The Faux interview

The interviewer in the blog that follows is fictional.  It is a tool to get the information out that I   survived dbs  surgery and that I continue to recuperate and wait to see the full results of the series of surgeries to place leads deep in my brain where they provide selectrical stimulation that works with conventional meds and provides a substitute for some the stimulation provided by natural dopamine.

In the short period of time that my  mind has been focused on dbs, I only felt let down personally by my beloved MAC computer which committed suicide after 6 years of service. For now it has been given new life with a new hard drive.  However,  the trust has been lost and I am afraid that our relationship will never be quite the same.

Interviewer: Time has passed and there are more than a few people who at least care enough about you to be asking.  How are you doing after surgery?

John:  I can say that I have been through 3 surgeries each associated with dbs or deep brain surgery.  The First surgery was intended to be the last surgery as far as placement of the leads but it had to be cut short(March 4), due to respiratory difficulties.  At that point a second surgery was scheduled for April 25. The outcome from each of those surgeries was fairly difficult to assess but every word I have to date indicates perfect placement of the leads. I then waited for a 3rd surgery to place the batteries and then turn-on the system.

Interviewer:  Was this interruption or time time delay to the surgeries difficult?

John:  I would have to say  yes.  In addition to the physical discomfort, there is a psychological component.   I found myself wondering if I Had subjected my brain to considerable risk with little chance of real gain. 

Interviewer:  What if a cure for Parkinson’s is found within the next 10 years? That would be the real gain and then what have you done to your brain?

John:  The surgeon has told me that if a cure becomes available that they can simply pull the Leads out and go back to square one. permanent  damage to the brain is not a part of this process.  Do not get me wrong.  There is risk of adverse outcomes.

Interviewer:  What did you find to be the most difficult aspect of the dbs series of surgeries.

John:  I Believe that it was the fact that I had to stay quiet for at least three weeks after each one of them.  I Found it difficult to stay close to home and not do things that were more strenuous and demanded more energy than I had at the time. I would cheat and do things that I knew not to be wise such as bending and pulling weeds on our place.

Interviewer:  Tell us more about that final or 3rd surgery?  

John:  The third surgery included surgical placement of the batteries and the powered  stimulater in the chest wall.  The leads which had been previously stored beneath the skin of my scalp after surgeries 1 and 2 were now fished down along the neckline and connected to the batteries. The batteries and the controller were placed just beneath the collar bone or the clavicle on each side of my chest.  Powering it up and programming the device began a few days later.  Just an initial energizing of the system to get things going.   The surgery itself created pain and soreness and since it was day surgery the lingering presence of the anesthesia was still pretty fresh when I left the hospital.  I am still in recuperation from the third surgery. It was probably the most painful surgery of the three. It left my shoulders sore and my body weak. I will not soon forget walking away or staggering away from the hospital while relying on my wife’s strength to hold me up. 

Interviewer:  Would you say the surgery has been a success for you?  

John:  As far as the actual surgery is concerned I would have to give it a yes with some qualification.  In my mind success happened last Monday morning at 8 o’clock. at the point the system was powered on. Now things are running in reverse and which means,  we were not talking about adding more drugs,  either to treat the disease or dealing with side effects of drugs previously used to treat the disease.  We  now have a new tool and are talking about the use of less or no drug and how I might react to that.  The qualification is there only because we are so early in this process.  The full outcome is a separate piece waiting to be written.

 I would like to say thank you for the support and prayers of my friends.  They held me up at a time when I may have,  on my own, have given up.

Less shaky in Coupeville,

John C. 

DBS: One more Chapter

Personal Parkinsons

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DBS: One More Chapter Posted: 03 May 2015 12:37 PM PDT Then he said to the man.  "Hold out your hand". The man held out his hand and it was healed. Mark 3:...5 I slept surprisingly well the night before the latest and hopefully my last dbs surgery.  In the previous 24 hours more than once I  began to wonder, "could I some how get out of this?" The answer quickly flashed back inside my head from somewhere, "no, you are much too far down the road to turn around now."replied my inner voice.  It was time to put second thoughts away.  After a brief morning with no coffee or meds Carolyn and I gathered our things and started on what appeared to be a long journey.  We stopped at admitting and the check in person attatched a wrist band which would identify me right down to matching medications by way of bar codes. Then I was given very precise directions, "walk down the hall with windows on one side and then turn right, go up the incline, and then pick up the phone and tell the person on the end of the line your name." I did this and the voice at the other end was real.  The time had actually arrived and they were waiting for me. The nurse at this first stop was very helpful and happened to be a man of about my age whom coincidently loved the Mariners and baseball.  He talked a lot, probably more than I personally wanted at the time. He checked my history, took vital signs and he eased tensions somewhat.  I think when I walked into to this department I was fully clothed, accompanied by Carolyn and perhaps still a bit groggy, having no coffee or breakfast. but now I was ready to leave and found myself dressed in nothing but a hospital gown, alone. on a gurney being wheeled out and down a long drafty, and windowless hallway to another hidden department. I entered the next area that  appeared to be populated by anesthesiologists going over their plans for their part of surgery with their patients. Plans for people much sicker than I.  I found that humility and thankfulness were most appropriate  properties at this level Here also I was also greeted  by the Surgeon's assistant. She appeared while the anesthesiologist was going over her plans and they now began to work together.  She once again said my previous surgery for the left side of my brain lead placement had ended in a less than ideal situation.  They believed that several things together had left me with me without any ability to clear my throat, in respiratory distress and very low oxygen  saturation. The end result was subsequent cancellation of the second half of the surgery.  She explained I had people concerned and that they were determined to not let that happen again.  Their plan included: keeping me at as high a level of consciousness as possible, adjust the angle of the halo to improve the opening of my airway. (A halo is a steel or aluminum device that attaches like a Christmas tree stand and immobilizes your head) They were determined not to let me fall asleep this time and diminish the risk that the pooling of fluids at the back of my throat might cause. When I finally arrived at the Operating Room I felt like a rock star, there were plenty of people there.  Mostly nurses eqiuipped with advanced specialties. No one appeared nervous but maybe they would not have been, given the expertise that was walking around that room. It seemed to be only a few minutes and the surgeon appeared and reintroduced himself and began as soon as the halo was in place.  He began by numbing portions of my scalp where he intended to cut the skin of my scalp back and then to bore a dime sized hole in my skull.  He warned that I might feel a little sting at first and then a little pressure similar to work at the dentist's office.  I felt them both, but neither amounted to anything significant.  No further local anesthetic was necessary.  Since the brain itself has no pain receptors. The drilling began and the The sensation of my skull being bored into was, loud and I felt the vibration.  I was given sedation at various times both morphine and propofol in low doses for light sedation.  The propofol felt as if it burned my veins as it went in but by the time it reached my elbow The burning had ceased.  I lost track of things somewhere around this point, but picked up again when time for insertion of the lead began and my participation was asked for.  The surgeon called out the position of the lead in millimeters.  It went something like this: "10, 9.5, 9, 8.5".  He was inserting the lead and he took it down to a negative number.  He then asked for my participation.  Working on the right side of my brain he turned on the power and then said, I want you to say when you feel a difference in your hand.  I soon felt a tingling sensation.  He adjusted things a bit  and then asked that I stretch out my left hand.  There was no tremor at all.  What an incredible feeling! Squeeze your thumb and finger together.  Usually a difficult task but this time It was smooth as silk.  I could have not felt better if he had called for me to stretch out my hand......and see it healed. At that time I became aware of music. Credence Clearwater and Who'll stop the rain.  Then some one asked if I wanted to stay awake the rest of the way.  Of course I did,  I wanted to savor this moment.

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The Time is Brief

We had spent two sunny and bright days day in a "1940's" style rustic cabin. The location was perfect with a view over looking the the fishing village of Seikiu on Washington's Olympic peninsula. The view of the village was bordered by an expanse of the sea called the strait of Juan De Fuca, which sweeps across to an uninterrupted outline of Vancouver Island, British Columbia. After two clear summer like days, today the wind and clouds have have blown in, as if providing a clear signal that it is time to pack up and leave. Time to say goodbye and thank you to son and daughter in law who thought up the trip and invited us to tag along. 

We had one passenger to drop off on the way home, daughter in law's brother. A young pilot on a break from flying in Alaska he was getting off at the Port Angeles air field where he had arranged for his father also, a pilot, to pick him up and fly from there to Bellingham. With an eye to the developing weather I wondered if the strengthening crosswind would be factor for his father's small experimental plane, but he himself appeared unimpressed. So we dropped him off and journeyed on.

The lively conversation of our previous leg of the journey turned to silence as Carolyn turned the truck toward home to Whidbey Island by way of the Port Townsend Ferry. I began to think over the remaining steps left to complete DBS surgery for the right side of my brain, now just over a week away. With the left side complete, recovery from the first surgery to my thinking had not been easy. But now that process for the left side of my brain was finished and waited for hookup of leads and programming.

The two week check up last week had gone well. After a neurologic exam the specialist nurse (ARNP) outlined the final positioning of the stimulation leads beneath the skin behind my neck. She talked about the process of of programming the units themselves which may take a few months and sometimes up to a year to complete. Finally, they had paid close attention to the pooling fluids in the back of my throat which had led to low oxygen saturation and subsequent termination of the first surgery. This time she explained how they would immobilize my jaw and reposition for more effective airway maintenance. Just to be certain I will kept at a higher level of conciousness throughout the procedure.  Yes, I am ready to get on with the next phase.

We arrived at Port Townsend and weather was now an increasing factor as the ferry which had already been interupted by two low tide canceled runs, began to limit the number of cars allowed per run due to wind created deteriorating conditions. We had to wait, so we walked our faithful dog. Enjoyed a picnic in our pick up truck and watched the rain spatter our vehicle as the wind continued to increase, shake our vehicle, and the sky darkened.

The ferry arrived nearly 2 hours late and made a slow and cautious landing at the Port Townsend terminal. Thankfully the ferry and crew were none the worse for the wear and declared it safe for at least another crossing. Loaded last, this was our ticket for a wild journey across Puget Sound and it did not fail to disappoint. Intermittent heavy rain and large swells kept us rocking and rolling all the way across. The captain announced that we would need to make a turn as we approached the terminal. He said "hang on to each other and get ready for a rough ride." We hung on and finished the crossing.

DBS is a lot like that ferry ride. I plan to hang on, trust God and the 
Professional crew to finish the job.

Dwindling Days

We had spent two sunny and bright days day in a "1940's" style rustic cabin.  The location was perfect with a view over looking the the fishing village of Seikiu on Washington's Olympic peninsula. The view of the village bordered by an expanse of the sea called the strait of Juan De Fuca.  which sweeps across too an uninterrupted outline of Vancouver Island, British Columbia. After two clear summer like days, today the wind and clouds have have blown in as if providing a clear signal that it is time to pack up and leave. Time to say goodbye and thank you to son and daughter in law who thought up the trip and invited us to tag along.  

We had one passenger to drop off on the way home,  daughter in law's brother.  A young pilot on a break from flying in Alaska he was getting off at the Port Angeles air field where he had arranged for his father also a pilot, to pick him up and fly from there to Bellingham.  With an eye to the developing  weather I wondered if the strengthening crosswind would be factor for his father's small experimental plane,  but he himself appeared unimpressed.  So we dropped him off and journeyed on.

The lively conversation of our previous leg of the journey turned to silence and Carolyn turned the truck toward home to Whidbey Island by way of the Port Townsend Ferry.  I began to think over the remaining steps left to complete DBS surgery for the right side of my brain, now just over a week away.  With the left side complete, recovery from the first surgery to my thinking had not been easy.  But now that process for the left side of my brain was finished and waited for hookup of leads and programming.

The two week check up had gone well.  The specialist nurse (ARNP) outlined the final positioning of the stimulation leads beneath the skin behind my neck.  She talked about the process of of programming the units themselves which may take a few months and sometimes up to a year to complete.  Finally, they had paid close attention to the pooling fluids in the back of my throat which had led to low oxygen saturation and subsequent termination of the first surgery.  This time she explained how they would immobilize my jaw and reposition for more effective airway maintenance.  Just to be certain I will kept at a higher level of conciousness throughout.

Yes I am ready to get get on with the next phase.

We arrived at Port Townsend and weather was now an increasing factor as the ferry which had already been interupted by two low tide canceled runs, began to limit  the number of cars allowed per run due to wind created deteriorating conditions.  We had to wait, so we walked our faithful dog.  Enjoyed a picnic in our pick up truck and watched the rain spatter our vehicle as the wind continued to increase, shake our vehicle, and the sky darkened.

The ferry arrived nearly 2 hours late and made a slow and cautious landing at the Port Townsend terminal.  Thankfully the ferry and crew were none the worse for the wear and declared it safe for at least another crossing.  Loaded last,  this was our ticket for a wild journey across Puget Sound and it did not fail to disappoint.  Intermittent heavy rain and large swells kept us rocking and rolling all the way across.  The captain announced that we would need to make a turn as we  approached the terminal.  He said "hang on to each other and get ready for a rough ride." We hung on and finished the crossing.

DBS is a lot like that ferry ride.  I plan to hang on and trust God and the 

Professional crew to finish the job.

Personal Parkinson's

DBS for Parkinson's - Play it again Sam

The neurosurgeon confidently walked into the exam room where Carolyn and I sat.  He introduced himself and he was very personable and quite enthusiastic about my forthcoming DBS (Deep Brain Stimulation) surgery.  I was very impressed by him and after only a brief talk I was ready to pack my bags and go where he was going.  He used an analogy in which he compared Parkinson’s to a dense fog which begins slowly and then closes in around you making it impossible to see or think of anything else. He said he had found that DBS surgery could push the fog back so that at least for a period of time there can be remarkable relief of the motor symptoms of Parkinson’s.  The tiny tip of the leads act similar to a pacemaker which controls the abnormal movement generated deep within the brain by Parkinson’s. He brought us back down to earth when he shared the side effects or how things can also go  awry.  Side effects, though not frequent, are very real.

The surgery scheduled for the next day appeared to be straight forward and the surgeon was very confident that my combination of “Tremor Predominate” Parkinson’s and youthful demeanor would add up to a successful procedure. He had told us to expect two sided lead placement, one for each side of the brain.  I would be awake and sedated for at much of the procedure and would be requested to give the right sided "go" permission after placement of the left lead was complete.

After a partial night’s sleep I got up the next morning, a bit groggy and believed that I was ready to go. My preparation had included nothing to eat or drink since the prior evening and no meds. The surgeon had been precise and accurate in his depiction of how things were to proceed but as he knew there is an endless number of ways people can react to surgery. After the first side lead placement the surgery was suddenly stopped.

I recalled being responsive to his request for my desire to proceed and at the same time battling for a chance to breathe.  The battle for respiration seemed to go on a long period of time but  it may have been only the briefest moment.  A dangerous drop in the saturated oxygen in the blood stream had occurred.  The surgeon made a command decision to stop the surgery immediately and he swiftly closed the incision he had made for placing the right side leads.  I was taken for a routine CT  scan. I also had a precautionary chest x-ray and I was now was wheeled to recovery where I would remain until the sedation drugs worked their way out of my system.

The surgeon stopped by and peered into my bed while I was in recovery and gave me enough information so that I would know that the surgery not gone perfectly and had been cut short. He would see me later.

I was returned to the neurologic ICU as do all DBS patients for a mandatory, one night stay.  It was here that I had an emotional and teary reunion when when wife Carolyn and daughter Claire also joined me.  I was uncomfortable and did not feel like moving as the hours began to tick away.   It came over me in a haunting manner again and again that somehow I had failed and now I faced a more complex pathway out.

The surgeon returned that afternoon and gave me the options, one of which included a second surgery to place the right sided lead.  Another might be to program the left sided lead and then to see how that does by itself.  In a bit of a post op fog I hung on to the disappointment of the earlier part of the day.  He then carefully examined both tremoring arms and was delighted with the strong “honeymoon” effect I was getting in my right hand.  The honeymoon effect is a calming of tremors caused inexplicably by simply moving a lead or leads into place.   This indicated nearly perfect location of the left side lead.  I still remained somber but these small but important details began to reveal that many things had gone right.

Through the night I dozed a few hours at a stretch between pain pills.  I was released the following day, tired, exhausted and desired not to think about DBS surgery for the time being.  It seemed that a second surgery existed out there beyond the mile marker and like a shark ready to pounce, it was a danger I wished not to think about.

At the same time I have been fortunate enough to to have been given a resilient frame of mind all of my life.  Now it is one week after the surgery and I am beginning to believe that with God’s help I can manage to endure a second surgery to place the other lead.  I can then focus on the fun stuff such as programming the controller to take over and do its job.  It can then be entered into the battle against Parkinson's.  The incredibly fine staff at the neuro science center have already made calls exploring options with me for a second surgery and a date has been set (April 29).  They have not forgotten me, rather they are systematically putting things together.

I like that feeling and soon enough I think that I will be ready once more to pack my bags and jump aboard the same train the surgeon is on and pray that the one who counts is guiding the way.

To be continued!

Still Shaky in Coupeville

Countdown to Surgery

The big and powerful 737 was running  East  when the pilot banked it and turned sharply amidst turbulence over the Atlantic.  Turbulence that was strong enough to bounce us around as we made the turn, making me feel uneasy.  Carolyn reached for my hand and squeezed gently signaling that if this be the end I am with you and then closed her eyes and communicated she was ready to a much higher authority.  Once the maneuver was complete, we had reversed directions and were in line for our Eastern approach to Fort Lauderdale International airport.  The plane lost altitude rapidly and touched down with powerful bumps that had me wondering how long a set of tires might last on this thing.  The rocky touch down may have signaled a rapid rate of descent and approach but the pilot was in control and followed it up with powerful reverse thrust and braking to slow the silver bird.  Slowing with a force so powerful that we would have slammed into the seats directly ahead of us had we not been securely belted in.  Now after all of this, we were finally ready for a more peaceful taxi to the airport gate.

Carolyn and I strode off the plane and into hustle of the Fort Lauderdale airport several thousand miles from home.   It felt like we were in a whole new world where clear blue sky and warmth were common events in the midst of winter.  We were prepared to spend the next couple of weeks here in Hollywood, Florida at our eldest daughter and son in law's home.  Our intent was to have some quality time with grand kids, take long walks on the beach and rest up for deep brain stimulation 
surgery.  Add to that the joy of Cuban coffee, a good beer now and then and I feel rested right now just thinking about the days in front of us.  After all, in the weeks ahead looms a momentous step: Deep Brain Stimulation Surgery.

Though our trip had been planned many months in advance and the steps toward DBS had similarly begun many months ago the events that scheduled them back to back with a Florida trip fell in place last week.  After last week's appointment with my neurologist we agreed to move ahead with surgery. I had placed a call to the DBS surgical center at Swedish Hospital and told them that I was ready.  With this call the wheels of what seemed like a massive freight train began to turn, picking up speed with each passing day.

Thursday late afternoon I was called back by their scheduling clerk and real times and dates were agreed upon:

2/26 Thursday 2015

Final fasting blood work and physical exam. Which means, no liquids or food after midnight.  Same day1230: MRI brain scan. An image to look for excessive brain shrinkage which could allow movement of my brain and complicate placement of the wire leads.  The image also would provide the surgeon with a map for guidance to subsequent placement of the leads into the deepest part of my brain.

3/03 Tuesday
DBS

3/03-3/04 Tuesday and Wednesday 
Observation in ICU for one night and then hopefully home to sweet Whidbey Island.

3/11 Wednesday 
Back to Swedish for outpatient surgery for placement of controller and batteries directly in my chest wall somewhere beneath the clavicle or collar bone.

For the time being still Shaky in Coupeville

Preparing for Deep Brain Surgery at The Swedish Neuroscience Institute

We sat waiting patiently while my Parkinson's doctor, a neurologist and movement disorder specialist reviewed the results of my tests that had been ordered and completed as a part of the requirements leading up to Deep brain surgery or DBS.  DBS is the surgical process where wire leads are threaded through the skull and then are placed deep, to nearly the center of the brain.  Once turned on the stimulation provided at the end of the leads provides a blocking action on cellular output from the targeted area and can have a remarkable effect on certain Parkinson's symptoms.  The tests I have been undergoing are required to rule out existing conditions that are contraindicated by DBS.  Primarily we are speaking of dementia and "poor response to drug therapy"  The doctor had these results assembled in a folder including: cognitive and memory tests,  my off of drugs movement testing, my on drug movement testing.  She also had the conclusions drawn from each of these tests by those who had worked with me when they were given.  I already knew that each of these professionals had advanced a green light for surgery.  Now my neurologist was ready to share her conclusions with my wife, Carolyn and Myself.  Her recommendation would be based on their notes, and those of  her own and others from nearly 5 years of my being seen for symptoms of Parkinson's and now approaching 4 years after diagnosis.

Carolyn and I have a very high regard for my neurologist and we believed that she had not only applied her considerable expertise to my care, additionally she also honestly cared about me.  Both of us were ready to put a lot of confidence in the conclusions she had arrived at and what she might say.  She started with, "I still believe that you are an excellent candidate for DBS."  No surprise, this was an opinion she had been repeating since nearly the beginning.  It was much more impactful now that I stood on the threshold of having such surgery.  She let that soak in for a minute or so and then went on to discuss what we might or might not expect from the surgery.  The effect of surgery is primarily on the motor or movement symptoms of Parkinson's.  I have a variant of Parkinson's known as "tremor predominate" which means that my primary symptom of tremors could be expected to respond well to deep brain stimulation.  The underlying cause of Parkinson's and other symptoms of the disease itself will continue.  She went on to say that "you may expect the surgery results to be as good as your best "on" drug therapy."  In other words at full drug dose and when the disease is responding optimally to drugs, it is similar to DBS surgery results.  The difference is that I could take fewer drugs and would not be as heavily burdened by the side effects of drug therapy. The roller coaster of drug therapy can be effectively smoothed since DBS stimulation is active and operating all the time, 24/7.  Unfortunately some drug therapy usually remains after surgery but the quantity is likely reduced and occasionally may be eliminated.

It became time for questions and I quizzed her "I am doing pretty well with drug treatment and I have read that tremor predominant Parkinson's often moves slowly.  So why would I want to undertake such a major procedure?"  She explained that in observing me for the past several years and seeing my drug list grow that she could not say my disease was slow moving.  She went on to say that she had some patients who were progressing more slowly and some who were progressing more rapidly.  I was average and at this rate I could expect significant disability within 5 years.  Her intent I do not believe was to frighten me but to put me in touch with reality.  The truth is that Parkinson's is a relentless disease from which there are no remissions.

We finished with discussing which receptor site in the center of my brain would best be targeted for the goals I have with the surgery.  The neuro surgeon at the Swedish Neuro Science Institute in Seattle, would place the stimulator leads in one of two sites.  The process must be done twice.  Once for each side of the brain since both sides of my body are affected.  knowing that I desired very much to reduce drugs as much as is possible she suggested that the surgeon be instructed to place the lead in an area called STN or sub thalamic nucleus.  At this location excellent results have been achieved after surgery with drug reduction.

Though she is not a surgeon, many details related to surgery and the post operative tuning of the implanted leads are all under my neurologists care.  Amazingly she is even willing to alter her schedule to assure her availability for follow up or for tuning appointments. It does take several months of tuning the output of the stimulator to achieve optimum results.

After returning home, I placed a call to the nurse practitioner at Swedish, simply stating that I want to move ahead with surgery.  She called back the following day and sounded delighted with our decision.  She reinforced that my youthfulness and excellent overall health profile helped boost my status as an excellent candidate for the surgery.  Final scheduling of the surgery will depend on the surgeon and the staff at Swedish Neuro Science institute.  I am expecting an early or late March date.

Still Shaky in Coupeville

DBS On My Mind

The road leading to deep brain surgery for tremor of Parkinson's and other movement disorders is a long and arduous one. It includes several tests prior to even talking with a surgeon. However, enough is known about who might benefit from this surgery and who might not, that the preliminary screening process is essential.

"Blue hole" over Whidbey Island 

On the Road
Carolyn, Bella and I wait for the 10:15 ferry to Port Townsend. A road trip to St Helens, Oregon lies ahead where we intend to spend some time with our son Jay and his wife Luka in their new place of residence. 

This morning the weather is moderate and there are breaks in the persistent Northwest cloud cover.  Patches of blue sky appear among the clouds and brighten my spirit.  Such a sky is a hallmark of central Whidbey Island. Geographically we live in the shadow of the Olympic mountains, a shadow that reduces our rainfall to 20-22 inches annually.  Mountaineer, author and former pharmacy customer of mine, Harvey Manning, called it the blue hole over Whidbey in his book "Walking The Beach to Bellingham."  However matters of weather often change rapidly and as we crossed the sound to Port Townsend the heavy clouds closed rank, the blue hole vanished and the once glowing Olympics were obscured by layers of gray, misty clouds.

This blog may be about a road trip but I find it difficult to put the events of the previous week aside and not think about them.  After all it has only been a few days since I was treated to a Skype style live computer conference to review the results of my recent cognitive and memory testing. This testing is required for those considering deep brain surgery or DBS.  If memory loss or the presence of dementia is detected during this process they are considered ito be reason enough to disqualify the patient from DBS surgery.

The video format proved to be an amazingly personal way to get the results of a medical procedure recently completed in Seattle.  Carolyn and I were able to make a much shorter trek to a satellite clinic to be given the results personally via the miracle of television.  We just got seated in front of a large screen television when the doctor, a Phd psychiatrist, dialed in and her live image, direct from her desk jumped to life.

After stating that I did all right in the cognitive testing. She went on to explain that I had scored below expectations on two areas of testing and above expectations in two others.  Below expectations included situations in which I would be slow to react on information given and difficulty functioning in situations where processing information from multiple sources(multi tasking). She emphasized that these changes were consistent with Parkinson's.  The condition described, that of slow response to a variety of stimuli and difficulty processing multiple inputs is called neuro-cognitive disorder. In my case it is mild neuro-cognitive disorder. The psychiatrist, went on to explain that in a ten year period one with mild neuro-cognitve disorder might expect that among similar patients 30% would remain the same, 30% would get better and 30% would get worse.  Mild neuro-cognitive disorder is not a deal breaker with DBS.

I was in charge Bella's needs but the duties were shared .

My cognitive and memory test results would be compatible with surgery.  The next stop in this process will be Swedish hospital in Seattle for physical assessment both on and off of medications.  Before the computer conference was complete the Psychiatrist, inserted what I took to be a warning. She cautioned that mild neuro-cognitive poblems may worsen with DBS surgery. She quickly added that many considered that to be a fair trade for the physical improvement. Is it? How could any deterioration of cognitive function represent a fair trade for something else? She inserted this warning into the conversation more than once.

The ferry had rocked and rolled just a bit this morning, with a light chop on the water but no whitecaps. After putting ashore in Port Townsend Carolyn pointed our Toyota away from town and about 8 miles later we turned South on highway101.  101 is a beautiful highway which runs quite a few miles along a natural fiord known as Hood canal which demarcates the large peninsula on the West side of our state.  I was not worthless on this trip and had a well defined role and a purpose: support man for Carolyn.  Under this title I was official road trip copilot, which included: GPS monitor, lunch server, and disc jockey.  Informally I was also in charge of Bella's needs.  Things like when where to stop for water and other basic dog needs.

We passed the turn off to the small town of Chimicum, the location of Bettty Macdonald's wonderful, humorous book, "The Egg and I." Her memoirs of life in the 1930's with her young husband on a chicken farm. A delightful book that made old fashioned hillbillies Ma and Pa Kettle household names in America during the 40's and 50's. More than 80 years later Chimicum is still rural and sparsely populated.

We passed through the Columbia river town of Longview

Later as we approached our destination we passed through the Columbia river town of Longview.  A dreary and industrial looking city and even more on this day we had begun with the uplifting sight of the blue hole over Whidbey. We approached the end of our journey in the dismal contrast flattening gray fog of Longview. Here we drove by acres and acres of fir and hemlock logs which lay trimmed and ready for loading onto, ocean going transport ships for export to Japan. Some will be milled to lumber and sent to California or other places for home building.

We crossed the bridge over the Columbia river and entered Oregon and then it is only a short stretch to St Helens. Soon we would be spending time with our son and his new wife in their new home. The matters of weather and other concerns fade when Thinking of this.

The road home

Shaky in Coupevillle