Coffee heat rising

Live-Blogging from the Doc’s Office

So…here I am at the dermatologist’s office…AGAIN. Ten minutes early: didn’t take as long to fight the traffic as usual. Only one moron, all the way across 103 north-south avenues and six east-west main drags.

Ah! This is amusing. I see typing on a keyboard annoys my fellow waiting-room inmates. Some woman just got up and moved herself closer to the (annoying!) yakathon television. To keep the patients calm, this particular practice serenades us with an UNENDING loop of some TV home-improvement show episodes. On and boringly on about ripping out shelving and installing cabinetry and fixing the plumbing. Sooo soothing…

Young Dr. Kildare’s office is right around the corner – this being the dermatology practice he likes to refer his patients to. Consumed a third of a tank of gas a couple days ago to consult with him about a weird traffic event in which I damn near killed four people by trying to pass an aggressive moron who I thought was in the middle lane but who was actually in the left-turn lane.

That was exciting…

And alarming, because in 42 years of driving, I’ve never gotten so confused I didn’t even know what damn lane I was driving in! So I wanted to…

Oh…the woman disturbed by the sound of keys tapping is yapping on her phone, sharing her personal life with one and all! Love it!

…where were we? So I wanted to ask him if he could tell whether I’m starting to Alzheimer out.

He said. “That’s not dementia. That’s road rage.”

😀

Oh, God! Her kid’s teacher called her on the phone earlier to report that the brat was “having an off day” in school: not paying attention in class. She gets into a worried heart-to-heart about this.

Did any child, anywhere, ever pay attention in those interminable, brain-bangingly stupid grade-school classes?

…where were we? So Young Dr. Kildare says the only thing wrong with me is road rage, and I need to get a grip. And, interestingly, he shares the fact that he also is plagued by constant road rage while driving around Our Fair city.

At this point, I share with him my Universal Theory of Phoenix Drivers. This, as you will recall, goes as follows:

Hypothesis 1: At any given time when you are on the road, one in ten drivers coming toward you is a moron.

He says: “Oh! I would have said two or three!”

I say, “Well, given the volume of traffic on a road like 7th Street, that could be so, but I believe that to be an illusion. Fewer people are morons than we perceive.”

Hypothesis 2: At any given time when you are on the road, one in ten drivers going in your direction is a moron.

Corollary: Therefore, at all times when you are driving in lovely Phoenix, you are surrounded by morons.

He persisted in his analysis, that the numerical value is grossly underestimated. This aspect will need further investigation to produce valid statistical results.

At any rate, the dearth of morons at 10:00 in the morning is puzzling. Usually, one would expect to encounter at least three or four of them.

Today must be some kind of moron holiday.

***

That was easier than I expected.

Meeting with the dermatologist’s PA, I explained that I’d gone to the Mayo to get a second opinion, because that is what I always do, after 40-some years of experience in the Land of Medical Science, and that the alleged doctor I’d spoken with would not give me a straight answer to even ONE of the three fairly simple questions I asked her:

  1. Is the most recently treated lesion, which remains red and has a white spot in it, healing properly, or do we need to do more to clean it out?
  2. What is the cause of the apparent nerve pain up and down my arm, which arose when this lesion was frozen off and has only partially cleared?
  3. Is it really necessary to use the Efudex prescribed by the westside dermatologist’s practice at this time, or can we safely wait to see whether freezing these things off works?

Mayo’s doc simply refused to give me an answer to questions 1 and 2. To question 3, said she: “Well…we normally prescribe that when there are a lot of lesions. Like, 15.”

There had only been two, at this point.

I said, “So, are you saying it’s reasonable not to use the product at this time?”

She said, “That’s up to you. It’s your decision.”

WTF??? Why the hell does she think I would ask her opinion if I had a clue about the advisability of applying a product that is going to blister up my hand, inflict an array of unpleasant and painful side effects, and very possibly cause permanent disfigurement?

So when I tell Wonder-Dermatology’s PA about this, she says…

  1. The recently treated lesion is healing quite well. The redness is to be expected and will go away slowly. The white spots are scars.
  2. It’s really unlikely the arm pain could be caused by treating that particular spot, because to reach the suspect nerve one would have to burrow in a great deal deeper than a squirt of frozen nitrogen can do. Young Doctor Kildare’s theory that it’s a variety of tendinitis or some kind of muscle strain is probably correct. But if it doesn’t go away, I should ask him for a referral.
  3. Hilarious! Yes, actually, we can wait safely to see whether any more keratoses arise after today’s treatment. Fifteen??? We often treat even one or two lesions with Efudex.

And then she kindly sprayed not just the latest visitation on the paw, but the big ugly brown spot on my face, too. The one I’ve been trying to get her to freeze off since I first showed up in her precincts.

Adventures in Medical Science…

What ARE you smokin’? And how do I get rid of you?

Ever ask yourself those questions? Arrrhhhghhh!

Question # 1: Heaven help us, what are you smoking?

So this afternoon I’m  banging around the house as fast as I can bang, trying to catch up with all the chores that didn’t get done while I was traipsing back and forth across the Valley (40 minutes each way, 80 minutes round trip, two endless drives in exactly opposite directions, once to the Mayo and once back to the dermatologist in the wild) and flying through 31 pages of Chinglish academic language on an impossible deadline and on and on and unfuckinbelievably on trying to fix things that broke while all the medico-swimming pool BS was going on and trying to catch up with all the financial and household and… and the phone rings.

It’s Jim the Superannuated Pool Dude, the one who didn’t fix things and who got sent on his way when I called Swimming Pool Service & Repair to come drain the pool, power-wash every part of it inside and out with chlorine, refill it, and recharge the chemicals.

The pool, BTW, is beyond gorgeous today. Like…wow. Like this…

As opposed to this…


So, sez he, how’s the pool?

Great, sez I.

How much stabilizer did they put in?

Huh??? How the Hell would I know? I was batting from pillar to post across the city while the guy was spending his time wrestling with the damn thing.

Well, how much water does the pool hold?

Uhhmmm… 18,000 gallons. I think I’ve told you this only three times.

He should’ve put in 18 pounds. A pound per thousand gallons. Is that how much he put in?

Whaaaat?????? I wouldn’t know, Jim. I had other things to do than stand over the man’s shoulder and watch his every move.

Jim persists: I’ll come by at 6 tomorrow morning to test it. If they didn’t put in enough it’ll turn green again right away.

Uh huh.

Get off the phone, think about this, call Swimming Pool Service & Repair. Get ahold of Ashley, who gets ahold of Aaron, who says he put in four pounds, which is the amount you’re supposed to put in, and if this guy dumps another 14 pounds in there it will trash the chemical balance.

Who do I believe?

Three guesses.

Back on the phone to Jim, telling his answering machine that I believe I’ll wait on the added stabilizer, thankyouverymuch. So tomorrow morning he’d better not show up.

And what is he smoking? According to the people who have a vested interest in selling you the stuff, you should add 4 pounds of stabilizer per 10,000 gallons, so that would be about six or seven pounds for the particular hole in the ground into which to pour money that dwells in my backyard. However, the pool tabs I use to dispense chlorine also contain cyanuric acid (which is what stabilizer is), and so you’re better off to go a little light on dumping the stuff in, because (especially in this heat) if you apply too much, it will tie up the chlorine and you’ll get, yea verily, green water.

Aaron’s four-pound dose was maybe a little light…but 18 pounds is effing crazy!!!!!

So, on to….

Question #2: How do I get rid of you?

Gawdlmighty.

How do I get rid of the superannuated pool dude? Well, I’d like to be kind to him, because he’s been nice to me and seems like a sweet (if eccentric) old fella. Just as soon not tell him to get lost, but I suppose if I have to, I will… Called him, reached his recorded yakathon, told him I would be out at 6:00 tomorrow morning, and there’s no need to add more CYA to the pool.

Will that get rid of him?

Whaddaybet it won’t…

And in the “Get Lost” Department, how do I tell the Mayo Clinic never to let one of their quacks come anywhere near me again?

Holy Sh!t. So I traipse way to hell and gone out there, halfway to Payson from my house, to get a second opinion on the lesion on my left hand, which still hurts and which doesn’t exactly seem to be what you’d call healing up properly.

I want to know if this thing has been treated correctly, and if so, how long can I expect it will take before it heals fully, and one way or another what’s with the burning pain that courses from the wrist to the elbow and hurts so much it wakes me out of a sound sleep in the wee hours of the morning, and should I use the fluorouracil the dermatologist in the wild prescribed (which is going to fuck up the skin on my hand and possibly do permanent damage) or can I safely wait a while to see if any more lesions appear there?

So first thing they do is sit me in an examining room and send in a resident. I am to be this kid’s teaching moment. First thing she does is demonstrate that she has no clue how to take an accurate blood pressure measure. Then she asks me a lot of questions, which I answer quietly and patiently.

She goes off and I’m left sitting and staring into space for about 20 minutes, until Her Nibs shows up.

When the actual fully accredited medical doctor enters, I hand over the printout of the biopsy showing the abnormal results, repeat what I’ve already said once about the present state of the ailment, describe what has been done and what has been recommended, explain my reluctance to use the topical drug, and ask if it would be ill-advised to wait a while to see what happens before slathering the stuff on my hand.

Well. This woman beats around the bush and beats around the bush and beats around the bush. She does not answer any of the questions that I’ve asked her.

Finally at one point she says, “You seem anxious. Are you feeling anxious?”

WHAT? What DOES that have to do with the price of beans or the state of the lesion on my sweaty little paw?

I think and almost say (but no, do not: my mother didn’t raise me in a barn, after all) damn right I’m anxious, bitch! I came in here with three specific questions — is this thing healing up properly, why does my arm feel like I dipped it in a vat of sulfuric acid, and can I safely delay using a skin-scorching chemical on my hand until we see whether in fact any more of these things comes up — and you have not answered a one of them!

From the “are you anxious” she goes on to ask me if I’m considering committing suicide!!!!!

No fuckin’ joke!

I’m going to kill myself because I have a 2-millimeter sore on my hand? WTF?

During all of this roundabout, wacko palaver, she parts with one (count it, 1) bit of useful information: about the fluorouracil she remarks (these are her words): “We don’t usually use it unless there are a lot of lesions in an area — like 15.”

Fifteen? I’ve had two in this spot, the back of my hand. All told, over the past four to six months, Dermatologist in the Wild has removed four from distant spots all over my body, none of them clustered together.

“So,” I ask, “you’re saying that it’s not necessary to use this stuff at this time?”

“That’s your decision,” she says.

Yeah. That’s exactly what she said. Helpful, hm?

In awe, I’m thinking how the Hell did you get into medical school? And HOW the Hell did you get hired by the freaking Mayo Clinic????

She was, it must be allowed, an extraordinarily beautiful woman. Indeed, one of the two most beautiful human beings I’ve ever seen. Can you get through medical school by dint of pure, unalloyed gorgeousness?

Possibly so.

By the time I got down to my car in the basement parking garage, I’d gone from annoyed to fuming. And by the time I’d driven my car from the Mayo Clinic on the east side of Scottsdale to my house perched on the tracks, I’d gone from a low simmer to a full boil. What a total waste of my time…and to add insult to injury, this supposed dermatologist tries to do an amateur job of psychoanalysis on me?

This episode occurred 11 days ago.

Yesterday I got in to see Dermatologist in the Wild, almost as far on the west side as the Mayo is on the east side.

By now I’m using a certain magical mystery elixir on this thing — some fine CBD cream a friend brought over as a house gift. She handed it to me and, without even thinking, I slapped a dab on the sore thing, and…holy sh!t, the pain stopped right then!

Yeah. So I’ve kept on slathering it on — happened to have another jar of the stuff in the house. And it is starting to feel much, MUCH better.

Or else I’m just feeling no pain, though we’re told this stuff can’t soak through your hide and make you high.

Westside Dermatologist (a.k.a. Dermatologist in the Wild) looks at the spot on the paw, the one I’ve been slathering with the magical mystery cream, which I have carefully washed off before surfacing in her precincts.

So she gets out her speculum and peers at the damn thing and she says…. “This is AMAZING.”

I think “uh oh…amazing that it’s already progressed to terminal cancer?????”

“I can’t believe this!” she enthuses. “It’s perfectly healed up! It looks great!

Uhmmm…who’d’ve thunk it…. 😀

Heh heh heh…naturally I failed to mention the presence of the quack nostrum to her.  But the instant I got home, I ordered up a four-ounce jar of the cream from some outfit called Eden’s Herbals.  Amazon doesn’t seem to carry it, but this place does, & the sales pitch looks almost credible.

Oh, effing em gee. Can you imagine?

At Amazon I found the heavy-duty sunscreen the dermatologist’s office recommends, at significantly less than said derm is peddling it for. Ordered up a bottle of that stuff, too.

Derm in the Wild said, when asked, that the burning pain up the right arm was not related to the lesion, but is probably some kind of neuritis. She suggested I ask my GP about it. I said well I have a checkup scheduled in October. She said fine. I asked if it would be reasonable to hold off applying the flesh-eating fluorouracil until we see if any more lesions appear on the back of the hand. Good plan, said she. She sprayed freezing nitrogen on two new lesions that have surfaced in other widely separated spots and explained, when asked, that all these things are popping up seemingly at once because I’m getting old and 74 years of sun exposure are catching up with me.

Little does she know I probably won’t ask her about a mosquito bite after this. But when I see Young Dr. Kildare, who’s scheduled in the near future, I’ll specifically  ask him about the arm pain. And…mercifully…YDK’s most sterling quality (besides his spectacular cuteness) is…are you ready? Common Sense.

I’m dead certain the pain has to do with our little surgical procedure, because placing an ice pack on the (ex-) lesion quickly makes the burning sensation go away. And because the lesion was located almost on top of where a nerve proceeds from your index & second finger, across the back of your hand, and up your arm…right where the pain goes. My guess is that while we were shaving off flesh to biopsy or while we were freezing off the lesion, we must have dinged a nerve or two. Whether it will ever heal remains to be seen.

So I’d better get used to going to bed early, in order to get in seven hours of sleep before this thing’s alarm clock goes off at 3:00 a.m.

Either that or commit suicide, hm? Take a flying leap off the North Rim…with an ice pack tied to my paw?

Summertime, and the Livin’ Is…Keeriminey!!!

Okay, so…one good thing: Out the door with the dog at 4:30 this morning.

This meant we dodged the wee-hours dog-walker rush — in 112-degree weather, everybody and their little brother, sister, dogs, and puppies swarm the neighborhood streets and the park at 5:00 a.m. Not that I don’t love my fellow humans and their dogs, but…well…yeah: their out-of-control dogs when combined with my out-of-control dog add up to a damned nuisance and an annoying start to the day.

Yesterday I thought maybe I could avoid some of that by walking around the park twice (a one-mile circuit: I’m trying to get in two miles a day), on the far side of the road. The park is overrun at dawn, with people who think our neighborhood park is their private dog park. And no…across the street is not so great. There was some stupid woman in there with TWO big dogs off the leash, chasing around like rockets on high-test fuel after toys she was joyfully tossing for them. And here and there, other dog-lovers letting their “fur-babies” run around loose.

By circumnavigating the park, I hoped to avoid the elderly lady who has invaded my favorite circuit around Upper and Lower Richistan. She’s very sweet and I’d like to get to know her, but not around two nuisancey little dogs — hers and mine. She has an ill-tempered Shi-Tsu that goes batshit when it sees Ruby coming up the street and starts barking and lunging and yanking around. The old gal, who said she was 93 years old, has braces on both legs and limps along with not one but two canes while trying to control her fractious pooch. Of course, when Ruby sees this hound coming at her, she tries to lunge into battle, too, so now I have to struggle and fight to keep her under control. All the while worrying that the sweet old lady is going to be yanked off her feet and thrown on the pavement!

Augh.

Well, the park route proved not to be such a great idea, because of the chronic law-breakers over there. (It is against the law — city, county, and state — to let your dog run around off the leash.) (And no, I don’t need anymore dog fights: three is enough, for this pooch.) Which is why I started walking through the Richistans in the first place.

Guess I’m not the only one who had that idea. 😀

At any rate, hitting the road a half-hour earlier this morning seems to have resolved the problem. We didn’t encounter the Shi-Tsu lady, nor did we meet many other dog-lovers. We passed the lady with the gigantic Bernese mountain dog — what a critter! He, despite his vastness, is well behaved and quiet. We passed the guy with the lab-like Heinz-57: ditto…a well-behaved and quiet dog. We came up behind the big, hefty-looking gay guy with the two wee little toy poochie things, always an amazing sight. But that was it. A cat tried to follow us home from Lower Richistan, but gave up when it noticed we were drifting into the slums.

It is hotter than the hubs of Hades here. AC is pounding away most of the time. My son is getting $500 power bills in that leaky old house of his. I suggested he bring his dog and camp out here until the end of August, but of course (being sane) he’s having none of that noise.

The pool, which tends to haze, looked clear when I got up this morning but by the time I’d finished breakfast was full of London Fog again, despite my having poured in about 8 or 10 ounces of granulated chlorine as dawn cracked this morning.

Dumped in another pound of chlorine; Cl level is now back up to around 4 ppm, fairly high. This will drop quickly, because chlorine degrades in sunlight.

…some things, you don’t wanna know…

NEVER have I had so much trouble with the chemical balance in this pool — and I’ve been tending it for 16 years. I’ve about come to the conclusion that I need to have the damned Pebblesheen jackhammered off and replaced with old-fashioned white plaster, which IMHO looks better and which is one helluva lot easier to maintain.

You cannot get it clean to save your life. Because the surface is coarse — like fine gravel in asphalt — it eats up a pool brush if you try to brush the walls and floors. Literally pulls the plastic bristles out, which then get into the pool cleaner and break the damn thing. That’s OK, because the surface itself will soon destroy Harvey, and I’ll have to replace him with a new $400 cleaner that has wheels on it — which, we’re told, will break quickly under the strain of running over this stuff. Algae settles into the coarse surface’s billions of pores, so brushing is futile, anyway: the only way to dislodge it is by scouring it down with a hard spray of water from the hose. That’s not practical in the winter:  to clean the walls & steps with water spray, you have to get into the water. Result: haze and algae curtains. So you’re constantly dumping chlorine into the drink, which BLEACHES the damn blue Pebblesheen! So now that expensive new surface is not blue: it’s blotchy yellow (bleached spots) and green (algae) and blue (Pebblesheen waiting to be bleached).

I suspect there’s something about the chemical composition of the surface that bollixes up the water chemistry. I cannot keep the chlorine levels up to save my life. Last night after dark, I poured in a dose of chlorine — the dose I’d administered in the morning having burned out in the 112-degree sunlight. This morning I dumped 3/4 pound of granulated Cl in there — which should have sufficed nicely for the day. That was around 6:30 a.m. By 9 a.m, a test kit  registered ZERO chlorine in there. Actually, that’s with two different brands of test kit. (Yeah: it did occur to me that maybe something was off with HD’s kits, so I bought one from Leslie’s y’day). (No, nothing is wrong with the Home Depot kit…)

Two and a half hours later, and ALL the chlorine is gone????? Huh uh. Something is seriously wrong there

On reflection, it occurs to me that the Swimming Pool Service & Repair guy may have failed to apply chlorine stabilizer when he did the start-up after the pool was refilled. Seems unlikely — this IS their business and they’ve been doing it for years. How could you forget that little detail?

But…it would explain why the chemicals go haywire within a few hours after application.

Whenever I get my act together today, I need to return the wimpy test kit Leslie’s sold me (I found a better one on Amazon, same price, more options, better vials, better chemicals). While I’m there I’ll ask them about the stabilizer issue. It would be good if they had a liquid form (stabilizer is basically cyanuric acid). Some brands of pool chlorine incorporate CYA — particularly chlorine tablets. These were pushing up the acid levels so high that the Leslie’s guy recommended using granulated Cl — which may be the problem right there. If the granulated product doesn’t contain CYA, then…duh! No wonder the water’s clouding up.

I personally prefer the granulated product, which you simply broadcast over the surface occasionally. It seems less nuisancey to me than keeping track of the damned floating pool tab holders and wrestling with alarming potentially explosive tablets every time you turn around. But…hm. But. If the tabs will hold down the haze, that may be the first recourse in a series of strategic steps:

  1. Try the tablets again;
  2. Pounce Leslie’s affable manager and interrogate him about the stabilizer issue;
  3. Possibly buy and add stabilizer…

Which I sure would ‘druther not be hassled with.

Speaking of hassle, on Monday I go in to get yet another goddamn actinic keratosis frozen off my hide.

This has gotten very old, indeed…. A forty-minute drive each way, a fun doctor’s visit, and then a wound to have to care for over the next week or two.

Yesterday, to my horror and amazement, I learned that the current thinking among researchers is that actinic keratoses are not discrete phenomena. Instead, they represent what is called a “field disease,” especially where they crop up repeatedly in the same patch of skin. The theory is that they represent a larger area of diseased tissue. And the suggestion? Treat that area with a chemical, as well as freezing off each flare-up. “The management of multiple AKs is a long-term prospect, with no clear cure,” we’re told. “The best approach is the sequential treatment with a lesion-directed and a field-directed therapy.”

This, quite frankly, does not sound very pleasant. It entails applying a topical gel that singes your skin and can elicit some interesting allergic reactions. Monday I’ll have to take a printout of the article to the doc’s office and ask them if they don’t think they should prescribe one of the recommended drugs. Which, no, I would rather not use. But…besides the hassle and discomfort of these goddamn things (each one itches and hurts at the same time), the fact is they can convert to squamous cell carcinoma in short order. And that stuff will kill you just as dead as malignant melanoma will.

In other precincts: this heat is making me freaking comatose. I have not gotten anything done. Have not posted another section of Fire-Rider. Have not tried to get back to writing Ella. Have not done much house maintenance other than struggle with the pool (many other projects await the human’s attention). Have done little else but eat and sleep. And clean the pool. 😀