Ow!

I was filling out a health questionnaire that is required of everyone who works with animals on campus, and it asked for the date of my last tetanus booster. Um....1998? Maybe?

I realized that wasn't good enough--I really need to be current on that because, well, chickens. You're supposed to get the booster every 10 years anyway.

So I popped over to the Student Health Center after class yesterday. I absolutely LOVE socialized medicine, which is what college students have access to. You pay a fee each term and have full access to all of their services. Lots of their services (such as counseling) are available to all students even if they didn't pay the health center fee. You might have to pay for some medicines but most are subsidized to very low costs. Sure, it's not open at night or on weekends. Sure, it's on campus and I don't live on campus. But I am on campus every day for class. Yesterday, I walked in, said that I needed a tetanus booster, was in with the nurse in just a couple of minutes, talked with her for a few minutes, got the shot, and was out the door. Total time: 15 minutes. No money changed hands. No insurance cards had to be provided. I paid up front for access at the start of the term, that is, I paid upfront for health care, and that is exactly what I got. (Health insurance is most decidedly not the same thing as health care.)

Sadly, I seem to be having a bit of a reaction to the vaccine. I don't remember being such a delicate flower when I've had the shot in the past but maybe they changed the vaccine. I'm older, too, and that could play a role. Anyway, after the shot, I met with my advisor for an hour, worked for an hour, went home, had lunch...and pretty much blacked out. I recall stumbling to the bedroom as tunnel vision closed down on me. I apparently managed to get Harry onto the bed. I woke up almost three hours later! Wow, that little shot knocked me for a loop.

And today, I can't lift my elbow above my shoulder. It's not bruised or swollen--can't even see the prick site. But my whole upper arm hurts like crazy when I move it or touch it (tetanus, anyone?). Reactions to vaccines are rare but that doesn't mean they never occur. It certainly isn't life-threatening and I suspect it will go away with time. But I guess if it isn't better by morning, I'll head back over there and have a nurse take a look. But I can do that! I've got access to on-demand health care!

Happy Pills

About a month ago I started taking a vitamin D supplement, specifically cholecalciferol which is the form of the vitamin your body would make if you applied sunlight to the raw materials. In other words, taking this particular form of vitamin D provides me with the product of the sunlight step without having access to sunlight. It's a little more complicated than that but since this is not a true science blog, I won't get into it in any more detail than that.

I have been aware for some time of the general medical consensus that many adults are deficient in vitamin D (although there are plenty of experts who say that even if this is true, vitamin D supplementation is unnecessary). My diet contains foods such as salmon and eggs (I eat a lot of eggs) that contain vitamin D, but it is hard to get enough solely through diet.

Vitamin D is a hormone with a critical role in a number of metabolic pathways. It is involved in some immune system activities, for example. It also modulates calcium pathways associated with bone health. It has been used to treat mood disorders (that may also be related to calcium regulation since calcium is important in nerve signaling). This is just the tip of the iceberg for vitamin D.

I just learned today that people who take vitamin D supplements often report increased energy levels. I didn't experience an energy boost, but within two days of starting the supplement, I noticed that my sleep cycles were more stable. I have suffered with severe insomnia for decades. Like many insomniacs, I obsess over this problem, which of course makes it worse. But it also means that I am sensitive to very small changes in my sleep patterns.

I have no problem falling asleep but struggle to remain asleep after the first couple of hours. It doesn't help that I am a very light sleeper. After I started the supplement, I noticed that I was sleeping more soundly for longer periods, and that when (not if) I did wake up, I was able to go back to sleep relatively quickly (I still sometimes lie awake for a couple of hours but those events are becoming less common). I also noticed that I don't feel drowsy during the day. That suggests two things, not exclusive: that the sleep that I am getting is more effective, and that I may in fact be getting a slight energy boost from it.

Please take note that I report my experience only as an anecdote. An anecdote does not prove anything. JimBob's Big Website o' Factoids is stuffed full of far more entertaining stories than mine. That still doesn't make them true.

Therefore I encourage you to learn more by googling sets of terms such as "vitamin D metabolic pathways" and "vitamin D supplementation". There you can find reasonably accessible, peer-reviewed, properly conducted scientific studies on the effects and value of taking additional vitamin D.

But while I have your attention, I'll still make a plug. Since vitamin D is one of the molecules that your body sheds if you consume or manufacture it in excess, it won't hurt you to give it a try. It isn't an expensive supplement. Your bones, brain, and immune system will very likely thank you.

The Price of Vanity

Not surprisingly, it turns out that the price of vanity is a pretty steep price indeed. I’ve had a minor medical saga that’s been going on for the past three months. It is at last coming to a close but there is no question that it has contributed greatly to my prolonged funk.

I decided to have some visible spider veins in my legs treated. Two patches on my left shin would turn very dark like bruises when my heart rate increased such as when I was really hot or when I was exercising. I found them unpleasant to look at. And because I wear shorts and skirts most of the year here, I was looking at them often. After some tests to make sure my veins and arteries and valves were functioning as they should, I arranged to have several areas of spider vein in my legs injected with a chemical that burns the tiny capillaries out.

The doctor clearly and on two occasions reviewed the risks with me: blood clots, ulcers at the injection sites, shifting of the spider veins to a nearby location, etc.I went ahead with the procedure fully informed of these risk. I want to be clear on this because what happened is not the doctor's fault.

The two patches on my left shin were large and required injection of a considerable volume of the caustic chemical. I had half a dozen other smaller areas treated at the same time. All is well with the small treatment areas. But within 3-4 days of the treatment, I developed two large ulcers, each about 2.5 cm in diameter, on my left shin. The chemical burned out the veins and the surrounding tissue as well.

I’ve been living with these open wounds on my leg for more than three months. They have to be treated with a type of antibiotic ointment that is used on burn victims (they were the result of chemical burns, after all) and covered at all times, mainly because it was very painful when fabric brushed against them. The doctor debrided both of them three times, an excruciatingly painful procedure in which he cut and scraped the dead tissue out. It felt like he was grabbing nerve fibers with tweezers and yanking them out of my leg. The ulcers were always extremely painful to the touch…I had to be careful that the dogs didn’t bump my leg.

There is no CVS here where I can get bandages or gauze or things like that. I managed to cadge some dressings from the doctor at each visit, but when those ran out I had to cobble together coverings for the ulcers out of eye patches, the only bandage I could find here that was large enough to cover them.

Finally, one of the ulcers got small enough to excise. Two weeks ago the doctor removed a lump of flesh from my leg about the size of a meatball and stitched me up with several yards of what felt like 30-lb test line. Now I had an entirely new type of wound to clean and care for. The incision was about 6 cm long. Not surprisingly, for the first week, it was very painful. But, amazingly, quickly, it began to heal. After two weeks, the doctor removed the external stitches (there are some dissolving ones inside) and seemed quite pleased with the result.

Even the quiet little Jordanian nurse seemed pleased, telling me “mafi mark, mafi mark,” an amusing conflation of Arabic and English (mafi means no or none). I agree: the thin scar that will eventually be left will certainly be better than the hideous round scar that would form if the ulcers were not removed—and who knows how many more months it would take for the ulcer to completely heal, if it ever did?

As an aside, I should mention that the excision procedure itself is rather messy. Only a local is used so I sat up and checked on things every so often out of morbid curiosity. The excision part itself goes quickly. Cauterizing the veins and arteries is a bit complicated; lots of them are exposed because of the depth of the incision. Because an electric current is used to cauterize them, I had to be grounded to the machine. Even with that, if the doctor held the probe to my tissue for too long, electricity would begin to flow through my leg and it would begin to twitch like I was some sort of frog in a dissection tray. He had to give me more local anesthetic injections to shut off the nerve response to keep my leg from moving. There was quite a bit of sizzling and smoking as well. Puts one right off beef, I'll tell you. But the stitching up part was by far the worst. I could feel every single tug and pull of the sutures; my brain was screaming "pain!" even though all I felt was pressure.

I don’t have to cover the first excision site now, and only have to apply some basic antibiotic ointment once a day for a few more days. Whew. Low maintenance wounds are a great improvement over those damned ulcers.

And at last, the second ulcer shrunk down to a manageable, or I should say, excisable size. It was cut out yesterday morning. Another 6-cm incision, another meatball removed, and more 30-lb test line. But by the time I head out for my holiday in mid-May, my medical saga should be behind me.

The price of vanity? I won’t have to worry about those damned spider veins on my shin now. No, I will now have scars to replace them.

Emergency Immersion

Nothing like a little crisis to hone one's language skills.

 While we were in Burgundy, my mother became very ill. As it turns out, she required surgery and ended up spending 6 days in the Centre Hospitalier in Macon, France. The details are not important here. My aim with this post is to thank the army of people who helped me and Judy get through that mess.

First and foremost, I want to thank Kim. She is a doctor and was monitoring my mother's condition and she was the one who said, we need to take her to the emergency room. And Kim stuck by my side for those very long 8 hours as we began our navigation through the French health care system. Kim was professional, focused, and calm. I would have been much more stressed if she hadn't been by my side for those first two days.

To give you some feel for our experience, the staff at the hospital, most of whom had no English at all, referred to my mother as "l'Anglaise," the English woman. The fact that the usually fastidiously polite French chose this name over Madame B. told me that having a foreigner as a patient was a pretty unusual event.

I also have to thank Madame Hala and Madame Rita, the two women from whom I've taken French lessons through Aramco Community Education. I've had over 100 hours of classroom instruction and speak only the barest of French. If they hadn't drilled me over and over in class, I might not have had the confidence to keep trying even though I was perfectly aware that I was barely communicating at all. Forget articles, forget gender, I was just trying to string together the right verb with the right pronoun with something like an object. I quickly realized that as long as my pronunciation was correct, I was being allowed all sorts of egregious grammatical sins. I did learn many new words, including lots of medical terms I never planned to have to know (le vesicule bilaire and the conjugation of the verb vomir [to vomit], for example), but some of them are quite useful, such as l'attestation de paiement (receipt).

We were so lucky to have an emergency room doctor with a bit of English who called in a specialist who has, as it turns out, quite a lot of English. In fact, I met the specialist's English teacher one afternoon! Dr. O. was kind, caring, and professional. His advocacy and support were amazing.

I have to also thank the ladies in the hospital billing department who spent hours with me while I was on the phone to Judy's insurance company, translating faxed documents from English into some sort of French that made sense to them.

Marc and Karen, the owners of Le Nid, threw open their house, their computer, and their internet connection to me, gave me a cell phone when mine was out of money on a Sunday, and even a couple of supportive hugs. They went far above the normal call of hosting guests at Le Nid.

Judy and her husband Dave's neighbors Karen and Greg deserve a mention too. Because Dave didn't have an email account of his own, I got their email addys and flooded their inboxes with flight reservations and other information that Dave needed to get to France.

Dave also gets a nod because I called when Judy was in surgery, waking him up and giving him about 30 hours notice of his departure for France. He managed to pull everything together and arrived in Macon more or less on schedule. Not a feat to be dismissed.

And I want to thank all of my friends who were with me in France. They shadowed me for almost three days before I was able to give them the slip (by getting up and leaving before they were up!). They came to visit Judy in the hospital the afternoon she was out of surgery when tubes were coming out of her in all directions! Now that is a group of good friends! These same friends also handed me glasses of wine in the evenings and even offered to play more Uno (not sure if they actually liked the game by then or if they were just being nice).

I barely remember sitting in the McDonald's in Macon using the free Wifi on my iPad to look for a hotel near the hospital while Duwain and Kim were struggling to get their locked devices to surf on the 'net. I know they were frustrated and jonesing for their email. Still, everyone kept a decently good perspective on the situation.

And Duwain, bless him, said, there has to be a silver lining to this mess: it may result in Judy being able to put a chronic health problem behind her entirely. And that is indeed how things are looking now. Oh, there are a few arguments still to be had with the insurance company. And my mother is still mending, by no means back to full health. But she is at home and doing well.

I am very lucky to have such good friends, both new and old.

Harry's Latest

For the past several years, it seems that there is always a dog crisis right before or during my trips away from home. Iz's long illness was only part of that collection of data points. So the result is that before any trip, I start looking for the next crisis.

Hey, you regular readers should already know that I'm a glass half-empty kind of person so this admission should not be a big surprise. But it should also not be a surprise to you that, with all of the very real dog crises that I have experienced, I don't have to look very hard or spend effort manufacturing a crisis to fit. Something ALWAYS comes up.

And of course I am heading OOK in just a few days. The latest dog crisis concerns Harry.

I noticed over the past 3-4 weeks that he has been drinking and urinating way more than usual. His urine is light colored and clear but there was always just too much of it. My first thought was kidneys but Harry had no other symptoms. He has lots of energy, eats with gusto, poops regularly, skin and coat are in great condition, etc.

Then I was playing with him one afternoon last week and noticed this lump, kind of a flap of skin, growing on his gum above one of his canines.

He has other lumps, warts of various types, that are all benign but that get bigger with time. A couple of them had reached the size of small grapes. I figured this gum lump was another of the same sort of thing--but in his mouth? Combined with the extra peeing, I decided the pre-trip crisis had officially arrived. So off to the vet he went.

I told the vet about my concerns about his drinking and urinating and the vet agreed to run a blood panel. Then I showed him the lump on Harry's gum and three of his other warts. The vet said, yes, they are all kind of related. The one on his gum needed to be removed. And he said, let's give him some light anesthesia and remove them all. We can run the blood panel at the same time. I agreed.

To his intense unhappiness, Harry went back to the vet yesterday. Four hours later I picked him up. He has three staples in his neck and two on his belly where the vet took off the really big warts. And turns out he had two more warts on his gums that were bigger than the one I noticed--all of those were cut off and cauterized.

You have to click on this image to get a good look at those staples. The vet sprayed a silvery powder on his neck, some sort of antiseptic spray I suppose, but there is bruising on his neck too.

And his blood panel? Perfectly normal for every single variable measured. So, I said to the vet, you're going to tell me he's drinking more because....it's hot? Yep, the vet said, that's about right.

Well, even though it cost me a few hundred riyals to learn this, I figure peace of mind is well worth it.

Harry is a wonderfully healthy, fit 12 yr old dog. Now he's wart-free! And as a bonus, he has some gnarly metal staples!

Mimi was suitably impressed. She sniffed every square centimeter of him when he came home from the vet then left him alone for the rest of the afternoon. Harry was groggy, in a bit of pain, and pretty confused most of the day after the surgery (I spent the day working from home to keep an eye on him) but today, about 36 hours after the surgery, he seems to be feeling pretty frisky again.

Harry resting after his ordeal.

Out and About With The Boys

It won't come as a surprise when I tell you it is pretty hard for me to be objective about my dogs' health. Iz and I struggled for months but we still lost the race.

Harry lost his last two toenails last weekend and was in extreme pain for about three days. Also, in retrospect, it was a mistake to board him at the kennel when I went out of town on business. I should have put him with the vet along with Mimi. He could hardly walk when I picked him up that Friday night. I called the dermatologist on Monday and insisted on a follow up visit, which we scheduled for the next morning.

I examine his toes several times every day looking for...anything. Magically grown new toenails, I guess. So when he lost those last two nails, I began to feel defeated. It was an emotion that was too familiar and too scary.

To my surprise, the dermatologist was pleased that the deterioration of his nails was not progressing. In other words, it was a sort of null result. Losing his last two nails was going to happen anyway and didn't represent a worsening of his condition. The visit was on Tuesday morning, and Harry was in fine form doing all sorts of tricks for biscuits, entertaining the vet and his tech. The vet examined all of Harry's toes. It was subtle, but there might be some new nail growth on a couple of them.

The vet said Harry was to continue the cyclosporine. The only remnant of his initial intestinal distress is some nasty flatulence but I'll take stinky dog farts over dry heaves and diarrhea.

Then we got down to the big question: when can Harry start doing flyball again? Not just flyball, actually, but training and conditioning work, too. I have been reluctant to even take him for a walk since December and playing fetch has been out of the question. Harry needs a lot of work to get him back into competition form, plus he really needs to practice with his flyball team.

It has been hugely frustrating to me that I had to pull Harry from the January and February tournaments. The next one is in four weeks. That doesn't leave a lot of time to get him ready.

The vet told me to start slow, but that I should start working Harry again in all of the things he is used to doing, including flyball practice. He told me that the diseased nail remnants will split and break and may bleed and that Harry may not be as fast as he used to be, at least for a few more weeks. He also told me NOT to wrap Harry's feet during flyball. This last part amazed me. But then, I usually wrap his feet to prevent his nails from breaking...so if we are truly addressing his condition, that may no longer be needed.

Since the vet visit, Harry has become a different dog. He brings me toys constantly and I've been increasing the ferocity of our tug games, which we now play three or four times a day. I'm able to play with Harry and Cap together because they both focus on their own tug and ignore the other dog. I could do this with Harry and Iz but never with any other pairing of my terriers. It's a different thing to have a dog that isn't a terrier.

I started taking Harry for walks this week (we do just under 3 miles ), which I'll ramp up to short periods of running in a day or so. And this morning I plan to take him outside and throw the ball a few times to see what happens.

Postscript: Harry chased the tennis ball in the backyard for about 20 minutes this morning. I checked all of his toes every five throws or so, and I didn't throw the ball too far, but he was ecstatic to play one of his favorite games. And the best part? Not a single torn or bloody nail. Woohoo!

In two weeks, I'll head to Austin for flyball practice.

I can only handle three dogs at a time so if Harry always goes on a walk, that only leaves two more slots. I took Cap along this week to start teaching him leash manners and of course the joys of taking a walk with the pack. Last night, Jack got the prized third slot. It was a walk with all of the boys.

Harry, Cap, and Jack.

Cap is now 19 weeks old. He weighs 14.4 lbs (checked on the vet's scale yesterday) and is just over 13.5" at the shoulder. He has not yet lost any of his baby canines, consistent with his tender age, but his front teeth have all been replaced. You can see in the photos how long-backed he is and also how much shorter he is than Harry.


Since I find the clump of dogs that gathers on the large dog bed for a nap as cute as anything I've seen, here's another picture.

Mimi, Dyna, Cap, and Jack.

Bits, Oddments, and Loose Ends

On Sunday, I worked Mimi in the field with our little PA system. The sound quality in the video below is kind of crappy because it was really windy (that's why I cut out all of the sound from the clips of Gracie and Cap). Still, you can tell that Mimi is flicking her ears back, standing up, and generally getting uncomfortable on the table as I'm counting down (the volume was up pretty high and I'm sure my neighbors were wondering what the hell the crazy dog lady was up to). But I was able to reinforce her on the table quite a bit and she went on to perform nicely.

I believe. . . dare I say it? . . . that she is slowly desensitizing to the PA sounds.

Enjoy the video. I shot it on Sunday morning. It was cool and breezy and all three pups enjoyed doing some work outside.

On Friday, I had my first lesson in TTouch (this link is reasonably informative). I am willing to try anything that might help my girlie and I figured TTouch could perhaps give me some tools to maintain a connection with Mimi in the gate area at trials. The idea is that with time, she will learn to associate a calm, relaxed, but focused state with my touching her and that perhaps I can recreate that state in the gate area before she becomes so stressed. My friend Denise suggested that I can also use TTouch after runs when she is also pretty worked up.

It will take a while for me to learn how to do it correctly and for her to learn to associate the touches with a calm state. Fortunately, I have an entire house full of animals who will line up to let me practice on them! I'll get a second lesson in a few weeks.

Harry is still feeling super crappy. I can hear his poor little gut rumbling and roiling. My friend Denise, a regular font of information tonight, suggested famotidine. Iz took that too. I'll get some tomorrow and see if it doesn't help Harry. I gave him some carofate tonight before dinner in the hopes that it might help him rest more comfortably tonight. He got me up twice last night to go outside with diarrhea, poor little guy. I spent many long months with Iz sleeping with the light on and one eye open. It is not a skill I am pleased to have. On the bright side, sick pups get to go to work with me and he's enjoying that special attention. I can't tell yet if his feet feel better--his GI distress is masking any change there. Today is day 5 of the nasty meds.

Lola is still fat. Maybe she's photosynthetic.

Cap went to my vet today for his "puppy wellness" exam. He has tapeworms and I wanted a course of strongid to treat him for all of the other kinds too. Puppies get worms and he's been in at least half a dozen foster homes so it's not a surprise or a big deal. Still, worms. Ew. Need to be dealt with.

The vet told me some very interesting things. Foremost of these, he said that in his experience, twice the weight of a pup at 16 weeks is about what they will weigh as an adult. The more accurate scales at the vet told us Cap now (at about 17 weeks) weighs 12.8 lbs . . . so he may only be around 24 lbs as an adult! Gracie weighs 22 lbs (but as I've said, she's a big, strapping bitch).

I already knew that Cap only has one descended testicle. The vet said the other one is up in his body but that it probably won't drop. Since Cap won't be bred, having only one testicle is not of itself a problem. But those undropped testicles often become cancerous. Now, his neuter operation requires more invasive surgery, more like a spay than the usual snip-snip. I'm glad I convinced the rescue group to wait and let me take Cap intact. I'll feel more comfortable having my own vet do this more complicated surgery.

Health Worries

My petsitter was nagging me late last year because she was worried about Lola, who was looking swollen and apparently getting bigger by the day. Lola was eating and drinking just fine and was in fact quite playful. But I had to agree, Lola was decidedly bigger than a couple of months ago.

I dragged her to the vet and had a full blood panel and some xrays done. The verdict? Lola's blood chemistry looks fabulous. Her organs are in the correct place and are all about the right size--except that they are all nestled in a huge bed of FAT.

She had gained 4 lbs in four months.

And how did this happen?

Well, all the cats were looking a little rotund in the fall so I had started restricting their portions. They don't free feed but get measured portions of food twice a day. Lola was chowing down on her kibble then shouldering one of the other cats out of the way to eat most of his food.

The trick was to first switch to low-fat kibble then cut the portions to the point that even the pushover cat sucks his meals down right away, leaving little extra but crumbs for the voracious Lola.

My bigger worry is Harry. He tore a claw in November at flyball practice. I thought it was healing but as December progressed, more and more of his claws started deteriorating. The nails flake and crumble off, separating from the soft tissue underneath, and the nail beds of the affected nails would tear and would bleed often. Like, bleed all the time. I took him to flyball practice in early January which in retrospect was a mistake. Although his hind feet were wrapped, his front feet were not and he tore off parts of two nails on his left front foot. His feet hurt so bad on our return home that he was unwilling to walk.

I took him to my regular vet who passed me on to a dermatological specialist. My regular vet did run a full blood panel and nothing unusual showed up there. Many days of worry passed. I pulled Harry from the January flyball tournament. Whatever was going on had affected all four feet and all but two of his nails.

At last we got in to see the specialist. He seemed quite excited to tell me that Harry has an extremely rare condition called alopecia areata with trachyonychia (that second part is the nail disease). It is an immune related disorder in which his immune system is attacking his nail beds and the special cells that make nail material. He is now on cyclosporine, an immune suppressant (anti-tissue rejection). It is dissolved in cod liver oil castor bean oil in gel caps. Castor bean oil smells really nasty.

The castor bean oil is causing Harry significant intestinal distress (diarrhea, dry heaves) but the specialist said that he should develop a tolerance for it in about a week.

Harry is still in a lot of pain. I found out that when his nails fall off, the bloody stub that is exposed is HIS BONE! My god.


And some of you might recall that he has almost no hair on his ears. That is in fact another expression of this immune condition, which he has apparently had for many years. It suddenly moved into his nails. Typical of immune diseases, it can wax and wane.

This condition is so rare in dogs that there is very little information on its progression, if there are recurrences, etc. However, the dermatologist was remarkably upbeat about treatment and prognosis.

The dermatologist said that I should see improvement in his feet and a reduction of the pain and the nausea and such in about 7-10 days. It's only been four days and it will be a very long week ahead. My boy is suffering and I can't do anything about it except wait.