Archive for June, 2013

Tasty chards

Sunday, June 30th, 2013

When I finally got pregnant two and a half years ago, many aspects of our lifestyle started to change. One of the best (and altogether unexpected) changes is that Bill took over the cooking.

I tended to cook in a rut, making the same 5-8 passable things over and over again. Then we’d get tired of eating the same things again and again, and order take out or go out, which was expensive.

In sharp contrast, Bill tends to experiment. He watches the occasional Food Network show, reviews recipes on the Internet, pays attention to what’s seasonal at the grocery or on sale, and then improvises new combinations.

Sometimes, the results are so-so (there was an early chimichuri that wasn’t), but sometimes they’re really delicious like last week’s baba ghanouj. He started with roasted eggplant, and puréed it with a bit of lime juice. Then instead of adding salt and pepper, he incorporated a balsamic reduction vinaigrette with herbs de Provence. So delightful!

Tonight’s surprisingly tasty vege: red chard, sautéed in olive oil, and then stewed in broth with raisins, carmelized onions, roasted garlic, and pine nuts. Yum!

Swimming or cooking?

Saturday, June 29th, 2013

Houston has never recorded a hotter June day than today (Jun 29, 2013).

Daddy Bill declared for staying in the kitchen to cook, but Cate and Sam requested to splash in the pink pool that Gram Nancy got us. That sounded like a good idea until we got outside.

According to my Raytek MiniTemp infrared thermometer, the shady deck is 104, the sunny grass is 122, the asphalt driveway next door is 126, and the side of the garage is 129.

Wow. We weren’t swimming; we were braising.

Adventias: No more shots

Friday, June 28th, 2013

Yesterday, when the Vitas hospice representative was telling Jean and me about their bereavement counseling and support groups, I bravely asserted that I don’t expect that I will be overcome by Gran’mom’s death. The Gran’mom that I knew has been leaving bit by bit for six or seven years.

This afternoon I met with the hospice admissions nurse. We reviewed the list of Sarah’s medications to decide which ones she should continue taking, and it was harder than I expected.

Hospice care sees “less as more” when it comes to meds. Some meds, like the B-12 injection were somewhat easier to end: how can you comfort someone with dementia when you stick them in the arm and they can’t understand why?

Likewise, alendronate (Fosamax) can damage the esophagus in someone who has trouble swallowing effectively (not that Sarah is there quite yet). Osteoporosis is not her most-pressing concern.

However, admitting that she no longer needed vitamins, minerals, and antioxidants, because she probably won’t live long enough to develop malnutrition, was tough.

Confirming the order to suspend a bunch of Sarah’s meds made me weepy. But I know that it’s what she asked for in her advance directive, and it’s the right thing to do.

Adventias: Starting hospice care

Thursday, June 27th, 2013

I reread Gran’mom’s advance directive to physicians this morning. In it, she says in plain language, that in the event she develops a terminal or incapacitating illness, her physicians are directed to withhold all treatment and ensure that she is comfortable until she reaches a gentle end. Ok. Got it.

It turns out that here in the fourth-largest metropolitan area in the U.S., there are more than 60 hospice providers. Selecting one to shepherd our Gran’mom through to a gentle and dignified end was a daunting task.

Recommendations from friends and Sarah’s current healthcare providers narrowed our consideration set down to five providers. A pushy and opportunistic sales weasel helped drop the list to four: Houston Hospice, A-Med, Vitas Innovative Hospice Care, and Hospice Compassus.

The costs of hospice care are covered 100% by Medicare, so providers are not differentiated by price. Our decision criteria came down to:

  • who do we trust to respond promptly and effectively to Sarah’s changing needs (even after hours and on weekends and holidays),
  • who can we count on to partner well with the existing staff of her assisted living facility,
  • who agrees to keep Sarah’s neurologists at Methodist apprised of her progress, and
  • who best supports the family through the death of a loved one, both with social workers to facilitate ahead of time, and bereavement counselors and support groups afterward.

On that basis, we eliminated A-Med, because they only have one physician and one social worker for their entire patient base. We ruled out Hospice Compassus only because they haven’t yet worked with Belmont or Methodist.

Of the last two, the Belmont care director likes Houston Hospice and has other residents under their care. The Methodist team likes the end care Vitas has provided many of their patients.

Based partly on Methodist’s recommendation, and partly on our greater confidence in the Vitas representative we spoke with, my mom and I decided to go with Vitas. The intake assessment is scheduled for tomorrow afternoon.

That said, I asked Bruce at Belmont to let me know how things go. If the Vitas nurses and aides don’t work well with Belmont’s staff and procedures, we’ll shift gears and switch to Houston hospice.

It’s reassuring to be moving forward, and also reassuring to have a fall-back plan. One way or the other, Gran’mom will now have a team coming to her who can assure that her end, whenever it comes, will be painless and peaceful.

Adventias: Falling

Tuesday, June 25th, 2013

My brain is so full it’s overflowing.

Gran’mom fell this morning and bonked/cut her forehead while a PAL was trying to get her into the shower. In retrospect, the PAL observed that Sarah had seemed weaker and less verbal than yesterday. It seems that Sarah’s experienced another step-down decline in cognitive function.

Belmont’s nursing staff sent Sarah to the ER by ambulance, to rule out internal bleeding. Sharon raced over to meet the ambulance and supervised Sarah’s care until I arrived. I’m again thankful for having her so close!

Sarah was particularly uncommunicative after the fall, and her pupils were tiny, constricted, dots. It was hours before she expressed anything that looked like she recognized me, and then only briefly.

Her neurologist, Dr. Roman, says her CT showed extensive atrophy of the brain and “relatively advanced Alzheimer’s”. He said that sensory processes become disconnected and “she’s not seeing the world through the same eyes as you and I.”

He also asked if we would consent to let them remove and examine Sarah’s brain post mortem. I’m confident that as a 40+year clinical scientist, Sarah would be delighted to be able to contribute in this way.

She was discharged by 1 pm, and transported back to Belmont by ambulance. She slurped down a chocolate Ensure shake, with help from the nurse, Joel, and then went straight to bed.

Before I left, staff had managed to get her to the dining room for dinner, but her PAL admitted that she’d been pushed on her wheels. Chris popped by after work, too, to give Sarah a hug and check on her.

Sarah’s physicians and nursing staff feel that her end is nearer now than it was, and that she would benefit from complementary hospice care. I spent the afternoon researching and contacting hospice providers. I have more calls to make tomorrow, and if I’m lucky, we’ll get her “admitted” tomorrow, too.

* * *
Tonight, I had helpful conversation with another hospice provider, perhaps the one we’ll use. I then connected with Melinda, a lay leader from St. Stephen’s, for a good talk about death and dying. I’m grateful that we connected via Facebook.

* * *
It takes me about 20 minutes to drive home from Belmont. I’m grateful that that’s long enough for me to call and catch up with my mom, and then, switch gears mentally to start thinking about our girls.

* * *
Both girls slept through the night last night. But tonight, Sam woke up crying for Mama and Dad around 11:45 am. After locating her binky and blankie, she asked for “Mama… chair” several times, so I sat down to cuddle Sam in my lap.

As I nuzzled my cheek against Sam’s hair, I thought also about holding Gran’mom this morning. It struck me that there’s a 95-year spread between the people I cared for today. That’s boggling. But the how of the care is really the same, and that helps.

Moving “refrigerators” left “Mama stuck!”

Saturday, June 15th, 2013

In spring 2008, I consulted with a neurosurgeon who explained that my then chronic back pain was caused by a herniated disc in my lumbar spine. He said the disc was “incompetent” but not worthy of surgery, and told me to “get on with my life, carefully” and “avoid moving refrigerators.”

He also ordered 12 weeks of physical therapy, that taught me how to reduce, and eventually avoid, stress to my L4/L5 joint. For the occasions when I messed up and stressed that joint, I learned which postures and exercises to use to alleviate the problem.

In the years since, I’ve mostly managed to avoid any serious lower back pain. At least, until we had children.

A year ago, when the girls were still little, my back gave me a stern warning that I was pushing my luck. Sam and Cate were about ten pounds or so, but I was still reaching to lift them like the tiny preemies they had been. Well-admonished, I did some postural checks, rested my back for a day or two, and moved forward more carefully.

As the girls have grown and grown, I’ve become stronger and stronger. Every time they say, “Mama, up! p’ease?” I get more practice. I’m impressed by my own biceps for the first time since I was a childhood gymnast. And I’ve recently felt just rested and/or motivated enough to want to start working out again.

So ten days ago, Claudia and I started taking the girls for walks around the neighborhood… without a stroller. Sam and Cate are now strong enough to walk several blocks under their own locomotion. We’re practicing holding hands, waiting to cross streets together, and reading letters off of street signs. For example, both girls can name the ‘O’ in “STOP” and recognize that the ‘S’ is also for “Sam.”

Then, when the girls get tired of walking, they stop and ask for “up! sho-der, p’ease?” We each sweep a girl up on to our shoulders to finish the trek home. With Cate at 22+ pounds and Sam at 24+ pounds, it’s quite a workout. We walked that way three times last week, and I actually congratulated myself for working to get fit.

D’oh!

In retrospect, it’s obvious that my spine was not and never will be well-suited to balancing 20+ pounds of wiggly girl child on my shoulders. Nor is it suited to bouncing two girls, one on each hip, during solo bedtimes. And since I haven’t done any core strengthening exercises in a long time, it’s a wonder my back didn’t fail me sooner.

But Tuesday morning, I did one wrong lift too many (hoisting a girl on to the biggie potty, while seated Indian style on the floor), and slid down the slippery slope to trouble. I tried a little stretching but it was too little, too late.

By mid-morning, I was in crisis. Claudia and I had taken the girls to toddler story time at the Montrose Library, and after getting down onto the floor with all of the other moms, nannies, and toddlers, I couldn’t get up again. The librarian found me a wheeley office chair and rolled me out the employee side entrance, because I was unable to walk.

As an aside, Cate was very disconcerted that Mama was not ok, and stayed close by my side. But Sam took several opportunities to wander away, first around the front of the library, until another mom brought her back, and later around the circulation desk from the librarian side.

From the library, Claudia helped me hobble to the van, then drove us all home, and then helped me hobble to bed. It was time to feed the girls before naptime, but Cate refused to leave me. So I asked Claudia to bring their chairs to the bedroom and they ate a quick lunch by my side. Sam and Cate were obviously puzzled as to why I wouldn’t get up, so I explained that “Mama is stuck,” referencing a theme from two of their favorite truck stories. That prompted Sam, and then Cate, and then Sam to chant, “Mama stuck!” repeatedly (569 kb .m4a audio file). Pretty funny.

I managed to nap briefly while the girls napped, but by mid-afternoon, I couldn’t move without triggering massive, excruciating muscle spasms. I felt trapped in the worst back pain cascade I’ve ever endured. I knew that I needed medical relief, but I couldn’t figure out how to get there without triggering still more pain. Claudia took care of the girls while I cringed in bed, unable to figure out what to do.

Fortunately, several of you urged me to call my primary care practice, even though I hadn’t seem them in two years. And more fortunately, I reached Carol MB, the kind and familiar nurse practitioner, who listened patiently to my predicament, even as I suffered several spasms, and then gave me a pep talk. She told me that yes, it would hurt, but that I *must* get to an ER right away.

So Bill led the bedtime routine and put girls into their cribs, while I continued to cringe in bed. Sam made it to sleep soon thereafter, but Cate wailed for 40 minutes, very upset that Mama would not hold her or rock her. Once the girls were asleep, Bill gathered a few essentials, and then heroically lugged me like a giant, whimpering, sack of potatoes, to the RAV/4. Once there, Sharon bravely transported me to St. Luke’s, and stayed with me until the wee hours when I was finally discharged. (Thank you, Bill, and thank you, Sharon!)

Once diagnosed, I received a powerful cocktail of intramuscular shots: a corticosteroid to stem the inflammation, Valium to quiet the muscle spasms, and morphine to shut down the pain while the first two started to work. Within half an hour, I was finally able to sit without holding myself up on my elbows, and by the time we got home, I was able to lie down without flinching.

Since that fitful, but blessedly unpainful night of sleep, I’ve managed to avoid any additional back spasms. I’m alternately resting and hobbling around. I’m having to explain repeatedly to Cate and Sam that I can’t pick them up because I have an “ouchie” in my back. Three days in, Cate is beginning to accept that holding my hand to walk by my side is an acceptable substitute for being carried.

Finally, I’m waiting for a follow-up MRI that will reveal how badly I did/didn’t screw up my back this time. I hope that I’ve only backslid to some point I can work forward from again, and not done anything irreparable. We’ll see.

Catherineism #9: naked Cate!

Thursday, June 13th, 2013

Cate just pulled off her diaper and cover in the middle of the dining room and exclaimed, “naked Cate”!

Claudia asked her if she needed to pee, and Cate replied, “si!” So they went to the bathroom, where Cate peed in the pink Little Potty.

Her diaper was dry. We have *not* talked about holding pee, and we’re still telling both girls that they can pee or poo in their diapers at any time. Nonetheless, Cate seems to be figuring out how to stay dry on her own.

Cool!

Samanthaism #9 & Catherineism #8: Mac Dogga (Cheese)

Friday, June 7th, 2013

Both girls are soaking up new words left and right. I previously mentioned that while Cate’s vocabulary is broad, Sam’s more-limited vocabulary clearly reflects things that interest her.

Wednesday morning, we went swimming at Sharon’s place. While there, we visited with Sean and two dogs, Sophie and Max. Sam seems quite taken with Max, and had already learned to say his name readily.

Wednesday evening, the girls’ dinner included some leftover macaroni and cheese, which we generally refer to as “mac.” This sparked some entertaining conversation (m4a audio file) with Sam and Cate. Enjoy!

ModHome: Project kick-off!

Thursday, June 6th, 2013

In the early months of 2013, Bill talked and met with a number of architects and building designers, until he found one that seemed like a good fit for our project. I met with the last two under consideration.

The “home designer” not only underwhelmed but alarmed me; the best architect impressed the heck out of me. When he said he was excited enough about our project to offer to reduce his customary fee, we had a winner!

Now that we officially own the Locust lot, it’s time to start design work. On June 5th, we officially kicked off our home building project with our architect, Erick Ragni, and his team from MaRS!


Drew, Rudy, Erick, Robin, and Bill

Catherineism #7: four syllables

Thursday, June 6th, 2013

As I’ve mentioned previously, the girls are into trucks. Monday was garbage day, and that means big blue trucks.

We were still in the bedroom (pottying in the bathroom, actually), when we heard the first big diesel engine of the morning. Cate looked up at the sound, smiled in recognition, and declared, “big gar bage truck!”

Wow.