Tuesday, July 23, 2013
I have to apologize to any readers who are opening this up after months of silence and finding a bunch of missing pictures. Google provides Blogger for free and seems to have no interest in fixing it when it is broken. Sadly, it has been broken at least since December of last year and continues to be extremely frustrating to try to use. It will not allow any editing. . .your only choice is to delete a whole post and try to redo it. Since it takes forever to put these things together, when it completely messes the post up by breaking all the photo links, there is really nothing I can do other than try to figure out what the pictures were and try to repost the, out of order, and probably making little sense. I may try this but in the meantime, this isn't my fault. Blame Google. Like many of the gigantic Internet companies, the don't seem to think customer service is something that is worth investing in. Not only won't they fix what is wrong but they make it impossible to even report it.
I will do the best I can under the circumstances but there are limits.
I will do the best I can under the circumstances but there are limits.
This group of photos is from the trip Abner and I took to Seneca Rocks, WV in late July of 2012. He was doing well enough with his adjustment to walking on three legs and my arm pain hadn't completely taken over my life at that point (although it did before the trip was over) so it was an opportunity for the two of us to get out of town for a bit of a break. Our friend Rob Rives was working as a guide and climbing instructor and took a couple days off to hike with us, eat, and catch up on life. We hiked Dolly Sods with Abner and then Rob and I did the hike up 1,000 feet to the top of Seneca Rocks while Abner rested in the cabin I had rented. The views from the top show the tiny village center of Seneca Rocks and a fork of the Potomac River. Who knew it went so far inland?
This last shot was taken by a co-worker of Rob's when I was getting ready to say good bye and head home. It was the last trip Abner and I got to take together due to my worsening nerve pain and ultimately to the return of his cancer. Rob was a great host and I will fondly remember this trip as Abner's and my swan song together.
The photo above is what I encountered when I got home from the hospital 3 days after my surgery. This is what the surgeon described as a "small incision". The photo below was taken a couple weeks later when Rob blew through town on a brief visit. The incision is clearly still visible but not looking quite so gruesome. Amazingly enough, it is now almost invisible. I still have large areas under my jaw on the right side with no sensation so shaving is still pretty weird.
I have not located many photos from the two months in California but this was early on in the trip when Rob and Carolyn spent a day with me. We drove up to Boeger Winery in Placerville to roam around, taste and visit with Greg, Sue, Justin and Lexi. Greg took us through the winery and spent some time with us in the tasting room. Everyone was pretty comfortable by the time this shot was taken.
Monday, July 22, 2013
Northampton Mass, near where Nicole and Jonathan's farm is located has a lovely old downtown area with great historic architecture. This rather grand old bank building is now Urban Outfitters
On the day Rob and I hiked in good weather the views were great and it was warm and sunny. Above you can see me trying out the self photo concept with my iPhone. Below is a tree that some kind of animal has carved out generously for nesting.
On the day we hiked when it snowed it was a whole different scene. The cold really wasn't all that bad but the snowfall was actually pretty heavy and on top of icy well used trails it got pretty treacherous. I was still nervous about falling given my recent neck surgery but the falls I took didn't seem to do much damage. Rob seems to thrive in this kind of weather having spent two winters in New Hampshire.
So I found myself in the passenger seat of Virgil, Rob's well worn Subaru Forrester and discovered the above text taped perilously to the dashboard. This incredibly clever observation on life is redacted from the liability statement on airline ticket envelopes. Frankly I think it is a far better use on Rob's dash.
Life in New England seems to be working well for Rob and Carolyn who looked great and happy. It was a good visit.
T
These shots were from Faye and Jay's visit here in the spring. We went to Charleston (Jay is at Fort Moultrie) and up to Highlands were we all posed at the top of Whiteside Mountain.
I encountered this odd looking creature in something like a cocoon hanging onto what looked like a big white egg. Turns out she is a Wolf spider and that is her egg sac. She stayed in the same spot for more than two weeks and ten moved about 4 feet away to a more exposed location. After staying there for two days she split. You can imagine my surprise when I went out one morning to water the tomatoes and found that she was no longer in residence.
Since I haven’t really posted anything thorough or detailed since my ill-fated trailer trip in the early summer of 2011 I think it is appropriate, before I start trying to blog on a semi-regular basis again, to fill in some of the blanks from the last two years.
The trip North in early 2011 was, for the most part, very enjoyable as I think I conveyed at the time. Unfortunately the problems I encountered with the trailer turned out to be big and ultimately prevented me from taking the second half of that trip. I was supposed to spend a couple weeks at home cleaning the trailer, and minding some business and household issues while Josh was away in Costa Rica with his family, but things didn’t exactly turn out. The manufacturer of my rolling disaster didn’t exactly stand behind the warranty and ultimately after a number of broken promises regarding repairs and unreimbursed expenses, I realized that it would be very risky to set off to California pulling a trailer that had a history, in its short life, of failing on every single trip. As a consequence, when delays became so great that the possibility of even a shortened trip to the West Coast had become impossible I asked the dealer from whom I had purchased it, and whose service department was trying hard to fix all the myriad of items the manufacturer had failed to fix or built wrong in the first place, to get it repaired and then sell it for me.
The short version of that story is that it went on their lot in August of 2011, roughly 3 months after I took possession of it, and didn’t sell until November of 2012. I lost about half of what I had put into it but at least it was no longer my problem. Ultimately it had become completely useless to me. I only hope the new owners have better luck with it than I did.
The remainder of the summer passed without much drama although I did injure myself using the auto-belay device at the climbing gym while I was at home during July. I knew it was a torn rotator cuff, having had that many years before. The pain of this injury is very recognizable once you have experienced it but that doesn’t mean that you can convince a doctor to take you seriously.
My primary care doc believed me but the orthopedic surgeon I went to did not. First we had the x-rays which cost a couple hundred dollars cannot show soft tissue damage. Needless to say they showed nothing. Rather than order the badly needed MRI immediately this arrogant jerk decided that I should delay doing anything and sit at home on prescription Naprosyn for 6 weeks to see if things got better. Since it had already been three weeks since the injury and I had already tried stronger pain meds than that I was pretty annoyed at this delay. I had told this guy that the previous experience with shoulder surgery had taught me that I didn’t want an open procedure to correct this tear if we could get to it quickly enough to fix it arthroscopically.
In any case I waited the 6 weeks and went back in just as much pain. He finally relented and ordered an MRI and Myelogram, which did indeed confirm my initial contention that I had torn my rotator cuff.
Unfortunately when I spoke with the orthopod he said that while I would need surgery to correct the injury he was going to have to refer me to another guy in his practice since he doesn’t do arthroscopy. Considering I had told him that I was looking for an arthroscopic solution within the first 3 minutes of my first appointment I was pretty pissed off that he waited until two months and $2,500 worth of diagnostics and tests before bothering to tell me that he wouldn’t be able to operate on me. Making the situation worse was the fact that his partner, to whom he wanted to refer me, wanted to do his own workup on me and charge me again!
The lack of ethics of this practice was simply beyond anything I had experienced in health care in this country up to that point so I decided to go to another practice entirely and ended up in the care of Chris Elder in early October.
He agreed that the only approach that could be taken was surgical and scheduled me for the 1st of December. This date allowed me to get this very costly procedure in during the 2011 calendar year (and allowed me to apply the $2,500 already spent toward a deductible that I would blast through with the procedure) but still make a trip to California for the wedding of my friends Jonathan Boynton and Shaghig Kodbashian in late November.
The trip to California was brief but fun. Jonathan and Shaghig got married in San Luis Obispo and most of the assembled guests stayed in Pismo Beach at a hotel perched on the edge of the Pacific. It was something of a reunion for a number of old friends from Sacramento who gathered for the event. We spent a few days hiking and being tourists (and eating) as well as attending the wedding. It as a really great break right before things would really get difficult in my life.
Within a few days of my return home I went in for the surgery. My friend Ben Zonnevylle agreed to take me to the surgery center and to take me home and stay with me for the first night. As it turned out, this wasn’t particularly onerous duty. At the beginning of the surgery I was given a nerve block that didn’t wear off for 22 hours. By the time the really bad pain hit me, Ben had left for work and I was alone. My sister and her husband arrived a few hours later and there ensued a rather desperate attempt at getting my pain under control.
The drugs that had been prescribed couldn’t touch the pain I was in, nor could anything from the pharmacopeia that is in my cabinet from previous surgeries. In the end I realized that the only likely fix was Dilaudid. I called Elder’s office and was referred to the doc on call that weekend. He was of no help at all. He pointed out that Dilaudid requires a paper prescription (certain pain meds cannot be called in) and in spite of my offer to meet him anywhere that would be convenient for him the only thing he could offer was for me to try to get through the weekend on Ibuprofen or Naprosyn and warm compresses. I was livid but desperate so I called a friend here in Asheville who is a practicing surgeon and convinced him to write me a scrip for enough Dilaudid to get me through the weekend.
On Monday I called Dr. Elder’s office and complained bitterly about the appalling lack of care provided by the on-call doc over the weekend and was given an ample supply of pain meds as well as an apology.
As it turned out, there was a lot more wrong than a torn rotator cuff. While it was indeed torn, in the same spot as had been repaired in the mid-90s in Sacramento, the tendon was also completely detached from the top of the humerus. In addition I had badly torn the tendon of the long head of the biceps, had two labral tears and had such severe osteophytes that they had to remove about an inch and a quarter of my collarbone to prevent further impingement.
As a result of all this, I was pretty much flat on my back for the 2011 holiday season. It was in December that the first of Abner’s problems emerged. While I was still pretty miserable from my very intrusive surgery I noticed Abner started standing in a way that un-weighted his right rear foot. This was disconcerting since there was nothing obvious wrong with the foot so I took him into the vet to see what was going on. We saw the wonderful Paul Duncan, one of the great vets at the Animal Hospital of North Asheville, who said it wasn’t clear what was going on, but that perhaps he had strained his knee. He gave Abner some prednisone and sent us home.
While this worked, the problem recurred about a month later. We tried the pred again and it worked again but in early February of 2012, just when my shoulder was starting to show some improvement, the discomfort came back and Abner was once again not putting weight on the affected leg.
At this point I decided that we needed to start doing some serious diagnostics to find out what was going on. X-rays were inconclusive as were blood work and urinalysis but there was something odd on the x-ray of the offending leg that Paul sent off to be analyzed by specialists to whom they refer tough cases. We also sent the x-rays to my friend Jay Stone who practices veterinary oncology in California.
The shortened version of this story is that a month later, with no confirmed diagnosis, Jay feared that what Abner had was some kind of anomalous version of Osteosarcoma which is a bone cancer that is disturbingly prevalent in larger breeds of dogs. His advice was to amputate the limb and shortly thereafter begin a course of chemotherapy.
This was an incredibly difficult decision to come to but Jay felt that if this was indeed Osteosarcoma that it would progress quickly to being fatal if we didn’t deal with it aggressively. So on March 5th I took Abner to Upstate Veterinary Specialists in Greenville, SC where Matt Ritter performed the surgery. Abner stayed there for a couple days and was not doing well so we all agreed that he might recover better in the comfort of familiar surroundings. On the 7th I drove back down and got Abner to bring him home.
When I got him home he was clearly distressed with his situation but I think was emotionally better than he had been at the clinic. He had a terrible time walking on three legs even with the assistance of a sling the clinic had provided for me to support his hind end. This was also very difficult for me since I was still dealing with the aftermath of my surgery. We were quite a pair. Things improved somewhat quickly though once I discovered that the spiny seed-ball from a liquidambar tree was wedged into his left hind foot. Within 24 hours of removing it he started learning how to walk on three legs.
By the time we saw Matt Ritter for a post op checkup on the 19th he was doing well enough that Matt felt it was time to start the chemo schedule.
Again, I am not going to go into the gory details but suffice it to say that Abner was not a dog who responded well to Carboplatin chemotherapy. Within 4 hours of the dose he was immovable and remained that way for days. He wouldn’t eat at all and only drank minimum amounts of water. He was again unable to walk and severely demoralized, as was I.
In the end the chemo caused a urinary tract infection, ear infections and a spinal infection that stayed with him to the day he died.
Knowing what I now know, I would not, in a similar situation, do the amputation or chemotherapy. We stopped the chemo at the one session because I didn’t want to risk completely ruining Abner’s life in an attempt to lengthen it.
Over the course of the summer of 2012 he got better at dealing with being a 3-legged dog although it was never easy. He tired much more easily and of course couldn’t handle walking on terrain that had much slope or any unevenness to the ground. He seemed pretty happy most of the time when we could get out to Biltmore to do easy walks and see his old friends.
In July of 2012 he seemed to be doing enough better that I decided to take him on a trip to West Virginia for a few days to visit Rob Rives who was working at Seneca Rocks Climbing Center.
In the meantime, in June I had gone back to my doc complaining of chronic left arm pain due, we both thought, to months of having to assist Abner with a sling I held in my left hand. Since my right shoulder was still trying to heal from the December surgery I was forced to use my left for Abner and now I was being punished 24/7. Steve Brown suggested some meds that tended to help nerve pain but in the end they didn’t really help all that much.
One day in Seneca, Rob and I did a hike to the top of Seneca Rocks. Over the course of that hike you do a lot of looking up and the hike itself has a pretty decent vertical component although the trail is good and switches back and forth enough that it isn’t a killer. Nonetheless, that night, on our way to dinner in a nearby town, the pain in my arm became so severe that Rob was afraid I was having a heart attack.
What I realized that night though, when lying down helped relieve the severity of the pain, was that the source had to be my spinal column. If getting out of a vertical position took the pain away it meant that compression of some kind was causing it.
After an excruciating drive home I got referred as quickly as possible to a neurosurgeon by the name of Eric Rhoten. Unfortunately he is a popular guy so while they got me into to see his PA and have an MRI done quickly, it took a long time to get onto his schedule. The diagnosis turned out to be a complex condition of partially collapsed discs, severe osteophytes, and foraminal stenosis. When I got the details of this diagnosis I didn’t fully realize what correcting it would entail.
Meanwhile in September I had been told to take Abner in to the vet to have follow up x-rays and labs done since at that point it had been 6 months since his amputation. What I was completely unprepared for was the x-ray showing him positive for cancer again. This time they showed several lesions in his lungs. Over the next few days I talked to everyone who had been advising me all along and was considering options for non-intrusive treatments but it was not to be. Within a couple of days, he began limping and when I took him in and had his left hind leg x-rayed it showed the same halo like image that the original x-rays had indicated 6 months earlier. At that point Abner’s health declined quickly and in about a week he couldn’t walk, even with assistance. He stopped eating and drinking and pretty much only could spend his time on his bed out on the deck behind our house watching what he could see of the world from there. It became painfully apparent that Abner was finished with his life irrespective of my readiness so at about noon on the 27th of September when Abner was 10 years, two months and 3 days old my friend Matt Vande came over, helped me get Abner in the back of my car, and we drove over to the Animal Hospital of North Asheville.
The vets there anesthetized him in the car and he fell asleep with his head in my lap, and that was it. They took him inside to euthanize him. . .I couldn’t go in. Matt drove me home and I spent the next few days in tears.
The pain of this loss was greater than any I can remember. Abner is the third dog I have outlived as an adult but I had by far the closest most important relationship with him. There are lots of reasons that I don’t need to belabor, but after he died I was dealing with relentless physical pain in my arm, which by then couldn’t be controlled with medication or position, and the horrible pain of a loss that seems like it cannot be borne.
I was, by then, scheduled to have my spinal surgery on the 12th of October, a mere two weeks after losing Abner. I agonized about what to do for a few days but ultimately decided to go ahead with the operation. It seemed that putting it off for a month would accomplish nothing in terms of my feeling mentally better prepared and the idea of extending the time of my physical pain even longer seemed pretty unwise. By that time I had been in pretty continuous pain for 4 months so the idea of doing something to at least relieve that made sense.
I made a brief trip to Indiana to visit my parents whom I had not seen since I had seen them the previous summer. It was difficult because I was terribly depressed and in physical pain so there was truly nothing that could have made me feel better but I realized that staying in my deathly silent house awaiting a surgical procedure about which I was pretty apprehensive was not going to work. I came home from Fort Wayne on the 8th of October, had my 3+ hour series of tests and pre-op meetings on Tuesday the 9th and after a brief cardiology burp on Thursday I went to Mission Hospital before dawn on Friday the 12th and checked in for my surgery.
The experience was surreal, but at this point I think you have probably endured enough detail on my various medical issues. What I will tell you is that the surgery lasted about 5-1/2 hours and I stayed in the hospital Friday and Saturday nights. Sunday at about 1:00 or so in the afternoon I was released and managed to squeeze my decidedly inflexible body into Josh Coopers tiny Mazda for the ride home.
I didn’t feel all that bad by then. I had certainly been on some serious pain management drugs during my stay at the hospital but oddly enough, pain management wasn’t that hard to handle after a few days. I did end up having to stay on Gabapentin (a commonly used drug specifically for nerve pain that I had been taking since June) and Meloxicam (NSAID) until May of this year but it was really to control the pain in my arm which took a long time to abate after the surgery. There was not nearly as much pain from the surgery itself as I had expected.
What I was unprepared for though was what I looked like. Eric Rhoten had told me that he would make a small incision in the front of my neck to get access to my spine for all the things he had to do. In the hospital they don’t put mirrors in the rooms and besides, I was in a major neck brace for months after the surgery so even if I had seen a reflection of myself I wouldn’t have seen anything of my neck.
When Josh took me home though, I hadn’t had a shower in three days so the first thing I did was go to my bathroom and take off the neck brace so I could undress and take a shower. Well that was a shock. The small incision was in fact 4-1/4 inches long, had a scab the entire length of it, was closed with a visible seam of glue and by then had the beginnings of my beard growing back. Since I couldn’t shave the incision site for quite a few weeks it ended up looking like a 4-1/4 inch long caterpillar crawling up my neck. Very attractive.
Josh and his girlfriend Alanna Nappi stayed with me the first night and according to them I seemed comparatively normal. I have almost no recollection of it so I guess I was still pretty well drugged.
For about two weeks I was homebound since driving is pretty much impossible wearing a neck brace. Once I did start driving again it was like an old man in a Buick. I had never allowed so much space between my car and the one in front of me. I also couldn’t turn around so backing out of driveways and parking spaces became quite a challenge.
I went back to Carolina Spine for a post op and then started my brief series of recommended physical therapy sessions but was still sad and depressed about how lonely I was at home without Abner. Roger Meade, the fine head of PT at Carolina Spine told me around the end of November that it was fine with him for me to travel as long as I was very careful about vibration and any kind of potential shock to my still hardening bone grafts. During the procedure, part of what Rhoten did was fuse the bottom 4 vertebrae in my neck to each other. The whole thing is held together by a very large piece of titanium that will be there forever. At this point the bones have fused to each other but there is nothing to be gained by removing the metal.
I felt strongly that for my emotional health I had to leave town, and most importantly my house, for a long vacation away. Everywhere I went in Asheville people knew me with Abner. The conversations were unavoidable and they reduced me to tears every time so I felt the need to be somewhere where people didn’t know me as half of a dog/human couple.
So at the beginning of December I flew to California for what would be a two month long visit with old friends and familiar places. I thought that by going for that long a period it would be more leisurely than my typical 7-10 day visits. This turned out to only be partially true. I was amazed at how busy I was and how many commitments I ended up making to see people and spend time with them in a variety of locations. I was in San Francisco, Aptos, Sacramento and Lake Tahoe over the course of the two months and had a fantastic time. What it accomplished was diversion. I did’t spend all my time thinking about how much I missed Abner. I spent most of my time running from lunch to dinner to art gallery to party. It was great but in the end simply put off the inevitable return to my the crypt-like stillness of home.
I began this trip with a lucky crossing of paths with Rob Rives and Carolyn Loeb where in Sacramento visiting Carolyn’s brother and his fiancée and I ended the trip with a visit from Ingrid and Larry who came to see me in Sacramento at Jim Sundquist’s house where I stayed for the time I was there. It was a great relief from the burden of my sadness but at the end of January I had to head back home.
When I got back my emotions took the almost predictable tumble at first. Two months of being constantly busy gadding about with friends had been really great at making me focus on something besides being sad and alone. The house and Asheville were constant reminders of these qualities where California had been the complete diversion.
A couple things did start to improve though and that began the process of coming out of the dark hole that I had dropped into when Abner got sick. For one thing, in late November the trailer finally sold. I have no idea who bought it but I wish them well. Without Abner, even if I had any faith that the damned thing would ever work, I had no more use for it. The whole reason I had bought it was to be able to travel with him whenever and wherever I wanted.
The second thing though was probably of equal importance. Toward the end of the time in California I started experimenting with reducing the dosages of the two drugs I had been taking to control my pain. Over the course of the next few months I cut back a little bit about every two to three weeks until, by the end of May, I was able to completely stop taking any kind of pain medication. While it is true that there are positions that I cannot assume any longer, and occasionally I will get a slight twinge of something in my arm, almost all my chronic nerve pain has gone. Eric Rhoten had said that about 85% of the people who have this operation will, eventually, be pain free, and I think I am going to be one of them. The simple fact that I don’t have to medicate myself two or three times a day is a big lift.
The other thing that is true is that time does make the pain of loss seem a little more bearable. I still have a huge hole in my heart and my life that Abner left. I miss him every day and frequently am still reduced to tears when I talk about him or remember some event with him, but I am able now to consider getting another puppy and starting over on developing a life for myself with a canine companion.
This spring has been one of many visitors and travel. This started with a terrific trip to see Rob and Carolyn in Vermont where Carolyn is doing a year-long internship at Merck Forest and Farmland Center. It was a great visit that was characterized by spending the days hiking with Rob and the afternoons and evenings with both of them eating and talking. It was spring when I left Asheville but there was a significant snowfall while I was in Vermont. It actually added to the fun for me although it made one of my hiking days with Rob challenging and wet. What I will tell you is that there is a level of stimulation that comes from hanging out, even briefly, with energetic well educated people in their 20s.
On the way up to see them I stopped in Western Massachusetts and got to see my old friend Nicole Blum and her husband Jonathan for the first time since their wedding day about 15 years ago. They live in a beautiful place on a farm they have pretty much built themselves. Jonathan has what appears to be a real emerging success in the hard cider business and Nicole still writes and is a genius with all things stitchery. They both look almost exactly like they did on their wedding day and considering that was a decade and a half and two kids ago that is quite an accomplishment.
I had been visited in late winter by Nicole’s mother Jackie and her partner Bill who were making their way to Asheville for the first time. We did as many of the standard things as we could with the limitations of time and Bill’s impending surgery. Still, it was a great visit.
When I returned from Vermont I was home for a couple weeks before I headed off to see my friends Ann and Bowers at their beach house in Florida. This was a long but easy drive and was really the harbinger of my being able to go off pain drugs. It takes more than 9 hours of driving to get from my house to theirs but I made it without any significant pain in my arm. It was great being at the beach for a few days of good food, relative sloth, and great companionship.
Shortly after my return to Asheville, Faye and Jay came for another visit and this time we included a quick trip to Charleston. I always have fun with these two and this trip was no exception. It seemed like mostly all we did was eat although I know that isn’t true.
Then I was visited in rapid succession by one of my first employers from Fort Wayne, his wife and two friends of theirs who were originally from Russia but now live down the road from me in Charlotte. This was great fun, quickly followed by Ben Fowler, another of my young friends from UNCA who graduated a couple years ago and was back in town for a visit with his girlfriend Desi and a couple of her friends from her hometown in Germany. While my house was the base of operations for this quartet I wasn’t really expected to do much entertaining so it was easy. It was nice having a busy house but little responsibility.
Then a few days later I entertained Werner Kreis and his wife Jill. Werner is an architect from Zurich with whom I worked in the very first job I had after graduating from architectural school 42 years ago. We had last seen one another in London in the mid-80s so as you can imagine I expected things to be somewhat changed. As it turned out, Werner seems like he is exactly the same. He has slightly less hair and slightly more creases in his face but I would have recognized him anywhere and he is the same sweet, interested, and interesting man he was 42 years ago. I had a great time with them although it too was compressed into a very short visit.
Finally, in June, my nephew Jon and his wife Erin were in town with a bunch of people from Erin’s family as well as my sister and her husband and Jon’s dad and his wife. The whole group was here to celebrate Jon turning 30 and as is the case with a group numbering 14 people and ranging in age from 9 months to 66 years, one just had to go with the flow. There is no way a group of that size ever wants to do the same thing at the same time so I ended up just kind of following around most of the time. It was exhausting since I am not used to hanging out in crowds of that size but it was fun and really nice since I got to meet Erin’s family and see my 15-month old grand nephew for the first time.
Once that group left, things got quiet and I have started trying to get my life back to something resembling normal. I am hoping to start posting with some regularity again, at least if there is anything to talk about. I also am hoping that I can start posting photos again. Something strange happened with Picasa and Blogspot back in December that has never been resolved. There are odd error messages that appear every time I try to post or edit a post and sometimes the posts don’t work at all but Google offers this system as a free host for bloggers and consequently there is no way to get tech support or customer service to find out what is screwed up. Like most Internet giants, I guess they think that as long as we aren’t paying for something they don’t have any obligation to fix it when it is broken.
So that’s it for now. I am sorry this is more like a short novel than a blog post but it seemed to be the only way to catch you up. I am going to try to post some photos from some of the events of the last couple years if I can find them and if Picasa and Blogspot decide to cooperate.
The trip North in early 2011 was, for the most part, very enjoyable as I think I conveyed at the time. Unfortunately the problems I encountered with the trailer turned out to be big and ultimately prevented me from taking the second half of that trip. I was supposed to spend a couple weeks at home cleaning the trailer, and minding some business and household issues while Josh was away in Costa Rica with his family, but things didn’t exactly turn out. The manufacturer of my rolling disaster didn’t exactly stand behind the warranty and ultimately after a number of broken promises regarding repairs and unreimbursed expenses, I realized that it would be very risky to set off to California pulling a trailer that had a history, in its short life, of failing on every single trip. As a consequence, when delays became so great that the possibility of even a shortened trip to the West Coast had become impossible I asked the dealer from whom I had purchased it, and whose service department was trying hard to fix all the myriad of items the manufacturer had failed to fix or built wrong in the first place, to get it repaired and then sell it for me.
The short version of that story is that it went on their lot in August of 2011, roughly 3 months after I took possession of it, and didn’t sell until November of 2012. I lost about half of what I had put into it but at least it was no longer my problem. Ultimately it had become completely useless to me. I only hope the new owners have better luck with it than I did.
The remainder of the summer passed without much drama although I did injure myself using the auto-belay device at the climbing gym while I was at home during July. I knew it was a torn rotator cuff, having had that many years before. The pain of this injury is very recognizable once you have experienced it but that doesn’t mean that you can convince a doctor to take you seriously.
My primary care doc believed me but the orthopedic surgeon I went to did not. First we had the x-rays which cost a couple hundred dollars cannot show soft tissue damage. Needless to say they showed nothing. Rather than order the badly needed MRI immediately this arrogant jerk decided that I should delay doing anything and sit at home on prescription Naprosyn for 6 weeks to see if things got better. Since it had already been three weeks since the injury and I had already tried stronger pain meds than that I was pretty annoyed at this delay. I had told this guy that the previous experience with shoulder surgery had taught me that I didn’t want an open procedure to correct this tear if we could get to it quickly enough to fix it arthroscopically.
In any case I waited the 6 weeks and went back in just as much pain. He finally relented and ordered an MRI and Myelogram, which did indeed confirm my initial contention that I had torn my rotator cuff.
Unfortunately when I spoke with the orthopod he said that while I would need surgery to correct the injury he was going to have to refer me to another guy in his practice since he doesn’t do arthroscopy. Considering I had told him that I was looking for an arthroscopic solution within the first 3 minutes of my first appointment I was pretty pissed off that he waited until two months and $2,500 worth of diagnostics and tests before bothering to tell me that he wouldn’t be able to operate on me. Making the situation worse was the fact that his partner, to whom he wanted to refer me, wanted to do his own workup on me and charge me again!
The lack of ethics of this practice was simply beyond anything I had experienced in health care in this country up to that point so I decided to go to another practice entirely and ended up in the care of Chris Elder in early October.
He agreed that the only approach that could be taken was surgical and scheduled me for the 1st of December. This date allowed me to get this very costly procedure in during the 2011 calendar year (and allowed me to apply the $2,500 already spent toward a deductible that I would blast through with the procedure) but still make a trip to California for the wedding of my friends Jonathan Boynton and Shaghig Kodbashian in late November.
The trip to California was brief but fun. Jonathan and Shaghig got married in San Luis Obispo and most of the assembled guests stayed in Pismo Beach at a hotel perched on the edge of the Pacific. It was something of a reunion for a number of old friends from Sacramento who gathered for the event. We spent a few days hiking and being tourists (and eating) as well as attending the wedding. It as a really great break right before things would really get difficult in my life.
Within a few days of my return home I went in for the surgery. My friend Ben Zonnevylle agreed to take me to the surgery center and to take me home and stay with me for the first night. As it turned out, this wasn’t particularly onerous duty. At the beginning of the surgery I was given a nerve block that didn’t wear off for 22 hours. By the time the really bad pain hit me, Ben had left for work and I was alone. My sister and her husband arrived a few hours later and there ensued a rather desperate attempt at getting my pain under control.
The drugs that had been prescribed couldn’t touch the pain I was in, nor could anything from the pharmacopeia that is in my cabinet from previous surgeries. In the end I realized that the only likely fix was Dilaudid. I called Elder’s office and was referred to the doc on call that weekend. He was of no help at all. He pointed out that Dilaudid requires a paper prescription (certain pain meds cannot be called in) and in spite of my offer to meet him anywhere that would be convenient for him the only thing he could offer was for me to try to get through the weekend on Ibuprofen or Naprosyn and warm compresses. I was livid but desperate so I called a friend here in Asheville who is a practicing surgeon and convinced him to write me a scrip for enough Dilaudid to get me through the weekend.
On Monday I called Dr. Elder’s office and complained bitterly about the appalling lack of care provided by the on-call doc over the weekend and was given an ample supply of pain meds as well as an apology.
As it turned out, there was a lot more wrong than a torn rotator cuff. While it was indeed torn, in the same spot as had been repaired in the mid-90s in Sacramento, the tendon was also completely detached from the top of the humerus. In addition I had badly torn the tendon of the long head of the biceps, had two labral tears and had such severe osteophytes that they had to remove about an inch and a quarter of my collarbone to prevent further impingement.
As a result of all this, I was pretty much flat on my back for the 2011 holiday season. It was in December that the first of Abner’s problems emerged. While I was still pretty miserable from my very intrusive surgery I noticed Abner started standing in a way that un-weighted his right rear foot. This was disconcerting since there was nothing obvious wrong with the foot so I took him into the vet to see what was going on. We saw the wonderful Paul Duncan, one of the great vets at the Animal Hospital of North Asheville, who said it wasn’t clear what was going on, but that perhaps he had strained his knee. He gave Abner some prednisone and sent us home.
While this worked, the problem recurred about a month later. We tried the pred again and it worked again but in early February of 2012, just when my shoulder was starting to show some improvement, the discomfort came back and Abner was once again not putting weight on the affected leg.
At this point I decided that we needed to start doing some serious diagnostics to find out what was going on. X-rays were inconclusive as were blood work and urinalysis but there was something odd on the x-ray of the offending leg that Paul sent off to be analyzed by specialists to whom they refer tough cases. We also sent the x-rays to my friend Jay Stone who practices veterinary oncology in California.
The shortened version of this story is that a month later, with no confirmed diagnosis, Jay feared that what Abner had was some kind of anomalous version of Osteosarcoma which is a bone cancer that is disturbingly prevalent in larger breeds of dogs. His advice was to amputate the limb and shortly thereafter begin a course of chemotherapy.
This was an incredibly difficult decision to come to but Jay felt that if this was indeed Osteosarcoma that it would progress quickly to being fatal if we didn’t deal with it aggressively. So on March 5th I took Abner to Upstate Veterinary Specialists in Greenville, SC where Matt Ritter performed the surgery. Abner stayed there for a couple days and was not doing well so we all agreed that he might recover better in the comfort of familiar surroundings. On the 7th I drove back down and got Abner to bring him home.
When I got him home he was clearly distressed with his situation but I think was emotionally better than he had been at the clinic. He had a terrible time walking on three legs even with the assistance of a sling the clinic had provided for me to support his hind end. This was also very difficult for me since I was still dealing with the aftermath of my surgery. We were quite a pair. Things improved somewhat quickly though once I discovered that the spiny seed-ball from a liquidambar tree was wedged into his left hind foot. Within 24 hours of removing it he started learning how to walk on three legs.
By the time we saw Matt Ritter for a post op checkup on the 19th he was doing well enough that Matt felt it was time to start the chemo schedule.
Again, I am not going to go into the gory details but suffice it to say that Abner was not a dog who responded well to Carboplatin chemotherapy. Within 4 hours of the dose he was immovable and remained that way for days. He wouldn’t eat at all and only drank minimum amounts of water. He was again unable to walk and severely demoralized, as was I.
In the end the chemo caused a urinary tract infection, ear infections and a spinal infection that stayed with him to the day he died.
Knowing what I now know, I would not, in a similar situation, do the amputation or chemotherapy. We stopped the chemo at the one session because I didn’t want to risk completely ruining Abner’s life in an attempt to lengthen it.
Over the course of the summer of 2012 he got better at dealing with being a 3-legged dog although it was never easy. He tired much more easily and of course couldn’t handle walking on terrain that had much slope or any unevenness to the ground. He seemed pretty happy most of the time when we could get out to Biltmore to do easy walks and see his old friends.
In July of 2012 he seemed to be doing enough better that I decided to take him on a trip to West Virginia for a few days to visit Rob Rives who was working at Seneca Rocks Climbing Center.
In the meantime, in June I had gone back to my doc complaining of chronic left arm pain due, we both thought, to months of having to assist Abner with a sling I held in my left hand. Since my right shoulder was still trying to heal from the December surgery I was forced to use my left for Abner and now I was being punished 24/7. Steve Brown suggested some meds that tended to help nerve pain but in the end they didn’t really help all that much.
One day in Seneca, Rob and I did a hike to the top of Seneca Rocks. Over the course of that hike you do a lot of looking up and the hike itself has a pretty decent vertical component although the trail is good and switches back and forth enough that it isn’t a killer. Nonetheless, that night, on our way to dinner in a nearby town, the pain in my arm became so severe that Rob was afraid I was having a heart attack.
What I realized that night though, when lying down helped relieve the severity of the pain, was that the source had to be my spinal column. If getting out of a vertical position took the pain away it meant that compression of some kind was causing it.
After an excruciating drive home I got referred as quickly as possible to a neurosurgeon by the name of Eric Rhoten. Unfortunately he is a popular guy so while they got me into to see his PA and have an MRI done quickly, it took a long time to get onto his schedule. The diagnosis turned out to be a complex condition of partially collapsed discs, severe osteophytes, and foraminal stenosis. When I got the details of this diagnosis I didn’t fully realize what correcting it would entail.
Meanwhile in September I had been told to take Abner in to the vet to have follow up x-rays and labs done since at that point it had been 6 months since his amputation. What I was completely unprepared for was the x-ray showing him positive for cancer again. This time they showed several lesions in his lungs. Over the next few days I talked to everyone who had been advising me all along and was considering options for non-intrusive treatments but it was not to be. Within a couple of days, he began limping and when I took him in and had his left hind leg x-rayed it showed the same halo like image that the original x-rays had indicated 6 months earlier. At that point Abner’s health declined quickly and in about a week he couldn’t walk, even with assistance. He stopped eating and drinking and pretty much only could spend his time on his bed out on the deck behind our house watching what he could see of the world from there. It became painfully apparent that Abner was finished with his life irrespective of my readiness so at about noon on the 27th of September when Abner was 10 years, two months and 3 days old my friend Matt Vande came over, helped me get Abner in the back of my car, and we drove over to the Animal Hospital of North Asheville.
The vets there anesthetized him in the car and he fell asleep with his head in my lap, and that was it. They took him inside to euthanize him. . .I couldn’t go in. Matt drove me home and I spent the next few days in tears.
The pain of this loss was greater than any I can remember. Abner is the third dog I have outlived as an adult but I had by far the closest most important relationship with him. There are lots of reasons that I don’t need to belabor, but after he died I was dealing with relentless physical pain in my arm, which by then couldn’t be controlled with medication or position, and the horrible pain of a loss that seems like it cannot be borne.
I was, by then, scheduled to have my spinal surgery on the 12th of October, a mere two weeks after losing Abner. I agonized about what to do for a few days but ultimately decided to go ahead with the operation. It seemed that putting it off for a month would accomplish nothing in terms of my feeling mentally better prepared and the idea of extending the time of my physical pain even longer seemed pretty unwise. By that time I had been in pretty continuous pain for 4 months so the idea of doing something to at least relieve that made sense.
I made a brief trip to Indiana to visit my parents whom I had not seen since I had seen them the previous summer. It was difficult because I was terribly depressed and in physical pain so there was truly nothing that could have made me feel better but I realized that staying in my deathly silent house awaiting a surgical procedure about which I was pretty apprehensive was not going to work. I came home from Fort Wayne on the 8th of October, had my 3+ hour series of tests and pre-op meetings on Tuesday the 9th and after a brief cardiology burp on Thursday I went to Mission Hospital before dawn on Friday the 12th and checked in for my surgery.
The experience was surreal, but at this point I think you have probably endured enough detail on my various medical issues. What I will tell you is that the surgery lasted about 5-1/2 hours and I stayed in the hospital Friday and Saturday nights. Sunday at about 1:00 or so in the afternoon I was released and managed to squeeze my decidedly inflexible body into Josh Coopers tiny Mazda for the ride home.
I didn’t feel all that bad by then. I had certainly been on some serious pain management drugs during my stay at the hospital but oddly enough, pain management wasn’t that hard to handle after a few days. I did end up having to stay on Gabapentin (a commonly used drug specifically for nerve pain that I had been taking since June) and Meloxicam (NSAID) until May of this year but it was really to control the pain in my arm which took a long time to abate after the surgery. There was not nearly as much pain from the surgery itself as I had expected.
What I was unprepared for though was what I looked like. Eric Rhoten had told me that he would make a small incision in the front of my neck to get access to my spine for all the things he had to do. In the hospital they don’t put mirrors in the rooms and besides, I was in a major neck brace for months after the surgery so even if I had seen a reflection of myself I wouldn’t have seen anything of my neck.
When Josh took me home though, I hadn’t had a shower in three days so the first thing I did was go to my bathroom and take off the neck brace so I could undress and take a shower. Well that was a shock. The small incision was in fact 4-1/4 inches long, had a scab the entire length of it, was closed with a visible seam of glue and by then had the beginnings of my beard growing back. Since I couldn’t shave the incision site for quite a few weeks it ended up looking like a 4-1/4 inch long caterpillar crawling up my neck. Very attractive.
Josh and his girlfriend Alanna Nappi stayed with me the first night and according to them I seemed comparatively normal. I have almost no recollection of it so I guess I was still pretty well drugged.
For about two weeks I was homebound since driving is pretty much impossible wearing a neck brace. Once I did start driving again it was like an old man in a Buick. I had never allowed so much space between my car and the one in front of me. I also couldn’t turn around so backing out of driveways and parking spaces became quite a challenge.
I went back to Carolina Spine for a post op and then started my brief series of recommended physical therapy sessions but was still sad and depressed about how lonely I was at home without Abner. Roger Meade, the fine head of PT at Carolina Spine told me around the end of November that it was fine with him for me to travel as long as I was very careful about vibration and any kind of potential shock to my still hardening bone grafts. During the procedure, part of what Rhoten did was fuse the bottom 4 vertebrae in my neck to each other. The whole thing is held together by a very large piece of titanium that will be there forever. At this point the bones have fused to each other but there is nothing to be gained by removing the metal.
I felt strongly that for my emotional health I had to leave town, and most importantly my house, for a long vacation away. Everywhere I went in Asheville people knew me with Abner. The conversations were unavoidable and they reduced me to tears every time so I felt the need to be somewhere where people didn’t know me as half of a dog/human couple.
So at the beginning of December I flew to California for what would be a two month long visit with old friends and familiar places. I thought that by going for that long a period it would be more leisurely than my typical 7-10 day visits. This turned out to only be partially true. I was amazed at how busy I was and how many commitments I ended up making to see people and spend time with them in a variety of locations. I was in San Francisco, Aptos, Sacramento and Lake Tahoe over the course of the two months and had a fantastic time. What it accomplished was diversion. I did’t spend all my time thinking about how much I missed Abner. I spent most of my time running from lunch to dinner to art gallery to party. It was great but in the end simply put off the inevitable return to my the crypt-like stillness of home.
I began this trip with a lucky crossing of paths with Rob Rives and Carolyn Loeb where in Sacramento visiting Carolyn’s brother and his fiancée and I ended the trip with a visit from Ingrid and Larry who came to see me in Sacramento at Jim Sundquist’s house where I stayed for the time I was there. It was a great relief from the burden of my sadness but at the end of January I had to head back home.
When I got back my emotions took the almost predictable tumble at first. Two months of being constantly busy gadding about with friends had been really great at making me focus on something besides being sad and alone. The house and Asheville were constant reminders of these qualities where California had been the complete diversion.
A couple things did start to improve though and that began the process of coming out of the dark hole that I had dropped into when Abner got sick. For one thing, in late November the trailer finally sold. I have no idea who bought it but I wish them well. Without Abner, even if I had any faith that the damned thing would ever work, I had no more use for it. The whole reason I had bought it was to be able to travel with him whenever and wherever I wanted.
The second thing though was probably of equal importance. Toward the end of the time in California I started experimenting with reducing the dosages of the two drugs I had been taking to control my pain. Over the course of the next few months I cut back a little bit about every two to three weeks until, by the end of May, I was able to completely stop taking any kind of pain medication. While it is true that there are positions that I cannot assume any longer, and occasionally I will get a slight twinge of something in my arm, almost all my chronic nerve pain has gone. Eric Rhoten had said that about 85% of the people who have this operation will, eventually, be pain free, and I think I am going to be one of them. The simple fact that I don’t have to medicate myself two or three times a day is a big lift.
The other thing that is true is that time does make the pain of loss seem a little more bearable. I still have a huge hole in my heart and my life that Abner left. I miss him every day and frequently am still reduced to tears when I talk about him or remember some event with him, but I am able now to consider getting another puppy and starting over on developing a life for myself with a canine companion.
This spring has been one of many visitors and travel. This started with a terrific trip to see Rob and Carolyn in Vermont where Carolyn is doing a year-long internship at Merck Forest and Farmland Center. It was a great visit that was characterized by spending the days hiking with Rob and the afternoons and evenings with both of them eating and talking. It was spring when I left Asheville but there was a significant snowfall while I was in Vermont. It actually added to the fun for me although it made one of my hiking days with Rob challenging and wet. What I will tell you is that there is a level of stimulation that comes from hanging out, even briefly, with energetic well educated people in their 20s.
On the way up to see them I stopped in Western Massachusetts and got to see my old friend Nicole Blum and her husband Jonathan for the first time since their wedding day about 15 years ago. They live in a beautiful place on a farm they have pretty much built themselves. Jonathan has what appears to be a real emerging success in the hard cider business and Nicole still writes and is a genius with all things stitchery. They both look almost exactly like they did on their wedding day and considering that was a decade and a half and two kids ago that is quite an accomplishment.
I had been visited in late winter by Nicole’s mother Jackie and her partner Bill who were making their way to Asheville for the first time. We did as many of the standard things as we could with the limitations of time and Bill’s impending surgery. Still, it was a great visit.
When I returned from Vermont I was home for a couple weeks before I headed off to see my friends Ann and Bowers at their beach house in Florida. This was a long but easy drive and was really the harbinger of my being able to go off pain drugs. It takes more than 9 hours of driving to get from my house to theirs but I made it without any significant pain in my arm. It was great being at the beach for a few days of good food, relative sloth, and great companionship.
Shortly after my return to Asheville, Faye and Jay came for another visit and this time we included a quick trip to Charleston. I always have fun with these two and this trip was no exception. It seemed like mostly all we did was eat although I know that isn’t true.
Then I was visited in rapid succession by one of my first employers from Fort Wayne, his wife and two friends of theirs who were originally from Russia but now live down the road from me in Charlotte. This was great fun, quickly followed by Ben Fowler, another of my young friends from UNCA who graduated a couple years ago and was back in town for a visit with his girlfriend Desi and a couple of her friends from her hometown in Germany. While my house was the base of operations for this quartet I wasn’t really expected to do much entertaining so it was easy. It was nice having a busy house but little responsibility.
Then a few days later I entertained Werner Kreis and his wife Jill. Werner is an architect from Zurich with whom I worked in the very first job I had after graduating from architectural school 42 years ago. We had last seen one another in London in the mid-80s so as you can imagine I expected things to be somewhat changed. As it turned out, Werner seems like he is exactly the same. He has slightly less hair and slightly more creases in his face but I would have recognized him anywhere and he is the same sweet, interested, and interesting man he was 42 years ago. I had a great time with them although it too was compressed into a very short visit.
Finally, in June, my nephew Jon and his wife Erin were in town with a bunch of people from Erin’s family as well as my sister and her husband and Jon’s dad and his wife. The whole group was here to celebrate Jon turning 30 and as is the case with a group numbering 14 people and ranging in age from 9 months to 66 years, one just had to go with the flow. There is no way a group of that size ever wants to do the same thing at the same time so I ended up just kind of following around most of the time. It was exhausting since I am not used to hanging out in crowds of that size but it was fun and really nice since I got to meet Erin’s family and see my 15-month old grand nephew for the first time.
Once that group left, things got quiet and I have started trying to get my life back to something resembling normal. I am hoping to start posting with some regularity again, at least if there is anything to talk about. I also am hoping that I can start posting photos again. Something strange happened with Picasa and Blogspot back in December that has never been resolved. There are odd error messages that appear every time I try to post or edit a post and sometimes the posts don’t work at all but Google offers this system as a free host for bloggers and consequently there is no way to get tech support or customer service to find out what is screwed up. Like most Internet giants, I guess they think that as long as we aren’t paying for something they don’t have any obligation to fix it when it is broken.
So that’s it for now. I am sorry this is more like a short novel than a blog post but it seemed to be the only way to catch you up. I am going to try to post some photos from some of the events of the last couple years if I can find them and if Picasa and Blogspot decide to cooperate.
Thursday, July 18, 2013
Things are happening in my life again in ways that would kind of motivate me to start posting to this blog again but Google, in their infinite wisdom, seems to have done something not only to Blogspot, the host for this blog for the last 7 years, but Picasa from which I posted all the photos. Something has been screwed up since last December and Google simply has no tech support or customer service for any non-revenue products so there is no way to get any instruction on how to make this thing work again. I would appeal to anyone out there who actually knows how the "new and improved" Picasa3 and the current versions of Blogspot are supposed to function.
There used to be a button in Picasa that said "blog this" that would allow me to upload photos from a Picasa file directly into this blog. That stopped working on my old computer in December. Today I downloaded the lastest version of Picasa and lo and behold it has no "blog this" button. In fact there appears to no longer be any way to post Picasa photos to a blog. Help from some really sharp blog nerd would be greatly appreciated. Meanwhile, one of these days I may just post a text catch up for those of you who used to read this rambling journal of life in and around Asheville. Meanwhile, I will attempt to load a photo or two from my computer and hope for the best. I may end up saying Sayonara to Picasa3. . .hopefully not to this blog.
These are pictures I actually took holding my 2 year old iPhone when I was in Vermont visiting Rob Rives and Carolyn Loeb last spring. One day the weather was beautiful and spring like and the next day it snowed like crazy and we got good and wet on our hike. Such is life in the spring in Vermont. A great time was had by all.
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