Got Offspring's school pictures today, his 3rd grade photos. His kindy, 1st and 2nd grade photos are all uniformly atrocious because a) I never remember its photo day and he was wearing some lousy t-shirt, b) he wouldn't smile or did a dumb smile, 3) it was on a godawful background. All 3 were in play every year. These those? GREAT! His hair is super cute (he is into spiking the top, short around the edges) and I pur a cute shirt on him and the background is relatively benign. But, as I looked at the package envelope, the tag line proudly proclaimed:
The oldest school photographers in the south!
All I can imagine is a very old, old, old man stooped over saying "I says smy-ah boy!" in a wobby croakey voice.
They need a new motto, don' cha think?
Wednesday, November 25, 2009
Well, if heroin addicts can do it ....
Wheeler has been struck down by the dreaded pseudomonas bacteria in his bladder. Its a particularly nasty bug that it exceptionally hard to kill, in fact, most of the time it can only be (marginally) controlled, not actually eradicated. So yesterday, we went in to the urologist dreading it because we knew that the only treatment was with antibiotics given by IV, which meant a stay in the hospital for a few days or a PICC line and home treatment. Problem is, we don't have home health care benefits so it would have meant a hospital stay, which is reallllllllly a pain for oh so many reasons. Not least of its an excellent place to get sicker, not better, particularly when dealing with a UTI in a spinal cord injured person.
However, it turns out that the doc recommended gentamyacin, which can be given by IV or by IM injection, a huge dose given every day for 7 days. So, he got an injection there in the office and we were supposed to come back every day to have another injection every day. The weekend was a problem though, since they are closed, so I asked if I could do it. Sure! Then I realized, well, if I'm gonna do it over the weekend, I might as well do it all and save us the 2 hours a day it would take minimum to get there and back ... and the $60 COPAY for a specialist visit every day. Gulp. More on that in a minuute. So, the girl (I'm a pig, I know, I know, but she was a girl) showed me how to do it, the doc gave us the prescription, called our pharmacist who ordered the meds in so they would be here today. They loaded us up with syringes and needles, and I got the meds today.
I stared down the bottle, the needle, the syringe and went for it. Swabbed top of the vial with alcohol, pushed 2 ml of air into container, just as the pharmacist told me to do to avoid a vacuum when sucking the drug out. Drew up the 2 mL of drug. Failed. I only got about 1.25 mL. And given it vitally impt to get all of this medicine down the muscle hatch, I was a bit distressed. Luckily, I had them write him for an extra day's worth of drug for just this reason, so I got another needle and tried again. Success this time. Swabbed his leg with alcohol, jabbed him, Then I went for the second dose (third vial) because he has to take 4 ml (80 mg of gent) and failed again, same thing, could only pull up about 1.25 mL even though I did it the same way. Hmmm. Not wanting to waste another vial, I gave him the 1.25 mL injection, then put a new needle on the syringe, alcohol swabbed the top off again, then plunged it in and pulled up the remaining gent. Jabbed him again (the one small advantage is that he doesn't feel any of this thank god .... then again, not being able to feel, this whole paralysis thing, is how he got the UTI to start with... hmmm, I guess its a draw). As I'm jabbing him he says "You're not pushing air in there are you?!". So now with visions of air emboli hurtling through his body and choking off his brain in less than 30 seconds, I push the remaining gent in and wait for him to die. Thankfully, he didn't die (yet).
I had no idea it was so intimidating to give an injection. Only 6 more days of this, by which time I'll be an expert. Wheeler said that I've watched enough Intervention on A & E that I oughta know how to do this by now. True that. If heroin addicts can do it, so can I. I bet they worry less though.
And if anyone wants an injection, let me know. Just bring your own drug of choice, the gent is ours.
However, it turns out that the doc recommended gentamyacin, which can be given by IV or by IM injection, a huge dose given every day for 7 days. So, he got an injection there in the office and we were supposed to come back every day to have another injection every day. The weekend was a problem though, since they are closed, so I asked if I could do it. Sure! Then I realized, well, if I'm gonna do it over the weekend, I might as well do it all and save us the 2 hours a day it would take minimum to get there and back ... and the $60 COPAY for a specialist visit every day. Gulp. More on that in a minuute. So, the girl (I'm a pig, I know, I know, but she was a girl) showed me how to do it, the doc gave us the prescription, called our pharmacist who ordered the meds in so they would be here today. They loaded us up with syringes and needles, and I got the meds today.
I stared down the bottle, the needle, the syringe and went for it. Swabbed top of the vial with alcohol, pushed 2 ml of air into container, just as the pharmacist told me to do to avoid a vacuum when sucking the drug out. Drew up the 2 mL of drug. Failed. I only got about 1.25 mL. And given it vitally impt to get all of this medicine down the muscle hatch, I was a bit distressed. Luckily, I had them write him for an extra day's worth of drug for just this reason, so I got another needle and tried again. Success this time. Swabbed his leg with alcohol, jabbed him, Then I went for the second dose (third vial) because he has to take 4 ml (80 mg of gent) and failed again, same thing, could only pull up about 1.25 mL even though I did it the same way. Hmmm. Not wanting to waste another vial, I gave him the 1.25 mL injection, then put a new needle on the syringe, alcohol swabbed the top off again, then plunged it in and pulled up the remaining gent. Jabbed him again (the one small advantage is that he doesn't feel any of this thank god .... then again, not being able to feel, this whole paralysis thing, is how he got the UTI to start with... hmmm, I guess its a draw). As I'm jabbing him he says "You're not pushing air in there are you?!". So now with visions of air emboli hurtling through his body and choking off his brain in less than 30 seconds, I push the remaining gent in and wait for him to die. Thankfully, he didn't die (yet).
I had no idea it was so intimidating to give an injection. Only 6 more days of this, by which time I'll be an expert. Wheeler said that I've watched enough Intervention on A & E that I oughta know how to do this by now. True that. If heroin addicts can do it, so can I. I bet they worry less though.
And if anyone wants an injection, let me know. Just bring your own drug of choice, the gent is ours.
Wednesday, November 18, 2009
One of my biggest fears
I have a huge fear of choking when it comes to Wheeler.
With anyone choking is very scary, but with Wheeler its extremely scary because he has a very poor swallow/gag reflex due to his injury - which makes him more likely to choke in the first place but also almost totally unable to cough anything up. Then, put him in a wheelchair, strapped down in 5 places (2 feet straps, a seatbelt, 2 arms bands, a chest strap and chin control) - it would be really hard to get him out of the chair fast enough and be able to somehow administer the heimlich maneveur since his legs are limp noodles. So I've always had a fear of him choking and I'm hypervigilant about it. Well, it happened on Monday, he choked. After 6.5 years together, its kinda amazing it took this long for it to happen.
He was in bed, I was feeding him ramen noodles (don't blame me, I just make what he asks for, there's no accounting for taste). He took a drink of water and it all got bungled up in his throat somehow. I saw the look in his eyes that said "trouble". I asked if he was choking - in the past when I've asked, its always been a false alarm and he would just say no, albeit sputtering most of the time. But this time, he didn't answer when I asked him, his eyes were just wide open staring hard at me. For a split second I wondered if he really was since he didn't say he was choking, then in the next split second I realized he can't talk because HE IS CHOKING.
I am a good person to be around in an emergency. I focus immediately, I stay calm cool collected and I just move into a zone, I just act and don't feel any emotion at all. And thats what kicked in at that moment. I made a plan and executed it. First I just pulled him forward and thumped him open-handed on the upper back a few times. Nothing. I hit him much harder, with a closed fist, very hard, down in the middle of his back. Nothing. I leaned back around to see how I could best jump behind him, hoist him up to try to do a real Heimlich and I caught his eyes again. There was panic in his eyes, and for a moment, I felt the same panic kicking in. But I fought it, and I decided I would give him one last thump before I tried to somehow get behind him. The thought crossed my mind of calling 911 but one can only be oxygen deprived for 4 minutes before brain damage begins, so I would have wasted precious seconds calling and there is no way anyone could have gotten here in less than 4 minutes, especially since we were already 1 minute in by this time.
I leaned him over again, as much as possible at the waist to keep the airway straight, I wound up my left arm, balled up my fist and I hit him with all my might, a punch worth of Muhammed Ali, pushing as much presure from bottom to top as I hit as I could. In response, I heard the most beautiful sound I've ever heard - a gasp of air in. He coughed weakly and swallowed over and over again, while still struggling to breathe. I wasn't entirely sure he could fully breathe so I asked if I needed to hit him again and he shook his head no (of course, he may have decided death was preferrable to another punch like that). After a few minutes he was breathing normally again. And that's when I panic - after the fact. I just starting to tremble and shake head to foot because I realized that he could have so easily have died right then and there. It was very frightening and just underscores what a bitch spinal cord injury is all around. Its not that you just can't feel or move, there is SO much more. At Wheeler's level, you can't pee or poop anymore - you need a tube to pee and you just don't even want to know about the back door. Your lung function is compromised, your immune system is compromised, you are subject to bone breaks because you can't feel your limbs if they get pinched or stretched in the wrong direction, prone to pressure sores because you sit in one place for so long, you get urinary tract infections (see previous about tubes to pee, they carry bugs quite effectively), you get fungal infections, which are opportunistic since there is little airflow due to lack of movement, and then there's the higher risk of everything from depression to heart disease. SCI sucks. Alot. And so much more than it seems on the surface, and it sure seems shitty even on the surface.
Moral of the story? Don't break your neck. And learn the Heimlech maneuver.
With anyone choking is very scary, but with Wheeler its extremely scary because he has a very poor swallow/gag reflex due to his injury - which makes him more likely to choke in the first place but also almost totally unable to cough anything up. Then, put him in a wheelchair, strapped down in 5 places (2 feet straps, a seatbelt, 2 arms bands, a chest strap and chin control) - it would be really hard to get him out of the chair fast enough and be able to somehow administer the heimlich maneveur since his legs are limp noodles. So I've always had a fear of him choking and I'm hypervigilant about it. Well, it happened on Monday, he choked. After 6.5 years together, its kinda amazing it took this long for it to happen.
He was in bed, I was feeding him ramen noodles (don't blame me, I just make what he asks for, there's no accounting for taste). He took a drink of water and it all got bungled up in his throat somehow. I saw the look in his eyes that said "trouble". I asked if he was choking - in the past when I've asked, its always been a false alarm and he would just say no, albeit sputtering most of the time. But this time, he didn't answer when I asked him, his eyes were just wide open staring hard at me. For a split second I wondered if he really was since he didn't say he was choking, then in the next split second I realized he can't talk because HE IS CHOKING.
I am a good person to be around in an emergency. I focus immediately, I stay calm cool collected and I just move into a zone, I just act and don't feel any emotion at all. And thats what kicked in at that moment. I made a plan and executed it. First I just pulled him forward and thumped him open-handed on the upper back a few times. Nothing. I hit him much harder, with a closed fist, very hard, down in the middle of his back. Nothing. I leaned back around to see how I could best jump behind him, hoist him up to try to do a real Heimlich and I caught his eyes again. There was panic in his eyes, and for a moment, I felt the same panic kicking in. But I fought it, and I decided I would give him one last thump before I tried to somehow get behind him. The thought crossed my mind of calling 911 but one can only be oxygen deprived for 4 minutes before brain damage begins, so I would have wasted precious seconds calling and there is no way anyone could have gotten here in less than 4 minutes, especially since we were already 1 minute in by this time.
I leaned him over again, as much as possible at the waist to keep the airway straight, I wound up my left arm, balled up my fist and I hit him with all my might, a punch worth of Muhammed Ali, pushing as much presure from bottom to top as I hit as I could. In response, I heard the most beautiful sound I've ever heard - a gasp of air in. He coughed weakly and swallowed over and over again, while still struggling to breathe. I wasn't entirely sure he could fully breathe so I asked if I needed to hit him again and he shook his head no (of course, he may have decided death was preferrable to another punch like that). After a few minutes he was breathing normally again. And that's when I panic - after the fact. I just starting to tremble and shake head to foot because I realized that he could have so easily have died right then and there. It was very frightening and just underscores what a bitch spinal cord injury is all around. Its not that you just can't feel or move, there is SO much more. At Wheeler's level, you can't pee or poop anymore - you need a tube to pee and you just don't even want to know about the back door. Your lung function is compromised, your immune system is compromised, you are subject to bone breaks because you can't feel your limbs if they get pinched or stretched in the wrong direction, prone to pressure sores because you sit in one place for so long, you get urinary tract infections (see previous about tubes to pee, they carry bugs quite effectively), you get fungal infections, which are opportunistic since there is little airflow due to lack of movement, and then there's the higher risk of everything from depression to heart disease. SCI sucks. Alot. And so much more than it seems on the surface, and it sure seems shitty even on the surface.
Moral of the story? Don't break your neck. And learn the Heimlech maneuver.
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