March comes in like....

This week winter decided to come back with a vengeance in certain parts of the country. The shot below is one taken through our back door.

I love how its branches twist like old arthritic fingers. These trees are quite abundant in our forest near the house. I did hear that the CCC -- or the Civilian Conservation Corps may have planted the locust trees and pines as part of the reforestation project. I cannot prove or disprove it. The locust tree log once debarked makes a great wooden fence post. They last quiet a few years. 

The shot below is one of the Red pines that still live on our land. We have three left. When we moved here, there was a stand of Red pines where one of the sheds now resides.

These trees are old. I mean old old. I took 4 down last year that were dying and am grateful that they won't fall on the house. However, their shade when they were in their glory days was wonderful. Plus, the wind sighing through the needles make a most calming sound.

When I had to go retrieve mail in the last ice/snow storm this week, I thought I'd take the slightly longer way through the woods. It was pretty. However the gusting winds kept things creaking above my head so I returned to walking up the driveway. 

You know I had to walk Charlie and take my camera at the same time. When I got to the ridge and stopped to look, I figured out what was causing all of the creaking above me. 

We had rain that became ice before the snow hit. The trees were heavy with it. 

Since I'd left hubby napping, I didn't take much time to scout around like I usually do when I get the mail. I generally take a round about route to tour my favorite part of the forest.

However, we are trying to establish a new routine of sorts.

Sorting and resorting the medications and the medication changes are quite the chore. 

I'm also trying to master some indoor photography. I had a bit of fun. Mostly though I have been too tired from the week to do a whole lot.

Nina took her goats for a walk and had to have a dog help her keep her goats together.

[The fake foliage is actually a cheap pack of plastic fish tank plants! The green is a green fake grass mat. The rocks are what the fake plants were stuck in. How fun is that?]

I've got an idea or two to work on this week. It is so muddy and windy outside that I gave up on trying to set things up right close to the house in the yard.

Hello March. What a month you already have been!

Well now

No Slime Today

Aren't you relieved?

I believe this is a purple finch. Hubby has been spotting them and I am usually too late with the camera to catch them.

Catching it in flight was completely an accident.
 

Most of the afternoon I hung out on the porch and did weeding and watering those plants that don't get much moisture because they are so close to the porch that the eaves keep the rain off them.

I was awaiting a return phone call after being shuffled around by the VA Community Care People. 30 minutes after being transferred 3 times, I got voice mail.

Community Care is sometimes frustrating. Communications between a non VA provider and the VA itself is tenuous a best. A medication was ordered for hubby two months ago. He still had a 'rescue' inhaler so it wasn't a vital medication.

However, the non VA provider followed her instructions that the VA provided and ordered the medication. It went 'somewhere'. I followed up by contacting several people and finally landed on a person who said she'd handle it.

That was 4 weeks ago. So I looked up hubby's info in MyChart and noted that the CC gal had called the local doctors office and gave the clinic the info for faxing or calling in meds.

The local doctor's office used HER name in ordering the medication. The VA pharmacy said no one by that name worked in that pharmacy. And that is where it was dropped.

So there was miscommunication between CC, the pharmacy, and the local doctor's nurse.

I need to draw them a chart on how to order meds, I think. 

Today I made more phone calls.

The solution was simple, whoever wrote down the fax number for sending in medications, wrote one digit off. A 1 instead of a 7. Or perhaps the handwriting was sloppy? Who knows?

Well now.

So it goes. 

Navigating Health care sure takes a good deal of effort on any person's part.

What next??

I know I have harped on my Severe Osteoporosis diagnosis since last September. It struck me very hard and I was stunned to find out that my stupid body had failed me. I did all sorts of tests and a full work up. Heart, lungs, BP, eyes, and blood work came back pretty darned good for an old fart.

But my basic construction was falling apart. 
I started to worry about hikes, about the normal things I'd been doing all along. Suddenly they felt like huge issues.

It has messed with my mind to say the least. My osteoporosis score in the low lumbar region was 2/10ths of a percent under a 99 year old frail person. I was nearly off the charts in a bad way.

The consensus was to start taking bone building medications. The first line was a generic form of Fosomax. After three months, the meds and I didn't get along. Fast forward to the second medication, which I didn't do well on.

In the mean time, I went back to the CrossFit gym for some Mobility Classes. I needed the exercise and gentle stretching. The class is geared to any aged person and improves strength and balance. Well, that is, if you stick with it.

Here is a photo from one of the classes. See? CrossFit isn't a bunch of burly dudes running around throwing weights and beating their chests. It can be so much more. I'm on the left and a good friend of mine is on the right. The Mobility Class has teens to elderly adults in it. 

Yesterday, I had a phone visit with the Endocrinologist. We discussed medications and the pros and cons of the medication called Prolia. It is an injection once every 6 months. The downside of the medication is that at the end of 10 years of this medication, you have to take another medication to prevent relapse.

It is complicated. Prolia builds the bone and keeps the cells from breaking down. It is a monoclonal antibody.

We discussed the fact that so far, I've had no fractures anywhere in my body. She attributes that to my activity level. 

I asked if I could take a reprieve from medications and try a different route for a while:
hiking - low impact - free weights - balance and mobility exercises. Good diet with milk for calcium and foods with vitamins in them.

I explained that the medications worked backwards on me. I had a hard time staying physically active.

She thought this was a good idea and she said she was very open to it. 

Note: This doctor listened to me and explained the benefits of the medications along with saying that new meds are being found all of the time that may help. She didn't speak down to me. She didn't get that air of being far superior.
She even said that it was my body and this felt like a good short term plan to see if I could improve things a bit on my own.

So here are a few things to consider. I signed up to go back to the gym for Mobility Classes and some personal training to tailor exercises for my specific needs.

I was asked why would I spend that money like that? 

Easy.
The cost of the exercises at the gym are far less than medications cost and far less than physical therapy costs.

The benefits for me are multi faceted. I live with a shut-in who doesn't socialize. I get exercise and social interaction at the same time. Plus I suck at doing exercises at home on my own.

Bonus points: It helps my mental and physical well being.

I must be odd...

I am taking the Teriparatide injection for  Severe Osteoporosis. It fairly fine for the first month. I think. It is not painful to inject and it was actually easier to remember to do. Easier than taking the Fosomax pill which was icky beyond belief.

After 3 weeks I started to get some aches and pains in my legs. Charlie Horses, pain behind the knee, pain in front of the knee, what felt like shin splints [if you ever have been a runner]. I wrote the issues off to the fact that I was hiking looking for morels and gardening more. 

Then I realized that I was not actually hiking more or being more active at all. In fact I was so tired some of the time I'd elect to take a nap rather than get out and do yard work. 

Sunday night it came to a head. I'd had a great day. But after sitting for a bit and watching Rich's new favorite series -- Wicked Tuna -- my leg and hands started to hurt more. My hands I'd written off to all the gardening and the Heberden and Bouchard nodes [arthritis of the finger joints] just being angry at pulling weeds. But they also felt swollen. I had a hard time picking small items up.

OH NO! How was I to mess with my tiny Lego People and my Squatch!  HMMM???

Yeah, my mind is strange.

By bedtime I could barely walk. 

I hurt so badly that I decided not to take an injection. It hurt too much to even walk into the other room.

By midnight I was sobbing in pain, wondering how to resolve this issue. Did I drive to the local ER? No! I couldn't leave my hubby along in case...well, in case something went terribly wrong.

I used ice, I used heat, I elevated the leg. I rubbed it, stripped it and found out that the only way to stop my pain was to simply stand up and stand still. 

This MADE no sense. Sorry for the shout out. But it made no sense and I was so worn out from the pain and from the worry. NO way was I going to stand all night.

Ok. So I looked up the medication I am taking. It works by activating the parathyroid in your body to produce hormones that will build your bones. That sounds like a miracle.

Side note. If your parathyroid is over active it can cause something called hyperparathyroidism which leads to Hyercalcemia.  Big Words for some icky feelings. That is my oversimplification. 

Bone pain, muscle weakness, muscle pain, joint pain, fatigue,...side effects from this medication can cause bone pain, muscle pain, fatigue, brain fog, increased thirst, ... well you know how those labels read don't you? There is always a mile long list of things you really need to know...but don't want to know.

That all said, it remains to be seen if the medication is doing its proper work or am I suffering from a side effect that caused my parathyroid to release too much calcium into my bloodstream which causes more injury than it helps and can eventually cause well...

death.

One shouldn't look this sh-t up in the middle of the night when they are suffering from pain, right? But we all do it in the internet age. Was I over reacting? I don't know. But in the middle of the night

the boogey man likes to visit those sleep deprived minds.

8AM rolled around and I called the nurse at the Endocrinology department. She asked several questions and I answered. 

Pain level at its worst? Can it be more than 10? Can it be passing out bad?

She said she'd get back to me after talking with the doctor.

I waited all day. I gimped around the house and sat in my partially completed flower garden. By afternoon I decided to put pillows up under my legs and take more Tylenol. 

Later I went back outside to plant some seeds and wait.

No calls.

I gimped up the hill to water the mules. I gimped around to move the goat and the pony. 

I skipped another injection. This medication doesn't stay in your system for long periods of time.

So I am doing my own experiment. 

The pain level was 10 on Sunday night.

The pain level was 8 all day yesterday.

I can walk today. I have stiffness in the leg and a minor ache. 

Pain level this morning? Like a 3!

But.

I am not in agony.

I'm very curious as to what the doctor will have to say to me if the nurses ever decide to call back.

Today? I have other things to do.

Charlie goes in for a tooth extraction! How that little dog cracked a tooth is beyond me.

So it goes. 

What next?

Catching up

Monday was my day for a lesson in how to administer a shot with the Osteoporosis medicine. 

First, let me say that the very idea of giving myself a shot daily was really not my idea of any kind of fun. I used to be deathly afraid of needles, but bearing children cured me of that.

So onward I bravely went to my appointment. Just about when I got there my Tire Pressure thingy went off with a little ding. I read the pressure on the tires and was alarmed to see 9 pounds difference in my front tires. 

Compound the stress of thinking about a shot and having to park in an underground garage that reminded me of all those movies ... where either a monster comes out or guys with blazing guns blow stuff up. Ewww.

My tire looked a bit low. So I decided that after the appointment I'd drive the half mile over to the dealer and get it looked at.

The nurses asked if I was nervous and I said "Not as nervous as I am regarding the low tire pressure!" 

The needle is so tiny! It is a micro needle and the hardest part of the whole thing was using the alcohol swab to clean my tummy. 

I left the dark, scary underground garage and pulled into the dealership. The service guy was nice and explained that there would be a wait for the lift. Next he told me [an hour later after watching the Drew Barrymore show 👎 ] that I had a faulty Tire Valve. In fact all of them were faulty but not bad. 

I smiled and asked him if it was the same valves as we replaced about 6 months ago. 

That through him for a loop. But I have to give the kid credit. He was polite and took care of replacing the faulty leaky one right away. I told him my appointment for 36K miles was next Monday and we'd address all the issues with the TPM system. 

I had to stop at the grocery store to pick up some pizza and milk on the way home. 
Jeeze. Don't you know it? Someone bumped into my front right bumper and bent the heavy rubber plastic around the fog light. 

Smacking forehead...

Tuesday was so bright and full of sunshine, but cold. I had to finish cleaning up the indoor pony pen and eeeks...drive the skid steer with its bucket full and dump it!

I braved that and then decided to get the old 4 wheeler out of winter storage. I put in the battery and got the old bird started. I noted that the front tires were soft.

I got out the Air Stick Thingy and tested the tires! No pressure! I got it to the Air Filler Up Thingy ... lo and behold. I got the tires filled correctly.

There was no stopping me now! It is pictured below just before I washed it. I filled the cart up twice with sticks and branches from the yard and drove it out to my brush piles.

I looked around at finding a UTV and I decided to forget it. I could replace my Subaru Outback for the cost of one right now and everywhere I looked the used ones were very pricey and new ones were all on back order.

After we were done with the yard work, I unhooked the cart and took Charlie for a nice little ride out back and around. He loves riding the 4 Wheeler. We go slow and enjoy ourselves.

Our CrossFit gym is doing a special summer class for Mobility and Balance. I sent off a message to get information on it. I do much better with daily exercise if I am with others. I do fine hiking on my own, but social exercise is a bonus for me.

Tires and engines. I really don't like them very much. But I feel that I accomplished a lot by driving the skid steer and getting the 4 wheeler ready for spring. Next up? I suppose the rider mower? EEEEKS!

My Osteoblasts are fighting my Osteoclasts!

 

I thought this was interesting in a way. I had a visit with an Endocrinologist yesterday. The first line of meds for those folks with bone loss is a med called Alendrontae. I did not get along with that medication at all. I didn't suffer GI issues, but the other issues were pretty severe. 

An Endocrinologist treats conditions related to the body's hormone issues. Apparently some hormonal part of my body forgot to tell the Osteoclasts to quit with the TNT sabotage or perhaps my Osteoblasts went on vacation?

Emily, the PA, was excellent at going over everything and asking the questions she needed to. She spoke directly to me and looked me in the eye. She did not stare at the keyboard and just type. 
She then told me what she was writing as she typed it into my visit notes.

We discussed the severity of my Osteoporosis. A score of -2.6 is severe. That is in my right hip joint. You know the part that swivels the hips? But wait! 
GO Big or Go Home!

My low back has a score of -4.4 

And what does that mean? Kinda like my bone loss is equivalent to a really really old lady? 

I prefer to think of myself as having bird bones, except I can't fly.

So some medication choices were discussed. The first med I tried made me extremely sick but is generally the first line of medication choices and works well. They are in a class of bisphosphates which my system doesn't like much.

So we discussed alternatives. Two meds that actually help rebuild bone use daily injections for 18 months. After 18 months, a med that is supposed to maintain the Osteoblast Guys and prevent the Osteoclasts from blowing me up is taken for the rest of my life.

So hmm. The rebuilders are called: Foteo and Tymlos. Average cost with no coverage per month for these meds are about $2000. I don't see it in the formulary for my medications. However the doctor has someone doing some research. 

The alternate maintenance med is in the formulary.

Osteoporosis is not painful. It is arthritis that hurts along with fractures. The diagnosis really threw me for a loop. I'm supposed to be Superwoman, right?  

Exercise in the proper way, good diet, and positive outlook are all helpful ingredients that cannot be found in a pill.

Because of the severity, I have a few recommendations. No skydiving, no jumping rope, no box jumps, no running~like distance running, and no twisting with weights or heavy weights over my head.

Good recommendations. Continue daily hiking, do weight bearing exercises, fresh air. Walk the dog, enjoy everyday.