Tuesday, December 28, 2010

The Twelve Days of...Oh Hell, I Give Up.

On the first day of Christmas, Gio brought himself to Old Wire Road.  Additionally, he brought with him tales of the Peruvian rainforest, covetous bird scientists, masked gunmen, unsanitary rice and beans and all manner of ex-girlfriends.  We expected nothing less.
On day two, Moss needed a bath.  

Day Three...Giles' acute glaucoma resolved and that was exactly what we asked ol' St. Druid for.  Thanks to everyone that made a positive contribution to his well being, especially: Dr.WTF, Shands UF, science and all his well wishers.   

On the forth day of Christmas, Gio and I took a paddle down the Ichetucknee River.  Two limpkins, five river otters, ten kingfishers and an osprey in a cypress tree...

On day five, I gave up on the entire '12 Days of Christmas' motif.   Allison visited us from Portland and brought gifts from the civilized world.  Thanks for brightening our holiday.         

Gio courted various surgeons and rock climbers online.  Who could blame him after three months in the Amazon Basin eating E.coli infused beans with members of a Columbian drug cartel.  I expressed to him my concerns with women who start their online dating profile with the sentence, 'I love rock climbing.'  I have nothing against rock climbers (except their muscular bodies and funny shoes).  As an old friend of mine would say, "please don't say, "I love rock climbing."'
I promised Gio that I would get him some time with a wild manatee.  Instead, we visited a zoo.  I tried to promote the zoo by relating heartfelt stories of how the imprisoned beasts were all rescued from certain and painful deaths.  I almost convinced myself, but I feel Gio never bought in.  He did manage to shoot a nausea-inducing composition of a vapid Bald Eagle standing in front of Old Glory.  And yes, Cymande is feeding Giles in the reptile exhibit.

Air: 50 degrees.  Water: 73 degrees.  Steam.

We were again the only visitors to the park for several hours.  When we were pulling our kayaks out of the water we met an entomologist.  Somehow, we started talking about ascariasis or giant human roundworm and she explained how she found one, well, in her stool.  Which allows me to state for the millionth time: no one might actually read this blog, but I have the number one or two google image hit for ascariasis.  I had so much potential in this life...but here I am..giant human roundworm...I always had a thing for parasites.

After we visited the Florida Animal Prison we found the most amazing Italian Deli in Inverness, The Little Italy Deli.  The owner berated Gio for being an Italian vegetarian.  The food was unbelievably good, a rarity in Florida...I felt like I was back in Gloucester being scolded for ordering incorrectly at Cafe Sicilia.
Count them: 12 manatees, one for every day of Christmas.  Actually there were several others that were in the manatee hospital, but they don't count because: A. they were not wild and/or B. they were manatee specters. 


Thursday, December 23, 2010

The Mysterious Case of the Thanksgiving Hyphema

Working in pediatric primary care as a nurse practitioner, I am presented daily with both the best and worst that humanity has to offer.  There have been tragedies and joys that often defy description.  Ethically, I feel I can never mention these things here, nor have I been compelled to, but over this past month I had a case that was so interesting and educational (for both parents and clinicians alike) that I'm inspired to break my own self-imposed censorship.  It helps that the patient is my son.  While I'm not particularly thrilled with advertising Giles' medical history I know this will help someone.  So, here it is...

He is usually a neat eater, but he was obviously not feeling well.  Note the hyphema on the right lateral iris and the hyperemia.  

Past Medical History:  6 month old full term male.  Fraternal twin A.  Delivered C-section.  Breast fed and recently started on baby foods. Vaccines up to date.  Mild upper respiratory infection 2 weeks previous to current illness which resolved with supportive treatment.  Normal newborn screening labs. Taking vitamin D, no other medications.  

History of Present Illness: Giles was in beautiful Beaufort, SC visiting his Grandparents for Thanksgiving.  He was having a great time and for the first time ate a little mashed potatoes.  Nothing seemed amiss until the day after Thanksgiving when we noticed he had a pink right eye.  We assumed it was conjunctivitis and we assumed it was viral.  We were wrong.

We drove home on Saturday and noticed that Mr.Giles was not feeling like himself.  He was grumpy and his eye looked like "let's take him to our clinic and have a pediatrician check him out."  He felt it was likely conjunctivitis and likely a virus.  It wasn't, but we primary care people all think alike.  We were wrong.

The next day we went to see a local ophthalmologist, Dr.Nothing-is-Wrong, where he was diagnosed with a grade 1 hyphema (blood in the anterior chamber, where the iris is).  It was theorized that he hit himself or his twin hit him in the eye.  Dr.Nothing-is-Wrong felt that the odds of another cause would be very rare and he would have other symptoms.  He prescribed prednisone drops (for inflammation) and atropine drops (to keep the eye dilated).  No pressure of the eye was taken.

Giles wasn't feeling any better.  He continued to sleep either all morning or all afternoon and woke throughout the night.  His eye looked about the same.  He was acting weird.  We started to entertain all kinds of horrific scenarios and it was scaring us.

We followed up with Dr. Nothing-is-Wrong who stated that his eye was looking good, that he had a hyphema that was resolving and to continue the treatment plan.  He tested his pressure and it was normal but, as we now know, this was probably false.  We asked if his lethargy, somnolence, and irritability could be contributed to the hyphema and Dr.Nothing-is-Wrong said, "It is not his eye giving him those symptoms."  It is at this point that Cymande almost demanded we go straight to the ER, but I felt that if Dr. Nothing-is-Wrong said nothing was wrong then nothing was wrong.  He was wrong.

(Note:  We had read in several pediatric ophthalmology textbooks that somnolence is often associated with hyphema and that it often results in a rule-out sepsis work-ups (foreshadow).  This was mentioned to Dr.Nothing-is-Wrong and he seemed underwhelmed.)

Over the next 3 days Giles got worse.  He was more somnolent, more irritable and acting strange.  It was rare to get a smile out him.  Finally, he refused to wake up in the morning.  So, off to the University of Florida ER...

Upon arrival we were put in a private room where the ER resident, Dr. Something-is-Wrong, took the history and looked very worried.  First, she called for an ophthalmology consult and the resident adult ophthalmologist arrived and was soon followed by her attending.  They examined him and confirmed that he indeed had a hyphema, but they were unaware of it creating symptoms like his.  Then the ER attending arrived and said 'We are worried about him.'  Which made us even more worried.  The work up: Head CT: no brain tumor or eye tumor. Labs: no obvious bleeding disorder, no obvious infection, no obvious metabolic disorder.  Urine: clean.  Diagnosis: Hyphema and Suspected Afebrile Sepsis.

At 2pm and Giles was still sleeping and not really feeding well.  The ER work-up revealed no significant illness, but there was no lumbar puncture done.  The great unknowns remained: afebrile meninigitis vs afebrile encephalitis.  It was decided that he needed to be in the PICU. The PICU team sat us down and went through their thinking process.  We felt nervous, but safe.  They were thorough, thoughtful and they listened to the entire history. They called back the ophthalmologists and examined him under conscious sedation where his eye pressure was noted to be over 3 times the normal pressure.  They stopped any further workup and started him on pressure drops that miraculously brought him out of his stupor.  He laughed and squealed for the first time in a week.  We squealed with him.

The next day he was transfered to the general pediatric floor and a pediatric ophthalmologist, Dr. I'm-Going-to-Figure-Out-What-The-F%@#-Is-Wrong-With-Him (DR.WTF) examined him.  His pressure was coming down and we were discharged.  She later examined him under anesthesia and she ruled out all the bad stuff.  The working diagnosis is juvenile xanthogranuloma (JXG) of the iris, but we are not 100% on that.

So, the likely scenario is this: JXG caused a friable lesion of the iris to bleed creating a spontaneous hyphema.  The hyphema and cellular debris clogged the angle (drainage system of the eye) and caused uveitis (inflammation) which led to acute glaucoma (increased intraocular pressure).  This caused a severe headache which led to his somnolence, irritability and near toxic appearance.

Thursday, November 25, 2010

The Day Before Thanksgiving 2010, One Day Late

Moss and Giles getting all Bass and Drum.
The boys are expressing themselves in new and surprising ways.  Moss is utterly amused by me singing 'doo doo doo, daa daa daa is all I want to say to you' and if I follow it up with  'squeak' then Giles squeaks his approval. 

The calm before Old Wire Road is widened and paved

Since our very first day on Old Wire Road we have been told that it was going to be paved 'next year'.  Next year has finally arrived and with astonishing efficiency they are widening Old Wire with all manner of large and exotic machinery.  To remind us that we live in a place where there are little rules or regulations, loggers driving tractors (that cut down a tree in 3 seconds) quickly took down over a mile of roadside trees with cars speeding by the entire time.  It was a frightening sight to behold. 

Moss is enthusiastic about his bouncy

The final days of Old Wire Road as a narrow dirt road

I've been trying to research the history of Old Wire Road but have found little information thus far.  From the information I collected I have pieced together the following:  The first telegraph line in Florida ended in the now defunct town of O'Leno and it followed old Route 47 which is parallel to Old Wire.  So, I believe that Old Wire Road is the old route of the telegraph line that ran to O'Leno (near High Springs).  There is suprisingly little history regarding this topic (as with many things related to Lake City.)  Over the years people have built their homes with respect to where the dirt road lies, but not with respect to where the actual property lines exist.  Some people are losing their entire front yards and several Live Oaks which were probably 200 years old were taken down for the newly alligned Old Wire Road.   

Giles investigates a pumpkin

One last look at the view North from our driveway.

Moss and Giles inspired us to be more festive.  I carved pumpkins while they watched.
The Great Idiotic Stump is now history, but the stupidity is alive and well. 
More on this topic to come...

Saturday, October 30, 2010

Rumble. Boom.

For several months a mysterious sound has been emanating from beneath our porch.  The first night we tried to ignore it and assumed that it was a rodent (notice how accepting we are of rats sharing our house.)  Then, it happened the following night and it was loud.  It was a rumbling sound, a boom, a persistent rumbling booming sound.  At 1AM, armed with a flashlight, I tried to figure out what was going on beneath the porch.  I stood outside listening.  Silence.  I went back inside, turned out the lights and went to bed.  Rumble.  Boom!  Rumble.  I pulled the covers over my head and decided if the beast was only going to make noise then I could endure it, but if it tried to enter the house then I would need to get up and destroy it with my bare hands.  I lay in bed listening.  Boom.  Rumble.  It sent shivers up my spine.  Why was it so loud?

This became a nightly occurrence (that eveyone except myself slept through.)  I would go to bed and fall asleep to the rumbling boom of an unidentified monster inhabiting the crawlspace.  Some nights, spiked with the insanity of twin-induced sleeplessness, fear and panic would take over as I lay in bed hypothesizing a variety of horrific scenarios that could produce a rumbling boom.  Rats are fine, but I couldn't allow a serial killer use my crawlspace for storage.  Rumble. Boom.  I went outside again with my flashlight accompanied by Lula and Buckley.  Again, I found nothing and was unable to locate the sound.  I came to terms with the idea that I would just live with the beast unless it decided to come indoors.

Then, just a few nights ago, the sound started up again.  I decided to take another look.  I grabbed my flashlight and looked under the porch.  Nothing.  Then, I saw movement.  The large plastic vapor barrier started to move.  Boom.  Rumble.  The entire 8 foot piece of plastic was now bouncing up and down.  'It must be huge,' I thought, 'and maybe full of bloodlust.'  It stopped again.  I watched in horror as one end of the plastic started to peel back.  The beast began to emerge...all 10 inches of ferocious juvenile armadillo.

Saturday, October 16, 2010

Twin Lights!

Rockport Harbor

I'm sitting here, five days after returning from our trip to Cape Ann, trying to write a concise description of both our wanderings and my feelings after being reacquainted with our former home.  It hasn't helped that the past few days back at work have been too long and fairly difficult, and sure, Astral Weeks is playing quietly in the background.  I'm trying not to write an indictment of Florida (it's too easy and there are some places and people I love in Florida.)  

A brief  history:  I first visited Cape Ann in my early twenties and it immediately felt like home.  I lived in Essex, Gloucester, Rockport and Pigeon Cove.  I met Cymande in Rockport and we were married on the Back Shore in Gloucester.  I showed paintings at the Demeri Gallery, Lanesville, Gloucester and Ipswich. Some of our closest friends still live there.  I know the shortcuts, where to eat and where all the great walks are. Maybe its the natural beauty or that my ancestors from Newfoundland passed down a coastal-pastoralism gene, but it is obvious:  Cape Ann is still home.  

And Lake City is home.  Our lovely house, full of family and pets, sits in the middle of a field of blooming wildflowers.  I love our little island of sanity.  It has provided so much and taught me even more.  I just wish I didn't need an island or feel the need to build a levy or a moat or a twelve-foot stone wall with turrets around my oasis.  Back to Cape Ann...

Jenn and Daniel's beautiful home in Amesbury

When we first planned this trip it was to be a driving vacation.  We were going to pack up our Subaru and head North.  Then, I panicked at the thought of two babies crying for 24 hours straight as I sped toward Massachusetts.  I booked a flight figuring 3 hours of crying is better than 24 hours.  As it turns out there was no crying at all.  Our friends, Jenn and Daniel provided shelter and a delicious meal on our first night.  The next day we walked to a local orchard and had the requisite apple cider donuts.

Moss and Giles get strapped in

Bowie demanding fetch time

The next day we checked into our little Rockport cottage, the Sea Mist.  It had everything we needed (except two extra nights that I didn't book in time).  Located on Broadway, it was within short walking distance of Front Beach, Bearskin Neck, fried clams, eggs florentine, apple strudel and coffee.  Vacation started to reveal the effects of 4 months of non-stop parenting: it became a special treat for one of us to walk to the convenience store after the boys were asleep.  Oh the freedom of fifteen minutes on 2000 feet of sidewalk.  

Cymande, Moss and Giles napping at the Sea Mist

Breakfast at Ross and Sarka's home in Ipswich

On Sunday morning we all met at Todd Farm for a walk around the antiques and junk.  We also spotted the latest in trendy menswear: skinny jeans tucked into english riding boots (something I shall never attempt).  Todd Farm is the only Sunday morning ritual I could ever devote myself to and it felt great going back.  After Todd Farm, Sarka made us a delicious breakfast, but I must admit that we stopped at Marty's to reconnect with the intimidating staff and the boiling weak coffee and fear not, nothing has changed. 

Jenn, Cymande and Giles at Topsfield Fair

Cymande and Giles at Appleton Farms

We spent Monday walking around another North Shore tradition, the Topsfield Fair.  The windy cloudy weather nearly tempted us into a BBQ bacon dog, but we were distracted by the fried twinkies. Thankfully, Ross set us up with a pile of veggie tempura (with a side of vinegar...which apparently is "hot this year!")  We returned to Rockport to warm up.  Cymande started The Yearling which was included in the cottage's library.  It's an interesting, somewhat mystical coincidence because it is about life in the Florida scrub where we now live.  We are regular visitors to the Marjorie Rawlings Homestead in Cross Creek.

Moss and I at Appleton Farms

Giles and Cymande in the Great Pasture

Tuesday was our Ipswich day.  First, we attempted breakfast at Stone Soup (closed on Tuesdays), but instead went down to Zumi's for coffee and bagels before heading over to Appleton Farms.  Ten years ago I took Cymande on one of our first dates there (raspberry wine, baguette, and brie in the Great Pasture...how could she resist?)  We then met Ross for a trip to the Crane Estate at Castle Hill.  We tried to explain to Moss and Giles that if they worked hard, saved and produced all the world's toilets like Mr.Crane, then, they too could have a Grand Allee that reaches the sea (though currently I would consider a job mowing it).  After the Crane Estate we visited Russel Orchards for more apple cider donuts and coffee.  We picked up some groceries and I bought a copy of  A House on the Ipswich Marsh which explains the natural history of Ipswich.  The farm animals were well behaved ('Caution Pig Bites!').  Then, back to the cottage for amazing and miraculous fresh vermont camambert and yes, raspberry wine. 

Ross, Cymande and Giles on the Grand Allee. Crane Estate, Ipswich

Moss napping in the wind-blown rain. Crane Estate

The end of the Grand Allee.  The southern tip of Plum Island is in the distance

The next day we tempted fate by going down the street to The (no longer Flav's) Red Skiff with babies strapped to our chests.  They were a hit with staff and customers alike and even seemed to enjoy the excitement of it all...even with hollandaise sluicing down their foreheads.  We walked around town and headed over to the Cape Ann Museum in Gloucester.  We lived three minutes away from this museum for three years yet somehow never visited.  Moss and Giles were utterly satisfied staring at Fitz Hugh Lane seascapes.  Then back to the cottage for the bedtime ritual. 

Giles endured a bumpy ride on the acorn covered paths of the Hamlin Reservation

Hamlin Reservation, Ipswich

Thursday was another Gloucester day.  Breakfast at Sugar Magnolias and off to Eastern Point Light followed by a drive along the Back Shore. The sun was finally out and the Autumn air was blowing waves past Twin Lights and washing them nearly to the dunes of Good Harbor Beach.  After our walk we delivered Moss and Giles to a very excited group: Great Aunt Carlie, Great Uncle Jerry, Aunt Debi and their friend Pat.  Moss and Giles were thoroughly enjoying all the attention until they abruptly fell asleep on the floor and couch. 

Black Beach, Manchester-by-the-Sea

Jillian, Giles, Moss and Cymande.  Demeri Gallery, Rockport

Moss and Giles at the cottage. Rockport

Friday was our last day at the cottage and we grudgingly packed our bags hoping that somehow we could stay through Autumn...and maybe Winter.  Instead, we moved down the street to the Eagle House Motel and it was totally enjoyable.  We spent the day with Jenn, visiting the shops, eating at Roy Moore's and walking Old Garden Path.  We walked past my old winter rental on Smith Road and I'm still not 100% clear why she kept my security deposit.  Jenn and Daniel babysat while Cymande and I went out to dinner first time without the twins.  They didn't even miss us.  Cymande had Finnan Haddie, which she wants noted here because it is so exotic sounding and reminds her of growing up in Gloucester.

The ocean off Eastern Point.  Gloucester

Cymande and Giles.  Gloucester Harbor

My lack of planning finally led us back to the York's house in Ipswich for our final night in Massachusetts. We somehow packed ourselves into one bed.  The return flight was uneventful except for the humorless hyper-vigilant TSA agent that proclaimed that the twins' bibs needed to come off and get scanned.  If they really were worried about something explosive and/or gaseous Moss and Giles were both packing diapers more dangerous and certainly more offensive.  I'll write no more about this; I don't want them to end up on a no fly list.  Moss and Giles, Twin Bib Bombers.  Bib Bomber Brothers.

Eastern Point Breakwater.  Gloucester

Giles and Moss in the backseat

Good Harbor Beach.  Gloucester

Family portrait while walking on Good Harbor Beach

On the way to Old Garden Path.  Rockport

Carlie, Giles, Gregg and Moss

And of course...Motif #1.  Rockport

In the introduction of The House on the Ipswich Marsh, William Sargent opens with 'I fell in love with a field in the Spring of 2001.'  I immediately realized that this is the same feeling I have about many areas on the North Shore and elsewhere (particularly Appleton Farms, Halibut Point and many of the Trustees of Reservations properties). When you come to understand and love a forest or field you experience great sadness and anger when it is harmed or destroyed.  The North Shore is doing a good job or protecting these areas; sacrificing short term monetary rewards for the preservation of large swaths of undeveloped open spaces "for everyone, forever". I fear this is something that North Florida will never understand or value. I watch this community continually bury wetlands to build yet another hideous strip mall.  There is no interest or energy to preserve this place.  The locals don't seem to know the beauty of the place. I read the minutes of the County Commissioner meetings as they time after time up-zone light residential zoning to commercial zoning and thereby threaten our delicate Ichetucknee Springs. I told Cymande shortly after we moved here that there is only so much of this destruction that I could bear to watch.  How high do the oasis walls need to be? Or should we instead have a small garden of hollyhocks with the cold Atlantic in the air?

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