Sibylle and I just had a fantastic weekend in Kansas City. We took in Yo-Yo Ma’s appearance with the Kansas City Symphony Saturday evening, spent the night in a wonderful hotel near Country Club Plaza, treated ourselves to a late night snack at Cheesecake Factory, visited some of our favorite shops in Leawood and Overland Park, and attended a Stanislav Ioudenitch piano master class.

It all started on Tuesday when I discovered that Yo-Yo Ma was going to be performing in the new Kauffman Center for the Performing Arts with the Kansas City Symphony. We were stunned to discover that there were still tickets left. Exactly two seats for the Saturday evening performance.

Knowing that the drive home is two long hours in the dark we started looking around for a place to stay. We choose the Courtyard by Marriot on J. C. Nichols Parkway and were delighted with our room and the entire experience there. The hotel was originally apartments, and the hotel has preserved much of the 1920s charm in the building. There are still milk closets in the hallways that allowed milk delivery while maintaining peace and privacy in the apartment. Our room, while cozy, was clean and wonderfully inviting.

The concert with Yo-Yo Ma was exquisite. When I was a child, perhaps 10 or 12 years old, my father took me to see him and Emanuel Ax play. I consider myself extremely fortunate to have seen him play live twice. The Dvořák Cello Concerto performance was very good. His encore performance of the Sarabande from the D Major Bach Cello Suite was simply superlative. After the performance we treated ourselves to a late night snack at Cheesecake Factory. We each had an appetizer and a piece of cheesecake. We returned to our room around midnight completely satisfied with our evening.

Sunday we had a long lazy start to the day that included the breakfast buffet in the hotel. Around 11:30 we headed south to Leawood and Overland Park to visit some of our favorite shops. Sibylle found two sweaters and I got a chance to visit the Apple store and drool over the iPhone 4S I’ll be getting in a couple of weeks when I am eligible for an upgrade. We also shopped at Whole Foods, picking up a small lunch there too.

Park University north of Kansas City has an excellent music department including Cliburn Gold Medalist Stanislav Ioudenitch. Sibylle learned that he was giving a piano master class at UMKC on Sunday afternoon, so we timed our shopping to allow us to return to central Kansas City to attend. Even a beginning cello student can learn many things from a well presented master class.

We packed a lot in to two days (especially since Sibylle had her normal Saturday lessons prior to our departure Saturday afternoon) and enjoyed every moment of it. Recently we almost forgot about a cello recital in Manhattan and had to rush to the hall. The spontaneity of that evening managed to make it better. Our trip to Kansas City this weekend had that same air of spontaneity, and it too has been wonderful.

I have fewer and fewer instances / bouts of nausea.  And I have noticed a sudden and dramatic increase in creative energy – like it’s been pent up for several weeks, three months, and now bursting forth.  Teaching is again pure joy.  My students and parents notice a different energy about me.  Being able to eat more, and more different foods is joy.  Living is joy.

Once again, life is good.

Young.  Wow.  I’ll be 50 this September.  Haven’t considered myself “young” in a while.

The “healthy” puzzled me at first:  how can one say that I am healthy when I have been struggling with persistent nausea and malaise for almost three months???  Yet, that wasn’t the health he was talking about.  It took me a moment to realize that he was talking about the blessed absence of any other health problems, the items he rattled off his list: no prior surgeries except for tonsils when I was maybe four and tubes in my ears when I was about 14, no problems with any medications, nothing neurological (Thank God), 140 lbs at 5’8″, no asthma, never had a stroke or heart attack, etc and so on – I guess in that sense I am healthy.   Definitely something to be grateful for.

While the surgery and immediate recovery did go extremely well – Mark took a short video of me walking, unaided, across the living room a mere six or so hours after the start of surgery, and I was almost euphoric the second day -, the days since then have been anything but straight-forward, linear recuperation.  I knew that walking and moving around would help with the healing, so I did that, and I am sure it helped.

What I wasn’t prepared for, though I should have known (because I did know but forgot), was the effect narcotics have on digestion:  serious constipation.  I should have started to take a laxative right with the very first pain pill I took, not wait until I realized two days later that, oh crap, I can’t go, with two days worth of stuff in my intestines.  Would have saved me some major discomfort.

Another lesson I learned, the very painful way the second night I was home, was that just because I’m in no pain doesn’t mean that I’m in no pain.  It means that the pain meds are doing their job.  Meaning:  the first evening, Mark set an alarm for 3:30 a.m. in the middle of the night, for me to take another dose of Norco (left-over prescription from the ER) – worked great.  The second night we didn’t (Mark would have but I thought nah, I’ll wing it).  Big mistake.  It took a miserably longer time for the meds to start taking effect than if I had kept the pain under control.  I wanted to get off the Norco as soon as possible, because I don’t like narcotics, and take Aleve or Tylenol instead.  Experimenting with different dosages kinda worked but I would probably not do it again.  Just take one or two pills every 4 – 6 hours as prescribed.

Walk and move and drink a lot, herbal teas for gas and bloating from the beginning would probably have alleviated at least some of the very uncomfortable gas and bloating.  The pictures Mark took of the incisions on my abdomen make me look like I’m pregnant.

The hardest part since last week though has been the return of the nausea.  Nausea is misery.  Every time I have a migraine (very infrequently), even while I am in pain, I say that I’d rather have ten migraines than one case of nausea or stomach flu.  I have had no reason to change my attitude about this.

Two concerns about the nausea:  first, why?  There must be a reason, and I would very much like to know what it is so we can take care of it.  (The thought was that my gallbladder, while perhaps not at the root of it, was at least contributing to it, so the surgery was a very good first step in the right direction.)  Second, even though I’ve been told many times that Phenergan is safe, and it does alleviate the nausea, I am concerned about covering up a symptom.

My mother’s second hip replacement surgery (surgery of the second hip) was unsuccessful, the replacement part never properly fused (?) with the bone.  Nobody knew, though, for many many months, because she was given very strong pain medication and was told to walk, walk, walk, and exercise, and do PT, which she faithfully did – and in effect damaged the hip even more.  She told me several times that on her own, without doctor’s orders, she would have taken much less pain medication, and therefore been alerted to something being wrong much sooner.  So, to be on the safe side, I called my surgeon’s nurse (one of the nicest people on this planet) who said that having the same symptoms as before the surgery is unfortunately not uncommon.  It may take a couple weeks for the nausea to completely go away.  Small meals, take it easy … And yes, Phenergan is safe to take as I need it.  Sigh.

In two days, I am starting to teach again; I asked several parents to move lessons to spread them out a bit – an hour and a half of highly focused attention at a time is probably all I want to handle for at least the next week or two.  My students have 100% of my attention 100% of the time they are with me; normally this is more invigorating than it is exhausting.  For the next week or two, we’ll do that in smaller steps.

The surgery is scheduled for about 12:30 pm this afternoon, but check in was at 10:30 this morning. She is back in the preparation area now getting an IV setup, the blood pressure cuff and pulse monitors installed and being made ready. I will be allowed to join her once all of that is set, and stay with her until the surgery starts.

We both have good feelings about the GI doctor who scheduled the MRCP and about the surgeon who will perform the procedure today. We are both understandably nervous about today and its outcome. If this addresses the persistent nausea that has plagued her for the past three months it will be well worth  it.

Update

Sibylle’s surgery was started about 15 minutes ago. If all goes well I should see the doctor for his post-operation report in about 90 minutes. Once Sibylle is moved from the recovery area to the preparation room I will be allowed to rejoin her. I spent about an hour and a half with her once she was prepped, until the surgical nurse came to get her. Sibylle had an IV started and had been given some Valium. The sedative effect of the Valium allowed her to doze most of the time we spent waiting. Shortly before she was taken to the operating room her doctor stopped by and explained what was going to happen.

After her surgery is completed she’ll spend some time in a recovery area, and once she is awake they’ll return her to the prep room.

It is very strange to be seated in the waiting area writing this knowing that she is being operated upon just down the hall. Fortunately I have the room to myself and therefore have turned the television off. I was tempted to hide the remote but decided that was passive-aggressive.

Post Surgery Update

I just spoke with the surgeon. The surgery went very well. Start to finish about 50 minutes. He said that he wasn’t able to inject dye into the duct between the gallbladder and the common bile duct as it was too small. So no imaging of bile flow during the surgery. There will be a follow up visit in two weeks with the surgeon to assess how things are going. Hopefully this alleviates her symptoms. He said that sludge or sand in the gall bladder (which she had) often causes more problems than a gall stone. The stone can’t pass the feeder duct into the common bile duct, whereas the sludge/sand can.

Three to five days of immediate recovery and then a week or so to return to full activities.

Whew.

The Morning After

Sibylle was discharged from the hospital at 6:00 pm Thursday evening. Seven and a half hours after we checked her in to out-patient surgery. She spent about an hour in recovery from 2:00 pm to 3:00 pm, and then dozed and rested in her room until 6:00. She was able to eat some red jello (the staple of hospital food), drink some water, and much on a few ice chips.

After we were home she took a pain pill prophylactically and slept for an hour or so. The hospital warned us that her right shoulder could be quite sore as a result of the surgery and that walking around and movement would help alleviate that pain. So after her nap we took a meandering walk through the house going from room to room. She had a smoothie for dinner and then spent some time sitting in her desk chair writing and reading email. Around 10:30 pm she had a double dose of pain medication and we went back to sleep. (Added by Sibylle: the Norco is actually left-over from the prescription the ER gave me on November 8.  Since pain had never been much of an issue, I had taken only one pill, once, not even for gallbladder pain but after the pelvic ultrasound to follow up on uterus issues they found while I was in the ER.  The prescription says to take “one to two” pills every 4 – 6 hours.  Last night, right before bed, I did take two pills, so I guess technically it wasn’t even a double dose.)

With two cats in the house, one of which loves to climb on and lay on people, she put a pillow over her stomach. With the blankets on top of the pillow to hold it in place she was nicely padded in case Taz jumped on her unexpectedly. We set an alarm for 3:30 am, which was about an hour prior to the pain med’s 6 hour span, and she took one more pill.

This morning she awoke with no appreciable pain or discomfort. One or two of the four incisions made yesterday is a bit tender to touch, but she is not in any pain. She was able to dress herself and make her morning tea.

By any measure this whole adventure seems to be going wonderfully well. We know that days two and three are often the hardest in terms of discomfort or pain, but so far her experience has been a very good one.

For as long as she can remember, since she was a little child, Sibylle has not been able to eat very much at one time. The medical term for this is “early satiety.” Most meals Sibylle eats a small portion and sets her plate aside for later. In a couple of hours she is able to eat more.

Between the early satiety and a general dislike of junk food, Sibylle has never been able to gain weight. Her weight hovered around 115 pounds regardless of how much she managed to eat. Any time that she eats less she would immediately start to lose weight.

Megace

Working with our primary care physician Sibylle started taking a liquid hormone called Megace. Normally this drug is used to stimulate appetite in cancer patients. In Sibylle’s case it made her voraciously hungry. For the first time in her memory she was able to eat everything on her plate and want more. By August she had increased her average daily weight to 150 pounds. At that point the Megace dosage was reduced to try and maintain her weight.

Germany

In late September this year we took a week long trip to Germany to attend Sibylle’s 30 year high school reunion. On that trip we were both sick. I had diarrhea and Sibylle was severely nauseous. My symptoms ended after a few days but her’s didn’t. She had better days and worse days, but never really felt well after our trip. She was forced almost weekly to cancel or postpone lessons due to not feeling well.

An Attack

Early the morning of November 8th she had a very severe nausea attack. Normally a dose of Pepto Bismol helped but this morning she had three with no relief. About 7 am we took her to the emergency room as she was shaking, sweaty, and generally miserable.

While in the ER two tests were performed. An ultrasound and a CT (cat) scan. Combined these two tests showed the presence os “sludge” in her gallbladder, and that both her common bile duct and pancreatic duct were dilated more than is considered normal for a person of her age. By early afternoon her symptoms had abated enough for us to go home.

Phenergan

One of the prescriptions she was given that day was for an anti-nausea medicine called Phenergan. Between November 8th and December 15th she had daily dosages of Phenergan. She also drastically altered her diet. Eliminating anything rich or complex she has lived on boiled potatoes, steamed carrots, banana smoothies, avocados and lots and lots of Melba Toast crackers. (Added by Sibylle:  and some cod, some salmon, zucchini, once or twice Thai red curry with chicken, pudding and strawberries from the Bamboo Buffet, greek yogurt.  Thanksgiving was delicious, too.)

Around the middle of December she started to feel much better, so much so that she tried a large dish of ice cream one evening with no ill effect. She even had a second helping. Two nights ago, however, a small bite of cheese pizza caused a return of the nausea and a bout of diarrhea.

Doctor, Doctor

In a case of very unfortunate timing our primary care physician moved out of state. Our experience with the substitute physician two days after the ER was not encouraging or good. We asked around and got a recommendation for another physician and switched to her. The new doctor arranged a HIDA scan to measure the effectiveness of Sibylle’s gallbladder.

This scan uses a small amount of radioactive material to trace movement through the liver, gallbladder, the common bile duct, and small intestine. Due to some difficulties with the machine the first 30 minutes of the test were lost. Consequently the liver was not observed. However they were able to see the gallbladder function and measured it at 94%. The common bile duct also appeared to be functioning as material was traced into the small intestine.

Our new doctor also arranged a consultation with a surgeon to discuss gallbladder removal. The surgeon, being conservative, told us flatly that based on her test results he could not guarantee that removing the gall bladder would address her symptoms. He wanted more tests.

Today we met with a gastroenterologist to discuss her case history and see what he would recommend. There are two tests available. An ERCP or an MRCP. The ERCP uses an endoscope to view the junction of the common bile duct with the small intestine, and even the inside of the duct itself. Through the endoscope it is possible to remove small gallstones and widen the opening of the duct into the intestine. However, some percentage of patients develop pancreatitis as a result of this somewhat invasive test. Since Sibylle’s pancreas may already be unhappy, further irritating it doesn’t seem like a good idea.

The MRCP is an MRI focused on the common bile duct. It is entirely non-invasive but it can’t always find small gallstones, nor can it see the condition of the union between the duct and the small intestine. The GI doctor recommend the MRCP and a removal of Sibylle’s gallbladder.

At the time of the gallbladder surgery, the surgeon will inject some dye into the duct near the gallbladder and image its progress to the intestine. If that test indicates some issue with the duct, then post-operatively an ERCP will be performed.

MRCP

Next Tuesday morning Sibylle will have the MRCP performed, and hopefully soon thereafter, will have her gallbladder removed. Our research into this surgery indicates that she should be up and about within a couple of days. While using her Christmas break to accomplish this is less than exciting, we are hopeful that it will mean she’ll be back on her feet in time for the spring semester. And more importantly, that she be free of the persistent nausea that has plagued her for nearly three months now.

Knee, Physical, and Uterus

Just to make things more interesting there are several other medical appointments on the schedule for next week. I am to have my annual well-man physical Wednesday morning, Sibylle has a gynecological exam on Wednesday afternoon, and I am seeing a knee surgeon on Thursday to discuss a possible medial meniscus tear in my right knee.

Watch the feeding frenzy I recorded last month here.

My first student performed at 9 a.m. so we left shortly before 7:30 a.m. to allow not only for travel time but also enough time to see Ava before her performance and to set things up, mainly the footstool which she would be using.

Ava and her family arrived, their mother quite frazzled – they had left their books at home. Word of our misfortune spread; fortunately one of the local teachers, Shane Galentine, offered us use of his copy of one of the books. Even more fortunately, the judge graciously said, “Oh, I know that piece” about the other piece for which we had been unable to find a book on such short notice.

Setting up footstool went well, Ava’s performance went very well – she is surprisingly grounded for such a young person, not easily shaken.

The rest of the morning went without problems or upsets; Rachael, Hasun, Chris, Sumin, and Suyeon played beautifully and received high praises from the judge: “dynamics are perfectly in place” – “You are so well prepared” – “expression that is quite mature” – “Your melody in the LH is just elegant and absolutely gorgeous!” – “very interesting and detailed playing!” – “This performance was absolutely brilliant – so satisfying!” – and about one of the Martha Mier jazz pieces: “This really cooks!”

Actually, there was one more upset: the floor was rather slippery = both the bench and the footstool tended to slip a bit. I had adjusted the left pedal for Sumin but as she started her piece, Gillock’s Dragon Fly, the left pedal of the footstool slipped off the piano’s left pedal. The judge was able to adjust it but Sumin, having started an octave too low, actually had to get up and take a quick look at the score to remind herself of the beginning of the piece. Once she did, she was able to play her piece as beautifully and convincingly as ever.

We didn’t have much time for lunch, so just drove quickly to Ru-Yi’s Asian restaurant to have a quick bite to eat. As usual, it felt good to get away from the hustle of a competition, even if it’s just for 30 minutes or so.

Two more students from my studio in the afternoon: both Gabby and Isabelle performed beautifully. I was a bit concerned that Gabby would perform for a different judge (too many students overall to be heard by one judge in one day) as every judge has different standards and judging / writing style which makes it more difficult to compare. However, his comments were as glowing as the other judge’s had been for the other students: “nice clean playing” – “your touch is solid & confident” – “superb rendition!”

The purpose of the District Auditions is to hear all students and determine who will go on to State on November 5, to compete at the State Honors Auditions. At the District Auditions, there is (supposed to be) no rating, only “state eligible” or not. However, for some reason, this year, the evaluation form had a line for “numeric rating” where *I* meant state-eligible, and *II* meant not.

Three of my students received a I rating, five of them received a I+ rating.

After the last of my students had performed, Mark and I took at little break. Walked to the Granada coffee shop for a vanilla latte and some cookies. In addition to the normal coffee shop wooden or metal chairs, the Granada has two very very comfy deeply upholstered chairs which felt delicious after standing (in order to video tape the performances) or having sat on not-upholstered chairs at the competition for most of the day.

We walked back to the ESU Music Department where the competition was taking place to listen to a few more students and then were able to meet up with Jonathan who had been busy all day with his band performances for the football game. We met briefly at the Music Department, and then drove to his house to see the new cat and then to Applebee’s for dinner.

On the way home, as usual, Mark was driving. I appreciated being able to doze off for a bit here and there. It had been a long day, with a long couple of weeks leading up to it.

Today I didn’t do much of anything. Uploaded the videos to my laptop, and – took a nap.

Sibylle and I just returned from a short trip to Germany. We hadn’t been since May 2010 and the occasion of her thirty year high school reunion seemed like a good reason to go. Sibylle planned for the week off when she was setting up her fall teaching schedule, and so we booked tickets, made a room reservation at our favorite hotel in Bürg, packed our bags, and went.

No Mail

We needed to mail a letter before we left and managed not to visit a mail box on our way out of town Wednesday evening. The Holiday Inn Express were we stayed didn’t have an out-going mail drop, so we took the letter with us to the airport. Guess what you can’t do at the airport? Mail anything. In the wake of 9-11 all US Postal Services were removed from all airports. There is a package service where you can put your pocket knife or 4 ounce bottle of what ever in a pouch and ship it to yourself for an exhorbitant fee, but you cannot mail a stamped letter.

Economy Comfort

When we bought our plane tickets we were offered “economy comfort” seats on the overseas legs of our flight, for a mere $40 per seat. We decided to splurge and were very pleased with the result. The seat rows were considerably farther apart, and our seats reclined much further than normal. It was possible to be less uncomfortable than riding in the rather cramped coach section. Both going over and coming back we were able to sleep some and arrive a bit more rested.

Intestinal Flu

Unfortunately we both came down with some kind of intestinal flu or virus. Neither of us felt particularly good the entire time we were in Germany. Sibylle felt so poorly on Monday that she spent the entire day in bed asleep. It was very disappointing and frustrating to have traveled all the way to Germany only to be sick enough that we didn’t want to be away from a bathroom. Public restrooms are few and far between in Europe, and leaving our hotel meant taking a very real chance that we’d need a bathroom and not have one available. No fun.

Internet Woes

Internet access is far easier to come by now than it was four years ago when we made our first trip to Germany together. The Starbucks in Stadtmitte Stuttgart has free wi-fi, as did our hotel. And our favorite restuarant in Winnenden sits next to an open wi-fi hotspot. All of which means we can check email and keep up with the world around us as we choose. However, we had difficulty getting to our domain hosted email accounts while at the hotel. I suspect their router was setup to block some ports, and unfortunately those included the ones used by our domain host for secure email. Also, I wasn’t able to use secure shell to access either of my computers here in the States, which mean I was unable to do any remote posting to my web site.

Home Again

We are safely home again, and in the process of readjusting to a new time zone. I know we’ll have other trips to Europe, I only hope that we don’t end up sick again.

Mark and I liked the idea of going to Germany for a few days at the end of September.  The weather is usually very pleasant in September, warm and dry.  Warm enough during the day to spend a lot of time outside, going for long walks, sitting outside at a streetside cafe, etc.  Cool enough at night to enjoy a blanket and not miss air-conditioning which many hotels don’t have.

Mark had found that Delta offers a new type of seat:  Economy Comfort with more leg room and seats that appear to recline further back.  It made a huge difference!  Being able to stretch our legs, and recline, and – since our seats were in the last row of the section – no one behind us to fiddle with tray tables, or kick our seats.  I took as many long naps as I could, Mark a few less because he was watching The King’s Speech, and we both arrived surprisingly rested.

It was nice – and we commented on it several times – to know our way around after we arrived in Stuttgart; we have  a bit of a routine:  take the S-Bahn to Stadtmitte (instead of going to the main train station or immediately to Winnenden) and walk a block or two to the Starbucks where we sit for a while and have something to eat / drink, use the bathroom, be online, and take a bit of extra time to arrive.

Then make our way down Konigstrasse to the main train station and take the S-Bahn to Winnenden.

When we made our hotel reservation there was almost no question which hotel we would want to stay at:  the Schone Aussicht in Burg, a small hamlet high above Winnenden.  This is where we stayed a year and a half ago, after my mother died, and we have fondest memories of peaceful and restorative seclusion from the world and a bit of distance from the preparations for my mother’s memorial service.

Of course, “small hamlet high above Winnenden” translates into “lousy bus service”.  While the public transportation system in the greater Stuttgart area is fantastic, it doesn’t quite extend much beyond the main towns.  Mon – Fri the bus runs once or twice an hour, Sat once an hour or less, Sundays once every three hours.

With meticulous planning it is possible to make use of the bus service and not need a taxi.  However, meticulous planning is hampered by a surprising sense of displacement – both physical and where it concerns the local time -, and at least once we didn’t think things through:  Mark’s phone (we don’t wear watches) hadn’t adjusted its time to German time, so we just added seven hours to get German time – except we forgot that his phone had adjusted to Atlanta time so we should have added only six hours … so we stood at the bus stop and wondered why the bus didn’t come.  Feeling dumb and frustrated when we finally figured out that we were off by an hour.

Both Mark and I felt surprisingly queasy after we arrived on Friday.  Mark’s intestines are never happy after travelling, but they seemed a bit worse this time.  My stomach felt a tiny bit weird but that was to be expected: ever since arriving, we indulged in rich food and had ice cream with (real) whipped cream at least once a day.

Yesterday, however, about an hour after we arrived at the reunion, I felt really sick to my stomach.  Perhaps it was the standing still for so long (we had gathered on a type of patio, standing around, visiting, walking a few steps, more standing before moving upstairs where the buffet was) or I don’t know what but we ended up taking a taxi back to the hotel before the food was even served.

The hotel brought a cup of camomille tea to our room, and later some ice cream for Mark because he had a taste for ice cream but didn’t want to leave the room.

We both are really tired, feeling more wiped out than normal (even considering that this is our third day today which is the day when we usually crash and take a really long nap in the afternoon).  Mark has had intestinal cramps and diarrhea.  We’re not sure whether we ate something wrong, or picked up a bug.

In any event, in addition to not feeling so hot from unhappy intestines, we are really frustrated that we haven’t been able to do the things we had so looked forward to doing here:  taking walks – the weather is absolutely gorgeous, it feels like a crime to stay in our hotel room (close to a bathroom …); eating food, food, glorious food!  Our favorite Cafe Benz has in its display case so many such delicious cakes – I could (if I could …) eat cake for every meal!  Yesterday afternoon, I did have a piece of plum cake (Pflaumenkuchen) with whipped cream and it was so so delicious I could have eaten a couple three more pieces!

Tomorrow, we wanted to go into Stuttgart and “do Stuttgart” which for us means walk up and down Konigstrasse, do a bit of shopping, probably eat at the Alte Kelter, sit in the sun, watch people.

Not sure I’m feeling well enough to do that.

What a waste.