Tag Archives: staph

A tale of two puppies

Mike should have known better, really.

I was so happy at the prospect of finally getting a puppy that the thought of two puppies had never entered my mind. Honestly.

Then, while we were on the way to the airport last Monday to be medivaced to Bangkok, Mike mentioned that he’d called the puppy lady and told her we wouldn’t be able to make our scheduled appointment at lunchtime that day, after all.

It has turned out to be more difficult to find a puppy in Laos than we’d bargained for. Once we’d settled the fact that we definitely not getting the imported Samoyed (a question that was only really resolved in my mind when we went back to the little store and she was gone) we started scouting around.

Then Mike’s colleagues got wind of the fact that we were looking for a puppy and, hospitality being what it is here, decided to take care of this for us.

“What do you mean Makan has found us a puppy?” I asked, when Mike told me what was going on.

“Well, I’m not exactly sure,” Mike said. “You know how indirect everything is here. The word on the street is that Makan has ‘ordered one’ but I can’t get anyone to tell me when we might expect this puppy to show up at our house, or whether these puppies have even been born yet.”

“But what if we don’t like this puppy?” I asked.

Mike shrugged. “Unless we find another puppy quickly we will have exactly zero choice in the matter.”

We really didn’t want Makan spending his hard-earned money to buy us a puppy, so we set to hunting down puppies with new will. We asked the owner of the little grocery store we go to, and the people in the hardware store. But we didn’t strike gold until we asked the German guy who sells the only decent ice cream in town.

Ice cream man was very confused to be asked about “mah noy” (little dogs) while we were paying our bill, but when he finally realized what we were after he obligingly dug out the phone number of the German butcher. The German butcher, he told us, had little dogs.

The German butcher and his wife, Soumontha, did indeed have little dogs. We told Soumontha that we’d come round on Monday lunchtime to see them.

Except, last Monday at lunchtime found us in a car on the way to the airport to catch a flight that would ferry us to hospital in Thailand. Damn staph.

“Maybe we should get a puppy in Bangkok,” I suggested, trying to think of ways to redeem this trip and get my puppy fix. “A yellow lab, maybe. Or a husky.”

“Soumontha said she’d keep one for us,” Mike said. “Or two. She asked how many we wanted.”

Have you ever had one of those moments when your perspective and vision for life shifts with all the brilliant immediacy of a lightening strike? That was how the possibility of two puppies arrived in my mind – in a single, mesmerizing, instant.

“What did you tell her?” I asked, pretending casual.

“I told her that it depended on how cute my wife thought they were,” Mike said.

Really?” I said.

“Stop!” Mike said, with all the sudden fear of someone who’s just realized that they have handled a Pandora’s box far too casually. “I was joking. We do not need two dogs.”

“How do you feel?” I asked, glancing down at the swollen legs that were jammed into his shoes.

Stop!” Mike said, ignoring my solicitous diversion.

“What???” I asked.

“I can see you thinking.”

“Once upon a time you loved it when I thought,” I said.

“Yes,” Mike parried. “And then we got married.”

I didn’t pester him too much about two puppies last week. It’s hard to muster up the steely willpower necessary to press an argument with someone dressed in green pajamas who has an IV decorating the back of their hand. So I bought him chocolate covered ice cream bars from the gift shop downstairs and bided my time.

That time came yesterday, when we finally got to go see Soumontha’s puppies. There are fifteen of them, five weeks old now, and they are a squirming tangle of adorable. I sat down on the ground and let them crawl all over me and wondered how we were ever going to be able to pick one in ten minutes flat.

As it turned out, there were only two left unallocated from the litter that we wanted – a little girl and a little boy – tiny, tawny, balls of fluff with black noses.

We were leaning towards the little boy, but then we noticed that he whimpered a lot and started to wonder whether he was chronically noisy, or anxious… or brain damaged. Then we started leaning towards the little girl.

“Perhaps we could take them both,” I suggested, smiling up at Mike and Soumontha.

“I told you,” Mike said to Soumontha.

Mike and I talked this over again last night as we walked down to an outdoor restaurant overlooking the Mekong.

“They could be buddies for each other,” I said. “When we have to go out they won’t be lonely – they can play nicely with each other while we’re gone. And during the day when I am busy they can curl up together like tiny, contented, bundles of love. They will be happier with a friend.”

“That is a beautiful vision indeed,” Mike said. “But I don’t think it works like that, exactly. When puppies are together all they want to do is play, and I think it’s far more likely that they’ll wind each other up and get into all sorts of mischief. Do you really want to be trying to write in the same room as two bored puppies and all sorts of things they should not be chewing on?”

“Huh,” I said, my beautiful vision dying a small death.

After we got home from dinner I put this to an informal poll and it seems that, as usual, the global facebook audience agrees with Mike.

“Uh oh!” warned a good friend from California, Danielle. “I know it’s tempting, but don’t get two that are siblings! They maintain a pack mentality and it makes them unbearably hard to housetrain and domesticate! They act like little wild wolves when you have two from same litter together.”

“Little wild wolves” piques my curiosity, I must admit – after all, how much trouble can two puppies be? But I suspect that my curiosity will be trumped by pragmatism-plus-spouse, and I am slowly resigning myself to being a one-puppy household.

Of course, we are going again on Sunday to visit the whole furry mob of them – a visit that is likely to take a pair of bellows to the dying embers of that beautiful vision of canine comradeship…

I’ll keep you posted.

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A three year “anniversary” in Bumrungrad

We are still in Bangkok in Bumrungrad hospital. Mike is still in those sexy green PJ’s with an IV line sticking out of the back of his hand and plastic bags full of Dalacin and Ceftriaxone hanging off a metal stand above his head. Periodically air bubbles get in the line and the machine emits a loud and obnoxious beeping that doesn’t stop until a nurse comes and sorts it out. Yesterday’s last course finished dripping into his veins at 11:20pm, and nurses came in this morning to take his blood pressure at 5:15am – which I think is a ridiculous practice. Why would you wake someone out of a restorative sleep every morning in the five’s just to take their blood pressure when they’re clearly in no imminent danger?

Yes, three days into this and our serene gratitude has started to disappear at odd moments. It’s like my good mood just takes off and wanders downstairs to the Starbucks to get a cup of coffee, then saunters back in some time later and acts all surprised to find that pissiness has taken up residence in its absence.

“What’s your problem?” my sensible and cheerful self asks in these moments, genuinely bewildered. “You’ve really got it very good. Mike’s getting much better, there’s a McDonalds downstairs, they sell Haagen Dazs in the gift shop, and the shower here is awesome.”

“Just shut up,” my pissy self answers. “You’re annoying.”

Sometimes my sensible and cheerful self gives pissiness the middle finger and reclaims the throne. Sometimes my sensible and cheerful self goes and sulks in the corner.

So here’s the update: Mike is getting much better – the infection seems to be disappearing rapidly, though we both had an expectations readjustment yesterday when the smiling doctor suggested we may not get discharged until Monday.

“We trust your judgment,” we told him yesterday. “If that’s what it takes we’ll stay until Monday.”

(Of course, we’ve spent much of the last day speculating as to whether we could possibly get released on Sunday, or maybe even Saturday.)

In the meantime we’re both trying to stay focused and working off our laptops (Mike is typing one-handed as I write this while the other is soaking up all those antibiotics). I’m really enjoying the French fries down in the food court. I had a crème brule latte this morning and wasn’t that impressed. I ventured out of the hospital last night for the first time to find a local spa – where I decided to get the traditional Thai massage because it was significantly cheaper than the Swedish oil massage. I won’t make that mistake again. She twisted my body into positions I hadn’t known I could achieve, and she yanked me into some of these positions while standing on me. It was like being mugged by yoga.

Today is an anniversary of sorts for us – three years ago today Mike emailed me for the third time. It was a lovely long letter that basically inquired as to whether I might like to embark upon a long distance relationship with a virtual stranger. We all know how that story ended. Or, rather, how it started.

So, tonight, if they let Mike off his plastic tubes at some stage, I’m going to take him on a surprise field trip date to the rooftop garden on the sixth floor to mark our “anniversary”. Then we might stop at the nursery and look at the babies. I spied a dozen babies yesterday through a giant glass window – all these impossibly tiny bundles neatly lined up, fast asleep. I stood for a couple of seconds and watched them. It was like visiting a pet store and watching the puppies, only much less entertaining. But, hey, good entertainment is a bit in short supply around here at the moment so wandering past the nursery will just have to do. That and Haagen Dazs ice cream bars.

Thank you all for your messages of support and apologies that I haven’t been able to get back to you all yet. We’ve been really touched by all the blog comments and facebook comments and emails that have flooded in. When you’re clothed in green PJs and far from home it’s really nice to know people are thinking of you. I sure hope you’re all having a good week and that your sensible and cheerful selves are reigning supreme in your own internal kingdom.

Greetings from Bangkok

About two hours after I posted A Tale of Two Right Legs I got a call from Mike at the office. Our emergency evacuation medical insurance company had gotten involved. Given Mike’s history with this particular set of bugs, they wanted him to go to Bangkok.

It all happened very quickly after that. We made the decision that I would come with him, and the insurance company made the reservations for both of us on the 2:20 flight to Bangkok. We packed in less than an hour, got to the airport, finished paying for my ticket with a credit card forty minutes before scheduled take-off, and we were on our way.

The hospital here is, well, lovely. We have a private room, there’s a couch in here I can sleep on, and if it weren’t for the fact that neatly dressed nurses keep coming in every couple of hours to take Mike’s blood pressure or hook up another bag of antibiotics to his IV, I might forget we were in a hospital – this place looks more like a particularly sterile hotel.

It’ll take a couple of days to get last night’s test results back, but Mike’s already on a cocktail of IV antibiotics that the doctors seem fairly confident will kill the staph.

I’ve found the last couple of days a little bit overwhelming. Not overwhelming in a bad sense, thankfully. But I have been overwhelmed by all the reminders inherent in this whole experience of how much Mike and I have to be grateful for in this life – how ridiculously blessed we are. We were talking in the taxi to the hospital about Sommai. He had the same problem Mike does now. He did not, however, have our options. We are profoundly grateful for our options.

We are also thankful for good medical insurance, and for co-workers and supervisors who prioritized caring for staff and strongly recommended we come straight to Thailand. Emails and comments on facebook and comments on the blog have poured in from all over the world to remind us that people are thinking about us and praying for us. We feel cared for in more ways than one.

Thanks all, I’ll keep you posted when I can.

A tale of two right legs

Something happened this weekend that I’ve been dreading for almost a year – ever since we decided to move to Laos.

I have lymphedema. For those of you lucky enough not to know what that is – it’s what happens when your lymphatic vessels are either missing or impaired. This causes your lymph fluid to accumulate in the area (in my case, my legs, especially my right one). Lymph is full of white blood cells and protein, and when it hangs out in tissue instead of filtering back into your tiny lymph vessels and on up to lymph nodes, it’s not good…

Things swell. They stay swollen. The whole area become the perfect breeding ground for any bacteria that finds its way into the limb – putting you at high risk of infections that come on quickly and sometimes require hospitalization so that antibiotics can be administered intravenously. Protein starts to accumulate in the tissues. This causes them to harden, further damaging joints and the delicate network of lymph vessels. Things swell more. Etc.

It sucks.

There’s no cure. That sucks too.

I’ve struggled with my right foot ever since I picked up a nasty infection in the Philippines in 2003. At the time I put the infection down to bad luck – I’d been volunteering in a slum area in Manila, wandering around in sandals, and these things happen, I thought. Eighteen straight days of penicillin killed the awful red streaks that had started to climb up my leg, but my foot was never same.

After that, I always struggled with swelling in that foot when it got hot. I started wearing compression stockings whenever I flew. I oscillated between realizing that I may have a serious problem and ignoring the situation.

Until, last May, two months after Mike and I returned from honeymoon, it became impossible to ignore.

For no apparent reason this time, my right foot swelled up dramatically, and so did my calf. When I gave in and went to find a physical therapist specialized in manual lymphatic drainage massage she measured my legs. My right one was bigger than my left all the way through my thigh.

Six weeks of therapy every couple of days reduced the swelling somewhat, but my therapist and a specialist in LA confirmed what I suspected – this wasn’t going to go away. I needed to start wearing compression stockings every day, do therapy regularly, and avoid risk factors.

What are those risk factors for exacerbating lymphedema worse? Well, flying is one. Heat is another.

When we told my doctor that we were considering moving to Laos she looked appalled.

“Why would you do that?” she asked in her typically abrupt, East European, fashion. “Better you move to Alaska than Laos. If you were my sister I would tell you not to go.”

Mike and I agonized over the decision to come here – my health was our single biggest concern about this move. We knew I’d struggle with the heat in the tropics, and we were worried about the implications of being a two-hour plane flight away from a decent hospital should I pick up another terrible infection. When, we wondered, exactly does risk cross that invisible border between sensible and stupid? But in the end we stocked up on compression stockings, invested in an expensive piece of medical equipment to help me with at-home therapy, and decided to give it a try.

And so far, so good.

I mean, not great. Compression stockings are uncomfortable at the best of times, and particularly frustrating when you’re bathed in sweat. My right foot is permanently swollen, and I sometimes mourn the fact that it will never be pretty again. I was never really a foot-person before, but now I catch myself checking out other women’s feet with a mixture of wonder and envy – the agile play of bone and vessel visible under skin, the beautiful curve of an arch, and their perfectly matched, delicate, naked, ankles. I am perpetually amazed (and occasionally resentful) that people prance around on these works of art, heedless of their good fortune.

But, overall, things have gone pretty well since we arrived here in Laos. I stay cool when possible. I keep my feet up when possible. I wear my stocking. I do my therapy with the pump machine. I treat every break in skin with antiseptic – I’m well aware that one infected mosquito bite on my right leg is all it could take to land me in hospital in Thailand.

Then, this weekend, what I’ve been fearing came to pass. An infection that started with a single nasty-looking nodule blew out in the course of twelve hours into a large, dangerous, angry, swamp of staph.

But the irony is that it’s not my right leg that could well land us on that plane to Bangkok in the next couple of days – it’s Mike’s.

Mike has battled staph before. Four years ago staph infections in his legs resulted in one medical evacuation from Sri Lanka to Singapore, four surgeries, and six months of antibiotics. Now, it looks as if the couple of hours perched on an elephant’s head last Thursday rubbed his shins raw and the opportunistic bacteria has struck again.

As soon as dark purple patches started to spread over his shins and it became apparent what was happening, we pulled up his test results from four years ago to check which antibiotics the staph was resistant to last time and which might have a hope of heading this off at the pass. Then we went looking for a pharmacy. We might not have a decent hospital up here, or many English speaking doctors, but you can buy all sorts of antibiotics over the counter.

So, dear doctor friends across the oceans have chimed in with helpful advice, and Mike’s on six tablets of cloxacillin a day. It’s been 36 hours since he started popping those orange and brown tablets, and he woke up this morning with his whole right leg swollen – his ankle’s so big it was hard to get a shoe on. We lined our feet up this morning and took a photo and laughed a little at our matched pair of mismatched legs, and sighed a little, too.

Now we’re crossing our fingers and watching for the next day or two to see whether cloxacillin is going to win this particular battle or whether we’re off to spend some unscheduled time in Thailand. I’ll keep you posted.