Sunday, May 29, 2011

Ringing Pigs

Rooting in the dirt is a natural instinct for pigs; they do this to create a cool place to lay or to forage for insects. Pigs can overturn a field of grass or dig their way under a fence quickly and easily...

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As you can see from the pictures we've tried many ways to discourage their escape but they are still able to dig and stay far enough under the electric fence that it doesn't zap them. So our only option to prevent the rooting is to put rings in their noses using very sharp triangular rings and a special pair of pliers...

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Ryan caught each pig and held them while I quickly put three rings in each of their noses. The pigs are still able to root lightly but the rings make it uncomfortable and irritating to root deeply.

The pigs squeal more from being caught and held than from the actual piercing.

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 This pig has hematoma (a pocket of blood and fluid) in his ear.  This is a result of shaking his head vigorously and injuring the ear or an injury that happened at birth.  He came to us like this and its slowly getting better.

Fishing with a 3 year old and a 1 year old ...

Getting back at her brother while he was napping...
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Motor-less lake for fishing with the little ones...
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Ryan spent the day fishing with Sawyer's pole more than his own...
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Danica did her own fishing too....with donuts and cheese popcorn...
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Who me?...
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What day fishing with little boys doesn't include...  (notice Ryan fishing with Sawyer's pole again)
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"A whittle one like me!"
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Couldn't keep her from playing in the water no matter how hard we tried...
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Supper at the lake...
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Saturday, May 14, 2011

Tuesday, May 10, 2011

Lyme Encephalopathy (aka - I'm losing my mind and I'm completely aware of it)

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I've been debating writing this blog.  As it is I will have to convince myself a few times to actually post it because afterward people will probably think I'm nuts and at this point some days I think I might be.  If your doubtful just google Lyme disease memory loss or Lyme Encephalopathy and see what you find.

The stuff I'm going through physically, the headaches and joint and muscle aches and pain are nothing compared to what is going on in my head.  Or maybe I should say the lack of things going on in my head.  It sounds funny but I can assure you.  Being in there and realizing there is something wrong but not being able to do anything to fix it no matter how hard you try is terrifying.  After my lab results came back my official diagnosis changed to Lyme Encephalopathy and/or Neuroborreliosis.
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(from Wikipedia) Encephalopathy -means disorder or disease of the brainIn modern usage, encephalopathy does not refer to a single disease, but rather to a syndrome of global brain dysfunction; this syndrome can be caused by many different illnesses. 

The hallmark symptom of encephalopathy is an altered mental state. Depending on the type and severity of encephalopathy, common neurological symptoms are loss of cognitive function, subtle personality changes, inability to concentrate, lethargy, and depressed consciousness. Other neurological signs may include myoclonus (involuntary twitching of a muscle or group of muscles), asterixis (abrupt loss of muscle tone, quickly restored), nystagmus (rapid, involuntary eye movement), tremor, seizures, jactitation (restless picking at things characteristic of severe infection), and respiratory abnormalities such as Cheyne-Stokes respiration (cyclic waxing and waning of tidal volume), apneustic respirations, and post-hypercapnic apnea.

I have all of the symptoms that are highlighted.

 Neuroborreliosis is a disorder of the central nervous system caused by infection with a spirochete of the genus Borrelia. The microbiological progression of the disease is similar to that of neurosyphilis, another spirochetal infection. Neuroborreliosis occurs as a rare manifestation of late Lyme disease, although it has also been reported during early infection.

Neurologic symptoms of neuroborreliosis include the meningoradiculitis (which is more common in European patients), cranial nerve abnormalities, and altered mental status.

Lyme Encephalopathy and Neuroborreliosis are often misdiagnosed as Alzheimer's disease, Acute disseminated encephalomyelitis, Viral Meningitis, Multiple Sclerosis,  or Bells Palsy because their symptoms mimic each other.

(from this article) Everyone with LE has their own unique profile of symptoms. The assessment of these signs and symptoms is one facet of the total clinical assessment of Lyme disease.  (I am going to cut and paste the ones I am experiencing and try to give examples)
Attention
           Attentions span ( a whole new level of A.D.D.) - Many Lyme disease patients have acquired attention impairments which were not present before the onset of the disease. There may be difficulty sustaining attention, increased distractibility when frustrated, and a greater difficulty prioritizing which perceptions are deserving of a higher allocation of attention.
            If we compare attention span to the lens of a camera, we need the flexibility to constantly shift the allocation of attention dependency upon the current life situation. For example, we shift back and forth between a wide angle and a zoom lens focus to increase or decrease acuity of attention depending on the needs of the current situation. A loss of this flexibility results in some combination of a loss of acuity (hypoacusis), and/or excessive acuity to the wrong environmental perceptions (hyperacusis). Hyperacuity can be auditory (hearing), visual, tactile (touch), and olfactory (smell).
            Auditory hyperacusis is the most common. Sounds seem louder and more annoying. Sometimes there is selective auditory hyperacusis to specific types of sounds. (When I'm on the phone if the kids are talking or messing around or fighting I am completely unable to ignore them. I have to find a different room because all I hear is them I'm unable to focus on the person on the phone)

Memory
            Memory is the storage and retrieval of information for later use. There are several different memory deficits associated with LE. Memory is broken down into several functions – working memory, memory encoding, memory storage and memory retrieval.
            Working memory is a component of executive functioning. An example of working memory is the ability to spell the word “world” backwards. Sometimes there are impairments of working memory as it pertains to a working spatial memory, i.e. forgetting where doors are located or where a car is parked.
(When I read this I tried to spell world backwards.  I didn't think it would be an issue but how often do you find yourself trying to spell words backwards.  I couldn't do it.  I had to spell it forward in my mind to get each letter of it backwards.  By the time I got to "r" I forgot where I was in the spelling of it and gave up.  I can't tell you how many times I've gotten into the passenger side of the car to drive somewhere only to realize I needed to be in the driver's side.  It seems silly which makes it all the more frustrating.  I should know better and yet I don't)
        Short term (recent) memory is the ability to remember information for relatively  brief periods of time. In contrast, long term memory is information from years in the past (or remote).
In LE,  there is first a loss of short term memory followed by a loss of long term memory very late in the illness. Patients may have slowness of recall with different types of explicit (or factual) information, such as words, numbers, names, faces or geographical/spatial cues. Not as common, there may also be slowness of recall if implicit information, such as tying shoes, or doing other procedural memory tasks.  ( I have a hard time remembering phone numbers.  Not new numbers but ones I call regularly.  My sisters, brother, mom, even Ryan's number sometimes. A number I call a few times a day.  A lot of the time I have to look it up in my cell phone to be able to dial...Cooking - recipes I used to have memorized I have to look up and read as I cook.  Its gotten so frustrating I find myself doing less and less "home cooking" and more convenience cooking because trying to do all the steps for a meal is too overwhelming.  If I take my shoes off some where other than by the door I might have to spend 15 minutes looking for them even if they're in an obvious place.  Loosing my keys when they're in my hand happens on a weekly basis. These are not the only things but just examples to give you an idea. )
            Errors in memory retrieval include errors with letter and/or number sequences. This can include letter reversals, reversing the sequence of letters in words, spelling errors, number reversals, or word substitution errors (inserting the opposite, closely related or wrong words in a sentence.

Processing
            Processing is the creation of associations which allow us to interpret complex information and to respond in an adaptive manner. Some LE patients say they feel like they acquired dyslexia or other learning disabilities, which were not present previously.   
Reading comprehension: The ability to understand what is being read.  (You know when you were in school and you had to read something for an assignment but didn't take in or remember anything you read? That happens to me no matter what I read.  I have to focus very hard to be able to take any of it in.  And even then I still miss parts of it.  I find myself skimming over large paragraphs because I can't process any of it.)

Auditory comprehension: The ability to understand spoken language.
( Easiest example is the teacher from Charlie Brown.  Some days and conversations that's what it seems like to me.  Ryan and I got in a huge fight this weekend because I thought he was leaving Sunday morning early for the yard when in fact he was leaving Saturday night after supper.  He insists he told me more than once but I honestly had no clue whatsoever.  In fact I corrected a couple of his friends who told me he was leaving Saturday thinking they were wrong.  Of course I would know better than them,
wouldn't I?)

Fluency of speech: The ability of speech to flow smoothly. This function is dependent upon adequate speed of word retrieval. (Easy example is having a word on the tip of your tongue but not being able to think of it.  This happens all day long.  I just give up and say I lost my train of thought so I don't look like a complete incompetent)

Fluency of written language: The ability to express thoughts into writing. (This you may have noticed in some of my blogs recently.  As I reread them I try to edit them so they make sense.  Some of them I have no idea where I was going with what I was thinking and so my thought ends with no further explanation which probably leaves you thinking ..WTH?...I also find when I'm reading back that I miss entire words or put the wrong words in for something.  When I notice I've done this after posting I'm embarrassed and I try to fix it as quickly as possible.  I'm going to stop doing that so I have something to look back on when I get better to see how far I've come)

Handwriting: The ability to write words and sentences clearly.  (You all don't see this but my handwriting has gone to heck.  I used to have neat handwriting.  Now I'm so busy trying to remember how to spell words and remember what I'm writing that I can't form the letters right as I write them. I find myself having to stop in the middle of my signature to remember how to flow into the next letter)

Imagery
       Imagery is a uniquely human trait. It is the ability to create what never was within our minds. When functioning properly, it is a component of human creativity, but when impaired, it can result in psychosis. Imagery functions that can be affected by LE include:
Intrusive images: Images that suddenly appear which may be aggressive, horrific, sexual or otherwise. (For me this is sort of like daydreaming but right in the middle of doing something like tying one of the kids shoes or talking to someone.  I zone out and they're left thinking I've checked out)
Hallucinations: Hearing, seeing, feeling and/or smelling something that is not present. In LE, sometimes this takes the form of hearing music or a radio station in the background. Unlike schizophrenic hallucinations, these are accompanied by a clear sensorium, and the patient is aware hallucinations are present.  (This has only happened to me once.  I was driving home at night from my dad's house.  I could see a ribbon of light above me.  Not like a shadow or a reflection off fog.  An actual ribbon.  I knew in my head it wasn't real but I couldn't make myself not see it.  It didn't affect my driving whatsoever other than be annoying because I couldn't get rid of it.  I was fully aware it wasn't real or I would have pulled over)
Organizing and Planning
          Organizing and planning a response is the most complex mental function, and is dependent upon all the functions already described. These functions, along with attention span and working memory, are referred to as executive functioning. Organizing and planning functions that can be
affected by LE include:  (this is where my biggest deficits are)

Concentration: The ability to focus thought and maintain mental tracking while performing problem solving tasks.
“Brain fog”: Described by many LE patients. Although difficult to describe in objective, scientific terms: it is best described as a slowness, weakness, and inaccuracy of thought processes. Prioritizing, organizing, and implementing multiple tasks with effective time management.
Simultasking: The ability to concentrate and be effective while performing multiple simultaneous tasks.
Initiative: The ability to initiate spontaneous thoughts, ideas and actions rather than being apathetic or merely responding to environmental cues.
Abstract reasoning: The capacity for complex problem solving.
(these symptoms are the reason I have been working on Danica's Christening gown since January and its still only half done. Why I haven't finished knitting the shorts I've been working on for 2 months.  Why cooking a big meal or even cleaning the house is so overwhelming.  I literally don't know where to start and even if I figure that part out I don't know what to do next, or next, or next.  I get so overwhelmed with what order I need to do things in that I can't even start it. It sounds ridiculous even to me.  I do manage to accomplish some things but only because I get so mad at myself for "being lazy".  I find myself needing to take a Zanax before I can start putting away laundry.  Believe me it even sounds ridiculous to me but I can't make those feelings go away)

Reading all of this and putting it out there is overwhelming for me but I had no idea that Lyme disease caused any of these things.  I'm hoping whoever reads this will be more aware of it and more understanding to those who are going through it. I told Ryan a few weeks before I found out I even had Lyme disease that I felt like I had pregnancy brain.  It really does seem like that only about 100 times worse.  Everything I've read says that once I get through this treatment I should start seeing improvement but it could take months before I fully recover.  I am counting down the days and doing a lot of praying.

Monday, May 9, 2011

Answers, Explanations, and the Right Treatment

Its taken me a little longer to update about my Lyme Disease diagnosis than I had intended.  Its been a whirlwind week and a half.  The day after my last post I spoke to my doctor's nurse.  My MRI came back normal.  I was under the impression I was going to give the new medicines the doctor prescribed me some time to work.  However, that afternoon she called back and said that my doctor didn't want to wait to do the spinal tap and they were going to set it up in Medford at a sister hospital.  It was already late afternoon so the appointment for sure wouldn't be until Friday.  I got the call from the anesthesiologist to schedule the appointment on Friday morning.  At 3 in the afternoon I went in for my appointment.  A spinal tap is the same as an epidural except your legs don't go numb because they don't inject medicine.  The put a long hollow needle in your epidural space and you sit there for 30 minutes or so while the spinal drips into 4 tubes.  Each tube needs 1 milliliter each.  About halfway through the procedure I started to get a funny sensation in my head.  It was almost as if there was cool water around my brain.  The headache I had for 5 months got better and my head felt lighter and clearer.  It was really a strange feeling after it feeling so stuffy and full for so long.  When I told the anesthesiologist how it felt he said that I probably had some pressure around my brain and it was being relieved by the some of the spinal fluid being taken out.  I really hoped it would last.

Saturday we spent most of the day making firewood.  I posted a blog about it here.  Sunday morning the headache slowly started to come back.  By Sunday night my head was throbbing.  Monday morning it was so bad I called the anesthesiologist thinking it was possibly a spinal headache from the fluid still slowly leaking out where the needle was inserted.  He asked me a few questions but ultimately decided it wasn't a spinal headache because it didn't get better when I laid down and it hadn't come on for almost 2 days after the tap.  I didn't hear anything all day about my labs but I knew they would take some time.

On Tuesday morning I called my doctor's office and left a message asking about my labs.  About an hour later the anesthesiologist called to check on my headache and told me he got some of my labs back and none showed signs of infection.  They were still waiting on the Lyme antibody test to come back but he didn't think it would show anything because of the lack of any remarkable infection in the rest of the tests. He said my doctor would probably call soon to plan the next move.  Another hour later my doctor's nurse did call and told me the same things about the labs and that they still hadn't gotten the Lyme test back yet.  The nurse asked how my new medications were working and I let her know at that point I had been taking the maximum dose of the migraine medicine all weekend after the headache came back and it didn't help at all.  I told her I had been taking the nerve medication for the twitching since I got the prescription and it hadn't helped with the facial twitching either.  The nurse said she would talk to my doctor and call back.

About 30 minutes later she did call back.  My doctor wanted to see me again as soon as possible because clearly there must be something more going on than just nerve irritation and migraines or those medications would have helped.  Landon had his cardiology check up the next morning so I decided it would be easier to do all the running in one day rather than two.  I scheduled my appointment for in the afternoon after Landon's.

The next morning Landon and I got up early and made the hour drive down to Marshfield for his appointment.  Landon's dad met us there.  It was 3 hours long but it went well.  Afterward we all went to lunch together and Landon's dad took him shopping for a prize for doing such a good job for his appointment.  We had some time to kill between appointments.  We drove the hour over to Wausau stopping in Mosinee to see Landon's grandma and tell her how the appointment went and what the doctor said.  Landon's dad was on vacation so Landon asked to stay with his dad while I went to my appointment.  This ended up being a really good thing.

At 3 o'clock I went into my doctors appointment.  My head was pounding so hard I had to wear my sunglasses in the hospital because the florescent lights were just too bright.  The nurse checked me in and took my vitals.  My blood pressure was high but most likely because of the headache.  The doctor came in and talked to me about the medications not working and then brought up my labs on her computer.  The Lyme test hadn't been there in the morning when she checked.  As she started reading through she was saying how everything looked normal.  Finally she said Lyme Antibody Levels - Positive.  Chronic Antibody Levels.  Apparently this means there is both new and old antibodies present even after treatment meaning so far the treatment has been ineffective.  The relief to finally know I had been right all a long was overwhelming and I cried.  Finally I was going to get the right treatment.  What I knew all along was confirmed.

My doctor didn't skip a beat.  She said that explained why none of the medications she prescribed were working.  She called radiology to get me in to have a special IV placed called a PICC line.  A PICC line is a peripherally inserted central catheter.  A special kind of IV that can be left in for a long time.  It can be used for putting medication in and drawing blood out.  She put in a referral to VNA home health and a prescription for IV Rocephin once a day.  Shortly after a medical assistant came and got me with a wheelchair and took me down to radiology to have the PICC put in.

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I changed into a gown and two nurses did an ultrasound of my arm and got me all prepped for the procedure and explained what was going on.  It actually happened really fast.  I laid on the table with a special xray machine over me to monitor where the catheter was.  The radiologist came in with an assistant.  They were laughing and joking which put me at ease.  The doctor assured me it would be fast and mostly painless.  They covered me with sterile sheets with just a small square of my arm exposed.  I had a sheet up by my face so I couldn't see anything.  I felt him put the Lidocaine in my arm and some pressure.  Then he was telling me they were done and just had to stitch the line to my arm and put the dressing on.  It was relatively painless.  Just the few pricks from the Lidocaine going in and the two stitches to hold the line in place.  A nurse walked me out to the entrance and I went and picked up Landon and went home.  That night my arm was really sore and uncomfortable.

Wednesday afternoon a nurse came from the home health agency and showed me how to do my infusion.  She changed the dressing too.  That was more painful than having it placed.  The catheter goes through a large vein in my arm, up over my shoulder and stops in a large vein just above my heart.  Its really important to keep it clean so I don't get an infection because it can go to my heart so easily. I do my infusion once a day around supper time. It doesn't hurt at all. The weirdest thing about it is that I can test and smell the saline when I do the flushes but that goes away as soon as the flush is done.

My PICC

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I get my stuff out first. Alcohol pads, two saline flushes, the medication, and tape to tape the line back out of the way afterward.

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I have to clean the end with an alcohol pad for 20 seconds.

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Then I do a saline flush.

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Then the Rocephin push. I push the plunger down 2 lines each minute. It takes 10 minutes.

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Then I do another saline flush and tape the line back up. Its really simple. I get to do this every day for a month. My doctor will recheck my Lyme Antibody levels after that to see if I need to do anymore treatment.

So far I haven't had much improvement but I've heard it can take awhile after the treatment to get back to normal. I'm just thankful I'm finally getting the right medicine.

Thursday, May 5, 2011

♥ Heart Check-up 2011♥

(Last year's blog here)
Yesterday was Landon's yearly heart check up.  I did pretty good this year and didn't get real nervous or anxious about it until the day before. He had an EKG first. Still ticklish as ever.

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Then he had an echocardiogram. Its an ultrasound of his heart. It takes about an hour because they do lots of measurements and views. They have a little tv and dvd player in the room so he picked out Finding Nemo to watch. The tech gave him a snack and a warm blanket.

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After the echo we met with his pediatric cardiologist, Dr Finta.

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Dr Finta explained that Landon's pulmonary valve continues to decline though not quite as badly as it did last year. She also said that his right atrial (upper) heart chamber is more enlarged than it was for his last echo. She said some of that is just regular growth. She is going to take a closer look and compare his echo pictures side by side. If the difference looks significant Landon will need to have an MRI to check the volumes and outflow from that chamber. The MRI needs to be very precise and Landon needs to be very still for it. Its also an hour and a half long so they will put Landon to sleep with anesthesia if he has to have it. We talked a little about how long she thought it might be until he needs the valve replaced. When he first had his repair they were hoping to wait until he was closer to adult age, if he needed it at all. She said it will for sure be before he's a teenager. Probably even before he's 10. For now we just continue to keep a close eye on it with yearly echos and being aware of any declines in stamina or endurance.

Sunday, May 1, 2011

Nothing better than free....

A month or so ago the power company cut a path under all the power lines. They delimbed all the trees they cut and chipped all the small stuff. We cut up the few trees they cut down in our yard. Lots of the neighbors have trees cut on their properties too that will probably be left to rot. Ryan stopped by some and asked if they knew who owned the property across from them. They told him a lady from Florida owns it and they watch the property for her. She hasn't been up in 4 or 5 years. Ryan asked if we could cut up and take the down trees for firewood. They appreciated that he asked. They were expecting someone to steal it during the night. There is quite a bit of hardwood. They gave Ryan permission to take it. We spent most of the day Saturday cutting wood, throwing it in the trailer, and hauling it home with the tractor. The boys had lots of fun helping and playing in the mud puddles. Danica took a long nap and played in the car for the little while she was awake.

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And we added a new baby to the farm. Ryan brought it home in a gunny sack in his Saturn.

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Easter '11

We had our Easter supper on Saturday because Ryan had to leave Sunday morning.  My dad was here and Ryan's mom.  We had ham and all the fixings.  It was a very busy day. Ryan was still outside taking care of chores and the pig fence when Sawyer and I started dying eggs.

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Somehow I missed getting pictures of their baskets and of them in their outfits for church. They were adorable. Landon was at his dad's for the first Easter ever. We missed him very much.

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