Before I start, I have to confess that the "photo" which is the subject of today's post is not mine. You'll understand why in just a few seconds!

Tomorrow, I will have the ninth surgery of my life. It's not because I think that spending time on a chilly stainless steel table in an eerily smelly sterilized room is the ideal way to spend a couple hours of spare time that I will embark on yet another surgical adventure. Trust me, I can find plenty of better ways to keep myself occupied! Nope, the time has come to remove yet another malfunctioning part of my body so that it will no longer interfere with those parts that do work as they still should.

The surgery itself isn't a big deal as far as operations go. In fact, compared to some of the others I've had, this one is as simple as a trip to the grocery store. The only hitch in the get-along, as my Papa used to say, is that the shopping list has a huge question mark right in the middle of it.

The right side of my thyroid gland (see "photo" to locate it) has a nodule about the size of grape on it. It moves around when touched and when positioned just right, can actually make it difficult for me to breathe or swallow properly. A needle biopsy taken several months ago showed changes to the cells in the fluid contained within the nodule, prompting the doctor to warn me about the big C -- cancer. The biopsy didn't get enough of the fluid or cells to determine which type of cancer, but that doesn't really matter because the nodule and the portion of the thyroid to which it has attached itself have to come out of my neck.

So tomorrow morning, my very own Dr. Oz will play slice and dice on my throat. He will remove the right half of my thyroid gland and send it off to the lab for analysis to determine just what those changed cells have done to it. Based on the results and what he sees, he will determine whether or not to remove the rest of the gland before stitching me back together. Honestly, it doesn't matter to me whether I have half a thyroid or none at all when all is said and done. I care more about making sure that what remains works the way it should and has none of those funky changed cells in it!

The surgery is supposed to be an outpatient event, and I anticipate being home in the early afternoon. There is, however, a slight possibility that I will have to stay in the hospital overnight -- something that will make me a very, very unhappy camper should it come to pass! I'll do my best to post a Twitter update as soon as I am able but if I disappear for a couple of days, you'll know that it's more than likely because I ended up having to stay at the hospital.

**Source for the "photo" -- I couldn't use my own thyroid gland because, well, I'm not about to slice open my own throat to get a bird's eye view not even for a blog post!

Tired and REtired accurately describes me for the past couple of days. No sitting around munching on bon-bons and watching soap operas all day here. So much for the glory days of retirement!

Despite really looking forward to the Thursday Thirteen meme, I just didn't have time to get to it today. Not that this is necessarily bad; it just means that I'm having another good day and have the energy and concentration to get some more work done. I might could get used to this!

The visit with my wunnerful wunnerful neurologist, Dr. S, went well. We're changing my anti-seizure medications again as the Dilantin has never really reached the level in my blood stream that it should in order to work effectively. Instead of continuing to increase the dosage of a drug that just ain't cuttin' the mustard as my Grandma used to say, I'll go back on Topamax. I did have some issues with Topamax causing brain fog a while back; however, I'm no longer teaching and required to have unfailing mental acuity on demand. I'll take a bit of fogginess over clusters of seizures any old day. Besides, Topamax has three delightful side effects from which I gained some additional benefit in the past and hope to see again:

• it causes weight loss
• it is also used to treat and prevent migraines
• it will allow me to stop taking two, possibly three, additional medications

The next couple of weeks will be challenging as I take both the Topamax and Dilantin until I reach the previous dosage of 100 mg of Topamax twice daily and start to wean off the Dilantin. Been there, done that -- at least half a dozen times -- and will survive it once again.

I don't think that I have ever talked about the fact that I am the conservator in charge of the care of an elderly neighbor and friend. And if it weren't for the fact that I am currently totally stressed over a member of her family and her current health, I wouldn't say anything; however, I really need to vent in a big way.

The Amazing Egyptian Dude and I bought our home from my dad, so except for a few years when the AED and I lived in a neighboring city after we got married, this place has been my home for close to 30 years.

My whole family befriended a delightful retired couple who lived across the street. For the sake of their privacy, I'll call them Bob and Betty. The AED always started his day by having a morning cup of coffee and visit with Bob. Our daughter headed straight across the street as soon as she got home from school for an afterschool snack and lots of fun before starting her homework. Two or three times a week, she watched The Wheel of Fortune with them, competing against Bob to see who could solve the puzzles first. Betty took a daily walk down the street and stopped at my house for a cup of coffee before returning home; she loved to share the neighborhood gossip with me. At sunset, Betty and I chatted from across the street as we watered our lawns. Not a day went by that they weren't an integral part of our lives the way that grandparents who live close by would be.

When Betty developed diabetes and a few years later, dementia, Bob resolved to care for her himself, with a little help from friends. The AED did their grocery shopping, played Mr. Fix-It when needed, and drove them to doctor's appointments; I bathed Betty, cleaned up after her when she had difficulty controlling her bowels, and assisted Bob with her care; our daughter helped to clean up when Betty had accidents, washed and brushed her hair, and continued to make the weekly visits to Bob for Wheel of Fortune. Through all of this, we saw very little of their children.

Bob and Betty had both been married previously and had children from those marriages. Bob had two daughters, and Betty adopted her first husband's son. One of Bob's daughters lives in another state and visited once every 2 or 3 years for a week or so; the other one lives locally but because she didn't grow up with him, they didn't really have much of a relationship. Betty's son wasn't around much, unless, as she said, he was in trouble or needed something. He has lived in another state for as long as I can remember.

As Bob and Betty grew older, sicker, and more frail, they came to rely on us for assistance. We did for them the things their children should have been doing. Bob asked me to be the conservator of a living will and trust because he was concerned that if something happened to him, Betty would not be cared for properly. I agreed. I knew that it was a big responsibility, but I also knew that they couldn't depend on anyone else to take care of them.

Betty's dementia worsened to the point that she repeated the same two conversations over and over again. One was the story of how she and Bob met and eloped to Vegas, the other was what a great life they had. Blissfully, her mind had frozen in her happiest memories. When she became combative about taking a bath and keeping herself clean, Bob knew that he could no longer care for her adequately, even with our help. Although her pension would cover the cost of a nursing home with no out-of-pocket expense involved, Bob refused to place Betty in one. After speaking with their social worker about other options, I found a fantastic assisted living facility close enough to our homes that we could drive him to see her every day. Bob was absolutely dedicated to making sure that Betty got the best of care and was willing to pay for it; the assisted living facility is not covered by her pension or insurance and costs approximately $3000 per month. She has received excellent care there for the past 7.5 years.

Six years ago last month, Bob took a fall that required an ER visit. He hadn't broken any bones but was bruised and in pain. Two days later, when the AED made the morning trek across the street for coffee and a visit, he found Bob on the floor in the den. He called me to come help him because, as he said, Bob wouldn't wake up. I knew what I would find before I ever left my house. Bob had died in the night. And with his death, my responsibilities and nightmare began.

Almost immediately, the vultures began circling overhead. I notified the daughters that their father had died and that as soon as funeral arrangements had been made in accordance with his wishes, I would let them know. The one who lives out of state said she couldn't afford to come, so after checking with the estate lawyer, I arranged for the trust to buy her a plane ticket so that she could attend her father's funeral. The one who lives here expressed upset at the cost associated with giving Bob the Catholic funeral he wanted. "Nobody will be there except us," she said, "so why spend so much money?" I made sure that our friends and neighbors knew about the funeral and attended. Betty's son didn't have the money to afford a plane ticket to attend, but he was sure quick to ask about property and finances and who was in charge of them. He was quite vocal about his objections to me being the executor of the will and conservator of the trust.

I haven't heard anything from the daughters since their father's funeral. Betty's son, on the other hand, has been a thorn in my side more than once. He had a fit because I decided to rent Betty's house instead of selling it right away. I figured that by renting it, the property would generate the additional income needed to pay for her care because her pension and social security don't cover it completely. He wanted to know exactly how much money Betty had and how much her care cost. For the past six years, he has been waiting for his mother to die and hoping that her money isn't all gone by the time that she does. After not hearing from him for more than a year, he called on Monday. His financial circumstances are dire, he's had hip replacement surgery, and he demanded that I send him copies of his mother's bank statements. The AED, who spoke to him, told him that those requests had to go through the attorney. He became enraged and said that he would overturn everything that Bob had set up. We wished him luck. What we know that he doesn't is that anyone who contests the will or the trust inherits only one dollar. Good luck to him.

Still recovering from the son's latest tirade on Monday, I got a call yesterday from Betty's caregivers to tell me that she was at the ER. Her blood pressure was high and was she mostly unresponsive. I zipped over to the hospital, which is just a couple of blocks from my home, and talked to the treating physician. Betty has pneumonia in one lung, so they will be keeping her for treatment. But when he asked me to verify that she has a DNR (do not resuscitate) order, also known as an advance directive order, I lost it. Why would he ask me that if she weren't in really bad shape?

As I drove home, all I could think of was something that the AED calls "the evil eye." Basically, it's a belief that people can wish bad things on others that actually come true. The Bible mentions it a few times, and it's talked about in the Qur'an, too. I don't like to dwell on superstitions, but it seems so ironic that the son, who needs money and is anxiously awaiting his mother's death so that he can cash in on his inheritance, called me on Monday with a demand for her bank statements and Betty falls ill enough on Thursday that she needs hospitalization. And worst of all, the doctor asked me to verify that she has a do not resuscitate order.

Am I being paranoid? I don't know. I'm worried about Betty, angry at her son, and praying that she lives long enough to spend all the money she has even though I will inherit 1/3 of it. I don't want her money, unlike the ingrates who can't be bothered to take care of her!

First, I have to say that I have the most amazing neurologist ever! Not only did she squeeze me into her tightly packed schedule, but she did so on her own time. When I got to the clinic today to sign in, the receptionist was confused because Dr. S, according to the schedule, was not in today. Following the instructions that Dr. S emailed me at 8 last night, I was to tell the receptionist to call upstairs for her. When Dr. S's assistant didn't even know that I was coming in, that's when I knew what this wonderful physician had done for me. I wish that everyone had such a caring physician!

Because I didn't want to take up too much of her time, I made a list of symptoms on the notepad on my marvelous iPhone. Dr. S read the list, asked some questions, checked reflexes and so on, and then told me what she thinks the problem is. She is pretty sure that I am having clusters of cluster headaches with a few migraines thrown in for good measure. So what do we do for them?

First, I will be adding a new medication to my ever-growing pharmacy. I've forgotten what it's called, but it's a medication commonly prescribed for high blood pressure that also works well for migraines. My blood pressure is fine, so that's not an issue. I'll start on a low dose of 40mg twice a day. The pharmacy in her clinic didn't have the med; however, the one closest to my home does. The Amazing Egyptian Dude will pick it up on his way home.

Second, oxygen. Oxygen, says Dr. S works wonders on cluster headaches. Soon, the pharmacy will deliver an oxygen tank and mask to my home. Then the next time I get a cluster headache, I am to use the oxygen for up to 30 minutes, and it should solve the problem.

We shall see.

Just a quick update to let everyone know that I have survived the day so far. My neurologist is wonderful, I swear. I got an appointment with her on July 22, the soonest one available, but I emailed and asked if she could get me in sooner. Because I'm not really a complainer, she knows that if I want to be seen, I'm miserable.

Part of the problem I've been experiencing with the headaches is that I have medications for each of the different kind that I get. Over the past week, they have been alternating from one type to the other which makes choosing the proper medication at the correct time difficult. The end result is that I suffer because when the Ibuprofen doesn't work, I don't know which medication to take.

I've been given the go-ahead to skip the Ibuprofen and go straight for the Cafergot. It's straight caffeine and works on "the hair of the dog that bit you" principle. Now you'll know why that idiom just had to be on my list, LOL! Dr. S said that it won't hurt me to have a couple of doses more per day than the bottle says. She asked if I wanted something stronger for the pain and when I said that I did, she knew that I was in trouble. Peeps, I am so afraid of using pain killers that I have had 6 major surgeries without ever using anything for pain besides Tylenol or Ibuprofen.

So now I am happily caffeinated, headaches under control for the time being, and waiting for Dr. S to squeeze me into her schedule as soon as she can. I should be bearable again soon enough.

Way back in the day, I began this blog as way to distract myself from the daily ups and downs of living with a degenerative illness that sometimes knocks me soundly on my butt. It took some time, but it has now become a much enjoyed part of my daily routine -- except on the days when headaches and seizures plague me like they have for most of this week.

I have made a conscious decision to avoid life on the pity pot. In this regard, I am absolutely Stoic. We often associate a lack of emotion with the Stoics, but these guys were far from emotionless; they just chose to avoid emotionalism through the use of logic, reason, and reflection. Like the Stoics, I know that I have no control over Chiari or what it does to me; however, I do have control over how I deal with it. I can make a conscious decision to perch perpetually on the pity pot, or I can choose to plop on the pity pot only as needed and to work with what I have and who I am now to the best of my ability the rest of the time. I nearly always choose the latter.

This past week, however, has seriously tried my determination to avoid feeling sorry for myself. I've had the hurts-to-breathe headaches every single day since Sunday. Thankfully, the medication has helped to bring them under control fairly quickly; however, they are so debilitating that it's hard for me to clear my head of the fog they bring and to focus on tasks. Add seizures, which I had on Tuesday and Wednesday, to the mix, and I become a real mess, really quickly.

To deal with the down time, I've learned to write my meme posts way ahead of time whenever possible and to schedule them to go live on the appropriate days. This makes my blog look like all is peachy keen in my little world, even when I'm curled up in a fetal position on the couch trying desperately to make the world go away. Unfortunately, what I can't do is respond to comments from the couch. And that is the whole purpose behind this post.

Peeps, it's been a miserable week, and I haven't been able to respond with any regularity to your comments. I am truly sorry. I know how important comments are in the blogosphere, really I do, and I appreciate every single one that is left for me. Please don't think that I'm not grateful or that I am ignoring what you have to say; this is not the case. If I don't reply to comments, it's because I'm looking for the toilet paper while I sit on the pity pot or because I'm playing roly-poly on the couch and haven't found a way to uncurl myself and still breathe.

So, here's to the end of the week:

Back in the days of grad school, I took a Chaucer class. My area of specialty was Renaissance Drama with an emphasis on the portrayal of the "Moor" in the Early Modern period. Chaucer belongs to the High Middle Ages, but I felt the need to delve into the work of the best known medieval writer in order to examine the depiction of the Islamic Other in Middle English literature. What better way to trace the evolution of an idea than to start at its root?

While I found the readings tolerable, the tapestry of Chaucer's world and the colorful threads that informed his work interested me much more than his poetry. My professor had a penchant for medieval medicine and was especially interested in the advances made in the Islamic world; I wanted to see how those Islamic medical practitioners were portrayed in the literature of the time. We were a match made in heaven.

Although often overlooked in the Western world, much of what we now take for granted in the medical field began in the Islamic world. Hospitals, for example, are among the greatest achievements of the early Islamic culture (see National Library of Medicine's "Islamic Culture and the Medical Arts" for further details). During the course of collecting research for a paper that I wrote for the Chaucer class, I learned a great deal about the Islamic hospital system:

• Hospitals were divided into wards according to illnesses, with patients who had contagious diseases separated from others.
  
• In 872, the first hospital known to identify and treat mental illness was built and operating in Cairo, Egypt.
• Physicians who treated patients in hospitals were required to pass competency examinations.
• I could add dozens more bullets to this list, but you can read more about the topic from any of the articles located here.
  

One of the most interesting things that I discovered was the emphasis that Islamic physicians placed on the connection between emotional and physical well-being. Patients in these early Islamic hospitals were visited by people whose only job was to provide positive feedback for the purpose of boosting the patients' sagging spirits. For example, a small group posing as doctors, nurses, or even visitors, would pass by the bed of a patient and make comments such as "Look at how much rosier his complexion is today!" or "The swelling on her cheek is really getting smaller!" or "That incision is healing quite nicely!" or "When eyes shine as brightly as hers do, we know that a patient is healing well." No matter how unpleasant the wound or symptom and irrespective of the gravity of the illness, these traveling do-gooders were forbidden from making any negative comments. And although some of the commentary would be classified as white lies, physicians noted its positive effects on patients.

I can personally attest to the benefit of hearing positive comments such as those used in the early Islamic hospitals. On days when sleep has been especially elusive, I know that my eyes are red, weepy, and swollen, and that I look every bit as horrible as I feel. With nary a prompt from me, Ali will say something about how my eyes look much better than they did a day or two before. He may gloss over the reality of my appearance but in doing so, he also eases my emotional distress. It's become a joke between us that if I want to know how I really look, I need to ask our daughter because she pulls no punches. I'll take Ali's compassionate white lies over Iman's brutal honesty almost any time!

Yesterday, a two sentence email from my neurologist asking how I'm doing had the same uplifting effect on my psyche. I've had a tough week thanks to seizures and headaches, so her message couldn't have come at a better time. I'll have to ask Dr. S if she knows about Islamic medicine because she sure has the same level of compassion required of early Islamic physicians.