Follow Up With the Surgeon, Ikea and the DOE

We saw the surgeon today.  Overall it was a positive visit.  Jim has been thinking he should be farther along the recovery trail than he is, but the surgeon says he’s fine.  He’s still having some issues, but they should resolve in time.

These are today’s x-rays.  The surgeon says that the bone fusion is proceeding in a robust fashion.  I can’t see anything there, but then I never could read an x-ray.  If you look at the left picture just above the screws you can see the curvature of the spine that developed because the vertebrae degenerated more on the left than the right.  The picture on the right shows the magnificence of the plates and screws used to rebuild his pelvis in 2006.



After the surgeon there was more Ikea walking.  There was an interesting article in the New York Times about designers doing upscale kitchen remodels.  To save money, they’re using the cabinet boxes from Ikea, and then fronting them with expensive doors and pulls.



We had a nosh in the cafeteria.  The number of children in there was astonishing.  It’s not surprising, it’s a kid friendly store. 



We now have new pillows for the couch.  Jim has pronounced them a great improvement over the old ones.  That’s where he sits.  I have a recliner, which is where I sit.



Here is a link to a Vanity Fair article about what’s happening at the Department of Energy.  It was written by Michael Lewis, who wrote The Blind Side and The Big Short. Things are rather dire.  Highly trained personnel are leaving in droves.  The proposed budget cuts funding for research and labs and cuts money to be used to secure the national power grid.  Did you know that Kevlar, GPS and atomic clocks are with us today because of DOE projects?  Currently there is a glacier of radioactive material running underground toward the Columbia River from the Hanford nuclear reservation.  There is concern in the department that money for clean up and mitigation will be cut.  It’s a fairly depressing, but extremely well written article.

Here is a darling picture from the internet.

Retail Therapy

Retail therapy in Bellevue continues.  Walking there is so much more interesting than walking on a bike path that runs along a freeway.  We passed through the shoe department at Nordstrom on the way outside.  Are these shoes not adorable?  The shoes are sort of furry, much more so than suede.  I love the pom-poms.



We walked over to Cost Plus World Market.  They’re closing that store and moving out of downtown Bellevue.  Cost Plus was always a great place for weird food.  Fried herring anyone?



Delicacies from England.



We did three laps around the Bellevue city park. Each circuit is a half mile.  This photo was supposed to capture these two crows bathing, but instead I got them flying away.



The ducks love this place.  It’s sort of odd that there are no Canadian geese, just ducks.



Jim sitting on a park bench.  Note the long sleeved shirt and the fleece vest on the bench.  It was a cool and windy day.  It’s been sort of a tough week.  Jim has had bouts of nausea all week.  We’re not sure what is causing this.  We see the surgeon on Wednesday, and hopefully will be enlightened as to what happens next and how long it will take.



These are blooming in the RV park.  They come up in the fall.  Anyone know what they are?



Last night we had several episodes of heavy rain.  The storage bay was dry this morning.  It’s too early to declare victory, but one can always hope.

Walking in Ikea

The last week has been difficult for Jim.  As you no doubt recall, all the impingement that was occurring was preventing the nerve from firing and stimulating the leg muscles.  Now that the nerve is no longer trapped, it’s waking up and rediscovering its environment.  How does a nerve say hello?  It hurts.  It hurts a lot.  So the pain in the back of the thigh and calf has been pretty bad.  We’re walking anyway.   On the bright side, his left calf no longer looks like he had polio.  There is more muscle mass and more definition than before surgery. 

We had to be in Renton this morning, so after lunch at The Lemongrass restaurant we decided to go to Ikea.  If you are in this area, I highly recommend The Lemongrass.  It’s Vietnamese food, and most of the people in there are native speakers.  It’s really good.

Anyway, Ikea has done a massive expansion.  I think they bought some adjacent buildings, tore them down and added parking.  They also added a second floor to the building.  The bulk of the additional inventory seems to be kitchens.  They have a lot of kitchens on display.



Kitchen faucets in the foreground, refrigerators in the back.  They carry a lot of small refrigerators.  If one were building a tiny house, I would look here for for food storage.



The cafeteria has been moved upstairs and enlarged.  There are now two serving lines, with more food offerings.  The meatballs still look terrible, however.  See the wheeled conveyance in the middle of the photo?  That’s a tray cart.  You can put three trays on it, put food on tray, push cart to table, and grasp your child with the other hand.  Pretty smart.



They have a lot of everything.  These are the throw pillows. Our couch pillows are deteriorating.  We bought a duck feather insert and a cover for it.  Jim likes it, so next time we’re there, we’ll get another one and the two old ones will go over the side.



When we were living in North Carolina, we bought Jim a chest of drawers at Ikea.  After years of thinking we needed heirloom quality furniture, we decided that was stupid.  All a dresser needs is functioning drawers and the ability to keep the underwear in nice stacks.  We were saddened to see they no longer carry the one we bought back then.  It was pretty. 

This is the area where you pick up your items, ready to be assembled by you, the home owner.  This is one of many rows.



Ikea offers a lot of level walking.  It’s also good for wheel chair bound people who need an outing.  When Jim broke the pelvis we would go and fondle the merchandise just for something to do.

Other than this, I have nothing of import to convey.

Doing Time in the GPNW

Could things be any more boring than recuperating from surgery?  No, I think not.  Jim continues to make progress.  He’s cut back drastically on the drugs and this time it appears to be tolerable.  Three days in a row he walked up the hill and back.  Today was somewhat painful afterwards, so we’re thinking maybe we should alternate the hill with a flat route.  He was out for 45 minutes.  I have no idea if that’s good or bad, the medical professionals won’t provide targets.  They just say go as far as you can, safely.

It’s so weird being here in the GPNW with our gloomy skies, a few spits of rain and no wind, knowing what’s heading toward Florida.  It looks like the west side of the state is going to bear the brunt of it.  I feel bad for the people who are about to lose so much.  It’s made even worse by Jose following so closely on the heels of Irma.

I saw this on Huffington Post.  Twenty five years ago when Hurricane Andrew came ashore, the zoo put the flamingos in the restroom.  This time they have their own concrete enclosure.



Other than this, I have zippity doo-dah all to report.

Dark Days in the GPNW

We woke up to yellow/grey skies and ash covering the pickup and the RV. The winds changed, blowing smoke out of eastern Washington to here.  The arrival of the smoke and ash happened last night, at the moment the winds are dead flat calm, so this atmosphere will be with us for awhile.
This is a terrible picture taken with my cell phone this morning at about 8:15.  It gives the general idea of the color of the sun and sky.



I scraped this from a facebook post put up by Friends of the Columbia Gorge.  The camera is currently positioned facing the Cascade Locks to give a live view of the Eagle Creek fire.  This is not the only fire burning in eastern Washington.



It does seem like the entire world is on fire, under water or under siege.
 
In Myanmar, 125,000 Rohingya refugees are walking barefoot through sucking mud to get to Bangladesh.  Daw Aung San Suu Kyi seemingly has not lifted a finger to prevent the military from destroying their villages and murdering the people.  The military says it’s retaliation for resistance by the Arakan Rohingya Salvation Army.  This is ethnic cleansing.

Here, in the US, we have our president vowing to deport all the Dreamers who came here as children despite the fact that it will cost our GDP somewhere around $105 billion dollars over five years.  Enlightened self interest would suggest that we not do this evil thing.  He’s also threatening to cease trade with countries that trade with North Korea.  That would be China and Saudi Arabia to name two.  Where does he think steel comes from these days?  China.  He wants a trade war on top of everything else.  And let us not forget the cost to clean up Houston and after this weekend Florida with Hurricane Irma on the way.  Despite these looming expenditures, he wants to give the rich a tax break.  I don’t think good things are ahead for this country.  It’s a good time to be old.

On the not dark side, Jim is doing better.  Drug consumption is down and walking distances are up.

Things Are Not as Bad as They Were for Jim

Wednesday and Thursday were just horrible.  At one point I was seriously considering taking Jim to the ER at Valley and getting him readmitted to the spine floor.  His back muscles had started spasming and it was really painful.  Friday was better.  We managed a trip to Costco and a big grocery shopping at Safeway.  That included some walking since we park at the far end of the parking lots to avoid door dings from other cars.  Today’s pain levels are better than yesterday.  Jim is now down to oxy every 6 hours instead of every 4.  We’re not sure how to continue the taper.  Longer time intervals or fewer drugs?  It’s a difficult choice because if it was wrong, pain ensues.

The allergic dermatitis is not as itchy and it’s not as red as it was.

So, we’re pretty happy things are better.



It’s hot again.  The high today is supposed to be 90.  90! In Seattle.  I guess the old, cold and wet summers are a thing of the past.

Jim Continues on the Path

Oy, it’s been a few days.  I have to tell you, this surgery is not for the faint of heart, it hurts.  Our first phone call to the surgeon’s medical assistant for more oxycodone was not encouraging.  So, we cut back on dosages to make the supply we had last a little longer.  That was not a good outcome.  Jim has been suffering like an animal for a couple of days.

Then the contact allergic dermatitis at the surgical site kept getting worse. When he came home, there were some lines of agitated skin from the bandages they used.  We quit using them, but the dermatitis kept getting worse.  This morning we went in to see the surgeon.  I was watching his face when Jim pulled up his shirt.  He was somewhat shocked.  They put vancomycin in the incision to prevent infections.  It could be a response to that, it could be from one of the many things they put on his skin to kill any bacteria.  The mystery is why does it continue to get worse now that he’s home.

That’s the incision, which is healing nicely, and that’s the allergic response in red.  It’s a terrible burning itch and it’s swollen.  It’s a three inch incision.



It’s good we went.  They’ve put him on a low dose of Prednisone for seven days.  We also got more narcotics which I am very happy about, as well as cortisone cream to smear on the dermatitis.

Jim’s been on narcotics every four hours, tylenol every 6 hours and a muscle relaxant every 8 hours.  I have spent a lot of time counting on my fingers to figure out which pills are due when.  If you find yourself in this position, may I recommend the humble white board as an organizational tool?



In other news, we have these tidbits from the internet.  This is a water spout photographed somewhere in Texas, courtesy of Hurricane Harvey.



This is from Twitter.  I can’t remember the rider’s name. Does it not appear to you that he is about to hit the deck?  It was during one of the stages of the Vuelta a Espana.



So that’s what’s happening here. 

Jim Leaves the Bus

Last night and today have been difficult.  When we left the hospital, they wanted Jim to take the drugs every four hours, instead of every three as he had been doing.  So, we did that last night.  Today we are back on every three hours.  Last night was not good.  We also failed on getting drugs to him in the middle of the night.  We will not make that mistake again.  Seven hours was way too long of a gap.

Today has been painful.  We’re wondering if it’s made worse by the fact that he quit taking Prednisone Tuesday, and its anti-inflammatory properties are wearing off.  When a person has spinal fusion, non-steroidal anti-inflammatories are also forbidden for three months.  NSAIDS interfere with bone production. 

Despite the discomfort, there have been two walks circling the RV park.  The good thing is that the walker is staying in the bus.



I promise that soon I will blog about something other than Jim and his back.  Our Fearless Leader has been providing so much material, but I know you’re all sick of it.

Jim Returns to the Bus

We were able to depart the hospital about 11:00 this morning.  Getting in the pickup was not as difficult as I had feared it would be.  I have to use the running boards, but Jim is tall enough that he can get his butt up on the seat and then pull his legs in.



This is where much of life will occur for the next few weeks.  This procedure is major surgery. Muscles and nerves are moved during the procedure, and they don’t like it.  They told us before the surgery that there would be six weeks of no bend, lift or twist.  They did not mention that to do so would cause severe pain.  Getting on and off furniture, the bed and the toilet are the major sources of pain.  When you lift your body up, you use those muscles in the back.  Since they’re currently angry, they get revenge.

We did end up renting a walker for a month.  It was an excellent choice.  He doesn’t actually need it for walking, but he does need it for sitting down and getting up.

So – now he rests, gets some sleep (which he was not getting in the hospital), and we wait for bone growth to occur.

The Day After Jim’s Surgery

Jim had a good day today.  The third day, tomorrow, is frequently a bad day.  Something about rates of inflammation, blah de blah de blah.  The surgeon gave us an acronym for it, which of course I can not remember, nor the explanation of why that is.  The older I get, the less recall I have.

Here is Jim walking out the door with his Physical Therapist.  She told us that 75% of people having this surgery go home with a walker.  The walker helps with balance and unloads the surgical site just a little.  At this point we don’t know if we’ll be buying one or not, but she indicated that Jim is a good candidate for not needing it.  Jim also walked up and down the four step stairs they have in the occupational therapy room.  That orange band is a strap that they grab if the patient starts heading for the deck.



This is Jim’s new hardware.  See the screws in his vertebrae? The screws hold the vertebrae in place with proper spacing.  There is cadaver bone acting as a spacer.



One of the things we’ve learned is that the spinous process is removed during the surgery.  They take the bone and grind it up.  It’s put back in to the space freed up by the removal of the disc.  The presence of the bone dust tricks the body into thinking there is a broken bone.  That results in the production of new bone cells in the area.  After about a year, the space between the vertebrae is full of new bone.  The screws become unnecessary, but they are never removed.  They’re buried in bone. Click on the screen scrape for more clarity.



The other thing you can see in this x-ray is the fix to Jim’s pelvis from 2006.  He has 17 screws from the surgery that rebuilt his pelvis after the crash.  At this point, he’ll probably never be able to pass through an airport scanner!



The PT and Occupational Therapist have been amusing to me.  They keep asking us if we have grab bars in the shower or shower chairs.  When we say no, we get a response (like a bug look) that wonders why we don’t have these things.  We’re in an RV!  There are no grab bars, a shower chair will not fit!  What do you want from us?  It’s fun to watch, I think they don’t get too many full timers.

Today’s key learning is this.  If you have compression of the spinal nerves with the concomitant pain, DO NOT SIT DOWN.  Jim is doing well because we kept riding.  After he couldn’t walk any distance, we kept riding.  I think we were still doing 70-80 miles a week after things went to hell.  The stronger you are before surgery, the better you will be after it.  If you can’t ride, swim.  If you can’t swim, then dog paddle or tread water. 

Jim is Out of Surgery

Jim’s surgery went well today.  The physical therapist walked him up and down the hall this afternoon.  Jim reports that the shooting pain down the back of his leg is gone.  There is significant pain at the surgical site, but they are giving him significant pain meds.

The Valley Medical Center Spine Center is just wonderful.  In 2006 Jim broke his pelvis and was taken to Harborview Hospital.  It’s a level one trauma center in a really blighted part of Seattle.  One of Jim’s room mates was a drug dealer!  If I’m lying I’m dying.  That night I would not leave the hospital until they moved that guy out because Jim was helpless and I was afraid.  They moved him (the drug dealer) to a room with a patient with a very large extended family who never left.  Anyway, the Spine Center has private rooms, and it is so quiet.  When the door to the room is closed you can’t hear anything.  So much better.  Is this not palatial?  Plus, they do not do broadcast messages over the intercom.




There is the patient waving at us.



He’ll be home on Friday.

Hot and Political Humor

Holy Cow, it’s hot.  Thursday it’s supposed to hit 99.  Very few homes in this area have air conditioning.  I feel bad for them.  This morning’s walk would have benefited from me getting out earlier.

The hibiscus are in full bloom.  It amazes me that they survived last year’s terrible winter.



This particular plant is in front of a senior living facility.  Maybe it’s an omen for us.



So far Jim is not seeing much improvement from the epidural.  I would have to say things are worse now than they were.  It can take up to two weeks to effect change, so it’s too soon to be despondent.

Are we all familiar with Representative Maxine Waters reclaiming her time from Treasury Secretary Steve Mnuchin?  Instead of providing crisp answers to her questions, he went off on meandering non-answers.  She used a parliamentary procedure wherein she repeated “reclaiming my time” to get her time back. The internet went crazy about this.  Her words were worked into a gospel song.  There are many articles on the subject, one of which can be found here.  I used to be able to imbed stuff from youtube, but that function seems to be gone.  Anyway, click here for the gospel version, it’s really a hoot.

Finally, I can not resist this meme from Twitter, it’s funny.

Walking out East and an Epidural

Jim had a good day yesterday.  We had planned to ride the road bikes, but it rained during the night.  I hate riding on wet streets, the bikes don’t like it, either.  So we drove out east.  That’s Tiger Mountain, shrouded by clouds and fog.



Do you remember the TV show, “Twin Peaks”?  I never watched it, but I do remember the thing with the damn fine cherry pie.  This is the home of the cherry pie, Twedes.  It’s in North Bend.



We ended up at Rattlesnake Lake.  There are no rattlesnakes in this area, so it’s unknown as to why it’s called that.  It’s a pretty lake.  It’s on the edge of the Cedar River watershed, which feeds the Cedar River, which is the main source of water for Seattle.  There is a lovely walking path along the edge of the water.



The weather was trying to clear.



This is the former location of a town named Moncton.



In 1912, the city decided to build a masonry damn to increase water storage for a hydroelectric plant.  Construction was completed in 1915.  The dam was water tight, but the surrounding area was not.  The hill sides were scraped and formed by glaciers, and they leaked like a sieve.  Within two months, the town of Moncton was submerged, and Rattlesnake Lake was born.



Today was Jim’s birthday.  He was gifted with a very early get up, and a trip to Valley Medical for a steroid epidural.  It’s an interesting procedure.  The interventional radiologist had studied Jim’s x-rays and MRIs beforehand.  She used a hand held wand that emits x-rays.  It’s called fluoroscopy.  She could see the area in question in real time on a monitor.  They numb the area, and then inject steroid at the site of the pinched nerve.  It took about 15 minutes.  We were expecting a lot of pain and misery, but Jim reports it wasn’t terrible. The third push of steroid gave him a brief lightning bolt down the nerve in the leg, but it was brief.  A few hours later he has a dull ache at the injection site, but no real change in things.  If you find yourself in need of this procedure, you need not approach it with dread.

Hopefully this will improve things on the pain front.  Surgery is scheduled for August 22, we’re going to be here for awhile.

Appointment With the Orthopods

Yesterday we saw the orthopedic surgeon’s Physician’s Assistant, Chad Swaims.  He’s a very impressive medical professional.  The entire office was running late, but once it was our turn he made it clear we would get as much time as we needed. As you no doubt recall, Jim’s L5 vertebra is displaced and the disc is bulging.

Jim has pain down his leg, weakness in the leg as well as foot drop when he walks.  The pain is due to a pinched nerve.  It’s a double crush at L5.  The nerve from L4 that travels down to L5 is crushed by the displaced vertebra, and an L5 nerve is compressed by the bulging disk.  Leg weakness and foot drop are caused by the pinched nerves.  The nerves can not signal to the muscle fibers to contract.  Worse, the nerve receptors in the muscle fibers die when they are not stimulated.  Once they are dead, they’re dead; there is no regeneration.  No amount of exercise or physical therapy will overcome this.



As the discussion developed, Chad wondered if the vertebra was fixed and displaced, or if it was moving when Jim moves.  Two more x-rays were ordered, one with Jim standing and one bent over.  The films done at the hospital were static.  Moving is bad.  Jim’s disc is moving.

What does that mean?  It means that the relatively non-invasive microdiscectomy (removal of part of the disc) is off the table.  We’ve now progressed to requiring spinal fusion to fix this.  For the life of me, I don’t know why it’s mobile.  Either he didn’t say or I can’t remember.  It’s a lot to take in.

Anyway, this is spinal fusion.  The disc is removed completely.  They screw into the vertebrae to anchor plates that hold the vertebrae in the correct position.  Cadaver bone which has been rendered totally dead is inserted as a spacer between the verterbrae.  Over time, Jim’s bone cells will migrate in to the cadaver bone, displacing those cells.  After a year or year and a half, the two vertebrae and Jim’s bone cells will fuse.



Currently, Jim is scheduled for an epidural steroid injection on July 28, which seems like an eternity from now.  This will reduce the inflammation in the crushed nerve.  I’m hoping (unencumbered by facts and data) that inflammation reduction will allow the nerve to start firing again and will decrease any further receptor death in the leg muscle fibers.  Surgery will follow at least two weeks out from the epidural. We will see the PA after two weeks and Dr. Chris Howe six weeks after the procedure.  It’s looking like we’re going to be here for part of the rainy season again.

It’s a six week recovery.  During that period there will be no Bend, Lift or Twist.  There will be walking.  I doubt if there will be bicycling.

Interestingly enough, this entire progression started around November 2016, but we didn’t know what we were witnessing.  When Jim would ride more than 20 miles, the bottom of his big toe would go numb.  Over time, the numbness covered more of his left foot.  Damage was occurring then.  I tell you this, because:  who knew?  Spinal degeneration starts in 100% of the population at age 20.  Over the years the discs dessicate and shrink, the ligaments that run along the spine grow lax, the vertabrae respond by producing osteophytes to protect their edges.  Jim now has a small degree of scoliosis because he has degenerated more on the left than the right.  Hence all the pain is left legged.  Pay attention to your symptoms when they develop.  Toughing it out, aggressive stretching and all the positive thinking you can muster will not fix a significant problem.

Dr. Howe trained at Harborview Hospital in Seattle.  It’s a level one trauma center.  In 2006 Jim endoed on his road bike, and shoved his femur through his acetabulum.  He was fixed by Dr. Chip Routt.  Dr. Howe immediately recognized Dr. Routt’s handiwork in the x-rays they took.  Dr. Routt has since moved to Texas.  Apparently there was some sort of staff reorganization at Harborview, and Dr. Routt moved on in 2013.  I can not believe they let him go.  He has done more acetabular repairs than anyone on the planet in the history of time.  It’s all he did.  So- keep that in mind if calamity strikes in the Houston area.

So, that’s what’s happening with us.  I will close this out with a picture of a Bee Hummingbird.  They are the size of bees.  Cute cute cute.

Cycling Washington and France

We didn’t ride this past weekend.  There was a large music festival in Carnation, and since the bridge was still closed, we knew the traffic in Fall City would be unbearable.  So we did stuff like get the dead bugs off the front of the bus, wash windshields, and polish the 3M film and the headlights.  The front of the bus looks much better.

We also refilled the windshield wiper fluid container in the bus.  This is what we saw this morning.  Apparently there is a hole in the bottom of said container.  Caulk will be necessary after it gets through dripping.



The music festival went on for three days.  There were camping options available for attendees.



The yurts were across the river.  I’m not really clear on where they found enough level ground to install these things.



Today the bridge was open.  Yay!!!!!!  Life is so much better.  Apparently the county decided to reopen with weight restrictions.  Commercial trucks are forbidden to drive across it.  This guy is about to take down the closed sign.



That’s the foot traffic suspension bridge in the background.  See how steeply the land moves away from the water?  That’s why we’re perplexed about how yurts and other camping sites were available for the weekend.



In 2002 and 2003 Jim and I did fully supported bike tours of the Tour de France.  They’d take us out on the course and leave us to climb something.  As soon as the publicity caravan came through the road was closed and we’d have to stay put and spectate.  We did a LOT of climbing.  We were younger, lighter, and much stronger than we are now.  They were both vacations of a lifetime.  If we ever went back, we’d need electric bikes.  My friend, Greg de Respino has put up an album of pictures from when he was there.  The photos are good, you should check them out.  This is Jim and me somewhere in France.



This is Greg and me on the lower slopes of Le Col du Columbiere.  I was not using a digital camera then, so it’s nice to see photos of that trip, mine are all in photo albums in storage.  Thanks Greg!



Jim’s doing better with the Prednisone.  It still hurts, but he’s not yipping.  His mobility is now much better than it was.



Mike, who runs the park, just came by to ask us not to dump any tanks tonight.  Apparently there is a broken pipe in the sewer system, and things are not good.  I’m pretty happy that we dumped the gray this morning! It is always something.