If the time comes for insurance to kick him out of the hospital, we have to pick a skilled nursing facility for him to go to. Our number 1 choice is Younker rehab at Methodist. They have such great food there and that is obviously what matters. The rooms are pretty nice too.
Number 2 is Iowa Jewish Home. It is pretty hard to get in there. Apparently you have to be friends with the governor and have no ties to Hitler.
Number 3 is Carlisle Care Center. I never really saw any problems there when I was going in and out of there on the fire department other than the fire alarm constantly going off and 1 particular nurse or aide doing CPR on a DNR patient while the other was bagging the vomit back down her throat. (I hope no one is eating while reading this.) Other than that, the convenience of it for him and everyone will be of most importance. He will have so many of us able to visit him and be there a lot to make sure things are good.
The Nurse Practitioner from the Aneurysm Center in Minneapolis called me back just now. I gave her the low down and she asked for me to get his radiology images put on a disk and send it up to her for the doctor to look at. I just called Martha, but she didn't seem to thrilled about it after the way Chaloupka responded to this surgeon yesterday. She is going to talk to dad and see what he thinks.
Anyway, he had PT today, his back is really starting to get sore from laying around so much. He was eating pure'ed cheese pizza and some random veggies he didn't care for. Sounds yummy. Oh, and he has pooped twice today. Our family talks about poop a lot. Debbie got mad at us yesterday for talking about sharting when the doctors were on the way into the room.
:)
Friday, January 30, 2009
Thursday, January 29, 2009
January 29th
Scott and I drove to Iowa City today for a meeting with Dr. Chaloupka, the neuro doctor and some random people that came in too. Martha, Debbie were also here.
While waiting, I found a hospital in St. Paul that has a doctor named Eric Nussbaum. The hospital has a specialty in hard to treat aneurysms. I read some case studies and this doctor seemed to be what we needed. I called up there and spoke with his clinical nurse and she was very nice. I gave her the whole she-bang and she put me in contact with Dr. Nussbaum's nurse practitioner. I left her a voicemail and she is going to call me back. We were so excited about this place and this doctor.
When our meeting started, Chaloupka started by saying that he is doing everything he can to get in touch with who he feels is the most qualified to do the surgery. There is a man in Chicago, Phoenix, St. Louis and San Francisco. One of these doctors trained the others and they all are top notch surgeons. He explained that trying the methotrexate was the best and least toxic option and it didn't work, so there really is no other option. He is becoming steroid resistant and even if there was an experimental drug to try, the hospital would have to approve it, insurance would have to approve it and some other group of people would have to approve it. Apparently you just can't try a drug without a good scientific reason.
I brought up Mayo and he didn't think that they can do anything and I also brought up Dr. Nussbaum at the aneurysm center and he politely brushed that guy off, so he is very familiar with him and we got the impression he didn't like him.
Chaloupka is going to do what he can to keep him here for a few more days and this weekend I will be looking into nursing facilities. He assured us that he will still be working for us if we get kicked out of here, that moving won't effect the treatment plan.
We are leaving now, so I will finish this when I get home. They are giving him a bath and kicking us out.
While waiting, I found a hospital in St. Paul that has a doctor named Eric Nussbaum. The hospital has a specialty in hard to treat aneurysms. I read some case studies and this doctor seemed to be what we needed. I called up there and spoke with his clinical nurse and she was very nice. I gave her the whole she-bang and she put me in contact with Dr. Nussbaum's nurse practitioner. I left her a voicemail and she is going to call me back. We were so excited about this place and this doctor.
When our meeting started, Chaloupka started by saying that he is doing everything he can to get in touch with who he feels is the most qualified to do the surgery. There is a man in Chicago, Phoenix, St. Louis and San Francisco. One of these doctors trained the others and they all are top notch surgeons. He explained that trying the methotrexate was the best and least toxic option and it didn't work, so there really is no other option. He is becoming steroid resistant and even if there was an experimental drug to try, the hospital would have to approve it, insurance would have to approve it and some other group of people would have to approve it. Apparently you just can't try a drug without a good scientific reason.
I brought up Mayo and he didn't think that they can do anything and I also brought up Dr. Nussbaum at the aneurysm center and he politely brushed that guy off, so he is very familiar with him and we got the impression he didn't like him.
Chaloupka is going to do what he can to keep him here for a few more days and this weekend I will be looking into nursing facilities. He assured us that he will still be working for us if we get kicked out of here, that moving won't effect the treatment plan.
We are leaving now, so I will finish this when I get home. They are giving him a bath and kicking us out.
Wednesday, January 28, 2009
January 38th 3 Part
It is almost 11 o'clock at night and I have resorted to watching some retarded show on A&E called, "Parking Wars." I can't tell if the meter maid is a man or a woman or a pre-teen. I don't see a "Hello God, it's me Ramona" book in "it's" pocket so it must be some sort of an adult.
After some research and suggestions by some friends, we have decided to ask for a referral to go to Mayo Clinic. Iowa City sent Martha a fax for nursing home skilled facilities to put him in and I just think that is unacceptable. They can't find a treatment, so they want to put him in a nursing home? I don't even think he is stable!!
I think Chaloupka did his job. He coiled the aneurysm. He said himself before the last stent that he has never seen this happen before, so how can we expect him to treat or know who could potentially treat this. He is a great doctor. He has patients referred to him from all over the country for coiling. But, I am sure he doesn't refer a lot of people out and he did what he could. Time again to move on.
Iowa City is number 25 on the list for the best neurology and neurosurgery hospital in the country. MAYO IS NUMBER 1!! I am sure they will have more ideas and if they don't, they may have a larger pool of qualified doctors we can choose from who might. Martha is driving up in the morning. Debbie is still there and will ask for the referral when she sees the docs in the AM. Dad is on board 100 percent.
Out.
After some research and suggestions by some friends, we have decided to ask for a referral to go to Mayo Clinic. Iowa City sent Martha a fax for nursing home skilled facilities to put him in and I just think that is unacceptable. They can't find a treatment, so they want to put him in a nursing home? I don't even think he is stable!!
I think Chaloupka did his job. He coiled the aneurysm. He said himself before the last stent that he has never seen this happen before, so how can we expect him to treat or know who could potentially treat this. He is a great doctor. He has patients referred to him from all over the country for coiling. But, I am sure he doesn't refer a lot of people out and he did what he could. Time again to move on.
Iowa City is number 25 on the list for the best neurology and neurosurgery hospital in the country. MAYO IS NUMBER 1!! I am sure they will have more ideas and if they don't, they may have a larger pool of qualified doctors we can choose from who might. Martha is driving up in the morning. Debbie is still there and will ask for the referral when she sees the docs in the AM. Dad is on board 100 percent.
Out.
January 28th Part Dos
Debbie called back. Dr. Lewis the admitting neurologist said there is no more tests that can be done. So, they are exploring the surgical options with this doctor in Chicago. I have also been emailing a relative of my sister-in-law who's husband had a brain tumor. He went to Mayo after Methodist couldn't fix it and he is raving about them. I am going to try and have Iowa City send his records up to Mayo too.
They also say that he would be getting the same treatment at a skilled facility as he is in the hospital although they aren't suggesting we leave. I will throw the world's largest fit if they try and do that any time soon. Guiness book will be there to record it.
They also say that he would be getting the same treatment at a skilled facility as he is in the hospital although they aren't suggesting we leave. I will throw the world's largest fit if they try and do that any time soon. Guiness book will be there to record it.
January 28th
Dad had his swallow test this morning. They sit with him and watch him drink and eat different food consistencies with green dye in it. Then they stick a camera down his nose and he and everyone else can see where exactly the food is going. He is still aspirating some things so they told him that he can have 20 teaspoons of pudding type consistancy foods 3 times per day. That will help the muscles in his neck regain lost strength so he can move on to regular foods.
One of the doctor's from Chaloupka's team came in also. Debbie asked him why it was that no one knew what was causing all of this. He said he didn't know why everyone was saying that because they DO know what it is. A small precentage of patients with large aneurysms have this side effect. In that small group of people, steroids work. But for some reason with dad it isn't. The brain tissue surrounding the annie is acting like the annie is a tumor and is reacting to it causing the edema. The rheumatologists have not been any help and so Chaloupka's team is kind of upset with them.
They did a test on him yesterday to try and determine if his over-all weakness was steroid myopathy, or from the edema in his brain. He told Debbie that if it was the steroids, we might have a problem. Even though the steroids aren't making him better, they could be prohibiting him from getting worse. Chaloupka is supposed to show his face within the next day or two. I told Debbie to give him my phone number to call me when it is convenient for him as I have some questions for him.
Deb said that he was great yesterday. He sat on the side of the bed for awhile and his voice was strong. He talked a lot and told Debbie of his desire to still go on a cruise AND he wants to look into buying a lake house in Missouri. I tell you what, when all this is said and done I am holding that man to all of this. I will tell you how many vacations I have been on with him since I was 6.. NONE!! When him and Jordan and Martha galavant all over, me and Scott have gone NONE TIMES. Donut. Zero. None. He was seriously looking into purchasing a Motor Home last summer, but Martha wouldn't have any part of it. I agree...a lakehome is better.
One of the doctor's from Chaloupka's team came in also. Debbie asked him why it was that no one knew what was causing all of this. He said he didn't know why everyone was saying that because they DO know what it is. A small precentage of patients with large aneurysms have this side effect. In that small group of people, steroids work. But for some reason with dad it isn't. The brain tissue surrounding the annie is acting like the annie is a tumor and is reacting to it causing the edema. The rheumatologists have not been any help and so Chaloupka's team is kind of upset with them.
They did a test on him yesterday to try and determine if his over-all weakness was steroid myopathy, or from the edema in his brain. He told Debbie that if it was the steroids, we might have a problem. Even though the steroids aren't making him better, they could be prohibiting him from getting worse. Chaloupka is supposed to show his face within the next day or two. I told Debbie to give him my phone number to call me when it is convenient for him as I have some questions for him.
Deb said that he was great yesterday. He sat on the side of the bed for awhile and his voice was strong. He talked a lot and told Debbie of his desire to still go on a cruise AND he wants to look into buying a lake house in Missouri. I tell you what, when all this is said and done I am holding that man to all of this. I will tell you how many vacations I have been on with him since I was 6.. NONE!! When him and Jordan and Martha galavant all over, me and Scott have gone NONE TIMES. Donut. Zero. None. He was seriously looking into purchasing a Motor Home last summer, but Martha wouldn't have any part of it. I agree...a lakehome is better.
Tuesday, January 27, 2009
January 27th
Today has been a good day and a bad day.
The extra special expensive vet says that JoJo is fine for now. She just needs to lose weight and I need to watch her. Once she really shows signs of continued pain, then we will have to explore the surgery options.
I am never ordering the small Super Potato Ole from Taco John's ever again.
As for my dad, they got the results back from his cerebral spinal fluid and they found nothing. So, there is nothing to treat. No infections, no spilled milk. Nothing. His brain just wants to have edema for no apparent reason.
Martha said that Chaloupka hadn't been up yet, neither had the rheumatologists. So, I became quite cranky and told her she needed to go down to Chaloupka's office and demand to see someone from his group if not him. Demand to know what is being done so we know and aren't sitting idly by wondering what they are doing. She didn't want to so I kind of freaked out said some nasty things and hung up on her. But hell, I AM FRUSTRATED!! I don't get FMLA where I work, I can't be there and miss work all the time and I can't try and run the show and prepare other people to ask appropriate questions if there is no follow through.
I don't think I will speak to her again today, so there won't be another update unless Debbie calls. I think she is there now and dad isn't answering his phone.
The extra special expensive vet says that JoJo is fine for now. She just needs to lose weight and I need to watch her. Once she really shows signs of continued pain, then we will have to explore the surgery options.
I am never ordering the small Super Potato Ole from Taco John's ever again.
As for my dad, they got the results back from his cerebral spinal fluid and they found nothing. So, there is nothing to treat. No infections, no spilled milk. Nothing. His brain just wants to have edema for no apparent reason.
Martha said that Chaloupka hadn't been up yet, neither had the rheumatologists. So, I became quite cranky and told her she needed to go down to Chaloupka's office and demand to see someone from his group if not him. Demand to know what is being done so we know and aren't sitting idly by wondering what they are doing. She didn't want to so I kind of freaked out said some nasty things and hung up on her. But hell, I AM FRUSTRATED!! I don't get FMLA where I work, I can't be there and miss work all the time and I can't try and run the show and prepare other people to ask appropriate questions if there is no follow through.
I don't think I will speak to her again today, so there won't be another update unless Debbie calls. I think she is there now and dad isn't answering his phone.
Monday, January 26, 2009
January 26th Part Deux
I just drove back from Iowa City. I wish I was independantly wealthy and could take the time off of work to stay up there with him, but unfortunately it took me until I was 28 to actually listen to my father's wisdom to settle down and keep a steady job. Living pay check to pay check isn't cool when you are in your 30's and if I keep missing work, that's what going to happen.
They cancelled his transesophogeal echocardiogram today. Apparently they had too many patients over the weekend with potential heart tumors that cause strokes and aneurysms, so they bumped him off the list until tomorrow. They are also going to do another brain test to determine if his right sided weakness has anything to do with the edema.
I had a long conversation with one of the doctor's regarding the game plan with dad. He really wouldn't commit to anything I asked and seemed very vague. I told him that at this point we were really willing to try anything, even if it was experimental but I think there is a need for urgency during this time that I am not seeing. The doctors that need to be talking to us aren't. If they are putting their heads together, great! Just come let us know!!
I think I overwhelmed him with my questions, and I found out later I wasted my time because he was just a resident. So, he really couldn't give me any answers. I wish the residents would walk around with a big sign that said, "RESIDENT!" or "RETARD!" Or maybe a dunce cap would suffice.
I do trust that Iowa City is doing all they can. Dr. Chaloupka seems to be absent a lot, but once you see him, he always makes you feel better. I am just disappointed he hasn't been in yet. I was told he is consulting with that doctor in Chicago and with rheumatology. Once the CSF cultures come back, I think we will have all the answers we need. This sounds completely odd, but let's pray he has a brain infection!! That can be treated with meds!!
Rollie thanks for your comment. I needed that laugh!! My dad is a tool and I can competely see him falling through the ceiling!! When I talk to him tomorrow I will definately tell him you reached out to us!!
You too Sherry!! You and Phil's friendship means a lot to my dad.
They cancelled his transesophogeal echocardiogram today. Apparently they had too many patients over the weekend with potential heart tumors that cause strokes and aneurysms, so they bumped him off the list until tomorrow. They are also going to do another brain test to determine if his right sided weakness has anything to do with the edema.
I had a long conversation with one of the doctor's regarding the game plan with dad. He really wouldn't commit to anything I asked and seemed very vague. I told him that at this point we were really willing to try anything, even if it was experimental but I think there is a need for urgency during this time that I am not seeing. The doctors that need to be talking to us aren't. If they are putting their heads together, great! Just come let us know!!
I think I overwhelmed him with my questions, and I found out later I wasted my time because he was just a resident. So, he really couldn't give me any answers. I wish the residents would walk around with a big sign that said, "RESIDENT!" or "RETARD!" Or maybe a dunce cap would suffice.
I do trust that Iowa City is doing all they can. Dr. Chaloupka seems to be absent a lot, but once you see him, he always makes you feel better. I am just disappointed he hasn't been in yet. I was told he is consulting with that doctor in Chicago and with rheumatology. Once the CSF cultures come back, I think we will have all the answers we need. This sounds completely odd, but let's pray he has a brain infection!! That can be treated with meds!!
Rollie thanks for your comment. I needed that laugh!! My dad is a tool and I can competely see him falling through the ceiling!! When I talk to him tomorrow I will definately tell him you reached out to us!!
You too Sherry!! You and Phil's friendship means a lot to my dad.
January 26th
Iowa City doesn't have wireless in the rooms at it sucks. The one "family" room they have on the floor is normally filled with rude parents who let their children play games on the only computer and don't tell them to get off when it is very apparent that an adult that actually has something important to do needs to use it. Or crazy people attack me with their canes, but that is a story for another day.
I found the cafeteria has wireless and expensive cold cheeseburgers. I miss Methodist. It is a comparison of eating at Waterfront or Long John Silvers.
They took CSF from his shunt today. They are going to test it to see if there is anything they can do to non-surgically treat the edema. It was a fairly simple procedure that was done in the room. No more invasive than a needle stick. They weren't sure when the results would come back. Soon they should be coming to get him to do the transesophogeal echocardiogram. Sometimes your heart can grow little tumors on it that can cause strokes and aneurysms so that is what that test is for.
The neurologist and the interventional radiologist think we should seriously consider going out of state. There is a doctor in Chicago that had a similar patient that they are considering consulting with. They will forward on the images and chart to the guy before he gets shipped out, so we aren't traipsing around the country for the doctor to say he won't touch him. They assured us they are exploring all avenues here and no one was giving up. But we need to be prepared for surgical intervention that may not have a good outcome.
I found the cafeteria has wireless and expensive cold cheeseburgers. I miss Methodist. It is a comparison of eating at Waterfront or Long John Silvers.
They took CSF from his shunt today. They are going to test it to see if there is anything they can do to non-surgically treat the edema. It was a fairly simple procedure that was done in the room. No more invasive than a needle stick. They weren't sure when the results would come back. Soon they should be coming to get him to do the transesophogeal echocardiogram. Sometimes your heart can grow little tumors on it that can cause strokes and aneurysms so that is what that test is for.
The neurologist and the interventional radiologist think we should seriously consider going out of state. There is a doctor in Chicago that had a similar patient that they are considering consulting with. They will forward on the images and chart to the guy before he gets shipped out, so we aren't traipsing around the country for the doctor to say he won't touch him. They assured us they are exploring all avenues here and no one was giving up. But we need to be prepared for surgical intervention that may not have a good outcome.
Sunday, January 25, 2009
January 25th
Sorry I haven't updated since Friday. I suck I know.
I am sitting at the Big Ten Inn in Iowa City. I came up today. I GOT A SPEEDING TICKET!!! When it rains it pours. I KNEW I should have taken Coleman's radar detector. I was zoning out following someone and got busted. I guess I deserve it. I was going 91!!! He only ticketed me for 10 over. So, he was cool about it at least.
They did an MRI and dad's edema has drastically increased. It is now pushing on his brainstem. They also said that it looks like he has had a teeny tiny insignificant stroke. The rheumatologist is also interested in my Ehlers Danlos syndrome and wants to see me tomorrow I guess. They are going to do a trans-esophogeal echocardiogram tomorrow and they are also going to pull some cerebral spinal fluid from his shunt to run some tests on it. Infections and all that good stuff.
They upped his steroids again, but I don't see the benefit in it. It isn't helping him and when he is on such a high dose, his voice gets really squeeky, he retains fluids badly and his blood sugars sky rocket. He now has foot drop and has to wear a splint. He has a bed sore too and it is hurting him a lot.
He is still in good spirits so that's good. I am coming home tomorrow, his sister is going to come up Tuesday morning and is going to stay for the rest of the week. It's really nice that she can be here for him so we can go back to work. I hate it that he is here, but this is the best place for him right now. Especially since no one in Des Moines wanted to touch him.
I hope to have more answers and information to give tomorrow. I am going to sign off now and watch Rock of Love Bus. OH YES I AM!!!! Lol.
I am sitting at the Big Ten Inn in Iowa City. I came up today. I GOT A SPEEDING TICKET!!! When it rains it pours. I KNEW I should have taken Coleman's radar detector. I was zoning out following someone and got busted. I guess I deserve it. I was going 91!!! He only ticketed me for 10 over. So, he was cool about it at least.
They did an MRI and dad's edema has drastically increased. It is now pushing on his brainstem. They also said that it looks like he has had a teeny tiny insignificant stroke. The rheumatologist is also interested in my Ehlers Danlos syndrome and wants to see me tomorrow I guess. They are going to do a trans-esophogeal echocardiogram tomorrow and they are also going to pull some cerebral spinal fluid from his shunt to run some tests on it. Infections and all that good stuff.
They upped his steroids again, but I don't see the benefit in it. It isn't helping him and when he is on such a high dose, his voice gets really squeeky, he retains fluids badly and his blood sugars sky rocket. He now has foot drop and has to wear a splint. He has a bed sore too and it is hurting him a lot.
He is still in good spirits so that's good. I am coming home tomorrow, his sister is going to come up Tuesday morning and is going to stay for the rest of the week. It's really nice that she can be here for him so we can go back to work. I hate it that he is here, but this is the best place for him right now. Especially since no one in Des Moines wanted to touch him.
I hope to have more answers and information to give tomorrow. I am going to sign off now and watch Rock of Love Bus. OH YES I AM!!!! Lol.
Friday, January 23, 2009
January 23rd
Dad made it safely to Iowa City. THANK YOU DON LUCAS! I spoke with Martha and she said that within 10 minutes of being there he had doctors on him. He has an MRI scheduled at 2, so we will know if there has been any major change in his edema. I just faxed a list of questions to Martha to give to the doctors:
In Reference to Jim Shoning.
We have been doing a ton of research on our own and have found some interesting case studies. I have learned a number of things:
The aneurysm may not be completely occluded which is causing the edema. (I don't think that is the case.)
There is something called a "water hammer effect" which means the blood flow pulsing across the aneurysm creates this phenom which causes the edema.
The coil itself can cause hydrocephaly and edema.
The aneurysm can have changes in the epithelial tissue that causes edema.
Steroids aren't working because there is no inflammatory marker in the edema that makes anti-inflammatory drugs work. Checking spinal fluid can answer that?
Stimulant drugs may work and have in some cases rather than steroids.
This is a healing process of the aneurysm that can happen as much as 24 months after the coiling and the symptoms will diminish.
The aneurysm wall changes to protect itself from bursting, and the edema is a trade off.
Here is a list of things I have found in doing some research. I am sure you know all of this, but I just had a few questions.
Would checking his CSF be beneficial in deciding what drug to try?
I am curious of the stimulant drug tried in one study. It didn’t say what it was, but is this something we could try?
Could the Legionnaire’s disease he contracted at Mercy Capital be the problem if his MRI results come back with little to no change since his last MRI?
Is there anything that could be done if there is a “water hammer effect?”
Is there a way to find out if he indeed has a reaction to the coil? That seems to be a common side effect in Bare Platinum Coils and Hydro Coils, although I know you used Matrix. (perianeurysmal edema and hydrocephaly strong indicators) Would any sort of anti-rejection medicine work if that were the case?
Can you just do a head transplant? :)
I will update later when I have more info.
In Reference to Jim Shoning.
We have been doing a ton of research on our own and have found some interesting case studies. I have learned a number of things:
The aneurysm may not be completely occluded which is causing the edema. (I don't think that is the case.)
There is something called a "water hammer effect" which means the blood flow pulsing across the aneurysm creates this phenom which causes the edema.
The coil itself can cause hydrocephaly and edema.
The aneurysm can have changes in the epithelial tissue that causes edema.
Steroids aren't working because there is no inflammatory marker in the edema that makes anti-inflammatory drugs work. Checking spinal fluid can answer that?
Stimulant drugs may work and have in some cases rather than steroids.
This is a healing process of the aneurysm that can happen as much as 24 months after the coiling and the symptoms will diminish.
The aneurysm wall changes to protect itself from bursting, and the edema is a trade off.
Here is a list of things I have found in doing some research. I am sure you know all of this, but I just had a few questions.
Would checking his CSF be beneficial in deciding what drug to try?
I am curious of the stimulant drug tried in one study. It didn’t say what it was, but is this something we could try?
Could the Legionnaire’s disease he contracted at Mercy Capital be the problem if his MRI results come back with little to no change since his last MRI?
Is there anything that could be done if there is a “water hammer effect?”
Is there a way to find out if he indeed has a reaction to the coil? That seems to be a common side effect in Bare Platinum Coils and Hydro Coils, although I know you used Matrix. (perianeurysmal edema and hydrocephaly strong indicators) Would any sort of anti-rejection medicine work if that were the case?
Can you just do a head transplant? :)
I will update later when I have more info.
Thursday, January 22, 2009
Jan. 22nd Part Two
Mediacom ran out of IP addresses so now all my stuff is in french. Coleman tried to explain it to me but I don't speak computer. It's a good thing I can read french so I could log into my blog...:)
They could not do the MRI today because of his shunt. When any magnetic imaging is done to his brain, he has to have the shunt adjusted. They didn't have the means of doing so here. So, he is going by ambulance to Iowa City at 6 am tomorrow. A friend of mine is actually taking him. THANKS DON LUCAS!!!
We have been doing a ton of research on our own and have found some interesting case studies. I have learned a number of things:
The aneurysm may not be completely occluded which is causing the edema. (I don't think that is the case.)
There is something called a "water hammer effect" which means the blood flow pulsing across the aneurysm creates this phenom which causes the edema.
The coil itself can cause hydrocephally and edema.
The aneurysm can have changes in the epithelial tissue that causes edema.
Steroids aren't working because there is no inflammatory marker in the edema that makes anti-inflammatory drugs work. You can check the cerebral spinal fluid for that.
Stimulant drugs may work and have in some cases rather than steroids.
This is a healing process of the aneurysm that can happen as much as 24 moths after the coiling and the symptoms will diminish.
The aneurysm wall changes to protect itself from bursting, and the edema is a trade off.
That is some of the things we have found. So many questions we have for Iowa City. Martha is going up with him in the morning and plans on staying the whole time. I think dad's sister is going Monday and staying a week. Scott and I are playing it by ear. I will make sure I am there for the important meeting with the doctors. I'll probably take Monday off and go up Sunday.
Thanks everyone for your well wishes. Das was really good tonight and was talking to people.
Jordan just started CNA school and she was saying how easy it was. I told her when I took that and EMT school I didn't think my teachers liked me because I thought it was so easy, I was a smart ass the whole time. Dad said same with him, when the teacher asked him an example of something that can occlude an airway, he said a '57 Chevy.
THATS MY DAD!!!
They could not do the MRI today because of his shunt. When any magnetic imaging is done to his brain, he has to have the shunt adjusted. They didn't have the means of doing so here. So, he is going by ambulance to Iowa City at 6 am tomorrow. A friend of mine is actually taking him. THANKS DON LUCAS!!!
We have been doing a ton of research on our own and have found some interesting case studies. I have learned a number of things:
The aneurysm may not be completely occluded which is causing the edema. (I don't think that is the case.)
There is something called a "water hammer effect" which means the blood flow pulsing across the aneurysm creates this phenom which causes the edema.
The coil itself can cause hydrocephally and edema.
The aneurysm can have changes in the epithelial tissue that causes edema.
Steroids aren't working because there is no inflammatory marker in the edema that makes anti-inflammatory drugs work. You can check the cerebral spinal fluid for that.
Stimulant drugs may work and have in some cases rather than steroids.
This is a healing process of the aneurysm that can happen as much as 24 moths after the coiling and the symptoms will diminish.
The aneurysm wall changes to protect itself from bursting, and the edema is a trade off.
That is some of the things we have found. So many questions we have for Iowa City. Martha is going up with him in the morning and plans on staying the whole time. I think dad's sister is going Monday and staying a week. Scott and I are playing it by ear. I will make sure I am there for the important meeting with the doctors. I'll probably take Monday off and go up Sunday.
Thanks everyone for your well wishes. Das was really good tonight and was talking to people.
Jordan just started CNA school and she was saying how easy it was. I told her when I took that and EMT school I didn't think my teachers liked me because I thought it was so easy, I was a smart ass the whole time. Dad said same with him, when the teacher asked him an example of something that can occlude an airway, he said a '57 Chevy.
THATS MY DAD!!!
January 22nd
You know what really sucks? When you find out pertinent information and you can't do anyting about it. There is a certain establishment that rhymes with Smercy Smapital that effed up pretty bad. They are LUCKY my dad pulled out if it. I can say I don't think my dad should have to pay for his ICU trip.
That's all I can say.
Anyway!! We found out that dad will be moved to Iowa City tomorrow. He is in agreement along with all of us. Hopefully they will continue working with him with physical therapy while we have more testing done and new drugs to try. He has atrophied quite badly. But, he isn't contracting or anything so that is great!
If anyone wants to see him before he goes, you can sneak in tonight. He is in room 453.
I will write more later.
*****Ooooohhhh!!
Sounds like Dr. Chaloupka is PISSED!!! He wants an MRI done TODAY and overnighted to him and wants all the labs from his ICU. Tee hee!
Now, let's see if they do it.
That's all I can say.
Anyway!! We found out that dad will be moved to Iowa City tomorrow. He is in agreement along with all of us. Hopefully they will continue working with him with physical therapy while we have more testing done and new drugs to try. He has atrophied quite badly. But, he isn't contracting or anything so that is great!
If anyone wants to see him before he goes, you can sneak in tonight. He is in room 453.
I will write more later.
*****Ooooohhhh!!
Sounds like Dr. Chaloupka is PISSED!!! He wants an MRI done TODAY and overnighted to him and wants all the labs from his ICU. Tee hee!
Now, let's see if they do it.
Wednesday, January 21, 2009
Jan 21st Part Two
Neuro lady came in. Snotty at first. Basically started off by ridiculing us for her even being there because it has now been the FOURTH time that neuro has been here and they can't do anything. I cut her off and made her stop right there.
I said, "First of all, we NEVER called for neuro before, you guys just showed up for whatever reason. Secondly, we NEVER wanted you to treat him and the only reason you are here now is because we were told that you HAD to be for us to have communication with Iowa City!"
After bantering back and forth for awhile (I will spare you the details.) She ADMITTED FINALLY that because dads case is so complicated, THEY REFUSE to treat him. So, great. rock on. She answered our questions.
We are now going to Iowa City.
Arrangements will be made tomorrow. Its nice that she finally had the balls to admit the reasons as to why they are nothing but ASSHOLES. :)
I said, "First of all, we NEVER called for neuro before, you guys just showed up for whatever reason. Secondly, we NEVER wanted you to treat him and the only reason you are here now is because we were told that you HAD to be for us to have communication with Iowa City!"
After bantering back and forth for awhile (I will spare you the details.) She ADMITTED FINALLY that because dads case is so complicated, THEY REFUSE to treat him. So, great. rock on. She answered our questions.
We are now going to Iowa City.
Arrangements will be made tomorrow. Its nice that she finally had the balls to admit the reasons as to why they are nothing but ASSHOLES. :)
January 21st
Okay, so I finally lost it last night. Cried the entire way home, once there I am greeted by my dog who can't bare weight on her front left leg. GREAT!! This is all I need. So, I slept on the couch with her and she licked my tears away. Those are the reasons dogs are awesome. Sometimes you don't want to hear anyone give you advise or tell you how good things will end up, you just want to have your tears licked away. Thats what a dog will do, even when they are in pain.
(Side note from vet trip: She has a bone spur in her elbow joint and has arthritis and calcium deposits, the whole 9 yards. We have been referred to a specialist. I am glad it isn't a doctor a Mercy.)
On to dad. Dad had the feeding tube inserted surgically into his stomach today. He seemed to be in much better spirits this morning. He told Debbie (his sister) and Martha that we needed a plan. Debbie summoned Scott and I to the hospital. We were with him when he went into surgery. Then we went to the waiting room and started to plot.
I have decided that I am determined to try and keep him here as long as possible. I think for him supportively, it is best. He has us all here. We can't all be in Iowa City. If it was up to the doctors here, they would have shipped him back when he first started getting sick. The floor PA here told Scott and Martha today that once we have this neuro consult, it is almost impossible for them to communicate with Iowa City. I think that is BULLSHIT. Is it an ego thing? The number one concern in my mind is the patient. These damn doctors need to understand that and talk to each other for the PATIENT and stop playing the who's dick is bigger game.
Martha, Debbie and Scott are more for going back to Iowa City and then on to Mayo if needed. I don't have a problem with that, I just don't want to move him if something can be accomplished here with a little freaking communication between the doctors!!
"Hi Dr. Chaloupka! This is Dr. Idiot and I am a neurologist at Mercy Hospital in Des Moines. I have had the great pleasure of seeing your patient Jim Shoning and his beautiful, funny, intelligent family!"
"Well that is wonderful Dr. Idiot!! I as well think they are beautiful, funny and intelligent! What can I do for you?"
"Jim here seems to be having a bit of difficulty regaining his left side which is inhibiting his
Dad is resting well since the surgery. He just asked for some morphine. They wouldn't give me any. We are waiting for the neurologist to show up so we can ask him a thousand questions and make him/her try and see our point. I will let you know the result. Do you want to take bets who is going to win? Me and Martha or Neurologist. *evil snicker*
(Side note from vet trip: She has a bone spur in her elbow joint and has arthritis and calcium deposits, the whole 9 yards. We have been referred to a specialist. I am glad it isn't a doctor a Mercy.)
On to dad. Dad had the feeding tube inserted surgically into his stomach today. He seemed to be in much better spirits this morning. He told Debbie (his sister) and Martha that we needed a plan. Debbie summoned Scott and I to the hospital. We were with him when he went into surgery. Then we went to the waiting room and started to plot.
I have decided that I am determined to try and keep him here as long as possible. I think for him supportively, it is best. He has us all here. We can't all be in Iowa City. If it was up to the doctors here, they would have shipped him back when he first started getting sick. The floor PA here told Scott and Martha today that once we have this neuro consult, it is almost impossible for them to communicate with Iowa City. I think that is BULLSHIT. Is it an ego thing? The number one concern in my mind is the patient. These damn doctors need to understand that and talk to each other for the PATIENT and stop playing the who's dick is bigger game.
Martha, Debbie and Scott are more for going back to Iowa City and then on to Mayo if needed. I don't have a problem with that, I just don't want to move him if something can be accomplished here with a little freaking communication between the doctors!!
"Hi Dr. Chaloupka! This is Dr. Idiot and I am a neurologist at Mercy Hospital in Des Moines. I have had the great pleasure of seeing your patient Jim Shoning and his beautiful, funny, intelligent family!"
"Well that is wonderful Dr. Idiot!! I as well think they are beautiful, funny and intelligent! What can I do for you?"
"Jim here seems to be having a bit of difficulty regaining his left side which is inhibiting his
Dad is resting well since the surgery. He just asked for some morphine. They wouldn't give me any. We are waiting for the neurologist to show up so we can ask him a thousand questions and make him/her try and see our point. I will let you know the result. Do you want to take bets who is going to win? Me and Martha or Neurologist. *evil snicker*
Tuesday, January 20, 2009
A Summary of What Brings Us to Today
In November and December of 2007, dad experienced a mild constant headache that was alleviated with Advil. It lasted between Thanksgiving and Christmas. After seeing his family physician who treated him for a troublesome sinus infection, on New Years Eve, dad had a 15 minute bout of dizziness while at the bar.
SAID BAR
Upon awakening the next morning, he noticed that one pupil was bigger than the other. Now my dad was an EMT for like 80,000 years so he knew enough to know that it was probably pretty serious. But, like any normal person, he freaked out and ignored it. Well, I shouldn't say he ignored it, he did go to the doctor and managed to play down his symptoms so the doctor didn't see the urgency in his predicament and immediately send him to the ER. So, the doctor gave dad a number to call to schedule a brain CT. Which, dad scheduled for like a week later.
So, being Mr Downplay that he is, he casually sent out an email to my brother and I at work and I think it was some retarded joke with a BTW, I'm having a head CT due to dizziness and large pupil have a nice day.
Wait. WHAT?
I picked up the phone and went CRAZY on him. He called the head CT place back after lots of cajoling from his number 1 and had it scheduled for the next day. So, I felt a bit better. Problem was, it was late in the afternoon and it was some stupid satellite clinic and they apparently don't keep on staff a radiologist who could read it. But, any pre-schooler could have been able to tell that there was a HUGE BRAIN ANEURYSM IN HIS HEAD!!
Dad called me at work that next morning and said, "Well I just got the results back and I have an extremely large brain aneurysm."
I instantly feel the need to crap myself, I start bawling and choked out, "What are they going to do?"
"They want me to go to Methodist ER." he said. I told him I would meet him there and he told me not to. Yeah, like I could non-chalantly finish my day at work.
I got in the car and beat him there. I guess I expected Martha (wife) was with him and I was standing in the ER waiting room waiting for him to get there. I called him and he said he was trying to find a place to park. I then spotted him driving through the parking lot by himself. WTF? I couldn't have done that if I were him. Drive myself to the ER after finding out I had a huge aneurysm?? I would have been so freaked out it would have dissected or I would have an aneurysm finding out I had an aneurysm. Or a stroke.
So, we get into the triage area and the nurse is talking to us trying to figure out why we are there. Martha shows up and we get taken down to radiology where they want to do an arterial angiogram to figure out what exactly the annie looks like. (I am going to use annie because I'm too lazy to have to write aneurysm out and be paranoid Im spelling it wrong.) Well, Dr. Berinni tells us its HUGE and because of dad's age and where it is, it would not be in his best interest to clip it or cut it out. But, there is a doctor in Iowa City, Dr. Chaloupka who can do a procedure called a "coil." It is done arterially and he is a great candidate for it.
His annie is 1.6 cm. That is an INCH for those of you who didn't know what a god damn cm was until a month ago. (I'm not that bright.) It is also deep in his brain.
Ambulance ride to Iowa City we go. I think this was a Friday. The doctor we went to see was out of town. So, after consulting with surgeons and radiologists and yelling at some douche bag doctors, we decided that coiling was indeed the best option. The only thing was that the doctor who needed to do it, was out of town. So, they had my dad lay flat, in the dark all weekend as a precaution.
Procedure was done on Monday or Tuesday. I can't remember. But it seemed to be a great success. He came back to Des Moines for rehab. He had a few deficits. He never really could write very well with his left hand after that and he is left handed. He had a slight facial droop and had some problems with perception and fuzziness. But, he came back home.
Towards the end of February he declined in health. He had MAJOR left sided weakness, had some bathroom issues and confusion. No one seemed to be able to figure it out. After some research we found something called Normal Pressure Hydrocephally and after going back to Iowa City, they agreed and put in a shunt. (Pretty sad the doctors couldn't figure it out. Google isn't that tough to use. But I guess they aren't brain surgeons...oh wait.)
He went back to rehab and learned to drive again, bought a corvette and a hybrid car. He had to retire from his main job with disability and dissolve his photography business. He retired from the volunteer fire department after 30 years and started having coffee in the morning with the ladies at the local coffee shop, lunch at the bar and finding whatever he could to keep him busy.
Around November he started getting left sided weakness that just kept progressing. We went to Iowa City and they tried steroids and it didn't work. The head CT showed that he has "perianeurysmal edema." They thought that if they put a stent across the neck of the annie, it should cure that. We had that done and at the same time while in Iowa City, they started him on an experimental drug called methotrexate. Its a chemo drug, but the vascular rheumatologist in Iowa City said that studies had shown that it helps in decreasing swelling.
He said he felt great and he could use his left side again. Martha stayed there with him for a week and then drove him back to Mercy Capital in Des Moines for rehab. He was walking and doing great. Right before Christmas he started getting sick. So tired he couldn't keep his eyes open. He sounded like he had crap in his chest. We thought he had a sinus infection so we kept asking for sinus meds. We usually celebrate Christmas on Christmas Eve and we kept on with the tradition. He couldn't hardly stay awake while we opened presents and he didn't have the strength to open his. He did stay awake to eat the dinner that was brought in for him though. (Of course)
After the 2nd dose of the methotrexate, he really took a dive. He developed sores in his mouth that went down his throat and blood clots in his leg. They had to go in and put an umbrella in his vena cava to protect any clots shooting into his heart. His bone marrow essentially stopped producing cells and he became very weak. He was having issues swallowing. Mercy Capital sent him to Mercy Main where they were so busy they really couldn't give him the care he needed. He ended up aspirating on New Years Eve (What's with him and New Year's Eve??) He ended up in ICU on New Years Day. It didn't look good. We called my brother home from the Outback Bowl.
He had pneumonia from aspirating. (Oh and we found out later he had Legionnaire's disease. the doctors didn't tell us, Warren County Disease Control called Martha. Nice, huh) He was completely unresponsive New Years morning and became better through out the day. A few times, we thought that he was going to have to get put on a vent, but we were able to get away without. Poor guy was too weak to cough anything up and breathed so hard. His blood pressure was all over the place. It was scary. But, he pulled out of it. We discontinued the methotrexate and now he has a complete left sided deficit.
We got out of ICU and spent some time getting stronger at Mercy Main. We are now back at Mercy Capital and it seems his spirit is slowly fading. At first when he was out of ICU he was all psyched and wanted to take us all on a cruise when he got better. Which is good, he was hopeful for the future. Now he is sad and bored. It didn't help that this past weekend we all came down with the flu, so he didn't have many visitors.
Iowa City told us that if the methotrexate didn't work they had some other ideas. Today we seemed to have a bit of trouble trying to communicate with Iowa City as to what the ideas are and can we try them. We seem to have too many doctors with their hands in the kitchen. We know that once his swelling in the brain goes away, he can use his left side. The problem we seem to be finding is this edema isn't an inflammatory response, so anti-inflammatory drugs aren't helping. So, we need to figure out what will and fast. I don't know how much more he can take of this. He is too independent and he has had to lay in bed for too long. I can see he seems to want to give up. But we won't let him!!!
Sorry this is long winded but I needed to catch everyone up. I apologize if my cussing or name calling offends people. This is me telling it how it is in my prospective. If you know me, you know I don't censor myself well and I will try in writing this. But, sometimes I may slip or go on a rant.
I appreciate any feedback or suggestions. Please forward this blog to anyone you might think would like to be kept up on dad's progress. He needs encouragement from all!! He has too much life left to live to give up now!!!!
It is Tuesday January 20, 2008 9:20 pm. I am sitting here in his hospital room watching him snore. He has been sleeping since 6:45. He just wants to disconnect and not deal with all this. I don't know how to help. He told me tonight he couldn't really see the tv anymore. He can't focus. So, what do you do?
SAID BAR
Upon awakening the next morning, he noticed that one pupil was bigger than the other. Now my dad was an EMT for like 80,000 years so he knew enough to know that it was probably pretty serious. But, like any normal person, he freaked out and ignored it. Well, I shouldn't say he ignored it, he did go to the doctor and managed to play down his symptoms so the doctor didn't see the urgency in his predicament and immediately send him to the ER. So, the doctor gave dad a number to call to schedule a brain CT. Which, dad scheduled for like a week later.
So, being Mr Downplay that he is, he casually sent out an email to my brother and I at work and I think it was some retarded joke with a BTW, I'm having a head CT due to dizziness and large pupil have a nice day.
Wait. WHAT?
I picked up the phone and went CRAZY on him. He called the head CT place back after lots of cajoling from his number 1 and had it scheduled for the next day. So, I felt a bit better. Problem was, it was late in the afternoon and it was some stupid satellite clinic and they apparently don't keep on staff a radiologist who could read it. But, any pre-schooler could have been able to tell that there was a HUGE BRAIN ANEURYSM IN HIS HEAD!!
Dad called me at work that next morning and said, "Well I just got the results back and I have an extremely large brain aneurysm."
I instantly feel the need to crap myself, I start bawling and choked out, "What are they going to do?"
"They want me to go to Methodist ER." he said. I told him I would meet him there and he told me not to. Yeah, like I could non-chalantly finish my day at work.
I got in the car and beat him there. I guess I expected Martha (wife) was with him and I was standing in the ER waiting room waiting for him to get there. I called him and he said he was trying to find a place to park. I then spotted him driving through the parking lot by himself. WTF? I couldn't have done that if I were him. Drive myself to the ER after finding out I had a huge aneurysm?? I would have been so freaked out it would have dissected or I would have an aneurysm finding out I had an aneurysm. Or a stroke.
So, we get into the triage area and the nurse is talking to us trying to figure out why we are there. Martha shows up and we get taken down to radiology where they want to do an arterial angiogram to figure out what exactly the annie looks like. (I am going to use annie because I'm too lazy to have to write aneurysm out and be paranoid Im spelling it wrong.) Well, Dr. Berinni tells us its HUGE and because of dad's age and where it is, it would not be in his best interest to clip it or cut it out. But, there is a doctor in Iowa City, Dr. Chaloupka who can do a procedure called a "coil." It is done arterially and he is a great candidate for it.
His annie is 1.6 cm. That is an INCH for those of you who didn't know what a god damn cm was until a month ago. (I'm not that bright.) It is also deep in his brain.
Ambulance ride to Iowa City we go. I think this was a Friday. The doctor we went to see was out of town. So, after consulting with surgeons and radiologists and yelling at some douche bag doctors, we decided that coiling was indeed the best option. The only thing was that the doctor who needed to do it, was out of town. So, they had my dad lay flat, in the dark all weekend as a precaution.
Procedure was done on Monday or Tuesday. I can't remember. But it seemed to be a great success. He came back to Des Moines for rehab. He had a few deficits. He never really could write very well with his left hand after that and he is left handed. He had a slight facial droop and had some problems with perception and fuzziness. But, he came back home.
Towards the end of February he declined in health. He had MAJOR left sided weakness, had some bathroom issues and confusion. No one seemed to be able to figure it out. After some research we found something called Normal Pressure Hydrocephally and after going back to Iowa City, they agreed and put in a shunt. (Pretty sad the doctors couldn't figure it out. Google isn't that tough to use. But I guess they aren't brain surgeons...oh wait.)
He went back to rehab and learned to drive again, bought a corvette and a hybrid car. He had to retire from his main job with disability and dissolve his photography business. He retired from the volunteer fire department after 30 years and started having coffee in the morning with the ladies at the local coffee shop, lunch at the bar and finding whatever he could to keep him busy.
Around November he started getting left sided weakness that just kept progressing. We went to Iowa City and they tried steroids and it didn't work. The head CT showed that he has "perianeurysmal edema." They thought that if they put a stent across the neck of the annie, it should cure that. We had that done and at the same time while in Iowa City, they started him on an experimental drug called methotrexate. Its a chemo drug, but the vascular rheumatologist in Iowa City said that studies had shown that it helps in decreasing swelling.
He said he felt great and he could use his left side again. Martha stayed there with him for a week and then drove him back to Mercy Capital in Des Moines for rehab. He was walking and doing great. Right before Christmas he started getting sick. So tired he couldn't keep his eyes open. He sounded like he had crap in his chest. We thought he had a sinus infection so we kept asking for sinus meds. We usually celebrate Christmas on Christmas Eve and we kept on with the tradition. He couldn't hardly stay awake while we opened presents and he didn't have the strength to open his. He did stay awake to eat the dinner that was brought in for him though. (Of course)
After the 2nd dose of the methotrexate, he really took a dive. He developed sores in his mouth that went down his throat and blood clots in his leg. They had to go in and put an umbrella in his vena cava to protect any clots shooting into his heart. His bone marrow essentially stopped producing cells and he became very weak. He was having issues swallowing. Mercy Capital sent him to Mercy Main where they were so busy they really couldn't give him the care he needed. He ended up aspirating on New Years Eve (What's with him and New Year's Eve??) He ended up in ICU on New Years Day. It didn't look good. We called my brother home from the Outback Bowl.
He had pneumonia from aspirating. (Oh and we found out later he had Legionnaire's disease. the doctors didn't tell us, Warren County Disease Control called Martha. Nice, huh) He was completely unresponsive New Years morning and became better through out the day. A few times, we thought that he was going to have to get put on a vent, but we were able to get away without. Poor guy was too weak to cough anything up and breathed so hard. His blood pressure was all over the place. It was scary. But, he pulled out of it. We discontinued the methotrexate and now he has a complete left sided deficit.
We got out of ICU and spent some time getting stronger at Mercy Main. We are now back at Mercy Capital and it seems his spirit is slowly fading. At first when he was out of ICU he was all psyched and wanted to take us all on a cruise when he got better. Which is good, he was hopeful for the future. Now he is sad and bored. It didn't help that this past weekend we all came down with the flu, so he didn't have many visitors.
Iowa City told us that if the methotrexate didn't work they had some other ideas. Today we seemed to have a bit of trouble trying to communicate with Iowa City as to what the ideas are and can we try them. We seem to have too many doctors with their hands in the kitchen. We know that once his swelling in the brain goes away, he can use his left side. The problem we seem to be finding is this edema isn't an inflammatory response, so anti-inflammatory drugs aren't helping. So, we need to figure out what will and fast. I don't know how much more he can take of this. He is too independent and he has had to lay in bed for too long. I can see he seems to want to give up. But we won't let him!!!
Sorry this is long winded but I needed to catch everyone up. I apologize if my cussing or name calling offends people. This is me telling it how it is in my prospective. If you know me, you know I don't censor myself well and I will try in writing this. But, sometimes I may slip or go on a rant.
I appreciate any feedback or suggestions. Please forward this blog to anyone you might think would like to be kept up on dad's progress. He needs encouragement from all!! He has too much life left to live to give up now!!!!
It is Tuesday January 20, 2008 9:20 pm. I am sitting here in his hospital room watching him snore. He has been sleeping since 6:45. He just wants to disconnect and not deal with all this. I don't know how to help. He told me tonight he couldn't really see the tv anymore. He can't focus. So, what do you do?
About My Dad: Jim Shoning
Hi there! My name is Liza and I am the daughter of Jim Shoning. Jim is 61. He has two other kids..I will call them Jordan and Scott. Jordan can't spell and Scott only bowls on the internet and his wife Martha I would assume wouldn't know the first thing about blogging. So, I will be the chosen one.
See, my dad has a brain aneurysm. IT SUCKS!
There are a lot of people who care about my dad and they are here in Des Moines, Carlisle and all over the country. I am so bad at calling people, although AT&T Wireless is really happy about it. So, I thought I would create this blog to keep people updated on dad's progress. Maybe, this can help other people and maybe someone might read it who can help us!! Who knows!!
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