  Carolyn looked it over and made some helpful changes, and I submitted the appeal.  I verified once again that we to EITHER appeal or pay the fine within 2 weeks.  I was even able to go back into their web site and see that the appeal had been received and booked.

Imagine then our surprise a week later when we got notice that we were delinquent in paying the fine and now had a $407 penalty and miscellaneous charges so our bill was now $823.50.  I sat down at the computer and immediately paid the bill.  Yes, we would definitely appeal that but this shouldn’t even have been a question.  Still, I didn’t want to see the bill double each week we were waiting for an appeal to be heard,  Carolyn patted me on the head and said she’d take care of it.  I believed she’d try if she had time but time is a rare commodity for her.

Over the next few days, I checked the website regularly seeing no change.  Then, we received word that our $800 fund transfer had been reversed.  Carolyn said she had called the office but had talked to no one.   She tried to explain the situations in a voice mail message and asked for a return call but it hadn’t happened yet.  The next day she was a little more persistent and finally got word that indeed they had reviewed our case and had reversed the whole thing.  We owed nothing. 

The reviewing officer asked why we didn’t have handicap license plates and we said we thought we had to choose between placard and plate.  The placards were just more versatile.  No, you can have both, he explained.

The visit to the DMV was almost a non-event.  I made an appointment online which minimized waiting time.  The instructions were clear and easy to follow, I had everything ready including removing the old plates.  I did have to laugh at the instructions posted at the entrance to the DMV.  There were three windows to check in at.  They read as follows:

All visitors without appointments All handicap visitors

All visitors must start here

All visitors with appointments Visitors without handicaps

The woman who checked me in explained that I, with a handicap and appointment, was welcome at any of the windows so I may as well use the one with the shortest line. I did but even the longest wasn’t much longer.   The happy ending is that at least for this vehicle, we should never have to worry about forgetting the placard again.

The DMV and Me

The DMV and Me

You’ll recognize the plot at once. It’s a story as old as mankind and a path virtually all of us must tread.  I’m talking about getting older; losing it; knowing what needs to be done but not being able to do it like we used to.  Of course it doesn’t happen just once but again and again.  Piously saying “I’m only doing it for your sake” the nurse, the boss, the wife, the friend each, in turn takes away a key, hides a bottle, revokes a privilege, or issues an ultimatum.  For some of us, such as those with Parkinsons, the path is long and the take-aways are many.  For those who die of sudden massive heart attack or rapidly spreading cancer, there may not be time enough to understand and appreciate the losses.

For me and the plot of this little tale, the events began with discussions of when older people should stop driving.  Discussions at church, work, support groups. Everyone has a personal anecdote or opinion.  I noticed some people who would find it more convenient to drive their own car rather than ride with me.  When directly asked these people wouldn’t say they found anything wrong with my driving.  Some of the people in the support groups I participate in proudly announced one week that they had voluntarily given up driving only to admit sheepishly the next week that there were just times when he or she HAD to use the car.  I began to wonder earnestly how I would handle the crisis.

I expected my crisis to happen in July since my drivers license needed to be renewed then, I thought I had dodged the bullet when I successfully applied on-line for the renewal and received it without question.  According to the paper I was good to go until 2018.  Two months later and over a week after my birthday, came a letter.  Out of the blue the DMV informed me that they wanted to carry out a reexamination of my ability to drive a motor vehicle.  It was, they informed me, for “my safety.”  From then on, everything the DMV did was “for my safety”..

The first requirement was to get my doctor to complete a 10 page medical summary. This was more extensive than I ever recall completing.  Fortunately I am a Kaiser healthplan participant and their Customer Services department knew exactly what to do.  Shortly after the DMV received the medical record I received notice of my in-person reexamination appointment.  Because the letter didn’t say exactly what was going to be reexamined, I called. A technical assistant assure me that the letter specified which test or interview I was being asked to attend.  When I assured her my letter did not, she agree to pull up her records.  “Well,” she equivocated, “when they don’t say which one, I guess that means you’ll get all of them.  That included a written test and a modified driving test.  I would also be interviewed for 30 minutes by a hearing officer to determine my state of mind and general cognitive abilities.  To this point it was all pretty low-key with the idea that I may have to have a “restrictive license” or take a remedial course. After all they’re only thinking of me.

It appears that some people do well enough at this point that their license is stamped “OK” and they go on their merry way.  But I was just beginning.  I got to take the dreaded “driving test”.  The pressure ratcheted up. 

On the test date, I felt slightly keyed-up but not uncomfortable.  The examiner was pleasant.  The day was beautiful.  I was shown the test and told that I could miss 20 of one group of maneuvers or only ONE of a small group of critical errors.  The pre-check of my car and pulling out of the DMV parking lot went well.  As the test progressed, I grew more and more relaxed.

Pulling into the debriefing parking lot, I sighed in relief thinking I had easily passed the test.  Boy, was I wrong.  The examiner lit into me like I had run over 5 kittens and a baby girl.  According to her, in less than 3 minutes I had committed over half the “critical errors” possible and 5 more than necessary to fail the test. When I calmed down enough to hear what she was saying it boiled down to my not looking over my shoulder before lane changes and turns.  I was missing the blind spot.  I certainly felt I had been blind sided.  I made an attempt to explain my practice and the controversy regarding blind spots.  That did not help my case as the examiner now felt I wasn’t even TRYING to pass the test.  The next day, as expected I got a letter saying my driving privileges were suspended immediately.

Feeling like I had been sucker punched, I found it difficult to focus on my life, deal with my Parkinsons, meet my obligations to others.  Fortunately, I have the most wonderful wife in the world who had already made plans for dealing with this crisis.  She had introduced me to a man 6 or 7 years my junior who helped me copy and fold the church newsletter.  Where I needed someone to do the heavy lifting Dave was there.  Now Carolyn suggested that David could be my driver while we “sorted out this mess”.  I knew that “this mess” could go on for weeks, months, or even years.

David has medical problems of his own but also has a great attitude and a willingness to make things  work out.  Although he would be getting paid as a driver, it meant some significant sacrifice on his part. Instead of sleeping  until 8 or 9 each morning he had to get up at 6, eat breakfast, make his lunch, and ride a mile and a half on his bike to be ready to drive me to my scheduled activity.  That activity might be a 14 mile bike ride or collecting and counting the cash from the local library lobby used book sales or a half dozen other things I’ve gotten involved in.  Overnight David was essentially asked to volunteer for everything I had volunteered for.  But he came through.  So much so that in many cases no one knew there had been a change in my mobility. I stayed involved in all my responsibilities and activities.

With that pressure off, I could concentrate on getting my license back.  The friendly folks at the DMV were more than willing to schedule another driving test for me (although it was a month in the future) and they seemed absolutely delighted that I was interested in a Special Instruction Permit which allowed me to drive again as long as a driving trainer, licensed Occupational Therapist, or licensed driver over the age of 25 was in the car with me.  When I received my permit in the mail David found that his driving duties were reduced at least by half.  He had “graduated” from driver to instructor.  I checked out what training programs were available for older drivers particularly inexpensive or free resources on the Internet. I was especially interested in those areas where I had made so many serious errors – lane changes and blind spots.

The next three weeks actually went by quickly. It turned out that David was a silver lining in my stormy cloud.  Having David along with me also provided a welcome change of pace. But I paid the price in loss of privacy.  Sometimes I felt like I was in the middle of a logic puzzle with three canoes, three chickens, three cannibals and three missionaries trying to cross a river without anyone getting eaten.  For example, I usually take two older women to church on Sunday morning.  But I couldn’t pick  up the women until someone over 25 was in the car but David didn’t want to ride his bicycle on Sunday mornings so he had to have someone else pick him up and bring him to our house.  Then we had to juggle walkers and scooters and wheelchairs.

Two days before my second driving test my neurologist called to schedule a routine appointment  During this appointment the doctor (and Parkinsons expert) made several references to my not being able to drive as my condition develops.  He couldn’t have lowered y expectations more effectively if he had been hired to do that.  

The first time I took the driving test this summer I was confident and became more so until the examiner punctured my balloon.  This time I was nervous and became more so as the test progressed. On the other hand, this examiner was much more personable during the test than my first examiner. About 3 minutes into the test he said, “Mr. Loveridge, we’re humans, not owls.  We’re not expecting you to turn your head 180 degrees to see your “blind spot”.  Look just barely past your shoulder like this (he demonstrated).  But it’s good to see you’ve done your homework.”

When the examiner told me I had passed I was so shocked that I couldn’t think to ask what was next. .  I had only 5 out of a maximum of 20 driving errors and NO critical errors.  I didn’t dare ask if I had heard right. I had.  Still, I didn’t want to publish this until the actual stay of execution (set aside of action) arrived in the mail.  It came with a built-in disappointment – I am automatically scheduled for a review one year from now.

You Lost Your What!?

You Lost Your What!?

As much as I disliked my trach tube, I realized that it would keep me alive should my wind pipe decide to again tighten up and reduce my available air intake as it did the first of this year.  So it was a sort of love/hate relationship.  And because the tube was there day after day, sun or rain, day or night, I began to take it for granted.  Oh, I paid close attention to it every morning after my shower to see that it was clean and that the collar holding it in place was snugly secured. But the rest of the day I didn’t think about it so much.

Which is why I was so surprised and distressed when while driving to a chiropractor’s office yesterday afternoon, I felt something unexpectedly bounce against my chest.  I touched it with my hand, then took several seconds to realize that it was my trach tube. M tube had fallen out of its hole and was being held loosely by the other end of the collar.   I pulled to the side of the road and made a sincere effort to reinsert the tube.  But without lubrication and a decent look at the site, it was an impossible task.  Besides, I was under no stress or breathing anxiety.  When I got back home and called my doctor’s office his nurse advised that I should sit back and relax.  She would notify the doctor,  I called Carolyn.

Carolyn called the doctor’s office with a little more urgency in her voice.  She convinced the doctor to  see me and assess the situation.  We rushed over to his office about 3.5 miles away.  The doctor pushed a fiber-optic scope into my nasal cavity and down my throat.  He verified that my pharyngeal opening was larger than the (now absent) tube.   There was really no need to replace the tube as long as I wasn’t in distress. We were exactly 2 weeks early from seeing the doctor about taking the trach out anyway.

 The next 24 hours were a little nerve wracking as I got to find out what it was like to breathe just with our usual equipment. But all is well (deep sigh).

I'd know that face anywhere

You know the term "Aha! moment".  It's when you see something new to you and suddenly you wonder how the world has gotten along without it.  The first time I saw a spreadsheet on a PC.  The first time I saw sound manipulation on a PC.  The first time I saw 3D graphics on a PC.  These were Aha moments for me, moments when I realized I had underestimated the power of computers that could be carried in your arms if not your hands.

I had another Aha moment yesterday when I had my first serious encounter with Face Recognition Software, which I'll abbreviate FRS.  Like many of my Aha Moments, I didn't go looking for FRS.  I was looking for  a program to keep track of the thousands of pictures we have in our family collection.  I want something that is capable of tracking picture by content as well as location and file name - the whole who, what, where, why, etc.  This is one of those times when I want the computer to not just give me what I ask for but also what I meant to ask for.

As a start I Googled "photo album software free" and got a nice list of "10 best".  The number 1 listed program was not produced by the organization that produced the list - one good sign that the list was legitimate.  And the brief reviews of each of the 10 pieces of software correlated with the scores.  Another good sign.

I was surprised, though, that the first program, the highest recommendation was Google's Picaso.  I had installed that years ago but could never warm up to it.  Maybe Google had upgraded it a little, I thought.  Have they ever!.

I didn't bother downloading the program although that would have probably been the best thing to do.  But Picaso noticed right away that I didn't have the latest and recommended that I update. I did.  Shortly the requested update was downloaded and installed and the program opened  up.  I was shocked to see dozens of my picture folders listed and hundreds of my pictures.  I hadn't asked for that.  The first thing I learned about Picaso is that it is one of  those programs that makes all kinds of assumptions about what you want and starts doing them, letting you change your mind and the  program settings later.  That's probably what turned me off about it when I first installed it.  This time I let it go.

I let it go because in front of my eyes I was seeing what you've seen on TV and theater shows where a face flashes on a screen followed by a dozen others and we see the computer's thought process in selecting a good match from its database.  The computer was building a database of my pictures as I watched.  It lacked the names or "tags" to go with the separate piles it was making but that didn't slow down the matching process.  I clicked on a picture of me.  The computer instructed me to key in who that was. I entered my name and verified that it was a new person for this database.  Pictures flashed around the screen and I was presented with 15 or 20 more pictures of me - some identical to the first, most slightly different.  I was instructed to X out those pictures that weren't Arnold Loveridge and confirm those that were.  Another dozen or more were added to the page.  Like playing a game of "Fish" the computer was offering me pictures that it "recognized" as Arnold Loveridge.  I was witnessing FRS.

Voice Recognition Software translates the spoken word into the written word.  But it has to be taught how you say things.  Likewise FRS translates faces into names.  But it has to be carefully taught.
With 98,427 catalogued faces, my computer's database has identified so far 1,449 groups, each of which may be a separate person.  So far I've identified 59 people, some with over 2,000 pictures in my computer, some with less than a dozen.  I have a lot more to teach the computer. And I suspect it has a few more surprises for me.

Here is an example of a picture analyzed by Picaso which identified each of the faces and then matched them with names in its database.

And here's a picture I retrieved by asking for one with my older brother Bernell and me in the picture.  The program even looked back several decades to make the match!

Dreams + Ability <> Success

This blog entry started out quite differently.  It was going to be the story of how local businesses help each other succeed.  And it really is gratifying to see how local businesses help each other.  But, in the end it was just not enough to overcome design flaws and incomplete plans.

It all started when we decided it w ould be helpful to have a bike rack on our Highlander so that we could transport Carolyn's bike as well as my trike if we wanted to go on a biking expedition that started anywhere but home.  Now that I'm riding my tricycle 3 or 4 times a week such a trip isn't out of the question.

I dropped into our local Sport Chalet which indeed had several bike racks.  However, the best one according to the sales rep was not currently in stock.  Besides, he said, I probably should talk to the experts at Rack and Road.  I couldn't believe my ears.  An unsolicited referral! Then he offered me a free license plate holder (advertising Sport Chalet, of course) which I took since the original one from my dealer was falling to pieces.

Next, Carolyn and I dropped in at Rack and Road and were told me needed an additional hitch receiver.  They didn't have that but referred us to Cole Fabrication, a local firm specializing in small welding jobs and whose motto is something like "If you can dream it, we can build it."  Shortly after we arrived and explained our situation, the lead worker Larry was discussing with the owner Jake the various potential solutions. They quickly weeded out the impractical solutions and Larry began preparing the pieces.

I have always been fascinated by welding, even to the point of buying little welding kits but never successfully welding anything useful.  That's why I'm in awe of someone like Larry or Jake who can make the whole process look effortless.

Within a couple of hours we had a new hitch receiver and were headed
 back to Rack & Road to finish our project.

We had had a good look at how small town businesses work together to provide big business customer service.

Unfortunately, here the story falls flat. To this point no one had bothered to actually check out the structural implications of a bike rack on the folded up chair lift.  For some reason the designers of the chair lift had included a spring mechanism that is bypassed when actually carrying a chair or scooter.  But in the folded up position the spring acts somewhat like the spring in a pogo stick.  When mounted as we had all envisioned, the bike would amplify each bump in the road making the car unsafe to drive, scaring the hell out of anyone following, and probably eventually ripping the lift off the back of the Highlander.   We didn't let it go that far, of course.  We returned the bike rack for full credit as it had not been used.  There was no  undoing of the welding, of course.  But hopefully we all learned a lesson about thinking things ALL the way through.

Long term illness

The problem with a long-term illness is that it is, well, long-term.  Days, weeks, and even months go by without any significant changes or mileposts that could indicate improvement or (dreadfully) deterioration. For instance, I have Parkinsons Disease.  I was diagnosed six years ago and have long ago come to terms with the idea that I’m never going to be “cured” from PD.  I have had and may still have ups and downs But Parkinsons has become a fact of my life.

The swelling (edema) in my throat especially the wind pipe, which sent me to the hospital twice earlier this year now Is likely to become a long-term illness.  This week I had appointments with my throat surgeon and two consultants concerning the long-term course of my problem.  Their short consensus "lower your expectations and you won't be disappointed:. Apparently my throat is showing some progress but not as much as we all would hope and it is premature to operate further or pull out my trach tub and G tube. I definitely have a passage through my windpipe so we're making progress. That means I'm in a "safe place" that should keep me from another crisis admission to the hospital even if the throat edema should start acting up. Basically all the doctors said the best course of action is "wait and see". Timeline: expect as much as a year and don't be surprised if that gets extended indefinitely.

As one of my friends told me when I said that I just want to get back to normal, "Face it, Arnold, for you this is the new normal."  So any time you want things to get back to normal all you have to do is define the current situation as Normal!

Well, at least that's the last ...

It's hard to believe that I've reached that delightful age when I can start beginning sentences with the phrase "Well, at least that's the last ..." as in "Well, at least that's the last time we'll need to put a roof on this house."  The shingles we used are rated 50 year lifetime but even if we only get 30 years out of them, I'll be 98 and probably won't be thinking too much about the roof.

Regarding the roof, we actually did it right this time - getting all the bids in a timely manner, checking out licenses and referrals, giving ourselves plenty of time to look around the neighborhood and city for comparable roofs, and not waiting until the rain is  pouring through the ceiling to sign a re-roofing contract!  After each windy day we canvassed the yard to see how many shakes had been blown off the roof.  We saw a noticeable drop right after Carolyn got on the roof (in the middle of a windstorm) and nailed the ridge line down.  But this year we started seeing the occasional shake on the ground after a storm so we thought the time was arriving.

The quotes we got were all in the same price range and about the same as what we paid for the first house we bought in Long Beach in 1970.  We have been getting quotes for the past five years, noting how some of the contractors didn't even last that long.  When we finally decided to move ahead, we had to wait 3 weeks to get on the contractor's schedule.  Then they moved fast.


The old shake roofing was removed and all remaining wood securely nailed down and replaced if necessary.












































Plywood was  laid down next on the entire roof and covered with roofing fabric (tarpaper).  That took a little less than 2 days.






























The contractor made quite a mess during the day but cleaned up everything before winding things up for the day.  The crew  varied between 1 and 6 people at a time.  it sounded like we had upstairs tenants learning how to line dance.







































A little over a week after they started, the job was finished.  The workers disappeared.

An interesting note is that the law (local? statewide?) now requires that a re-roofer ensure that as part of the scope of work, a home be equipped with a working smoke detector and a working CO detector.     I thought we had signed a statement to the effect that the contractor had complied but for some reason it wasn't with the rest of the papers when the inspector made his final inspection of the job.  So I answered the doorbell and answered the inspector's question about the necessary detectors.  Then I made a flippant comment about wishing I had checked out the job myself  but with my walker I didn't get on many roofs.  The inspector chuckled politely then added, "Well, you don't need to worry about this job.  Zimmerman always does excellent work."  I thought that was a great unsolicited comment.

Arnold's health notice (5/3/13)....

Arnold's health notice 5-3-2013:

Two weeks ago I had some minor surgery performed on my pharynx in an attempt to reduce the amount of "redundant" tissue which had sent me to the emergency room twice earlier this year and was the cause of my 19 days in the ICU or Telemonitoring Unit in January and February. The surgeons were cautious, conservative, not wanting to take too much tissue and not knowing how my pharynx would react to the surgery. At the conclusion they promised to look over the results in two weeks and determine the next step to take. Today was that promised observation and review.

The result - disappointment.

My throat continues to show redundant tissue, inflamed and waving in my breaths like strings of pennants at the Grand Prix. Waving and telling me, "Go ahead, remove that breathing tube and we'll treat you to another stay in the hospital when you can no longer get a good lung full of air." My surgeon shakes his head and says we'll probably need to be more aggressive when we operate the next time but let's wait for another couple of weeks and see if it heals more. Neither of us thinks it will. But another review date is set - May 21. This time we'll invite the senior throat surgeon in the department to join us and give us the benefit of his opinion. I ask that we set a surgical date now rather than wait for May 21. The doctor agrees.

Two hours later the surgeon calls. In setting up the surgical date he has found a "pharynx specialist" in the system and he'd like me to be evaluated by this man. l agree, of course. I don't know whether that will speed or delay the process but having more information can't be a bad thing, can it?

Tuesday, May 7, is the consultation date with this new specialist. Look for the next installment then.

Arnold

Arnold's health notice

Spoiler Alert: the following is an update on my health condition, a subject which has probably been given way too much coverage in the past three months.  The bottom line is that I’m doing well and, following currently  planned treatments, expect to be as healthy as one can reasonably hope for a 68 year-old with Parkinsons.  You can now comfortably skip the rest of this essay.

When I last reported, the life-threatening constriction of my pharynges  which was responsible for my 19 days in the hospital during January and February was still a puzzle to my doctors.  The constriction was possibly the result of infection, pneumonia, or allergic reaction to a medication.  A trach tube was placed to bypass the obstruction and the tube remains in place, an uncomfortable inconvenience.   While one part of me wants that out NOW, another part of me says it’s a small price to pay to keep me from another emergency admission and the possibility that I won’t make it in time he next time.  I also have a direct gastric feeding tube in place should my throat become so constricted that I cannot eat or drink normally.

Yesterday, my head and neck surgeon fed a scope into my right nostril and down to the problem area in my windpipe.  Comparing that to the way I looked last month and the month before, he recommended laser surgery to remove  “redundant posterior pharyngeal mucosa” loose flaps of tissue that appear to serve no purpose except make it more difficult for me to breathe.  Instead of having a wind pipe that is one inch  in diameter, I have one that in places is barely the diameter of a drinking straw.   When aggravated or irritated, even this small opening begins to close up. 

The surgery is scheduled for this coming Friday, April 19, around mid-day.  As currently planned, it will be on an outpatient basis.  That means no overnight stay in the hospital.  For the first couple of days following surgery, I will likely need to eat through my stomach tube.  Two weeks following surgery, if the airway has been sufficiently cleared and enlarged, the trach tube can be removed.  Yayyyyyyyy!!

A Place Called Normal

So I've been home now for 3 weeks.  This experience should be comfortably behind me, a part of my past.  Why, then, do I find that I am still caught in the complex web of healthcare?

Well, for one thing I still have a hole in my throat with a tube (trache) sticking through it.  Every morning I am reminded that I have to clean around the tube, change the dressing, and put in a new inner lining  in the tube.  I have to cap off the tube to prevent water coming in while showering and cap it with a different cap in order to speak without plugging the ceiling hole.  I worry that the stiff tube will take on water somehow and I could become waterlogged.

Another insult to my body is the G-tube sticking out of my stomach.  Just like the trache, this bummer tube reminds me that this is my third try to get it right trying to swallow.  If I begin to have breathing problems again, I will need to receive nourishment by g-tube or n-g tube.  Since I have already removed two G-tubes and more than 1 nasal gastro tube, my personal care physician is reluctant to remove this current structure.

My diet, while recently expanded to include almost everything I care to eat, is still restricted.  I'm to eat mostly soft foods and food with uniform consistency which makes it is easier to swallow.  Of course in addition to the precautions I take when I shower I have to watch how I change my clothes that I don't mess up the wounds.  Swimming is out of the question.

And how long does this all last?  Could be days, weeks, years.  The double hospitalization makes everyone a bit nervous.  If Dr. A says it should be okay to pull everything out and call me cured, and things go bad again, Dr. A will feel a personal loss of status.  One or two doctors have used "end of the month" in their reports making me think that was a sort of "out of the air" projection made in one of their case management meetings.  Whatever the magic date is, I don't have much of a choice but to wait and do all my exercises 

Follow-through

There used to be a time when patients bounced back and forth from home to hospital or from home to hospital.  Sometimes it got so bad that patients who needed almost no care were occupying some of the most expensive hospital beds.  Home health care (HHC) done right can solve 90% of those problems.
For us, HHC seemed like just piece of a complicated system  - excellent in its own environment and totally cooperative in the big picture.

To begin with, they were involved early on with my case from an early notification from the hospital.  Plans were developed during my stay so there were no last minute surprises or crises.  Supplies were ordered, shipped, and even inventories.  In fact a training at the home was possible using 100% of our own product.  A charge nurse coordinated all the units that we dealt with.  She was blown over by Carolyn's organization with regard to meeting all the caregiver's challenge.  Because of personal schedules, this charge position was shared by two nurses.  Saying we were the "best" patient/caregiver she had seen in her 32 year career, the case was closed.  We had successfully transitioned.

Our next visitor from HHC was thw Physical Therapist..  An experienced therapist brought a person whom she introduced as her replaeement.  She would be retiring soon.  This older therapist was well qualified but, seeing that Carolyn had put things together well, decided to start micro-managing.  I was battling with my inner self  not to smack her with some of her suggestions.  Then my aide said something that rang a bell with the PT and she immediately changed gears.  From the "ongoing assistance" mode, she shifted to the "advise and close" mode.  She wrote up her observations along with one or two suggestions and told us she was closing her part of the case unless we had reason to insist she come more often. We didn't.

Like the PT, the Speech Therapist found things so well organized that they moved immediately into recommend and close mode.  I had difficulty focusing on their recommendations after they shared with us the results of my Modified Barium Swallow test.  If I couldn't improve my score on that physical test I would probably never be able to eat another normal meal.  I did pay close attention to some swallowing exercises they shared with us.

Going one better than the visitors who came only once was the Nutritionist who held a telep;hone consultation.  She asked her pertinent questions, answered ours, our and gave us referral numbers if something new came up.  She also gave us permission to skip our 3:00 am feeding.

All in all a good professional team who accomplished their mission then left us alone.