St Croix River Road Ramblings

Welcome to River Road Ramblings.

Saturday, November 19, 2016

Deer hunting story part 2

A few years ago I began a deer hunting story that was continued.  I finished it today.  You need to begin at the beginning, so start at this link.  Deer Hunting Story Part 1   and then continue back here. 

“So where did you hit the deer?” asked Byron, wondering if my hunting story would ever get finished so he could start his.  
“Well, I didn’t find that out until much later.  After I saw the deer floating out in Rogers Lake, I had to figure out how to get it out.  Marv and I had done some fishing that summer at the lake when we worked the afternoon shift at Dresser plastic factory and Dad didn’t have any morning jobs on the farm.”
“That job at UFE was pretty boring.  We sat at the hand plastic molding press, with the cement block wall right behind the machine and used our arms to close the mold, swing over the very hot injector, lock it in place, wait a short time, then swing it back and open the mold, all day long, a straight eight hour shift with 10 minutes for a break and sandwich,” commented Marv.  
“Yeah it was 100 degrees in the building.  I remember we each were allowed a fan – that helped a little.  Got $1.35 per hour – about $50 per week to save for college.  Think we worked there for 3 months – must have made about $600 – about half of the college cost, “ I added. 
“I worked at Stokely’s every summer during college,” said Ev, “got about twice that much with the 90 hour weeks and higher pay.  Enough to pay for a year of college.  And I was so tired of 7 days a week and long hours, even college looked good to me by September.”  
“Do you remember when we went on strike?” added Dad, who also worked one summer and part time other summers on the field crew at Stokely’s too.
“Get back to the deer story,” complained Byron. 
“Well, I walked down along Wolf Creek, walked across at the big beaver dam and found Marv hunting on his 40.”
“I had my 55 Chev Belair, that I earned from working at the Nelson Pea Viner when I was 16 parked at Grandpa’s house.  Figured we might be lucky and Mack Fors’ boat would still be at the lake, so we drove up, opened Uncle Marice’s gate and back to the top of the hill where I parked it.”
“Probably where Rogers’ Hotel was located.  All that is left is a hole in the ground and a lilac bush.  When Dad bought it the building was still standing.  Big wide old white pine boards.   We tore it down and I used some of it in fixing up the barn on the farm,” said Dad referring it his father who had originally bought Uncle Maurice’s farm on Rogers Lake. 
“Did you know Thomas Rogers was killed by being gored by a bull?  His kids divided up the land, several hundred acres, and Clara, who married Charles Marriette, moved down the creek and built the buildings where Grandpa Gene lives now,” said local historian Russ. 
“We scrambled down the snowy hill to the edge of the lake. Mac’s old boat was there tipped upside down with the oars under it.  We got it launched along the trail of old boards that sort of made a path through the thick cattails to the edge of the lake.  I remember if was froze over along the edge, but most of it was still open.  We sort of shoved an oared it out to the open water and then rowed out to the middle where the buck was floating high in the water, looped a rope over his horns and started rowing back when we noticed the boat was leaking pretty badly.”
“Yah, you gotta put those old wood boats in the water for a week to swell up before you use them every spring or they leak like a sieve,” commented Dad.  “We used to saw out some thin ½ inch basswood planks for boats when I was a kid and my dad had his big sawmill. Big wide planks for the sides and a flat bottom with a few ribs.  Could make one in a day even with hand tools.  They were light, watertight after they swelled up, and lasted several years if you painted them and kept them in the water all summer.”
“There was an old coffee can in the bottom, so Russ bailed while I rowed as fast as I could until we got on the shore.  By then we had both stepped into the lake edges and our boots were soaking wet inside, and it was really cold outside too.”
“I remember we dragged it up on the shore to hard ground on the hillside and you did the gutting,” I said.  “You had done it before, and I hadn’t.   I remember the deer insides were warm, and felt good to my frozen wet fingers.”
“So where did you shoot it?” asked Ev.  
“It was really odd” said Marv, “no bullet holes in the deer at all, and even when we skun it out later, no holes in the skin.  Almost like the deer died of a heart attack from seeing Russ whale away with his gun.”
“It was all bled out inside, so it was hit good.  Just no entry or exit wound.  We didn’t find a bullet inside either, but we didn’t really look through the guts and we left the heart, lungs, and innards,” I said. 
“It was decent sized 6 point buck.  Sort of short fork, but husky horns” said Ev who every Sunday sat at the dinner table at Mom’s across from the mounted deer horns on the wall. 
“So did you ever get a theory on how you shot it?” asked Byron.
“Yes, you remember how I told you that when I shot, the buck sort of jumped in the air did a bunch of gyrations and twisting around before taking off after I shot him from the rear?  Well, I think I shot him right in the bung hole, and with his gyrations the bullet went right up through the twists and turns of his intestines, into the stomach and then out into the heart, where it probably lodged.  Only way I match the lack of holes and the inside damage.   Probably that doesn’t happen every day, but that is what happened.”

“Do you remember the big buck I shot on the sand – back in ’67,” began Byron, before the rest of the folks could digest the bullet story.  

Monday, November 14, 2016

Cataract Surgery record and cost estimate

11/11/2016 Cataract Surgery Details
(This is my medical record of the left eye cataract surgery.  My comments are in parenthesis).  
Date of Surgery: 11 NOV 2016
Visit Type: Outpatient
PostOp Diagnosis: Senile cataract, left eye.  

(Not sure if the cataract was senile or the patient)

Procedure: > Phacoemulsification with implantation of a Toric intraocular lens, left eye.
(slice and dice the old lens suck it out and put in the new one)

Lot/Serial #: 21136080007, Catalog/Model #: sn6at5-17.0D, Implant Name: lens, toric aspheric sn6at5-17.0, Manufacturer: Alcon Laboratories.

(information as to lens information for possible recall.  I wonder if the serial number is written into the lens so my body could be id’d by it like breast implants -- maybe a bar code?)

Implant Placement: Left In the preoperative holding room, the horizontal meridian of the left eye was marked with the patient in the upright position using the Toric lens marking system. The patient was then brought to the operating room where the correct surgical site was confirmed with the patient, the medical record, and all members of the surgical team.

(with the Sharpie pen marked top and bottom for lens on my skin around the eye )

Under monitored anesthesia care, a retrobulbar injection of 2% lidocaine solution with hyaluronidase was given. With adequate anesthesia and akinesia, the left eye was prepped and draped in the usual sterile fashion. A lid speculum was placed to retract the eyelids, and the operating microscope was rotated into position. Using the markings that had been placed preoperatively, the 65-degree meridian was identified and marked using the Toric lens marking system.

( draped -- Covered all of my head but my left eye hole opening with a Menard’s-like tarp, numbed it and propped it open, and got the microscope in place to magnify the eye area.  The doctor didn’t use his naked eye to see what he was doing, but a highly zoomed in view to see all the tiny details of my eye)

A paracentesis was then created at the inferotemporal limbus using a No. 75 blade. Through this limbal paracentesis, the anterior chamber was inflated with Healon Endocoat. The anterior chamber was entered again, this time through the temporal limbus using the diamond blade. A capsulorrhexis was initiated using a bent 25-gauge needle as a cystitome and was completed in continuous and circular fashion using the capsulorrhexis forceps.
(cut a tiny opening into the eye lens lining and got the ultrasonic probe into the lens area)

The lens nucleus was then hydrodissected and hydrodelineated using balanced salt solution injected through a 27-gauge cannula. The phacoemulsification tip was introduced into the anterior chamber and was used to sculpt two perpendicular grooves in the lens nucleus. Using these grooves, the lens was mechanically disassembled into four equal quadrants, each of which was emulsified and aspirated in turn.

(using salt water, pressured syringed the old lens loose from its covering -- the lens capsule, Then using the tiny ultrasound probe like a knife, cut the old lens into four pie wedge sections and then broke each of those four into tiny fragments and sucked them out)
The residual cortical material was removed using the automated irrigation-aspiration handpiece, and the capsular bag was polished with the irrigating polisher. The capsular bag was reinflated with Healon, and the wound did not require enlargement.

(Cleaned up the lens parts. The old lens was held in a capsule (lining) and polished that smooth and clear so all of the old lens was out and ready for the new one).

A 17.0-diopter single-piece acrylic Alcon model SN6AT5 acrylic Toric intraocular lens was loaded into the injection cartridge and was inserted into the capsular bag where it was allowed to unfold in its appropriate position. The lens was oriented at the 65-degree meridian as suggested by the Toric lens calculator.

(Inserted the new lens that was folded up tiny, and then unfolded it into the right spot and adjusted it to be lined up for the astigmatism angle.  Toric is the name for a lens with astigmatism correction built in -- an additional $1000 cost to me, but worth it as it will actually mean I can see distance without glasses).

The lens power selected was based on a careful review of the optical biometry measurements (IOLMaster) that were obtained preoperatively. The residual viscoelastic material was removed in its entirety using the automated irrigation-aspiration handpiece, and the wound was demonstrated to be self-sealing with no suture required. Cefuroxime was instilled into the anterior chamber at the conclusion of the procedure. The lid speculum was removed, and the eye was patched with Maxitrol, following which a shield was placed.
(With everything correct, and the tiny opening so small no sewing up needed, everything was removed, and a few bandages and a shield taped over the eye)

The patient tolerated the procedure well, and there were no complications. The total phacoemulsification time was 42.7 seconds with an average phacoemulsification power of 29.9%. The cumulative delivery of energy (C.D.E.) was 5.16. The patient returned to the preoperative holding room in satisfactory condition.
(The time on the machine to get rid of the old lens was 42.7 seconds,  Probably the machine cost is about $1000 per minute so maybe the time is to charge for that very expensive unit).  

The Medicare estimate of cataract removal appears to show that my cost is $728.  I think my supplemental insurance will cover most of that. I selected a $1000 extra option for the Toric lens to get rid of the large amount of astigmatism in my eye.  I always figured the astigmatism was in the lens, and that it would go away with a new lens, but it is in the cornea in front of the lens which is not replaced in cataract surgery.  The cornea can be fixed with laser surgery sometimes -- what they call Lasik I think.  Anyway I chose to deastigmatize with the lens.  

Medicare estimate  (I pay about $728).  
I chose the Toric astigmatism correcting lens so that added $1000
My Medicare supplemental insurance will likely cover most of the $728 if I have my co-pay deductibles for the year paid already.  

Friday, November 11, 2016

I Can See Clearly Now, the Cataract has Gone

Cataract removal – left eye   Day 1  11/11/2016

At 7:15 am I checked into Mayo Clinic Gonda Desk 7 for my cataract surgery.  Some forms to fill out and then 15 minutes waiting.
  I visited with a woman, probably in her 40s who was having the first of two cataracts done.  “I can’t see well enough to drive now, and should have done this earlier, but was scared to do it.  However, Dad had his done recently, and he said it was wonderful, and pushed me into getting it done.”
Some of the pre-cataract surgery eye exam machines

Bed side monitoring machines

  A member of the surgery team then took be to the back to a small room—sort of a hospital bed room, but smaller.  I set in a chair that was both chair, hospital cart and hospital bed—my home for the next hour and a half.
After the id check (state your name and birth date) affixing a wrist band, connecting heart monitoring electrodes (the ones that stick over your chest hair and act as hair removers when they are detached), and an IV opening.  I had a few minutes alone, so got out of the chair and watched the heart monitor and blood pressure monitor.  Heart rate was 72, with an occasional skipped or abnormal beat (something I have had for 30 year and is considered normal), and blood pressure was 136 over 115.  The 115 is too high, and I can hear my family doctor rattling me about losing weight, exercising and taking some BP medicine when I see her in three weeks for my annual lecture on healthy living.  
Prepared for surgery with eye numbing gunk oozed into the eye and taped over to hold it there
The nurse who hooked up the IV tried the left hand for a vein, then the right hand, sticking me each time (these sticks are hardly noticeable as the needles are very small) and finally got one in the left arm.  Flabby veins or something like that was the comment.
The anesthesiologist came in, someone as old as I am, and got some more info and told me I was going to be given a local cream based numbing agent that would deaden the whole area around the eye, as well as a mellowing agent through the IV as I would be awake and somewhat alert during the procedure, but they didn’t want me too alert.
He said “I think I must have worked with you back in the 80s—at least Russ Hanson sounds familiar.”  I wasn’t quite in my best memory mode so couldn’t make the connection, but later realized that group I worked in at that time had one project to computerize the anesthesiology surgery record – and likely bumped into him then.  Still a little vague though.  I spent 25 years at Mayo and was in a lot of projects and am much more memorable to others than they are to me, as I was always involved in projects that brought change (computers) and folks were generally rather intimidated by changing to computers in those days. And things that happened 30 years ago are not quite as clear to me nowadays anyway.  
Dr. Kanna, my surgeon dropped in, now making about 5 folks in the small room and marked with a Sharpie pen a dot above the left eye to make sure the left eye was the right one to operate on.  Then he marked the orientation of the lens ---“have to get it in right as it has astigmatism correction—so there is a top, bottom, and angle to measure.”  More black marks around the eye  -- sort of like a bullseye with crosshairs (I actually couldn’t see them, but they may show up after I get the patch off).
The preliminaries all done, the chair was wheeled to the surgery area.  “How many cataracts in a day done here?” I asked. “About 24 today (three surgeons working today) and as high as 32 on busy days.”   I think they do two surgery days a week most of the time.    Scott, in the waiting room, said he watched a steady progression of folks going in with glasses and coming out with eye patches.
The Mayo building and the Gonda building are two buildings that appear as one inside.  Seventh floor on the Mayo side is the eye doctor side, and on the Gonda side is the surgery side.  Some of seventh is for urology, so I made sure the nurse pushing my chair aimed towards the eye surgery area.
The operating room was the size of a large living room, lots of instrumentation, and machines.  I was tilted flat, the chair becoming a bed, and the hovering folks began to hover.  One kept the IV (anesthesia) dripping and monitored my vital signs; a couple were the surgery assistants, and some others were there to save any removed parts in case of an autopsy. 
“If it is alright with you, I am going to video the procedure today.  Monday I am gving a talk to the folks in the eye area about cataract surgery and want to show them. Most of the staff never get back to the operating room,” said the surgeon. 
“Sure” I said, hoping I might get a copy of it for myself.  However that does not appear to be likely as I asked him about it after the surgery.  “Not even sure it recorded OK, and then we have to edit it before the talk.”  However, I will nudge him on this again in 3 weeks when I see him for the progress report.
My guess is he chose me for the model patient for the staff to see as my photogenicity is really quite high. 
As I had ask him to describe what he was doing during the surgery so I could understand it, and that fit with the video, I got the blow by blow details.  Although I was mildly sedated, I think I can remember the gist of it all.
I was in my street clothes, with only my glasses off and some blue paper shoe covers.  No removal of belts, shirts, or anything, but a hospital gown over my shirt. Then my head was completely covered with a blue tarp (not Menards), with a hole cut out so to the operating staff, I was an eye peering out of the sea of blue plastic.
The rest I am going to write as if the doctor said it, but as I was a little woozy and of course I can’t remember exactly, you have to accept there is likely some missing, added, and misstated parts.
“First we open a tiny hole in the edge of the eye to insert the ultrasonic probe into the lens.  Then, with my foot pedal (speed control?) I use the probe to make four pie slices of the round sort squashed spherical lens (think of a soft M&M candy).  Then I vibrate each slice into small fragments and use the vacuum part of the probe to suck out the fragments.  The lens is inside a lining so I carefully clean it out right up to the capsule that holds it and suck it all out.”
The ultrasound probe and vacuum made different musical tones based on speed or vacuum level (not sure which or maybe both).  “The sound helps me gauge the speed/vacuum levels so I can tell how the probe is working.”
I was able to ask questions and seemed like I was rational, and I asked “How do you get the big lens into the tiny opening, or do you have to make it bigger and swe it up?”  “The lens is sort of folded up and I can slide it into the empty capsule and unfolded it inside.  It is a flexible plastic, so it bends easily.  The opening is so small I don’t have to sew it up after I get the lens in.”
“Now I have the lens inside, and I have to get it oriented the correct way so your astigmatism axis is right.  There are several adjustments I do sliding it around until it is just where it is supposed to be.   After surgery it takes a while for it to get fixed into place and so you have to be gentle with your head movements and keep your fingers out of your eye so it remains lined up perfectly.”
“All done.  Everything went the way it is supposed to.   Looks good.  Now you can get unhooked and I’ll see you at 3:30 pm this afternoon.   Remember, it will look strange at first, and gradually get better and better over several months, although in a day or too should be usable.  See you this afternoon”  Don’t drive today, and let me know if anything seems abnormal.”   Abnormal was changes like flashes of light, worsening vision instead of improving, pain, etc. 
And I got unhooked, some more instructions on being gentle on the head and eye for a month or so, and walked out with Scott, my left eye patched with some gauze and a metal shield. 
Getting around with one eye, as I had already learned with Myasthenia Gravis in 2012 (I had to patch one eye for a few months to get rid of double vision), is sort of like dropping your vision level to 1/3 of what it was with two eyes.  Everything seems unreal and incompletely there.  And sitting in the passenger seat with Scott driving was clearly necessary as I didn’t think I would have felt safe to drive myself yet.
At home, I took off the shield to put in the two different kind of post surgery drops (5 minutes apart) and got really worried.  I could see through that eye, but everything was sort of like looking through a snowstorm and whatever came through the left eye was slanted about 30 degrees – like the TV screen was tilted that much—the whole world was.   Gee whiz, did the doctor get the lens put in rotated by 30 degrees?
Remembering the doctor and nurses said “your vision won’t be normal for a day or two, and then will keep improving for months” I refused to panic and turned to Dr. Google who assured me that as the numbing agent wears off, the slant should go away too.  At 1:45 pm, I tipped up the patch to look out and the world is level with both eyes, but the left eye sees a white fog over everything.  So I won’t panic yet, but keep waiting to see what happens.

Post surgery with temporary eye shield and still a little sleepy from the mellowing agents
Update:   4 pm day of surgery
The good news: went in for my post surgery checkup and took the eye patch off and I can see pretty good already with that eye. The doctor says it will take a few more days to get to normal, but everything looks pretty good. 

The bad news: My glasses are no longer any use for the left eye as it has been corrected. I can't really get new glasses until about 1 month when the vision is completely stable from the surgery. "All I have to do is remove the left lens from my old glasses and the distance vision will be good" I told the doctor.
"Don't you remember me telling you that doesn't work right with severe nearsightedness like yours?" he replied.
"Sort of, but remind me why again"
"Your right eye still has to use the glasses -- and for nearsightedness, the lens makes everything you see smaller. And your new left eye leaves them larger, like they should be. So you will see one big image on top of a small one. It will be enough difference it will confuse your brain"
"So can't I get glasses that will fix that?"
"No, you either have to shut one eye or patch one, or get your other eye done too. I knew you would need that, so if you want to go ahead, I scheduled it in 30 days on December 9th. That is as close to each other as we do the second eye."
So I am in that sort of between stage where my new eye sees much better, but won't work together with the old one. I already learned to read with one eye shut, and drive with one eye shut when I had myasthenia gravis double vision, so its back to that for a month.
The new eye lens gives me whiter whites, more colorful colors, but is still a little foggy -- sort of like a bar in the smoking days. That is supposed to clear away soon. Overall, I think it was quick, easy, painless, and likely to improve my life. However seeing folks more clearly may change some of my friendships.
In college, a girl friend always took off her glasses when I came to join her at the library or lunch table. "You are just vain and want to look better," I told her. "No I take them off so you will look better!"

Friday, November 4, 2016

November's Bright Warm Weather

Time to plant fall bulbs and keep some for forcing

I grind up leaves with the mower. 
November 2016 has started with exceptionally mild weather, continuing the September and October trend.  Here on the Farm, our flowerbeds are mostly still in bloom, some tomato plants are still growing, and the fall raspberry plants are bearing.  According to my calculations we have had 200 days growing season so far, with the first real killing frost here on top of the hill at least a week away. 

We did have a couple of frosts that hit the tops of the morning glories and a few tomato vines, but that just pruned them a little. 

Hauled a couple of loads of wood to the cabin from Grantsburg where friend Walt's trees are dying from Oak Wilt. Sad to see so many oaks dead or dying in this area. Have to cut a few more loads of dead elm (died from Dutch Elm disease) and will be ready for maple syrup season in March. With the Ash trees next in line to die, the butternuts mostly gone too, one wonders if there will be any left in the future.

Best chance is for scientists to genetically modify the trees to adapt them to the problems. Right now there is not enough profit to be made in doing that, but in a few years, the process will be even easier than it is today so we may see some of these trees come back again.

Elms are somewhat different in that they seem to be able to grow to about 20 years old before getting diseased--and that gives them time to reseed more elms. The huge spreading elms in the cow pasture of my youth all died in the 1960s and 70s so my son has never seen the elm lined streets of a city that we remember. However, the 20 year old elms are perfect for firewood. They die during the spring or summer, and a year later, still standing, they are dry and immediately ready to cut and burn. Don't know how I got along with out them in the old days, as now we have a ready supply of dried wood available at anytime -- there are many of them along the road ditches and farm fencelines and in the open patures.

The parts came in that should let me repair the starter on the Farmall Super C tractor. The starter solenoid (a mechanical one) and the battery cables are weak, and I think the starter may be wearing out too, but first the cheap parts go in. I haven't used the starter for years, as I just crank it, but it would be nice to have it start easier! The old 6-volt tractors never did turn over very well, and so most of my tractors are converted to 12 volts--probably should do that with the Super C too, as 12 volts to a 6 volt starter turn it over faster and don't require such heavy cables.

A few photos from the Farm and neighborhood this week.

Painting the house -- this is the north side.  The bottom part is done, top part scraped and ready for primer and a coat of finish paint

Didn't sell apples this year.  The extremely wet year caused a great deal of apple scab, rusts and other problems making so many blemishes the apples didn't look appealing at all.  Next year I add a fungicide to the Sevin spray I use.  Warmer and wetter years, what scientists predicted for us in Global Warming, is here.  For us, it means an earlier maple syrup season as well as getting used to wet warm conditions that foster more plant problems. 

Got the west side and here (north) sides of the house painted this fall.  Only the east side left -- for next year.  The house was built in 1917, so the new paint is to celebrate 100 years!