Picotte Has Flown

Dr. Picotte had been scheduled to do my next TACE procedure at Munson on Feb. 12.  We are flying home to T.C. on Feb. 10 for this procedure.

 It seems that Dr. Picotte has left Munson for greener pastures, and now there is no one in Northern Michigan who does this TACE procedure.  Now it will be done in Ann Arbor.

 We've decided that we'll still fly in as planned, and drive to Ann Arbor and stay in a motel for a couple of days before heading back to T.C.  Our return flight to Florida is scheduled for Feb. 20.

Best laid plans, etc., etc.

Paracentesis

This procedure is creepy, unbelievable, pain free and relieving all at the same time.  We knew that fluid was being retained in my abdomen and needed to be removed, but we had no idea what to expect. It's embarrassing for me to write down how much fluid was removed.  I'll just say that afterwards I was eleven pounds lighter.  Totally creepy and unbelievable - or am I repeating myself?

Martin Memorial Medical Center North in Stuart is undergoing some construction, so everybody has to enter through the main entrance, which is very far from where we needed to go.  Unlike Munson, they have a guard station at the entrance where your drivers license is scanned and turned into a name tag with your picture on it.  We got lost, but ran into a helpful employee who gave us good directions and a wheelchair for lucky Dick to push.  The check-in operation at outpatient registration is actually more efficient than Munson's - I was pleased.

After checking in, there was a visit to the lab for a blood draw, and then a wait, wait, wait for the procedure.

It's a great procedure - no need to disrobe, just lie down, expose your belly and lie still.  Chrissie and Tara were the ultrasound operators, and Gina was the student.  They were all very personable and fun - made things a lot less anxious for me.  After Chrissie marked me with an X for the best spot for the tube, Dr. Hillmann came in and did the needle insertion, which was painless.  He was in the room for about two and a half minutes! The chargw for the Doctor was $309.08!!  That 8 cents must be really important. Then Dick was allowed to come in, and we just sat and chatted with everyone while I drained.  (Creepy and weird - the draining, not the chatting.)

Came directly home afterwards to rest and recuperate.  You do get some odd feelings in the midsection.

Abdominal Paracentesis

John L. Zeller, MD, PhD, Writer; Alison E. Burke, MA, Illustrator; Richard M. Glass, MD, Editor

Ascites is an abnormal increase in fluid within the peritoneal (abdominal) cavity. The normal abdominal cavity has a small amount of fluid (usually less than 150 mL). Cirrhosis (chronic liver disease) with associated portal hypertension (blood pressure within the liver above the normal range of 5 to 8 mm Hg) is the most common cause of ascites. Other causes of ascites include cancer, heart failure, kidney failure, tuberculosis, and pancreatic disease. An abdominal paracentesis involves the surgical puncture of the abdominal cavity with a needle and placement of a catheter line for the removal of excess fluid. The procedure can be diagnostic in helping identify the cause of ascites or may be used as a therapeutic measure if a large volume of fluid can be removed to lessen discomfort and improve breathing. The March 12, 2008, issue of JAMA includes an article about paracentesis techniques. It identifies ways to decrease the risk of complications and to improve diagnostic accuracy.

PATIENTS WHO SHOULD UNDERGO DIAGNOSTIC PARACENTESIS

• Patients with new-onset ascites
• Patients with chronic ascites and at least one of the following symptoms:

• Fever
• Abdominal pain
• Increasing ascites volume—increasing abdominal girth
• Unexplained encephalopathy (confusion or disorientation)
• Declining liver function
• Kidney failure

RISKS AND COMPLICATIONS OF ABDOMINAL PARACENTESIS

With current techniques, diagnostic paracentesis is considered a safe procedure. Some coagulopathies (bleeding disorders) may make the procedure too risky to perform. Pregnancy, organomegaly (abnormally enlarged organs), severe bowel or bladder distention, and previous abdominal-pelvic surgery may increase the risk of the procedure. In those situations, an ultrasound-guided paracentesis should be considered. Procedural complications are rare but can include

• Persistent leakage of ascitic fluid
• Circulatory problems, such as lowered blood pressure
• Localized infection at the puncture site
• Abdominal wall blood clots or bruises
• Bleeding
• Injury to organs in the abdomen

ANALYSIS OF ASCITIC FLUID

Tests of the removed fluid help to establish the cause of the ascites and to rule out infection. These tests include counts of the numbers and types of cells in the fluid. Testing for albumin (a simple protein) should be done in cases of new ascites. Additional tests may be done depending on the patient's history and physical examination.

Second Appointment

Very convenient, but still not where you really want to be qualified to park, thank you very much!

Nice building with some nice people inside, and some who don't really enjoy their job!



My appointment was originally for 10 a.m.  It was changed to 8:30 a.m. at the last minute,  It was another Stuart Oncology last minute time change.  We arrived around 8:15 ish, and were not out of there until 10:45.  Oh well, we're retired.......
Appointment began with a CBC and blood pressure in the lab and then we went in to see the PA, Kathy.  We waited  half hour to speak to her.  She didn't know about the ultrasound, and didn't know that the paracentesis is scheduled for Friday.  It seems the Martin Memorial (epic) hard drive crashed last week, and it's hard to get it back up and running properly.  Blood test showed low ferritin, so I had a ferritin injection, a half hour wait to check blood pressure and then we were done.

I'm really not comfortable about Friday.  I have no order to take with me, and no instructions for prep.  I heard once that there's no food or drink for 12 hours prior, but I have no written instructions.

Mulligans afterwards for muffin and fruit - very yummy!  And Laurie has invited us over for dinner.  Hooray!

Okeechobee Day

Lake Okeechobee Fishing Pier

Everybody gets their picture taken at the Pier.

Okeechobee Sandhill Cranes

We met up with Chip at the Pier

Found it 01/26/2014    You found Traditional Cache To twist or not to twist?         Visit Log
We came, we saw, and we scored the find. It was a great day to enjoy the views and find a few caches. Thanks for adding to the fun. Now on to Lunkers for a late lunch/early dinner.

Found it 01/26/2014    You found Traditional Cache "Wait, is that the Cache?"         Visit Log
Boy this sure deserves a favorite from us! A great cache for an urban environment. Mrs Sharkie spotted it. We signed the log and replaced as found. We may copy it this summer up north. Thanks for adding to the fun we had today.

Found it 01/26/2014    You found Traditional Cache Country Roads         Visit Log
Came over with the Sharkie Crew today to soak in the sights around the lake and find a few caches. This was on our list because we had a DNF to erase. Found it this time but the log book is moldy or something. Covered with dirt. We found a clean page and signed the log and replaced as found. TFTC

Didn't find it 01/26/2014    You couldn't find Traditional Cache Trading Post Express         Visit Log
Not today, we still aren't good enough to make the find.

01/26/2014	You found Okeechobee Rocks! 2.0		Visit Log
We had not been out to see the lake yet this year so we teamed with the Sharkie Crew to come out and enjoy the day, grab an early dinner and snag a few caches. Made a quick grab of this. Thanks for adding to our fun today.

Good Night

A Good Night

	Caris LeVert

Jan. 25, 2014

• Box Score |  Notes |  Photo Gallery 1  |  Photo Gallery 2  | Highlights 

Site: East Lansing, Mich. (Breslin Center)

Score: #21 Michigan 80, #3 Michigan State 75

Records: U-M (15-4, 7-0 Big Ten), Michigan State (18-2, 7-1 Big Ten)
Next U-M Event: Thursday, Jan. 30 -- vs. Purdue (Crisler Center), 9 p.m. ET [ TV: ESPN ]

EAST LANSING, Mich. -- The University of Michigan men's basketball team (No. 21 AP, No. 25 ESPN/USA Today) used an 11-point second-half advantage to upset Michigan State (No. 3 AP, No. 3 ESPN/USA Today), 80-75, on Saturday night (Jan. 25) inside Breslin Center. Michigan has now won nine straight games, with the past three coming against top-10 ranked opponents

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01/25/2014	You found R U A Leapling? (Florida)		Visit Log
Stopped on the way back home from a trip to Harbor Freight. Found quickly, signed log, left nothing, took away some trash. TFTC
01/25/2014	You couldn't find We All Need A Little Grace		Visit Log
We weren't good enough today. A car entering stopped, backed up and asked us what we were doing. We explained Geocaching to him. He drove on in and entered the church.
01/25/2014	You found CROSS Roads		Visit Log
We were on our way home after picking up some tools at Harbor Freight and decided to grab a couple of caches. We got the walker out and while Mrs Bend stretched her legs, I came down and made the find. The log is absolutely soaked. It needs to be replaced. I would have done it but I did not put my cache bag in the car when we left home. Perhaps the next cacher can do it. Signed as best I could and replaced as found.

Ultra

7:15 a.m. at the Martin Memorial Diagnostic Center - so many people get up way too early!  We're here for an ultrasound to evaluate my ascites to see if I need or qualify for paracentesis to relieve discomfort.  The ultrasound tech was a really interesting person with lots of tales to tell.  She talked nonstop and it was very entertaining!  Ultrasounds are "easy peasy" because you don't have to disrobe - you just lie there, listen, and get warm gel all over your clothes!

Afterwards we had breakfast at Mulligans - muffin and fruit - very yummy.  Then grocery shopping - oh joy.  Although I must say that we do really like Publix - a great store with nice prices and extensive selections.

Laurie had her substitute teacher class today at the administration building.  It was an all day event, with lots of hand-outs - stacks of paper!  She enjoyed it more than she had thought that she would.

Dylan missed school today because of a sore throat.  We monitored him by text 3 or 4 times - he seemed to not need anything.  Laurie came home from her class for lunch to check on him.

01/24/2014	You found Martin and Mapp		Visit Log
Nice hide, great cords. Found on our way to Jiffy Lube. TFTC

Burgers on the Barbie

Laurie came over for a visit this afternoon - always a treat for us!
 After picking Dylan up from tennis at South Fork, they came over for burgers.  She brought a big, beautiful salad - very yummy!

Medical Attention in Florida

Here is Dick's report on our problems with the medical establishment in Florida.  Spoiler alert - it does have a happy ending!                                                                                                                              *****

Getting medical attention in South Florida is an adventure.  I don't know if you remember our panic last year which caused us an early departure.  Nancy was getting blood work done on a weekly basis with the results to be sent to her primary up in TC. It turns out that instead of sending them to her Dr.'s office, they were calling and leaving a message on our home phone,which we learned when we checked the messages when we got back. We learned that her Dr. didn't receive them so we decided to pick them up on paper and take them ourselves when we left.  She called the lab here each week to get the results herself.  On the last call she made to them, the woman on the other end of the line reported that her platelet count was 17!  That means no clotting!  A small cut or bad bruise could kill you!

I quickly packed the car, we drove over to get the results, and planned to make a short stop at Laurie's for farewell hugs and kisses.  On the way to say our goodbyes, Nan read the paperwork and discovered that the woman had read the wrong column. The count was low but not life threatening. Since we were all packed we just took those guys out to lunch and then took a leisurely trip home.

That brings us to this year. On 12/12 she had a TACE procedure  in Traverse City for her liver cancer.  We decided that she should have an Oncologist down here in case of an emergency.  She did extensive research looking for someone who had graduated from an American med school rather than some Caribbean outfit etc.  There is nothing serious, just some minor after effects from the procedure that are uncomfortable.  After Christmas she called the Dr.'s office and got an appointment.   The earliest they could take her was Jan. 22 at 8:30 a.m.  T hey asked for her records, she contacted TC and asked that they fax them to the Oncologist office in Stuart.

Now the fun begins, on the 21st, late in the afternoon, a phone call from the office reminding her of the appointment.  She was told to arrive at 8:15 to fill out some forms.  After another half hour or so, another call asking her if she had her records. She explained that they had been faxed - "Well we didn't get them". A discussion followed with Nancy asking a number of questions. Then the phone went silent on there end. "Hello? Hello? Is anyone there?" She was about to hang up when a different voice came on the line and asked "How can I help you" like Nancy had called them. A long discussion followed with the conclusion that "Since we did not have the necessary records", the 8:30 appointment was canceled and Nan should call at 9:00 to determine if the necessary records had arrived.  Just when the appointment to see the Dr. was going to be was unclear.

So now, instead of leaving the house at 7:45, we now had no idea of when we might be going into Stuart to see an Oncologist. As is normal for a grumpy old man, I mumbled and grumbled about why they had waited until her TC Dr.'s office was closed before telling us about this problem and wondering what had happened to the first caller. We went back to our computers and a short time later, the phone rings again. This time it's the PA who tells Nancy to bring any paper work she might have when she comes to her morning appointment and they will work it out from there.  Nan asks "In other words, I should disregard everything in my previous conversation with your office."  "That is correct, see you in the morning".

We got there a little early but the place was open. Nancy checked at the desk and was given some forms to fill out. As she went into the waiting area, I overheard one of the desk people tell the other, "We don't have her records, She's from up north. We tried to call them but because of the blizzard, the phones are out".  What nonsense!  In the first place, the blizzard is in Massachusetts not Michigan and second, the T.C. Dr.'s office isn't open yet. I stepped out into the hall and called their number. The machine picked up and gave me the time they would open as 8:45, it was then 8:10. When Nancy was called at 8:30,  I went to the desk, asked for and received their fax number.  I went back into the hall and at 8:45 called TC.  I explained the problem and the gal told me they had sent the file, 36 pages, to that number on December 31st.  I asked her if they would send them again and she agreed to do it immediately. I went back inside and sat where I could see the gals at the desk. They sat there talking on the phone, to arriving patients and to each other. After about 20 minutes or so, I went to the desk and asked if Nancy's records had arrived on the fax machine. She responded, "I don't know, I haven't looked". The machine was about 10 feet behind her. A passing tech stopped at the machine reached down and held up a stack of papers and said "Here's something that says Steiger".

Mission accomplished! What happened to the first set we'll never know. They were probably recycled because the secretary who pulled them didn't recognize the name back at the end of the year. The upside is that the Dr. and the PA are dealing with Nancy and her situation well and not just blowing her off.  I know that we are both glad that the next TACE will be in Traverse next month but we are also relieved that if a problem develops after we get back down here, it should be handled promptly.

Martin Luther King Day Plus the End of Palooza

The last event of Cacheapalooza is the MondayPalooza Meet and Greet.  It consisted of just showing up in the parking lot and signing the log - followed by more caching!

MondayPalooza in the parking lot of the Kimbell Center

MondayPalooza runs on Dunkin!

After paloozaing, we went for more caches.  We did nine caches plus the event, with one DNF.  For us, that's a good day :)

Your Geocaching Details

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01/20/2014	You found CP8 Poker Run 4 (Flush)		Visit Log
We enjoyed the M&G and then had a nice stroll along the paved trail. On the way out of the park to lunch, we stopped for a few that were dry and close to the road. We did not participate in the poker run but we enjoyed finding a few of the caches. Took 0, left our card, signed the log and replaced as found. TFTC
01/20/2014	You found On the road to CP 8 – Juliet		Visit Log
We enjoyed the M&G and then had a nice stroll along the paved trail. On the way out of the park to lunch, we stopped for a few that were dry and close to the road. Mrs Bend did not remember seeing a preform so I took a picture to show her. Needed tweezers to retrieve the log, signed and replaced as found. TFTC
01/20/2014	You found CP8 Poker Run 3 (Straight)		Visit Log
Found while on our way out of the park after the M&G. TFTC
01/20/2014	You found CP8 Poker Run 1 (2 Pair)		Visit Log
We had a nice stroll along the paved trail and then switched to caching from the car. Pulled up and made the find with the Virginia BoxCar team. Signed log and left our card. TFTC
01/20/2014	You couldn't find CP8 Poker Run 2 (3 of a Kind)		Visit Log
After a nice stroll along the path, we switched to caching from the car. Tried to get to this one but it was just too wet in there, kinda like it was under "Water" in the Yellow Pages.
01/20/2014	You found Jonathan Dickinson's Wild Kingdom VI		Visit Log
After finding IV, Mrs Bend had had enough of the trail for today so we packed up the walker and cached from the road for a while. We found this one but missed V. We'll be back another day. TNLCSL TFTC
01/20/2014	You found Jonathan Dickinson's Wild Kingdom IV		Visit Log
We are definitely Old School cachers, we remember when just about the only containers were nut jars and ammo cans. Our nemesis is the dreaded "Micro in the Woods". That is another factor which made this series so enjoyable to us. Signed log, left our card, and replaced as found.
01/20/2014	You found Jonathan Dickinson's Wild Kingdom III		Visit Log
Continuing on our caching stroll after the M&G we enjoyed this one because of the Ranger Rick container. After finding the RR series down here last year, we placed a series in a nature preserve near Traverse City. It has been a big hit with the kids and has attracted a number of scouting groups working on their merit badges. We took nothing, just signed the log book, left our card, and replaced as found. TFTC
01/20/2014	You found Jonathan Dickinson's Wild Kingdom II		Visit Log
After enjoying the Meet & Greet, we parked up the road, unpacked the walker and went for caching stroll on this beautiful sunny day. The caches along this trail have become our favorites because they are easily accessible, even for those of us with a hitch in our giddyup. We also loved this series because the cords were so accurate, (I sat down the iPad when it read 3 feet, the cache was about 34 inches away.) Took nothing, signed log, left our card and replaced as found. Thanks KrumBens and all the Catchepalozza Crew members for the time, effort, and expense they expended to bring fun into our lives.
01/20/2014	You attended CP-8 MondayPalooza Meet & Greet		Visit Log
Fun time. Thanks for putting it on. We were a little late but still had a chance to meet a few cachers.

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Lunch at Reuben's Diner, and then home for a bit of a rest!  Lovely day.

1.

Reubens Breakfast & Lunch

3120 SW Martin Downs Blvd, Palm City, FL 34990 (772) 288-3126