Special Treatment

K's ortho doc has been very conscientious, making every effort to give her the opportunity to heal, and even calling me after every one of her visits, to summarize her status and his approach to her care. His latest effort today, was to put K's right leg in a full-contact cast. Here she is at dialysis, with her new day-glow pink accoutrement. He's hoping it will distribute any pressure on the foot more evenly, and give the wound on the bottom a better chance to heal.

Follow up

K had a busy day on Wednesday. House stuff, errands, dialysis, and a follow up appointment with the ortho doc, who said he's going to try something different, to help her feet be able to heal without being totally off them all the time.

Sunday

K's numbers (glucose, temp, pulse/ox) seemed OK this morning. She stayed in bed awhile, recovering from the stressful hospital visit. With her off-the-feet order, dog class on Monday seems pretty much out of the question.

I took Mandy for a walk up Lee Gulch to the pond at Ashbaugh Park, and even tried her off leash for awhile. She was so good most of the time. She really wants to be 50 feet ahead of me, but once she gets out there, she slows down and keeps pace, using the extra distance as a time buffer, so she can sniff around to her heart's content, without falling behind, as I catch up at my slow human-walking pace. When I start running, she lets me catch up, then lopes along next to me, and glances up occasionally with a sort of happy dog look, if you can picture that. Then came the moment when she spotted someone walking a couple of big dogs, off in the distance. She went on her usual alert, ears up, all four legs stiff, and started into her stalking mode. But wonder of wonders, she stopped on command, and waited for me to come up beside her. We had a nice run on leash, the rest of the way home. Here she is, running alongside me, although looking at it now, she's obviously barely putting out any effort to keep up with me.

The painters were here over the weekend, doing the windows and doors. The big room is looking pretty done, aside from the shelves not being trimmed in yet.

K's Home

K came home from St Jo tonight. My estimate was way off. Last night I was thinking that I'd have her out of there by 3pm today, with just dialysis to do in the morning. But with the confusion with the antibiotics, and other general hospital slowdowns, I didn't get her out of there until after 8pm. The antibiotic question was resolved in favor of having DaVita administer them during dialysis, but that's only every other day, so it's a poor compromise at best. She had a 100 degree temp just before checking out, but the tech was creative, and had her drink some water and measure again, which of course brought it down. So now we're watching her temp very carefully, and it does seem to be going down.The last thing they messed up was her prescription for pain meds on the way out. They forgot the pharmacy had closed, and sent the hard copy down in the pneumatic tube, so there was no way to get it back. It took nearly an hour to get everyone to understand what needed to be done, and to get a doc to sign a new prescription, and get it back to us. By that time, we were so tired, we just came home anyway - maybe she'll get it filled at Kaiser. She's on a no-walk no-drive order, and wearing a big unwieldy boot on her right foot, so it will be interesting getting her to the follow up appointment on the morning of the 21st, especially since that's her dialysis day. We'll be asking around to see if someone can take her. The good news is that the DaVita center was willing to slide her dialysis appointment back from 1pm to 5pm that day. Sigh. Another long day. I just got back from walking Mandy one last time before bed, and now it's time to get these tired eyes closed.

In Dialysis

They got K into Dialysis this morning around 8am. It's funny that it took so long, because the dialysis facility is on the same 3rd floor where she's staying, just a few feet from her room. Dr Brook called the house to tell me he changed his mind about allowing her to walk, and will be ordering that she keep all weight off her foot. I know it will be a great inconvenience, but that's really pretty great news to me, since it seems obvious that this latest round of foot problems is all about the trauma caused by walking around on the wounds. K called from Dialysis a little while ago. She says the antibiotic order is problematic. They'll want her on daily IV antibiotics for awhile, so she may need to have a PICC line inserted. The dialysis folks are concerned about losing a possible site. I'm not clear on this, but it sounds like for some reason DaVita won't administer antibiotics, which is forcing the PICC line issue. It sounds like they want to leave the decision to her, but I asked her to get the docs talking so they can resolve it as best as possible for her.

Post Op

K's out of surgery as of 5pm. Dr Brook just called to give me the details. He debrided existing wounds, removed the medial sesmoid bone, and planted antibiotic beads. He also loosened the Achilles tendon to prevent future problems. He's going to confer with an infectious diseases specialist about what antibiotics to use. The problem is complicated by the various antibiotics they've already had her taking recently. He says he'll be sending her home tomorrow after dialysis at the hospital, and wearing a cam boot, which has a rounded bottom to help prevent putting too much pressure on the bottom of the foot. It sounds like she's now in the best possible position, to be able to recover from the current situation. She has a follow up appointment with the doc and his nurse on Wednesday.

Waiting for Surgery

K says they never got around to taking her to dialysis this morning, so they'll either have to delay the surgery, do the dialysis later today after the surgery (doesn't seem likely), or have her do a make up session at the DaVita center on Saturday (not as easy as it sounds to schedule one of these on short notice). I think they should keep her another day, and do it in the hospital tomorrow morning. The cardio doc called the house this morning, to say the result of her nuclear stress test was "normal", which means her heart shouldn't be a factor in U of Chicago deciding whether or not she should go forward with a transplant.

Checked In

Mandy and I drove K up to Exempla St Joseph hospital this (Thursday) evening, to check her in for tomorrow's (OK, technically, today's) planned foot surgery. She's in the South wing on the 3rd floor, in a nice clean single room at the end of the hall, just across from the Solarium. She should be getting dialysis in the morning, and the surgery in the afternoon.

Basement Carpet

The basement made a big jump towards looking done, after the carpet was laid down. In this picture you can see the new carpet, the cabinets installed along the East wall, and the new French doors, which replaced the metal sliding doors we had there before. You can also see the new heater vent down low, which will heat the room more efficiently. We are so excited about how close this space is to being usable!

Nuclear stress test

K went for her nuclear stress test today. At least that's the name they used, when they called to confirm her appointment. Cool name for a fairly long (3-4 hour) test that evaluates blood flow to the heart. This is to collect more data in preparation for a possible future transplant operation some day.

Surgery Date

K was notified today that her foot surgery will be Friday at Exempla St Joseph Hospital. It was supposed to be a "day" surgery, but the person calling to notify her said she needs to check in on Thursday afternoon, and was unable to explain why.

On a positive note

Our homeowners association held the annual spring cleanup and brunch today. The brunch was held at the house just down the hill from ours, so we got to see what our new deck, with its trellis and roof, looks like from below. Everyone seemed to like it.

Things are coming along swimmingly on the inside as well. The baseboard is installed, and the closets are sprouting shelves. The big room is currently full of freshly painted interior doors, left to dry by the trim people. Here's Mandy exploring the "door art".

I took Mandy for a walk down to Sterne Park this afternoon. I just love the sundial by the rose garden across the street. Mandy wasn't all that interested, but I caught a regal looking profile shot of her standing in front of it.

Bone Infection

K heard back from her Ortho doc (Pino) this morning, before she left for dialysis. The MRI was difficult to read, but he and an associate think they understand it now. It looks like there is a localized infection in a small bone that's between the big toe and the rest of the foot, and that bone must be removed to prevent the infection from spreading. So the good news is that right now it looks like a relatively minor surgery. This will require a day surgery, after which she'll wear a special protective boot for her foot. She'll need to be on daily IV antibiotics, which they'll administer in dialysis (if they don't blow it again). The scheduling is problematic - they can't get her in, until sometime next week, and Dr Pino will be out of town then, so another surgeon will have to do the work.

No news (is tough to bear)

K got to the Ortho doc on Wednesday morning, and he didn't have anything to report. The scan images were available online instantly after the MRI was taken, but he wanted the official interpretation of the scan from whoever does that stuff. So we still don't know the status of her foot. The good news is she's been taking antibiotics since her first meeting with him, and there's a reasonable possibility that any infection is being held in check, or (hopefully) being beaten back. The doc said to call by Monday if we haven't heard anything. My stomach is in knots waiting for this info, when I have time to think about it. I suppose the good news is that I rarely have that kind of time these days.

The Univ of Chicago transplant group called today, to let K know that she's been moved to their "inactive list". The KP transplant coordinator had called them to report that K's foot wounds are still not healed.

Got an MRI appt

The Radiology dept called and had found an appointment for K for Tuesday evening. We'll know more after that. She's got a follow-up appointment with the Ortho doc on Wednesday morning. In the meantime, K is extremely worried and depressed about the possibility of serious foot surgery in the near future. I'm not holding up so well myself.

Foot concerns

K's previously recovered heel has reverted to wound status, but it's not as serious as the balls of her feet, which have both been deteriorating. The right one is looking especially bad. The Ortho doc on Friday thought he could touch bone through the wound with a Q tip. He put her on oral antibiotics and ordered an MRI. He wants it done before the follow up appointment on Wednesday, but the MRI dept doesn't have any openings before next Saturday. Typical. There's so much going on in our life right now, that everything seems to blur together, and it's hard to get anything done, especially when the system doesn't cooperate.

Walk

I took Mandy on a little walk up Lee Gulch to the high school and back. A great Blue Heron flew by, throwing a huge shadow over us for a second, then settled gracefully onto the bank of the gulch, and hopped down to pick at grass and minnows in the creek.

Mandy has this thing about just going right up to the top of any steps we pass by. I think she must've once lived with someone who had a house with steps up to the front door. Either that, or her adventurous soul can't resist the opportunity to see what's up there.

The spring blossoms are coming out beautifully about now. They're looking especially good on the plum and crabapple trees in the front yard.

Railing

The decking is all laid down, and now the railing is going up. The vertical supports will have composite material around them to keep the weather out as much as possible. This Trex material looks really good, and feels wonderful to the bare foot. I'm thinking it will be a real pleasure to wander out there bare footed, and not have to worry about splinters!

Decking

Most of the decking material has been laid down. The ends are ragged, but that's just a matter of buzzing them straight with a saw. This time around, we're opting for composite decking, to eliminate splinters, and also to hopefully extend the service life a little longer than last time.

Textured

It hardly took any time for the basement walls to be textured. The pattern looks really nice.

Primed

The basement walls are all primed and ready to be textured. Here's my office. I'll even have a bit of a view of the Rockies, or at least a little of the Front Range, off to the Southwest.

Deck Supports

They're making rapid progress on the deck now. All the demo work is done, and the new underpinnings are in place. For sure it will be treated wood this time around, so maybe it will last a bit longer.

Walk the Platte

Ken and Freddie and I took Mandy on a walk along the South Platte River to Panera Bread for lunch, on this fine sunny Sunday. In the past, Mandy wouldn't want to get anywhere near the water, but these days she's more than happy to not only lap up some water from the shore, but she also is more than happy to wade through ankle deep water at the beach. She took great interest in a group of people hanging from a nearby tree - probably a class on rope climbing.

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.