Category Archives: Medical

Running for the bus

Holly Doyne Posted on by  

It was one of those mornings. My alarm probably went off, but it really didn’t matter since the sound was turned too low to be heard. This lead to my confusion on the way out the door and forgetting the lemons.

What lemons you say? The ones from our MeyerLemon tree that are becoming ripe by the dozen and that I use to thank the lovely nurses at the SFVA infusion center.

Back to the rest. My lack of organization led to my catching a later BART than usual (and having Dani 15 minutes later than usual at work). Pulling into the Powell Street Station at 0538 I figured that I was going to have a wait for the SFVA bus but decided to hoof it. Coming around the corner onto 5th, the bus was at the stop.

I can jog, right? or run at a mad dash down two + blocks. And the bus driver waited for me! Seriously, the previous transport drivers would wait till you were less than 50 meters from boarding, close the door and pull out. This lovely guy waited. There were less than a dozen of us on the bus and it is not like there is a lot of traffic in downtown SF before 0600.

So there I sat wishing I had coffee till the infusion center opened. Port accessed, an amazing amount of labs sent off and a nice chat later, I checked into Nuclear Med to find that they were more than happy to take me 30 minutes early which means I finished 30 minutes early. (Note, this did not help me get out any earlier since there was a screw up on my anti-malarials which took up more than an hour for thirty (30) measly capsules. It is at this point that I want to set out on my next errand.

The #38 Muni bus picks up in the drive between the hospital and clinics building. Out the door, dash down the sidewalk. The driver looks at me, closes the door and pulls out. ARGHHHH!

Now, If I jog  the path leading off the campus, across Clement, two blocks down hill, cross both sections of Geary which are effectively two streets, turn left and run another block to the bus stop, I can catch the same bus. Which I do. This is the second run today. I am not in the shape I would like to be. Bus to UC Hastings. Hiked to AT&T park. Tram to BART and home.

According to my watch, I more than got my number of steps in….

You could have left the weather home

Holly Doyne Posted on by  

I mean really. It was the second day in the Mariners vs the As schedule. It was cold. It was damp. The Mariners should have felt well at home. After all, we know the reputation of Seattle weather – right?  I guess the As could blame the weather for their less than sterling performance. It seemed like the pitchers were ruling and the batters just couldn’t get on base.

Funny when a lousy evening at the Ballpark completes a day spent at the SFVA enjoying (not) being a patient again for a day of killing off lymphocytes.

 

Don’t wear blue

Holly Doyne Posted on by  

or at least a medium blue to a rehab facility. At least not when that is the color of the scrubs worn by all the personnel working there. Never mind that they are all – without exception wearing pants. Never mind that each and everyone has both the facility name and their role embroidered in large white letter on their top. My showing up today in a dark blue Columbia skirt, t-shirt and long sleeve over shirt tied at the waist caused confusion.

Correcting fellow visitors is fine as long as I point them to, or get them to the person who can give directions.  But causing confusion in one of the patients at dinner had me feeling completely horrible. The reassurance by the staff member on duty that that special patient wasn’t particularly oriented to time or place with almost absent short term memory didn’t help.

It was something, the clothing color, that I noticed yesterday but didn’t take into consideration when I got dressed this morning. I was just thinking the weather was going to be nicer and I could leave my last pair of leggings for tomorrow’s flight home.  Now I know better, but hopefully once my friend is out of there, I won’t ever have to worry about this particular “uniform” again.

Blowing Hot or Cold

Holly Doyne Posted on by  

Ok, yes, this another rant about the US and it’s love affair with climate control. Which usually means air conditioning in most states at this time of year. As part of the rant, consider that I have complained about not being able to open windows which some might say is a safety precaution on the second floor of a rehab facility.

You don’t want to hear my reply to that bit of absurdity. To whit: If patients could open a second floor window by themselves and crawl out to fall, they wouldn’t be in a rehab facility. Anyone accomplishing that particular task could probably kill themselves in a myriad of other ways and, again, wouldn’t be bothering with a method that would be interrupted.  Not being morbid or anything. Windows can be engineered to let in air while also keeping in children, small animals and others who might otherwise use this as an escape avenue.

Instead – we get versions of climate control. In this case, it is a system normally seen in low to medium budget hotels. You know what I am talking about. On the wall next to the window is this metal container which holds a fan along with a heating and/or cooling element and one to two control dials. If you have one dial, your choices are normally along the lines of fan at high or low along with a heating or cooling choice of high or low. Anti-clockwise gives you one set of temps while clockwise gives you the other. Another favorite design option is one dial for the fan speed and another on which you can do “dial a temp.” Lastly, and probably the cheapest arrangement has pushbuttons for hot or cold and the dial is only for fan speed.

I think I should be really impressed – in a two bed room there is actually a unit on each side so that we can have dueling temperatures! And fan noise, let us not forget the fan noise. Loud, but certainly not anywhere able to drown out a determined television watcher.

Oh? I didn’t mention the presence of dueling TVs?

Immigration and US Health Care

Holly Doyne Posted on by  

The following thoughts also apply to OZ, original EU countries. There are two serious sides to health care delivery in the Developed World. The first is supply of adequate numbers of trained providers at all levels to meet the increasing acuity, demand and complexity of First World medical standards and regulations. The second is the impact on those countries which provide a large number of the above mentioned health care staff.

This struck me once again as I hang out with Carmen as she wends her way through the system. Adventist Hospital visibly does not discriminate in employment that I can see. Race, color, creed, religion, gender, country of origin, religion make absolutely no difference.  What they are looking for is expertise, care for patients and a willingness to work hard. That is not to say that there are not going to be hiccups in the system (not enough staff on is always an issue with nurses in every hospital in which I have worked) but that this is not a hospital that looks like the kind in which I trained (Minnesota in the 70s). 

But there are serious issues facing the US health care system: we simply don’t train enough native born individuals irrespective of ethnic origin to fill the number of personnel needed. Not by any means. The same is true in the UK which draws on both the Commonwealth and the EU (up to now) to fill its ranks. The situation in Scandinavia (working off 5 year old memory now) is that the Eastern European EU countries have filled many of their needed slots. We have an aging population in the US, the same as many of the original EU countries. Population is at replacement level or below except in the immigrant/refugee population. All countries in the west are becoming more diverse whether they want to or not. And it is not just the acute care system that needs medical personnel, an aging population, one that lives long enough to develop many of the challenges of extreme age (read 95+) requires personnel for nursing homes, rehab facilities, visiting health nurses and respite.

Over the last two days, I have had the wonderful opportunity to talk with numerous staff. Many were immigrants as teens or children when their parent/s came as refugees/immigrants to the US. A few others were trained outside the US and moved here for further training. Or to use the skills they had learned from books but had no opportunity to use at home due to lack of facilities/equipment.  And here is where the moral/ethical considerations come into play. Countries that can barely afford basic health care, in fact generally not able to provide much of anything due to lack of funds/infrastructure/political will can not afford to train individuals who then leave to practice elsewhere. Or can they? There are those countries which actively produce excess providers knowing they will go overseas and send their salaries home to family remaining in country. The classic example with which we are all familiar is the Philippines which has citizens working everywhere else in the world in hospitals to ships in order to make more than at home.

Where are they from? Africa, the Caribbean, Indian subcontinent, Central America. All well qualified, all feeling like they are actively contributing. With rare exception, they couldn’t do this level of work at home (see comment about lack of everything above). Would they go home? Maybe. If there wasn’t civil unrest, if there was a chance to practice high acuity medicine, if there was family to go back to, if there were excellent schools for their children, if they weren’t looking at massive overcrowding and primitive living conditions.

Can we [US] continue to deliver the standard of care that we except to receive as patients without immigrants? Obviously not in some areas of the country, perhaps not in most. Maybe so in others where there are bountiful training opportunities and young people who want to stay locally (see San Francisco).  Can we do something in return for those countries which are loaning us health care professionals? Probably, and not just the Gates Foundation or those Universities which have research projects or limited partnerships.  All of what could be done is well above my paygrade as the old saying goes. But these are things to think about. And to seriously understand what is going to be the US future if we seriously curtail immigration.

 

A long day

Holly Doyne Posted on by  

Which I think was longer for my friend having surgery than me.

I haven’t been an inpatient for a while and certainly not one facing major surgery since 1995. I don’t count a shoulder scope as major surgery. Rehab yes, but nothing major as far as recover on the surgical side. So anyway – Adventist Hospital with staff and patients coming in all sizes and shapes. Visitor parking that is free. Yes, free parking which is unheard of in most major metropolitan areas. Except for the SFVA which offers free parking but has extremely little actually available.

Back to the present – surgical waiting room for hours where I had a chance to talk to a myriad of interesting people: a gentleman in his early fifties who was there supporting his sister-in-law while his brother faced yet another in what seems to be an endless number of surgeries, a guy who fits the classic “long haired looking hippy” of my era who is probably mid40s worrying both about his family member in surgery and their 9 month old family pooch who has just had a leg amputated secondary to a tumor and an elderly man waiting on his partner hoping for good news but not really expecting it. Everyone gets a case number when they come in. Visitors have it written down along with a sticker saying they are a visitor. The electronic board on one wall lists location of patients by their case number by pre-op, in procedure or pacu. (Post anesthetic care unit for those not of US medical background).

I found the cafe/cafeteria. Their coffee is quite decent and a lot cheaper than Peets or Starbucks. They don’t offer completely healthy choices, but each and every item lists caloric load as well as distribution and amounts of protein, fat, carbs and sodium. I could easily live without knowing how many calories in each item come from fat, but that is just me….

Followed by transfer to the ward and settling in before I headed out in the rain.

 

 

Rutaximab

Holly Doyne Posted on by  

Is not exactly my favorite medication in the whole world, but if it puts off a recurrence of my NHL, I am more than willing to deal with an infusion every couple of months. Obviously that means that this was my Wednesday to land at the SFVA bright and churly.

Unlike my last couple of trips, there weren’t any issues with my port this time and I sailed through everything in more than enough time to catch the 1440 shuttle back to BART.

Unlike the last few times I wound up with serious nausea and am still wondering what is up with that. Meanwhile, Dani managed to get herself home from work, Alex is still in NY and George is at JP Morgan most of the week.

My best bet for me is more sleep…

ugly lounge chair

Holly Doyne Posted on by  

It is Wednesday, with Friday the 13th arriving in the middle of the week. I am sitting in the infusion room at the SFVA. My break is over and I am back to hanging out with other vets and the infusion nurses.

I’ve finished the main run of chemo and am now shifting over to maintenance therapy. No promises but the best guess is that returning for regular infusions (immunotherapy) will prolong remission and I am all for that. Never any promises, but we will see.

So it was up at a really early time this morning, dropping Dani off at work before parking at BART and heading to SF. In a long, round about way, I managed to make my way to the SFVA via the #38 Bus on Geary.  I arrived about 10 seconds too late to catch the usual MetroLink bus. This particular driver is overly prompt and doesn’t stop or wait for anyone (unlike the drivers on the previous Bauer Contract). Just after I was leaning disgustedly on the wall, preparing to wait 40 minutes for the next bus another person bound for the VA. In a flash of really dumb thoughts, we decided to head over to Geary and catch the 38R. Said bus, of course, didn’t come along. After waiting a while we grabbed the second 38 and wound up dropped in front of the VA just about the same time as if we had waited for the free shuttle.

None the less, the ride was fun as it was just about only VA staff + a couple of vets by the time that we arrived at 42nd street.

The clinic hasn’t changed but there has been considerable nursing staff turnover since I was here 90 days ago. I was able to give away the bag of lemons I brought and get a latte even before I started my appointments.

It is going to be a long day – I have dental after I finish at the infusion center. But I should be done in time to catch the Metrolink home. By that time, George ought to be home!

Four eyes

Holly Doyne Posted on by  

The VA, as part of my benefits, provides me a new pair of glasses without cost every two years. That was Jan/Feb 2016. As glasses more complicated than those needed by the average 35 year old (i.e. bifocals, trifocals or progressives) are made in a central location it means something less than a few day turn around. I had a second pair made at a local Lens Crafters before I left for India last year.

Of course my pair from the VA arrived in the afternoon mail, the same day I was already at SFO on an outbound airplane…

So that made two pairs; except that I hadn’t dared travel with only one pair so I had found an older pair (see pink…. see the bifocal line…) which I think date back more than 10 years.

Fast forward to this year. Even with a scratch resistant coating, my VA haven’t survived all that well. The commercial pair was stepped on (not me) and, funny thing, there are no replacement frames to be had – would I like to order a completely new pair?

I don’t think so, not at that price.

So for $500 less than what Lens Crafter’s wanted, I ordered a new pair from the VA. Progressives, no photo grey and dark frames so I know which pair is the newest.

And, I now have four pairs of glasses to lose in the house….

glasses, so I can find at least one pair

and cycle 6

Holly Doyne Posted on by  

of just about all poisons but one. By mutual consent (my doc and me) we dropped the Vincristine this time around. I was just starting to get some symptoms that could be attributed to side effects. Or – I was willing to admit that I was having side effects from the drug and there was no good reason for me to risk them getting any worse.

It was a long day – George bailed me out and we stopped for supper on the way home. I was glad there wasn’t a home game tonight. OTOH, well the As are not exactly operating at the top of their abilities. On the rare time they win… oh never mind.

And what did I do while hanging out at the infusion center?

worked more on my fractal but forgot to take pictures….

 

Round five

Holly Doyne Posted on by  

In which I got to the SFVA early, found out from the lab draw that I still had a few white cells left floating around my body and hung out for a number of hours of infusion. The good thing about a full day is that I finish in time to get the shuttle back to the BART. From there it is just a hop, skip and and jump to…

I had skipped last night’s baseball game as I was just really tired. Today however? It wasn’t even remotely within the possibility of going home. Instead, I watched a decent pitcher’s battle at the Oakland Coliseum with a great bunch of people. Saw Mark Canha pull off a homer in the bottom of the 10th to clinch the victory for the As, breaking the 2:2 tie. Beating the Red Sox. How lovely.

CISTM15 – Day 3

Holly Doyne Posted on by  

Both the education and the entertainment continued today. Takeda (Pharma) was kind enough to provide both wifi and an app for the program. As a result figuring out where to go and what to do has been extremely simple. It has also made the evaluation of each presentation and panel easy as the usual questions can all be answered on line.

The highlight of the day was a presentation by Jay Keystone (Canada) who has an extremely dry sense of humor as well as a breadth of knowledge in infectious disease. For this conference he was tagged to discuss STIs (sexually transmitted infections in CA/UK parlance often referred to as STD – diseases in American English) as they relate to the travel population. The issues of human trafficking, sex tourism (which includes both men and women on the travel side – men, women and children on the host country side) and disease spread aren’t particularly funny. But confirmation of sexual activity in the younger set (hey – alcohol, drugs, opportunity with fellow travelers and rarely planned) is not the same as the business traveler (older, money, often planned) still leads to consequences in both groups. As a side note – the CDC’s condom information includes the reminder to “open the package.”  Most of us assume a slightly higher level of intelligence in our patients. Our issue is reminding them to take condoms along on the trip.

The business meeting at the end of the day was just about as boring as one would expect. The money is being handled responsibly, awards were given out, the outgoing and incoming executives shook hands and gave speeches (yada, yada, yada).  I stayed through about 15 minutes of the reception then headed to the Tram. My flight is early in the morning (looking at an 0430 cab ride) and grabbing coffee at the airport. It is going to be a really, really long day…..

CISTM15 – Day 2

Holly Doyne Posted on by  

There wasn’t anything in the 0800 offerings that thrilled my heart which gave me more time to wander from the hotel to the conference center. It also meant being on a slightly more crowded Tram which wasn’t all that exciting.

Today’s sessions covered the range from effects from climate change through public health emergencies in the morning to special groups of travelers, new vaccines and the usual discussions on malaria.  What I didn’t do was attend the Gala Dinner thinking an early bedtime was much more interesting

The cross stitch is now going more slowly. Not surprising as the sections are smaller, starting to curve. This results in ending the fun of long runs of a single color mostly in straight lines which translates to mindless stitching while listening to an audio book. I’m on the last Daisy Dalyrumple (Carola Dunn, author) that is available on Hoopla. But this way I don’t wind up with another half dozen audio books in my “collection.”

16 May 2017

CISTM15 – Day 1

Holly Doyne Posted on by  

Picking up where I left off yesterday, this is the official first full day of the conference. As professional organizations go, it isn’t all that large. Even with membership from 120 countries, the vast majority still belong to the major four English Speaking (UK, US, Canada, Australia) which makes sense in terms of the founder group and the original focus on medical care for tourists.

The first plenary session addressed the issues of migration from the EU perspective. From the US side of the Atlantic, we read about immigration from Afghanistan, Iraq, Syria but don’t always have a good idea of the actual impact on the towns, cities, villages and countries that are the receiving side. It is startling to realize that there are now countries where 1:4 or 1:7 total population is refugees. Few, if any countries are stable enough or wealthy enough to absorb that kind of population increase. From the medical side, infectious diseases aren’t really the issue; it is trauma along the way and chronic disease that put a significant burden on the receiving country.

I spent a fair amount of the rest of the day listening to vaccine updates or conversing with various other members of the Responsible Travel group.  I also ran into an old French Military Colleague and may just have gotten suckered into working on the establishment of a new interest group.

Taking the tram back was easy but used up the last of the change in my pocket….

 

Fractal

15 Mary 2017

Travelers, Immigrants & Refugees

Holly Doyne Posted on by  

From it’s inception in 1991 the emphasis of ISTM has been the traveler. Usually in fact the tourist. Over the years the membership has expanded both beyond Western travelers and health care providers into areas of travel and those who worked there.  Over the last ten years both regional meetings and involvement in issues of population movements has spread. No longer just oriented on the tourist experience, the organization has been active in environmental impact, expedition, altitude, wilderness medicine in addition to increasing involvement in travel by and problems of refugees.  It has taken a lot of work over the years to reorient even a little from a primary concern with infectious diseases. Face it, we all like malaria. It has a clear path from infection to treatment, lending itself well to Western concepts of curative medicine.

And so, the emphasis of this year’s ISTM conference is on travelers of all kinds, not just tourists.  The young Japanese doctor who is the chair of the Refugee & Migrant Interest group had put together an extremely interesting and educational recourse for those of us who want to maximize our learning for the number of hours spent in Barcelona.

 

Completely aside, this is probably about the 9th or 10th time I have been in Barcelona.  There is always something to explore; a museum, a gallery, an old neighborhood .  I am finally conversant with the Metro and tram system; leaving me to wonder why I had not made much use of it in the past. Getting from the airport to the Congress turned out to be easy and 4.50€ (compared to taxi or private transfer fees).  As an aside another participant asked me in all honesty if a day would be enough to see the city after the conference.  Hum, would you expect to be able to do that in Berlin, St Petersburg, London, Paris, NYC? Perhaps five days might be a good start….

So I attended the afternoon course following my early flight from Munich before going to my hotel.  I had stayed for the opening remarks but bagged the reception on the grounds of being tired.  I’ve free wifi at both conference and hotel resulting in my sparing of our phone budget

 

 

 

Last flight out

Holly Doyne Posted on by

All of us who fly to Europe are used to the “leave in the evening and arrive the next morning” method of travel. For years when traveling from the East Coast, this meant a flight leaving somewhere after 2000 and sometimes as late as 2230. After moving to the West Coast things changed a lot. If you are stuck (schedule or expense) changing planes in the US it normally means a morning departure. You have to account for 4-5 hours of flight plus three hours of time change. And, if you are smart, at least 2 hours at the change airport just to have 1/2 a chance of making your flight.

Even the direct flights from SFO seem to leave early afternoon. But then, my most recent flights have involved Frankfurt, a plane change in Frankfurt or Copenhagen. Imagine my surprise when informed that the flight to Munich (why wouldn’t I fly direct?) didn’t leave till 2055! Of course, it doesn’t exactly arrive in the morning, now does it? This is not a flight for someone who needs to be able to work the same day they arrive. But it is totally and completely perfect for someone who needs to get there, have a light supper and crash for the night.

Oh, I didn’t say? It doesn’t arrive till 1715 in the late afternoon. For me, this is perfect. I need to be at the SanAK the next day for registration and my conference is Tue-Thurs. Makes complete sense; within the week travel for everyone in Europe and in country.

My studio is almost clean. There are several hundred books and a dozen or so audio books ready to go to the used bookstore. I passed along a couple dozen weaving books to a new weaver and 500 gm of beads to a friend of the Eldest. Between College Guy and myself, there are three bags of clothing to go to the Charity Shop and three baskets of craft supplies are going to be rehoused on my just emptied shelves in the garage.

I’ll have phone and wifi while gone. I will miss the family (no, not you dogs) but not the construction noise. The Eldest is documenting the whole process for me.  Meanwhile, there has to be something interesting to snack on here in the United Lounge (no, I’m on Lufthansa).

Ah!, cookies….

Forgot one!

Holly Doyne Posted on by  

Since I am whining, I realized that I forgot a med or two yesterday. The Acyclovir is twice a day, but two capsules in the evening isn’t all that bad. What I forgot to mention is the not so friendly

Zarxio

which was my challenge with TSA when I flew to LA. Three more doses remaining. In the fridge and the directions are correct – it is much less uncomfortable if I remember to give it 30 minutes to room temperature before sticking myself. I suppose I should just be grateful that it is subcutaneous. It is not like any of us at this age have a lack of a fat layer just hanging out below the skin and waiting…

with a retractable needle

The engineering has improved so much, the needle automatically retracts at the end which I think is really cool. Not to mention decreasing the chances of needle sticks on everyone’s part. Still an occupational hazard for medicine/nursing – but short of emergencies, you have to really try or be clumsy unlike the 70s when I trained.

The injectable is a neutrophil booster (they get whacked off along with the rest the fast growing cells from the chemo) in an attempt to decrease my infection susceptibility. Since I really would like to continue avoiding docs, nurses, clinics, hospitals or ERs between sessions, I decided it would be worth the six days of needles.

Other than that – it is a fine day to clean and organize – or so I keep telling myself. Of course, it is all interlocking. The garage, the studio, the bedroom. This lifetime? Perhaps not but I am making an effort. By the end of the evening, my side of the closet, dresser etc are all under control.

Now there is just the small matter of the detritus on the bed and floor. There is actually some time criticalness to this all since I think the washing and machine and dryer are getting pulled on Monday prior to more [de]construction.

Oh – and if you want a bit of fun – go here to Short Fiction Breaks. Brad has had his first “break.”

Blech

Holly Doyne Posted on by 14

a morning dose

Now, for some people, that handful might seem like nothing.

But for me? Blech exponential. I have gone from taking one small thyroid replacement in the morning (20+ years) to this handful of horse choking pills and tablets. Admittedly, some are temporary – those four nasty round tabs are 20mg each of Prednisone and that is only for a few days. The pretty blue and white are Acyclovir and help protect me from the idiots out there who don’t stay home when they are ill. Same for the huge Levoquin which is gag worthy. This only leaves a tiny pink tab – anti-nausea. I am just safe siding it with that one. The chemo isn’t really bothering me, but I can’t think of anything worse than having to repeat this dose!

The rest of the day was much better. Had lunch with a friend, Started on my closet and actually discovered the floor along with some electronics which I thought had been lost for good!  The evening saw me out in Richmond at the Eldest’s to celebrate one of her friends birthday’s.

Now – back to cleaning…..

Interesting

Holly Doyne Posted on by  

Unlike the crabbiness of the last couple rounds of Prednisone, it is UP this time. So I have been cleaning and organizing and playing computer games.  Now, I just probably should get some sleep. Two of my unfriendly poisons also were dose reduced so that might be helping a bit.

So today it has been laundry, a lot, dealing with the pups while Dani is at work, and then there is progress on the puzzle which I have probably failed to update you on…

Light snowfall over Manhattan

 

Like all the other Liberty Puzzles – there are a lot of whimsy pieces that are appropriate to the picture plus some wonderful details.

 

In house construction, the heating guy has been here, the plumbing guy has been here. There is a plan. Now if the construction crews shows up with the diggers on Monday – everything will be wonderful.