Thursday, July 22, 2010

Top 10 Ways To Get Out Of The Hospital Alive

"A hospital is no place to be sick." ~ Samuel Goldwyn

Anyone who has spent any amount of time in a hospital is aware of how difficult it is to be in one. Between being sick, emotional stress, lack of sleep, a million people in and out of your room, overworked nurses, fresh right out of medical school residents, etc., it can be nothing short of a nightmare. I have had the distinct pleasure of being hospitalized four times in the past year and a half and I think I have learned a few things along the way that may be worthy of passing on. Hopefully you will never need to know them but just in case, here we go:

1. Always carry a list of your medications on you either in your purse or your wallet. This is especially important if you take multiple medications. I know, you are going to sit back and say "well I only take one or two, I know them by heart." Trust me, when they are hooking you up to all kind of machines and sticking needles in you left and right; it is hard enough to even remember who you are, never mind your medications.

2. Ask your nurse to tell you every medication she gives you and what the dosage is. Everyone makes mistakes and I have to tell you, I have caught some whopper mistakes. Personally, I think the hospitals with the best nurses will bring the medications to you still in the package and open them in front of you while telling you what each one is.

3. Make sure the doctor in charge of your care orders ALL of your medications, not just the prescription ones. This may mean you have to bring/use your own stash. Sometimes pharmacies may not carry a certain prescription medication and forget about getting something non-prescription most of the time. I was in a situation where a doctor said I would be OK not taking a prescription eye drop for a few days that the hospital did not carry. I am sure my eye doctor would have thought differently. So what did I do? I had the eye drops in my purse. I told the nurse I was using them (this is VERY important) and I used them. No need to make one medical problem worse while you are trying to fix another, right?

4. Write everything down if you are able to. If you are too sick, ask your doctor/nurse to write down anything important they just told you. You are much too stressed, too sick, and too exhausted to be expected to remember anything that is told to you.

5. You will not sleep in the hospital unless you are doped up on so many drugs that you have no choice. For the average person though, this is not the case. Ask for sleeping medication to be ordered for you. Sleeping medication is usually ordered on an as needed basis, so you get to decide if you need it later or not. The best time to ask for this is when the doctor comes in to do your initial evaluation when you are admitted. If your forget, ask your nurse as soon as you remember. It is a lot easier to get a doctor's order while they are around rather than at 2am when you just want to cry because you are exhausted and can't sleep.

6. Speaking of sleep, try to get it when you can. This may mean shutting off your phone, asking visitors not to come, etc. Anyone who knows anything about good sleep hygiene will tell you don't nap during the day as you won't sleep at night. I say to hell with that, this is the hospital. People are going to wake you up at 4am to take your blood pressure even though it has been normal your entire life and you are sleeping for the first time in two days. Nap when you can, even if it is 4pm. You will be grateful later that you did.

7. If you are not a frequent flyer to the hospital or something really critical is going on, try to have someone with you during the day and not just anyone. Don't automatically think the person closest to you in your everyday life is the best choice. Try to pick someone who can handle you at your worse, can stay calm when it all hits the fan, and will advocate for you. The last thing you need is someone hovering over you every minute saying "oh my god, oh my god." Have them take the notes if necessary and be direct with them about when you need to rest, sleep, or need them to smuggle in a stiff drink (OK, just kidding on that one).

8. Make nice with your nurse. He/she is your biggest ally (besides yourself) and your best chance for getting through the whole experience. If you can summon up the energy, try to establish a rapport with your nurse. Also, ask them if they can try to be your nurse the next time they are working (if you can stand them). A lot of hospitals try to do this but it can oftentimes get overlooked. There is something to be said for a nurse who already knows you and it allows for better continuity of care.

9. Know who is who and if you don't, ask them. They should also be checking your bracelet (that is why you have one!) and/or asking your name before they do anything to you such as give medications, draw blood, bring you for tests, etc.

10. This is the most important. When you know you are right or something does not feel right, speak up. And keep speaking up until the issue is resolved. There is a hierarchy in hospitals and it depends on whether it is a teaching hospital or not as to what the hierarchy is; but there is one. If it is a nursing care issue, start with your nurse and work up from there; everyone has a boss. In terms of the medical plan, speak with the doctor in charge of your care and if you are not getting the care or answers you need, ask to speak with their boss (usually a more senior resident or an attending physician).

I was once admitted from an emergency room. My pulmonologist (doctor who specializes in respiratory issues) made it clear to me what the plan would be overnight but the resident working on the floor did not follow the plan and this included breathing treatments and an increase in a medication. I was still having some difficulty breathing. I spoke with my nurse four times during the night who in turn called the doctor. He did not change anything and was too busy to come talk to me. By 6am, I told the nurse I was calling a family member to come pick me up ASAP (and I was serious-I would go to another hospital if I had to). Boy, did that doctor come to see me fast! I got a lecture about leaving a hospital AMA (against medical advice). I gave him a lecture about medical negligence. My pulmonologist was called at 6:30am on a Saturday. He agreed with me that the medical plan was not implemented. By this point, I had lost all trust in the people taking care of me and strongly felt that even if the plan was implemented now, that it was not a safe place for me to be. He agreed to discharge me with the medical plan we had initially discussed. The understanding was I would get back to the hospital if I needed to and I would stay with a family member. The pulmonologist agreed to see me in his office first thing Monday morning. Ultimately, I ended up making it through the weekend staying with family because I was implementing the medical plan my pulmonologist and I had put in place.

Now, I am not advocating to threaten to leave the hospital anytime you think something is not going right. This was a pretty unusual situation. Hospitals are very chaotic though; information does not get communicated and mistakes are made. However I think it goes to show that as a patient, you are the one ultimately responsible for your body and your medical care so listen, observe and most importantly, speak up!

Saturday, July 17, 2010

Molly and Me ~ Part Three

I was on a mission; one to save my dog from the hell she was in and one to save my sanity. I was fully aware that my regular vet just was not being very helpful because they did not appreciate the severity of the situation and in all honesty, did not have the experience to deal with this issue. A family member told me about an animal behavioral program at Tufts Veterinary Hospital and she thought maybe they could help Molly. I was willing to try anything at this point. I knew financially it would be difficult but I was willing to rearrange my financial priorities, even if it meant accessing my emergency fund.

It was truly one of the best decisions I ever made. Molly and I established a relationship with Dr. Ogata at the animal behavioral clinic and after leaving a two-hour evaluation, I walked away with the one thing I needed more than anything and that was hope. We then started what would be a very arduous journey that involved several different medication trials as well as a behavioral plan that would make your head spin. I was not a big fan of the medication aspect at first; I got a lot of criticism from people I told about the medication. Dr. Ogata put this in perspective for me though. She explained that it was more harmful and neglectful to continue to let Molly suffer. She pointed out that if a person was suffering from panic attacks, we would use medication to help their suffering. Her final point was that all the behavioral modification in the world would not do Molly any good if she was too anxious too participate. She needed the medication to calm her down enough to participate in the training. We tried at least 4-5 different medications in different combinations and doses, FINALLY finding the right combination that would allow me to implement the training program.

I cannot even adequately describe how intense this behavioral modification stuff was to implement. It was made more complicated by the fact that I did not keep a regular routine since I was out of work and had an unpredictable medical condition. However there is something to be said for being organized and well, a little Type A. After the initial evaluation, Dr. Ogata kept in touch with me through e-mail and the phone anywhere from once a week to as often as every other day reevaluating how Molly was doing and customizing her plan to her progress and oftentimes, to her lack of progress. Six months later, she actually was making progress. It wasn’t a sudden change but every week things got a little bit better and every week I began to see the light at the end of the tunnel.

One of the most critical things I did with Molly was get her exercising and around other dogs. Dr. Ogata had recommended as much exercise for her as possible but at times, my physical limitations made that difficult. That being said, I realized it was the best thing for her so even on those days I was in pain or severely fatigued, we walked as much as we could. What I didn’t expect is how much it would help me to the point that when we couldn’t walk, I really missed the physical activity and the positive effect it had on my well-being. We did puppy play dates with friend’s dogs. Our saving grace though was finding a dog park in a town ten minutes away. I had found out about it through a guy I had dated a few times who lived in the town where the park is. The guy ended up being well, we’ll save that for another time but the dog park was a godsend! We could walk the park and/or spend time in the dog park with other dogs and probably just as important for me, other people. Molly is definitely not the most energetic dog in the crowd but the socialization has done wonders for her. There is not too much that makes me happier than seeing her playing with other dogs and enjoying herself.

Today, it has been approximately 11 months since her first evaluation at Tufts and the difference is dramatic. She is still on two different medications for the separation anxiety, one of which I have recently begun to start weaning slowly. I still have to be quite conscious of how much time she is left alone (right now five hours which is quite an improvement from 5 minutes!) and the way I go about doing that. Putting her in a kennel to go away is out of the question but I have found ways to get around that with a fabulous dog sitter and friends/family for emergencies. We still do the behavioral therapy but the difference now is, it works! Its actually quite exciting to see her progress. She has stopped following me around the apartment and actually, I can spend hours at home and never even see her as she is very comfortable doing her own thing. I have to confess, it still brings tears to my eyes sometimes to come home, open my front door, glance at the top of the stairs and see her coming out of the bedroom calm, happy, and wagging her tail. I never thought I would see that.

As I have been writing these blog entries about Molly recently, it has really forced me to look back over the past 11 months and what she has taught me. I have been so caught up in the aspects of getting her better, I have not truly appreciated the impact she has had on my life since we went through that traumatic move last year. First, there is something to be said about owning a dog with another person (especially when there is a second dog in the household) versus being the sole owner. For us anyways, there is definitely a deeper level of connection than when we lived with my ex and Jake. I hope that my ex has gotten to experience that with Jake as well.

When the whole separation anxiety thing started and got out of control, many of my family and friends encouraged me to give her up. I was told that the situation would be too difficult for me to handle by myself with my health issues. I know they had my best intentions at heart; I was in a really tough predicament. Looking back, I remember people thinking/saying that I was over involved with her. Well, they were and are probably right. How could I not be? She was in trouble and unless you have ever had a dog in a similar situation, you cannot possibly know what it entails to get them to the other side so ultimately, I make no apologies for that. She has sustained me during a year that otherwise might not have turned out so well for me. Because of her anxiety, I was forced to get out of my apartment most days even when I would rather lie in bed and feel sorry for myself. She has reminded me of the value of unconditional love and loyalty. She has taught me how to go the distance with someone despite obstacles and naysayers. She has made me laugh despite the darkest of days.

Recently I was hospitalized unexpectedly for several days. Molly spent a night with my brother and then two days at a friend’s house (whom we met at the dog park!) I came home from the hospital exhausted, miserable, and discouraged because I had been feeling so much better until these recent events. All I wanted was to be hugged. Molly did her typical thing where she looked minimally excited to see me as is the case when I have left her with someone else overnight and just fell back into her routine. Prior to this hospitalization, she had been sleeping (voluntarily) in her crate or on the rug; occasionally blessing me with her presence in my bed. In all fairness, she had been having difficulty with a pulled groin muscle and the bed is pretty high. After being home for several hours and getting into bed though, she looked at me from her favorite spot on the rug and jumped into bed. As I was lying on my side, she nudged my arm and when I lifted it, threw herself under my arm. She then rested her head gently on my shoulder, pushing her body up against mine as much as she could. I opened my eyes the next morning to find us both in the same exact position and she was staring right at me. I don’t think she moved the whole night which has never happened before. At that moment, I knew without a doubt that she was mine and I was hers, forever.

Saturday, July 10, 2010

Molly and Me ~ Part Two

Molly and Jake were getting separated, the final decision had been made. My ex-husband and I were finally getting a divorce and despite all the difficult decisions we had to make, the most gut retching decision was what to do with Molly and Jake. It is still hard for me to try and explain that decision to people. Dog lovers especially do not understand how we could split them up after several years of having them live together. It was complicated and personal but the bottom line was, if they stayed together, one of us would have had to give them both up and in all reality, it was not feasible for either of us at that time to manage both dogs on our own. Once we realized this, the decision came down to which dog was going with which parent. Both dogs were equally attached to each of us it seemed. In all honesty, Jake had my heart more...he really did. However I knew my ex husband wouldn't survive without Jake. Jake was probably the only real friend he had left in the world and despite all the resentment and anger surrounding the divorce, I knew that Jake living with him was the right thing to do. I also knew that most likely once the dogs and the two of us were split, there would be no further contact. To this day, I still mourn him.

So Molly and I moved out to an apartment and started over. I can think of few times in my life that I have ever been as overwhelmed. I had lost my job due to a significant illness, gotten divorced, sold my home, and moved. I was struggling physically and financially. Every day was a challenge to keep a positive attitude and not be swallowed up the enormity of it all. Apparently, I was not the only one who was having a difficult transition. Although I did anticipate that the transition might be a little difficult for Molly, I was in no way prepared for how overwhelmed she would be. Those concerns about separation anxiety my ex husband and I had initially when thinking about adopting her, all of a sudden came out like a force of nature.

She completely fell apart within twenty-four hours of moving to the apartment. I am talking total puppy melt down. Within the first two trips (each lasting maybe an hour) I took out of my apartment after the move, she had gone completely insane. In our old home, we crated the dogs, each in a separate crate. For months before the move, we even moved each dog's crate into a separate room in preparation for the transition. Now, she couldn't tolerate her crate. She would howl/bark and hurt herself trying to get out. I tried everything. I mean after all, I had gone through this with Jake when we first got him. I used every behavioral technique I had used with him; which had worked. I even brought her to the vet who put her on a low dose of medication. I would come home to find her pacing, drooling, crying, blinds destroyed from her trying to escape out of the windows. She lost thirteen pounds because she was too anxious to eat. Even if I was home, she was always stalking me and anxious, wondering when I would leave her alone again. She would try and anticipate my every move; even walking across the street to the mailbox would set her off. Overnight my feisty independent girl became a completely different dog.

I was concerned about getting kicked out of the apartment. I had spent a lot of time finding the right place for both of us. It was a dog friendly farmhouse with a yard and plenty of room inside for her to roam around. If we couldn't make it work at this place, it just wasn't going to work anywhere. I only had one neighbor and a business next door, but they could hear her anytime I left the apartment. The barking and howling would start within five minutes of my departure. It was anxiety provoking for me when I left because I was so worried she would do something to seriously harm herself. Separation anxiety in dogs is usually progressive. If not appropriately treated, the behavior escalates and dogs have been known to do serious bodily damage to themselves, as well as to their environment. In addition to that, it was so clear to me how much she was suffering. It was like she was having a massive panic attack every time she was alone.

After about a month of this, it was getting to be more than I could handle. Getting myself to doctor appointments, tests, etc. was getting more and more difficult. She looked sickly. My vet at that time was not much help. Everything I tried failed. I remember coming home after going for some blood work to find her howling, shaking, pacing, and drooling. I literally sat on the floor with her that day, held her, and cried. I didn't know what to do. I did not want to give her up, yet this was no way to live for either one of us. I could not give her the home she needed. She needed a home with lots of people around or some type of rescue. Getting another dog was out of the question. I was fortunate enough to have family members, friends, and people I could hire on occasion to stay with her so I could get out but it was not a realistic, permanent solution financially or otherwise. As I was sitting on the floor with her and all these thoughts were running through my head, realization hit me head on. I had lost so much. She had lost so much. We were not going to lose each other...

Tuesday, July 6, 2010

Molly and Me ~ Part One...

"The one absolutely unselfish friend that man can have in this selfish world, the one that never deserts him, the one that never proves ungrateful or treacherous, is his dog...He will kiss the hand that has no food to offer; he will lick the wounds and sores that come encounter with the roughness of the world...When all other friends desert, he remains." ~ George G. Vest

She was never supposed to be mine, my dog Molly. Our intention was to go investigate a beautiful bluetick coonhound mix at the local shelter which had popped up on a search. We already had a coonhound mix named Jake and loved the breed with their graceful frames, hound faces, and delicate disposition. Apparently though, it was Molly's lucky day. We were told the bluetick coonhound did not get along well with other dogs, especially other male dogs. Although we were looking for another dog, it was not an urgent matter and we wanted to choose the best companion for Jake. Even though we glanced at some of the other pens on the way out of the shelter, it looked like we were going home empty handed.

I turned the last corner to leave the shelter though and there she was. I thought to myself "what the hell is that?" I thought she was one of the most bizarre dogs I had ever seen. A friend of mine recently referred to her as a product of "design by committee"; meaning it looked like a bunch of people gathered together and each one put a body piece together to form who we now know as Molly. If you look up the term "design by committee", some of its defining characteristics include logical flaws and lack of a unifying vision. Well by looking at her, that certainly seemed like the truth! She was just an odd assortment of parts all put together. She definitely was part basset hound as evidenced by the size of her paws, short stature, and long (although not basset hound long) ears. However that basset hound parent of hers definitely got mixed up in something sketchy which has yet to be determined.. Some people say the rest of her looks like black lab. She has a brindle color which has had a few non-dog educated people claim she must have pit bull in her. I guess some people have never observed the tri-color pattern of a purebred basset hound, the white, black, and brown.

My ex-husband was apparently thinking she was too bizarre as well (plus he really had his mind set on another coonhound), because he kept shaking his head. We were a little concerned because she had been brought in with a brother who was subsequently diagnosed with heartworm and was adopted by another family a few days prior to the day we first saw her at the shelter. They could not afford to take both dogs as Molly had just finished being treated for Lyme Disease and they were concerned about medical costs for both dogs. We had been in a similar situation with separating dog siblings when we adopted Jake. He got separated from his brother when he was brought to the shelter four years prior because his brother had to be put down for aggression issues. After dealing with his separation anxiety once we had him at home, it gave us reason to think twice about the possibility of dealing with that issue again; we finally had worked through it...did we want to entertain the possibility of going through that all over again with a second dog?

There was something about her though. I am typically so practical and I overanalyze things until everyone around me wants to run, but I didn't care in this case. I would come to understand years later, she was meant to be mine and I hers. I just had to see her and interact with her up close. So Molly got taken out of the pen and began her show. Within seconds, she had thrown herself on her back anticipating a belly rub and we truly thought her tail would break into a million pieces because it was thumping on the floor so hard. On top of that, she added in some of her classic moans and howls to sweeten the deal. And that, as they say, was all she wrote...

She actually did really well with the transition to her new home. She was quite the spitfire though. Poor Jake could rarely get a moment's rest, my ex husband constantly had to be worried about being suffocated while watching TV. She felt the need to throw her whole body over his face and try to smother him at times, which of course she never did to me-smart dog! Overall she just kept things lively. She was stubborn and although affectionate, she was not the one that would be the first to comfort...that was Jake's job. It was always interesting to observe the difference in the two of them. Molly seemed so much more engaged but not as sensitive. Jake, on the other hand, was the one who could sense me crying from the opposite end of the house and would immediately came to my side. Actually, I didn't even need to be crying; he could sense my need for him just by being in the house with me. They made a perfect pair but like many pairs, their time together was about to come to an end....