OUR ALMOST TRIP TO EUROPE

Germany, Austria, the Czech Republic

 Yesterday we would have been
 





on the Danube River

Today,  traveling the Glass Road 






 through Bavaria

Tomorrow, exploring Prague

Way back in January we signed up to go on this tour, organized by a Unitarian Universalist friend, a retired college professor, who leads a group every year. Tom's last trip to Europe, specifically Germany,  was with the US Army,  years ago and I spent a study summer in Europe my Senior year in college more than 50 years ago.  Neither of us has been off the North American continent since, even on a cruise. We were excited, Tom less so because he thinks of a cookie cutter tourist-y trip as a trendy extravagance. 

But he said yes, to please me, and we paid for the trip a little along till we had the whole thing paid for. It was truly inexpensive for that kind of trip, because Don takes no commission. Everybody just pools their money and he gets the best deals for everything--and after all these many years, he knows where they are.

So we got 449 emails from him. He updated the itinerary.  He sent us the menu for our Mozart Concert Dinner.  He presented us the option and we voted yes to adding a visit to Dachau to the original list of sites. We received travel tips on what to wear, what to carry, how to pack, what and where to eat. We were educated about the currency, cell phones, rest rooms, shopping, electric converters and walking shoes.

Then Tom's gout/stress fracture happened.(See posts about Differential Diagnosis) That was at the end of June and we had till mid September to deal with it--13 weeks--so we weren't worried.  The foot would be well long before September 16th--our departure date.  July came. July went.  We attended the trip party and met our fellow travelers. The foot continued to swell and hurt. We purchased and began to read Rick Steve's travel guide to Europe. Things grew more peculiar as the foot stubbornly refused to get better. August came.  We bought our euros, after much consultation concerning how many we might need. Then, on our fourth visit to the orthopedist, exactly three  weeks before our plane was to leave for Munich,  Dr. B. found the second fracture!  And so our trip preparations came to an end.  Top priority was to find out why two fractures and to get the foot well.  Tom could not look forward to spending half the trip in a hotel room 
 


while we hiked to Hitler's Eagles Nest 

or walked through the Salt Mines, places where he would be unable to go.



We did recover some of our costs.  On September 2nd, 14 days before the plane flew, we found a good friend who was willing to buy the trip and some of our euros. We gave him a good deal and he found a friend to go with him.  She applied for a  passport renewal and received it 4 days before the departure date. We lost the cost of the plane tickets to Munich (unless we want to go sometime this next year.) and they had to fly out a day early because so many flights were full by September 9th, the day they booked, it was the only one available. But they made it and promised to return with many pictures, as did the rest of our fellow travelers. 

The group returns at the end of this week. I hope they bring me awesome I-feel-sorry-for-you presents.  They all said they would, but I don't know how long before thoughts of those they left behind were crowded out by the new experiences they have been encountering. 

Neal, Pat, Don, Carol, Jerry, Annie, David, John, do you hear me?

Differential Diagnosis II

More Medical Adventures

This week brought some good news and some interesting twists regarding our health status.

Odd how, with age, this topic becomes more and more the subject of conversation.  I remember how I used to dread asking certain members of our family how they were, lest the inquiry unleash a torrent of unwelcome detail about their various ailments. Ah, well, so here goes......

We returned to Doctor Burnworth's office for the results of the bone density test. The good doctor shall be referred to hereinafter as Dr. B, having so named himself in his comments to my first post on Differential Diagnosis. You might want to read those in his lively exchange with Tom below.  The happy news was that Tom had passed the test. He is dense--from head to toe.  This is actually no surprise to me. He eats well and has been an exercise fanatic as long as I have known him, so seemed an unlikely candidate for osteoporosis.

 Dr. B's diagnosis, a differential one now, having eliminated the first possibility, is that Tom's second fracture was caused by his total inability to obey doctor's orders to stay off the foot as much as possible, to walk carefully whenever walking is necessary, to elevate it often, etc., etc. This too is no surprise to me.  He doesn't ever follow my advice either. Tom marches to his own drummer. His x-ray showed the fractures healing well and he will be out of the boot in three weeks.

My own medical adventures began on Saturday, when I decided to take a nap, and was thunderbolted awake from a deep sleep by a whole-body jolt that threw me straight up, slap out of my chair.  It was like I had been hit with a defibrillator! Well, since I've never been hit by one, I guess I need to say it felt like what I imagine it would be like. Before I could even begin to process what had happened, I had an asthma spasm and couldn't breath!  For about 8 seconds I stood there, realizing that it would do me no good to find my inhaler--the attack was too severe to have been helped by such a puny rescue device.  Suddenly it let up, thank God. I could breathe again! Just as I began to feel safe, another spasm grabbed me and lasted for an awful 10 seconds. Long enough to make me wish I had cleaned the house that morning, or at least straightened up and emptied the trash.

Way shaken up, I sat down in the chair and tried to decide if I should wake Tom up from his nap to ask him to take me to the hospital.  While I was trying to decide, I thought I would test to see if I had had a stroke--possible cause of the body bolt, maybe.  So, standing in front of the bathroom mirror I tried to remember the three- part test to identify a stroke. Smile.  Is it crooked? Well, mine already kinda is anyway, but I looked to see if it was a lot more one sided. Stick your tongue out. (Was that one of the tests? What about your tongue? Was the test if you could move it in and out easy?  Well, I could) Hold your arms up over your head  I totally could not remember what about your arms you were supposed to look for.  I resolved to review and really learn the tests, cause sorta knowing doesn't help.  My diagnosis, maybe really my wishful thinking, was that I had not suffered a stroke.  Nothing seemed amiss, except that I was weak and scared.

Not long after, I was recounting the events to Tom, now awake from his nap. To his insistent plea for me to go to the hospital, I said no.  After all, nothing weird had happened since.  And now I felt fine.  Besides, what would I say when they asked me about my symptoms?  I got hit with a thunderbolt? How foolish does that sound. I know that women's heart attack symptoms are unusual, but that's a little over the edge isn't it?  It seemed just embarrassing to have had such a weird body experience--and I didn't want to have to try to explain it in case folks would think I was a crazy old lady.  I just wonder how many women don't go to the hospital when they should because their symptoms are unusual or vague.  Maybe they are afraid folks will think they are foolish or they are just complainers or that their symptoms are imaginary.

After a perfectly normal Sunday, on Monday I stopped at the drug store on the way to work and, while there, decided to let Jason, our pharmacist give me my flu shot. It briefly crossed my mind that it might be a bad idea, considering the unusual goings on from the day before, but, not really.... Jason did say he would call to check on me in a little while, to be sure there was no adverse reaction.

I was at the office by 10. In the middle of a busy day about 2:30 I was hit with a wave of nausea and dizziness. I felt myself fading away into a faint, so stood up and began walking around, announcing in a calm voice, that I did not feel at all well.  I went into Tom's office to lie on his couch and call Jason, who found no such side effects mentioned in the flu literature. Lie down, drink water and call me back in 10 minutes, Jason had said. As I lay there, with the room spinning and sick as I could be, and with folk fluttering around trying to be helpful,  I finally called my primary physician.  When I recounted my worsening symptoms, and those from Saturday---she told me to go immediately to Providence Emergency Room to explore if I might be having a heart attack.

Finally convinced, I told Tom, who grabbed me and ran, as fast as a man in a boot with a cane can move. 

If you want to avoid waiting in the emergency room, as we have done many times, go in bleeding heavily, or with asthma or any other condition which renders you unable to breath, or appear having heart attack symptoms.  You will be rushed right in for examination and treatment, as I was Monday afternoon. The doctor administered an EKG while he took a medical history and listened to my thunderbolt/defibrillator story, with only an occasional Humph. First good news was that it was not a heart attack, or at least the kind revealed by an EKG  (and I had already eliminated stroke right on my own!) Now began a series of tests--urine, 4 vials of blood, x-rays, another kind of heart monitor, and on and  on--all this to  eliminate other possibilities.  The doctor came in to talk-- a different one, who told me that the clues did not add up to anything--especially the thunderbolt thing--perhaps a first in the annals of medicine.  Maybe it was just the way I described it!  

While we waited for some of the tests to come back (she was pursuing some educated guesses with specific assessments), she taught me the three tests for a stroke--important for everybody to know for the sake of yourself or a loved one. 1) The crooked smile was the only one I had remembered right. 2) The arms. Hold them straight out in front, not over your head.  Watch to see if you can hold them steady.  If one drifts down, that is a bad sign. 3) The say-a-sentence test.  If you can say a slightly complex sentence without difficulty, then you are probably in the clear. For instance, "You can't teach an old dog new tricks" would be better than "See Spot run."  If you slur, or can't form the words at all, then clearly, something is wrong.





About 7pm all the tests had run their course and the final differential diagnosis was in.  The doctor pronounced that I was super deficient in  potassium, cause unknown. The cure--replenish the body's potassium through a slow drip, drip, drip 


into my arm for 4 1/2 hours. It was boring; It was painful--maybe because potassium is thick and doesn't want to go into the vein (I am guessing here).  Tom stayed by my side, holding my hand almost the whole time, alert and sympathetic to my pain.  When he could bear to see me suffer no more and had to take a break,he would slip out for a beer at the local bar. He could bear it no longer a lot. He had to take a break a lot. He drank some beer a lot.  He did stay alert by my side a lot during that long 4 1/2 hours, and he did drive me home at 12:30 that night.

The doctor's further diagnosis was that it had been coming on for awhile. Part of the cause was dehydration, from not drinking enough liquids. She sent me home with directions to see my doctor for follow up. I feel great;  obviously my recent tiredness was a symptom--as was dizziness, nausea, shortness of breath--everything I had had, except thunderbolts. My doctor found that my potassium level is holding fine. She did not put me on any medication, just ordered me to drink lots of water. I have had 37 other consultants, mostly friends, some folks I hardly know, prescribe the consumption of bananas on a regular basis. I am now eating 6 bananas and trying to drink 64 ozs of water every day.

I have had no recurrence of thunderbolts.  

Founding Fathers had many flaws

Tuesday's Letters to the Editors
Tuesday, Sept., 13, 2011

Worshippers of the Founding Fathers would return us to the “good-ol’ days” of 1787, when most African-Americans were slaves, many poor whites were indentured servants and women couldn’t vote. At the time the founders wrote the Declaration of Independence and Constitution, Native Americans were being slaughtered for their land, and Mexicans indigenous to parts of what became the United States were included in the genocide. No women, Jews, Muslims, poor people or non-land owners were numbered amongst the founders, who were rich white men.

Conservatives seek simple solutions to poverty, violence and war that make rich folks richer while poor people suffer and weapons makers and war profiteers make big bucks while killing and injuring innumerable innocent people.

The problems are caused by big-moneyed interests with the help of simple-minded sycophants wearing colonial-styled clothes and holding signs with right-wing slogans.

They look backward, believing the mythologized Founding Fathers are more intelligent and moral than anyone today except a Rick Perry or Michelle Bachman.

Tom Turnipseed
Columbia

For some interesting responses to this letter go here:

Read more: http://www.thestate.com/2011/09/13/1968692/tuesdays-letters-to-the-editor.html#disqus_thread#ixzz1XrXWU1DX

The cost of 9/11

By NEAL R. JONES: Guest Columnist
THE STATE

On this 10th anniversary of 9/11, it would be a mistake to remember only what was done to America. We also should look back on what we have done to others and ourselves in response to that cruel day.

Whenever individuals or nations suffer great loss, their pain can be expressed as either grief or anger. Unfortunately, our political leadership chose to channel our pain into vengeance and retaliation by launching two wars — one against a country that had nothing to do with 9/11 and another that persists though we accomplished our goal of toppling a hostile government.

These wars have cost more than 6,000 American lives. Hardly ever counted is the so-called “collateral damage.” By some counts, more than a million Iraqis have died directly or indirectly because of our war, most of them children. Hardly ever mentioned are the more than 600,000 American troops who have been treated so far in veterans’ medical facilities, many of whom will be physically and psychologically disabled for the rest of their lives. Hardly ever mentioned is the tremendous number of divorces and family breakups and veteran suicides, which have topped 18 per day in recent years.

These wars have been costly financially. When Noble Prize-winning economist Joseph Stiglitz estimated the wars’ costs three years ago, his conservative tally was $3 trillion to $5 trillion. That doesn’t include future borrowing for war expenses, interest on the debt or the cost of replacing military equipment. Neither does it include the long-term disability and health-care costs of veterans, which Stiglitz projects will run $600 billion to $900 billion. We will be paying for these wars for a long time.

These wars have been costly to our national priorities. The tea party has tried to convince us that the reason for the deficit is that school teachers, policemen, firemen and other public workers are making too much. They conveniently forget the cost of these two wars over the past 10 years — the first wars in history paid for entirely on credit. In every other war, we raised taxes to help pay for it. President Bush inherited a budget surplus, which he erased with a tax cut mainly for the rich. Then, incredibly, when he declared war and with deficits already soaring from his first tax cut, he plunged ahead with yet another round of tax “relief” for the wealthy. You don’t have to be an economist or a mathematician to know that if you increase spending and cut revenue, you create a deficit. Let us be clear: Conservatives are now using the deficit they created to excuse their shredding of the social safety net and their slashing of programs to protect and empower our most vulnerable citizens.

These wars have been costly to our national soul. We have squandered America’s position of moral and political leadership in the world and sullied our global reputation. We have forsaken our precious civil liberties and violated our constitutional rights, authorizing the government to spy on its own citizens, wiretapping their phones and intercepting their emails without a warrant. We have rounded up thousands of civilians and sent them to prisons beyond the reach of the law, where they have been held indefinitely without formal charges, without legal counsel and without trial, and where they have been tortured. We have poisoned our national discourse with intolerance and fear and paralyzed our political process with distrust and acrimony.

We finally killed Osama bin Laden. But if his intent was to undermine the American economy and America’s moral authority, then he may have won.

The Rev. Dr. Jones is the minister of the Unitarian Universalist Congregation of Columbia, our preacherman. Contact him at nealjones@sc.rr.com

DIFFERENTIAL DIAGNOSIS

Is It Or Isn't It? What The Heck Is It?

Tom woke me up moaning in pain.  His foot was throbbing, swollen and slightly red.

I was pretty sure right away that I knew what it was.  About 6 months ago the exact same thing had happened to me. I waited several days before going to the doctor and when I did, they x-rayed for a stress fracture but found nothing; took blood to test for uric acid level to diagnose gout and found it was not elevated, but decided to treat it as though it was anyway.  They gave me medicine, put me in a boot so I would stay off it and predicted that the intense pain would immediately diminish. It did and I was soon well.

There were differences.  Tom's hurt just below the last joint in his middle toes; mine had been in the last joint in my little toe; gout usually occurs in the big toe.  His hurt more when he walked on it; mine hurt all the time.  But then men are tougher than women, aren't they?  And of course he walked on it all the time, against my strong advice, while I rested mine and elevated it.  He believed that, whatever it was, exercise--at least moderate exercise--would be beneficial, as would loud complaining.

He limped around for more than several days (so like a man) and listened to the law office entertain guesses -- an insect bite causing Lyme disease was one ominous diagnosis. Stress fracture and gout got equal votes. Someone supposed that a scratch from one of our cats, called cat scratch fever, could  be responsible. My consistent prediction, shored up by my google research,  was always gout and I urged him to go to the doctor.

At the same time he was having some intestinal problems, which he had used otc medicine to deal with, diarrhea, to be specific. Suddenly it was the day before our trip to our annual family fourth of July week Edisto beach trip and he realized he couldn't head off to such an isolated place, with only one doctor--if she was still in practice--without checking things out. We spent the day going from doctor to doctor; first for the intestinal problem, then for the gout.  The intestinal problem was taken care of quickly enough, but the foot problem required a long wait and then we had to be seen by a new doctor.

First an x-ray to eliminate the possibility of a stress fracture-same thing they had done with mine-then a blood test which revealed no elevated uric acid, then the diagnosis of gout-just like mine!  (I was
right, wasn't I, Tom!)  He got a shot, a prescription for a round of 

 steroids and an admonition to stay off it as much as possible while in Edisto, with the promise that the medicine would work its magic and he would soon feel better.

 
He did not! 

 Every night he went to bed with his foot swollen and throbbing, swearing he would stay off it the next day.  

Every day he went crabbing, swam with the grandkids, rode out on the boat for hours (though at

least he didn't go tubing), danced on the porch during our talent shows and danceathons.

Jeff recommended some folk remedies which he had read about, on-line of course. Cherries were the ticket.  Tom is a great believer in the old adage "in for a penny, in for a pound"   and more is better, so he ate cherries, and ate cherries and ate cherries till every dish and trash can in the house was filled with cherry pits and he was doing midnight runs further and further off island to grocery stores, as the nearby ones sold out of cherries.  Unfortunately Jeff also suggested celery. Soon the bunches of celery crowded out the eggs and milk and other essentials in the refrigerator and the continuous celery crunch assaulted our ears. Tom's foot got no better.

Several weeks after we returned home,  we went to an orthopedist, who, pursuing the idea that it might not be gout, decided to do further testing.

Doctors really don't know.  I used to think they did.  They talk to you about your symptoms; they perform various tests; then they know--they diagnose; they treat,  based on their diagnosis and then you get well.  How could I have been so naive?
What they do is,  they take an educated guess.  Then if that isn't it, they eliminate that diagnosis and go to the next possibility, then the next, till they hit the right one--if they are lucky.  It is called differential diagnosis.  They are good at it and usually get it right the first time--or the second.

They got Tom's right the second time.  Dr. Burnworth ordered an MRI which revealed what the xray had not--a stress fracture. Now the treatment of this many times is a boot--that big, heavy, removable, Velcro wraparound with straps that has a rocker bottom.  It stabilizes your foot while it heals, yet you can walk on it--carefully. Tom was unwilling to wear such a thing--too unwieldy, too time consuming to put on each morning.  The doctor agreed to let him wear his Birkenstocks,  because they have a stiff sole which gives much support to the foot.  We left armed with pain medicine, some topical pain reliever to apply to his foot and an admonition to stay off it.

He did not!


Tom really tried.  We had many meetings to attend though--The Hispanic Leadership Conference, the Christian Action Council Racial  Healing Workgroup, the Carolina Peace Resource Center, Food Not Bombs, Homeless Helping Homeless. Our turn to work at Transitions for supper, the HHH car wash, a worship service that we were the worship leader for were all on the calendar.  Our garden was in full tending mode.  And of course there is the law firm.  No time to rest and put his foot up--even under doctor's orders.  He did make some concessions.  When we went to the grocery store, he used a wheel chair--and loved it. He didn't use the electric one, but the manual one, which he propelled down the aisles and across the parking lot with great abandon.  After his knee on the other side started hurting because of the way he had to walk to favor the injured foot, he did use a cane. Sometimes, when he wasn't doing anything else, he did elevate it.  He did let me do some things in the garden that he usually does--but sometimes I would catch him out there.

His foot continued to hurt, to swell, to be red.  Our next adventure was with his friend, Tim,  of Pedorthic Orthotics who fits orthopedic corrective devices, which Tom wears in his shoe because of an old football injury. Tim persuaded him to wear a short, simplified boot. Desperate to do something, he agreed to try it. He has been in it since.  Tim said he would notice a difference right away.

He did not!


It got worse.  In addition to continued pain, the swelling took on a whole new shape--which we agreed was quite odd.  The next emergency visit to Dr. Burnworth on  August 29th was quite a revelation, to him and to us.  Another x-ray showed a new fracture in Tom's foot, next to the original one--this time large enough that it did not take an MRI to reveal it! 

Now what?  Tom is really trying to take it easy. He is iceing the foot every hour, staying off it more and worrying.  He is scheduled for a bone density test on Monday.  The doctor didn't call it Osteoporosis, but I believe that will be his differential diagnosis. 

He mentioned Boniva.

  You know--Sally Fields--on television.  Pharmaceutical advertizing. 

We'll see.