Bronchoscopy

Today I went to the UCSD Medical Center for my bronchoscopy, and I thought, the removal of scar tissue. I was a little nervous since I had never seen this doctor before. But, this was unfounded. Dr. Harrel is one of the top pulmonologists in San Diego. I was told that I was just having a bronchoscopy so that the doctor could decide whether to remove the scar tissue from my trachea. A young doctor did the procedure, but Dr. Harrel surpervised. After putting the scope down my trach, and having a look around, the scope was removed. The procedure was done. Dr. Harrel decided not to remove the scar tissue and ordered a different trach for me. My trach tube had been advanced past the scar tissue last time I visited the E.R. (see blog post of 10/17/2007) In its present position, there was no sign of scar tissue below the trach tube; the tissue was smooth and a healthy pink. There was no danger of scar tissue blocking my trach tube. The new trach will have a non-adjustable tube. It will stay in the same position. My present trach has an adjustable flange which allows the doctor to move the trach tube to any position. But, since I have scar tissue higher up, the trach tube doesn't need to be moved. It will stay where it is. I feel relieved that I will not need surgery. It looks like I don't have to worry much about trach obstructions. I feel very positive. The new trach sounds like it will be good. Of coarse, when the new trach is put in I will know for sure. But, I feel it will be just fine. I hope it comes in soon.

Fire!

10/22

I went to sleep Sunday night feeling safe in my home. The wildfires burning in San Diego County were too far away, especially the Witch Creek Fire near Ramona, about 30 miles away. How wrong could I be! As I slept, the Santa Ana winds continued to blow west fueling the fire (see previous blog post 10/21) and causing it to advance over the bone dry hills, valleys, and canyons towards the coast and destroying hundreds of homes in its wake. The phone rang at 5:30. It was my cousin Greg; His family had to evacuate their home in Poway down the mountain from Ramona. About two hours later, the phone rang: it was my sister. Her family had to evacuate their home in Escondido (about 20 miles to the northeast of us). They were headed to our house. Less than a half hour later, the phone rang again. It was a reverse 911 message telling us to evacuate. I couldn't believe it. My mom woke my nurse, Ernie, who was sleeping in the guest room between shifts. He quickly got me up in my wheelchair, gathered some supplies, and we were out of the house.

Outside there was a fog of smoke and ash, obscuring the sun and creating an eerie, orange glow. The winds were gusting and ashes were raining down all over the place. I hurried into my van. The windshield was covered with soot. We drove out. My mom followed behind in her car; my dad decided to stay behind. The driveway was littered with twigs,branches and leaves blown down by the strong winds. As we drove out of town the ash continued to fall and eddys of ash and soot swirled around.The roads were covered with a layer of soot and ash. We drove straight to Scripps Memorial Hospital in Encinitas. I was supposed to go to the evacuation center at the Del Mar Fairgrounds, but I was afraid they wouldn't have the proper accommodations for me.

Once at the hospital I rushed inside. The smoke made its way into the E.R. waiting room. I took refuge in the radiology department waiting room. While there I picked up x-rays and CT scans for my medical procedure Thursday. I had planned to go there today anyway. They were nice enough to let me hang out there all day. I spent most of the time following the news of the fire on the radio. Another fire in Fallbrook (in the northernmost part of San Diego County) forced Ernie's family to evacuate their home. He stayed with me. Fires were blazing all over the county. It was unbelievable. It was getting worse by the minute. My dad finally left the house and went to a family friends house in Leucadia, near the coast. My mom was already there with her cat, Sassy, and my cat, Lucky. Also, my sister was there with my niece and nephews, one of their dogs and the turtle. Her husband stayed behind with their other dog, two rabbits, and the bullfrogs.

That evening I was informed that I had to leave the hospital because it wasn't an evacuation center. They suggested I find a motel or hotel. There was not a room to be found; because of the fires burning all over the county, about 250,000 people were evacuating. My sister contacted her neighbor, who is on the Board of Directors of Scripps hospital. He called the hospital and told them I was staying the night. It helps to pull some strings. They gave me a bed in the corner of the E.R. overflow unit. They bent over backwards to make sure that Ernie and I were comfortable.

10/23

After a restless sleep worrying about whether I had a house to return to, I woke up at 5:00 and turned on the news. A reporter was reporting from my town of Rancho Santa Fe. Houses were burning up the street from my house. I had a sinking feeling in my gut. Later, a social worker told me I had to find other accommodations. They only allowed me one night. She was very helpful. She found me a place to stay after calling around and even called some of my medical supply companies to have supplies sent to the hotel. She tried to see if some board and care places would take me in, but they wouldn't take me because I had a feeding tube. I have no idea why not. She found a hotel called California Suites in San Diego, away from the fires. I drove down there, settled in and watched the news. Houses had burned on streets near my house. I wasn't sure if my house had survived the early morning firestorm.

The father of one of my classmates from my town, Dr. Buncher and his brother Martin contacted my mother and asked if I got everything I needed from the house. My mom told them I left my bedside ventilator, bedside suction machine, and clothes. They got through the roadblocks by dressing as firefighters (Martin used to be a volunteer firefighter and had uniforms). They made it to our house and called my mom to tell her they were standing in our living room. Our house had survived the early morning firestorm intact. I felt great relief, yet some trepidation; we weren't completely out of the woods yet. The Santa Ana winds were still blowing, and there were still hot spots that could flare up and start new fires. My dad got my equipment and delivered it to the hotel.

My sister told me that our house was threatened by the firestorm. Flying embers ignited trees near our house. The firefighters got on our roof and made a stand against the fire. Thanks to their actions they saved our house and others in the immediate area.


10/24

Today I was still not allowed to return home. There were still many hot spots that could flare up. My parents got through the roadblocks and went to the house to get more of my things. The house still stood. It was undamaged. What a relief that was! We dodged a bullet.

To pass the time Ernie and I decided to drive up the coast to Oceanside. Before driving the coast we drove inland towards my house to see if they would let us through; Ernie left some medicine at my house. As we neared my town we met the roadblock. There was a National Guard Humvee with armed soldiers standing nearby. They were there to keep people, especially looters, out of the area. They wouldn't let us pass. We turned around and tried to get in through another street. We were met by another National Guard roadblock. The soldier politely turned us away. We gave up our quest and decided to continue on to the coast. It was nice driving along the coast. The air was a little bit better but the sun was still obscured by smoke. In Oceanside we stopped at the hotel where Ernie's family evacuated to. We visited with them for a while. Then we went to Costco, where Ernie bought food for his family, and I picked up some more things I needed. After dropping off the food we drove back down to the hotel. On the way back we tried to get into my town again by another route. At the National Guard roadblock we were turned back yet again. This proved to me they were doing a good job protecting our community. Looters would have loved to get into my community. Also, they were keeping us safe. There was still danger from hot spots. Back at the hotel I watched the news coverage of the fires, trying to find out when my town would reopen. I slept well that night with the knowledge that I would have a home to go back to.

10/25

This morning as I wondered if I would go home, I was also a little nervous about my medical procedure today to remove scar tissue from my trachea. The phone rang: it was the UCSD Medical Center. My procedure was cancelled because the doctor had a family emergency. Now my thoughts were focused solely on going home. I waited in the hotel room to get the green light to return home. I watched the news anxious to find out when I could return home. After what seemed an eternity, my mom called to give me the good news: we could go home! Ernie packed up my stuff and when my dad arrived they loaded my stuff into his car and my van. With little delay we were headed home. It was a great feeling to drive up the driveway and see the house standing there. It was even better to be in the familiar surroundings of my home. Though I was elated to be home, I felt sad for those in my town and around the County who didn't have homes to return to. Over 1500 homes were lost in San Diego County to the fires. The nerve wracking ordeal was finally over. Every time the Santa Ana winds blow from the east there will be anxious feelings and fears of another conflagration. I hope we don't go through this ordeal again anytime soon.

Additional Comments

My nurse, Ernie stayed with me the whole time I was evacuated and remained calm and collected. Even though his wife and kids had also evacuated their home, he chose to stay and take care of me. His loyalty and consideration is commendable. I am lucky to have a nurse like him.

On a somber note. My thoughts go out to our friends Michelle and Mack and their children, Michael and Mellissa who lost everything as a firestorm destroyed their house. I hope all the best for them as they and their children rebuild their lives from the ashes.

I am also very thankful to the firefighters for working day and night in oftentimes grueling conditions in their fight to stop this beast of a fire and to try to save homes. We should always be grateful for the service these firefighters give to us. Hats off to all of them. To me and countless other people they are heroes.

Here Come Those Santa Ana Winds Again

The hot, dry desert winds are blowing in Southern California again. The temperatures are in the high 80's, 90's, and 100 in some areas. Though it is nice to have summer weather in October, the strong, dry Santa Ana winds, or "devil winds" as they are called can bring devastation. They bring the dreaded California wild fire. The brush is so dry, especially with our drought, that the smallest spark, such as downed powerlines, or a spark from a truck backfiring can trigger a fire, which is fanned by the 30 to 40 mph winds. In some areas the wind gusts are over 100 mph.

All day the smell of smoke has been heavy in the air, while a pall of smoke has been hanging over us; the sun glowing orange through the smoke and ash and creating an eerie orange glow over the landscape. As I write this blog, two wildfires are burning out of control in San Diego County; one in the south, another to the east. The fire in the east, called the "Witch Creek Fire" is burning near the towns of Ramona and Santa Ysabel about 30 miles, as the crow flies, from where I live. With all the smoke and ash being blown from the east to the west, it seems like the fire is just around the corner. Lucky for me it is not. I hope for the best for all those people forced to evacuate their homes, and hope they have homes to go back to.

E.R. Revisited

I had to visit the emergency room at Scripps Hospital in Encinitas again today. My trach was obstructed again. Early this morning while being trach suctioned, I couldn't breathe and my nurse, Ernie had to grab the ambu bag and got me breathing again. I decided to go to the E.R. later this morning after trying to get some sleep. At the E.R. I found out that Dr. Eisman, the pulmonologist who always treats me, was not there; they thought he had left the country for vacation. I have a lot of confidence in Dr. Eisman, and to have another pulmonologist treat me made me a little apprehensive. No one knows my situation as well as he does. He has been treating me for 13 years. I would be treated by Dr. Clark, his associate.

Again I had the usual chest x-ray. But, this time they had to do the dreaded blood work. I am very difficult to draw blood from. I usually end up like a human pin cushion from all the poking. Luckily, I was only poked twice. The RT(respiratory therapist), Janet, who has worked with me many times over the last 13 years, came in the exam room to set up the bronchoscope. Unlike the two stooges who had trouble setting up the bronchoscope during my E.R. visit Saturday night, Janet is very much on top of things. I have a lot of confidence in her. Dr. Clark soon came in. To my relief, he had contacted Dr. Eisman, who gave him advice on how to handle my situation. He put the bronchoscope down my trach and saw the flap of scar tissue in the trachea that keeps blocking my trach tube. He advanced the trach farther past the obstruction. After he was done I was allowed to go home. But, I will need to undergo a procedure soon to have the scar tissue removed.

E.R.

Saturday morning started off badly. I was having frequent trach suctioning and the suction catheter would not go down all the way. Also, there was a persistent wheezing coming from the trach. It felt like there was an obstruction. My mom squirted saline water numerous times down my trach to loosen things up. But, it had no effect. I felt something was wrong. After a restless morning, my lungs were somewhat clear. I thought the worst was over. When my nurse, Ernie showed up for work at 2:00pm things seemed much better. I had less suctioning, but the catheter kept meeting resistance, but Ernie was able to force it through. I thought it might be a dried mucus plug at the end of the trach tube. But, at around 6:00 as I was talking to my sister on the phone, I felt an urgent need for suctioning and had to end the phone call. Ernie went down the trach with the suction catheter, but the way was blocked. As he went down again, I couldn't breathe. Frantically, I mouthed to him that I couldn't breathe. He quickly grabbed my ambu bag, and in a few seconds he had it attached to my trach and pumped air to my lungs and I could breathe again. My heart was pounding so hard it felt like it would come out of my chest. It is always a scary experience, especially when you have the fear that the ambu bag may not get you breathing again. Thank God for the ambu bag! After that episode, I knew it was no dried mucus plug; I suspected scar tissue. I have been down this road before. In January I stopped breathing a few times, until the pulmonologist at Scripps Memorial Hospital in Encinitas, Dr. Eisman, finally removed the scar tissue. For the next seven months, my trach was unobstructed. I felt that the problem was gone for good. I was surprised when it came back again. I had to go to the dreaded E.R. Ernie drove me in my van to Scripps Hospital in Encinitas. On the way, I listened to U2, to take my mind off things.

When we arrived at the hospital, the E.R. waiting room was almost empty; a good sign that they were not very busy. After a somewhat short wait, they called my name and I was allowed in the E.R. First I had to meet with the triage nurse. She was told what the problem was, and then took blood pressure, and temperature. I was promptly ushered into a procedure room to wait, and wait for the doctor. While waiting, the nurse hooked me to the heart monitor, automatic blood pressure monitor, and pulse oximeter to measure my oxygen levels. My heart rate was 120. The nurse told me to relax and not to talk. When she was gone I continued to talk. It wasn't the talking making my heart rate go up, it was because I was stressed out from what happened to me earlier! They also took a chest x-ray. After a while the E.R. doctor came in the room to evaluate me. At the time I was breathing well, and by the doctors tone it sounded like he would send me home. During the evaluation I needed suctioning. Again the catheter met resistance and I couldn't breathe. My nurse, Ernie grabbed the ambu bag and got me breathing again. This convinced them there was a problem. The E.R. doctor contacted the pulmonologist, Dr. Eisman. I was relieved that he was on duty. He knows what to do. That put my mind at ease.

Soon two R.T.s(respiratory therapists) entered the room with the broncoscopy machine. The two stooges couldn't figure out how to connect the equipment. My nurse, Ernie helped them connect it. He was an RT in the Navy so he knew how to do it. It's unbelievable they didn't know how to do it. The doctor came in and put the bronchscope down my trach. He found a flap of scar tissue at the end of the trach tube that was causing the obstruction. He advanced the trach tube past the scar tissue and the airway was completly clear. I was soon allowed to return home.

Miramar Air Show

Today I went to the annual airshow at MCAS(Marine Corps Air Station) Miramar in San Diego. I have always had a love for aircraft ever since grade school, so I was excited to go. It was an awesome experience. The first demonstration I saw was a Marine Air-Ground Task Force Assault Demo. It was a demonstration of close air support, armor,artillery and infantry. It was complete with helicopters, jets, tanks,marines and a lot of fiery explosions. The explosions were so intense I could feel the heat. Next was the F/A-18 Hornet showing it's capabilities. After that was a step back to the past. They had a legacy flight with some WWII era fighter planes, and flying alongside was an F/A-18 Hornet fighter jet. I thought the juxtaposition of old and new was quite an interesting sight to see. Following that was a civilian acrobatic flyer in a bright red bi-plane, the "Oracle Challenger" piloted by Sean Tucker, a veteran of the airshow circuit. His loops and death defying spins were amazing to watch. After that was the Patriots Jet Team. As they soared overhead they trailed streamers of red, white, and blue smoke. I missed the next act, Shockley's "ShockWave" Jet Truck, because I was looking at the various aircraft assembled on the tarmac. I'm just not that interested in trucks. After that was a civilian acrobatic flying team, the Red Baron Squadron 4-Ship Stearman Aircraft. They did some amazing synchronized maneuvers. Next, they had a demonstration of one of my favorite jets, the AV-8B Harrier Jet. I find it interesting because it is a VTOL(vertical take off and landing). The sight of a jet hovering in the air is amazing. The final act was the United States Air Force Thunderbirds, the stars of the show. Usually they have the Navy Blue Angels, but this year is the 60th anniversary of the founding of the U.S. Airforce, so they had the Thunderbirds.

The Thunderbirds are just as awesome. There was much anticipation as the Thunderbirds prepared to take to the sky. I could feel the excitement in the air as the jets roared down the runway and soared majestically into the sky. The roar of jets makes the hairs rise on the back of my neck with excitement. I felt like a kid. I am always amazed at how the pilots can be so precise in their maneuvers. The six red, white, and blue Thunderbirds perform formation flying and solo routines, most of which are pretty hair-raising. In one routine, two jets fly full speed towards each other and then bank away from each other as they seem about to collide. In another, a jet flew upside down. In the mirror formation one jet flies upside down directly above the other jet creating a mirror image. The "bomb burst" maneuver is a sight to see. The jets fly straight up in the air then veer off in different directions. They end the show with all six jets flying in the delta formation. A beautiful sight to see.

I left the airshow feeling elated and looking forward to next year's show.

Bookshare.org

Reading has been a lifelong passion of mine; my books have always been among my most prized possessions. So, when last year I lost the ability to turn the pages of books I felt a great sense of loss. I couldn't imagine not being able to read books anymore. I looked into electric page turners, but they turned out to very expensive and not so user friendly. But, then I thought of electronic books. I always preferred reading real books, so I wasn't too interested in electronic books. But, I realized I had to shed this bias and embrace the future if I was to enjoy reading again. I decided that e-books were the answer. While doing an internet search for e-books, I came across Bookshare.org. They make print books available on-line to individuals with visual impairments or people who are unable to hold or turn pages of a book due to a physical disability. This was the site for me. I signed up right away. To qualify, all I had to do was fax them a proof of disability signed by my doctor, stating that because of my disability I was unable to turn pages to read books. Once I was approved for membership, I payed a one time fee of $25 and a yearly fee of $50. I am allowed to download 100 books a month out of a growing collection of books which are scanned by members and volunteers and sometimes the owner of the copyright. It is legal because of an exemption in U.S. copyright law that allows the reproduction of publications into formats for the disabled. The books are available in two formats, DAISY and BRF. DAISY is a text format that can also read the text if needed; BRF is a Braille format. I downloaded a free reader called Victor Reader to read the books. It does a pretty good job, but I wish it was a little easier to use. But, it is better than nothing. I recommend Bookshare.org. It has allowed me to enjoy reading again.