So Much for Those Ideas

In response to yesterday’s post, Kaitlin laughed and reminded us the reason they were coming next weekend instead of their usual Fourth of July trip was because they wanted to wait until the rains had turned the grass green. (We’ll have a good time anyway.)

And Andy and I bought a lot of wildflower and clover seeds this past spring — he was going to sow them once the rains had soaked the soil. We’re still waiting.

The good news is enough rain fell that the Forest Service opened up the forests, which is why Andy was able to take the Cerro Grande walk Wednesday. It could have been a lot worse.


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Cerro Grande Walk

Andy hasn’t any symptoms for over a week, and his walk up Cerro Grande went fine. It only took him three minutes more than last May to walk to the top.

The most interesting thing about the walk is that even though we’re supposedly in the midst of our rainy season, most of the grass is still brown.

We’re in the “Exceptional Drought” part of the drought map.


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Yay, Mayo Clinic!

I spent a lot of time yesterday reading reviews of the Mayo Clinic — many were negative about the hassles involved and the sometimes rude doctors, but there were positive ones too, of course. Still, it made me rethink whether it made sense for us to go. I want to make sure Andy is getting the best possible care, even though I feel comfortable with the treatment the doctors have prescribed. He wanted to be sure he shouldn’t be getting a stent for his carotid dissection. My reading has convinced me it’s not a good idea, but he wasn’t sure the Mayo Clinic didn’t have a way of reducing the dangers.

Bless the Mayo site. When I searched for carotid dissection they sent me to Carotid Artery Disease, which is about plaque build up, not dissection (dissection is rare except in cases of trauma). So I tried “carotid stent” and was directed to Carotid angioplasty and stenting . It says stenting is done when regular artery surgery is counterindicated, and only if the artery is blocked 70% or more. That’s not Andy’s case — his dissection is blocking a lot less than that.

The article also says,

Blood clots can form within stents even weeks or months after angioplasty. These clots may cause a stroke or death. It’s important to take aspirin, clopidogrel (Plavix) and other medications exactly as prescribed to decrease the chance of clots forming in your stent.

He’s already doing that for the dissection, so why get the stent?

When he read this last night Andy agreed it doesn’t make sense to go to the Mayo Clinic for this problem now, but they had already been a big help.

Then this morning we received this email:

Mr. Browman,

We appreciate the confidence you have expressed in Mayo Clinic and thank you for your recent request.

The Division of General Internal Medicine in Rochester, Minnesota has reviewed your information. Unfortunately, we do not believe that a visit to Mayo Clinic would add to the care you have already received. Therefore, we are unable to offer you an appointment at this time. Since we cannot offer a different treatment plan or additional options, we are unable to schedule an appointment at this time.

Please know we do not make this decision lightly. Mayo Clinic strives to provide the best possible care to all those in need. If your health situation changes, we would appreciate another opportunity to evaluate whether our services can complement those provided by your current provider….

How cool is that?! Yay, Mayo Clinic! We did get our fourth opinion without having to go there, and we trust them as a great resource to have if we need them in the future.


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A Certain Amount of Struggle?

I enjoyed reading this article about tablets for 4-year-olds:

One of the intrinsic problems with tablets and games is that children do not experience much frustration while playing them. Whether they are “educational” or for fun, many games geared toward preschoolers are constantly recalibrating themselves to match the level of the child. This means your sweet ­4-year-old will be rewarded whether she is winning or losing. This doesn’t sound problematic — in fact, the brain absolutely loves it — but it can become a huge developmental roadblock. The way we emotionally mature and grow is not through everything coming easily. We grow when we struggle through something hard; the brain learns and adapts, and we move forward. Tablet games do not aid with this growth.
My friends all give their preschoolers tablets. Should my 4-year-old have one?

Amen to the idea that kids should learn to deal with some frustration, whether or not they have electronic gadgets to play with. Am I alone in thinking we adults/oldsters also thrive with a certain amount of struggle, with not everything coming easily? There were times in my life when things were going too easily and I had to look for new challenges. That doesn’t seem to be the case now, enough challenges seem to come all by themselves! What about you?


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We haven’t heard from the Mayo Clinic yet, so I phoned to see what the usual wait is. The woman said she knew they were backlogged, but she couldn’t tell me how long it would be. She did say she recently talked to someone who applied July 3rd and hadn’t gotten an appointment yet. It’s a huge organization, so we’re not holding our breath. (I wouldn’t be surprised if billing and insurance turns out to be an adventure — practice what I preach and all that!)

In the meantime Andy hasn’t had any more episodes — his right arm feels a bit funny sometimes, but that may be a permanent effect — and yesterday he walked about three miles with a 600 ft (183 meters) elevation change. He’s now tapering off on the Keppra, down to one pill a day instead of two. Hopefully that won’t change things.

Tomorrow he will do the Cerro Grande walk again, about four miles round trip, 1200 ft (366 m) elevation change. And he’s hoping to go on longer walk with Beate and Tim before they leave for the summer. They took a long, strenuous walk in our area last Saturday, but Andy plans to avoid walking on those trails now. Because of the fire and erosion they’re just too rough — the last thing he needs is to fall or bump his head. Here are some pictures from the past:




As usual, fingers crossed, and enjoying what we have while we still have it.


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It doesn’t look good!


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Making Plans II

So why “waste” time making plans you may never use? It’s not a waste of time if it brings us joy. My brain is my favorite toy.

Having a relaxed body and a playful mind is an invaluable resource state to have at one’s disposal at any time, but especially when facing big life changes.

Commitment and practice — no one ever said the practice can’t be fun.


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Making Plans

The old saying,

Man plans, God laughs,

doesn’t apply to me. I have Possibility lists rather than To Do lists, and I generate all sorts of plans, but I’m seldom wedded to any of them.

I read this quote the other day, and it suits me better:

If Plan A doesn’t work there are 25 more letters in the alphabet.

Andy and I have been reviewing what happened in the hospital and discussing what we would do differently if the same thing happens again. So last night we packed a small duffel bag with a tooth brush and toothpaste, three changes of socks and underwear, and reading material. If he needs the bag I will toss in his electric razor before getting it to him.

Last time he called me around 6 pm and the ambulance didn’t leave town until almost 7:30 — I would have had plenty of time to get a bag over to him. Of course, things seldom happen exactly the same, and that’s all right. We’ll just come up with something else.


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Pleasantly Surprised

We didn’t expect much from Andy’s appointment today with our substitute doctor (ours is on sabbatical in France) at our local medical group, but we were pleasantly surprised.

Once we checked in and were ushered into the exam room, we had to wait about a half an hour. That can often be a bad sign, but in this case the doctor had been reading the information from the hospital and was trying to make sense of it all. She took notes when Andy told her what has been happening, and she agreed with the neurosurgeon that the carotid artery dissection was a more serious problem than the blood on the brain. She excused herself at one point to talk to the head of the group, a cardiologist, to get another opinion, and they said that Plavix plus aspirin (and the vitamin E he takes in his eye supplements) was the best treatment — Andy shouldn’t worry about how easily he bruises now, the dissection is more important. They don’t think a stent is advisable, not just because of age, but because the dissection is too close to the brain — a stent would be too dangerous to take the risk. And, as we’ve read, with medication dissections often heal themselves.

Andy’s discharge papers from the hospital said he had acute renal deficiency, and we asked about that. She said the dyes they inject for an MRI with contrast can be hard on the kidneys but the effect can be temporary so she gave him an order for blood tests to check if it’s still a problem.

We also asked about the discharge orders to take Keppra twice a day for 14 days, then stop — we have read that it’s best to taper off gradually. She said go down to one a day until Andy finishes all 28.

We have a follow-up appointment with her in a month.

I was very pleased. We will still go to the Mayo Clinic just to be sure, if/when they set up an appointment. It usually takes two to three days to hear, so presumably in the fullness of time….

I should point out the cardiologist said that to be safe (close to the ER) Andy should take his walks around town for a while, but that clearly isn’t going to happen. When the doctor told us that I told Andy, “That means don’t go up to the land!” His body language gave his answer and the doctor laughed and threw up her hands. That was on him, not on her.


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Let the Patient Beware

The neurosurgeon’s office phoned again this morning, this time to reschedule the operation to put a stent in Andy’s carotid artery. I told her we had cancelled the appointment they had originally scheduled because we didn’t want to do it. She was friendly about it and didn’t ask why. If she had asked I would have told her we did the research and decided the operation was dangerous and not the best treatment.

Bless Google! I found a lot of good articles on the subject, and this study from the Lancet, plus asking the Mayo Clinic for an appointment, convinced us. We had already decided that unless it is a life-or-death emergency, we won’t agree to invasive procedures until we have done the research.

Then last night I read this web article, Most Dangerous Medical Procedures You May Want to Avoid If You’re Over 50. The first one listed is carotid artery disease. When tammy and I were talking about the article she sent a link to this Atlantic article — When Evidence Says No, but Doctors Say Yes. Just one more confirmation that we can’t believe everything doctors tell us, even when they’re well meaning and doing their best. It’s our health and it’s best not to believe everything we are told.


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