Category Archives: Medical

Halloween

Holly Doyne Posted on by 5

Which wasn’t the first thing on my mind as we headed across the Bay Bridge to UCSF. After only one extra trip in, George is back on the Mon/Thurs twice a week visit schedule. Normally I really prefer morning appointments – driving over in the car pool lane and coming back before rush hour is ideal. We were not that lucky this week – the earliest available appointment was 1100 with the follow-on at 1430. As you can imagine, by the time we finished it was 1700 which means we didn’t get home till close to 1900 (ok, discount 20 minutes for a grocery store stop, but still).

In recent years, most clinical and retail locations have put strict guidelines on costumes in the work place. Admittedly, if common sense doesn’t prevail, you really don’t want anything that is going to scatter pieces, expose an excessive amount of skin or scare really young children.

The oncology/heme-transplant clinic at UCSF only deals with adults, and children (short, disease carriers) are specifically prohibited. Those facts didn’t change the costume guidelines, but the staff still managed to have a lot of fun.

I didn’t manage to get a picture of the skeleton, the jailbird with a chainsaw, or Trump in the orange jumpsuit with ball and chain. Waldo missed the photo opportunity –

but was spotted later

where in the world

Migraine

Holly Doyne Posted on by 4

There is not much to talk about today. I never left Berkeley. For a short while I pretended that I was fine. But when I contemplated attempting to deal with a bus, traffic, people, etc I went ahead and acknowledged my limitations and took my meds and went back to bed.

George still had platelets in the double digits this morning, avoiding all need for transfusions. His docs are pleased. I may be able to spring him as early as Thurs. In any case, Will drive over in the morning so that I can pack up everything in preparation for heading home.

I can also bring along the supply of meds we have so as to prove to the pharmacy people that I am not kidding and have no intentions of repurchasing anything I already have on hand.

words in my head

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don’t do me anywhere near as much good as words on paper (which, in today’s world translates to words in an electronic document). I have come to acknowledge that putting off finishing the requirements for the two outstanding incompletes from grad school is not doing me any good. In fact, it more resembles the garbage left too long under the sink. The longer it sits, the more it smells. The more it smells, the less you want to deal with it. At some point, the nose is held (clothespin optional) and the stinking container is emptied, washed, and put back with all good intentions to avoid this cycle in the future.

Then the future rolls around again.

Please understand – I don’t give a flip about grades, all I want it is “met enough work to warrant a pass.” Having said that – it is hard to imagine putting in hours of work researching and writing for no good reason if the end results could possibly be of benefit.

It is the old Tikkun olam. Build the world a better place.

So… the background to today’s public health challenges include the following:

  1. San Francisco is an extremely expensive place to live
  2. The tech boom has resulted in an increase of 100k jobs over the last decade and the loss of 30k in housing in just the last few years
  3. The weather in California is not as bad as many of the other parts of the country
  4. changing demographics have resulted in marginalization of portions of the population.
  5. San Francisco became the mecca for a number of lifestyles starting in the 1960s

 

Now, back tracking to 2008-2009, there were several medical publications that discussed Hepatitis A infections and risks in homeless populations. Those discussions centered, of course due to the standard medical tunnel visions, on immunizing everyone to avoid disease.

So why was everyone in both city governments and public health circles so stunned when an epidemic of Hepatitis A started sweeping through homeless & IV drug user communities (and yes, there can be an overlap between the two). I fail to understand why anyone was surprised. Or, even more stunned to be in a situation where a normally mild disease most often seen in childhood in most of the developing world, various institutions was causing hospitalizations and death. This epidemic was recognized, not because of the obvious failure of the city, the infrastructure and public health to recognize the failure to provide for a vulnerable population but that hospitalization costs were skyrocketing.

The solution? According to the CDC – we should adopt the 2009 recommendations (hello, this is now 2017….) to add homelessness, IV drug use or MSM* to the list of peoples needing HepA immunization.

For those of you who don’t remember the history of Hepatitis A – this was the food/water borne version of hepatitis for which you (as a citizen of a developed country) received a large shot of gamma globulin in a major muscle group (usually gluteus maximus). 5cc is a significant volume, trust me. In 1995, the first versions of HepA vaccine became available. Every military member with a brain in his/her head was more than willing to get immunized. One shot with maybe a booster vs large/painful shot every 3-6 months while deployed? Other than the military, most of the other developed world citizens at risk of HepA were tourists indulging in street food while visiting developing countries. With the usual transmission being the fecal-oral route, it was obvious to everyone concerned that sanitation was as important to breaking the infection cycle as immunization.

We seem to have forgotten that bit of intelligence. It doesn’t matter if you immunize the whole world against a disease. That is one disease. As anyone who has every had noro-virus, salmonella food poisoning or one of the hundreds of other possibilities, the key to not getting diarrheal disease is availability of toilet facilities accompanied by strict adherence to hand washing. Which takes us to a city where there are no 24 hour public toilets, hand washing facilities are limited, no one wants homeless encampments, there is not enough shelter space for those who need it, and serious money is spent on a daily basis on power washing human excrement off the sidewalks.

Yes, we can immunize everyone. But it is not going to solve the sanitation issue.

I am making some basic assumptions. The first is that most people do not chose to be homeless. That they don’t set out to be vulnerable, dirty, and hungry. That, if they had the money to have food and shelter, they would. But San Francisco has teachers in their schools living in cars because they can’t afford a place to live.  I also make the assumption that mental health, substance abuse issues, and physical health issues impact lives to the point where many become homeless. And those problems don’t become better by being without a home.

<two hour break in which I spent digging through PubMed. Surprise, surprise, all the public health people, when discussing issues related to the HepA outbreak mentioned and repeatedly mentioned that sanitation was a serious issue and one of the most difficult to resolve. Having said that – it is no where in any of the CDC guidance. Just immunizations. Go figure>

I finished off the draft memo – sent it on its way, and spent sometime working on a Hitchhiker variation in a lovely yarn color called – magic unicorn.

 

*MSM= men who have sex with men…

 

Yogurt

Holly Doyne Posted on by 1

There are serious limits on George’s diet right now. Processed foods are fine, prepackaged complete with preservatives and fixatives. But nothing fresh, nothing from outside that doesn’t fit into the above categories, and certainly nothing home made.

UCSF runs an a la carte menu for patients. Rather than trying to come up with multiple daily menus, balanced meals and pap that no one would possibly want to eat – they actually treat patients as adults and let them order anything they are allowed to have off the menu. Up to six times a day. The only limits actually being the times of day that the kitchen is open.

But they have breakfast all day, soups, snacks, pizza and entrees after 1100. There are options from more than just the standard middle America fare, the ice cream (available in vanilla or chocolate) is Hagen Das, the vegan shake option smells horrible.

Last spring, the pudding option became one of George’s favorite and I had to find a local source for the first couple of months home before the novelty wore off. The yogurt wasn’t to his liking. A couple of days ago, I noticed that the Peet’s I have been stopping at on the way in morning carries smallish containers of his favorite brand of yogurt. It is prepared. It comes in a sealed container. He is allowed to have it, along with canned vanilla lattes.

It is a nice change from bananas, crackers, and peanut butter in single serving containers.

 

Strider

a sneakily simple knitting pattern from Martina Behm – takes one skein of sock yarn and is all garter stitch.

Strider

Fleet Week

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is just starting in San Francisco. In the back of my head, I sort of had filed the information away along with all the other local events that are interesting but don’t elicit any personal interest in participation.

Then I noted some rather low flying, fast, expensive aircraft buzzing the Golden Gate Bridge.

Right – Fleet Week – when Navies get together and show off – their ships, their abilities, and, in the case of the US Navy – the Blue Angels.

I don’t remember where I was or what I was doing last year – but I remember 5 Oct 2017. I was headed round trip through the Panama Canal on the NCL Sun in the company of good friends from Australia. We were due to pull out from San Francisco at a reasonable time of the afternoon. And then the fun started. It was a Friday afternoon. The tannoy announcement informed us that we were going to be delayed secondary to the Blue Angels rehearsing. Along with dozens of others, I went and staked out my territory on the upper deck. Up at the bow with a good camera and excellent lens. I checked the old post to discover that I hadn’t uploaded pictures at the time. And since I have changed laptops since then, I have to find the connector, pull out the backup drive, and find the photos.

Right.

Anyway. It is Friday. And what started out this whole train of thought was seeing what I thought was a low flying aircraft out of the corner of my eye. George’s window mostly faces another section of the Long Building. I can see toward downtown (East) if I look out and too the right between the two wings of the building. Huh? Walking to the lounge at the end of the hall, I had a clear view of the stretch of Bay which separates San Francisco from Marin and includes the Golden Gate. Contrails slowly dissipating. Oh – ok, Fleet Week, Blue Angels.

Back to my audio books and knitting.

Thursday already

Holly Doyne Posted on by 4

Kind of like time flying? Actually more like creeping along the ground a la inch worm. There isn’t much to distinguish days of the week for a hospital inpatient. The nurses here are on 12 hour shifts of which they work three in a row. So every three days there is a new nurse. Occasionally, George even sees one of them again. Since the nurses rotate between this floor (12Long) and 11 Long the total number of faces on the staff board is on the high side of 150.

Meanwhile, we wait. The routine seems to be fairly set on 1) visits by the oncologist; the hospitalist (who never come in together and I am not sure that they really communicate with each other) 2) the nurses 3) all the misc personnel from cleaning staff to laundry to trash emptying to food delivery 4) medications 5) various IVs from platelets to blood to antibiotics to electrolytes.

Making a round of the station (since walking off the station falls into the NO box) can be the highlight of the day since it is a different set of walls to stare at.

All of this makes me tired, just writing it. I am contemplating sleeping here tonight as I am just to tired to want to deal with the N-Judah….

Drip, Drip, Drip

Holly Doyne Posted on by  

(reprise)

Actually, when I think about it, watching paint dry might just provide a bit more satisfaction than watching IVs. When the paint is dry, that bit of the renovation is complete and you can move on to a new room. In the case of IVs – one is simply replaced by the next in line, and the next, and the one after that. Whether it is blood, platelets, calcium, magnesium, potassium, immune suppression drugs, antibiotics or solution-du-jour – the little boxes attached to the IV pole modulate the flow and seem to announce a change rather loudly. That change, completion or “air-in-the-line” of course is most likely to happen in the few minutes between interruptions that might possibly have been intended for a nap.

Otherwise – this is D+11. Things are proceeding. At least we think they are. No signs of rejection in either direction, but no real sign of some of those millions of stem cells settling in and setting up housekeeping either.
There is NPR, and the baseball playoffs (such that they are) and the occasional phone call/email to keep George entertained. I think he is beyond the worst of lousy feeling secondary to both the chemo and radiation. No clue how much longer he will be here as an inpatient, all depends on when those stem cells settle in and start producing.

Not Paint

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I think we are all familiar with an expression that relates an activity as about “as thrilling as watching paint dry.” Well, there is a hospital equivalent – about as entertaining as watching IVs drip. Unlike the days when many of us trained – nurses and docs no longer have to be able to calculate concentrations, count drops, or manage flow rates. Instead, they program electronic pumps that manage it all for them. And as far as concentrations? The pharmacy sends every thing up premixed so that task is taken out of busy hands; instead being performed by someone who is mindnumbingly bored by repetitive mixing under a hood.

Frankly, garter stitch is more of an intellectual challenge.

The garter stitch comment is a result of my digging out some skeins of fingering yarn and turning them into scarves. Knitting back and forth is soothing. Not having to keep track of anything more than a two row pattern is soothing. And, when my brain feels completely numb, I switch over to a complicated lace pattern for one repeat, curing me for hours of being stupid.

Back to the IVs. There is blood. And platelets. And antibiotics of several kinds along with maintenance, calcium, magnesium, potassium. And rejection inhibitors of which I know either chemical names, or brand names, but not both – nor, frankly do I care. Just that there maybe up to four little electronic boxes, each with their own tubing, doing their own measuring after being carefully programed.

And they drip, drip, drip…..

Needles and Rays

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which in this case has absolutely nothing to do with trees or baseball.

Rather, it has to do with stem cell stimulation shots into College Guy which lead to him spending the day @ the infusion center hooked up to the pharesis machine so that his stem cells could be collected.

At the same time, George had the fun of having to hold still for a 30 minute session before turning over like a pancake to bake on the other side. TBI = total body irradiation in this case rather than traumatic brain injury.

Tonight the Bone Marrow Transplant lab will do their thing and the transplant is scheduled for sometime tomorrow.  Meanwhile, Noah, tired and with slightly sore arms from having to hold them straight all day was glad for the ride back to our side of the Bay.

 

No trees

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Right outside George’s window to vanish and reappear with the fog. His room this time (and the room he started in the last time) has a north facing window through which I can see that the construction of this spring is just about complete. All that remains is the shrouding and scaffolding at the end of the building section directly across. Gazing toward the east, portions of downtown San Francisco are visible. Provided, of course, that one enjoys gazing at those places which are off limits for the foreseeable future.

I will just mention, beyond some of the most fantastic nurses I have ever met, that one never gets much sleep in a hospital. Between frequent vital signs, beeps from the IVs which run continuously and traffic in the ward corridor, there isn’t much opportunity for rest. So catching short naps (i.e. drifting off) during the day is about the only option.

The protocol this time adds whole body radiation to the chemo regiment in order to essentially completely wipe out his immune system. It doesn’t look to be a whole lot more fun than the last time; so far he has been spared the nausea, but I suspect his hard won hair return will shortly depart.

On the positive side, when you don’t have any white blood cells of your own, you are at high risk for infection and are spared from having to share a room. No one to argue about the TV remote and the hospital Wifi means access to one’s daily dose of news programs.

Another day, another drive

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Instead of driving to Parnassus (UCSF) this morning we had to head to UCSF Mission Bay. No biggie, right? Wrong. We were given an arrival time of 0715 which meant absolutely zero chance of adding a passenger to make use of the HOV lane. Instead, we wound up in that mess called “the Maze” where I-80, I-580 and other assorted freeway entrance ramps combine to approach the Bay Bridge Toll Plaza. Twelve minutes to get from home to the Maze (including the coffee stop). 35 minutes to get through the Maze and Toll Plaza, less than 15 after that to get to Mission Bay including getting off an exit too early.

As it turns out, the CV Center in Mission Bay doesn’t even open till 0730 so I have no clue as to why we were instructed to be there so early. The only advantage that I found was that lovely on street FREE parking spot about a block away. Of course, the meters don’t operate till 0900, but still. Free parking in SF? Totally amazing. I had never driven into Mission Bay before. I don’t get it. Two tiny bridges across the estuary. Tons of new buildings, densely packed. UCSF, Warriors Stadium, inadequate public transportation. Not an area which I would willingly visit or work in.

Tests went fine and we were home right about 0900 including a stop at Acme Bread for fresh Peach Puff Pastries. Yum. I spent most of the rest of the day with brain in idle. Watched part of the As manage to sneak past the Astro’s in Houston before they head to Arlington tomorrow. For the moment, they are actually ½ a game up in the Wild Card race.  Shana kindly volunteered to pick up Noah from the airport late tonight. Home for a day before we head to San Diego to get him set before school….

Too many appointments

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A long time ago – oh let us say May – I made a couple of appointments for myself. Figured that George would be well past the time that he needed to go to UCSF twice a week, and besides, his appointment days were Monday and Thursday. So here I am, end of August and needing to be at the VA at the same time he needs to be at UCSF. He did agree to be dropped off early so that I wouldn’t be late.

Imagine my surprise to find that there was essentially no traffic at all heading to SF over the Bay Bridge. I mean, zero back up at the Toll Plaza at 0815 on a Friday morning. There is normally more traffic that that at 1400 in the afternoon or 0200 at night. Dropped him off at UCSF, went to the VA.

In case you are wondering why we didn’t do it in the other order (besides the fact that I don’t really want him driving right now) it is simple. UCSF charges $4/hr for parking. Parking at the VA is free….

I finished with my appointments just about the time that the infusion center released him from transfusions

it is not ghee

(and a bone marrow biopsy).

traffic back was unusually light for a Friday afternoon.

Then we watched the As defeat the Yankees for the fourth time in a row (three in Oakland and now the first game in the Bronx).

Pussy Cat where have you been?

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Well, it certainly has not been to London, nor visiting a queen. This is as close to a queen as I have come

from a shop window

where she does the wave which I am sure is solar powered. The dogs (corgis?) wag their tails.

Most of the month it seems, I have been treading water – house hold chores, baseball, a bit of sewing, reading, a few puzzles, procrastinating (i.e. those papers are about at the 50% complete stage) and keeping an eye on George.

Unfortunately, starting last Thursday – that has turned into close to a full time job. We knew that his stem cell transplant had produced white cells, but not as many platelets or red cells as would have been expected to this point. An attempt to back down on the immune suppression didn’t help. His hemoglobin was way down and there was hardly a platelet to be found. That last is concerning, since platelets are ½ of the bodies clotting system. Clotting factors can do only so much without platelets to sort of plug up holes.

So Thursday he received necessary but unexpected transfusions and a request for a return visit on Saturday and Monday. Thursday evening he received a request to come back in on Friday which we managed. Then there was Saturday. And a request to come back on Sunday. (Dani pulled the Sat & Sunday drive). We did Monday, then Tues, then Wednesday which leads us to today. It has been platelets every day, plus more blood on both Saturday and yesterday.

The summary of which will be confirmed with a bone marrow biopsy tomorrow – but everyone is pretty sure that the stem cell transplant failed. Probably because he had a few white cells left which have managed to kill off the transplant. It could be that it just didn’t take. In any case, a couple of new donors have been potentially identified and are being screened.

Obviously, George is not thrilled and this drive is getting really, really old. Much harder on him than me since, instead of seeing restrictions lifted as we get close to the magic 100 days post transplant he has more treatment in the future.

 

What? No Platelets

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This morning, getting George’s lab results provided a nasty surprise. We knew that his red cells and platelets hadn’t come back the way that his oncologist was hoping. But being severely anemic again and essentially having no platelets circulating was not on the planned list of results.

The brief, short visit turned into hours as he received both platelets and packed, irradiated red blood cells.

And, if I haven’t said it before – my sincere thanks to all of you who are regular blood donors. It isn’t just the military, traffic accident victims and those caught in mass shootings who benefit from a healthy and robust blood supply. It is also those who are older, or under treatment for various malignancies who are kept alive during the course of treatment by the generosity of total strangers.

and we will have to be back tomorrow. Probably Saturday and Sunday as well.

Oh, joy.

Less than an hour

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My skin normally starts to crawl when I even think of facing the traffic into San Francisco from my side of the Bay. Since this is Thursday, George has an appointment at UCSF.

Taking a deep breath, I made an early run to fill the gas tank. Trust me, the very last thing I want to do is run out of fuel on the Bay Bridge and become “one of those idiots” who impact traffic with their rudeness. I think you understand. So, full tank of gas (petrol) followed by a coffee stop at Peet’s for human trip fuel before heading back to the house to grab my passengers. Since Alex had to make a run into the city today, I had the three of us–the magic number for the HOV lane. Rather than committing myself to having to get off at the Fremont Exit, I skipped picking up a fourth passenger at the North Berkeley Ride Share and just headed out.

My least favorite part of the trip, if one could say that any portion of the trip was all right, is having to work my way across five lanes of traffic to get to the HOV lane from the University Avenue entrance. Three of those lanes are Oakland bound and they are by far denser than the right lanes. And, hello – this is California where a turn-signal doesn’t seem to mean much of anything. I can actually be appreciative of large trucks, they never ride the bumper of the vehicle in front of them so there is usually space that I can squeeze into.

Once we hit the HOV lane, it was clear sailing all the way to the San Francisco side of the Bay Bridge. Even the traffic up Olivia wasn’t that bad. All in all, we were at UCSF in less than an hour from leaving home, an unheard of fast trip for rush hour. George is stable, getting a bit stronger everyday. It would be really nice if his red blood cells and platelets were recovering as fast as his white cells, but I guess we don’t get to have everything. He has been shifted to weekly visits from twice a week, so that is excellent from my point of view.

After we returned home, I spent the afternoon organizing my studio a bit more and machine embroidering lace doilies, just because I could. And, they are pretty mindless with few, if any, color changes.

large and small

Driving in a bubble

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The time was 0930 in the morning and we had left the house on the way to UCSF. The HOV lanes were still active so after making a kamikaze series of four lane changes to the left, we sailed along to the left sided flyover headed toward the Bay Bridge. There isn’t all that much traffic in the left lane, made even less by those single drivers smart enough to get out of the HOV lane before the cameras documents their law breaking activity. From there the flyover lane crosses to the right side and meets up with the HOV lane coming from the Oakland direction. Sailing through the toll plaza, we entered the main portion of the traffic just past the metering lights. To our left, and ahead of us was a small, reddish Fiat. There was no one around the Fiat by 10 meters or so in any direction. In a location where traffic was almost bumper to bumper, there was this bubble of “no drive” around the Fiat.

From there, all the way across the bridge, no matter the speed for the rest of the traffic, this Fiat seemed to travel at a slow and constant speed with everyone avoiding it. Traffic going 40? The Fiat is going 30 and everyone passes it. Traffic going 20? The Fiat continues to sail along with everyone avoiding it. Admittedly, I didn’t see much with it traveling faster than everyone around it. More like it turtling along with every single last car, truck and motorcycle avoiding getting anywhere near the Fiat.

When last seen, it was puttering south on the freeway, its bubble space still intact.

Arriving at UCSF early, George had his labs drawn and his follow up appointment. From there it didn’t run as smoothly as I would have liked. Because his feet hurt, someone hadn’t been drinking enough fluids. Not drinking fluids puts one’s kidneys at risk. Instead of heading home, we wound up spending almost an additional  four hours while someone (fill in the name yourself) received a significant amount of IV hydration.

The drive home was painful as the afternoon rush traffic had already started. My afternoon errands had been completely and totally taken over by hanging out at UCSF while someone’s IV went drip, drip, drip. Taking a deep breath here and releasing the last of the pent up anger, frustration and general disgust….

But the next time someone doesn’t drink enough on his own – he can Lyft or Uber home….

enough to gag a horse

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just in case

you were thinking that the medication fun stopped when he was released from the hospital – the pill progression continues. Technically there are 5-6 times a day that something on the scheduled kicks in. The first thing we did after returning home was to take an extremely good look at that schedule.

Of note – the reason that there are 0600 medications in a hospital is that shift change is at 0700. This allows the nurse to make sure that all meds are administered and computer logged prior to the end of the shift. In the bin are those which are once a day, those which are q12 hrs, one which is three x a day, one which is twice a day. Not being completely stupid – I started from the end of the day and worked backwards. My night owl is going to be up past 2100 in the evening, especially with naps during the day. So 2200 is more sensible for “bedtime” meds than 2100. That means that the q12 hours are 10 & 10 and while I am at it, twice a day can follow the same pattern. 3x a day can be distributed between 0700->2200. Those that have to be taken with meals are assigned to breakfast, lunch and dinner and the rest in the morning. (on the basis of that old adage about doing the worst thing first and getting it over with – something about a frog?).

did I mention that there is also a few hundred cc’s of IV magnesium every day?

thought not.

And all of it needs to be balanced around those really essential things in life – naps, meals, news programs, baseball….

Not Vanished

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A quick summary:

Contrary to public opinion, none of us have up and vanished. Life has just been a bit of a slog, more so probably for George than the rest of us, but still, the days have sort of blended together in an unending cycle of up, meds, meals, more meds, naps, work around the sleeping dude, more meals, meds and attempting to have enough energy to do all those basic life functions that involve laundry, grocery stores and cooking (hello? I made a deal 40+ years ago that my life did not include kitchens or bathrooms. Something is seriously wrong here….)

Between 2x weekly trips through insane traffic to SF and running various and assorted errands around here, the last week and a half have sort of slipped by in a blur. Life has been defined in 5 x day medications, sore feet (George), taking out trash & kitchen clean-up (Noah), filling our freezer with tasty goodies (Shana), dog visits (Gwen) and attempting to straighten out the amount of “stuff” that is trying to take over our lives

other than that – the Minnesota Twins are in town for a three day series over the 4th. Tonights game was a bit of a slug fest (3 home runs on each side). For the Twins – Jason Castro is local to the Bay Area. He had a huge number of family and friends present. If someone wThere as going to hit two home runs for the Twins, I am glad it was him. If someone was going to hit a grand slam – it was terrific that it was our brand new catcher in his first game in the majors.

And believe it or not – there are some rude Twins fans. LA and Houston fans have come to understand that there is always sound coming from the Coliseum Right and Left Field Bleachers; it is not worth complaining about. Especially if one attempts to do it a al D Trump on Twitter. Hello? There is no such thing as “too much Cow Bell…..” Oh – final score? 8:6 As

Monday morning traffic

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Sucks at the best of times. This morning was not one of those. In the future, I think there are two choices – either get on the interstate at University Avenue, work my way over to the left hand HOV lane and drive faster than a crawl. Or.. take the frontage road all the way on the Bay side to Powell Street and get on the freeway there which is just at the start of the maze and just short of where the HOV lane dumps in from the northbound branch of 580. I did the worst – got on in between University and Powell which meant there was no chance at all of getting safely across 5 lanes of traffic and having to spend more than 20 minutes crawling along between two freeway entrances.

The only good thing was that once we were past the start of the congestion we were able to access the right hand HOV lane and literally flew along the right fly-over looking down with sneers at all of those sitting in stopped traffic. HOV here is 3 people in the car which should explain why I had Noah up and about much earlier than his normal routine. Him getting sleep was much less relevant to me than shortening our car ride by an hour or more. Once past the toll plaza, the traffic wasn’t all that great but moving is much better than creeping or standing still.

I have finally figured out UCSF’s parking ramp. Having also appropriated Alex’s old wheelchair from its (final-not) resting place in the garage where it was stored just in case anyone would need it again, we made fast work of getting from the garage to the clinic. Yes, George can walk but he still is having significant foot pain so why would we make him hobble?

Appointment went well. Number of meds is not going to decrease anytime in the near future. OTOH, it is obvious that the stem cell transplant has taken hold.

I managed to finish embroidering the last of the little girls onto the quilt top.=

color gamp 3×6 embroidered

now it is just a matter of the backing, quilting and tossing it over to Shana for the finishing.

 

A walk in the park

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From where I am staying in outer Sunset, it is just a short hike across Golden Gate Park to the SFVA. Of course, I can just ignore the fact that the portion of the stroll from the park to the VA is straight up 42nd.

at the top of the map

 

you can see the location of the VA. and at the bottom you can see the small upside-down “V” where the cross-road park road connects to the streets on the north side of the park. Please count them, five blocks straight up hill, a definite challenge on a cool and foggy morning.

It was dental day for me. Like many others of our generation, I have a significant amount of dental work. Due to the care and diligence of Army (and Air Force) dentistry over the years, I still have all of my teeth (except for wisdom which exited when I was in med school thanks to the U of MN Oral Surgery Residency Program. $25, thank you very much). In fact, I have had one crown for a significant number of years, enough that I actually have worn through the crown. Today’s mission impossible for my poor dentist whom I have gotten to know rather well over the last two years, was to see if it could be patched with the alternative facing me of a new crown. Much as I really appreciate the SFVA dental staff, I don’t need to devote another several ½ days to the dental clinic. A successful patch later, I was about to go out the door. Only one dental issue left in my future – replacement of crown that will involve a visit to the periodontist. Since the previous dentist retired, there is only a part-timer on contract. His tech stopped in – would I be able to trade my August appointment for returning this afternoon?

Of course!

It was only a matter of taking the shuttle over to UCSF and hang out with George for about three hours and taking the shuttle back. Nice guy (family Ukraine -> Israel -> to California) which means, of course, his practice is in Menlo Park (altho he denies living in Sunnyvale). His tech’s family came from China when she was young. My dentist’s family came from India. The nurses and cleaning staff are equally reflective of who takes care of our veterans–it is the new immigrants and their children. The ones that feel that they are contributing to the U.S. by taking care of those who serve. And often, they are also first to volunteer should the country need them and at a much higher rate than those who are two generations or more in the U.S..

(off soap box).

After being told to expect pain, I breezed through the pharmacy and ran for the shuttle, getting back to UCSF by 1600. I spent the afternoon just hanging out with George, then we watched the first three quarters of the Warrior-Raptors game before I headed to the N-Judah. He still has squat for white cells or platelets; I figure another week in this place. He is bored, he is tired. If you want to email him directly – georgeDOTrehmATicloudDOTcom with substituting the appropriate punctuation  It would be a lot more appreciated by him than me playing momma monkey and plucking loose hair.