Telemedicine visit was mostly good news today

 I just finished my first month on the sample pack my doctor gave me of the Xarelto blood thinner for the clots in my left leg.  Imagine my surprise when I went to pick up the prescription for the next 30 days and it was $467.16.  Wow!  It's just like street drugs, the first one is free!  I called my agent that handles my Medicare Drug Supplement and thankfully, it is on the list of covered drugs but unfortunately for my wallet, there is a $400 annual deductible and then it should be less than $100 per month.  I've already seen improvement in the swelling in my lower leg, thanks to this miracle drug and my stylish compression stocking that goes all the way up to my crotch.  I have a greater understanding and compassion now for what women go through with pantyhose!

I had a nice telemedicine visit with my doctor this afternoon and we went over a range of things.  The 17 vials of bloodwork didn't reveal any anomalies that could lead to clotting.  I did mention that I had forgotten all about my 3200-mile road trip around the Midwest in early August and now felt that it was a contributing factor.  Doc said it might also be one of the side effects of the Covid that I had in June in Kenya, he had seen one other patient that began clotting after a bout with the virus.

The good news is that I will probably only need to be on this drug until mid-December and maybe use it as a preventative before long road trips or flights to Africa.  I am going to have my leg re-examined with ultrasound equipment in early December and then we'll go from there.  Doc did give me the history of how things went before these newer drugs.  You needed to start them in the hospital at great expense and then you went on Coumadin, also expensive, which required blood work every few weeks to monitor its effects.  So, while these meds, including Eliquis are expensive since there are no generics yet, they are far more cost effective than earlier treatments were.  My prayer is 3 months and done is what will happen.

When I do a road trip from now on, I need to follow my usual practices for plane flights.  Get up every hour and a half maximum, stay hydrated, stretch out, walk to keep blood flowing and use common sense.  I can do that!

Thanks everybody for your concern, I'll keep you posted as the journey continues.  The picture to go with this post is an Osprey with a freshly caught fish at Lake Georgetown.  I know it just caught it because I saw it and it still has its head.  The first thing the Osprey will do when it gets to a tree on shore is to bite the head off.  It takes the fight right out of the fish!  Blessings everyone!

A nice surprise this morning!

 Thank you, Jesus! I woke up this morning and my left leg was nearly the same as the right one.  I didn't expect to see improvement so soon.  Time will tell and we'll see how much swelling I have by tonight.  It's a great relief to take the thigh high compression stocking off before bed, I've had quite enough of it by then!

I had an "Aha" moment yesterday which made me go "Duh" to myself.  While my doctor and myself were concentrating on the effects of my long flights to and from Kenya earlier in the year, I had completely forgotten about my nearly 3200 mile road trip last month.  I'm sure too much sitting is not good for you at sea level either!  I've always been very careful to stay well hydrated on long flights, meaning I have to get up about every hour and a half or so when nature calls and I stretch out for a while each time I'm up.  This would explain how this occurred well after the Africa trip. When I talk to to Doc this week, I'm going to confess and I'm sure we'll both get a good laugh out of me having a major senior moment.  Wow.  Maybe 17 vials of blood work weren't necessary after all.  I hope I don't see a bill for all of that!

Osprey flyby at Lake Georgetown

Thanks again for all of your prayers and well wishes, I'm convinced they make a difference, both for you and for me.  There is great power in prayer.  The answer is always yes, no or wait.  Many times when wait is the answer, in hindsight it was the best possible answer because I didn't know what I was asking and He had something better in store for me or there was a lesson I needed to be taught.  As my friends in Kenya are fond of saying "God is Good all the time!" and the reply always is "All the time, God is Good!"

The waiting is the hardest part...

My Friday morning Bible study group men laid hands on me and prayed over me this morning, adding to your prayers. This ancient practice brings amazing peace and relief, knowing that our loving Father is in charge.  I am so thankful for my community of faith at Redeemer and my many friends on Facebook and in the real world that have checked in on me with encouragement and thoughts and prayers for healing.

When angels are near, Cardinals appear!

The title of this post says it all, according to a Tom Petty song, the waiting is the hardest part.  I really don't like question marks, I like to know what the next steps are and then get after it.  I'm thankful that my doctor got the blood thinner going immediately for me.  I have no idea how long 17 vials worth of blood tests take to process, but my preference is to know what's going on before the weekend rather than waiting until Monday.  It's human nature to want it all and to want it now!  We looked at Noah this morning and the 120 years it may have taken him to build the Ark, all the while being ridiculed by his neighbors.  I need to take a lesson in patience from him!

I'll post here again as I get filled in, thanks everybody for your caring and love.  It's truly humbling.

Blood clots! Another little bump in the road...

 A new adventure started this week.  For the last month, I noticed some swelling in my left leg from the knee to the ankle at the end of each day.  After a good night's sleep, it would return to nearly normal.  I've had a chronic issue with circulation for years in this leg and take daily penicillin to keep it under control.  I got into my general practitioner yesterday after calling for an appointment Wednesday.  As an aside, to you younger readers, make a point of living until you're 65.  After you're on Medicare, you get immediate attention.  I used to wait a month for them to get me in if I wasn't in the middle of dying.  I arrived yesterday afternoon and checked in with the desk.  I sat in the waiting area and looked at my paperwork and discovered I was not 70 year old Dave DeVore anymore but had become an 86 year old woman named Hilda with severe back pain.  All of the ladies at the check-in counter got a big kick out it when I announced that I was not female nor 86 years old!

I told my doctor about my bout of Covid in early June in Kenya and he thought the swelling might have been a result of the long flights and my age catching up to me.  But I pointed out the swelling didn't start up for more than a month after I returned, so it got him thinking about other possible causes.  Anyway, after examining the leg, my doctor prescribed a thigh high compression stocking and had me get some blood work.  The phlebotomist agreed I was not 86 and drew the blood.  My doc also  set me up with an ultrasound for today to look for clots, just in case.  I had a really cool lab tech, Manuel.  He began running the test, probing the major veins from the top of my leg to the ankle.  I asked him if while he was at it could he check to see if I'm pregnant or not.  He got a big kick out of my political incorrectness.  When he got to the knee area he said "Uh oh!"  This is something you don't want to hear from your brain surgeon, your computer guy or a lab tech during an exam.  He just said he had found clotting and when he was done told me to stay in the waiting room until my doctor could be contacted with the results.  I thought it was a sure thing that my next stop would be the hospital.

My doctor instructed the lab to send me home and while I was on the expressway, he called me.  He explained that the situation is serious enough that he wanted me to come in for blood work right away and to start a sample pack of Xarelto, the latest blood thinner that doesn't cause bleeding ulcers quite like Coumadin was known for.  He stressed that the worst case scenario is a blood clot breaks away and travels to the lungs with deadly results, so he had my full attention.  He also told me I needed a lot of blood tests because once I was on the medication the tests wouldn't give good results and he had several scenarios to test for.  I wolfed down some lunch and headed back downtown.  I told the check-in staff that I still wasn't an 86 year old woman.  They will definitely remember me from now on!  I got the same tech to do my bloodwork and she decided to work on the other arm.  She couldn't believe the number of tests on the lab order and had to look up codes on the computer for some of them.  One of her co-workers stepped in and helped with the codes and the labeling of the vials that would contain each set of tests.  It took about 10 minutes to get sorted out.  After all was said and done, there were 17 vials of blood.  I asked for a glass of orange juice and they gave me a juice pack.  I was worried I might get a little woozy on the way back to my truck.  I thanked the lab folks and said I felt I had been drained by a vampire!

I expect I'll get results of the blood work either tomorrow or Monday and know what other treatment options are called for.  If all remains as it is now, I should be on the meds for about 3 months.  It will keep more clots from forming and my body will dissolve the ones that are already there through natural processes. 

Please keep me in your prayers for healing.  I feel fine and am in no pain, so hopefully this will be just another bump in the road.  After having kidney stones removed, a hip replacement and prostate cancer treated with radiation, I was really hoping for 5 years or more of things being boring.  I guess my plan is not the real one! 

My first follow up with my urologist was mostly good news

 As usual, I don't think it's possible to have a urologist's appointment without giving a urine sample, so I did!  I also got to show a picture of the day to the nurses and my doctor and they liked this one. It's the same one I showed at the radiation lab last week when I got my blood work done, but they hadn't seen it yet.  After taking my blood pressure, the volume of my bladder was scanned.  Once these preliminary formalities were out of the way, my urologist came into the exam room and told me he was happy at this point that my PSA level was undetectable, the lab report showed it was less than 0.05.  I was told that we will be monitoring it every 3 or 4 months for the next 2 years, but that we were definitely starting out on good footing.  Once my testosterone levels begin to rise in early November, there may be some changes in the PSA.  He was not so pleased with the fact that my bladder was not empty enough after my urine test.  This could be a sign of incomplete healing from the radiation treatments or maybe an infection, among other possibilities.  So, we set a followup appointment to measure how my bladder is doing in another month's time.  I'm not in any discomfort but I am very blessed to have such a great medical team that is paying attention to every little detail.  More to follow as the adventure continues.

The picture of the day is of a Hummingbird hovering at a spider web, a lucky shot if I ever got one!

Follow-up began today with a PSA blood test

 I drove to the radiation lab in a monsoon, something we haven't seen here in Austin for months.  I welcome the rain, but the road was slick after such a long drought.  I arrived a few minutes before my 1 pm appointment and showed my picture of the day to Isabel at the front desk as she took my temperature and got me checked in.  

The reason for my visit was to get my PSA checked via a blood test in advance of a visit to my urologist next Thursday.  My understanding is that the first reading can be almost anything from 0 to twice the reading I had before the radiation and hormone therapy started.  It is used to begin to establish a baseline for what the new normal is going to be.  I will be tested periodically for the next couple of years to try to determine what the range is that it will eventually settle into.

I had a great time, I was able to go to the back and see the radiation therapists and visit with them about their lives and of course, everybody wanted to see the picture I brought with me this time.  It was nice to hear about modified upcoming wedding plans and everybody wanted to know how well I was recovering.  I was happy to report that every side effect was getting better by the day.

Here is the picture of the day, a Black-chinned Hummingbird at the Mueller Greenway butterfly garden that I took on August 1st.  It was so cool that I was able to capture this image with the cobweb in just the right position.

The Final Radiation Treatment. Thank you, Jesus!

I can't begin to express how relieved I am to get my schedule back again after my final treatment today.  While there will be followup doctor's appointments and lab work in the months to come, the 9 week daily grind of absolutely, positively having to be somewhere every day does take its toll, particularly when it is in the middle of the work day.  

I am proud to say I was never late for even one appointment and also have a perfect record of demonstrating the joy a serious Christian should have to all I have encountered, even on days when I didn't exactly feel like it.  Just being joyful no matter what the circumstances you find yourself in can be a very powerful witness, it really doesn't require any special words or favorite Bible verses.  It does cause people to wonder why you are the way you are and that's when you can give them an honest answer, telling how much Jesus has done for you and how it's a gift that is available to all who believe.  This giving a testimony by the way you live has never failed me, even in foreign lands and in dealing with people of other faiths.  Rather than beating someone over the head with "My way is better than your way!", waiting for a sincere question works like a charm.  There is no wrong answer if someone really wants to know what makes you tick.  It does take time and relationship building.  The person may come away thinking you are crazy or a zealot, but they will know what your sincere world view is when you're done with your story.  And sometimes, being moved by the Spirit, they want to know more.

I checked in as usual, showing the front office staff my picture of the day and getting my temperature taken for the last time (I always ask if I'm going to live because it's always 96 degrees after coming in from my air conditioned truck!).  I went to the waiting room and listened for them to call for Mr. DeVore.  I tried as hard as I could and still never got them to yell out for Dave or even Mr. Dave.  They are well trained and their mothers brought them up right.  One last time showing the radiation techs my smile of the day, which is what I call the picture.  Then telling them my birthday to make sure I wasn't some impostor just wanting to get some radiation and one last time getting comfy in my body cast.  I thought it was actually a rigid cast of me from the waist down and asked at one point if I could take it home, paint it pink and use it as lawn art to moon my neighbors.  That got some laughs! It turns out it has air in it and they sanitize it, deflate it and use it for the next guy.  Oh well, it was a funny thought.  After positioning me in the radiation machine, the technicians left the room to go behind the slowly closing lead door. I laid there motionless, listening to my last song in that room, which turned out to be piano music like you would hear in a hotel lounge.  I don't know if they have a music service, I've never heard any commercials, but they do play a lot of 60's and 70's stuff for us old guys.  It makes the time go.  The piano music threw me for a loop, I was expecting Beatles or Led Zepellin.  Kind of a surreal ending note!  Once in position, I was looking up at the ceiling.  They have transparent pictures of clouds and blue sky covering the fluorescent lighting.  I really need to get them to put some of my pictures up there, the clouds never change and have gotten pretty boring after all this time. 

Once my treatment was done, I had gotten dressed and made the obligatory mad dash to the bathroom, the staff surprised me with a going away celebration.  Not really a surprise, I knew it was coming, a client of mine had gone through the process at this clinic a few years ago and spoiled it, plus I had suspected several other completion parties during my 9 weeks when I could hear clapping and cheering.  As I rounded the corner to leave the clinic for the last time, at least for treatment, there was the staff, just as I thought, clapping and cheering.  They handed me a bell to ring as much and as loud as I could.  I told them after ringing it with vigor that now I also needed hearing aids!  I was informed of what my next steps would be, blood work and followup visits with my urologist in 1 month and with the radiation oncologist a month or two later.  I was given a bag of goodies, including a diploma and a lucky horseshoe to remind me of them.  When it was my turn to speak, I thanked everybody and told them I had something for them as well.  A printed out thank you note and a different picture for each of them.

I gave a copy to each of the folks at the clinic that I know by name along with a personal thank you written on it and each person got a different one of my nature photos that I printed out myself as 4x6 images.  The ones I never met also got an envelope with the generic thank you and their own picture.  I made 15 of them, figuring about 12 to 15 staff members work at the clinic.  I told the doctor that I thought about a dozen people worked in his practice, but that I had made 15 packages just in case.  He said a total of 15 worked there.  I think a God thing happened!  I gave him the extra ones for those that couldn't be there and we said our goodbyes.

Following is the text of the open letter to everyone in the urology practice that has treated me:

I thank the Lord for each one of you!  For some of you, mostly the front-line staff, I have been able to bring a smile to you daily with my nature photography.  I am fully aware that there are many more folks behind the scenes doing lab work, designing treatment plans, determining radiation dosages, doing necessary back office tasks and assisting in and performing the various outpatient procedures I’ve needed leading up to my sessions at the radiation oncology center.  The professionalism you have all exhibited has been outstanding.  Regardless of the situation, you have made me feel like I am the only person in the world at that moment.  This is something I strive to do in my own business endeavors, it takes a conscious effort and a natural heart for serving people.  Well done everybody!

As some of you know, I have written a blog detailing my journey with you.  It does not include the name of the medical practice or any of your own names, but I would be glad to share my experiences privately with anyone who asks me or wants a reference from you.  The main goal in writing this blog has been to encourage others, both men and women, to get annual checkups so problems can be detected while they are still treatable.  A major passion in my life is nature photography, so I have brought in a picture a day to each of my 45 radiation sessions and other appointments and you have been eager to see them.  At first, I was suspected of bringing in National Geographic photos, but I pointed out that my copyright watermark is on each of them!  These pictures of the day are at the end of each blog post and in a Google album I made just for you.  Please feel free to follow my photography on Facebook, where I am Dave DeVore.  I have posted at least one picture per day there since January 1^st of 2015 and I credit this discipline for my steady progress.  I currently have over 2000 FB friends and there are many more that look at my work daily, so please friend me or you can just stalk me from the shadows!  I have a professional photography web site at www.photoartbydave.com where it is free to look at my images from central Texas and around the world, including photos from my 19 trips to Kenya.  I have split my time there between leading missionary teams in the slums of Nairobi to correct vision problems for free and instructing anyone in nature photography who wished to stay for 4 or 5 days after our vision clinic was over, always at the best game parks in the world.  It has been quite an adventure!

My blog can be viewed at http://davesexcellentadventures.blogspot.com and the link to the Google photo album I have kept while I have been with you is at: https://photos.app.goo.gl/e7TJALr9jSDha94K6

You have all become an important part of my life during these last 9 weeks and I will truly miss you.  I look forward to bumping into you during follow up visits and maybe out in real life.  It may be hard to recognize each other since we’ve been masked this whole time!  My hope is that when you think of me, you’ll remember that joyful Dave guy with the pictures who always tried to bring a smile  with a kind word or a bad joke.  We have laughed a lot together, it promotes healing, both physical and spiritual.  Please send me an email if you would like an electronic version of this document to make following the web links easier for you.  Blessings to each of you, you have been a huge blessing to me.  Amen!

Dave DeVore, info@photoartbydave.com or cell or text: 512-815-5045. 

The last picture of the day, for this phase of my relationship with the clinic anyway, is of a Black-chinned Hummingbird sipping from a Texas Red Yucca plant at the South Mueller Greenway butterfly garden.