Sammy and antibiotics

[Sammy]
Sammy on new sofa, April 26, 2013.

One of the many difficulties I’ve been dealing with this summer
is that my dog got sick.

He’d been drinking and urinating a lot more than usual for a
couple of weeks, and then he started being very restless and
having occasional accidents in the house, which he never does.

So when we were both uncomfortable with the situation, I took
him to the vet, and explained why I thought something was wrong
(beyond him being almost 13 and arthritic), and said I hoped it
was something the vet could fix.

So first there were $450 of tests which were all negative. It
was nice to know that his kidneys were still functioning and he
wasn’t diabetic. The next step was $250 for more tests, one of
which was “not negative”. This was the antibody titre for
leptospirosis.

The next set of tests sounded really expensive, so I
decided we should act on the non-negative result we had, and I
spent $72 on two weeks worth of antibiotic. He started that last
Wednesday, and it does seem to be working. He hasn’t had an
accident since Saturday, and he had been having them almost
daily. He’s also recovered a bit of his energy.

So now the problem is convincing him that he needs to go on
taking the pills, which are capsules (three a day) containing a very bitter
powder. You or I would just swallow the capsule, and never taste
the bitter powder, but Sammy doesn’t do that. The first day, I
tried saying, “Here is a nice pill that will make you feel
better,” and he clamped his jaws shut very tight and said,
“No.”

So I put the capsules in some yogurt, and he ate it right up.
So I thought it wasn’t going to be a problem, but the second day,
he said, “That yogurt is going to be bitter. No.”

So I’ve been putting them in a stew, and that mostly works,
expecially if I surround them with a small piece of meat each.
When I finish the stew, I may try the peanut butter trick, but
I’m not sure that’s going to work better than the yogurt.

I keep thinking about my friends who call up their doctors and
get antibiotics whenever they get sick. I don’t approve of this
— I think you should have to have some kind of indication that an
antibiotic will do some good before you unleash it on your
microflora, but I would have expected to be able to get one for a
dog in less time and money than this took.

Beer for the dying

At the beginning of Victoria’s
memorial service,
George, her husband, gave a welcome speech.
The first memory he told us about was of the last few
weeks or months of her life, when every morning she would wake up
and they would share a beer. Even on her last day, he wet her lips
with some beer, and he thought he could see a smile.

This reminded me of the story my uncle told after my Grandmother’s
funeral. He
had visited her the weekend before she died. He’d
asked her if there was anything he could get her or do for her to
make her more comfortable, and she asked him to bring her a beer.
I didn’t think of her as a beer-drinker at all — she drank wine
with dinner, and sometimes a brandy before bed. But apparently
one of the things that shuts down when you’re dying is your
ability to swallow, and beer was what she believed would go down
the easiest.

This makes me sad that I
didn’t work harder to bring Bonnie (who was a beer drinker) beer
when she was dying. I just assumed that it would conflict with
all the other drugs she was taking, and be a problem for all the
tubes. At the period when I was spending a lot of my visiting time giving
her sponges to wet her mouth with, I did bring some coffee, and it
turned out to be a mistake — the diuretic effect of even less than an
ounce of decaf coffee was too much for the tubes she was on.

This is only two anecdotes, but until recently I didn’t really
hear that many anecdotes about the care of the dying, so the
fact that there are two suggests that there might be lots more.
So maybe the institutions and people who deal with the dying all
the time should try to figure out how they could provide the benefits of
beer to all their patients.

The Spare Room

This
book
is about aspects of taking care of a dying person
that I mostly didn’t do with Bonnie.

The main character (Helen) lives near Melbourne, and has a
close friend (Nicola)
with cancer
who lives in Sidney but has found a “clinic” in Melbourne that she
believes will cure her cancer. So she moves in with Helen for the
three weeks the treatment will take.

During those three weeks, Helen has to do a lot of physical
nursing, deal with Nicola’s denying that she is dying, and deal
with Nicola’s refusal to realize that this clinic treatment
she’s getting isn’t going to do any good and she has to go to
real doctors for real treatments.

The writing is good, and the discussion of the issues of how to
deal with a dying person is perceptive. But in the most amazing
paragraph, Helen describes how Nicola organizes her own home care after
Helen finally convinces her that she can’t do it all:

I didn’t know yet how many times I would fly to Sydney to
play my small part in the remains of her care, or how often,
when I buzzed at Iris’s apartment, the door would be opened by
Harriet from Yass, her round, weather-beaten face sweating and
wild with fatigue, or by Marion the Buddhist, white, composed,
and stoic after a five-day stint without relief. I had not
prepared myself to sleep on the floor beside Clare from Byron,
when Iris, half out of her mind, pulled on a backpack and
fled north, on foot, along the coast of New South Wales.

I coule not imagine the urge to start drinking that would
seize me every time I entered the high, airy rooms of the
apartment and found Nicola enthroned on the sofa where, propped
against its hard padded arm, she woke and slept and laughed and
coughed, commanding the stewing of Chinese herbs, planning brown
rice fasts and drastic alkaline diets, turning her face up each
morning to the sun that streamed in through the uncovered
windows. Nor could I foresee that one day, with her swollen
legs resting on a stack of cushions, she would announce
brightly, “I’ve suddenly realized why I feel so terrible — I
must be anemic.” Or how dull my life at home would seem between
my visits to Sydney, how I would write to her on a postcard: “I
miss you. I’m bored. I’d rather be scrubbing shit off Iris’s
bathroom tiles.” For this too would be required of me: like
otherw who served her, whom I came to love in the intimacy of
our labor. I would have to help carry her to the lavatory,
where I learned to wash her arse as gently as I had washed my
sister’s and my mother’s, and as someday someone will have to
wash mine.

I might have guessed that she would resist the hospice until
the contents of her lungs began to bubble up into her nose and
throat, until everyone around her was deranged with exhaustion,
fury, nad despair. She relented only when Marion said to her,
“Don’t regret the things you haven’t done. That’s the past.
Let it go. Rejoice: you’re our teacher now.”

None of Bonnie’s illness worked out much like that — Bonnie
went into the hospital as soon as it was clear that she couldn’t
take care of herself, and by the time she might have been
denying what was happening, she’d had the stroke that left her
unable to talk. But I do recognize both the urge to drink and
the love and closeness with the other people caring for
Nicola.

This is a short book. At the beginning I wondered if the
one-column review
in the New York Times had told me everything I was
interested in knowing about this book. But it really does get
even more interesting at the end.

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Crutches

I got a phone call at 8 AM Friday morning.

I was nervous when I realized who it was — it was the partner
of one of the people I was playing the concert with yesterday.
The last time I got a call from someone like that the day before
the concert, it was the wife of one of the performers saying he
had slipped on the ice and was flat on his back in bed and
couldn’t possibly get to and play a concert the next day.

So I was relieved when it turned out that this call was because
my friend wanted to borrow my crutches.

The story was actually somewhat alarming. She’s a fairly fit
person who climbs mountains and does folk dancing and ride a
bicycle for long distances. Two weeks before she’d been to a
folk dance weekend and danced 15 hours between Friday night and
Sunday afternoon and felt fine during and after.

For a couple of days before, her knee had been bothering her a
little, but then all of a sudden she went to leave work, and
pushed back the chair, and she couldn’t stand on her right
leg.

She was glad I didn’t mind loaning her the crutches. Until she
got them, she wasn’t able to move anywhere without assistance. So
she had to wake up her partner to go to the bathroom at night. I
said that was like having a dog, but she said the dog probably
didn’t whimper both to and from the bathroom. Actually it’s
probably easier with the human, because for the dog, you have to
put shoes and a coat on to take them out.

Anyway, I reminded her when she was being grateful that she
wouldn’t have thought to call me if she hadn’t been so helpful
during the six weeks I was on them — she regularly called to
see if I wanted to come to the supermarket with her, and went to
the pharmacy for me, and took me to visit Bonnie.

I was also glad I’d tested getting them out of the closet while I
was fit. They had enough ice skates and vacuum cleaners and
camping equipment in front of them that I wouldn’t have wanted to try
to do it standing on one foot. I’ll be more careful when I put
them back in the closet.

We don’t know quite what’s going to happen with my friend’s
knee. She’s had an x-ray, and it looks like torn cartilage or
maybe other junk in the joint. She has an appointment to see an
orthopedist next week.

Crutches aren’t so expensive that comfortably off people can’t just go buy
them, but they do take up enough space in a closet, and
reasonably fit people use them seldom enough, that it seems silly
for every household to have a pair. I think it’s something the
socialist model “From each according to his abilities; to each
according to his needs” should apply pretty well. So there
should probably just be a central supply depot that delivers a
pair when you need them, and then you bring them back there when
you don’t any more.

My rationale for keeping mine after the hip surgery instead of
donating them to one of the places that gives them free to poor
people, was that when you sprain your ankle, which I had been
doing every 3 or 4 years, people tell you it heals faster if you
use crutches and keep the weight off of it. I’d never tried that,
because of not having the crutches, but I was going to test it
out the next time my ankle gave out on me. It hasn’t given out
since the hip surgery. I hope that’s because the physical
therapy I got then, which focused more on balance than on
strengthening hip muscles, fixed the problem with my ankle, but
maybe it’s just having crutches in the closet makes it less
likely that you sprain your ankle. The same way carrying an
umbrella makes it less likely to rain hard.

A good story about the health care system

The health care system gets a lot of bad publicity these days,
including some on this blog. Most of it is deservered, but I
have a short story to tell about the system actually working the
way it’s supposed to.

[rash on foot]

Over the weekend while I was in Fall River, I started waking up
at night with an itch on my right buttock. As far as I could
feel, there was a fairly large area with itchy bumps.

On Monday morning, there was an area of rash on my foot, (Picture above. All these places where I have this rash are difficult to photograph.)
including one on the sole that was uncomfortable to walk on.
Monday evening, I noticed a similar patch on my right calf.

I woke up in the middle of the night that night sure I had Shingles.

So yesterday morning, I called the clinic where I get my health
care and asked to talk to a nurse. She said she thought I
should be seen and made an appointment for yesterday
afternoon.

The doctor listened to the story and looked at the rash.
He said he had no idea what it was, but he didn’t believe it was
shingles. He says shingles usually happens all the way down the
nerve path, so that there would be some rash in between the
buttock and the calf. And he also says that people have usually
felt some pain in the area before the rash appears. So he said
if it gets worse, I should come back, and he gave me some
cortisone cream to put on it for the itching.

So although I didn’t get much treatment (I’d already been using
cortisone cream), I feel much better. I slept much better last night. I’ve heard lots of
stories of people suffering for months with shingles. Of
course, there are also apparently stories of people itching for
a few weeks and then being fine, but those aren’t the ones
anyone tells you. So I’ll probably itch for a couple of weeks
and be fine. If I’m not, I’ll go back and see the doctor.

Christmas Shopping Status

It’s a busy day (the afternoon at the Pub
Carol Sing
and the morning turning an old
client site
into a the
new wordpress-based site
).

So I’ll just tell you how the Christmas shopping is going.

I don’t do all of it online, but I have a firm rule
that I never go into any store that I don’t like. Which is most
stores during the Christmas shopping rush. After all, what would
I be doing buying presents for someone who doesn’t share enough
of my tastes to want something from one of the places I
like going to?

I don’t have that much to do, since I only buy things for my
mother and my sister. Occasionally the dogs, and occasionally a
stocking stuffer for someone else, but nothing very strenuous.

My sister’s birthday is December 15, so that means waiting
until the Christmas deadlines is out for her. And she’s a
musician who makes about 60% of her income in the month of
December, so I try to get her something for her birthday that
she can enjoy without spending time on it.

She doesn’t read this blog regularly, but there’s no
guaranteeing that she won’t peek at it sometime, so I can’t give
you details at this point. But I got her an article of clothing
similar to something I’ve really enjoyed wearing, and a book I’ve really enjoyed reading. Then she
asked for an LED
piano lamp
, so I ordered her that. I’ll be going down
there next weekend, so if the lamp arrives in time, that will be
the birthday present, and the surprise items will be the Christmas
presents. Otherwise the article of clothing will be the birthday
present and the book and the lamp will be for Christmas.

My mother pretends to not be able to turn her computer on, so
there’s no chance of her reading this blog item by accident, so
I can tell you in a little more detail about her presents. Her
asthma is even worse than mine, so I’m passing on the Asthma
book
I talked about a few days ago, and a roll of the surgical
tape
I’ve been using since I read it, and
I got her some Tea
Tree Therapy Eucalyptus Chest Rub
, which I use as a lip
balm.

Incidentally, using the surgical tape to keep my mouth closed
when I sleep is working well — I seem to sleep better and wake
up more refreshed.

I should still get something more major for her, maybe a
houseplant or a heftier, prettier book. And I don’t have any
good ideas for the dogs. But this is farther along than I
usually am at this time of the year.

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Asthma-Free Naturally

I mentioned having been intrigued by this
article
a couple
of weeks ago.
I decided that buying this
book
by Patrick McKeown would make sense if I were really serious about doing
breathing exercises.

Like a lot of these self-help books, the “science” is probably
completely bogus, but the anecdotal evidence that the advice
helps is interesting if it’s advice about a problem you really
need to solve.

I had independently figured out that breathing through the nose
actually helped during an asthma attack. So I believe some of
the rest of the stuff about practicing breathing through the
nose and I have been doing some of the recommendations. I’m not
going as far as figuring out how to laugh with my mouth closed,
but I did order some surgical tape to try taping my mouth shut
while I’m sleeping. Instead of his nose unblocking exercise for
nasal congestion, which sounds uncomfortable, I’m continuing to
do the alternate nostril breathing I learned in Yoga class.

The advice about diet and exercise is fairly standard, and not
particularly well-written. For example, here’s the paragraph
about meat:

Fruit and vegetables are of primary importance. A
little meat is essential for good health, but for some people in
the Western world it has become an obsession.

I don’t know how many vegetarians the author would have known
in Ireland in 2008, but you certainly can’t talk to the population
of Cambridge, Massachusetts that way.

I have completely stopped taking my steroid inhaler, and am
controlling attacks by a combination of breathing exercises and
the albuterol (rescue) inhaler. I’m not saying it’s a complete
solution, and when I get over the undesirable side effects of
taking the maximum dose of steroid inhaler for so long after
that cold in October, I may well go back to using it a bit. But
it’s possible that these exercises will help reduce the need for
it.

So I’m making a qualified recommendation of this book. I don’t
really believe the thesis that asthma is a result of a shortage of
CO2, or that asthmatics take in 4-6 times as much air
as normal breathers. But some of the recommendations probably
help some people, and if you’re having trouble with your asthma,
it’s worth thinking about.

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