Sunday, June 16, 2013

Missing Mr. Small

I completely forgot today was Fathers Day.

No longer needing to remind my son to call his dad on this day and his birthday, no longer having my dad around to say things to, this becomes just another day.  Mothers Day is a bit different (my mom died 5 years before my dad) because I have my precious and only child, my son, who always makes Mothers Day something special.

Each time there is a special day that many people celebrate, I am reminded over and over just how fortunate those are that have their loved ones here with them.  I lived in Taiwan in the 80's, and both my parents (who were divorced) and I stayed as close as when I was in the U.S.  We made it happen.  No computers, texting, no instant anything.  Long-distance (expensive) phone calls from land lines, and snail mail was it.  Taiwan is 15 hours ahead of California, calling was challenging and had to be prearranged to work for each side of the world.

I felt like the most fortunate daughter in the world when my dad called and told me that he was coming over to Taipei for business.  He worked for Ford Aerospace his entire life as a contract administrator, overseeing billion dollar defense contracts with U.S. allies.  (I was the only fourth grader I knew that brought a reel to reel film of a tank shooting ballistic missiles for show and tell).

Taiwan straight out of the camera
(Photo credit: Lif...)

I was busy studying Mandarin Chinese and working as a model in Taiwan and Hong Kong when my dad came over, along with some other Ford employees, and took great delight in telling me about going to a local department store.  They were all going up the escalator and one of his coworkers said something about 'the pretty American girl in the poster'.

My dad looked over and said, "That's my daughter", and when
he was telling me this, the gleam in his amazing green eyes was bright.  That was in 1986. I had my son that year in Taiwan.  He sure loved his 'Papa Web'.  

In 1995, I was a Hospice nurse by profession and a full-time nursing student when I took care of my father when he was put on Hospice.  He had colon cancer (as his mother did) that had metastasized to his liver.

I was given the amazing gift of taking care of both my mother and my father during their last days here.  Once, after gently wrapping my dad's swollen, weeping legs, I leaned over and said, "you're the best patient I've ever had", and my dad responded in a soft whisper, "you're the best nurse I've ever had honey".

These words I will treasure forever.

Inscribed on the granite stone with a bodysurfer on a wave, remembering my champion athlete dad, my younger brothers and I chose: Our Friend, Our Father.

Miss you Dad.      


Gentle Hugs....(and give your father some on this day.... if it is possible)
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Sunday, June 2, 2013

Pain and The Positive Power of Animals

A Warm Spot on the Recliner....again  


I asked God before I left for the shelter, to let me know the right dog the moment our eyes met.  I also asked for the dog to recognize me as its new and forever mom.

It has been three years since my last Jack Russell Terrier died.  2010 was a tough year with many levels of life, and a sudden, unfamiliar life with no dogs in it certainly took some adjusting to.  The years have been a journey since she died, and the healing had taken place in my heart.  I knew it was time to bring a new, innocent, loving dog into my life, and time again to have an outlet for my love and adoration of these creatures.

And it happened!  She was the first dog I saw, and I promptly fell in love.  She was going by 'Mimi' at the Sanctuary, a 5 lb. Chihuahua estimated at a year of age.  She was found in a nearby town, spotted wandering a farm for 2 days before she was brought to the Fallbrook Animal Sanctuary, a No-Kill Rescue.  They also take animals from other shelters that are not no-kill.  This is my first experience with a no-kill policy.  It was obvious when I walked in, that love was the driving force there, taking in each and every animal they can possibly accommodate.  These innocent creatures have a fighting chance here, with plenty of water, food and medical care, and a hope of adoption without limitation on their lives.  Donations are needed always, and direct donations of dog food, supplies, etc., are necessary to keep this haven operating.

To adopt, there is a process, including a home visit that was done by a volunteer from the shelter.  A health check was the last step.  She had spent 3 months there (in an outdoor run) most likely scaring off most potential adopters with her highly active antics.  Licking faces like a nut, excitedly jumping and running around.  Her energy was amazing!

I saw a sweet, happy, intelligent, active young pup, yet a bored, lonely one.  All she needed was someone to trust, consistency, and love.  With that, comes the needed boundaries of training, bringing respect, and out comes a trusting, well-behaved dog.        

The day came to pick her up.  She was brought out from the back, held close by the man whose enormous heart runs this haven for innocent, lost, abandoned (or worse) animals.  He told us that he had taken a special interest in her and had tears in his eyes when he said thank you, for caring, for giving her a chance, a loving home and hope again.  I could hardly look at him without my heart breaking.  That moment I will have ingrained in my heart always.

A couple weeks have passed, and she has settled in.  She is a joy!  A little clown, so playful, and so intelligent.  This is the first dog I have not raised from a puppy, also the first I have adopted.  Her short past is a mystery.  The first thing she was taught the first night home was 'no table', a one-time command, and she immediately stopped trying to step on the side table next to the couch.  Since then, not once has she even tried to walk on it, and has fully cleared it on one of her giant leaps from the couch over the 'no table', landing on the chair on the other side.  (Can't argue with her being correct on that choice!)  The laughter she brings is continuous (even when she's asleep).  I have missed the laughs that always were part of having my dogs.  The love that these little hearts give to us can heal many wounds.  Through their pure love, we are able to return the same.  The healing power is unseen, yet runs deep; with the canine’s uncanny ability to sense human emotions.

Lying on my lap now as I write, the warmth I feel is not just from her little furry body, but also is touching my heart with tenderness.    

Laughter is one of the saving graces in my life.  Waking up every day with such an overwhelming physical (and therefore mental) sensation of pain is and has been my experience.  Our bodies are wired to send pain signals to the brain when any part of it has been hurt.  My body was seriously injured, experiencing severe trauma in the rollover accident.  Then it was cut open multiple times to try and fix the injuries.  To alleviate some of the discomfort that had gotten to levels that were unbearable.  I learned how to process acute pain at a young age and how to deal with large surgeries, long recoveries, and the complete cessation of life as I knew it each time the scalpel when in.  The multiple spine and knee surgeries, the unending procedures, the trials I participated in, the failures; all are in the past.  I chose to stop extended-release pain medication last year.  This is not a simple life.  I can no longer physically hold a position as a nurse in the field.  I lost the ability to do what I love the most: Help Other People.  That is crushing.

Learning how to live, in some sort of self-contentment, despite these large personal losses is the journey now.  As I get older, I feel my spinal pain in a much deeper way.  Mornings are not my friend.  My thoracic spine feels like its crumbling, just like the amazing painting 'Broken Columns', by Frieda Khalo, illustrating the painful trauma to her own spine, also injured in an accident when she was 16.  The cervical and lumbar radiculopathies are still very much alive, showing up randomly and as always, unannounced.  I can be playing the guitar and my hand will become completely numb.  Bending forward has always been a challenge-- Thoracic spine pain rips through my back, chest and ribs when I stand back up.  The forward flexion of my spine releases some pressure on the discs, but raising myself up and extending the spine, is becoming extremely painful and this pain now lasts longer.  I am unable to perform proper body mechanics and use my legs to lower myself down, due to the first knee surgery in ’77 that repaired the displaced patella, realigned the tendons beneath (and a torn meniscus now) squatting is out, so bending at the waist has been the only choice.  Maybe it's time for a pick-up-stick thing.  Argh.

Just another day.

Today, with a sweet little girl asleep on my lap, her tiny face against my arm as I write, her head moving with each letter typed, keeping on through this never-ending, always-increasing onslaught of pain……..is just that much sweeter.



Gentle Hugs....
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Tuesday, April 30, 2013

Farewell To Walgreens Pharmacy and a Tsk-Tsk Too

The mortar and pestle, one of the internationa...

A Judgment Call


Walgreens Pharmacy has served me for years, been a partner in my medical care, and been a friend at times when I felt as if the entire system was against me simply because I live with pain every day.  (I have also been a long time customer of the entire store)  This connection has been built over many years, and as with any part of the management of my pain or other medical issue, is  very important.  I knew the various staff, I was comfortable.  It is sad to lose that.

I am not a 'pharmacy-hopper' or a 'doctor-shopper'.  I create long-lasting partnerships in my pain management, including the pharmacy at which I choose to fill prescriptions.  After decades of spine and knee surgeries, various procedures, trials and novel treatments, all performed by respected surgeons (Neuro and Ortho) Pain Management physicians and the well-known clinics they practice in; I am a credible and compliant patient with a medical history starting with severe trauma going back to my teens.

One thing that does change over the years is employment, health status, etc., and I have been a customer with various insurances, and also a cash pay customer.  One year I paid about $12,000 cash for prescriptions, and I did not spread that love around to other pharmacies, that was all for Walgreens.  Ouch.

So why am I leaving Walgreens pharmacy?

Let's start with the phone call.

I was returning a call from the Walgreens pharmacist who was refilling some medications I had submitted via the convenient text & email refill alerts they offer.  He had said on the message that there was a "problem with one of the medications" and needed to talk to me.  I thought I may know what he was referring to with one of the refills, and was shocked to find out what the 'problem' really was.

Asking what he wanted to talk to me about, the pharmacist said something about a new Walgreens policy regarding pain medications and that he couldn't refill the Soma prescription.

Soma, or Carisoprodol, is a muscle relaxer.  Granted, it definitely helps with the deep pain and the movement restriction of severe muscle spasms (ergo why it has been prescribed to me for years) but I beg to differ on his wording.  I asked him if he could repeat what he had said.

"We at Walgreens in an effort to protect ourselves and our customers, have a policy regarding certain medications and in all good faith, I cannot dispense this medication at this, or any other Walgreens."  I was a bit taken aback and asked him to please repeat himself, and I grabbed a pen & paper.  He stated this again, and was definitely reading this statement off a paper.  I asked him if this meant that no Walgreens now would fill Soma, and the pharmacist read the same thing to me.  He chose to do this instead of talking to me like a person.  He was completely ignoring my pertinent, non-argumentative questions.  This was very aggravating and I felt it necessary to be 100% clear on what the pharmacist was attempting to get across to me.

I said that I need him to clarify this.  He began a another script-reading and I stopped him.  I told him I am a nurse, I am not arguing with him, I just needed to understand exactly what he was telling me.  Had Walgreens implemented a new rule that certain medications were not to be filled?  That doesn't make much monetary sense.  Was there some problem with my profile on their system?

Or was this a judgment call?

He refused to speak to me on a human level, and began to re-read the same thing.  At this point, I realized there was no getting through to this Pharmacist on the phone.  I asked him for his name, and he gave me his first name, which I already had from his voice mail.  I asked for his full name, and he hesitated, saying, "I don't usually give my last name", and proceeded to tell me.  I asked him to spell it, and he did.  I thanked him and hung up.  I was never angry or rude, I was calm and respectful.

Speechless, I began writing down everything that was said.  I looked his name up on the licensing board, and he looked to be related directly to Walgreens.  My friend then called the store and asked for the name of the store manager, who was not in at the time.  The assistant manager was eager to help, and gave the name of the Pharmacy manager when asked.  The Pharmacy manager is one and the same as the script-reading Pharmacist. Helpful assistant manager asked if he could do anything else, and at the time, that was all that was needed.

Recently, Carisoprodol was introduced into the DEA Schedule as a Schedule IV.  After January 11, 2012, Carisoprodol prescriptions are limited to 6 fills per prescription.  (Initial plus 5 refills)  I was aware of this change and my doctor's office also, letting me know last year that the doctor would need to write a new prescription to comply with the refill limits due to this change.  (The Walgreens I've gone to for years also alerted me to this)  Nothing else changed in the filling or refilling of this medication that affected me in any adverse way.

Until now.

Unable to find anything else that would clue me into why this one Pharmacist refused to refill this medication, I decided to go in person, and meet face to face.  We had spoken on the phone late, and I went in to his pharmacy the next day.  Unfortunately, he was not in, and would return after the weekend.  The Pharmacist there was not contracted with Walgreens, and was one of the nicest people I have met lately.  Smiling, he answered what he could of my many questions, letting me know that he could not fill the Soma because of what the other Pharmacist had done, and he was unable to override the manager.  I expressed my frustration with the pharmacy manager including his lack of communication skills and his inability to just talk to me and explain the situation.  It was recommended that the prescription be transferred across the street to another pharmacy, I agreed, and that was that.  The Soma was filled with no problem.  Yet I was not finished with this.  Too many unknowns.  I dislike unknowns in my own medical care.

A few days later, it was time to fill my monthly pain medication.  I have filled this same med at Walgreens Pharmacy for years, just as I have with my Soma.  I decided to take the security prescription to the same Pharmacist that had denied my Soma prescription.  I felt this would most likely not be a simple fill like usual, as this med is a Schedule II.  I was not looking for a challenge, I was hoping to simply meet the Pharmacist and let him see me, hear me, and understand that I am a stable and compliant patient, not a drug-seeker, or anything close to that.  If that was his reasoning for denying to refill the Soma, he made that call before he ever left me a voicemail that something was wrong with one of my prescriptions.  I could have easily filled this medication at the Walgreens by my physician's office where I have been a customer for years.

Again I went in, and again, the Pharmacy manager was not there, and again, the really nice Pharmacist that doesn't work for Walgreens was.  I had to laugh when handing him the prescription for my pain medication saying, "I imagine this will not go over very well considering what happened with my Soma."  He had more information this visit about the new rules that required the pharmacy to contact my physician, who then needed to write very detailed notes about my pain, if 'weaker' meds had been tried out, etc., and that this documentation would take a few days, leaving me without medication during this time.  I still wanted to speak to the manager.  My back was in severe pain and I was unable and unwilling to make a third trip back.  I realized then that I was not meant to meet the Pharmacist that had denied me a medication that allows my body some freedom of movement, some sort of help for the severe muscle spasms I have all day long.  I realized filling any type of medication related to pain was going to be a problem here.  I also realized that this Walgreens Pharmacy was not one that I wanted to be a customer of.  (Excluding the non-contracted Pharmacist from all of this-- he was so helpful, with excellent customer service skills and would be a perfect Pharmacy manager).

It didn't take long for me to decide that because of this one Pharmacist's judgment call, who has never met me, who only has a computer screen to 'know' me through, who never said, "why don't you come in tomorrow and I can explain this to you in person"; because of that I am now done with Walgreens Pharmacy altogether.

I recently moved just a few miles further south, and the Walgreens I speak of (with the Pharmacist and his interesting customer service style) would have gotten all of my business, both in the Pharmacy, and in the store.  It is convenient in location, it is the same familiar layout, all the little things that go with a place frequently shopped.  I did my best to try and establish a new and hopeful long-term relationship with the Pharmacist.  No attempt was made to contact me after I had gone in, and I made every effort to speak to him in person.

After my experiences in both nursing and as a patient, I understand there are some people that simply won't budge, who refuse to open up, and are all too quick to judge.  Decades of Pain Management have taught me to not waste time in any part of the treatment of my daily pain.  Let's all remember:  I live with severe spinal pain.  I am the patient here.  I am not the nurse, the manager, or the lawyer who must plead their case.  

When Walgreens Corporate receives my letter including my blogs address so they can read this, will they care?  Take note?  Respond?  Or am I just a person that really doesn't matter to them, even if I am a long-time loyal customer?  However it all shakes out, it took only one, one employee, one Pharmacist, one Pharmacy Manager; to quickly bring down what many other Walgreens Pharmacy employees have worked hard to build with me.  Tsk-tsk, Mr. B., you should be ashamed.

Oh, and when I filled my meds across the street, it definitely was personal.          



Gentle Hugs....



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Thursday, March 21, 2013

Costotransversectomy Video

The second Thoracic spine surgery I had was in 2001, called a Costotransversectomy, with discectomy and fusion.  At T-9/10, I had an anterolateral disc protrusion, causing severe upper back pain.  A highly respected and recommended spine surgeon in Arizona was doing a newer (at the time) anterior approach through endoscopy for cervical and thoracic spines.  I was excited at the thought of a few band-aid scars and the easier recovery from a spine surgery without the large paraspinal muscles being cut!

After reviewing my studies, he suggested that the surgeons go with a more traditional approach, and do open back surgery.  My Neurosurgeon chose Costotransversectomy, removing a piece of the rib (costectomy) the herniated disc material (corpectomy) and finishing with the hopeful added stability with a fusion of the T9/10 vertebrae.

Costovertebral articulations. Anterior view.
Costovertebral articulations. Anterior view. (Photo credit: Wikipedia)
Costotransversectomy was first performed in 1894, by Dr. Menard.  In this surgery, the spine is accessed through an open back incision, the proximal rib that attaches to the thoracic vertebrae creating the Costovertebral joints, is cut so as to allow a clear view and room to work on disc, tumor, spur, etc.  The simple fact that the ribs are 'in the way' for many thoracic procedures, lends to the use of this approach, and also used for surgery on anterior or lateral herniations, osteophytes, etc.  The transverse process of the vertebrae is then cut, leaving a nice view and area to work.  This surgery can only be done in the thoracic spine.  

Costotransversectomy is a combination word, like most medical terminology.  Costo: ribs.  Transverse: the transverse process of the vertebrae.  Ectomy: the act of cutting out.  ('ectomy' is usually preceded by the name of what is to be cut out, i.e., Tonsillectomy- here it is the rib and transverse process).

I found a video of a Costo, and may I note here that I have nothing to do with the soundtrack.  Thank the rockin' surgeons at University of Southern California Neurosurgery !!

In this operation, the patient is having work done at the same level as my surgery: T9 to T11.  There is also work done on this patient above at T7.  It is the approach via Costotransversectomy that is exactly like mine,  showing the cutting and resection of the rib and transverse process to visualize the needed area, and it is always interesting for me to see what my spine has had done to it!  Also in this video the surgeons insert hardware, and I did not have any put in.  Although twelve years later I feel as if the hardware shown in this surgery may give some feeling of stability to my spine.

Note the cut paraspinal muscles and the retractors necessary.  Minimally invasive surgery now completely eliminates the need for this, lessening recovery time, and even post-surgical pain.

Enjoy!!    Those of you that can watch surgeries that is.  ;)


Gentle Hugs....




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