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Carl,

We have missed your musings over the last few days. I hope this means that you are busy with therapy and progressing.

Please continue to update us as we send healing thoughts your way.


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I think it is the new subject. Now I have embarrassed him.


Bert
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Oh, Bert!!
We can always change it back.


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Yep we can. I would guess that is not why he is not responding. The board is very, very slow is not an appropriate subject line for the interesting and well-written posts on Carl's blog.


Bert
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Hi Bert & Donna,

Embarrassed? Bah!

Just nothing much to say for a day or two.

***

It is always a good idea for doctors to be patients and see what it's like, or so a number of doctors who've been patients told me,

Friday, I waited for 60 minutes to be hoisted from the chair to the bedpan.

Saturday, I asked morning, afternoon, and evening to be hoisted from the bed into the chair, with lots of assurances, but no action.

Sunday, I waited for 2 hours to be hoisted from the chair to the bed and bedpan.

Today I've waited 2 hours to be hoisted into the chair and have been told that it may happen between 1:30 and 2:00, but I'm not holding my breath.

It's noticeable that when Eric is the CNA, things get done. Otherwise, there's a lot of no-can-do attitude.

***

Kaiser once again tried to have me discharged, despite no change in my status--four limbs non-weight-bearing, just the same as when I arrive

Luckily, the appeals process promptly pushed Kaiser's nose in again, though today's nurse hadn't heard the news and thought that I was leaving.

***

The only exciting medical development is that high-tech bladder training has begun.

The nurse used an office paper clip, the big black kind with metal wings for leverage, to clamp the Foley tube:

https://www.dropbox.com/s/3idx06c5fh5jqh3/binder_clip.jpg?dl=0

She said that we'd try to stand it for 4 hours. I suspect that she can stand it better than I will.

***

Meanwhile, I'm doing a series of five hand exercises that the angel of Occupational Therapy calls tendon glides.

Anyone watching would think that I was trying to make animal silhouettes--shadow bunnies to amuse children.

Cheers,

Carl Fogel

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Carl,

Those are horrendous delays in your care, awful!

And, a binder clip? Really? Good grief. There is a real clamp made for this, should we send you one?

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Clamp

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OK, that weirded me out for a moment. But, Carl must be getting better. He is shouting.


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Hi Donna,

Well, given the amount of paperwork around here, a binder clip is handy and surprisingly powerful.

I managed to get the damn thing off once, but it took two feeble hands to do it.

Then I made the mistake of mentioning this to the nice Occupational Therapist, who immediately excused herself and came back in a minute or two with three damned binder clips that she wants me to squeeze.

In other news, Kaiser Insurance has tried to discharge me three times.

I won the first two appeals because the doctor reviewing the situation noticed that both my tibial plateaus are shattered, so are the ends of my ulna and humerus, I'm non-weight-bearing, and have CLL.

All these points, however, escaped the latest physician to review my case, who seems to think that I have a few simple fractures and am in fact up and walking with the aid of a walker. He doesn't mention the leukemia.

***

I'm reminded ot one of Dashiell Hammet's 29 observations on his career with the Pinkerton Agency:

"21. The chief of police of a Southern city once gave me a description of a man, complete even to the mole on his neck, but neglected to mention that he had only one arm."

The other 28 are fun to read:

http://www.umsl.edu/~gradyf/film/Hammett.htm

Cheers,

Carl Fogel

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Hi Bert,

What's weird about folding the catheter tube and securing it with a handy binder clip from Staples?

I would have used a handy vise-grip or C-clamp, myself--much more adjustable and powerful.

***

Speaking of shouting, I'm ridiculously hoarse and complaining about it.

It's not due to shouting, but probably just the very dry air inside the facility.

The staff doesn't get hoarse because they get half the day outside after their 12-hour shifts, and then get two days off every week out in a normal environment.

I only get out a little bit in my electric wheelchair, but it's enough to see the wildlife snarfing up dandelions:

https://www.dropbox.com/s/68lb87li9qyb3pu/012_rabbit.jpg?dl=0

Cheers,

Carl Fogel

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Carl,

The problem with the binder clip is that it has sharp edges and potentially could cut the tubing. Then you might need the catheter replaced, no fun! The real plastic catheter clip doesn’t have that problem, it also has a retainer on it so even when it is unclamped it hangs on the tube so it doesn’t get lost.

But, using the binder clips for exercise is very clever!

I presume that you still have another avenue for appealing the idea that you’re ready for discharge. It’s ridiculous that you should have to deal with that while you’re trying to recuperate.

Cute rabbit! Is that from your previously described encounter, or have you had repeated meet ups with it?


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Hi Donna,

Well, the catheter tube is rather thick and made of high-grade plastic, so it's likely to survive--besides, they throw it away every month.

I'm more likely to to cut myself on the binder clips than the staff is to cut the thick plastic--I may stick to squeezing silly putty.

A secondary appeal is grinding its slow way, with several nice people here promising that they'll try to make things clear to even the meanest intelligence. For some reason, the initial appeal takes three days or even less, but the secondary appeal takes 10 to 14 days.

The rabbits here are fairly reliable--I see them every other day or so, and they are quite rightly unafraid of even the snazziest electric wheelchair.

Cheers,

Carl Fogel

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Carl,

You may have rabbits, but here we are having the beginning emergence of the periodical cicadas, Brood X. They are the largest group, emerging once every 17 years. There are projected to be as many as a million per acre. The first one fell onto my deck today, the dog and cat were enchanted. The cat is 14 and the dog 4, so neither has seen them before.

The dog promptly went out and tried to eat it. Luckily, I had the foresight to buy a muzzle with which she cannot consume things. Apparently, if they eat too many, the chitinous shells create quite a GI upset, not pleasant for the dog, or its human.

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Did I miss something? CLL?


Bert
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Donna they are looking at the amazing rhododendrons.


Jon
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Jon,

I can assure you that they were looking at the buzzing, red eyed creature flopping on the deck. But, it has been a stupendous year for the rhodos.

Got any cicadas at your house yet?


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Hi Donna,

Nice flowers!

I'm weird in that I like ordinary cicadas and the noise that they make.

My basset hounds find cicadas tasty in the spring, no matter how hard I try to pull the dogs away

Cheers,

Carl Fogel.

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Hi Bert,

I may not have mentioned it earlier--I tend to forget about it.

Routine blood tests uncovered it after the accident.

Today they removed my catheter and I discovered that things work but burn like hell at first.

So I'm one step closer to seeing the oncologist who felt it best to wait until I'm past the orthopedic problems.

Cheers,

Carl Fogel

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I am still confused on the CLL and the message in the Shout box.


Bert
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Do they force you to get up at an early time each morning, probably the only time you have peace?


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Hi Bert,

Blood work after the accident showed a white cell count of 100,000, ten times the normal 10,000, and introduced me to an oncologist, a really nice fellow, one of the few doctors whom I remember. I'm told that CLL is often diagnosed this way, trauma leading to the disease declaring itself and being diagnosed because of the routine blood work.

As for the shout box item, it just seemed like a good idea to point people to the HeadCase post about AC V11 clearing up the Erx window problem--it's a long thread and a short post.

Cheers,

Carl Fogel

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Hi Bert,

Reveille here is anywhere from 5:30 to 6:30 a.m. with pills and my first Lovenox injection.

Breakfast is around 7:30, and Matt the Physical Therapist usually arrives a little after 8 to make me wave my legs and bend them for range-of-motion.

***

I don't have much trouble sleeping here, so I've been saying no to the sleeping pills offered at night with the second Lovenox.

With the blinds open this morning, the sunlight finally let me see what they've been talking about when they stick me with the Lovenox--lots of small bruises from the previous blood thinner injections, making it harder and harder for them to find an unsullied spot for the new injection.

Sort of like snake venom, I remarked, and then had to reassure the nurse that I didn't think that she was a snake.

Probably a lamia, I decided after she left.

Cheersssss,

Carl Fogel

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Carl,

Clearly my education was more lacking than I realized. After I read your posts,
I have to look things up. I have added lamia to my new knowledge.

Sorry to hear about the CLL in addition to the orthopedic trauma.


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Hi Donna,

Education is an ongoing process.

I'd seen "comminuted" in print and knew that it means a bone broken into more than two pieces.

But I didn't know how to pronounce it.

Google to the rescue!



Meanwhile, my handsome copy of the OED gathers dust on a basement shelf, and my parents' 26-volume Encylopaedia Brittanica serves as a dignifed bit of interior decorating in a hallway.

It's marvelous to be able to look up all sorts of things--in my day, no museum would let you touch a First Folio like this, much less borrow it:

https://internetshakespeare.uvic.ca/Library/facsimile/book/SLNSW_F1/760/?work=ham&zoom=850

But now I can read it whenever I please.

Cheers,

Carl Fogel

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I know comminuted! grin


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Hi Donna,

My lawyer hopes that whoever Kaiser pays to discharge patients knows what "comminuted" means in his letter about "comminuted intra articular fractures."

My hopes are limited to a fervent wish to stop peeing every hour around the clock and a desire for my elbow to stop hurting too much for me to use a fork--I blame the drugs and the endless hand exercises.

However---

Pardon the interruption.

The staff descended on me just now to hoist me into a chair, and I noticed an alarming development.

One of the things that gentleman have two of appears to be hard, swollen to twice the size of its twin brother, and tender to the slightest touch.

With luck it's just a complication of a UTI.

Cheers,

Carl Fogel

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Carl,

These are most unwelcome developments.

Iatrogenic infections after a indwelling catheter are far too common. Hopefully, they already have sent off a urine culture and gotten you started on an antibiotic.

You have such a charming way of describing the awful things that have happened to you. Your sense of humor goes a long way to as you continue through this medical misadventure.

Continued best wishes for improvement.


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Hi Donna,

They started me on Cipro, which the internet suggests is not the best choice, but they may have their reasons.

At first the nurse talked about a blood test to check my white cell count.

I explained that my white cell count had been at 100k instead of 10k at the start of all this foolishness.

A closer look at my chart on whatever EMR they use revealed that it was down to 33k, but it's still leukemia.

A urine analysis may be in my future, but it's Sunday, so the doctor is off.

Cue the Colonel Bogey march with the blue lyrics:



Not sure where I fit in the Nazi hierarchy, but it seems apropos.

Cheers,

Carl Fogel

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Carl,

Any better today?


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Hi Donna,

The Cipro may be helping a UTI, but no one has bothered to take a urine sample--sigh.

It's nice weather, the rabbits are lurking when I take a lap around the facility, and I was up in one kind of chair or another for six hours, so I'm feeling better.

Regrettably, another anonymous KePro doctor reviewed the same incorrect notes and naturally denied my appeal, presumably on the grounds that my supposedly simple fractures healed long ago and I'm just malingering while strolling around the facility.

KePro allows no further appeals, so my lawyer is looking into ways either to get them to wake up and look at what Kaiser's own doctors say or else to appeal to the government site that handles things beyond KePro.

I want lots of credit for not instructing my lawyer to start suing every idiot in sight, just to see if they'd pay attention when served.

Meanwhile, the friend taking care of my basset hounds emailed a picture of an ugly skin sore on one dog, probably the result of his chronic skin trouble and his brother being left alone to lick sores to his heart's content.

The silver lining at the moment consists of free and easy urination and the kitchen realizing that chocolate cake is never a bad idea.

Cheers,

Carl Fogel

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Originally Posted by carlfogel
The Cipro may be helping a UTI, but no one has bothered to take a urine sample--sigh.

Hi Carl,

"UTI" is a broad and generic term. You may well have epididymitis, which may be associated with prostatitis. (The joys of being male....)

Neither of these would be likely to be found with a urinalysis or urine culture. Physical exam (Does it hurt more here.....) usually makes the diagnosis.

Cipro is quite an appropriate choice, sometimes a longer course, 14 days or more, is necessary.

Keep on posting!

Gene


Gene Nallin MD solo family practice with one PA Cumberland, Md

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Carl,

Nice weather, cute rabbits, catheter free, more time out of bed, and chocolate cake all sound good!

Sorry for the aggravation of the ridiculous insurers.

Your bassets are probably missing you terribly.

Here we are in the middle of the Brood X emergence, the noise is ramping up. And, as you reported with your dogs, mine finds them quite delicious. She is very quick to find and ingest them. And, she is quite annoyed when, after she has a few, I put on her muzzle to stop her from gorging.


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Hi Donna,

A long time ago, I caught a young fox trapped in an abandoned waterworks channel, took it to my vet, had its wounds, worms, and fleas taken care of, pulled its baby teeth, fattened it up, and released it.

Among the many things that surprised me was the vet's assurance that the full-grown fox probably ate a lot of grasshoppers.

Reminded me of a nature film that showed lions eating African bullfrogs.

Cheers,

Carl Fogel

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Carl,

That was nice of you to rehab that little fox.

I have a fox who has made a den in the hill of my front yard. I have a camera set up where she frequently traverses the front lawn. I have a video of her rolling on the grass like a dog. Oh well, I can’t figure out how to attach the video, here is a still.

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Hi Donna,

I may be wrong, but when you use the full editor, you can only insert media tags to videos that have been uploaded to yahoo, google, or youtube--those show up as a still image from the video like this:
nicely


If you've uploaded a video to your own dropbox, onedrive, or google drive, you can put in a link to it and title the link, but it doesn't show the preview:

rabbits

Either way, you have to upload your video to some place accessible on the internet.

Cheers,

Carl Fogel

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A few weeks ago, I asked a nurse about an odd round reddish scar that had appeared on my leg amidst all the other marks of the surgeon's trade.

"Ringworm?" I joked.

No, the nurse was quite clear and reassuring, probably a mark from an external fixator that pressed into the skin.

Or something,

But not ringworm--how would ringworm appear out of nowhere in a skilled nursing facility?

***

Today a new nurse took one look at it and said, "Ringworm." She'd had it in high school and knows what it looks like.

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Carl,

Of course I did not upload my video anywhere.

I want to start using OneDrive to store things, but I don’t want everything synchronized, just to upload manually. Not that I have devoted any time to it, but I couldn’t figure out how to prevent it from taking over.

Ringworm can appear any time, on anyone. We live with fungus as a colonizer on our skin cells.

Hope the urinary situation has improved with less discomfort in the delicate area.


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Hi Donna,

OneDrive has a 5gb free storage limit, but lets you create direct links easily.

GoogleDrive has a 15gb limit, but you have to us a google tool to create a link to a file:

https://sites.google.com/site/gdocs2direct/home

I haven't figured out what the hell my DropBox account is doing with links.

Perhaps other posters will mention online storage that they like.

Cheers,

Carl

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Wow, I am going to keep participating in this thread. My post count is getting decimated. smile

You can use box.com and make links in one click or send them. But, it is a subscription. But, you do get 100 GBs of storage and any of the higher subscriptions are unlimited.

One of the higher ones gives you HIPAA/FedRAMP compliance.

Not sure what FedRAMP is but I think it protects you from ransomware if you are a pipeline. Certainly $35.00 a month to save $15,000,000 is worth it. Not sure why you need all this extra protection from the Feds, when you can just walk out of the NSA with all the classified, sensitive documents you want.

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Bert
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Good news and bad.

***

Good news first.

My asymmetrically enlarged nether regions have succumbed to anti-biotics.

My younger sister made an agent at the KePro appeals company so mad that the agent began reading their chart for my case aloud over the phone to my sister to prove that nothing was wrong.

The agent hit a spot where I turned into a patient with another name right there in the text, some lucky fellow who can walk and climb stairs.

So several embarrassed bureaucrats are apologizing and straightening things out. No one knows how the other patient's notes got into my chart, but then two doctors reviewed it during appeals and noticed nothing odd.

My left arm is now officially okay, so my Occupational Therapist pounced and has me waving shamefully small weights.

***

Bad news is another week before toe-touch weight bearing with my right leg, four more weeks and maybe start weight-bearing on the left leg with a brace to stop sideways wobble.

Hand specialist noticed two bone fragments have worked out of the elbow's capitellum, but at least they're not in a bad place and can be left alone for now.

"For now" is eight weeks to the next appointment, when he expects to schedule surgery to debride scar tissue, release some ligaments, and maybe remove the errant fragments.

Meanwhile, he's sending my OT a RAS dynamic arm splint that she'll get to crank up slowly for eight weeks in hopes of straightening my arm.

She likes the idea of a dynamic splint even better than the eight left-arm weight-exercises she printed with pictures for me.

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Carl,

I am glad to hear the good news about the man parts.

What extraordinary incompetence at the insurance review, how could have multiple people fail to notice that the records were not yours? Well, hopefully they will stop bothering you about discharge.

Good to hear that there are some improvements in your abilities, however small. This is such a long process to recover because of the severity of your injuries. I hope your are finding enough distractions to pass the time.

Here we are in the midst of the massive cicada emergence, it is quite amazing. Unfortunately, there have been multiple reports of dead birds, and birds with neurologic problems. It is postulated that they are people who are trying to kill the cicadas with insecticides and in turn, poisoning the birds. I don’t understand why people can’t leave them alone, they’re only here for a few weeks every 17 years. And they provide a tremendous source of nutrition for wildlife, to say nothing of pets.


Donna
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