Ketring Park

I took Mandy for a little walk around Ketring Park and Gallup Reservoir on this very windy Saturday. She loves the big grassy space, and was particularly fascinated by the guys playing Frisbee with their dog across the grass.

Sheetrock's Up!

The drywall's up and taped, so we're pretty far along. I do miss that feeling of spaciousness, when looking through the empty basement, or even peering between all the open framing. Now we're starting to get a sense of what the space is going to feel like. Here's the hallway. I happened to catch Mandy exploring in the dark. I didn't know she was there, until she showed up in the flash picture :o)

Not too late for snow!

We got a few inches of snow last night. All the trees had a fairyland kind of look to them this morning, all delicately coated in thick white stuff.

Launch of AV014!

We successfully launched AV-014, an Atlas V carrying the ICO mobile communications payload, this afternoon. It was one of those "relatively civilized" countdown schedules, where we worked a mostly normal day.

I took advantage of the nice Spring weather to ride my bike after work, down Lee Gulch and Highline Canal, to the bike shop. I missed them by 5 minutes, but it was a nice short fun ride anyway.

Framed and Insulated

The basement is still progressing. In this stitched panorama picture, just about all the framing is done, but you can still see through all the walls, and get a feeling of lots of space down there. I love that. After all the sawing and other construction activities, we have a fine layer of sawdust over almost everything througout the house. You can see the particles still floating in the basement air, reflecting the flash back at the camera as big suspended blobs.

And then... in the blink of an eye.. it's all insulated and ready for the sheet rock! Here's the South wall. It's already beginning to look so cozy and warm and quiet. I miss being able to see all the pipes and wires up there, but I've mostly let go of needing to have access to all that. We are *so* looking forward to using our new living space, when it finally becomes available.

Infiltration

Sher asked about infiltration. I found this description online at globaldialysis.com: Among the most dramatic and troublesome complications of dialysis is access infiltration. In most cases the infiltration is minor and usually results from either inadequate hemostasis at the end of dialysis or needle perforation through the access site [this is what happened to K]. Extravasation injury to the access is more likely when a needle errantly transfixes a graft or vein or when it accidentally becomes dislodged into the subcutaneous tissue. The venous return needle presents the biggest problem. In the face of typical pump speeds of 400 to 500 mL/min a potentially huge volume of fluid can enter the soft tissue before the pump stops in response to the alarm for elevated venous pressure. In many cases, the graft is unusable for weeks after such an episode. Continued use of the access in this setting may result in loss of the access site.

Progress

K's feet continue to heal, but there are still open wounds. She had an infiltration when they started dialyzing her on Friday, so she had to go back at 5am on Saturday morning to try again. She's been seeing someone to help her breathe better, and it seems to be helping. She tested by going off oxygen last night for several hours, and reported that her O2 saturation was bouncing between 85 and 92. Not perfect, but way better than last year. She'll stay on the supplemental oxygen of course, since she should really be above 95 all the time, and we're convinced the higher O2 level is helping her wounds to heal.

The basement work is proceeding. It's amazing to see, even though we had some idea of what to expect, all the people that are coming and going, and the incremental progress being made. The framers had the initial framing done in a couple of days. Then the heating/mechanical guys got in there, and moved a bunch of heating ducts around. The framers came back, and framed the soffits around the ducts. The central vacuum folks added a few more lines. The plumbing folks decided some things were in the wrong place, and jack hammered up some concrete. The electrical folks routed a bunch of Romex around. It's a virtual whirlwind of activity around here.

Mandy's been entirely unsure of the who, what, where, why, and how of the past few weeks, and has decided that barking at every little noise and every new person will help her feel more comfortable with the process. She quiets down immediately, when I pick her up and let her sprawl across my left arm, and sits contentedly watching the activities from that safe haven. She really looks forward to our occasional walks. Here's a picture of her scoping out new territory, on a berm near the Highline Canal where it passes not far from the Littleton Dialysis Center.

My Sister left today after being here for a couple of weeks. It was really nice to have her here. I sure enjoyed her company while going on some nice long walks, doing a few household fixit jobs, taking a short bike ride, running various errands, and of course watching a bunch of movies.

Starting on Basement

Well... we've finally committed to finishing our basement. I've held back for a long time, thinking we didn't need the living space, and liking the access to pipes and wires down there, but it seems it was just a matter of time, before we got around to customizing the space into something livable. The framers came on Monday, and started out by helping us move the last of our "precious possessions" upstairs into the PODS container and other nooks and crannies around the house. For a moment around noon, we had a completely empty basement - something we haven't seen since 1995. We're very excited about the possibilities the new space will bring.

My sister Otamay arrived last Sunday night, just in time to ride home from the airport in a delightful little snow shower. We've been enjoying taking Mandy with us on some walks on the local trails, the past few days.

MV332 Launch!

We successfully launched MV332, a Delta II rocket carrying the GPS 2R-19 payload, this morning at 2:10am Eastern time, less than 48 hours after our first West coast Atlas V launch, and the same day (well, night, actually) that I got back to work in Denver, after my trip to support the AV-006 launch. That's a lot of excitement (and not much sleep) in a short time period!

AV006 Launch!

We successfully launched AV-006, an Atlas V rocket carrying the NRO's L-28 satellite this morning at 3:02am Pacific time, from Vandenberg AFB. I usually support the launches from Denver, but I was onsite for this one, so I was a little surprised at first, and then thrilled, to hear the rumble of the rocket engines through the ceiling of the launch control center, shortly after liftoff. This was our first Atlas V launch from the new West coast launch pad, and a major milestone for our new ULA company. We're all pretty tired here, after a very shifted work day, but ecstatic all the same.

Missed Opportunity

We were awakened at 5:54 Saturday morning, by a phone call from the University of Chicago. They were calling about a possible match for a kidney/pancreas transplant. K's feet are healing, but the wounds aren't closed, which disqualified her for this opportunity. This is so disappointing.

We spent the day packing up more stuff in the basement, and filling up the crawlspace, as well as starting to fill up our temporary PODS unit. After hours and hours of work, and many trips up the stairs and out the garage, we did make some progress, but looking at the basement, I have a bit of a sinking feeling that we hardly made a dent. K disagrees, and is trying to get me to see that we really did make a huge impact. I just see all the stuff that is still to be done, and it's very daunting.

POD People

I went with K to the wound care person on Thursday afternoon. She doesn't think the wounds need more than the superficial trimming that she was able to do, at least for the moment. All the wounds were smaller than they were the last time she saw them, which helped relieve my anxiety a little.

We spent Friday afternoon packing up stuff in the basement, and taking rubbermaid storage bins out to the PODS container that's now sitting on our driveway. Well, actually, K was in dialysis, while I and our very helpful neighbors Ken and Freddie helped me pack up the Christmas stuff and move it into our recently fixed up crawl space. Then after I picked up K from dialysis, Ken and I started carrying the boves out to the POD. We only got one line of boxes in place at the far end of the POD, about 3 boxes high. It was a lot of work, but the result isn't very impressive. The basement doesn't look very much emptier, either.

Holding My Breath

K tore a big deep chunk out of the bottom of her foot yesterday morning, when removing the bandage to change it. The other older wound isn't looking that good either, in my non-medical opinion. She's trying to get in to see somebody about it, but as usual personal logistics are getting in the way. The wound care person wasn't available when she called. Her PCP doc could only meet with her at 3:15, but today's 10:30-3:30 dialysis schedule pretty much squashes any chance of her getting there on time. She's got a scheduled appointment with the wound care person tomorrow. I'm holding my breath waiting to see how things work out. *Update* K got in to see the doc after dialysis, and he set her up with oral antibiotics. He wasn't certain the old wound was even infected. The wound care person is supposed to evaluate it tomorrow, and determine if surgery is indicated.

PSL Transplant Class

It was cold and windy yesterday, and this morning we have a few inches of snow on the ground, with more drifting down. We spent the better part of yesterday afternoon at Presbyterian Saint Luke's (PSL) introductory Transplant Class with our neighbors. We learned some new things, such as transplant recipients are about 100 times more likely to get some kind of cancer, often skin cancer, which is easily treated if caught early enough. Ugh. In about 10 days, K will be on their kidney recipient list, which will give her a 2nd possible source of an organ replacement. After all that excitement, we decided we needed (!) to have dinner at the Spaghetti Factory.

CA Trip

My trip to the West coast had some travel (delayed and canceled flights) and business (delayed launch) hiccups, but the family part was pretty perfect. I was *so* looking forward to seeing Dorothy in her mostly-recovered state, and wasn't disappointed. I got hugs, went on errands, and went for a night walk around the lake with her. I even sat contentedly on the couch between her and Tyler as they played Eternal Sonata. I got to play Frisbee golf with Bob, something I've sorely missed since the last time we played over a year ago. My original return flight was canceled, because the pilot broke his leg getting off the plane at a previous stop. So I used my two free hours to scramble up Mt San Luis with Bob and Mikele and the dogs. It's a nice easy hike, and there's such a delightful view from up there! We flew through some snow showers on the way into Denver, which was sufficient warning that I wasn't surprised by the cold blast when I walked out of the airport terminal. It figures that this time I had to wait inordinately long for a cab, in a T shirt and light jacket, but at least the ride home was uneventful.

Kidney Group

Mandy and I walked 4 miles along a new route to The Original Pancake House this morning, and met up with K for lunch. K said she was reminded that she really likes driving my new car (Uh, oh... ;-) The walk seemed to fly by, as I was chatting with Bob and Mikele for most of it. I really do think cell phones, free weekend minutes, and bluetooth ear pieces (when used responsibly ;-) are just the cat's meow of technology!

We went to a meeting of the Front Range Kidney Patients' Association at Porter Hospital this afternoon. For information contact George Bravdica at 303-934-0077 or gp134b@yahoo.com. We heard some interesting stories by people who have been in dialysis for years. One fellow was wearing a "House of Blues" baseball cap, which had me wondering if he went to Chicago for his transplant. We were even able to relate a tale or two ourselves. We learned some more about peritoneal dialysis, and why it might be a very attractive alternative to hemodialysis. For one thing, it can make traveling much more possible. For awhile, I was finding it difficult to get completely immersed in the dialysis scene, with the potential for a transplant (hopefully just) around the corner. However, hearing stories of transplanted kidneys failing after a few years brought home the reality that dialysis will always need to be an option. The most important thing I heard, was a reaffirmation of the thought that K needs to always stay on top of the caregivers at the dialysis center, and immediately elevate any problems to the next level, when she's not being treated appropriately. This was in response to the issue that arose with the IV antibiotics last week. The worst part of that event was when they just plain weren't listening to her.

Nauseous

Still hanging in there. K's been nauseous most mornings lately, no idea why, and hasn't been able to think about breakfast. I think she's liking her new MWF dialysis schedule. Mandy and I ran some errands on Friday, and visited her in dialysis. The nurse shooed M out right away, but I came back later for a short visit. I like that the room is bright and seems more cheery than the last place. She wasn't pleased to discover they haven't been giving her the IV antibiotics that were prescribed after her surgery. She is so wiped out by dialysis, that she generally sleeps through it, so she had little opportunity to notice if they were doing it right. The instructions had transferred over from the Lakewood center OK, but apparently no one actually read her chart when she arrived at the Littleton center. Even when she asked about the specifics, they assured her they had no instructions for it, until the nurse from Denver Nephrology looked into it. By that time, it had been a week, and it was too late to restart it. The good news is that most of her foot wounds are still healing up, although slowly. Her Kaiser primary care doc has assumed some control of the wound management, which could be a good or bad thing, depending on how it goes next. He's going to determine when to take out the stitches that were left after the surgery.

I've still got a dry cough from the cold I caught in early January. I've got plans for a business trip soon, and am struggling with how to make sure K does the right things while I'm gone. Any support in keeping her on track would be much appreciated.

This is shaping up to be the year of home improvements. Last year, we had our friend Mark finish up several smaller improvement projects, including making our crawlspace usable for storage. Now we're looking at some big projects - recovering the roof, finishing the basement, refurbishing the deck, and maybe even adding a trellis or something, to shade the sun. It's hard for me to imagine doing all that, with the possibility of a transplant looming in K's near future, but that's the plan.

Littleton Dialysis

K switched over to the Littleton Dialysis center this week. Hooray, she's saving 20 minutes of driving each way! She's feeling good enough about her feet healing, that she's back to driving herself to dialysis. She went to Lakewood on Tuesday and Littleton on Wednesday, so she's been well dialyzed by today! We got a few inches of snow early this morning, and expect a few more this evening. Our darling niece Dorothy was released from the Santa Clara Valley rehab center in San Jose today, with the expectation that she'll be living at home, visiting a local rehab facility, and returning to school as soon as it's practical.

Feet Still Healing

K's feet continue to heal. A nurse comes daily, checks her feet, and changes the bandages every visit, which sure makes me feel better about her being home, instead of laid up in the hospital. I am occasionally around when the bandages are off, and K showed me yesterday that most of the smaller wounds are almost gone. The big one on her right foot is still very much there, but looking better. The antibiotic beads are still stitched up inside, but are probably mostly absorbed by now. She's still on oral antibiotics for another few days.

Windy

It's been blustery today, really since last night. We were out at an appointment this morning, talking to someone who wanted to meet her husband up at Beaver Creek, but it didn't look like she was going to be able to get there. Apparently the I-70 corridor to the ski areas has pretty much been shut down for some time, because of harsh windy conditions - blowing cars off the road, that kind of stuff. K's visiting nurse just left, talking about moving to Texas. With her job, she's out in the weather all the time, so it affects her far more than most people. The nurse said K's foot is healing pretty well, but they're watching a new crack that's developed on the bottom of her foot since last week's surgery.

K learned yesterday, about an opening at the Littleton dialysis center, which is only 10 minutes away, instead of 30. The time slot was at 5:45 AM MWF, which gave us pause, but then we decided to go for it. We were even beginning to look forward to the change to our daily schedule that it would bring. By the time we got down to the center to talk to them this morning, they'd given that slot away, and instead had an 11-3 MWF slot to offer. Even though that takes a big bite out of the most useful part of the day, leaving little time for other medical appointments, we think it's worth the trouble, at least for now. We're hoping they'll have a 6:30 AM slot available soon.

She's Home

The surgeon said as far as he was concerned, K was ok to be released today. She can use her feet - she should walk flat, and distribute the pressure evenly. They had her ready to go by 2. Mandy was waiting in the car for her, and rode home on her lap. We stopped at Spicy Pickle to pick up soup and sandwiches on the way home. We had our lunch, and now she's settling in.

Whirlpool

K did her Saturday dialysis in the hospital this morning. Then they took her for a warm whirlpool treatment on her feet. That's supposed to help with circulation, and also do some gentle debriding. She got to see her wounds after surgery, and was relieved to see they weren't very deep. Other than that, I think she had a pretty quiet day. With all my coughing, and our interrupted early morning, and K's sleepiness, we decided I should stay away from the hospital today, and just let her sleep whenever it hit her, which was about the time we were talking. Ken and Freddie came by, and we took Mandy for a medium sized walk down to the Littleton light rail station. We sat in their little waiting room, and drank coffee while Mandy had dog treats. Mandy got the dreaded cold foot syndrome a few times during the walk, but each time after a short foot warm up, she was back on her feet again. We were ready for a nap when we got home, and did so while the 1954 movie, "20,000 Leagues Under the Sea" was running on the TV, which was a slightly surreal experience. Ken and Freddie came by later, and we went out to dinner, then played several rounds of Rummikub. K called just after they left, and reminded me to get to bed early, so here I go...

Opportunity Missed

Day 4 at St Jo. I was awakened at 5:34 this morning by a call from the University of Chicago. They had a possible pancreas/kidney transplant match for K. I was terribly disappointed to have to tell them that K is in the hospital fighting a foot infection with antibiotics and surgery. This was (in more ways than one), a wake-up call for us. We were told our first call might be as soon as 3-6 months, but in fact it came in 2 weeks. I didn't feel like we were ready to go, but K had a completely different perspective. Sitting in her hospital room at St Joseph, she felt like she could just as easily be in Chicago. She told me to call them back, while she checked to see if her doc at St Jo would release her. The docs on both ends agreed this wasn't a good time, so we missed this one, and will plan to be ready for the next call. K was heartbroken at the bad news, and is very mad at her feet right now. She morosely wondered if the next call will ever come, and I asked her to focus on being ready when it does. I was going to sleep in today, but now that I'm all fired up, I figured I might as well let you all know what's happened.

Friday Night

I stayed with K until the late afternoon, then headed home to try to get an early night. I found some nice flowers in the gift shop, and delivered them to her room while I was waiting for my car to be retrieved. Our caring neighbors Ken and Freddie have been graciously watching Mandy while we're away from the house, so she's a very well cared-for pooch. Considering how much she seems to like those guys, I'd say she hardly misses us, but that would just be wrong. She spins in energetic circles when I walk in their door, which makes me feel very much missed and welcomed at the same time. At night before we fall asleep, it's clear she's wondering where K is, as she sits on the bed, and goes on alert at every noise. She wants her K home, as do I. On the other hand, I'm really glad she's in the hospital, and practically under armed guard that won't let her leave her bed. That's the most important factor in getting these wounds to heal, is to get off her feet. We got a light coating of corn snow this evening, while we were playing Rummikub after dinner. I'm still dealing with a dry cough from the cold that hit me 3 weeks ago. It sure will be nice, to be completely over that one.

Back in Room

K's back in her room. I waited 90 minutes for her to get out of a supposed 20 minute surgery. It turns out the waiting room attendant messed up in adding my name to her list when I'd arrived, and so no one knew I was waiting, and I got no updates on what was happening, or even the final debrief from the doc. The waiting room was very full, more so than I've ever seen, after several occasions of being there, and I didn't want to bother people unnecessarily by asking them about her every 10 minutes, but I guess I should have. After they sent her back to her room, someone finally came out, and asked if anyone had shown up for her. I said I'd been waiting an hour and a half, and they were caught completely off guard, thinking no one would respond. Boy, did that get me fired up. It's bad enough having this all happen, and worse to be completely in the dark, when they were supposed to be keeping me updated.

The surgeon didn't find the need to amputate anything today. He debrided wounds on both feet, packed antibiotic beads into the wounds, and bandaged up both feet very securely. The infectious disease doc came by to tell her that they'll have the results of the deep culture sample by Monday, and then they'll know what kind of antibiotic to use, to target the infection. So it looks like she'll be here awhile.

Out of Surgery

She's out of surgery and in the recovery room. No word on how it went.

Into Surgery

Day 3 at St Jo. The Ortho doc read the results of the MRI scan of her feet, and has scheduled K for surgery this morning, to address the multiple wounds. He expects to only do some debriding, and not any amputation today. The decision for that will rest mostly upon the blood circulation in her feet, and he'll get a sense of that during this first surgery.

Frustrating Day

Day 2 at St Joseph hospital. Today has been very frustrating for her. A broken MRI machine delayed getting the important internal picture. A big delay getting into dialysis, while waiting to figure out if the MRI machine would be available. When the MRI machine finally became available, they go the pictures, but the Ortho doc was too busy with other surgeries to read the MRI pics. Because of all that, her foot surgery has been deferred until tomorrow. She feels the foot has been getting worse very quickly today, and this was important time lost. Infections can move so fast, and we've seen that happen more than once, that it's amazing to me when things like this happen.

K at St Jo

Day 1 at Exempla St Joseph Hospital. I visited with K in her room late tonight. She's on an IV broad spectrum antibiotic. I think because this is an issue with infection, they gave her a private room, so maybe she'll be able to sleep through the night during this stay. The doc thinks she'll be there at least several days. The idea is to enforce the "stay off your feet!" directive she's supposed to have been following for the past several weeks. It seems like some surgery is required, but there's no discussion of it yet, aside from K asking about it. With any luck, having the pressure off her feet will help allow them to heal. Her dialysis center knows she's not coming anytime soon. It snowed several inches tonight, but our new CR-V made the trip to and from the hospital an easy and safe proposition. Mandy was disappointed that she had to stay in her nice warm bed in the car while I was up visiting K, but with the issue being infection, it didn't seem appropriate to take her up.

K to Hospital

K called from the cardio doc's office. She noticed this morning that her foot wounds are looking worrisome. The cardio doc agrees, and is making arrangements to admit her to the hospital. She'll need to be in a special area, because of her recent antibiotic use. They won't be able to admit her until 4pm, so Freddie will take her home for an hour, so she can grab a change of clothes before they go back for the 4pm admission.