We have been able to watch the baby doves grow before our very eyes.
These videos were taken a few days ago.
Sunday, March 29, 2009
Thursday, March 26, 2009
Wonderful Visit
My sister Jenny and her daughter Makayla were here for a visit.
Wednesday, March 18 - Thursday, March 26th
Wednesday, March 18 - Thursday, March 26th
Thursday, March 19th
We went to Disney On Ice 'Mickey's Magical Journey'
We had front row seats.
Friday, March 20th....More visitors arrived
Jacklyn came home from college and Jill/Josh came from Conroe.
Saturday, March 21st
We had a PINK PRINCESS party to celebrate Makayla's 4th Birthday.
Everyone wore pink...It was required.
We had plenty of PINK food
We played many PRINCESS theme games.
Everyone was a good sport and Makayla had LOTS of fun.
We ended the event with cupcakes and ice cream.
Sunday was a day of fun at the house.
Swimming in the "small pool" ... aka the hot tub.
Going to the park and playing outside.
Monday, March 23 we went to the Dallas Arboretum.
The theme this year was playhouses.
The weather was beautiful and we took a ton of photos.
Click here for photos
Tuesday, was a day of shopping.
We were able to get Jill to make some decisions about flowers for her wedding
and other wedding planning.
Wednesday...Hobby Lobby!
Need I say more.
Thursday - a sad day.
We thoroughly enjoyed the conversations and the antics of having a 4 yr old in the house.
We will eagerly look forward to the next visit.
Check Jenny's blog for other interesting photos...maybe a buffalo grin or two!!
Click my photos of Disney On Ice, Pink Princess Party and more!
Wednesday, March 25, 2009
Hatched!
Well it's been 11 days since we noticed eggs in the nest.
Today, Wednesday, March 25th
"Mary Jane" our resident Mourning Dove hatched two baby doves.
Today, Wednesday, March 25th
"Mary Jane" our resident Mourning Dove hatched two baby doves.
Aren't they cute!!
Feeding time for the baby doves.
Monday, March 23, 2009
Back to Work
Monday, March 23rd was Doug's first day back to work.
He did not need to use his Short Term Disability after all.
He did not need to use his Short Term Disability after all.
MEDICATION UPDATE:
He is currently taking 7.5mg of prednisone
He will taper to 5mg of prednisone on Sunday, March 29th.
He will take this until he sees Dr Cohen on April 15th.
He continues to take the Zoloft and Ativan and he will discuss the length of this treatment
with Dr Cai at this appointment on April 2nd.
He is doing ALOT better this week !!!
His mood is better, his anxiety is better and his energy level has increased.
HEARING UPDATE:
He also has an appointment with Dr Kutz the ENT physician at UTSW.
He will have a hearing test to see how well the 3 ear injections he has received
over the past few weeks has affected his hearing.
I notice he has not asked me to repeat things as often so I'm hoping for great news!
His mood is better, his anxiety is better and his energy level has increased.
HEARING UPDATE:
He also has an appointment with Dr Kutz the ENT physician at UTSW.
He will have a hearing test to see how well the 3 ear injections he has received
over the past few weeks has affected his hearing.
I notice he has not asked me to repeat things as often so I'm hoping for great news!
Saturday, March 14, 2009
EGGS!
Thursday, March 12, 2009
Psychiatrist Visit - Dr Cai
Today, I took Doug to see Dr Cai, a psychiatrist. A psychiatrist was recommended, because they are a physician that deals with medical and mental related issues.
After an hour long discussion with Doug and I, the doctor came to the following diagnoses:
1) Generalized Anxiety Disorder
2) Major Depressive Disorder, specified as with psychotic behavior.
Dr Cai recommends Doug continue with the Ativan 1mg as needed and stay on the Zoloft 50mg. He does however want us to ask Dr Cohen, how much longer he will need to be on the Prednisone. If it is longer than 6 more weeks, he would like Doug to increase his Zoloft to 100mg.
Dr Cai, feels Doug's anxiety and work related stress could also be what is triggering his auto-immune hearing loss as well. He states stress and re-occurances of auto immune disease go hand in hand. So if we can get his anxiety under control, his hearing "could" also get better.
We both left, happy with how the discussion went and confident that the treatment we are following will work over time. He will follow-up with Dr Cai on April 2nd regarding the medication management of these medications.
Tomorrow Doug has another appt with the ENT doc at UTSW for a repeat hearing test and steroid injection in the ear.
After an hour long discussion with Doug and I, the doctor came to the following diagnoses:
1) Generalized Anxiety Disorder
2) Major Depressive Disorder, specified as with psychotic behavior.
Dr Cai recommends Doug continue with the Ativan 1mg as needed and stay on the Zoloft 50mg. He does however want us to ask Dr Cohen, how much longer he will need to be on the Prednisone. If it is longer than 6 more weeks, he would like Doug to increase his Zoloft to 100mg.
Dr Cai, feels Doug's anxiety and work related stress could also be what is triggering his auto-immune hearing loss as well. He states stress and re-occurances of auto immune disease go hand in hand. So if we can get his anxiety under control, his hearing "could" also get better.
We both left, happy with how the discussion went and confident that the treatment we are following will work over time. He will follow-up with Dr Cai on April 2nd regarding the medication management of these medications.
Tomorrow Doug has another appt with the ENT doc at UTSW for a repeat hearing test and steroid injection in the ear.
Tuesday, March 10, 2009
Doug Update
Today, I called Doug's primary care doctor about some of the symptoms he's been having. He suggested we come to the office around 11:15am. The doctor evaluated Doug and suggested we head to the ER at Presbyterian Plano for ASAP blood tests and EKG. The blood tests and ekg were all normal. His potassium was 4.1. It was great as a matter of fact! His blood pressure is high 169/91 and pulse rate was 119 in the ER but they discharged him with that and attributed it to the anxiety. Fix the anxiety and all the symptoms "should" get better. The problem has been finding something to take care of the anxiety.
Doug's anxiety is attributed to the "steroid induced psychosis" caused from being on the high dose prednisone for so long. His Zoloft (for depression) has been increased from 25mg to 50mg and they changed his anxiety medication from Xanax to Ativan (lorazepam) 1mg every 8 hours.
I've also placed a call to a psychiatrist in Plano. I think we need professional help related to the anxiety and the medication management of this part of the illness.
We've also started the process for short term disability, as we do not know how long these symptoms will progress. Dr Cohen is sure, these symptoms will subside once the prednisone taper is completed and when Doug's adrenal glands start producing steroids on their own. I talked with the HR person at DeLaRue today and she will start the necessary paperwork with UNUM and let us know by email our next steps.
Stay tuned!
Doug's anxiety is attributed to the "steroid induced psychosis" caused from being on the high dose prednisone for so long. His Zoloft (for depression) has been increased from 25mg to 50mg and they changed his anxiety medication from Xanax to Ativan (lorazepam) 1mg every 8 hours.
I've also placed a call to a psychiatrist in Plano. I think we need professional help related to the anxiety and the medication management of this part of the illness.
We've also started the process for short term disability, as we do not know how long these symptoms will progress. Dr Cohen is sure, these symptoms will subside once the prednisone taper is completed and when Doug's adrenal glands start producing steroids on their own. I talked with the HR person at DeLaRue today and she will start the necessary paperwork with UNUM and let us know by email our next steps.
Stay tuned!
Mourning Dove Nest
The Mourning Doves coo may sound sad, but bird watchers know it signals
the beginning of this birds habits of nesting, claiming territory, and raising young.
the beginning of this birds habits of nesting, claiming territory, and raising young.
The nest was built in the past few days on top of our hose reel in the back yard.The male and female are taking turns sitting on the nest.
Zoomed in photo of the mourning dove on the nest.A loosely built nest of twigs, grass, weeds and pine needles.make up the nesting materials
Doves use. In fact, this loose pile of twigs is so lightly
put together that often you can see through it from the bottom.
If the Dove is startled and flies off the nest too quickly, the eggs could fall from the nest.
Bird watchers would be wise to wait until the eggs have hatched before approaching any nest.
Nest abandonment is very common with these birds.
If they feel any threat from predators whether human or animal, they may go elsewhere to nest abandoning both eggs and nestlings.
The nest can be found 5-25 feet above the ground,
often in the crotch of a shrub or tree.
Laying 2 white eggs that are incubated for 14-15 days.
The young will leave the nest in 12-14 days.
Mourning Doves have been known to reuse the same nest for
five sets of eggs in a single season.
Usually 2 - 3 broods are raised each season.
Sunday, March 08, 2009
Jill's New Car
Jill and Josh went car shopping on Saturday.
She is shown here with her first car purchase.
She is shown here with her first car purchase.
Saturday, March 07, 2009
Jill is 23!
Happy 23rd Birthday Jill!
Josh brought Jill an ice-cream cake and flowers.
Jill's boss, Mindy, brought Jill the balloonsand bath/body gifts and FAMILY photo frame.
We will celebrate Jill's birthday, when she comes home in a few weeks.
Friday, March 06, 2009
UTSW - ENT appt
Today Doug saw Dr Kutz. He is an ENT at UTSW (University of Texas SouthWestern Medical Center) that is one of a few physicians that is versed in Auto Immune Hearing Disease.
Doug first had an extensive hearing test. The hearing test was unchanged from the one he had in November of 2008. Following the hearing test, Doug received a steroid shot in his left ear, an intratympanic injection of dexamethasone. The injections are painful and he needs to be still and not move or swallow for 20 minutes. He will receive a total of 3 injections over a three week time frame. He will receive another hearing test and ear injection next Friday, March 13th and again on Friday, March 20th.
This course of treatment is being used as Doug is tapering off of the oral prednisone and the specialists are in hopes that a site specific steroid injection will work to reduce his hearing loss.
Next steps if these are not successful are hearing aid(s) /cochlear implant.
Doug first had an extensive hearing test. The hearing test was unchanged from the one he had in November of 2008. Following the hearing test, Doug received a steroid shot in his left ear, an intratympanic injection of dexamethasone. The injections are painful and he needs to be still and not move or swallow for 20 minutes. He will receive a total of 3 injections over a three week time frame. He will receive another hearing test and ear injection next Friday, March 13th and again on Friday, March 20th.
This course of treatment is being used as Doug is tapering off of the oral prednisone and the specialists are in hopes that a site specific steroid injection will work to reduce his hearing loss.
Next steps if these are not successful are hearing aid(s) /cochlear implant.
DeLaRue says "Get Well Soon"
Friday morning, a couple of DeLaRue employees dropped off a couple of
Get Well Soon baskets for Doug.
Get Well Soon baskets for Doug.
This is an Edible Arrangement...all of the fruit was excellent!
This is a photo of both baskets he received.One was an edible arrnangement of fruit.
The other had various snack items:
bananas, apples (green & red), summer sausage, crackers,
packaged cookies, Pringles, fruit snacks, candy bars, popcorn,
couple of car magazines and Get Well card.
They enjoyed a short visit with Doug before we had to get
ready to leave for a doctor's appt.
Thursday, March 05, 2009
Doug's Eye Appt
Doug has been complaining about problems with his vision over the past 7-10 days. Dr Cohen, recommended he see an opthalmologist as long term use of high dose prednisone can cause glaucoma or cataracts. Today he had an appointment with the opthalmologist. The eye doctor states Doug does not have cataracts or glaucoma. He feels one of the new medications (probably the Zoloft) is affecting his near vision. Reading glasses over his contacts may help or he could add bifocals to his current prescription.
Zoloft is an SSRI and it is known to cause mydriasis. Mydriasis is an excessive dilation of the pupil due to disease, trauma, or the use of drugs. Normally, the pupil dilates in the dark and constricts in the light to improve vividity at night and to protect the retina from sunlight damage during the day. A mydriatic pupil will remain excessively large even in a bright environment.
Doug has started feeling less anxious and has decreased his Zoloft from 50mg to 25 mg. I am sure once he is off this medication, his vision problems will go away. He also has been on prednisone at 15mg per day. He will continue this for a few days and then decrease to 10mg until he sees his rheumatologist on March 18th.
Zoloft is an SSRI and it is known to cause mydriasis. Mydriasis is an excessive dilation of the pupil due to disease, trauma, or the use of drugs. Normally, the pupil dilates in the dark and constricts in the light to improve vividity at night and to protect the retina from sunlight damage during the day. A mydriatic pupil will remain excessively large even in a bright environment.
Doug has started feeling less anxious and has decreased his Zoloft from 50mg to 25 mg. I am sure once he is off this medication, his vision problems will go away. He also has been on prednisone at 15mg per day. He will continue this for a few days and then decrease to 10mg until he sees his rheumatologist on March 18th.
Tuesday, March 03, 2009
Another trip to the E.R. - Hypokalemia
Today, we received a call from Dr. Cohen. Doug had seen him yesterday and labs were taken. Dr Cohen called to say a few of Doug's labs were really, really low. Potassium was 2.2 and the Sodium level was 127. Normal potassium levels are 3.5 - 5.0 and normal sodium levels are 135 - 148 mEq/L. He stated this could be a life-threatening condition. Dr Cohen put in a call to Doug's primary care physician, Dr Strength...but never received a call back in a timely manner. Dr Cohen called us back and asked us to go to the nearest hospital for IV fluids with extra sodium and potassium. He said he would call the E.R. and fax them the lab results, so they would be prepared for Doug's arrival.
On admission to the E.R. an IV with sodium was run in over an hour, and oral potassium was given. Labs were re-drawn. The potassium was 2.4 in the E.R. and the sodium level was within normal limits..but now the phosphorus levels were noted as being high. Doug was given a potassium drink as well as another 1,000 ml saline drip with 40mEq of potassium added to run in over 2 hours. After this labs were redrawn and the potassium level was 3.4 - This was close enough to normal that he was discharged from the hospital.
The doctor did not know what caused his potassium/sodium/phosphorus levels to be low. He will add more potassium rich foods to his diet and monitor it with his primary care physician.
Hypokalemia is a condition of below normal levels of potassium in the blood serum. Potassium, a necessary electrolyte, facilitates nerve impulse conduction and the contraction of skeletal and smooth muscles, including the heart. It also facilitates cell membrane function and proper enzyme activity. Levels must be kept in a proper (homeostatic) balance for the maintenance of health. The normal concentration of potassium in the serum is in the range of 3.5-5.0 mM. Hypokalemia means serum or plasma levels of potassium ions that fall below 3.5 mM
On admission to the E.R. an IV with sodium was run in over an hour, and oral potassium was given. Labs were re-drawn. The potassium was 2.4 in the E.R. and the sodium level was within normal limits..but now the phosphorus levels were noted as being high. Doug was given a potassium drink as well as another 1,000 ml saline drip with 40mEq of potassium added to run in over 2 hours. After this labs were redrawn and the potassium level was 3.4 - This was close enough to normal that he was discharged from the hospital.
The doctor did not know what caused his potassium/sodium/phosphorus levels to be low. He will add more potassium rich foods to his diet and monitor it with his primary care physician.
Hypokalemia is a condition of below normal levels of potassium in the blood serum. Potassium, a necessary electrolyte, facilitates nerve impulse conduction and the contraction of skeletal and smooth muscles, including the heart. It also facilitates cell membrane function and proper enzyme activity. Levels must be kept in a proper (homeostatic) balance for the maintenance of health. The normal concentration of potassium in the serum is in the range of 3.5-5.0 mM. Hypokalemia means serum or plasma levels of potassium ions that fall below 3.5 mM
Monday, March 02, 2009
Doug: Steroid Induced Psychosis
I took Doug to see the doctor today. He has been diagnosed with Steroid Induced Psychosis.
Here is some information about this disorder. Hopefully he will be fine in a couple of weeks if he is able to taper down from this medication. Doug started at 60 mg of prednisone. He is now at 20mg of predisone. He will taper to 15 mg tomorrow and then will take that for 5 days; before tapering to 10 mg for 5 days.
A study about steroid induced psychosis suggest that patients receiving daily doses of greater than 40mg of Prednisone or its equivalent were at greatest risk for developing a steroid psychosis.
The most prominent symptoms appear during the course of the illness consisted of the following:
Emotional lability: no laughter, crying or smiling
Anxiety: uneasiness, fear or worry
Distractibility: lack of interest/lack of attention
Pressured speech: non-stop talking/hard to interrupt
Sensory flooding: difficulty with the process of ideation (forming an idea of using a known movement to achieve a planned purpose), motor planning (planning the action needed to achieve the idea), and execution (carrying out the planned movement)
Insomnia: difficulty falling asleep/ difficulty staying asleep
Depression: abnormal depressed mood
Perplexity: being perplexed / puzzled
Agitation: restlessness, unpleasant state of arousal, increased tension & irritability.
Hallucinations: audio/visual disturbances (dreaming while awake)
Memory impairment: intermittent difficulty to store, retain and recall information
Mutism: inability to speak the thoughts/ unable to express thought process
Delusions: belief based on false information
Apathy: state of indifference, lack of interest or concern
Hypomania: persistant / pervasive irritable mood, thoughts, behaviors
Physical Symptoms: insomnia, loss of appetite, blank stare
Steroid induced mental changes are common. The overall incidence of steroid psychosis when steroids are used to control systemic medical disorders varies between 3 and 6%. The average person gets better with the decreasing of the corticosteroid treatment. (93% had a complete recovery, but 4% had continued symptoms or recurrence of symptoms and 3% committed suicide.)
In reviewing these articles, several conclusions can be made.
First, the neuropsychiatric complications of steroid treatment are quite common.
Second, the specific types of neuropsychiatric impairments comprise a range of symptoms from anxiety, irritability and impaired cognition to depression, mania, psychosis, and suicidality.
Third, although the available literature fails to reveal a uniform approach to the treatment of these specific side-effects, it is clear that these symptoms are common enough and potentially very severe so as to warrant aggressive and early intervention by psychiatric consultants.
Lastly, given the overall lack of published scientific literature on this topic, it behooves patients, family, and care-providers to work to improve the promulgation of this knowledge with the goals of stimulating further research on this subject as well as improving the quality of care for patients with this condition.
Here is some information about this disorder. Hopefully he will be fine in a couple of weeks if he is able to taper down from this medication. Doug started at 60 mg of prednisone. He is now at 20mg of predisone. He will taper to 15 mg tomorrow and then will take that for 5 days; before tapering to 10 mg for 5 days.
A study about steroid induced psychosis suggest that patients receiving daily doses of greater than 40mg of Prednisone or its equivalent were at greatest risk for developing a steroid psychosis.
The most prominent symptoms appear during the course of the illness consisted of the following:
Emotional lability: no laughter, crying or smiling
Anxiety: uneasiness, fear or worry
Distractibility: lack of interest/lack of attention
Pressured speech: non-stop talking/hard to interrupt
Sensory flooding: difficulty with the process of ideation (forming an idea of using a known movement to achieve a planned purpose), motor planning (planning the action needed to achieve the idea), and execution (carrying out the planned movement)
Insomnia: difficulty falling asleep/ difficulty staying asleep
Depression: abnormal depressed mood
Perplexity: being perplexed / puzzled
Agitation: restlessness, unpleasant state of arousal, increased tension & irritability.
Hallucinations: audio/visual disturbances (dreaming while awake)
Memory impairment: intermittent difficulty to store, retain and recall information
Mutism: inability to speak the thoughts/ unable to express thought process
Delusions: belief based on false information
Apathy: state of indifference, lack of interest or concern
Hypomania: persistant / pervasive irritable mood, thoughts, behaviors
Physical Symptoms: insomnia, loss of appetite, blank stare
Steroid induced mental changes are common. The overall incidence of steroid psychosis when steroids are used to control systemic medical disorders varies between 3 and 6%. The average person gets better with the decreasing of the corticosteroid treatment. (93% had a complete recovery, but 4% had continued symptoms or recurrence of symptoms and 3% committed suicide.)
In reviewing these articles, several conclusions can be made.
First, the neuropsychiatric complications of steroid treatment are quite common.
Second, the specific types of neuropsychiatric impairments comprise a range of symptoms from anxiety, irritability and impaired cognition to depression, mania, psychosis, and suicidality.
Third, although the available literature fails to reveal a uniform approach to the treatment of these specific side-effects, it is clear that these symptoms are common enough and potentially very severe so as to warrant aggressive and early intervention by psychiatric consultants.
Lastly, given the overall lack of published scientific literature on this topic, it behooves patients, family, and care-providers to work to improve the promulgation of this knowledge with the goals of stimulating further research on this subject as well as improving the quality of care for patients with this condition.
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