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I can’t believe it’s already April. It’s been an intense year so far, and the twilight-feeling – with all the uncertainties – is still part of our lives. I was hoping things would get more “stable”, but so far, it has just gotten more… let’s call it complicated.

I am actually one day late with this update, since it was yesterday (April 4th) when my ADR surgery took place six years ago. I just didn’t have it in me. But better late than never, right? Well, with everything else going awry in my life, I am beyond grateful that my back (and LP-ESP) is still unchanged. No pain or limitations; in fact, I started working with a personal trainer to safely get back in shape and lift weights. I am hopeful that this part of my body will hold up like this for years to come.

Even though we are barely in month four, a LOT has happened – from work-related travel (twice!) to more hospitalizations (also twice!), a destroyed kitchen (again!), and serious health issues for myself (for a change).

The first trip was to attend and present at the IMSH 2024 Annual Convention in San Diego in late January…

… followed by a trip to the hospital with Ralf (sudden-onset bowel obstructions) beginning of February…

… followed by my second trip to implement my Introduction to Clinical Simulation course in Las Vegas mid-February (that included arriving on Super Bowl Sunday, a wedding, and zip-lining with Helen)…

… followed by me getting REALLY sick with a respiratory infection the week after I returned…

… followed by Ralf’s second trip to the hospital with another round of bowel obstructions…

… followed by severe water damage manifesting in our kitchen ceiling, caused by a leaking pipe from the upstairs bathroom. Apparently, the water has ever so slowly leaked into the ceiling for a long time, before it finally reached the threshold and ultimately cause the plaster from the ceiling to collapse. Repairs are underway as we speak – with no idea what the financial damage will be yet. At least we were able to safe the stove and cabinets. Not having a functional kitchen poses a significant challenge, especially when it comes to maintain Ralf’s nutrition and food-related limitations. But, we can shower again, so that’s a plus!!

In the meantime, I finally got my lung CT done, in an effort to find out why I have been coughing for a year. Results suggest permanent scaring and damage to my lungs due to Bronchiectasis – a rare chronic condition that is usually observed in patients with cystic fibrosis. That most likely is the reason why I had so many respiratory infections (including flu and covid last year), and why I was so sick in late February. Got my appointment scheduled with a recommended pulmonologist in a week from now, so I am anxiously waiting to find out what this means for me in the future.

Now I can print myself a t-shirt with “it’s NOT Covid!”, to wear when I cough my lungs out in public.

Stay tuned, 2024 has barely gotten started yet!

Ralf just mentioned that I have not updated my blog in a long time… and he is right. I guess I just didn’t have it in me. I have been trying to come up with a description that could capture how life feels like at this point: “bipolar” comes to mind. Ever since Spring of 2023, we have been constantly pivoting between hope and hospice - sometimes within the same day. It’s not just the physical pain but the emotional repercussions that left their mark on both of us. 

I will try and just summarize the progression through 2023 (while excluding a lot of non-cancer related issues for now):  

April/May - As it turned out, the medical oncologist Ralf was referred to at Moffitt was mediocre at best, prejudging him from his file, dooming him to die soon from catastrophic bowel obstructions. And we trusted that doctor, which is the only reason that Ralf agreed to that oral course of chemotherapy - to buy us some time. Well, let’s just say, he didn’t tolerate that poison at all and had to discontinue treatment within two weeks. Severe fatigue and beginning foot/hand syndrome were just the beginning, and quality of life has always been the number one priority, especially if you consider that chemo has very low efficacy in this case. So here came the “downward/hospice” trend.

Crippling cancer treatment

June/July - to our surprise, the medical oncologist introduced a new treatment option, based on a specific genetic mutation found in Ralf’s tumors: Immunotherapy (who knew they kept his tumors on ice since 2019 - and why didn’t they test it sooner?…). In fact, initiating genetic testing is the only good thing this oncologist did, given that we had no further treatment options at this time.

This new treatment was suggested to be potentially effective but needed to be infused every three weeks, for up to two years. So here we were, full of hope again, driving 2 1/2 hours each way to Moffitt every three weeks for a 30 minute infusion. And they didn’t make it easy: scheduling was a nightmare, and it became very clear that we are just another faceless number in the system. I dreaded those trips, which lasted all day, and with Ralf’s dietary restrictions it was just brutal and exhausting. But we had hope again for more time.

Immunotherapy infusion

Additional curveball: concurrently to all the cancer-related stressors, Ralf’s artificial right hip was getting progressively worse. After a consultation with a hip specialist, it was revealed that his hip implant was about to fail - in fact, it was on the verge of breaking out of his femur! He was put on non-weight-bearing precautions and scheduled for urgent revision surgery for mid-August. 

July - it started suddenly during the evening of July 30th. Ralf’s started to have excruciating pain, his belly getting hard and distended. We didn’t know what was happening and were trying everything to manage this - to no avail. Curled up in pain, drenched in sweat, and white as a sheet, we went the closest ED in Deland. Diagnosis: multiple small bowel obstructions. They managed his pain with opioids and attempted to place a NasoGastric tube (NG) - four times, until blood ran out of his nostrils and he begged them to stop. What happened next was most scaring, cruel, and insane: the GI/surgeon on call declared “there is nothing we can do for you, you have to transfer to Moffitt. In fact, you should sign out AMA and drive to Tampa yourself to speed things up”. In hindsight, we should have filed a complaint, but in that moment in time, all I could think was “I have to get him to Moffitt so that somebody is helping him!”. 

Since that horrible MD on call now passed the buck to Moffitt, Ralf was just being kept in that dirty, cold ED room - pretty much left to die an agonizing, painful death. I remember sitting alone at 3:00 AM by his side, holding his hand, while witnessing in horror as his belly got more and more distended. What ended up saving him was his body expelling copious amounts of black bile that spew out of him “Exorcist-style”. It decompressed his belly enough to relieve the tremendous pressure. In the meantime, I am becoming “that family member”, raising hell until a social worker showed up to help. 

Long story short: turns out, Moffitt isn’t a hospital with acute/emergency capabilities and were dragging their feet with the transfer. In fact, Moffitt didn’t help at all. So I cancelled the transfer and Ralf was admitted inpatient to manage the obstructions. He started to improve and the obstructions started to resolve on their own. But the overall long-term projection was grim. All of our hope was replaced with despair and end-of-life reality.

During the follow-up with the Moffitt oncologist, the prognosis was that his disease had progressed to the very final stages, and we were told to expect more episodes like this.

After discharge, we had two hospice consults at the house, where Ralf wants to die (rather than in a hospital). We now have a number to call to initiate the setup and hospice care quickly when the time comes. I can’t really put into words what that felt like - Surreal? Morbid? Despair? I guess it was a combination of those. But at least, we have a plan now.

August - Not being able to walk or work out has been a detrimental factor in this entire nightmare and still needed to be addressed. If his implant were to break out of his femur, that would have been the end of him right then and there. This hip revision surgery was so urgent that despite the recent bowel obstruction episode just 10 days prior, the surgeon still went ahead with the surgery and fixed Ralf’s hip. It went extremely well, and even though Ralf was still weak and very underweight, he had a great outcome. 

However, we weren’t discharged without another complication: we both got he flu during the hospital stay! How cruel is it to just having had a hip revision and been hit with the flu during the first part of recovery? Did I mentioned that Ralf rehabbed his hip on Tylenol only, avoiding opioids at all cost? It was a brutal time but kept my mind of the bowel obstructions for a bit.

Despite it all, Ralf was getting better, especially now that he was able to move normally again. It felt almost normal, and we were so hopeful that the immunotherapy will work to buy us more quality time and keep those obstructions at bay. 

October - it was the day of our anniversary and Ralf’s birthday. We had a scenic boat tour booked at our local state park, which we wanted to do with Ralf’s cousin and his girlfriend, who were visiting from Germany. Everything was fine - until it was not. Again, in the evening of the 20th, Ralf had the same sudden-onset of pain, nausea, and distention. We ended up in the ED again, but this time at the Advent Health Daytona Beach hospital. After the horrible experience at Advent Health Deland, I had researched surrounding hospital options and picked the one in Daytona. 

The overall presentation and progression was very similar to the first episode, and the CT scan confirmed the multiple bowel obstructions, just like before. I brought the hospice binder, just in case. 

He was admitted to manage the pain and nausea. But this time, he didn’t get better, even though the evidence suggested that the bowel obstructions had resolved (just like the first time). Instead, his belly kept getting harder and bigger by the hour, causing excruciating pain, making it difficult to breathe. In fact, the pressure got so intense that his stomach herniated into his chest cavity. And all I could do was sit there, hold his hand. He said his good-byes to me, thanking me for the best years of his life. We talked about old stories, the Ponce, our adventures. And again, I am having a hard time putting words to my emotions. It just changes everything within you. But it is also not the time to fall apart. Be brave and savor the moments left. 

Then came another unexpected turn of events: the real diagnosis! One of the tests suggested the presence of “enteritis”, which is a possible side effect of immunotherapy! The treatment is IV steroids, which he never received because the assumption was always that the ascites/cancer were the cause of the obstructions. There is so much more to the story and the battle I had to fight with the hospitalist, trying to convince him that this was an autoimmune attack, not infection or cancer-related, and that Ralf needed steroids. Long story short, a local oncologist was finally brought into the conversation, and he agreed. Steroids were given right away, and Ralf started to improve! He was able to go home two days thereafter - and not in a coffin!! Before he was discharged, the new oncologist also tested for drainable fluids in Ralf’s belly and despite the fact that Moffitt always told us that his ascites could never be drained, they found a large pocket that wasn’t mucous and drained 1.2 liters from his abdomen, providing further relief. We decided to keep the local oncologist, who is only 30 minutes away and lot more positive than Moffitt’s care has been. 

December - Everything was going pretty well, considering the circumstances. Ralf has been scheduled for an infusion of a new drug that may help to keep the autoimmune attacks under control. However, insurance has been dragging their feet approving it. 

I had to travel to Germany to look after my mom, which made me so anxious to leave Ralf behind. Things back home with my mom are also difficult and complex, demanding my attention and intervention - I just hope it will be enough for the time being. I can only be in one place at a time, dealing with one issue at a time. 

Life has been so unpredictable - a bipolar rollercoaster, and I am now in a perpetual “fight or flight” mode, waiting for the next shoe to drop - something I may need to address professionally eventually. Everything was fine with Ralf when I returned on the 23rd, and we had a nice Christmas Eve at home… almost normal. But then it happened again, just like that: during the night from the 24th to the 25th, Ralf was getting the same hallmark symptoms, despite being on Prednisone. We ended up in the ED at Advent Health Daytona Beach around 7:00 AM on Christmas morning. Not really the gift we wanted to get. Given that it was a holiday and available resources scare, getting the treatment we needed was frustrating and difficult to get, but Ralf was finally admitted early afternoon and given his first dose of IV steroids. Thankfully, he responded well and was able to be discharged two days later. However, since we still weren’t punished enough, we both came down with COVID the day after: a scary diagnosis, especially now. And neither one of us ever had it before, so our anxiety level was high. Thankfully, we don’t have severe symptoms but will be in isolation over New Years.  

This constant up and down, in and out of hospitals, being jerked between hope and hospice, life and death, fighting the healthcare system, struggles with my family abroad, keeping up with my job…. It all has left a significant physical and psychological toll on both of us. 

Here is to a better 2024. At least we have more information now to go into battle more prepared. 

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The LP-ESP is doing its job well!
April 4th, 2023 was my 5-year post-op anniversary date. I am not sure if five years count as “long-term” outcome, but I would say it’s a pretty great outcome so far. Going from the disabling and unbearable pain from my degenerated L5/S1 to being able to face what life had thrown at me since 2018 is a borderline miracle, all things considered. Hopefully, I will be able to continue on this path – and I am trying to commit to regular workouts and (bone) strengthening weight-lifting regimen. I admit, I haven’t done any structured workouts for a long time, which is partially due to my completely out-of-whack hormones that made me feel weak, creaky, and aged me at an alarming rate. However, I was still able to carry, lift, clean, and bend just fine during our move, which would have been impossible prior to ADR. I recently started on bio-identical hormone replacement therapy; I am slowly starting to feel better. Let’s see if it lasts. I resisted going this path for a long time, but something more radical had to be done to feel whole again, and as it turns out, hormonal balance is a pretty crucial part of that.

I haven’t done any x-rays or other type of evaluation of my artificial disk, and - to be honest – as long as there are no changes, I will keep it that way. I don’t want to repeatedly image my spine just because. I did have a bone density test done for the BHRT, and I am happy to report that my spine is strong and without any evidence of osteoporosis. The fact that I can do what I do, including deep cleaning a duplex for five hours straight without being paralyzed for two weeks thereafter, speaks for itself and is enough confirmation that my hardware is doing its job, and doing it well. I rarely think about my surgery anymore, and just want to live my life, with my Ralf, while I can. That includes walking to a local Mexican restaurant that also serves homemade ice cream....

In this update:

  • Goodbye Lake Nona, Hello DeLeon Springs!
  • Ralf's Next Battle
  • Brutal Move – Never Again!
  • First-time homeowners' lesson: expect the unexpected
  • Diamond Ball and Hanging Out with Friends

Goodbye Lake Nona, Hello DeLeon Springs!
Saying goodbye to Lake Nona has been… weird (for me, anyways). I called that area my home for over five years, and despite the never-ending road construction, mind-blowing growth in the construction of homes and apartment complexes, and horrendous traffic, it was harder to move away than I imagined. I guess the fact that I still have to commute to Lake Nona for work a couple days per pay period makes the disassociation process more tricky. And having to get used to a commute of more than one hour each way (as opposed to ten minutes) didn’t help at all. But now that some time has passed, I am finally starting to feel more “at home”, and I am getting used to the drive. It is beautiful here; I love listening to the wide selection of birds and the wild peacocks that are close by. And for Ralf, this has been a dream come true: being able to bicycle out the back door and be in the woods in less than five minutes.

Ralf's Next Battle
It is the end of March, and we just had our follow up with Moffitt regarding the status of Ralf's condition. In hindsight, I am so glad that we didn't look at the tumor marker results or the CT scan report beforehand. As it turns out, Ralf's cancer is active again, filling his abdomen with fluid, which actually explains his most recent symptoms of heartburn and gastric issues. However, in a kind of weird way, we are both relieved that his issues are related to his 'good old cancer', rather than a new type. When Dr. Dessureault explained to us the results and what it means, it was nevertheless a viscous blow: chemo therapy. Tumor markers went from 8.3 to 24 since late fall of 2022, and imaging confirmed the increased activity of the peritoneal cancer. Ralf is now being referred to a medical oncologist at Moffitt; then we need to see what the next steps will be. The purpose of chemo therapy will be palliative, not curative, but we are very hopeful that it will ease Ralf's current symptoms and slow down the progression of the disease. Ralf is terrified of chemo but ready to take on this beast once again. Cancer is an asshole!
With that being said, the painful move from Lake Nona to DeLeon Springs was so worth it by changing to a much more therapeutic environment and access to nature.

Brutal Move – Never Again!
I admit, I underestimated the stress, anxiety, and physical demands of the actual move. I mean, I knew it would suck, but this experience was borderline traumatizing. Last time we moved, Ralf wasn’t sick and haven’t had this brutal surgery yet. But this time, the demands and stress of moving (over an hour away) into a new home that also still needed (needs) a lot of work was pushing us to our very limits – physically and mentally! We ended up renting a Uhaul truck twice – a nightmare all on its own. But we made it through… somehow. We are so lucky though that we have our wonderful friends Brian and Kim supporting us along the way – including homemade dinner at the end of the moving day.

First-time homeowners' lesson: expect the unexpected
We are not just first-time homeowners, we bought a house that was built in 1926. It has been well maintained and updated (including electric and septic), which was a prerequisite for us to consider purchasing such an old home. This house has so much character and charm, we fell in love immediately. It also comes with half an acre with lots of privacy and native habitat. I found an old picture of the house online when it was new, which is so cool! This is truly a piece of Florida history – unique in its own kind.

However, there are apparently many lessons to be learned when moving into a new house – regardless of its age. There is much to consider, from picking out appliances to getting all your utilities activated and set up. One thing we learned is that just because vendors like Lowe's and Ikea give you a delivery date and time doesn’t mean that it will happen. And just because you bought a new fridge doesn’t mean it comes with all components (such as a rubber gasket), nor will it be installed by those third party delivery companies that all these stores apparently started to use. We also had to educate ourselves about maintaining a septic system and well, which led to us getting a new pressure tank and filtration system. All my life I have been on city water, so this is a whole new experience. Having no water bill is a plus, though. Lesson number two: whenever you have to get something done, it will cost an average $2K. There are some things that really needed to be taken care off, such as tree trimming, the pressure tank/filtration system, A/C check and maintenance, termite bond, and a kitchen remodel (which is still a work in progress). We also need to get a permit for a new driveway (eventually) since the previous owner (a real estate company) had the new septic tank and drain field placed right into the original driveway... Can’t drive on that, so we need to put the driveway on the other side of the property. Baby-steps though…Our savings are shrinking at an alarming rate, so that will have to wait. But I was told that being “home poor” for a while is to be expected.

The kitchen remodel is an ongoing beast and had many curve balls already. We ended up buying all the cabinets from IKEA, with the help of one of their kitchen design experts. It was rather tricky to get accurate measurements, and some of the layout was predetermined by outlets and water lines. So we decided on the kitchen style and had everything ordered to be delivered the following week Friday. We were still between Lake Nona and DeLeon Springs, so this constant back and forth was very stressful, especially for Ralf who can't spring into action right away in the morning. Since our old kitchen was going to be torn out that week, it was perfect timing. Or so we thought... to make a long story short: the delivery company that was selected in the IKEA system informed us the day before the scheduled delivery that they don't service our area because they are in Jacksonville. They got the merchandise from IKEA but it was sitting in their warehouse, to be returned to the Jacksonville IKEA store a week later... say, what...? I am not sure how many hours I spent on the phone the following days, trying to figure out what happened and how we are going to get this damn kitchen delivered. In the end, the IKEA Orlando store manager got involved, and the entire kitchen got reordered, to be delivered for sure that time, on the next Friday. Awesome. Our old kitchen was reduced to pile of trash, sitting in our backyard, so we were camping out in the dining area where our fridge was now plugged in. It really sucks not having a kitchen or even a sink.

So, it's Tuesday of the week where our cabinets were supposed to be delivered. We were halfway across town, running errands, when I received a phone call:
Some guy: "Hi, we are here!"
Me (confused): "Ok, who are you and what do you mean by 'here'?"
Some guy: "We are at your house to deliver the IKEA kitchen!"
Me (even more confused): "But the delivery was supposed to be on Friday, we are not even home! Why didn't you call ahead?"
Some guy: "Well, we are here!"
Awesome. Thank goodness our handyman was working on the demolition of the old kitchen, so he was able to manage the delivery, but that was NOT the plan. But hey, we got our kitchen!
Then I get an email from IKEA: good news, your kitchen will be delivered on Friday. Wait, what??? First we had no kitchen, now we get two??? Turns out the delivery company realized that they DO service our area after all and had the original order delivered, while the second order was also being prepared to get shipped to us. What a mess... the second order was then cancelled, so after much delay, we ended up with the original kitchen cabinets.

The initial plan was to assemble all the cabinets ourselves (to save some money) but we ended up having our handyman handle that instead (for sanity reasons alone). We were so worn out already, we didn't have it in us to tackle the assembly of an entire cabinet array on top of everything else. Turns out, our handyman and his partner were much more efficient than we could have ever been...

Meanwhile, we had to deal with other issues and tasks at hand, including the evaluation of our plumbing, getting a new pressure tank and filtration system installed, buying a new mattress (in a box), installing the washer and dryer (thanks again, Brian!), and having the electrician take down a chandelier in the dining room that was trying to assassinate me. That sucker was hanging from the ceiling right in the middle, and it was just low enough to align its pointy iron tip with my forehead - which I hit full force TWICE within five minutes. I ended up taping the empty Swiffer box to it to prevent repeated insult to my poor head, so that chandelier had to go!

When you move from one place to another, it unfortunately feels like trading one chaos for another for a while. So when we finally got all of our stuff out of the Lake Nona home, we kind of had to "park" a lot in various places in the new home. Especially since kitchen wasn't done yet, and the bonus-room-turned-gym/laundry needed rubber mats before we could arrange the workout equipment, it has been a mess. But, for the very first time, it was ours.

We weren't completely of the "assemble your IKEA furniture hook" just yet. I guess they didn't make those giant walk-in closets back in the 1920s, so we needed a second dresser for our clothes. So we bought a second Nordli dresser unit, which was actually delivered with our original kitchen order. It took as half a day just putting that together, I can't even imagine an entire kitchen!!!

We are on a limited budget, so our projects were listed by priority (need to do now vs. must wait). The trimming of the trees and other necessary landscaping items that needed to be done were not really on top of the list. However, when I looked out one Sunday morning, I saw pretty large limb that must have broken off during the night and nearly missed the house/AC unit. So now tree-trimming moved to the top of the list of priorities, so we got an estimate and scheduled the yard work asap.

Speaking of landscaping: we decided to plant/maintain natural Florida habitats, based on what's already there and the type of soil and light conditions we have to work with. We also needed to decide what to plant on the drain field, since it's not to be used as a driveway anymore. The borders are now made out of railroad ties, and we bought six plants from a local nursery, which we were told would make a great "surface cover". I was crouching down to place each plant where Ralf had dug up a little hole. I find gardening pretty theraputic, I must say. Ralf put some of the leafs that I had raked before back over the plants to keep moisture in, then watered our final project. That is when I stepped back and took a look: "hmmmmm, sweetheart, we didn't think this through all the way...." The way we arranged our first addition of "let's plant some things" makes it look like as if we just buried a body. I guess we don't need a "No Trespassing" sign, as this may make people think twice about stepping into our yard.

Oh well, that should blend in once we plant more wildflowers, etc. But until then, we shall water our "grave" daily to make sure the plants will thrive.

Looking back over the past couple of months, I must say that I am so grateful to our awesome realtor(s) Maureen Kemp and Lisa Koenig. Even long after we closed on the house, their referrals to local contractors and handymen were priceless. In fact, every single person she recommended and we worked with so far are long-time locals and neighbors. It's like joining a tight-knit community where people take pride in their work, which is not a given in today's time. We even got a dozen freshly laid eggs from DJ, who had picked up the rubble from the back yard. A "Welcome to the Neighborhood" gift - how sweet is that?

Soon, our handyman will continue to finish our kitchen project, and we need quite a few more things done on other projects. However, as we are approaching "house-poor" status, some things may need to wait.

Diamond Ball and Hanging Out with Friends
Two great events happened during these stressful times. First, Ralf and I attended the Society for Simulation in Healthcare's annual Diamond Ball - a fancy event that took place at the Hyatt hotel by the convention center. I got free tickets because I became a Certified Healthcare Simulation Educator (CHSE) in 2022, and I am so happy that Ralf felt well enough to go! He still looks smoking hot in his tux!

I also spend a day with Michaela, who travelled from Germany to visit her son, who currently is a Disney cast member at the German Biergarten in EPCOT. In fact, her son is in the same international program that Michaela and I both completed (she in the late 1980s, me in 2000). That was a nice break from all the stress, and I just love going to EPCOT. I never really go anymore, especially since the admission prices are insane, but her son was able to sign us in for free. Yay!

April will bring a couple anniversaries, but Ralf's pending treatment and the fear of how that may look like is always in the background. But I am very hopeful that Moffitt will once again come through and provide the best possible care for his rare condition.

In this Update:

  • Taking care of mom & Karl-Heinz
  • Getting Ralf to see his mom
  • First travel (for work) to San Francisco
  • Surviving two hurricanes
  • Crazy journey to find a home

Today is December 31rst, 2022: the past six month have rushed by like a high-speed express train, and since I didn’t get to update my blog in due time, I decided to just do an overview of the highlights. Reflecting on events has become an important part of my coping, and it also makes me appreciate much more what I have and can do. Life is difficult, life is hard, but I am grateful for being able to do what I did and hope to be able to continue to do. So…

July 2nd through 14th: Flying to Germany (Hamburg/Büsum) to see my mom and Karl-Heinz
In a nutshell, I decided to do something crazy. I flew to Germany to check on my mom and Karl-Heinz the first two weeks of July, returned home for less than two weeks, just to fly out AGAIN to Germany with Ralf for him to see HIS mom the first two weeks of August, returned home for one week, then traveled for work to San Francisco for five days. Oh, and I still had to work in between, including leading an in-person class at SimLEARN.

Why would I do that to myself? Well, Büsum and Stuttgart are too far away from each other to combine. I still need to look after my mom, and since it was her birthday July 3rd, I decided to squeeze in an impromptu visit, prior to the journey to Stuttgart. The things you can do with the right motivation! What added to the mess was the fact that airlines were completely overwhelmed with the tremendous increase in summer travel, both domestic and internationally…. One of the lessons learned: do not ever check any luggage during times like this…

Travel nightmare: the summer of '22!

Birthday dinner on day of my arrival at Miguel’s Tapas Bar. At that point, I had been traveling all day and just made it in time to freshen up and change my shirt.

I suspected that there was something wrong with Bella for a while now. She has lost weight and would throw up pretty frequently. She wasn’t eating right either, and she slept a lot. Deep down I knew I had to start preparing my mom (and myself) for the inevitable. But how do you do that? My mom adopted Bella as a puppy 15 years ago, and even though she was always pretty alpha and at times difficult, she was part of the family. And especially after Karl-Heinz’s stroke and move to the assisted living apartment just prior the COVID lockdown in Fall of 2020, it was Bella’s company that helped my mom through this difficult time. I treasured the time I had in July with Bella, who always treated me as “part of her pack”, even though she only saw me very infrequently. Sadly, my gut was not wrong. On September 5th, Bella passed away at the vet, wrapped in her favorite blanket and my mom at her side. Thank you, Roswita, for being there, and for driving mom and Bella to the vet when it was time.

Of course, I also spent time with Karl-Heinz, and whenever we picked him up we did some trips to the ocean and into town. It was getting harder and harder for my mom to push his wheelchair, so I was able to fill that gap for the time being. But I already investigated the installation of a push-assist so that my mom can continue to take him to Café Bohne on her own.

Surprise visit from Michaela, an old friend from my hometown and the reason why I ended up in the Disney program that brought me to the US.

Trip to Heide to visit the Friedensmarkt 2022. This is a medieval festival, which had been postponed for the past two years due to the pandemic.

Then it was time to say good-bye to my mom and Bella, which is always one of the most difficult things I have to do. And as it turned out, I also had to say good-bye to my suitcase…

July 31st through August 14th: Flying to Germany (Stuttgart) to see Ralf’s mom and family
This was a big one! We had given up hope that Ralf would ever be able to travel to Germany to see his mom and family again – EVER! And I am not sure if we can pull this off in the future, which makes this event even more special. This new medication that Ralf has been on has been a game-changer; it is helping the damaged nerves of his gut to work more properly. Before this, every day was completely unpredictable and posed the possibility of impending doom, pain, and a visit to the ER. Now, at least the constant threat of rapidly declining to a point of being hospitalized is under control. Our correlating quality of life has significantly improved, and even though this is not a cure, it opened up this opportunity to reconnect with his family and given us hope for a future.

To be clear, this trip required meticulous planning and the purchase of very expensive refundable tickets in business class (Ralf could never sit for more than an hour in an airline seat). There were dietary considerations, daily physical therapy routines, and medical equipment needed to make this happen. This was not easy for him (or me), but the prospect to hugging his mom was the incentive that helped us succeed.

The actual travel was a nightmare but at least the Global Entry and access to the Lufthansa Business Lounge minimized exposure to the masses. Keeping Ralf safe was the main objective, so any expedited process to get us from A to B was crucial.

Of course, there were delays at every step of the way, including the train station in Frankfurt. Ralf survived the long flight, mostly due to the fact the he could lay flat and took some meds to help him sleep. But he was awfully pale when we set up shop at a Starbucks in Frankfurt while waiting for our connection train to finally depart.

Our AirBNB in Heumaden was “an adventure”, and just getting the keys to get inside felt like an Escape Room experience… The place was clean but had some unique challenges. However, we got a good price, and it was the only place close enough to walk to the condo where Ralf’s lives. Apropos walking, here is a fun fact: I suck at directions! After we arrived, I told Ralf to do his routine and rest while I go to the near-by grocery store to get some supplies. Took me double the time though because I walked in the wrong direction for at least a mile before realizing that I was lost…

There is so much to tell about this trip, which included an car accident, but for the sake of keeping it brief, I will only include some highlights. I may circle back and write a more comprehensive update on this epic trip in the new year.

Reunion of Ralf and his mom! We also discovered our fondness of playing Rummikup!

Ralf's mom just returned from rehab after another bypass surgery (in her right leg). So both, Ralf and his mom were struggling with pain, fatigue, and recovery…

My awesome half-brother, Nils, came all the way from Munich to spend one afternoon with us. We also met his soon-to-be wife Marie (they got married later this year in November). This was such an emotional moment, especially since I don’t’ have much family left. I was still coming to terms that my own father is a selfish, childish, and cruel individual, who gave me a guilt trip just a few weeks ago because I didn’t visit him in early July when I was at my moms. Just to be clear: there was just no way I hell I could have made that happen. The distance was too far, and I had so little time with my mom. But even though I told him that I would visit him now (in August), he decided to send me and Ralf nasty messages and threatened to disown me. Oh well, so be it. I didn’t do anything to deserve this, and nobody upsets Ralf the way he did – and for NO REASON. But so be it. It was so great see Nils and meet his wonderful Marie, and I wish we could have been there for their wedding.

Ralf also reunited with his first girlfriend, Alexandra, who he is still in touch with after all these decades! She actually kept his vinyl record collection safe in her basement!

Then we had coffee and cake with some of Ralf’s mom’s friends, including Jürgen and Taiba, whom we met in June of the same year when they came to Orlando.

A visit with the “Kupferstecher” Christian, who is also an old-time friend of Ralf’s.

And finally, Ralf’s brother Arnd came to stay for a week, and he brought his daughter Karla, Ralf’s five-year old niece! This was a such a great highlight of our trip, and Ralf’s heart was full.

The (Wilhelmina) Zoo:

Digging for fossils in the Steinbruch:

Need for speed at the Summer Bobbahn. Not a good match for Ralf, but hey, there is also aunt Iris...

Visiting with Tante Lore and Onkel Walter, Ralf’s aunt and uncle.

Dinner at Jürgen and Taiba’s place!

Last event was the Museum of Illusions:

And then it was time to say good-bye. This was a very emotional moment, and I wish I could have stopped time.

On our final walk back to our AirBNB, we stopped by the cemetry, so that Ralf could also visit the grave of this dad, who passed away many years ago.

Our journey back home was as nerve-wracking and stressful as our arrival. We didn’t check any luggage but only traveled with carry-on bags. Both a curse and a blessing. Ralf was so beat but also happy that this trip was possible in the first place.

August 23rd through 28th: Trip to San Francisco

After returning back home from Stuttgart late on August 14th, my first day back to work was 7 AM on the 15th. No rest for the wicked, I suppose. We had a big, multi-day even at work that week, so I had no time for jet lag or such nonsense. The following week, I was ready to travel yet again, but his time to the west coast. This was the first time traveling for my new job at SimLEARN, and it was also my first time in Alameda/San Francisco! Let me just say, summer in San Fran is cold and humid - I do prefer heat with humidity.

I am glad I didn't travel by myself since the hotel was in the industrial part of Alameda with absolutely no food around... not even a gas station. So after we arrived, my colleague Ivan and I took the tram to the Alameda baseball stadium to score a hotdog, and I got to see my first baseball game. Even got a picture with the mascot...

I was of course mainly occupied by the think tank event for work, but I also got to explore San Francisco a bit. On my last day, I was on my own but at the time, I got the routine down with the Clipper Ticket, commuter ferry, and public transportation system.

And of course, I had to visit the Golden Gate Bridge. Fun fact: if you make the effort to cross underneath the bridge to the other side, there is a hiking path all the way down to the the beach where no tourist will ever venture. However, coming back up the steps was a workout indeed!

September: House Hunting & Hurrianes

When our lease was up in August, our landlord decided to significantly increase the rent. Ever since the inflation has driven the real estate market in Florida into ridiculous price ranges, rents increased on average by 30% also. That was the final push for us to seriously look into buying a home. I mean, what are we actually waiting for? Ralf is on borrowed time and always dreamed of a home where he could bicycle out the backdoor into the woods. Me, I don’t have to be at work every day. In fact, I now work 80% from home. So we got referred to an amazing real estate agent, and a wonderful mortgage broker who helped us through this intense process. To make a long story short, we looked at a lot of flipped “lipstick on a pig” houses, and most of what we saw was “just not us”. We are not fans of cookie-cutter, zero-lot homes. Even the oh-so-common Florida bungalow style from the 1960s is rather “meh”. We almost bought a mid-century modernist home in need of some repair, but thankfully we found some hidden defects in due time before it was too late. At that point, we were pretty deflated...

In addition, the feds kept increasing the interest rates, so even with excellent credit, we were looking at an inflated market with interest rates as high as 7%. In the meantime, we had not one but TWO major hurricanes join the party in October/November, which made house hunting even more intense. On the bright side though, we got to drive to neighborhoods of interest right after they hit to see how much damage and flooding occurred there…

Our rental home actually had three leaks in the roof, so my office and our kitchen had some flooding. The water came all the way up our driveway, which was the worst I've seen over the years. In fact, even in Central Florida faced significant damage. A friend of mine had a gator swim by her house in her driveway, along with some turtles. That is how bad the flooding got, especially if you lived close to a body of water. With that being said, lake- or ocean front property lost its appeal for good!

November 2022: our dream home just before trip number three to Germany!

Skipping over the events of Ralf’s birthday (Happy Birthday again, Sweetheart) and Halloween (I looked so cool in my dark outfit until my co-worker slapped an inflatable Flamingo outfit on me – true story), I saw a wonderful house pop up on Realtor.com. It was a tad out there, in DeLeon Springs, but it had character and all the features we were looking for! That was around Thanksgiving weekend, so my last trip to Germany was just around the corner! Timing is everything, right? Well, to make a long story short, we viewed the house and decided to go for it! Put in an offer, and after some back-and-forth, the seller (also investor) accepted. We only had one week for the inspection period, and I really didn’t want to leave this all to Ralf. Luckily, we got all the essential inspections done the day before my departure to Germany.

December 2022: One last trip to Germany to visit mom!

It was rather stressful to travel yet again to Hamburg/Büsum, but my mom was so looking forward to me coming. She has been very lonely, especially since Bella passed, and in December it’s such a dark time of the year in Germany. I didn’t get the direct flight to Frankfurt, so I had to add a United connection over Washington to the mix. That was pretty bad, not only because it made my journey even more complex and stressful, but also it was WINTER. Disruptions due to weather are almost certain that time of the year, and I really, really needed get back and forth in time to see my mom and close on our house! But it all worked out, delays and all. No regrets!

Fun Fact: since the German healthcare system is more screwed up than I realized, I ended up taking Karl-Heinz to a cardiologist appointment, and then to his pre-op appointment for his PEG removal. "We don't accompany our patients to such appointments", I was told by the nursing home staff. Well, thank goodness I was there, but really???

I found a wonderful picture of Bella, which I had engraved into a crystal. My mom was so in awe, she kept looking at it, it broke my heart. "you can even see her whiskers"... Gosh, how I wish I could do more to help her over this loss...

There was so much more to this trip, but for the sake of condensing this update, I just leave it at "I put out more fires and fixed some stuff".
When it was time to leave for the airport, my mom was in tears. She couldn't come to the airport because Roswita, who drove me, had to keep going to visit her boyfriend for the holidays. My heart just breaks into a million pieces every time but there is just no good solution. I hope that after we've settled in our house, maybe we could get her to come for a few weeks and see how it goes. Moving to the US is not an option: no healthcare, she doesn't speak English, she would lose all her independence and routines, and in any case, she wouldn't leave Karl-Heinz behind. A dilemma all around. On my flight home, a kind flight attendant from Lufthansa brought me a candle setup to cheer me up.

Of course, the same day I arrived in Washington, the "winter storm of the century" also arrived. Awesome. I was so worried that I get to spend Christmas Eve in the airport but thankfully, it all worked out. When I landed, my connecting flight had already concluded boarding, but after running like a crazy lady with all my carry-on luggage to the gate, I made it with a couple minutes to spare. Kind of felt like a "I'll be home for Christmas" Hallmark movie moment.

Fast forward: I made it home late on the 23rd, was up the next morning to prepare my traditional Rouladen dinner, and had Christmas via Video Frame (like last year) with my mom, Karl-Heinz, and Ralf. Renate came over for Christmas Eve dinner, which was nice. Then we spend Christmas Day at Kim & Brian's - our friends who happen to live just five minutes down the road from our new house! I am not sure who is more exited about our move: us or them, lol!

Yesterday, December 30th, we really closed on our dream home! It was as stressful process, including the power being turned off prematurely by the careless seller, but in the end, it all worked out. Thanks to Maureen, Lisa, and Tara - the most amazing real estate agent/mortgage broker team we could have ever asked for! 2023, here we come!

In this Update:

  • A 30-Year Reunion
  • Adding a Sled
  • Puppy-Sitting!
  • Funky Health

A 30-Year Reunion
Between Ralf’s surgery and bumpy recovery, and freaking COVID, visiting his family overseas had become an impossible task. Ironically, the last time Ralf has been to Germany was for my ADR back surgery in April 2018. In hindsight, I am so grateful that my immediate pain relief and swift recovery allowed us to travel the two hours by train to see his brother and (then baby) niece. That trip was between my discharge from the hospital and having my stitches pulled, and even though I had to take frequent breaks to lay or sit down, we had a great time. Little did we know that it would be the last time that Ralf was able to travel – until now. With that being said, since Ralf could not go to the mountain, the mountain ended up coming to visit us: Ralf’s cousin, who he hadn’t seen in over 30 years, came to Florida with his girlfriend for vacation and decided to stop by in Orlando for a family dinner. That was absolutely amazing, and those two hit it off as if no time had passed at all. We ended up meeting at a Bahama Breeze by Disney Springs, which was close to their hotel. The evening started out with a minor hiccup, when we were seated outside while we waited for Jürgen and his awesome girlfriend Taiba. Jürgen texted Ralf that he had arrived but was nowhere to be found. Ralf was getting worried that he may have given the wrong address to his cousin but as it turned out, they were also seated outside – in a completely different section. After some back and forth, we all figured it out and united at our original table. Sitting outside was a plus, despite the heat, and we spend four hours together that evening. Let’s not let 30 more years pass before we meet again, shall we?

FAMILY!

Puppy-Sitting!
Speaking of visitors: we had the adorable Wasabi over for summer camp! Fortunately, our landlord approved us doggy-sitting the Wasabster while his mom and dad went to Vegas. Our Poncebear went to “summer camp” at Nickolas and Sharon’s many times, so Wasabi used to be his part-time brother. Wasabi is now a senior puppy as well, half blind with arthritis, but he is happy and such a good boy, it was so nice to have him over. It’s been three years since Ponce passed, and we haven’t had a four-legged fur baby ever since. 

Adding a Sled to our Garage Gym
Ralf’s hips, especially the right, had been an issue for a while now. He is so diligent with his workouts, trying to stabilize them, it feels quiet unfair that he always get these curveballs handed to him. So we invested in another piece of equipment for our home gym: a sled! Pushing an object against resistance is actually a very beneficial exercise, and we used to do that while we were still doing Crossfit. However, this sled by Torque Fitness has wheels, using magnetic resistance, as opposed to metal skate scraping along the asphalt (I am sure our neighbors and the HOA appreciate that).

The first workout (and test of our patience) was assembling the sled, which I can proudly say we mastered without major issues.

Now the time had come to test-push the sled up and down our road: a workout indeed, especially in the Florida heart! But it does make a difference in Ralf’s hip, so it’s a win in the books.

Vero Beach Getaway
Finally this month, Ralf and I went on our long-planned weekend getaway to Vero Beach, which was my latest birthday present. The last time we were there was in 2018, a few months after my ADR surgery. With Ralf’s diagnosis and associated struggles, travelling and staying in hotels is more challenging now, but overall, it all worked out fine. Ralf requested the same type of room (ocean front, corner room, with the bullseye window) – it was perfect!

We had a very nice time, hanging out in our cabana, soaking up some sun, and swimming in the ocean. In fact, I got a boogie bord and had some fun with the waves – the water was pleasantly warm, and I spend a good amount of time afloat! We also witnessed an impressive front moving in, with gusty winds and amazing cloud formations!

The only thing that we had to postpone was our fancy dinner. All the changes were a tad much, so we played it safe and ended up eating fantastic homemade gnocchi at a local Italian place…!

We even had the best Ceviche at this Peruvian place on our way home. That was a worthy end of a great weekend.

Funky Health
Granted, ever since early 2019, life has been stressful, almost non-stop: Ponce passing, Lourdes passing, Ralf’s cancer diagnosis, still having to finish MSN program, Ralf’s surgery at Moffitt, the global pandemic, being a frontline worker in the ED during COVID Wave One and Two, starting a new job in simulation/education, Karl-Heinz’s stroke and associated struggles, traveling back and forth to Germany during a pandemic, hip surgery, getting bullied out of simulation job, starting yet another new job… to be continued. I suppose, it’s not surprising that the stress would leave its mark, eventually. In my case, I ended up with hair loss, hot flashes, and amenorrhea that started beginning of 2021, which was in addition to my increased anxiety and depression, topped with a torn labrum in my right hip. “Stress-induced, premature menopause” was my diagnosis. Awesome. I admit, I really, really struggled with this. It feels like you lost part of what makes you a woman. Silly, maybe, but undeniably another irrevocable life event that has left its mark. At least my back is still fine, and my hip (although not perfect) has not been an issue either.

After reviewing my labs, I decided to try a supplement to get my progesterone up. That was in September 2021, and it made a significant difference. Those viscous hot flashes calmed down, my hair stopped falling out in strands, and my eyes weren’t dried shut in the morning. Since I still need to monitor my labs moving forward, I finally had an appointment with a GYN, even though my latest labs weren’t back yet (they took forever to be processed). However, that was pretty depressing and a waste of time and co-payment: apparently, menopause-related symptoms are “part of being a woman”, and they only monitor labs if you are on actual hormone replacement therapy. Sorry, that is unacceptable! I think I will stick to my plan for the time being, and I hope my supportive PCP will continue to order my labs when I need them. However, I will keep searching for my best long-term solution, which means finding a GYN, who actually takes menopause repercussions seriously.

In this Update:

  • Certified (AGAIN) at Last
  • The Forgotten Florida Adventure
  • Happy Birthday

Certified (AGAIN) at Last
As a nurse, I always believed that being certified in your specialty is a must. It shows dedication and commitment to your profession – and let’s face it: nurses LOVE to add letters behind their name/signature block. But these certification exams are so nerve-wracking, especially since I have significant testing anxiety. And just like with the Certified Emergency Nurse (CEN) certification, I made plans for taking the Certified Healthcare Simulation Educator (CHSE) exam but then never actually signed up. But eventually, I paid the (hefty) fee, and set a date. Granted, I had to wait until I could show two years of experience in healthcare simulation, but that was also the excuse of being in the “I will” vs. “I do” mode.

When it became clear that I had to look for a new (simulation-related) job in October last year, I revived my efforts and participated in a ($350) CHSE Blueprint Prep course. But I still put the actual CHSE application on my “I will” list. However, In February, when I started my new position as National Simulation Educator, I kicked my own butt and got the process started. I prepared as good as I could, did sample questions, read up on simulation operations policies, learning theories, and the like. I didn’t really get into study mode until three weeks prior, which is exactly what happened when I took the CEN… Fast forward to May 6th, 2022, the day had come.

Driving to the testing center is always a challenge, especially since I had to drive across town and was a bundle of anxiety. What if I don’t pass this ($495) exam?? I didn’t want to announce to others that I was taking the CHSE, but a few people knew. By the time I made it, I was already in need of a shower and change of clothes… But at least I found the place and arrived in one piece.

It doesn’t help that the “intake process” at the testing center is rather intimidating. It feels like going to prison, where all your belongings are locked away and you must turn your pockets inside out to prove that you don’t have anything on you to cheat. Like that could even happen, with cameras capturing your every move during the exam.

The nice lady then showed me to my computer and started the program. My eyesight has been very funky over the last few weeks for some reason, and the bright white background and font that was so hard to read, and that didn’t help me relax at all. I started the exam, and when I clicked “next” after question 14, I got he “circle of death”, then everything went white. Awesome, I broke the computer… I alarmed the lady, who ended up shutting down the computer to reboot the system. At least my input up to that point was saved, and I (again drenched in sweat on the verge of a nervous breakdown) continued on the torture’s path toward question 115. The moment when I hit the “are you sure you want to submit?” button, I was so nauseated that I thought I’ll toss the breakfast cookie I forced myself eat that morning. “Circle, circle, circle”….  Score: Passed! I actually blurred out a “ooooh, thank God!!!”, then slapped my hand over my mouth. Kind of like the library, make no noise! 

When I exited the testing room, I felt so relieved. The lady on the other side (second testing area) looked at me and asked, “Haven’t I seen you here before?”. Yes mam, this is the place I tend to return to torture myself. First NCLX, then CEN, now the CHSE. Let’s see if I can keep my own “never again” promise to myself this time.

More letters! Iris Appenrodt, MSN, RN, CEN, CHSE

The Forgotten Florida Adventure
Grateful to have crossed the CHSE off my “to-do” list, I was now ready to focus on the next adventure: The Forgotten Florida bikepacking event. This is the last official Singletrack Samurai bike event of the season, and Ralf was (nervously) looking forward to take Coco out for her first serious outing. Over 200 miles through Florida’s most remote and beautiful countryside. Since hotel options were rather limited, we decided to book a hotel in Perry, Florida, which was strategically located sort of in the middle of the loop that Ralf was riding by bike. About 30 minutes to get to the pick-up/drop-off locations was actually not too bad at all, and not having to move every day to another hotel was actually nice.

The first night, however, we stayed in a very small hotel in Steinhatchee, about a three hour drive from home. But I must say, it was… charming and had a laid-back kind of atmosphere. That entire place felt like a blast from the past… from check-in (sporting a mounted phone by the entry) to the actual accommodation. The front desk lady was super-nice, and after she handed us the (actual!) key to the room, we were ready to settle in. The bathroom was tiny, but the closet was as big as a studio apartment in New York City. I did like the kitchen area and overall space though. Wifi was spotty, and you kind of lost signal when moving to the bedroom. But the only real “complaint” we had was the noisy air conditioner, which would kick in randomly throughout the night like a rocket ready to launch into space. Ralf has been a tad scarred from the “Tour de Roach” experience during the Huracan event, but I must say that the room was spacious and clean – just a tad… dated. I do appreciate these opportunities to experience the many facets of Florida that you don’t get to see under normal circumstances.

Steinhatchee was pretty remote, and the only four places to eat there were all owned by locals, with two locations being closed that day. But again, everyone (mostly locals) was very pleasant and welcoming. We ended up going to choice number two, Kathi’s Krab Shack, less than a mile away. We had an awesome Mahi sandwich with fries – a perk when staying in an area that is most famous for freshly caught seafood. After that, we went back to the hotel to prep for the morning and get some rest. 

Day 1 (65 miles): Steinhatchee to Mayo, Florida 
The main reason for picking the “Steinhatchee Inn & Marina” was the very close proximity to the starting place, which was less than 10 minutes away. Poor Brian had to drive up that morning from Deland – about a 3-hour journey. This was Brian’s first bikepacking adventure since his hip surgery (and subsequent recovery from a blood clot complication) – team Cyborg reunited, so to speak. At least, Day One take off was scheduled for 10 AM, which meant we didn’t have to get up at 4 AM to get ready.

On the short drive over to the Steinhatchee library parking lot (a library combined with recreational outside pavilion and wooden playground), I couldn’t help but notice that the main way of advertisement in this area appeared to be by old-fashioned road signs… a lot of them.

When we got the parking lot, many of the fellow riders were already busy getting their bikes and gear ready for take-off. Brian had also arrived, so we pulled in next to his car and got going as well.

After a group prebrief by Karlos (aka Singletrack Samurai), it was time to get this show on the road. 

One thing about May in Florida: bugs are a thriving force – biting yellow flies included. Those mean pests don’t just take a bite out of you by chance: they pursue you! Great motivation to pedal at least at 10 mph on your bike, I suppose. Well, I was not out on a bike but sitting in the driver’s seat of the Element, ready to get to Perry. But first, I had to evict one of those predators that I discovered sitting on the INSIDE of the windshield.

Now it was back to me, the Honda Element, and Red Hot Chili Peppers (Californication). I don’t really have CDs anymore, so this one happens to be the only music on CD to keep me company. Kind of a tradition at this point, lol.

The drive to Perry was very straightforward. In fact, most “major” roads in this part of Florida tend to be straight, which reminded me of driving through rural Indiana. When I got the Holiday Inn Express, I was told that check in wasn’t available until about two hours later. Plan B: find the closet supermarket and get some supplies. Luckily, Walmart was less than a mile away and offered what I needed, including air conditioning.

At last, I was ready to check in and inspect the room. Again, dated but (pretty) clean. Fun fact: the closet in the Steinhatchee Inn was humongous and the closet at the Holiday Inn barely big enough to hang my travel bag. What ever happened to happy medium? But anyways, I got all the suitcases, bags, and groceries upstairs and settled in. 

Now the “GPS stalking” began, where I am gauging when to leave to arrive about the same time wherever Ralf’s first check point would be – so far, I always found him. This time was no exception, but I am always relieved when I actually see him (and Brian). I pulled off the road, onto the short side path leading to a barricaded entrance a primitive camp site, right at the Suwannee River, around 6:20 PM. I delivered a gallon of water to Brian, who stayed behind for the camping part, and collected Ralf and Coco. Ralf was sad that he again missed out on the camping and camaraderie, but there was just no way for him to do that part. 

Day 2 (83 miles): Mayo to the Big Bend (Scouts Lodge) 
Roll-out was at 8 am, which meant a very early start for us. Ralf and I have his morning routine down by now, which helps to reduce anxiety. We arrived around 07:30 AM at the same spot where I picked Ralf up the evening before. While Ralf was getting Coco ready, small groups of riders emerged from the wooded path behind the barrier, including Brian. Finally, just after 8 AM, team cyborg departed for the next segment of the Forgotten Florida adventure. 

And me? I was actually grateful that I was able to return and stay in the same hotel. No packing, hauling luggage, and hunt for the next early check in. After I got back to the Holiday Inn, I intended to take a shower but discovered that the maid took all the used towels but didn’t leave any fresh ones. After a trip to the front desk, I was informed that the towels needed to be washed first before they get re-distributed. Hmmm, ok, that’s a new one. But ok, I decided to get some breakfast in the meantime. After a couple hours the towels arrived, and I took a leisurely shower, followed by an assassination attempt of the ancient hair dryer that was mounted to the wall. When I was drying my hair, a teeth-shattering “BANG” originated from the device, which was unfortunately close to my ear, then the hair dryer started smoking… “shit, shit, shit!!!”, I quickly pulled the plug and made sure no flames were in need to be extinguished. Awesome. Since I needed a hair dryer to also blow-dry some of Ralf’s bike outfits, I again headed down to the front desk. They actually delivered a spare Conwair dryer that looked much fitter than its deceased  predecessor. 

In the meantime, I also found other creative ways of drying Ralf’s shirts. Fun fact though: when I returned from picking up Ralf and Coco that night, I realized that the shirt in the window was now very visible and kind of looked like someone was hanging there, lol!!!

Oh, yeah, speaking of picking up Ralf from the second check point. The second night, most riders stayed at Scouts Lodge, which is an amazing structure in the middle of Florida’s “Big Bend” jungle. Getting to the general area was easy enough, but after I made the left turn on an unpaved path, my silly GPS happily announced, “you have arrived!”. Ahm, I have?? But, where..? 

I had two choices: turn around or keep going. As it turned out, I was lucky that the GPS said anything at all, since suddenly I lost signal –not even one bar, a true “no signal” scenario. Again, awesome. Well, I took option two and slowly bounced along on the beating path ahead in hopes of a sign. Ha, and there it was: the sign was there in form of Ralf, who raced back from Scouts Lodge to find me (even though he wasn’t sure which way the GPS would end up sending me). Boy, that was a relief for both of us, lol.

Ralf loaded Coco in the back and then we drove another couple miles through uncharted territory, back to the lodge where the other riders where indulging in pizza and beer. Did I mention the bugs though? Yeah, being out there in the jungle, especially at dusk was… intense. I had doused myself in Deet, but holy fudge, those mixed clouds of flies, mosquitoes, and god-knows-what were all over the place. But the Scouts Lodge itself was AMAZING! Wow, wooden cabins on stilts, in the middle of nowhere. So cool! In fact, they were air-conditioned and had inside plumbing! The inside look somewhat like the cabins at the Wallaby Ranch. Maybe next time, Ralf could try and stay there overnight. The best part to me though was the owner’s super-friendly, cute doggie that was roaming the grounds. Puppy!!!

Now it was time to get back to the hotel. Ralf needed to get his routine and meds going, and it was getting late. In addition, he discovered a tick on his leg – thank goodness for his multi-tool device, featuring tweezers. However, we now have invested in an official tick-removal tool for future reference.

Day 3 (68 miles): Big Bend back to Steinhatchee

Take-off on day three was scheduled for 9 AM. The hosts of the Lodge offered home-made biscuits and gravy for the riders, and I brought some doughnut holes as well. We were early enough to hang out a bit and say hello before Brian and Ralf mounted their bikes to tackle the last leg of the journey.

As I waved Ralf and Brian good-bye, I dawned on me that I now had to find my way back to civilization myself. There were only two turns to be made – just the right ones, lol. When I came up to the very narrow “bridge” though, I knew I was on the right track. Made me feel a little like Indiana Jones (and not the screaming female sidekick).

I negotiated a late check out for noon at that Holiday Express. Better than nothing, I suppose. The initial projected finishing time of day three was around 4 PM. However, poor Brian began to struggle with the heat and associated dehydration a bit. Besides, he was still recovering from the past year’s surgeries and complications, so this started to add up. That put Ralf and Brian way behind schedule, so the new projected time was closer to 6 PM or even later. Therefore, I had to plan my day accordingly.

When I opened the door to leave five minutes to noon, the poor maid was already waiting right in front (scaring the living hell out of me), ready to clean the room. Even though that made me feel a tad guilty, the hair-dryer incident and towel thievery from day one justified giving me refuge for my last day, I think. 

As I opened the rear of the Element to load the luggage, I found a stow-away, which I am pretty sure we picked up at Scouts Lodge. Anybody who knows me is aware of my arachnophobia. I don’t do spiders, like hell no! So here it was, brown, big, and disgusting, sitting right behind the driver’s seat in the rear. Out of reflex, I grabbed the first available spray (a bottle of Deet), in hopes to permanently disable the creature. I know, I know, since Deet is a repellent, all it did was making the spider a loner, since none of her buddies would go near her now. But it doesn’t really kill anything… and boy, she was FAST! I sprayed, she ran, and disappeared …. somewhere. Awesome. I looked for her everywhere, but she was gone. Nothing I could do about it. I was still in Perry, Florida – 3 hours from home. I still had to pick up Ralf in Steinhatchee (eventually). So I put her out of my mind for now…

I ended up sitting in the hotel lobby at a desk until 4:30 PM, writing my proficiency report for work. Not very exciting but necessary (and airconditioned). At least I got that off my pretty full work to-do plate. According to GPS tracker, Ralf and Brian were still a couple hours away. It would take me about 30 minutes to get to Steinhatchee but I also wanted to pick up some snacks and Subway sandwiches to feed Team Cyborg upon their return. I bounced from Walmart to Subway, hoping that the cooling elements will last long enough to keep the food cold(ish). Then I decided to hit the road, which was thankfully a two-lane, straight shot. I saw movement in my lane from the distance, so I was able to safely swirl around the creature the was trying to cross the road (no idea why). As I looked into rearview mirror, I was overcome with guilt: should I pull over and help the creature across to avoid getting hit by traffic? Well, if it was a tortoise, absolutely! But this was a small alligator… sorry dude, I really don’t think you would have appreciated the gesture. I truly hope he made it, though.

Without further incidents, I made it back to the parking lot of the Steinhatchee library. Sadly, the only car left there was Brian’s… all other riders already finished and dispersed. 

But that’s ok, Team Cyborg will make it, with no man left behind. So I parked the Element and waited…

I did stay inside the car though, especially since mutant-bugs were filling the air during the late afternoon hours. I could hear them “pong, pong, pong” off the windows. In fact, I was surrounded, lol!

Shortly before 6 PM, the GPS indicated that the arrival was eminent!

I had my (iPhone) camera ready to go to capture the moment, and at last: Here they come!!!

After some recuperation, change of clothes, and food, Ralf loaded Coco in the rear and Brian packed up his gear. We felt really bad for Brian that he had to drive the 3-hours back home alone… But that was unfounded: his awesome wife Kim stayed on the phone with him the entire time to make sure he stays awake and makes it home in one piece! Now it was time to make the final journey back home ourselves. Thankfully, Ralf insisted on driving – despite my insistence to volunteer. A good decision, as it turned out…

The forecast predicted a significant thunderstorm for later, which was unavoidable. But we were still two hours out when the real drama unfolded. We were somewhere on a highway, Ralf driving in shorts and sandals, when he suddenly said, “something is crawling on my leg”, while simultaneously reaching down to scratch said leg, and when he put his hand back on the steering wheel, there she was!!!! The Deet-sprayed, stow-away spider from the morning, taking the wheel!!! I am so proud of myself, as I started to chant “ooookay, oooooookay, oooookay”, while controlling my breathing and initial instinct to just leave the car to the creature and exit the car at 65 mph. Ralf was also not too happy about this invasion but calmly put on the signal and pulled over. When he was moving the steering wheel, the spider followed counterclockwise to defend her position. Ralf stopped the car, got out, and tried his best to evacuate the spider. The Deer clearly didn’t slow her down, so instead of leaving, she found a crack and disappeared somewhere into the dashboard. Awesome. I guess she was determined to relocate to Orlando. In the good news department: as proud as I was on my subdued response, I don’t know what would have happened if I was in the one driving… in hindsight, I WAS driving half the day with that very possibility. I just didn’t know it… 

Needless to say, the remaining two hours where a little more filled with anxiety, especially when it was getting dark. I did manage to capture a beautiful rainbow on the way, which unfortunately turned out to be the precursor of the looming thunderstorm we were about to drive into.

Despite zero visibility and a spider on board, we made it home unharmed. Welcome home, Ralf, Coco, and persistent spider, welcome home.

What an accomplishment: 215 miles through Florida’s nature -against all odds. 

And here are some pictures Ralf and Brian took, which are a lot more scenic than mine:

Someone in the group (Pedal Power Adventure) made a nice video of the Forgotten Florida event.

Happy Birthday
May 26 also marked another year under my belt. I almost forgot but was reminded by Ralf, who calls it “the most important day of the year”. I am not quite as enthusiastic about my ever-progressing age, but since it was inevitable, I enjoyed a nice Margarita at Don Julio’s. As a surprise, Ralf booked a beach resort getaway in Vero Beach for June, so that trip is coming up shortly! Let’s see if I can get bikini-ready in time, lol.

In this Update:

  • Last MCI
  • Last Good-Bye
  • Welcome, Coco!
  • New Hope for Ralf

Last MCI
I’ll be honest: when I was asked by the (new) Orlando VA Emergency Management (D50) person in charge to not just help plan, coordinate, and participate in the Mass Casualty Incident (MCI) community disaster drill, but to be a Nurse Lead for the event, I was not sure what to say. After what happened to me in my previous position, which prompted my transfer to SimLEARN, my first impulse was,” yeah, no, thank you, I'll pass”. However, I also knew he needed help from a D50 nurse, who has had experience with those MCIs and the common pitfalls and challenges associated with it. That, and being supportive of my friend Bonnie, who also was filling the role of Nurse Lead but couldn’t possibly tackle that beast alone, led me to accept. And since the Orlando VA is in VISN 8, which belongs to my Engagement Group responsibility in my mentorship-role at SimLEARN, it was still technically associated to my new position.

To make a long story short: I have done these MCI events with the Orlando VA since 2014, so I know what I was getting myself into. Historically, it was always the same limited group of D50 team members, who would actually show up. Supply carts we painfully put together (mostly Bonnie and I over the years) would be a hot mess when they reappear from some forgotten storage area, and now that a couple years had passed without taking out the tents and supplies, it was even more frustrating. Between COVID and the long stretch of no team-training activities, we lost some key-members. That left us with mostly untrained members, who were not familiar with MCI guidelines, decon, and/or disaster triage protocols. I strongly suggested a dry-run to leadership (as in, take out the tents, set up the equipment, etc.), but that didn’t happen… Oh well, I tried. 

I am not going into details, but Bonnie and I ended up running around, filling in a variety of roles to get us through… at one point, I heard my name being yelled from five different directions, but I just can’t split myself in half. Somehow, we made it through, but it wasn’t pretty. 

No, no, no, you can’t park here!!!
Still waiting for decon to be ready to go…
Well, I guess I will transport the victims to the treatment tent myself…
… AND I will do the assessment, no problem

I was just glad that nobody got actually injured, and at the end of the day, we had all teenage victim volunteers accounted for… 

Aaaand, it's a wrap!

Last Good-Bye
When Mikey passed away last year in August, it was one of those “it can’t be” moments. I am so grateful that Ralf was able to make that trip to Tampa a couple days prior, to say good-bye, but given the fact that Mikey was taken so quickly after his cancer diagnosis, this still hits very close to home. Cancer is an asshole. And Fay? She got cheated out of many years of spending her retirement with her mate. So unfair. Mikey was special and left a huge void. April 2022, the Wallaby Ranch hosted the “Mikey Barber Memorial Boogie”, celebrating his life and the legacy he left behind in the hangliding community. I do believe he would have been so pleased, bringing together hundreds of friends and family, some of whom flew in from around the world, to spend time together and remember the many stories surrounding him. There was an amazing live band playing, great food and drinks, dogs and kids running around, people laughing and sharing stories. A special day for a special person. Bitter-sweet for sure. But I am glad Ralf was well enough to go and not just honor his longtime friend but also reconnect to the Wallaby Ranch community. Time is precious. 


It was already getting dark outside when we had to leave, and just at that moment an enormous tree was lit up (I am still puzzled how they wrapped it in lights like this). A magical moment where the real world doesn’t seem to exist. We love you, Mikey!

Welcome, Coco!
As I said before: time is precious, so what are you waiting for? Ralf has been debating on getting this new Curve bicycle, which is made in Australia. He has been flip-flopping between “I really, really want this bike” and “how can I justify spending so much money on a bike when I may not be around for much longer”. To me, those moments were the most heartbreaking ones. True, due to the nature of his cancer, nobody has been able to give us a prognosis. Could be 6 months, 5 years, 20 years? But you know what? That is EXACTLY why he should buy this bike NOW. Tomorrow is not guaranteed for nobody, so if that brings you joy, go for it!!! After a year of back and forth, along with supply issues, the Curve bike finally arrived.

Ralf still had to drop off the frame to JC’s Bike Shop in Deland, where Ryan was on standby to get to work and assemble the final product. Then the day had come: we got the call that we could come over for Ralf to test ride and pick up his brand-new Curve bike!

Ready for the virgin voyage!

So, I have the habit of naming things. I really don’t want to, it just kind of happens by default. However, since this was Ralf’s baby, I wanted him to name his new ride (yup, my habits may have rubbed off). Unfortunately, I already named her (in my head) the first time I laid eyes on the frame, which sports a beautiful Cockatoo on the stem… Coco!!! While I told Ralf that he should name his new ride asap, I started to refer to her as “Coco”. Ralf would usually reply with “her name is NOT Coco!”. A couple weeks later, Ralf said to me, “I need to bring Coco back to the bike shop before the Forgotten Florida ride…”, it was settled I suppose. Welcome home, Coco!

New Hope for Ralf

Ralf’s GI issues, abdominal pain, and inability to even consider international travel because of the unpredictability of his symptoms, among other considerations, has left such a negative impact on our quality of life. He has been to multiple GI specialists, but nobody was a good fit or offered different approaches. Then I saw an ad from Orlando Health, advertising a new GI section at their facility, promising the best of the best. Ironically, it was around that time the Ralf’s friend Brian also complained of ongoing, debilitating GI issues, so I mentioned that place to him. He actually made an appointment for the following week and really liked the specialist he ended up seeing. We decided to give Dr. Gosalia a try – but to be honest, I wasn’t really getting my hopes up. We had been disappointed too many times… But as it turned out, this GI specialist was refreshingly different! And he was even familiar with Ralf’s rare diagnosis and brutal CRS/HIPEC surgery. It appears that he understood the physical and mental toll all of this had on Ralf. And, he offered different solutions: an new drug, Motegrity, that is still very new on the market (no generic) but has shown great results by affecting the “gut nerves”. Ralf has been on this med for a while, and it really seems to make a difference… new hope at last!

The Rise and Fall of my SimLab
As I mentioned quite a few times during the past four months, I experienced a series of devastating events that shook my world. With Ralf's (day-to-day) unpredictable health issues, becoming a caretaker after Karl-Heinz' stroke, my mom's struggles, my own struggles under the constant stress, the freaking pandemic … the SimLab gave me a new sense of purpose. It became my "happy place", where I was able to create something positive, something I had some control over and could make a difference - until it was taken away by someone I not only invited into my world, but whom i trusted.

I am now ready to reflect on it, but I will not go into a detailed rant. I am just grateful that I found a solution, but I admit, this was a hard life-lesson I had to learn. I guess what made this experience so much more devastating was the fact that I poured my entire heart into this place.

When I received the keys to the SimLab back in June of 2020, I had no idea where this opportunity would lead me. I can proudly say that I built this amazing resource for clinical staff to practice a variety of skills in a safe, efficient, and innovative environment that wasn’t available before. I loved my SimLab, and I loved witnessing the impact it had on staff and patient outcome. I loved the autonomy and trust that I received by my then-supervisor to transform simulation-based education at my hospital and dabble in the wonderful world of innovation. In fact, this video was taken by the Innovation Specialist and later featured as a SimLab Quality Improvement Project (for which I won an 5S award for):

After all the great outcomes I produced and all the praise I received from leadership, I never thought this could all go away overnight – until it did.

Let’s make a long story short(er): as the SimLab expanded and gained momentum, I realized that I needed help. My vision was to build an interprofessional team that included an MD and a Sim Tech, maybe even another simulation educator down the line. Since I really clicked with this MD during the development of an interprofessional airway course in late 2020, I decided to mentor and include her in the wonderful world of healthcare simulation. We were such a great team with a joint vision and ambition – or so I thought. I have no idea why I didn’t see it coming, no red flags, nothing! But I guess when you create something shiny and valuable, the predators will come, which was a lesson I was about to learn.

And that is how I see her now (hindsight 20/20): a predator who used me and my friendship to gain a huge promotion based on my work. After her “hostile takeover”, she tried to break me by taking away everything that was dear to me. And let there be no mistake. She knew exactly what she was doing and kept me in the dark until it was too late.

When the day came where this MD was supposed to join the team as equal counterpart, she finally revealed her true intentions during the introduction staff meeting. Just like that, without a warning. She became the new Chief of Simulation and assumed “ownership” of the SimLab and all operations. My autonomy, decision-making skills, and my ability to collaborate with vendors or any outside parties were revoked, along with our friendship. Apparently, my immediate leadership decided that it was time to create a new section for simulation within the department, and that an MD had to be in charge, not a nurse. I guess it was an “immoral offer” that this MD couldn’t resist. Gaining power, recognition, and an enormous promotion from clinical staff to Section Chief without having to do any of the work is a pretty sweet deal.

But what made this even worse: she took everything she learned through and about me and used it against me. She bullied me, tormented me with “it came to my attention” emails, and locked away all electronics that I needed to run simulations, requiring me to ask for permission every time I needed something. She prohibited me to collaborate with any outside stakeholders, especially if they were associated with national programs. I wasn’t allowed to initiate any projects anymore, appointing herself as the sole point of contact, while cutting me completely out.

When I tried to escape through a detail to the Innovation Department, she twisted some inside knowledge, which she gained through me, in such a way that it actually shut down an entire section of innovation within the facility for a while. No way out. And there is so much more that happened, the many ways she tried to break me; I have an entire binder full of evidence. But leadership decided to look the other way – I was completely on my own.

I realized that I have lost my precious SimLab. My mental and physical health took quite a beating, leaving me with insomnia, anxiety, and chest pain. That is when I decided that it was time to let go and leave it all behind. And as it turned out, losing the SimLab in such a cruel, painful manner finally caused me to look outside this organization, which had been my professional home for the past eight years.

Here is a motto that has proven to be so true:

When I finally accepted “what is”, I was ready to turn the page. Timing was just right when the National Simulation Center (SimLEARN) posted an RN position in late Fall of 2021. I actually completed a simulation residency at SimLEARN back in 2019, where I was able to build many relationships and connections, so joining the national VHA system turned out to be a natural progression. After lots of uncertainty and unexpected turns, I ended up accepting a new position as Simulation Educator with SimLEARN, which is ironically the national recognition that the MD has been after so desperately.

I am proud to say that despite the pain and suffering I had been through because of this, I still gave my full effort to give staff the best simulation-based activities whenever I was able to…

I would lie if I said that I didn’t enjoy the moment when I broke the news to the MD. At that time, she must have believed that she finally broke me, since I kept my head down and just complied with her (often ridiculous) orders. I just got my start date for February 28th, which was for less than two weeks away, when I told her face to face.

She didn’t say much but it was pretty obvious that she wasn’t pleased. Too bad, so sad. Now she had to find someone else who was competent in healthcare simulation and would do her work. The final days were pretty nasty, but I had my eyes on the prize and made it through in one piece.

I actually got lots of kudos and even a farewell “party” from my peers, which was very humbling. Then my last day arrived, and it was bitter-sweet when I logged out of my computer for the last time, exchanging my office space in the SimLab with my home office. Yes, I now get to work a lot from home – just one of the perks that came with my transition to National. New page, new chapter.

Four Years Post-Lumbar ADR Surgery
April 4th, 2018, I took a giant leap of faith by having lumbar artificial disk replacement surgery in Germany, with a surgeon I only met the day before in person, receiving a device that is not available in the US. Oh, and I paid out-of-pocket, since my health insurance denied all my claims (in the US and overseas). How do I feel? Grateful. Grateful for having an amazing outcome, grateful that the cruel and disabling pain I experienced prior to surgery is gone and never returned. Grateful that, in the end, I won the external appeal and got reimbursed for my out-of-pocket expenses.

I am mostly grateful that I was able to be there for my family when they needed me most – something I wouldn’t have been able to do if ADR hadn’t worked out. This includes flying back and forth to Germany to take care of my mom and Karl-Heinz and supporting Ralf in his multi-day bikepacking events. I couldn’t have done any of that if I was still crippled the way I was pre-op.

I haven’t been very active in the Facebook ADR forums anymore, partially because they have become a tad convoluted and complicated. I still get contacted by people who are either considering ADR or just had ADR surgery and are looking for some guidance. I don’t give out medical advice or advertise even my own surgeon. I only share what I came to realize over the past couple years: ADR is a wonderful intervention but only if you are a good candidate and find the right surgeon. In fact, I strongly recommend getting at least three evaluations from experienced ADR surgeons to determine if you are a candidate and then picking the surgeon you feel most comfortable with.

I firmly believe that my good outcome is due to the fact that I “only” had one degenerated disc that was my pain-generator, which needed to be taken care of. Even though I really didn’t want to have ANY spinal surgery, I knew that it was just a question of time until more extensive, permanent (nerve and structural) damage would occur to my body, reducing the chances of having successful surgical intervention to fix the underlying issue and get rid of the pain. As I mentioned many times before, surgery was the last thing I wanted, but I also realized that it was inevitable. I am glad I acted fast, and as I said, I have no regrets and would do the exact same thing if I were faced with the decision today.

I stopped getting yearly x-rays because I decided to move on with my life without obsessing about potential issues. I don’t think very often about the fact that I had spinal surgery, and as long as I can live a normal life, I’ll take it. I more aware of the residual soreness in my thigh from the labral tear repair surgery I had ten months ago than I am aware of my back. Of course, I am also no spring chicken anymore, and things need time to heal and fall into place. My hip is much better than before, so I would count this as a success as well.

  • New Year’s Day Drama
  • Trying to Grow Stuff
  • Huracan 2022 Bikepacking Event/Tour de Roach

New Year’s Day Drama
January 1st, 2022: Facing the new year in high hopes! The current “circumstances” over the past 3 months have had me on edge for quite some time, but with the growing anxiety was also a growing hope for change. In fact, I was hoping for the much-anticipated resolution any day now.

With that being said, Ralf and I decided to take the new Origami Paddler out for a trial. I supported a crowdfunding project about a year ago, and I finally received the fold-up paddleboard we had been waiting for. Our storage space in the garage (or elsewhere) is tight, so a traditional paddleboard would be difficult to store and transport with our current setup. This Origami Paddler sounded like a great idea at the time, but to our dismay, it didn’t quite work out as we had hoped. It is a solid product, but the maneuvering of this thing is much more difficult than anticipated, and the seat option to convert the Paddler into a sit-on-top kayak was completely unsuitable for Ralf and me. Since a lot of other users appear to be happy with the Paddler though, I may try to sell it on the Facebook group page.

I wasn’t in the right state of mind that day either, which may have contributed to our disappointing floating attempt. I guess that’s why I didn’t really take any pictures (Ralf did one).

So, even though it was a beautiful, sunny day, we decided to fold up the Paddler and hit home after a short while. And that is when our day was going from bad to worse. While driving on one of the country roads, we saw a beautiful Gopher Tortoise trying to cross to the other side. It all happened so fast: Ralf pulled over immediately to run and pick up the tortoise, who already made it ¾ across the lane. But there was traffic coming and sure enough, the second car that passed drove right over that poor thing. We both saw it coming, screamed and articulated widely with our arms to alarm the car to pay attention, but to no avail. It was absolutely horrible! The tortoise was tossed to the side of the road, Ralf ran over and picked it up. When he beelined back to our car, holding the poor creature in his hands, I could already see the blood dripping. The shell was crushed but the Tortoise was still alive and moving. Now we both had a brief meltdown, sobbing by the side of the road and still screaming after that oblivious driver. Now what? We couldn’t just leave it out here to die a slow death. So, we wrapped it into a towel, nestled it securely behind the paddler in the trunk, and call (yet again) the Back to Nature Wildlife Refuge in hopes of some guidance. Given that it was New Year’s Day, it bordered on a miracle when Bonnie picked up the phone. She gave us the number of Carol, who was running a wildlife rescue operation out of her house close by. She too picked up the phone and told us to come over right away. After an emotional 15-minute drive, we pulled into her wooded driveway. To this day we are beyond grateful to have the doomed tortoise taken care of in the most humane way possible. Ralf donated to her cause, but not money can ever repay the dedication and selfless care 365 days a year people like Carol provide. And you know what? After we left Carol’s place, Ralf actually looked at me and said, “please don’t take this as an omen for the new year”. I admit that thought had crossed my mind, but I was trying hard to convince myself otherwise. And you know what? Unless proven otherwise, I am clinging to the hope that maybe she was able to save the tortoise after all. And we decided to become monthly donors for the Back to Nature place. After all, we have called there already on several occasions while trying to save various animals.

Trying to grow stuff

Ralf and I have looked into ways to improve and enhance our diet, which included also regular juicing and eating more fresh greens. However, it has become a real challenge to find any fresh produce at Publix, and oftentimes, the kale and other greens look rather sad. So we decided to try and grow our own. This would be much more efficient if we actually had a backyard, but since we are renting a home without such outside opportunities, we bought the Hamama microgreens starter kit.

We read the instructions, put the first sheet with kale seeds in the pan, and lovingly added the water. Then we waited. A couple days later, the first sprout actually peeked through, which was very exciting! But the amount and rate of growth was… sub-optimal? I added a desk lamp to shower our little sprouts in light, hoping to expedite the project and awaken the other sleeping beauties. But after about a week and a half, our first harvest was a tad meager. Maybe a handful at best. I guess we need to wait for our future backyard after all.

I also killed Tumi, who initially grew so nicely just to succumb to the Florida heat on our patio. I am not giving up though: Tumi 2 has been planted, and I will do my best to not become a serial killer…

Huracan 2022 Bikepacking Event/Tour de Roach

The Huracan 300 Challenge is one of those major bikepacking events put together by Singletrack Samurai (aka Karlos Bernart). It entails over 300 miles (more give than take) of biking a variety of trails and connecting roads, starting at the Shangri La campground near Ocala, going to Brooksville, then Clermont, Altamonte Springs, before looping back to Ocala. This is the most challenging event that Ralf has done so far (twice), and he was so looking forward to doing this again after his gruesome surgery! And to make this even more special, his good friend Brian Fleming is joining him again. Those two have been riding buddies for years now, and Brian also has had many recent health issues to overcome before attempting this event again. He had a spinal fusion a year ago and a hip replacement last fall, with some added drama in form of a blood clot in his leg. Long story short, Ralf and Brian are now "Team Cyborg" and were riding the Huracan 300 together for the first time since their respective surgeries. Here is to perseverance and friendship!

Of course, Ralf had to carefully manage his health and stick to his strict routines to function. That is why I came along again with all the essentials, checking into hotels/motels along the way. The night before the start on February 5th, we stayed in a hotel about 10 minutes away from Shangri La. That actually worked out great, and it was really helpful not having to get up even earlier than 4 am to get ready and be where we needed to be on time. Unfortunately, the weather-God wasn’t in a good mood, as evidenced by a nasty cold front rolling in overnight. Bah! The day before it was in the 80s and sunny, that morning it was grey, cold, and rainy. Oh well, so be it!

Day 1: Take off from Shangri La to Brooksville
I was looking forward to see the guys off to their adventure. While we were still getting ready ad the hotel, Karlos finally announced the direction (clockwise or counter-clockwise). I had a list of hotels to book but had to wait until the morning off to find out in which order. Luckily, I got rooms for both, Ralf (and I) and Brian even on short notice: check!

I remember dropping Ralf off in 2019 for the same event. The Ponce was with us, and that was the first and last time I saw my indoor dog eat horse poo. We are still laughing about that one, he was such a character! I was also looking forward to catch up with Brian’s awesome wife Kim, who dropped her bionic husband of that morning as well. Ralf was nervous, but after we made it to the trail head and he started to get his bike ready and connect with the group, all was good. Awesome!

And off they goooo! After all was said and done, I talked to Kim some more before taking off myself. Since it was very early, I decided to check out the cute town of Inverness, which was on the way (sorta) to the hotel in Brooksville. I wished the weather was nicer, but I got lucky and explored the historic town district while staying dry. Inverness also has Florida’s longest paved bike trail route through, the Withlacoochee State Trail. It reminded me a little of the Cady Way trail we used to ride when living in Winter Park but at 46 miles in lengths, this is by far the longest.

After some sightseeing and late breakfast, I drove through the countryside to the Days Inn in Brooksville. Let me just say, when we pick hotels to stay in, we are very restricted by what’s available, especially in more rural areas. This Days Inn was… an adventure? And the patrons I encountered on the grounds prompted me avoid eye contact, lol. And the hooded guy, who was sitting on a picnic bench right outside the room, apparently didn't have a care in the world while he enjoyed smoking some weed.

Well, the hotel served its purpose, but I wouldn’t recommend walking barefoot in that place or look too closely in the corners. It had a fancy remote control though for the ancient (and sticky) air condition unit and a separate heating unit (did I mention it was COLD out there), which I repurposed to dry Ralf’s cycling shirt the next morning, which I dared to wash in the sink that had seen better days.

Finally, around 6:30 PM, Ralf and Brian finished their first leg of the journey (in one piece). While they showered, I ordered pizza for a quick and carb-loaded meal. Ralf still had to do his evening routine as well to ensure that he stays “out of trouble”.

After that, the two started to deteriorate and shortly thereafter, it was lights out. Day one was a wrap!

Day 2: Brooksville to Clermont
Since the guys were going to take off from the hotel, we didn’t have to pack up and load everything into the car already. That removed the stress of having to be at a remote starting point at a specific time to meet the entire group. We got up at 5 AM, which was an improvement compared to the 4 AM wake-up call the morning before. While Ralf was dealing with his morning routine, I checked out the free continental breakfast. It wasn’t surprising to find a rather slim selection of cereal bars, bagels, and muffins. Oh well, at least there was mediocre coffee to be had, lol.

Now it was time for Ralf and Brian to take off to Clermont. It was 8 AM and the weather-God was still in a foul mood. Cold, grey, and drizzly rain on and off. But those two were in good spirits, ready to tackle the 100 miles ahead before getting tonClermont.

Since I had a late checkout, I took my time, packing up and finally loading the car. I decided to stop by at the Yalaha German bakery & restaurant in Howey-in-the-Hills, since it was only a minor detour on my way to Clermont, and I needed to kill some time before I could ask for an earlier check-in. I had a Bratwurst for lunch, along with a Koestrizer Bier, and got some Bienenstich cake and pretzels to go for the guys.

Now it was time to get to the Roadway Inn and try to check in. Good news: the rooms were ready. Bad news: this turned out to be another “interesting” motel, but for different reasons. The view didn’t improve much and featured an almost empty parking lot across from another (abandoned!) motel complex. I found the stranded car that clearly was in an accident particularly strange.

The rooms turned out to be a challenge as well: first of all, there was no coffee maker and no continental breakfast either. Secondly, there weren’t enough outlets to plug in our devices. In fact, I ended up unplugging a lamp to have at least one outlet available. And thirdly, there appeared to be a shortage of lamp shades. That one made me actually laugh out loud! So, in our room, we had two bedside lamps mounted either side. However, the one on my side didn’t work and when I investigated, I realized that the power cord waaaay too short to reach the only outlet behind the bed. I don’t think that lamp was ever in use, unless someone stole a pre-existing extension cord. But both had a shade. When I checked on Brian’s room, he only had one lamp mounted, and his only source of light had no shade (only the bare bulb). Easy fix! Since I had a mounted lamp with a shade that didn’t work, and Brian’s room had a mounted lamp without a shade that DID work, I simply took ours and attached to his. Tadaaa! When I later mentioned this to the front desk lady, she looked confused and then stated that the hotel had a lamp shade shortage…. Okee-dokee.

So we traded a sticky, dirty room with sufficient outlets with a (still dated but cleaner) room with missing lamp shades and no almost no power outlets (and NO coffee maker!). I still had plenty of time before the guys would arrive, so I headed out to the nearest Publix to stock up with water and instant coffee and creamer. I also pre-screened dinner options to be delivered via Doordash or Ubereats. Then it was time for a nap.

By the time the guys finally arrived, it was already dark. I guess it was pretty cruel that after riding almost 100 miles in freezing and wet weather, the last several miles included the steep hills Clermont is known for. Needless to say, both were pretty beat upon arrival. So after a shower and food, both retired to the chambers.

Day 3: Clermont to Altamonte Springs
Since this leg of the journey was the shortest route, the guys decided on a later start, just around 10 AM. The instant coffee (Starbucks brand) turned out to be a good choice, and since we had instant oatmeal to go with, the missing continental breakfast wasn’t an issue either. Then it was time for the departure to Altamonte Springs, which was “only” around 50 miles. Not too bad, right?

This time I kind of sucked as video-producer…

I didn’t bother with a late checkout this time because I decided to drive home before checking in to the Altamonte Springs Mainstay Suites hotel. Since Clermont wasn’t that far away from home, it made more sense to go home to shower and drop off dirty clothes. I promised a friend to help with a teaching a virtual TNCC class online, but that wasn’t until the later afternoon. However, since Ralf and Brian would be in Altamonte relatively early, I wanted to check in and settle in the room prior to their arrival. So around 2 PM, I was walked into the lobby of the Mainstay Suites in Altamonte – not anticipating the humbling experience that awaited me.

This hotel struck me as strange from the moment I arrived: there was a lady in front of me, who was trying to convince the front desk clerk that she should have enough reward points accumulated for a free night. Then a guy came to ask if he qualified for clean towels. “Did you bring the dirty ones?”, the clerk asked, which is when the guy handed her an old plastic bag filled with towels. Odd indeed. Now it was my turn. I was only able to check into one room since the second one wasn’t ready yet. That kind of sucked since I needed to be online by 3 PM for the TNCC class. So I grabbed a cart from the lobby and l headed to the parking lot. I now really noticed the tall building close by. If you live in Central Florida, chances are that you know about this abandoned project along Interstate 4 – a building that has been ridiculed by the locals for years for some reason. Well, I never thought I would ever stay right across from it.

I loaded all the luggage and bags on the cart to bring to our room for now. As I pushed the trolley down the hall towards our room, the smell of freshly smoked weed was pretty evident. The whole feel of this place was more like a run-down apartment building, rather than a hotel.

The room setup itself wasn’t bad at all because it had a complete kitchenette, with full-sized fridge/freezer, sink, silverware, small dining table, and decent-sized bath. However, there were mysterious stains on the armchair a “stale” odor in the room. But every lamp had a shade, and outlets were present in sufficient number.

After unloading the luggage and logging into Zoom with the free wifi for the TNCC class, the front desk lady called me to let me know that the second room was ready as well. Awesome! I beelined to the lobby to pick up the key card when one of the other “guests” just came in. She looked like she came from work, and the front desk lady stopped her by saying “I think you got mail, but I can’t read the label because I lost my only glasses when I was in the hospital, and everything is blurry…”. The lady took a package, checked the label, and confirmed that the mail was indeed for her. Now I started to get it: this was a place where people without permanent housing tried to stay when they could afford the $80/night and/or had enough (Choice Hotels) points accumulated for a free night. Then I remembered the voices of young children I heard from a second-floor room while unloading the car… I had to put it out of my mind or now, especially since I had to be online and fully present in about 10 minutes. I grabbed the key for the second room, which was thankfully next to ours, and quickly brought Brian’s bags and supplies over to his suite. I just made it in time for the class and had to give it my full attention. As it turned out, the free wifi in this place was rather spotty, so the Zoom call was also not the quality I was hoping for, and my virtual trauma manikin didn’t load even once.

Fast forward to 5 PM: Ralf and Brian already arrived from Clermont, which was even faster than I anticipated. I was still finishing up the TNCC class, so Ralf quietly took a shower and then settled into bed to rest until I was done. Thank goodness I was just finishing  up with the class when poor Ralf jumped out of bed in horror! Apparently, the mattress was wet allover, so when Ralf laid down in his clean clothes, the moisture made its way through until he noticed. We lifted the mattress to see what was going on, and sure enough, an enormous stain was find underneath. Since it didn’t have a potent odor nor yellow color, I was hopeful that this wasn’t what I first thought it was… but nevertheless, this was disgusting!

Ralf was so exhausted and angry; it broke my heart. Managing his condition so that he could complete this bike packing event was difficult enough, and this clearly almost made him give up and go home. But he had come so far, and I really, really wanted him to finish! So, while Ralf was packing up our belongings, I went to the front desk to ask for another room. Brian’s room was ok, and he didn’t have any major issues, but we definitely needed to move. The poor front desk lady (who lost her glasses) was so apologetic, and a tad overwhelmed, especially since there was no manager coming in until the next morning. It wasn’t her fault, and she clearly was distraught by the situation. Long story short, we got a new room down a different hall, and when we checked underneath the mattress, there was no evidence of critters or any kind of fluids. It’d been a long day, and this was only for one night, so we quickly moved our stuff over and then ordered burgers through Doordash delivery. Brian came over when the food arrived to join us for dinner, then we all retired for the night.

Day 4: Altamonte Springs back to Belleview (Shangri La):
Without any more dramatic events, we made it through the night. At around 6 AM, I went to the front desk to give Ralf time to do his morning routine. I now was very curious what the continental breakfast would look like in this place. I read on a sign that breakfast needed to be picked up at the front desk (one per person), which was a new concept. As I was walking down the hall towards the lobby, I saw a very young woman, dressed in a pink jogging suit and a tiny Chihuahua on a leash, standing there. As I got closer, I first thought that someone had punched her in the face because I noticed a bruise-looking discoloration under her left eye. But then I realized that it was a tattoo (some writing that I couldn’t quite decipher). I said “hello”, padded her adorable puppy, and asked her if she was waiting to pick up breakfast. She said yes, but that the guy behind the front desk had disappeared and was nowhere to be found. As we waited, we made some small talk, and when the front desk clerk finally appeared, I took the opportunity and requested our breakfast. The young women said her good-byes and returned to her room.

I sat in the only chair, across the counter, close to the entrance. The two small (stapled) paper bags I was handed contained the pre-assembled breakfast. I opened one bag to investigate and found a cup of instant oatmeal, a small bottle of water for said oatmeal, a fruit cup, and a breakfast bar. A pretty sensible choice, since I assumed that many of the folks staying here depended on it. I observed a few people who were clearly leaving for work. Then a lady in scrubs arrived at the front desk, trying to pick up her breakfast. She appeared to be in a hurry, looking for the clerk (who again had disappeared). A couple minutes went by, and the lady got more and more anxious, most likely because she needed to get to work and needed the food. I grabbed my second, unopened bag and offered it to her, stating that I didn’t need it. She thanked me, grabbed the bag, and beelined out the door.

As I sat there, in the lobby of this dated place that clearly wasn’t used by guests on vacation, I was overcome by gratitude of what I have. Nobody is safe from falling into bad circumstances, especially when you take the repercussions of the pandemic into consideration. Not everyone is a “screw up” or drug addict. Most people I encountered were trying to make ends meet, going to work, surviving on a budget that clearly wasn’t enough to cover food and permanent shelter. I was once close to living in my car, after my abusive ex-husband from another lifetime had ruined me financially and professionally, forcing me to start from scratch. So yes, I am grateful that I was able to rebuild my life, grateful for all the things I do have: sufficient income, a roof over my head, quality food, a car to get me where I need to be, ability to fly back and forth to Germany to take care of my family, and the means to pay for healthcare. This last hotel stay turned out to be a humbling experience and a good reminder to be grateful.

In the meantime, Ralf was ready to rumble. A check with Brian confirmed that takeoff was going to take place as scheduled.

At 7 AM, it was time for Ralf and Brian to tackle that last 100 miles back to Shangri La near Ocala. The weather forecast was NASTY, but those two were in good spirits and adequately layered in rain gear.

I went back to the rooms, packed everything up quickly, and loaded the car. I didn’t want to wait for the manager to come in at 8 AM to address the wet-mattress incident, but the front desk lady (who had returned) promised me that she’d follow up. It took me a little longer to get home, especially since I got caught in morning rush hour, but I finally made it home. HOME! I still had to finish up the TNCC class on Zoom at 10 AM, but then I took a glorious shower and washed all the clothes right away. I went to the store to stock our fridge, cooked a homemade chicken soup, and waited for Ralf and Brian to get closer to the finishing point. Brian’s awesome wife Kim was bringing Publix sandwiches for everyone, so I didn’t have to think about what to feed Ralf upon his arrival back in Shangri La.

Due to the weather, their arrival was now estimated for around 8:30 PM but was still a tad unpredictable, and the drive to/from Brooksville was also about 1 ½ hours. So Kim and I took off at 6:30 PM (her drive was a tad longer from her home), in order to be there early, just in case. It was still raining and pitch black, with heavy traffic on the turnpike. I hate driving in the dark to begin with, so I was glad when I entered the Shangri La parking lot.

It was so cold, so I stayed in the car while I waited for Kim. She made it about 30 minutes later, and since she had the sandwiches ready to go, we sat in the car, ate our share, and waited. I checked the GPS tracking again and had to realize that the guys are still at least an hour away. But that was ok, especially since this gave Kim and I time to catch up. Last time we were here, in the same place for the same event, was in 2019, just a week before Ponce passed. In fact, with a heavy heart I remembered Poncebear, who came along that night, tucked away in his stroller, to pick up daddy. A memory I actually share with Kim.

Just after 9 PM, Kim and I walked over to the pavilion of the campground where Ralf and Brian would eventually arrive. It was cold and dark, but at least the rain had stopped. And finally, at 9:26 PM, we saw some lights and voices approach: the eagle had landed!

The guys were completely exhausted, dirty, and a tad discombobulated, but so happy! They just finished a 350 miles loop around Central Florida, despite nasty weather and physical challenges. After we took some pictures, the guys changed into dry clothes, and then Kim and I stuffed them in our respective cars to make our final drive home. Ralf ate half of his sandwich, then fizzled out.

Wow, what an experience for both of us! I am beyond proud of Ralf for this accomplishment, finishing 350 miles on trails, gravel, and pavement, despite nasty weather and ongoing health issues. Being able to do events likes this is always a “hit or miss”, depending on how he feels, which makes this even more special. Me, I have a renewed appreciation of my blessings, thanks to the “Tour de Roach Hotel”, as Ralf calls it...

  • Another (Spousal Supported) Bikepacking Event
  • Van Gogh Exhibit (Happy Birthday, finally)
  • Flying to Germany… Again
  • Merry Christmas

Foreword
Well, I actually wanted to post an update about the significant change that occurred in my life. A change I did not see coming AT ALL, a change that makes me feel a tad stupid and naïve for NOT seeing it coming AT ALL. But I decided to wait for two reasons: first, I would like to focus on the good for this last update of 2021, and secondly, I am hopeful that I have a resolution to the change. Please universe, have mercy on me.

Another (Spousal Supported) Bikepacking Event
Since Ralf’s first bikepacking event went fairly well, he decided to keep the momentum going and attempt another, the Kings Road event, biking from Yankeetown (Gulf of Mexico) to Flagler Beach (Atlantic Ocean). Camping was still out of the question, and because of his rigid routine and regiment, I tagged along again, staying in hotels along the way. Yankeetown is very small and has no accommodations, which is why we stayed the first night in the closest town nearby: Crystal River. The start of the Kings Road ride was on Saturday, December 3rd, so we arrived at the Plantation on Crystal River the preceding Friday. Since the room wasn’t ready yet, we decided to have a light lunch at a cute little bistro that had outside seating. After that, we took a stroll through the area and discovered a little Christmas market close by. They had fake snow and a fake “ice” skating ring set up, which wasn’t very convincing when compared to the real deal I remember from Germany.

Then it was time to settle into the first hotel. The Plantation on Chrystal River is indeed a converted, old plantation. Even though it was a tad dated, the room was clean. The main oddity was the heating unit, which was put into a WOODEN cabinet. Since neither Ralf nor I had any desire to burned to a crisp during the night, he wrestled that thing out of the cabinet and placed it on the floor. Even though this is Florida, the nights can get quite chilly during the winter, so it was a needed component.

After unpacking the essentials, we decided to take a stroll around the property. I was nice, kind of secluded, and right on one of the canals feeding into the Chrystal River. We didn’t see any manatees but instead tons of birds. This was pre-Omicron, and COVID numbers where down during that time. However, we decided to get takeout from the hotel’s restaurant and eat safely in our room.

The meeting spot for the Kings Road take-off was about 30 minutes away, and since Ralf needed to be ready to roll at 7 am, we had to get up around 3 am. By now, we were a well-tuned team, so without major issues, Ralf was ready in time to hit the road to Yankeetown.

What we (literally) didn’t see coming was the intense fog that dramatically reduced visibility, especially in the dark.

The GPS was a Godsent and safely routed us to the rural parking lot, just off the starting point. It was a little creepy setting up in this dark, gloomy place in the middle of nowhere, and movie scenes from “The Fog” (aka Nebel des Grauens) came to mind.

To our luck, we didn’t encounter any mutilated corpses, nor did anyone get killed by supernatural beings, so just before 7 am, the group of riders started to assemble at the start.

And off they go! As the group departed into the fog, I actually lost sight of them. Now it was time for me to get to Gainesville, where the next hotel was waiting for me. However, it was only 7 am, the fog was still thick as soup, and I was stranded in a remote parking lot in the middle of nowhere. So, I decided to sit in the Element and talk to my mom for a bit while I waited for better visibility. However, after half an hour I lost my patience and decided to put on my trusted GPS and head out to my next destination. As I was driving for about 10 minutes, I couldn’t believe my eyes: there was Ralf with three others, riding along the road! How did that happen? The route was supposed to be off-road at this time but as it turned out, some grouchy officer blocked the entrance to the preserve, so the majority of the riders had to use main roads for now. As I turned on US 19, I waved Ralf good-by, again, and kept going towards Gainesville. I passed a large group of riders and was hoping that their route would turn more scenic soon.

I was very glad that I didn’t wait for the fog to dissolve before taking off, because that never happened. The drive to Gainesville turned out to be rather stressful since visibility was very poor. In fact, I was so grateful for my GPS because it showed me traffic lights and turns, which I wouldn’t have been able to see until they were right in front of me. An hour and a half later, my GPS indicated that the hotel was just to my left but I still couldn’t see more than a few meters ahead.

Finally, I made it to the Hotel Eleo. It wasn’t even 9 am yet but I tried my luck in hopes for an early check-in. And guess what! My room was not just ready but also upgraded to lake view! Not that I was able to see much at that time, but I was so happy to be able to settle in, maybe get some breakfast and a snooze, while I waited for Ralf to get to his first check point in Hawthorne. The valet guy was a good sport since I came with everything but the kitchen sink. In fact, the hotel and their staff were absolutely awesome. The room was modern, clean, and spacious. I am sure the view would have been stunning too if it wasn’t for the persistent fog. A quick check on the tracking app that showed me Ralf’s approximate whereabouts confirmed that I still had plenty of time, so decided to check out the hotel’s restaurant.

Breakfast delicious, and the service excellent. I even was given the dinner menu to take to my room, so that Ralf could pick his dinner choice when he got there. Past experience taught me that Ralf would be hungry but also toast by the time he made it, so I thought it was more beneficial to eat in the room asap.

I must say that I really got my money’s worth during this stay. I had a lazy day, took a nice shower, and watched some TV. By 4 pm, Ralf was getting close to the Hawthorne checkpoint, so I called for the car to get there myself. Again, the drive was about 30 minutes, and since the fog was gone now, I actually was able to see where I was going. I had to find a mural painted to a wall in the center of Hawthorne. After some back and forth, I finally made it with 15 minutes to spare. I parked the Element and waited for Ralf to arrive. He was tired but happy – as was I. I am always relieved when I see him rolling in…

Now it was time to get back to the hotel. The valet guy knew me by now, and I as I handed him back the keys, Ralf peeled himself out of the car. As anticipated, he was toast, so when we got the room, I had him pick out dinner from the menu, which I fetched from the restaurant while he showered. Soon thereafter, he passed out, lol.

Day two: early rise and shine! The goal was to depart from the same mural in Hawthorne at 7 am, which required us to get up (again) at 3 am. Even though we didn’t get the car as quickly as I was anticipating, due to an entire swim team leaving the hotel at the same time, we made it just in time to the checkpoint. At 7 am sharp, Ralf was rolling off again, towards the final destination: Flagler Beach.

As I mentioned earlier, I really did get my money’s worth with this awesome hotel. With a late check out for 1 pm, I had time to get back to the room, shower, and sleep some more before heading to Flagler Beach myself. Yay, me! I looked ahead to see where I could kill some time, since there wasn’t a hotel waiting for me over there. I picked a Panera's, where I spend a good amount of time before heading for the pier, which was the meeting point and final destination. I got lucky with parking, too, right at the pier. I strolled around the beach a bit when Ralf made his appearance, clocking in at exactly 200 miles total distance!

Lucky him, I brought Chipotle and a hot Starbucks tea, so he could eat before our two-hour drive back home. This concludes the second bikepacking event since Ralf’s surgery. I couldn’t be more proud!

Van Gogh Exhibit (Happy Birthday, finally)
A week after the Kings Road ride, we finally got to go to the Van Gogh Immersive exhibit, hosted at the Orlando convention center. I bought these tickets for his birthday, but since the exhibit was delayed for several weeks, only got to go on December 9th… two days prior my departure to Germany.

Due to the pandemic, we really haven’t been out for stuff like this at all. It was a nice treat and we really enjoyed the event. Luckily, I bought the VIP package, which included two seat cushions, which were a lifesaver. The exhibit was set up in on big room and the only seating opportunities were either on the floor or on some wooden benches scattered across. I loved to see Ralf so content, doing something cultural and “normal” for a change. He has been confined to the house for almost two years, so this was certainly a treat!

Flying to Germany… Again
December 11th, my trip to Germany was underway. Normally, I would always fly with Lufthansa directly to Frankfurt, then Hamburg. However, it is so agonizing when I decide I to fly home because I have to leave Ralf home alone, while traveling during the never-ending pandemic. So I delayed the inevitable and waited too long to book the flight, which had not just significantly increased in price but also had only limited options to pick from. I ended up booking United flying to Germany, and Lufthansa on the return flight. Business class was too expensive (over $4000!), so I settled for Premium Economy, in hopes for a last-minute upgrade. Thankfully, that upgrade with United came to pass, but not for the Lufthansa return-flight. I guess I got a tad spoiled with being able to afford relatively cheap business class upgrades in the past, which made the prospect of sitting in economy pretty awful.

The Orlando airport was busy, but thanks to my Global Entry/TSP-pre status, I was able to skip the long line at security and was through in less than 10 minutes. Minimizing exposure is my top priority when flying, so this perk certainly paid off.

Oh, hell no!

Next, I headed for the United Business lounge, which I was lucky to have access to. I was hanging out there until I was able to board the first flight to Washington – so far, so good. Fun fact: I ended up sitting in the same row with a guy named Wade, who also lives in Lake Nona, not far from me. We also ended up on the same flight from Washington to Munich, also in business class! What are the odds of that happening again? On my last trip in August, I sat in the same row with Lars, a guy who lives in the Orlando area. This flight was from Hamburg to Frankfurt, and then we met again, sitting next to each other in business class on the flight to Orlando. I begin to think that Lufthansa does that on purpose, lol.

Anyways, so here I am in Washington, hanging out by the gate since there wasn’t enough time left to spend in the lounge, but I ended up having a Blue Moon beer at the airport bar close by. United’s Polaris business class is nice and seating very secluded. As it turned out, the upgrade was worth so much more since I got to spend a lot more time on the plane than anticipated. We were off to a good start, rolling away from the gate towards take off when the plane suddenly stopped. About 30 minutes later, the pilot announced that “there is a delay due to an electrical problem with the plane”, so we ended up rolling back to the gate. Then we waited. We waited some more. We were told the maintenance crew was trying to “fix the problem”, which concurred images in my mind of some guys in overalls, waving with rolls of duct tape, yelling “I think we got the problem taken care of!”. Let me just say, it can make you a tad uneasy to sit in a giant airplane with “just fixed” electrical problems, just before going on an 8-hour flight over the great abyss of the Atlantic Ocean. Secondly, I only had an hour layover in Munich to catch my flight to Hamburg. So, after a 3-hour late start, it was apparent that I won’t make that one. But what can I say, it is what it is, and after chatting a bit with Wade and watching an entire movie before ever leaving the ground, we were finally airborne.

Hitting the ground running in Munich is an understatement. When we arrived, I connected my phone to the airport wifi and got the notification that my flight was re-booked but that the flight was leaving in 45 minutes by the time we rolled to the gate. It has been at least 10 years that I flew through Munich, and I didn’t get to look around much as I was running to make the connecting flight. When I made it to the new gate, I realized that I didn’t have to hurry all that much since that flight was also delayed because they were waiting for the bus. Seriously, the bus! I haven’t had that happen when flying in the US, but in Germany, some domestic flights transport their passengers still by bus to the plane. There, you must climb up some steep metal stairs, no matter what the weather is like. But hey, at least I was finally on my way to Hamburg.

I couldn’t get a hold of my mom to let her know about my delay, so I phoned poor Ralf at 2 am his time to help me out. I was pretty stressed at that time and running with all my carry-on luggage (one contained the electronic 15-inch frame for my mom) was quite a workout. Finally seated, I could relax for a bit. Did I have a couple glasses of sparkling wine? Maaaaybe… I also got a nice snapshot of the landscape.

In the meantime, my mom was already hanging out at the airport in Hamburg since 9 am. Even though Ralf informed her that I will be hours delayed, she decided to still have her driver Ruediger get her there (it’s a 1 ½ hours ride) on the original time. Unfortunately, Ruediger couldn’t wait that long, so he left mom at the airport and had his brother come to pick us up. But not just us, but also Ruediger’s wife who arrived around the same time from Australia. Wait, what? Anyways, I made it to Hamburg around 2 pm. But guess what didn’t make it? Yup, my suitcase. That one was still in Munich but supposedly already loaded on the next flight to Hamburg. So I had two choices: wait for another 45 minutes for my suitcase to arrive, or to have it delivered to Buesum but that could take days. Sorry, Ruediger’s wife, I am not going without my luggage. I knew she was tired and wanted to leave as soon as possible, but I left her to wait with my mom and the brother while I headed back to the baggage claim belt (that was another adventure to get back there). Then finally, at last! We were both there! Myself and all my luggage!!!

Even though I was a zombie at that time, I ended up getting a fancy meal at a pre-planned dinner event later that evening. German cuisine, especially during the holidays, is the best!

Duck as welcome dinner

I arrived on a Sunday, and on Monday, I already hit the ground running by taking care of some business. I had an appointment at the local bank to FINALLY transfer Karl-Heinz’s account over from out of state. On Tuesday, we picked up Karl-Heinz to spend the day with us. I only had another very intense work-related appointment to take care of that day, but besides Bella trampling my notes, that also went pretty well.

The weather was of course cold but surprisingly mild and sunny, considering the time of the year. I had my German gear ready to go, and this selfie still makes me laugh because Bella and I look like we were caught in the act…

And speaking of Bella: my mom bought a wider bed and a new couch with a chaise to ensure that Bella (and my mom) has enough space. But like most dog owners know, just because there is more room doesn’t mean you get more space… the entire couch is available but these two still squeeze together on one end. Figures…

After that intense appointment, my mom and I took Karl-Heinz to the (very small but open) local Christmas market in Buesum, where we enjoyed a glass of traditional eggnog (well, Karl-Heinz had the non-alcoholic punch). For a retirement and wellness town, Buesum is surprisingly difficult for people in wheelchairs. The sidewalks are narrow and uneven, and when we got to Christmas market, it was impossible to approach the outside tables directly since the ground was covered in wood chips that stopped anything on wheels in its tracks. So I had to push Karl-Heinz around the entire market place, past the town hall and down the gravel path, leading to the back of market. Oh well, I needed to work off the eggnog calories somehow! But it was all worth it since Karl-Heinz seemed to really enjoy the outing and his punch.

My mom doesn’t drive anymore, and she is not comfortable to take the train due to the large gap she is afraid of falling in while entering/exiting the train car. What she didn’t realize is that there is a bus going directly to Heide, the next bigger city. I did some research, mapped out the appropriate stops and schedule, and then took a bus to Heide. Not only was there much more available in terms of shopping, Heide also had a much larger Christmas market. Fun fact: there was a check point prior to entering the market, where we had to show our vaccination passports and our IDs were verified. Without vaccination (or proof of recovery), you were denied access. The same was true for using public transportation. It gave me some peace of mind, knowing that at least everyone I was exposed to in places was indeed vaccinated.

In any case, we had a great time in Heide, and I had a delicious Gruenkohlpfanne (kale with sausage and potato), a classic dish during this time of the year. We also tried some Marzipan-eggnog, yummy! I also re-discovered the fact that public restrooms are not free but require a fee of 50 cent. My mom was so happy, which made me very happy.

During the second week, I still needed to take care of more business. As Karl-Heinz’s guardian, I had to finalize the annual accounting requirement for the court and mail that novel while I was still in Germany (much cheaper and quicker). Besides the accounting task, I had to really focus on writing certain numbers the “German way”, which was a pain in the behind. But I finally got it done, every penny was accounted for, and off it went to the post office.

Then I installed the Viewclix video frame that I bought in the US and hauled around in my carry-on luggage. My mom is not very tech-savvy anymore – in fact, anything where she must log in or push buttons, she will mess up sooner rather than later. That has been very frustrating for both of us, especially when we tried to facetime/whatsapp video call. Skype was equally a disaster, so I mostly talk to my mom on the regular landline. After a lot of research, I found this great 15-inch video frame (Viewclix), which I control via an app. I can send pictures to the fame remotely, and they are displayed as a slide show. But the main feature is the video call function. Through the app, I can initiate video calls, and all my mom has to do is sit in her chair and face the frame. No account for her to log in, she doesn’t even have to pick up the call! But I had to make sure I install it correctly and do some troubleshooting. To this day, that sucker works wonderfully!

Since I wasn’t able to stay for the actual Christmas holiday, my hope was to celebrate Christmas “together” via video frame, including Karl-Heinz.

What else… oh, yes, I bought a new vacuum cleaner since the two (!) she had didn’t work anymore, I ordered new curtains to separate the hall from the living room, and I discarded (again) all the boxes my mom tends to accumulate in her basement. We attended a Christmas get-together, organized by the nursing home. My mom and I weren’t much fan of the singing of traditional Christmas songs (just keep on smiling), but the event ended with awesome cake and eggnog.

The last couple days prior my departure back home got noticeably colder, with frost covering the ground and windshields of cars (I don’t miss that part at all). Pretty and appropriate for winter, but I am still not a fan of getting a numb face and thighs, along with loosing dexterity of my fingers, lol. I had to really laugh when I saw the doggie poo stations in Buesum, which very detailed instructions starting from the “point of origin” to disposing the bag in a bin.

COVID testing is super-convenient and free in Germany. I only had to register online once, then I got a QR code sent to my phone, which was scanned by staff at the testing center to initiate the test. Fast, efficient, safe. In and out in less than 3 minutes, and results were emailed and/or texted within 30 minutes. I used this service for my test that was required within 24 hours of my flight back to the US. No more stressful “proctored” Covid home tests for me!

On our last night, I took my mom to Miguel’s Tapas Bar, a Portuguese restaurant in Buesum my mom always wanted to eat at but didn’t want to go alone. It was great, we got the nicest table in the house, and the food was amazing. Everything was homemade, including the final bill. Definitely doing this again next time I visit.

Now the time has come for my departure. I was looking forward to seeing Ralf, but it is always so very hard to say good-bye to my mom. She looks so small and alone. But I felt better this time since she appeared more established in her new life. However, not being able to be together for Christmas was sad. I was very hopeful thought that the video frame would make up for it a bit…

Flying back to the US was more straightforward but still not without hiccups. My flight to Frankfurt was of course delayed. Needless to say, I only had an hour layover prior the departure of my international flight, which was the only flight for the day. Here we go again!

We were supposed to take of at 11 am, but it was not until 11:30 am that we finally did. When the plane touched down in Frankfurt, my big flight was already boarding. Awesome. And while I was anxiously remaining seated while we taxied across the airport, we suddenly stopped in the middle of the field. And waited, and waited. Finally, the pilot announced that due to staff shortages and missing equipment, we could proceed to the gate to deplane but were now waiting for a bus to pick us up. NO! Not again the freaking bus! I am already late!

It was so cold as I descended the steep metal staircase with my carry-on luggage to board the bus. As I was standing there, waiting for the bus to move, I witnessed this very, very slow older gentleman coming down the stairs – step by step- assisted by one of the flight attendants. It’s those moments where time appears to race on while everything else comes to a screeching halt.

An eternity later, everyone was on the bus, and we made our way to the terminal. Since I still had to get to the international section (Z-gates), I had some ways to (power) walk. Finally, I arrived at my gate, huffing and puffing but grateful I didn’t miss the flight. But as it turned out, this flight was also delayed, due to time-consuming checking of re-entry paperwork.

In the meantime, I really was hoping for a last-minute upgrade to business class, but I was told they were completely booked. Yes, I had to face it: economy it is! Well, at least it was premium economy (wider seats, more recline) and in the first row without having someone in front of me. Or so I thought. Apparently, I was re-seated two rows behind to accommodate a mother and her baby (which had very healthy lungs).

I get it, I really really do. But I guess the business class experience of the past has left me mourning the loss of a lay-flat seat option, privacy, and champagne. When did I got so snobby? But to be honest, I came to treasure this “special time” above the Atlantic Ocean, which has become my “me-time”. Trust me, it’s much harder to go back behind the curtain to economy after that.

However, the universe had some mercy on me because the flight attendant from the business class came over and told the mom that it wasn’t safe for the baby to remain in that row (there was no baby cradle mounted there). She ended up relocating to the middle row next to me (much better for her and the baby), and I took the opportunity to ask the flight attendant if I could return to my initial seat up front. “Yes, of course, let me help you move”. Awesome! We had a really nice talk afterwards, about all kind of stuff (we were still delayed, so I guess he had time). To my surprise, I got a bottle of red wine to take home and two glasses of actual champagne for some reason. Ha, got my champagne after all! And this seat was much, much better. But it still was a very different experience, and knowing what is behind the forbidden curtain still sucked a bit.

I still made it in one piece, and even though I kinked my neck while snoozing in this awkward position, I was happy to be home. Since I had a window seat, I got a picture of the Orlando VA and actually flew over my house.

Global entry was a breeze, and after my suitcase appeared (thank goodness), I was almost reunited with Ralf. I was also grateful that I wasn’t picked for a random check again, since I wasn’t sure how the homemade eggnog that my friend Patrick gave me as a gift, would have been perceived by customs.

Merry Christmas
I arrived back home on December 23rd, so Christmas was already the next day. I already bought the meat and most ingredients I needed for my Rouladen dinner before I left, and Ralf had taken them out of the freezer in time. So the next morning, I started to cook our Christmas dinner and wrapped last-minutes gifts from Germany.

At 10 am, it was time to video call my mom and Karl-Heinz for Christmas eve. I was so nervous that something would go wrong but to my relief, it was great!!! My mom was seated on her usual chair, Karl-Heinz was parked just to the side, and I could see how nicely she had decorated the table. They also had Rouladen for Christmas, delivered by this awesome restaurant that she orders from twice a week. I also saw the glasses of sparkling wine, ready for a toast. So I got our sparkling wine ready (hey, it’s 5 pm somewhere), one glass for me, a sip for Ralf. Now we were ready to toast, then open our presents (on both continents). I would say, this was a great success and made Christmas a tad more merry!

We had invited Renate and Tom to have dinner with us, but unfortunately Tom had fallen ill. I made their Rouladen to-go, and Renate picked them up Christmas eve. And then it was time for our own Rouladen dinner. Ralf’s GI issues can really put anxiety into eating, but thank goodness, he was able to enjoy the food without repercussion this time.

We ended the year on the same note: video-called my mom at 11 am (5 pm German time) while Karl-Heinz was still there (more sparkling wine before noon)…

… and then again at 6 pm (midnight in Germany) to officially wish my mom a happy new year! I was so excited that this worked out and that we toasted to 2022 together (although apart). Concurrently, Ralf had his mom on a Whatsapp video call, so we all exchanged our new year’s wishes. Here is to awesome technology!

Ralf and I? We didn’t quite make it, lol. We passed out around 10 pm but I had an alarm set for 11:30 pm, in order to watch the apple drop and toast to the new year (for the third time). After watching an awkward performance of Anderson Cooper and his totally wasted co-host Andy Cohen, we called it a night for good and went back to bed.

I am hopeful that 2022 will bring the resolution to my current predicament and new opportunities. I am worried about Ralf but hope that we'll get some answers, better guidance, and support for him this year. Stay tuned!

  • Self-Maintenance
  • Happy Birthday and 2nd Anniversary
  • Ralf’s First Bikepacking Event

Foreword
This is always such a difficulty situation: I really want to post updates more often, especially when a lot of events happen in such short period of time. However, the most recent event (and this one shook me to my very the core), I never saw coming. I have been in flight-or-fight mode over the past month, and I just couldn’t get myself to do the reflection necessary for updating my blog. I guess part of it is denial, not mentally ready to deal with what happened.

So, I decided to separate two significant events that started/happened recently: one is a personal milestone for Ralf and me, the other one is of the most detrimental, evil nature that I have ever experienced (besides a cancer diagnosis). So, let me focus on the positive in this update, since this milestone deserves to be featured without being contaminated by evil. I hopefully will be able to post the next update in a week or so. As always, baby-steps…

Self-Maintenance

My hip has been sore, and I can feel the scar tissue burning and pulling deep inside my thigh. I have been using a myofascial massage roller, and PT used a Gastron “scraper” to break up more tissue. Bruising is expected, I suppose, but it makes it awkward to go to the pool for rehab swimming… But I am still making progress, my range of motion is improving, and PT has gotten me on the right track for recovery.

I concluded the last update with a preview of the IV Lounge project. Ralf has had a lot of issues with staying hydrated and getting certain nutrition because his diet has been restrictive in many ways, and his GI system doesn’t function normally anymore. So, we looked into IV hydration/supplementation. In my time as ED nurse, I witnessed first hand how a liter of fluid administered IV could “perk up” a sick patient, especially in cases with underlying GI issues. When I saw a dear friend post about her great experience with the IV Lounge, we decided to give it a try. Covid numbers had been improving, so the benefit was worth the risk at this time. Ralf and I are an item, and I am always game if it helps my mate get better. Besides, the couple that infuses together, stays together, right?

But seriously, we are both very hopeful that adding IV infusions to Ralf’s (and my) monthly maintenance program would be another angle to improve our health. I admit, I have started many IVs in other people, but I am actually quite phobic of needles myself.  Getting poked on purpose took me some courage, but I am getting better with that. We have done weekly infusions over the past month, which entailed one liter of normal saline with added electrolytes, amino acids, vitamins, and minerals. Especially for Ralf, this appears to be a promising intervention, so we signed up for a couples membership to see where it goes. Expensive? Yes. Worth to enhance quality of life? Absolutely.

Happy Birthday and 2nd Anniversary

October 21st marked Ralf’s birthday and our 2nd year Anniversary. The evil that already entered my life the week before did unfortunately contaminate this time of celebration a bit, but it was still a great day. This day marks the birth of a survivor, who has overcome the impossible, and despite all the curve balls, uncertainty, and pain, he never gave up.

Our landlord doesn’t allow pets, and even though we talked about the possibility of adopting a new furry son or daughter, that will have to wait until we find a new home. In the meantime, I got Ralf a Tribble. Since I introduced him to the wonderful world of Star Trek, I believe this is the perfect first furry pet. We named him Kelvin, and when you touch him, he shakes and purrs. I am glad though that we didn’t end up with a house filled with Tribbles while we were gone on the upcoming trip – and it actually makes me feel a little old when I realize that many people I know will have no clue as to what a Tribble is.

Ralf’s First Bikepacking Event
After relentless planning, prepping, troubleshooting, and reassurances, Ralf finally attended his very first bikepacking event since his cancer diagnosis: the River-to-Sea Loop, which was a three-day, 200 miles bicycle ride, mostly off road, and with long stretches “off the beaten path”. The event started in Seville (30 minutes North of DeLand), to Palatka, to St Augustine, and then back to Seville. Ralf had done such rides in the past, and he'd made great friends who he hasn't seen for a very long time. One of the reasons why I decided to come along and book hotels along the River-to-Sea route was to bring all the specific food items and medical supplies that Ralf needs every day to function. His routine needs to happen in a certain order and requires a lot of time. That’s why he couldn’t go camping with the group this time around. But you know what? It didn’t take away anything from this experience, and he ended up riding the entire course. I couldn’t be more proud if I tried.

Starting Point/Day 1: DeLand/Seville to Palatka
After a visit to the IV Lounge for “pre-hydration”, we made it to DeLand on the evening of October 21 (Ralf’s birthday & our anniversary). We checked into the hotel, the first time in years, and got ready to meet a dear friend and his awesome wife, Brian & Kim, for a nice dinner. On a side note, when we entered the parking lot of the hotel, we passed a car that was parked there and caught my eye. I guess being from Europe, I am still amazed when I see stuff like that, so I had to take a picture…

...However, HE did not save your eyesight or parking skills...

After a very nice dinner with our friends, we walked back to the hotel to get Ralf’s strict evening and morning regimen set up. We both had to get up at 4 AM in order to be ready in time. We were pretty nervous because this was the first time since his cancer surgery in 2019 that Ralf had been away from home overnight. But even though it wasn’t perfect, it worked out. When we left the hotel, the lobby was still completely deserted, and even the coffee place wasn’t open yet.

It took us about 30 minutes to get to the starting point in Seville. Our GPS routed us to the wrong place at first, but since that happened to 90% of the other riders as well, we didn’t feel so bad, lol. After someone called the organizer, we got some clarification and the group caravanned to the right spot, which was about five minutes away. One by one, cars loaded with bikes arrived, and everyone was busy setting up their gear and getting ready for take-off.

You know, going through what Ralf has been going through is bad enough, but the isolation due to Covid had certainly added to the mess. That made this event even more meaningful, and my heart was full when I watched him assemble his bike, saying “hello” to old friends, and getting ready with the group to start this new adventure.

And at last, the River-to-Sea 2021 is officially on the way!

After the group had left, I got into the Element, put on the “Red Hot Chili Peppers”, and drove towards Palatka to check into the hotel at check point 1. I had Ralf’s tracker on my phone, so I was able to see where he was at (approximately) and gauge an estimated time of arrival.

The group was supposed to meet at a Beef O’Brady’s, just across from the St. John's River bridge that leads to Palatka. I joined the group for (an outside) dinner before picking up Ralf and his bike for the evening routine.

After we got to the hotel, Ralf took a shower and completed his Avazzia (electrocurrent) abdominal treatment. When I looked over to ask him a question, he was already out…

Second Day: Palatka to St. Augustine
After another early morning, Ralf was ready to start the second leg of the journey. It takes a lot of do his routine, along with all the planning and packing/unpacking to keep organized, but it went better than expected.

Getting to the second starting point was a lot more adventurous than Seville – even without getting lost. The deal was to meet the group at a trailhead parking lot in the middle of the Etoniah Creek State Forest. Besides the lack of paved roads, it was still pitch-black, completely remote, and given that it was the week before Halloween, pretty spooky. As we were bumping along on the washedboarded gravel at snail-speed, movies like the “Chainsaw Massacre” came to mind…. But I am happy to report that we didn’t encounter any werewolves or mass murderers, and after three miles deep into the woods, we found the trail head.

After we pulled into the parking lot, Ralf got to work, setting up his bike and gear again. We still had to wait for the group to assemble, since the other riders were camping in a nearby primitive camp site and needed to get ready as well.

While he was busy doing that, I took a stroll around the trailhead to see where were are actually at. Funny enough, werewolves were not as common as bears here, so in hindsight, I am glad we didn’t run into one of those furry guys on the way.

After everyone was accounted for, Ralf rode off with the group to the next check point: St. Augustine.

Meanwhile, I put the address for the next hotel into the GPS to get to St. Augustine myself. But first, I had to make my way back to civilization. Slowly at first, very slowly, until I had pavement again under the wheels… at least now it was full daylight, which took away feeling of being part of a horror movie.

I made it to St. Augustine by mid-morning, and it was BUSY! I didn’t realize that it was not just tourist season but also homecoming weekend. I couldn’t check into the hotel until the later afternoon, so I parked in the hotel’s parking lot, changed into shorts and sandals, and walked into town. I have been here before, many years ago with Ralf, my mom, and Karl-Heinz, I believe. But this time, it felt a lot more “touristy” to me. I walked to the famous Castillo de San Marcos National Monument but after I saw the line, decided to just sit by the water and listen to some music for a while. My anxiety and panic attacks were still there, even though I tried hard to put it away.

I kept checking on Ralf’s progress on his tracking app, and I still had a lot of time before we were going to meet at the Ice Plant Restaurant and Bar later that evening. So walked through the “old town” section of St. Augustine, ate some lunch, explored the residential areas, and talked to my friend Sharon on the phone.

I finally got to check into the hotel, freshen up, and walk about a mile to the Ice Plant to meet with Ralf. Due to the amount of traffic and people, it appeared more logical to walk a mile, rather than taking the Element. A wise choice, as it turned out.

Ralf finally made it to the restaurant around 7 PM. However, he was very beat, and there were just too many people at this place. So, we decided to skip dinner and walk straight back to the hotel. And as it often happens: you keep on going until you relax, then you crash. That’s what kind of happened to Ralf. I ended up ordering pizza through DoorDash, and after he ate, it was again “lights out”. That was until a MASSIVE muscle cramp in Ralf’s right calf disturbed the night, I mean, that was a bad one! Thank goodness for the mustard packages I took from the previous hotel. Ralf guzzled down two packs, and the cramp finally let go. Yes, mustard is a remedy for these kind of muscle cramps, and so far, that always worked.

Third Day: St. Augustine back to Seville

The last early morning of the River-to-Sea had arrived. Given that we had no idea how staying in hotels and managing Ralf’s medical routine would work out away from home, I was so incredible proud of him for what he already had achieved. It hasn’t been easy, but being able to ride in this event so far exceeded our expectations.

We left the hotel to get to the last meeting point, about 20 minutes away. Ralf looked tired but also happy…

The last check point wasn’t’ very scenic. In fact, it was a tiny Subway plaza right off the main road. After we arrived, Subway was still closed for another 30 minutes, which sucked because we both needed to pee. For the last time, Ralf took out the bike and got his gear ready. The group was again camping at a nearby campground, but at this point, riders would take off for the final destination without assembling as a whole group. So when three of Ralf’s friends arrived, the four of them decided to take off, in order to make back to Seville by daylight.

Me, I waited another 10 minutes for Subway to open to go pee, then I had to kill some time. It was only 9 AM, and because there wasn’t another hotel to check in, I decided to explore a state park near Palatka. It was only a 45 minute ride, and I read online that the Ravine Garden State Park was nice.

When I got there, I tried to take a power nap, but my anxiety was not letting me rest. So I did what I did before: I put in my headphones, turned on some music, and power-walked the 2-mile trail – twice! I also explored some of the many side-trail and climbed down to the bottom of this enormous sinkhole to walk around some more. It was actually really nice, even though I was now sweaty and grimy.

Now it was time to get close to Seville to wait for Ralf’s arrival. My internet connection was rather spotty, and I had a hard time getting an update on Ralf’s tracker app. So I drove to the nearest place before Seville, where I could get a snack and wait. That turned out to be a Winn-Dixie, where I got some food and water for myself, and also for Ralf. After collecting him, we still had to drive 1 ½ hours back home.

I must say, I was very proud when I gestimated my arrival so perfectly that Ralf and I arrived exactly at the same time. He was still with the same group of friends, which made me very happy.

He was tired, beat, and his behind was most certainly hurting. But he DID IT! Halfway home, he snoozed off – well deserved, I must say.

Words cannot describe how proud I am of this man! From being given a death sentence, to surviving a morbid surgery and hot chemo treatment, 16 days at Moffitt Cancer Center, countless setbacks, ED visits in the middle of the pandemic, being let down by healthcare providers left and right, let alone the mental agony of processing it all and still press on, Ralf has fought through it all. He is setting an impressive example of perseverance and strength.

With that being said, the evil that has disrupted our lives has already impacted us, mentally and physically. I have to make some tough decisions very soon to protect my family. But that is for next update.

In this Update:

  • Third Germany trip in one year (still pandemic-style)
  • Welcome back to the battle zone
  • Self-care efforts

Third Germany trip in one year (still pandemic-style)
It’s been two month since my labral tear repair and tendon release surgery, and to be honest, I underestimated the recovery time and challenges. I am “ok” but far from recovered. There have been a lot of ups and downs in pain, weakness, and limited range of motion – very different than recovering from lumbar ADR, I must say. But “ready or not, here we go” was the motto as my departure date arrived on August 14th. As always, leaving Ralf behind for two weeks has been giving me HUGE anxiety and insomnia, but across the Atlantic Ocean was my super-excited mom waiting for my arrival. I had a tight agenda again, trying to finalize some legal and logistical matters. But just because you have a plan, doesn’t mean you’ll get it done…

The Orlando airport was busier than expected. I was mortified because the Delta variant was in full swing, listing Florida as the worst state regarding infection and mortality rates in the country. Even though I am fully vaccinated, I decided to do a PCR test a couple days prior – just in case. And sure enough, Germany declared the US a “high incident region” again on the very day I flew out. Still got around quarantine restrictions, thank goodness, since that would have severely limited my plans. I made through the check-in, used my Global Entry/Pre-TSP privileges to limit my exposure during the security check (5 minutes vs. 30 minutes), and took the monorail over to the terminal. Typical Florida, wearing a mask optional, so I zigzagged my way to my gate. I was so very anxious, it felt like being in the twilight zone.

One of the perks of flying business class is that you board relatively early, and since you are seated in the front of the plane, there is no parade of people passing you by. Once I was in my seat, I could relax a bit. There was this very nice German flight attendant servicing my area, and when she came over to greet me and to see if I wanted something to drink, I asked her if I could have a glass of Sekt. In Germany, Sekt is the equivalent to regular sparkling wine, such as Cooks. So, she looks at me and says, “well, if you insist, I can bring you Sekt; however, you could also have Champagne instead…”. Well then, bring on the Champagne!

The flight itself was as pleasant as can be, and I even got to sleep a little. On all Lufthansa flights, passengers have to wear a surgical/NK95 mask at all times. No cloth masks allowed. I also had the entire aisle to myself, plus I brought my lucky charm cat. So far, so good.

I usually hit the ground running after I reach my destination. Now I was curious how Germany would compare to Florida, in terms of Covid restrictions and compliance. So far, everything went pretty smooth. Having two passports, especially my European Union one, served me well. I witnessed the looooong lines of frustrated non-EU citizens trying to get through immigration, whereas I got through in less than five minutes. After one more short connection flight from Frankfurt to Hamburg, I finally reached my destination.

My mom was already waiting for me when I walked with my luggage through the exit. This moment always gets to me because Karl-Heinz’s absence is the first painful reminder of this new reality. Outside at the curb, an acquaintance was waiting with his car to drive us back to Buesum.

It’s still so strange to walk into my mom's assisted living apartment. A one-bedroom, 45 square meters, with a little patio attached. I realized pretty quickly that my mom would need ongoing help to keep the place clean, but first things first: taking Bella for a walk, or so I thought...

I guess living in tropical climate for so long has spoiled me. Besides, last year in August, there was a heat wave. I clearly remember that it was a record-high summer in Germany. This year? Not so much… Let me just say that even the dog refused to walk any further, pulling on her leash to go back inside. I surrendered.

The first couple of days were just nasty! Cold, wet, and windy. Over the next two weeks, the weather would wildly fluctuate, between brutal late-fall and early spring temperatures. But when it was dry and warmer outside, it was much more bearable. On those days, we would pick up Karl-Heinz and go for a walk. Something that is a lot more physically challenging than it should be for a wellness town. The sidewalks are too narrow, uneven, and with high curbs, which makes it quite a workout to maneuver the wheelchair safely. Kudos to my mom, who manages to take Karl-Heinz to a café for ice cream or cake twice a week.

Speaking of Karl-Heinz: on August 17th, 2020, he missed his 70th birthday since he was still admitted to the hospital after his stroke. This year, we decided to celebrate twice. On his birthday (a Tuesday), we picked him up for the day and surprised him with a birthday cake, gifts, and a pop-up card. The weather wasn’t very nice that day, so we stayed mostly in. However, the following Saturday, we took Karl-Heinz to the Eis Café Bohne, where all of his close friends came to celebrate. I fact, this was the first time they had seen Karl-Heinz since his stroke. The smile on his face warmed my heart, and I am so grateful to the employees of the Café, who went over and beyond to make this get-together special.

So, before I go into the “epic fails” of my agenda, here are a few themes I picked up on while submerging back into German culture:

  1. It is completely acceptable to drink beer for any meal but breakfast (unless it’s a brunch). I guess that qualifies the majority of us to be labeled “alcoholics”.
  2. Germans LOVE to smoke – despite all we know about the detrimental health consequences. And they smoke everywhere!
  3. Trying to get anything done, such as banking or registration matters, is frustratingly complicated and backwards – despite the German reputation of efficiency and innovation.

Here is a collection of different beers I enjoyed while being “German” again:

Of course, food and desserts were also explored extensively:

Despite the challenges and anxiety that this visit brought me, I must say that I was the most “social” person in a loooong time! Nothing is perfect, but Corona wasn’t nearly as scary in Germany than the US. First of all, there was the mandate of wearing only surgical/NK95 masks whenever indoors. NO cloth masks allowed. And guess what? There was 100% compliance! EVERYONE wore a mask over the mouth AND nose – no dangling halfway.

Secondly, whenever my mom and I went to eat at a restaurant, we had to show proof of vaccination before we were allowed inside. They also do tracing with an app (mostly) to make sure possible exposures are followed up on. Very refreshing and reassuring indeed! I haven’t felt comfortable enough to eat out back home in US since regulations are more or less optional, and I never felt safe since Delta came along.

So, back to my ambitious agenda: I needed to transfer Karl-Heinz’s bank account from one state to another. Same bank, no problem, right? Wrong! Not only was I required to submit all kinds of documentation while waiting for an appointment, I also didn’t realize that his ID had expired back in June – and without his ID, I can’t move accounts. So, why am I the court-authorized, legal guardian if I can’t move the account of someone who resides in a nursing home and has been declared incapacitated? Well, after much back and forth, I now have to file for exemption for his ID and try again when I return.

Secondly, I paid an attorney to help me with that freaking supplemental disability insurance Karl-Heinz paid many years for. And now that he is disabled, they deny payment because he isn’t “disabled enough”. Seriously? All I can do now is wait to see what comes of it.

Thirdly, as an add-on issue, I wondered if my mom’s ID and passport expired as well. They did. Fudge. Here I was, again making phone calls and appointments with the Rathaus (local courthouse) to renew her ID. Straight forward, right? Nope, as it turns out, I needed to submit her birth certificate to RENEW her ID. Did she have one? Of course not. So I had to request a copy from a courthouse in a different state where she was born, but of course that wouldn’t happen in time. At least I sweet-talked the courthouse employee into letting us come in and sign the paperwork to at least get started. To be continued, I suppose…

Concurrently, my mom was apparently waiting for me to address a few more skeletons. She doesn’t like to ask strangers for help, so she waited for me to return. Needless to say, taking it easy to give my poor hip a break was out of the question. Besides sleeping on an air mattress blown up in her living room, I assembled a shoe cabinet, hung a bunch of pictures, discarded of several cardboard boxes, bought a new radio, and cleaned the shower (repeatedly). I also tried to find a cleaning service to help my mom, but even the assisted living resource had nobody to offer – massive shortage of cleaning personnel! Who knew?

I miss my Ponce so much, and having Bella (my mom’s Jack Russel) on or behind me all the time was kind of nice. She also really enjoyed my air mattress and took full advantage of it.

Despite all the setbacks and struggles, I tried to have some good times with my mom as well, especially since she waited for me to do a lot of things. So, when the weather permitted, I took her to the beach area, or just for a stroll in the city. We had a beer in that cute little pub where locals hang out (and she was too shy to go my herself).  We also encountered a training event of the local fire house.

Germany is also very progressive by providing designated parking areas for your Centaur.... However, I waited some time to spot one, alas to no avail...

In addition, I was subjected to quality German television… one amazing revelation was that any in-person shows had 100% compliance with mask-wearing.

I also realized that Otto is still around!

As the end of the trip came closer, I had to do this Covid home test from Ellume. Apparently, this is the only (emergency) approved home testing kit that can be used to return to the US. However, I had to order a proctored appointment along with it to make the results official. This was a new pretty nerve-wracking experience, and the person who walked me through the steps and observed me doing the test had a rooster crowing in the background, which made me almost snort out the swab. Since the results were uploaded electronically and generated an official PDF form, which I presented to the airline during check-in, I was good to go. I do admit that event though I knew I didn’t have Covid, the last 10 seconds gave me anxiety nevertheless…

What else… oh, I actually got to meet Patrick for coffee this time around. Patrick is a taxi driver in Büsum and drove us several times last year when Karl-Heinz just had his stroke. Turns out that he is a huge America fan, so I brought him my expired license plate as a gift. He found an awesome place for it!

On our last day, we went to the Eis Café one last time: my mom, Karl-Heinz, and I. The weather was mostly compliant, and we made it without getting soaked. I was rewarded with the biggest smile I have ever seen on Karl-Heinz’s face!

The next morning, my mom and I got picked up by the same friend, who drove us back to the Hamburg airport. Did I get done what I set out to do? Nope. The bank account is still in another state, the attorney to fight the insurance was taken care of but the outlook of success is unpredictable. Since my mom’s birth certificate hadn’t arrived yet, I wasn’t able to finalize the renewal of her ID and passport, and I was also not able to find a cleaning service to help my mom keeping her apartment clean. Oh, well, why have all the fun all at ones, right?

Appropriate for the occasion, the weather was grey, cold, and rainy.  I knew I had to return before the year was over, but leaving my mom behind day, alone, looking so small and vulnerable, and with everything being so different nearly broke my heart. But then there was Ralf, waiting for my return home, and I was also looking forward to seeing him. Can’t win either way…

Welcome back to the battle zone
Overall, the travel back home to Germany was pretty smooth and mostly uneventful. Both flights were in business class, so I had plenty of space. Everyone was wearing their masks, and going through security in Hamburg was efficient and safe. Fun fact: I was seated in the same row as a fellow traveler, who also lives in Orlando. We then ended up next to each other on the long flight as well. Small world. And guess what my first beverage of choice was when the flight attendant came over…? Hey, got to take advantage of luxury items when you get the chance…

10 hours later, we landed at Orlando International. Exiting the plane and going through immigration was a breeze. In fact, I was the first person to enter the big hall where all passengers have to go through immigration. Still, I tried out my Global Entry perks and made it through in less than 5 minutes. After my suitcases finally arrived, the struggle began. People, so many people: some with masks, some without, no keeping distance… yup, I am back in the States. I didn’t want Ralf to come into the airport, so he waited outside to pick me up at the curb.

I arrived on Saturday evening, so I had Sunday recuperate before starting work on Monday. Initially, I wanted to telework to mow through my gazillion emails and reorient myself, but since there were some unexpected issues that needed my personal attention, I got cleared by occupational health and made it to the Sim Lab by 10 AM.

We were still cross-training staff who had been detailed to inpatient areas. The mobile ICU was assembled in the ED parking lot and ready to receive Covid patients the next day. The hospital was beyond capacity as Covid went rampant throughout the community. Welcome back to the battle zone!

Because so many nurses poked my IV training arm in such short periods of time, it actually started to leak, so I had to order replacement veins already. I also got my repaired Nursing Anne back, so I dismembered the loaner to ship back to the vendor. While I wrapped the torso in a plastic bag, I couldn’t help but feel like a serial killer disposing of a body.

Self-care efforts
Even though I was still coming to terms with the idea of having returned to the capital of Corona and was pretty anxious, I picked up PT to tend to my neglected hip. I also did my first short bike ride but my overall endurance has much declined. But as always, I am picking up the pieces and try to make the best of things…

Speaking of biking: Ralf is really trying to get back into biking shape. I admire his resilience and determination to find a way to overcome his health issues. It really has taken a profound toll on his/our quality of life, the daily pain, fear of a looming obstruction, the morning rituals that prevent him to even leave the house before 10 AM. It’s bad. It’s unfair. And the post-Covid world we live in adds to the hardship tenfold. It makes me feel so helpless. So I support his efforts whenever I can, which included a rescue mission to save an Osprey.

Ralf was out with his bike when he encountered a beautiful Osprey, who hung upside-down in a barbwire fence! He disentangled the bird and shushed it away from the fence. But the Osprey appeared hurt and would not fly off.

That is when he called me for assistance. Since no agency was able or willing to come out and rescue the Osprey, we were going to try capturing him ourselves. The nearby wildlife refuge was willing to take in the poor thing, but they were unable to come out to help retrieving him. It was so hot outside, the sun was burning, and there was no shade to be had. Thank goodness though, when we finally approached the Osprey, he suddenly spread his wings and flew away.

Well, this update has become much longer than anticipated, so I decided to defer my experience with the IV Lounge to my next one. We just had the third infusion, so one more to go next week to complete the loading phase. Let’s see how it goes…

  • Hip Surgery
  • Return to Work
  • Moffitt Follow-Up
  • Upcoming Travel to Germany

Hip Surgery
After two weeks of non-stop work and prepping my Simulation Lab for my two-week (or more) absence, my labral tear repair surgery day was finally here. On June 17th, 2021, I reported at 8 AM to the Outpatient Surgery Center at Orlando Health. It was already a difficult morning because Ralf’s’ strict morning routine usually prevents him to leave the house before 10 AM. Outpatient surgery is a very different experience and reminded me of the countless spinal injections and the two endoscopies I had endured years ago. Overall, the process was very organized, staff was welcoming, and the nurse, who started my IV (in my hand, of course) did such an amazing job that I didn’t feel much at all. After my pre-op workup was done, Ralf was able to sit with me until it was time. I am very thankful that the Delta variant hadn’t hit the hospitals in Florida yet, so he was allowed to be with me.

Now, post-op was a wholly different story. I remember waking up, Ralf was there, and the nurse asked me about my pain. As was trying to evaluate the different sensations that I was feeling, I realized that my right hip/thigh was getting pretty uncomfortable. It was hard to gauge, and it kind of intensified by the seconds… “um, I am not nauseous, but my right thigh hurts – it’s about a 5….no 7…actually make that a 9!!!”. Thanks to the opioid crisis movement, I was getting only “homeopathic” doses of Dilaudid, 0.2mg at a time! I know for a fact that the lowest dose comes in 0.5 mg syringes, so I assume that the nurse diluted 1 mg of Dilaudid in a 10 mL normal saline syringe, giving me these minuscule amounts each time. That doesn’t work, just FYI… after a couple hours of this, I realized the pain wouldn’t get any better with this, so I decided to get dressed and get home. Poor Ralf had to witness my ordeal, and while he hurried out to get the car, the nurse transferred me into a wheelchair and parked me near the back door.

After we got home, I took a Percocet and went to bed. That actually helped me a lot better to control the pain, and I wished I had gone home much sooner. I was pretty messed up, falling asleep while chewing some bread, just to snap awake again with a little confusion. But at least I wasn’t nauseous, and I even managed to hobble to the bathroom on crutches. I realized two things: if I didn’t engage the abdominals when the right leg came off the floor, I was punished with VERY sharp pain in my groin. I was also very happy that I had the raised toilet seat installed – it would have been a nightmare without it.

I slept all throughout the night, and when I woke up, Ralf was there with my meds already lined up. Then I made a pretty disturbing discovery: because my iliopsoas tendon was inflamed and super-tight, the surgeon released it (by slicing my tendon in the middle). I was told during a pre-op appointment that my right leg would be “weaker” for the first couple of weeks. But as I was laying there in bed, trying to abduct my right leg, nothing happened. I mean absolutely nothing. I looked like a failed magician, trying to levitate an object. My brain was screaming “leg: MOVE”, and my leg was like “what? Did you hear something? Nah…”. In fact, I couldn’t lift my leg up for several weeks to come. It slowly improved, but I admit I was freaking out a little at the beginning.

I spent the first two weeks in Ralf’s armchair, learning how to get up and move without violating the “no-past-90 degree-bending” rule. Ralf was also having increased abdominal pain and related issues, which was not surprising, considering the stress and messed up routine. But we managed, and he took good care of me, helping me getting dressed and making sure I get my meds on time. Another thing I learned during those two weeks was that crutches SUCK! Especially if you are non-weightbearing on one leg. Boy, my hands were so bruised and tender from the repetitive pressure, it was pure agony. But overall, I was getting better.

Looking at that big dressing that covered my right upper thigh, I wondered what was underneath there. I had to wait 3 days before I was allowed to take it off and shower (with waterproof bandages). To my relief, I only found the three small incisions, and they looked good. I invested in a good supply of Mepilex dressings, since they are very gentle to the skin and stay in place for a few days. That harsh tape already caused some irritation, so after my first shower I changed them for the Mepilex.

I was so touched by the many well-wishes and gifts I received during this time. My friend Geraldine, with whom I graduated from UCF in 2014, sent me a lotion and pamper set. I also received a box with fruits and nuts from some friends from work, and a variety of other helpful things from Erika, Bonnie, and Bergie, who all visited me at home.

I was very eager to get my recovery going, so I started PT five days after my surgery. I was lucky to have found the Lake Nona Sports and Rehabilitation Center because it was not only 4 miles away, but the therapists Danny and Chris are also amazing.

First day of PT!

On July 2nd, I finally had my follow-up appointment, and I was determined to get off those despicable crutches. And I really needed to be able to drive, at least short distances to work and PT.

The PA who saw me was very happy with my progression and the way the incisions looked, so I was now allowed to walk without assistance. I was also cleared to drive if I felt confident enough. After the stitches were removed, I happily walked out with Ralf carrying my crutches.

Well, here is another fun fact about tendon release effects: once I was behind the wheel and had my right foot on the pedal, driving was very easy. I had full strength pushing the breaks without any pain, and I also could move my foot side-to-side. However, I was still not able to abduct my leg, which resulted in me having to physically pick up and lift my right leg into the vehicle… I hope nobody witnessed that, since it probably didn’t look very competent to drive (looks can be deceiving, lol). In any case, I was now able to go back to work and look after my Simulation Lab.

I had been doing my routine PT exercises every day at home, and I continued PT, mostly with Danny, which I credit with my current level of progress. I have to say, though, recovery from this procedure has been very different from ADR back surgery. I have had huge fluctuations in pain, with a major set-back two weeks ago when I was in a lot of pain. But overall, I have been trending up – every week a little better. I am on light duty at work, but I am still pretty active there, so that may have contributed to the ups-and-downs. I am now about 6 weeks post-op and even though I am not pain free yet, my ROM has much improved and I am ready to tackle the flight to Germany that is coming up tonight.

Return to Work
During the first 10 days post-op, I was able to telework from home. I took some hours of sick leave on short notice, based on how I felt.

After I was cleared off the crutches, I went back to work in person the following Monday. Since I still don’t have a Sim Tech yet, there was a bit of chaos (as expected), so I started to clean up and prepare the place in snail-mode. Not being able to lift heavy manikins or even walk at my usual fast pace was testing my patience, but I promised myself to not jeopardize my recovery by doing too much too soon. But I still got a lot done, updating and maintaining my manikins and help the new nurse educators to implement consistent staff training.

I got really lucky when the Education Department assigned me a Pathway intern to be with me for three months, and Casey has been a huge help so far. In fact, having her around has been a nice preview of what how it could be with permanent help in place. And as it turns out, the timing was crucial….

As the Delta variant started to spread like wildfire among the unvaccinated in mid-July, it became clear to me that we were heading into another pandemic crisis. I had various training events already scheduled in advance, but my gut told me to start looking into tightening Covid restrictions again. Ironically, I received an email from leadership the very next morning, asking me to do just that and provide a list with activities, along with group sizes, ect. That same day, I had a pretty elaborate central line catherization class going on, involving 21 students plus instructors. The CVC course was divided into parts 1 through 4, which I separated into four skills stations. But it was still a lot of people…

So, imagine me trying to figure out how to coordinate and manage future simulation-based activities moving forward, freaking out a little about the buzz that was currently unfolding all around me (even though I just got the email that morning, but still…). With my mind back in acute pandemic mode, I finally listened to my bladder to use the restroom. Since there was a bunch of folks in the front part of the Simulation Lab, discussing “common complications”, I decided to slip by the “what’s in the CVC kit & sterile field set up” station and exited through the back door. As I was rounding the corner to go to the bathroom, I suddenly stood in front of my boss (Chief of Education), the Chief of Staff (second in command of the hospital), and a guy with a camera. Mind me not, we are all standing in front of the main entrance to the Simulation Lab. It took me at least 5 seconds process what was happening: I won the 5S Quality Improvement Award of the facility, and Dr. Zacher was presenting me with the certificate! Right then and there! I clearly remember my thoughts, going from “oh, ok, I guess we are doing this…”, to “How am I going to explain what is happening behind the closed door”…. It was inevitable, they wanted to tour the Sim Lab, and I knew it was coming. When I look at the picture that was published in our newsletter, I can clearly see the anxiety in my eyes.

Again, in reality, I didn’t do anything wrong, especially since everything was so calm for a while, with no COVID patients at all in the hospital, just before Delta hit. But still, things had changed rapidly, and when I opened the door, there was such an energy and buzz going with a gazillion people everywhere (or at least that’s how I perceived it). To my relief, Dr. Zacher was very impressed with the high-quality training we just recently put in place. Needless to say, I didn’t get to pee for another hour.

A week later, I got another visit in the Simulation Lab: Dr. Zacher (twice now in one week!), the Medical Director, and a lady I didn’t know. Casey and I were actually busy with planning the skills stations for cross-training nursing staff to be detailed to inpatient care units to buffer the lack of staffing. I was just setting up the “IV insertion” practice station (complete with fake blood) when they arrived, asking for a tour. I was like “sure, come on in, pardon the dust”… I found it odd that the Medical Director was asking me all these questions about the Sim Lab and my Virtual Reality innovation projects, so later that day, I did a Google search to find out who that lady was. Well, as it turns out, I was paid a visit by Dr. Clancy, Deputy Undersecretary of Health from Washington! I guess the Simulation Lab has now morphed into an asset to our hospital and staff education, which really makes me happy and a little proud.

As I mentioned earlier, I was busy with setting up skills stations to train nurses to cross-train for inpatient care. That means that nurses, who usually work in areas, such as mental health, PACU, primary care, ect., get prepared to support inpatient care in existing and newly-created patient care units. Yes, we are back to that, just like last year. Since I already had my flight to Germany booked, I needed to make sure all stations were set and operational, resources were in place, and the nurse educators were able to trouble-shoot when necessary. I do feel a little guilty leaving right now, but I am also relieved a bit. With so many people (including healthcare providers!) unwilling to get vaccinated, we haven’t seen the worst yet.

But before I even go there, the last week at work also included Ralf’s follow up visit to Moffitt. The anxiety and fear were indescribable, and especially the days leading up to this appointment were very difficult for both of us. In addition, we lost a dear friend, Mikey, just the week before. He was very unexpectedly diagnosed with stage 3 colon cancer six months ago, underwent emergency surgery, and had been declining from that point on, despite all the fight. My heart also goes out to his wife, Fay, who barely left his side. She was fighting with him to the end, and it was because of her that Mikey was able to go on his terms, at home in their Airstream, with hospice service in place. It just all went so fast in the end, and even though it was also extremely taxing and scary to drive the two hours in the car, Ralf and I were able to make it to Tampa to say good-bye. It was so emotional when Mikey recognized Ralf, a smile forming, and saying “Ralf, you came!”. I left the two alone for this moment, and I was sitting with Fay, a soul I can relate to so much, as I have had my own share of “what if” thoughts and emotions. Mikey passed away three days later, on August 7th at 9:35 AM.

It still feels so surreal, so unjust. And with our heart still heavy, we had to shift gears to face Ralf’s own follow-up the following Monday. The good news: the cancer appears to be stable, with some “waxing and waning” here and there. He will never be cancer-free, and the repercussion of this brutal surgery, along with the fact that sheaths of cancer still encase some parts of his organs and intestines, explain some of the chronic GI issues and pain. This will likely be with him for the rest of his life, but Ralf is determined to find the best “new me” version he can be. Also, there is no prognosis: the cancer can be stable for decades to come… or not. Nobody knows, but my gut is telling me that he will have many, many years to come! The next follow up is not until next year February, and hopefully we can then go on an annual schedule.

Upcoming Travel to Germany
I have refrained from posting anything about the current Delta surge and vaccination issues. This has become an ugly debate between the proponents of the vaccine and antivaxxers. My own mental health has been pretty affected by everything that has happened. I didn’t want to become a target of people who refuse to get vaccinated for various reasons. I have lost precious friendships over this, which I never thought would be possible. But I realized: I AM angry. And since it is ok for others to voice their opinion, I decided that I also have the right to get this out of my system:

After we started to finally get more and more people vaccinated, the numbers of infections and hospitalizations dropped during the spring. I started to feel somewhat safe again, and Ralf and I went out to meet with vaccinated friends in restaurants a couple times, and going to the grocery store was much more relaxed. However, we both kept wearing our masks inside buildings. I even got to go to Universal Studios the end of May, and it was such a liberating feeling. But then came the Delta variant, fueled by the huge number of people who refuse to get vaccinated. This variant is much more infectious than the original strain, so now we see this sharp increase in Covid infections – again! Do you know that my hospital is now so overwhelmed that they took stretchers out of the Simulation Lab because we are running out of beds? We are back to emergency tents in the parking lot, trying to create more space! This affects all of us, and I feel betrayed by the people who decided that they rather take their chance with this deadly virus than taking this “experimental” vaccine!

Here is how I see it:
The only reason why we were able to come up with a vaccine at all this fast is the fact that mRNA vaccines are NOT new. They have been researched for a long time, which is the reason why this vaccine could be customized to this virus so quickly. It works, it is safe, and we have massive amounts of worldwide data to back that up. Sure, we can try and reach herd immunity over the next several years to come, exposing ourselves to potentially even more deadly mutations along the way. Well, this virus is nothing we have seen before, and with the vaccine, we could have prevented this massive surge.

It is not just “your choice”, since this affects everyone, no matter what. The fast majority of hospitalized Covid patients are the unvaccinated. Since we now have no more ICU or other hospital beds, other people with medical emergencies are dying because there are not resources. Chronic diseases, heart attacks, accidents…. All those people can’t get the care they need because we have, yet again, overwhelmed the hospital systems. Oh, and did I mention the significant amount of healthcare providers who are out sick? Overrun with patients and understaffed – and the virus keeps spreading and spreading…

Sure, we now see a percentage of vaccinated patients who get infected regardless. It’s inevitable by the massive spread of this virus, but the vaccine still does what it is supposed to: it prevents severe disease and death from happening. No severe disease, no tying up a hospital bed. In my mind, getting vaccinated is the least anyone can do to help end this madness! I don’t like the idea of the government forcing people to get vaccinated. But then again, they shouldn’t have to!

Am I selfish? I guess I am because I want to be able to go to a restaurant with my husband without fear. I want to be able to go grocery shopping, go to the movies, or a theater. I want to be able to travel to see and take care of my family without being petrified of getting infected and potentially hurting my family. The higher the virus load is out there, the higher the chances of getting infected even with being vaccinated. The main fuel for this virus is provided by the unvaccinated, and until that changes, we will continue on like this, from one wave to the next.

I am getting ready now to go the airport, in fear, and travel to Germany to take care of my family. It’s not a vacation, it’s a necessity. I did my part and got vaccinated, but that is all I have control over at this point. Rant over.

In this Update:

  • Taking it one day at a time
  • Becoming a Sim Tech
  • Vaccination = More Freedom
  • Universal Studios
  • Prepping for surgery – again

Taking it one day at a time
I am finally sitting down to write this update, just in the nick of time prior to my labral tear surgery next week. I just wish I could be less stressed/worried/overwhelmed, but life has somehow become a world of tasks and responsibilities. I really wanted to go see my mom and take care of a couple of things in Germany, but the slow vaccination progress and continuous lockdown in Europe made that impossible. By the time I would have been able to fly in May, it was getting really close to my hip surgery on June 17th, and Ralf has not been well either.
Now my mom is desperately waiting for me to be well enough to finally visit, but Ralf’s condition hasn’t improved much, and I really don’t like to be away. Mainstream medicine has no answers as to why he is struggling so much with debilitating digestive issues and pain, which has really taken a toll on our lives. I am also having a really hard time to enjoy even the little things – things I should be grateful for, but I often just feel so tired and empty. Then there is the pain in my hip that reminds me now daily that I am injured, again. I am also fighting Karl-Heinz’s supplemental disability insurance (ironically called IDEAL). They happily collected 70 Euros a month for many years but denied him the promised benefits because he is “not disabled enough.” Seriously? Now I have to file an appeal and fight this, too? At least work in the Simulation Lab continues to be great, but since the VA hasn’t been able to even post the job announcement for the promised Sim Tech, I am really busy managing all the aspects and projects by myself. But soon I will get to work with an amazing anesthesiologist, who will be dedicated to the Simulation Lab, starting with 4 hours/week. I take it...

Well, as I said, I am taking it one day at a time in order to push on and deal with whatever is put on my plate… I hate to sound so whiny, but I had to get this out.

On a more positive note, Ralf and I managed to get a few outings in when he was feeling better. We also went for some swims at our community lap pool (I now swim without leg-use), and we purchased an ECHO assault bike to enhance Ralf’s rehab efforts. It is still hard for me to work, even though I know I should; I just don’t have the energy, but I hope my state of mind will continue to improve. I really need to commit to rehab after my surgery!

We also introduced new activities at home: due to my work with VR, I decided to buy the Oculus Quest 2 headset. Ralf enjoyed swimming in the ocean with various creatures, as well as shooting angry birds at piggies. It’s really a lot of fun. Me, I tried one of the Star Wars games! That was intense, and I ended up (regretfully) crouching behind imaginary walls while being under attack by a bunch of storm troopers…. That is when realized that I am not a Jedi, especially since just getting up from the floor was a painful and awkward process….

Our latest hobby is solving murders at home: Ralf got us a murder mystery box, and I must say it’s a lot of fun! It took us a while, but we found out who killed the bar owner. Now we are hooked and will get more of those cases for sure.

And one other thing happened that really made me smile: we got some home-grown turmeric roots from a friend last year for juicing, but I kept one root and planted it in a pot. Because it was October, I was told that the root will most likely stay dormant until summer... and what do you know? When I checked on Tumi a couple of days ago, guess what???

Tumi is sprouting!!!

Becoming a Sim Tech
My work has been a good distraction, and I must say it really makes me laugh when I imagine those poor guys in the warehouse open my boxes to inspect the content, just to find human-looking skin suits, vaginal cuffs for the laparoscopic task trainer, or various other body parts for training.

As I mentioned earlier, it will still take some time before the promised Sim Tech will get hired, and so I had to find a way to set up, configure, and repair my equipment myself. I even created a below-the-knee amputation by cutting and bolting an old rubber knee from another task trainer on this guy....

I also tried to get my innovation projects implemented before my surgery, so I took creepy Norma and the Hololens Augmented Reality technology to the CLC to conduct my Stroke Education Pilot Project with the nursing staff.

And I got the Cleanbox project under way as well! Those boxes are supposed to clean VR headsets reliably with UV lights, so I made three carts to support the other VR innovation projects in the CLC and Whole Health. I love the fact that the face of one of my manikins is visible as reflection of the Cleanbox to my right, lol!

Since Virtual Reality in healthcare education has become my research focus, I got the unique opportunity to demo the Oxford Medical Simulation VR platform to train RNs and providers. Let’s see if we can somehow implement this for the next round of internal medicine residents.

Especially with all the stress and worries that continued into 2021, it was nice to be recognized for my work in the Simulation Lab. First, I was nominated as “Federal Employee of the Year” for Central Florida (I didn’t win but I guess it’s still and honor to be nominated), and then I won the 5S Earth Day Contest for my facility (this was for the transformation and clean-up of the Simulation Lab). This award actually came with a $2000 prize, which was a nice surprise.

Vaccination = More Freedom

With both of us being fully vaccinated, Ralf and I started to venture out into the world again. Our first dinner at a restaurant was at Nona Blue, and especially since we opted for outside seating, we felt pretty good about it.

Our second choice was Chroma, which is also in Lake Nona. Because Ralf’s condition is pretty unpredictable right now, we chose places that are close to home. But just being able to be to do things like dinner at a restaurant gives me some hope of more normalcy…

On my birthday in late May, Ralf took me to Don Julio, which is one of the newer restaurants in Lake Nona. The food was excellent, and I got to enjoy the first (delicious) Margarita in a year and a half!

And then we finally got to spend some time at Nicholas and Sharon's. We used to go out for dinner on our respective birthdays, but due to sickness and the pandemic, we weren’t able to meet up for a very long time. Thank you for the balloons, too!

Universal Studios
In an effort to regain some of my emotional well-being, I decided to spend the day at Universal Studios/Islands of Adventure. Even though my hip had started to really bother me, I figured if I walk more slowly, take my time, and don’t squat down, I’d be alright. I am so glad that I didn’t have to wear a mask outdoors anymore, only when in line for a ride or when inside. It was very nice to be able to go out to the theme parks again – even though emotionally, I am still kind of “muted.” I have a lot of memories connected with this place, with my mom, Karl-Heinz, and even from the time when I first came to America - I was so much young. It reminded me at times that things will never be the same again.

In any case, my first destination was the Hulk! As a single rider, the wait was not bad at all, and I ended up in the front row!!! Awesome start to address my “need for speed,” lol.

But it got even better: there is a new ride in Jurassic World that wasn’t officially open yet, but they let people in intermittently to do some trials. Again, I got really lucky: right time, right place. The VelociCoaster ejects the ride at 70 mph and offers a couple more acceleration spurs during the ride. So, the Hulk has now dropped to second place of my favorite rides…

But just because I took the day off from work doesn’t mean I didn’t need a reminder from the universe that I am still a nurse… I decided to do the Simpson’s ride, which is a 4D animated ride that really does an amazing job to trick the brain into thinking you are actually on a bonkers roller coaster. In fact, this was the first and only time I heard Karl-Heinz squeal with joy when I took my family there in the past. As I was watching the silly security movie in the holding chamber, the doors opened, and as I waited for the family to exit the ride, I heard a loud “thump”, followed by “oh no! Are you alright?”. Sure enough, a large lady fell out of the vehicle and landed on her knees. So, what is my first instinct making me do? Yes, I squatted down next to her and did a quick assessment to determine the potential injuries. The family gathered around, then it got pitch-black and really loud as the ride behind me started again!!! Thank goodness, at some point the cast member realized that something has happened and stopped the ride. I told him to get a wheelchair, and after we got everyone out safely, I was given two Express Passes as a “thank you” and got to do the Simpson’s ride all by myself. With Express Passes in hand, I added the Harry Potter ride and The Mummy to my agenda before leaving back home.

Prepping for surgery – again
As I am writing this update, I have four more days before the hip surgery. Ironically, even though I didn’t do x-rays for my the three-year anniversary of my disc replacement suregery, I did get updated picture of my ESP after all when I had my hips evaluated…

I joined another support group on Facebook, in order to get a better feel for what I may need during my recovery. It is amazing to see the group’s interactions, sharing of experiences, and questions – which has a very, very similar feel like the ADR support groups. Here we go again, I suppose. At least I think I have my ducks in a row: got my elevated toilet seat installed, got my crutches, and bought some gel ice packs. I still have a two-day course to facilitate next week, but at least that prevents me to think about the surgery too much… Next update will be post op – again.

In this Update:

  • L5/S1 Lumbar ADR: 3-Years Later and Still going Strong
  • Some Progress, Some Setbacks
  • Making the Best out of Things
  • The wonderful World of Simulation
  • A Blast from the Past!
  • Happy 11th Anniversary

L5/S1 Lumbar ADR: 3 Years later and Still going Strong
My last update was posted on December 31st, 2020, and even though four months have passed, I will start out with a self-assessment of my LP-ESP disc that has been part of my spine for three years. In the past couple of years, I had X-rays taken annually. However, I decided to change to every other year (unless something unusual comes up). So how do I feel? Well, even though I have kind of neglected my rehab during this last year from hell, my back actually feels even better since the last update. The overall tightness in my neck, shoulders, and back has eased off, and I have no pain to report in my lumbar spine. It is pretty amazing that I don’t feel something “foreign” in my spine, and never have. I can bend, lift, and twist without any issues, so I am just grateful at this point and hope that I have many more good years to come. I guess, three years is not really considered a “long-term” outcome, but I’ll take it. Next year, I will get X-rays again to compare, but I truly don’t expect any drastic changes. I take my calcium every day to keep my bones strong, and I will hopefully get more motivated to resume a structured workout program soon.

However, I have finally faced a different elephant in the room that has set up shop in my right anterior hip since spring of 2020. I first noticed that there is something wrong during my workout at the gym (just before the first lock-down). I was doing foot-elevated lunges, which never been an issue for me, but when I went down with my right leg, I couldn’t come back up due to intense pain in my right groin. Ever since then, I have had this deep, dull ache in the anterior hip region that was aggravated by certain movements, such as squatting, twisting, or fast walking. However, due to all the madness, stress, and fear that made up most of 2020 due to COVID, I sucked it up and ignored it. When the new year came, I promised Ralf and myself to start taking better care of myself. So, I went to investigate what’s happening in my hip. My new physical therapist, Lynn, was pretty sure that I had a tear in my labrum, … aaaand he was right. After getting an MRI of my hip, the report revealed a “shallow anterior tear with fraying." Great, that is just great. After everything I went through with my back: insurance nightmares, trying to find the right procedure, finding the right surgeon, I feel like it starts all over again. In fact, the first surgeon (who put in the order for the MRI because "I know you will ask for one") told me "well, if you were in your twenties, I may have referred you to someone to scope you, but at your age..." His approach, thus, in my case, is for me to pretty much "just suck it up and live with it." Needless to say, I didn't follow up with that guy.

Well, next Monday I have an appointment with a different orthopedic surgeon, who specializes in labral tear repairs. Let’s see what the recommendation and prognosis will be.

Back in the fancy "one size fit all" pants, ready for X-rays... Not of my back but my hip for a change

Some Progress, Some Hope
I am not going to lie: the pandemic, being a frontline worker in the ED during the first two waves, lock-downs, political insanity, Ralf’s health issues, Karl-Heinz’s stroke (when I had to travel to Germany twice in the middle of the pandemic), starting a new job, while living in isolation from society and constant fear of getting Ralf sick has left a mark. I have crumbled a bit under the circumstances, and I am still struggling to find a way to live in this new reality.

I saw this picture posted somewhere a while back, and it really spoke to me. It kind of sums up how I feel about the world right now…

But with that being said, there also have been glimmers of hope: I got my second Pfizer vaccine on January 8th, 2021, which was a big relief, knowing that I eliminated Ralf’s biggest risk factor of getting infected – me! I am also a lot less anxious when grocery shopping or going to work, which has been a step in right direction.

Not counting the unspeakable madness that took place at the Capitol on January 6th, the political climate has much improved, and I am hopeful that this country has now a chance to maybe recover from all the hate, greed, and lies. At least the new administration has really sped up the vaccination efforts in this country. Because of an executive order from Florida’s governor DeSantis, people like Ralf with preexisting conditions were excluded from being vaccinated. “Seniors first” was the motto, and to make things worse, the vaccine rollout was slow and inefficient. But after the Biden administration took over, things started to move. So Ralf was finally getting his (Moderna) vaccine the beginning of March. He just got his second dose, so by mid-April, he should have significant immunity as well.

Making the Best out of Things
Speaking of vaccine screw-ups, Europe really dropped the ball on securing enough vaccines and resources to vaccinate their citizens. Instead, Germany has been in lock-down (changing from severe to moderate back to severe) since mid-December, and it was just announced that the lock-down will be extended to at least mid-April. But since they can’t get their act together, I am sure that will be moved out again soon. My poor mom has been “imprisoned” in her new apartment and is only able to walk Bella or go to the grocery store. The weather has been mostly nasty too, so it can get really lonely and depressing after all this time. At least she was able to pick up Karl-Heinz again a couple of days a week, so that has been an improvement. He is doing reasonably well, and the nursing home is taking good care of him. Also, both are now vaccinated (my mom should get her second shot next week), but that was only due to the fact that they both belong to the DRK nursing home complex. I try to make the best of things and talk to my mom almost every day. We also video-chat (via Whatsapp) when technology isn’t getting in the way.

Her “carrot on the stick” is my impending visit. I really wanted to fly back to Germany beginning of February to tend to my mom and take care of a few thing related to Karl-Heinz. However, since the lock-down keeps getting pushed out, I still wasn’t able to even book a flight. But when the time comes, I will be able to speed up my travels because I just got my Global Entry membership approved.

Ralf continues to struggle with pain and gut issues, and it is so hard to find a GI specialist who actually thinks outside the box to help him. In addition, his own mom needs a triple open heart bypass surgery which will take place in mid-April, and his tumor markers are due. He may or may not go through another colonoscopy/endoscopy, depending on his current GI's office getting their sh#$ together. But we still try to go on our outings on some weekends to spend some time together, away from all this. One phenomenon I observed is that ever since the pandemic, a lot more people find their ways to the outdoors. The parking lot at Split Oaks was so full the other day that cars were lined up on the side of the road as well. Downside: you run into people more often, which is what we have been trying to avoid.

So we started to explore new and old places that are more remote and, therefore, have less people going there. We ended up on some really nice hikes, and one plus living in Florida is our nice weather…

 We also visited the Wallaby Ranch on one occasion to meet old friends (while socially distanced) and watch some hang gliding action.

The wonderful World of Simulation
Ironically, the one thing that has really going well for me is work. I have only been in my new position as Simulation Coordinator for about ten months, but I have come a long way. Putting all my energy on building this Simulation Lab and getting things moving serves as a great (temporary) distraction from my worries. As a result, my career appears to accelerate, and I am now collaborating with peers across the country. I even learned how to share my screen on Teams, which became necessary due to multiple presentations I had to give lately. I am also educating myself on the more “technical aspects” of simulation-based education, since the Simulation Technician position has still not been posted. Another specialty that I am also deeply involved in are Virtual Reality projects, which is very cool...

I guess it is a little creepy that I get body parts delivered in boxes, and that I dismember manikins, prime fake arms with fake blood, and hang them up to dry later. I love to use my manikins as props, and I have named them all. Yes, I do talk to them sometimes, but I figure as long as they don’t start talking back, I am ok…

Hololens 2 Augmented Reality Demo!

A Blast from the Past
Oh my goodness, this was the strangest thing that happened in a long time! Even though I sometimes wish that I had more pictures from my time as an adolescent, I am also grateful that not all the crazy things ended up on social media, like it is the case today. To my huge surprise, that isn’t entirely true: when I was just shy of turning 14, we moved from Hannover city to this tiny village Hotteln, which had 500 citizens. That was not only a culture shock for a young teenager like me due to the size of the place, but also due to some really old, local German traditions are really a thing there. I think we hadn’t even lived there for a year yet when the time came for the annual “Putze Tanz Fastnacht.” The entire village was so involved and excited, and this celebration (which was supposedly based on true events) took place outside in the streets all day and ended up in the main “event hall” late at night. Part of the tradition involved masked guys (Plumpsäcke) running through the streets to “beat up” older children and girls with a stocking stuffed with socks. I am not even sure how I ended up talking about this event to Ralf a couple of weeks ago, but I couldn’t remember the name of it. A quick google search yielded more than I bargained for: a 15-minute documentary, sponsored by the state of Niedersachsen, from…. 1990!!! Yes, the only year I was actually there! And guess who was beaten up by masked guys in the beginning? Moi!

And guess who else appeared multiple times in this documentary: my mom and Karl-Heinz! In fact, my mom was the same age as I am today when that took place. Now, let me just say, this whole event is just bat-shit-crazy, and anybody who is brave enough to watch the video footage may think we all lost our minds… Judging by my mom's and Karl-Heinz's' expressions, they couldn’t quite process what was happening either!

Happy 11th Anniversary
April 1st is our designated anniversary date. That was the day I moved in to look after the Ponce while Ralf was away for a freediving course… and I never left. That was 11 years ago, and I can’t even remember what life was like before Ralf and I became an item. Due to the pandemic and other issues, we couldn’t celebrate by going out. However, we got take-out from a fancy place and had a nice meal together at home. Happy anniversary, Sweetheart!

1

In this Update:

  • Summary of Current Affairs
  • Clear Passage
  • Germany-Part 2
  • Hanging in There for Now

Summary of Current Affairs
This has been the longest break between updates ever. I just couldn’t do it – even though maintaining this blog and reflecting on life has become very important to me, I just wasn't able to sit down and focus. Somehow, it has all been a bit too much lately. Living in constant fear of getting Ralf sick, even when going to the stupid grocery store, the inability to go to retreats like the theme parks, getting my teeth cleaned at the dentist, or just getting a simple hair cut has really left a mark. In addition, having to witness Ralf’s’ ongoing set-backs (his weight was 140 lbs at one point) without being able to do anything about it, along with dealing with the aftermath of the Germany disaster kind of topped it all of.

I have reached the end of my (mental and physical) capacity, for now, until I figure out how to recover and find some joy and hope. Anticipating "the next shoe to drop" on a daily base can truly take the fun out of life. However, I do enjoy my new job in the Sim Lab very much, even though I now must telework a lot more due to the rise of COVID cases. I also am grateful not to be disabled with a broken back on top of everything, which would have prevented me to do a lot of tasks the way I did. I do feel sore – all over sore, and I haven’t worked out much at all. I just couldn’t get myself to do it; it's hard to explain. But I believe that after I get my overall health into a better state, the body will follow.

Every so often, when Ralf feels ok, we would go for a bike ride, or a hike. It's nothing like what we used to do but it gets us out of the house every conce in a while...


Clear Passage
It has been a struggle to get the adhesion treatment approved and scheduled by Clear Passage, to say the least. Insurance doesn’t pay for it, so the $7,500 came out of our pocket. But that truly doesn’t matter, it needed to be done for sure! Ralf’s health has been declining rapidly, with excruciating abdominal issues, pain, and fear of yet another episode during a time where going to an ED would be a disaster, due to the fudging pandemic. When Ralf finally was confirmed for the second week of August, he was a mess. Yes, he “beat cancer”, but the shocking aftermath of this radical treatment has robbed him of quality of life beyond measure. He was so afraid to eat, and there was no rhyme or reason to what he would eat and how his body would respond to it.

Long story short, we arrived in Gainesville on a Sunday, after a 2 hour drive, and checked into the guesthouse of the owners from Clear Passage. The accommodations were pretty amazing and even included a pool, a theater-like set up in the living room (including 10 leather recliners), and a full kitchen.

At one point, the owners invited us on a mellow boat ride in the evening, which was a nice way to get our minds off the constant worrying. Plus, there were three happy Golden Retrievers on board, making us smile.

Over the next five days, Ralf would have four hours of therapy per day. It was painful at times, but the treatment really helped a lot to restore digestive function by “rearranging” and manipulating the adhesions that are strangling his insides.

With that being said, Ralf was a lot better after the therapy, and he still does his “homework” every single day as instructed. However, the fear of episodes remained, and he had some scary set-back weeks after, which we were able to manage at home though. I was just hoping with all my heart that this was the final treatment to restore his well-being, but it appears there is still a vital piece missing…

Germany: Part 2
Well, as events unfolded, I had to leave Ralf’s side yet again to tend to the crisis in Germany. My mom was just a few days away from moving into her new (assisted living) apartment, but she was so helplessly overwhelmed. I was hoping to delay more international travel due to the pandemic and Ralf’s state of health. But after a FaceTime call with my mom, where I actually took a screenshot because she looked so bad, I had to make this most difficult no-win decision: leaving Ralf behind, or abandoning my mom.

Distressed

So, I needed to get to Germany to make sure things were taken care off. With very mixed feelings, I booked my next flight. At least upgrading to business class is much cheaper these days, so I did my best to “social distance” on the plane. I also did a rapid COVID test the day before to make sure I am not sick without symptoms.

As mentioned before, my mom moved into her new place about a week prior. My goal was to find a good routine with her, put resources in place, and practice with her to pick up Karl-Heinz, who lives now in the nursing home portion to the DRK. My mom’s apartment is actually in the same building as Karl-Heinz’s unit, which would be so convenient if she could just walk down the hall to get to his unit. However, due to COVID, she wasn’t (and still isn't, of course) allowed to do so and instead has to walk all around the building to the other entrance to pick up Karl-Heinz (after making a reservation).

At this point, it was also time to reunite Bella and Karl-Heinz. She hasn’t seen her master since the stroke happened in July, and now she is in a new place three months later. I arranged the first meet outside, and it went very, very well. Karl-Heinz and Bella were so excited, and he cried when we brought him back later that day.

My mom and Bella were so exhausted after the reunion that both fell asleep right away…

Before I left, I made sure my mom had a good routine with Bella, including a nice path to walk her. I also took her to a new primary care doctor to establish care and to make sure she was ok. I am very proud of her, because she is now able to manage the wheelchair by herself and shuttle Karl-Heinz between her apartment and the nursing home without major issues.

I also signed the sales contract for the house, dealt with the court system, and mowed through the mountains of paperwork to figure out banking, utilities, and insurances.

I think I did my best to put most important resources in place and deal with all the legal issues involved in the transition. So, when I traveled back home, I felt better about the set up than before. But now I had to switch gears and focus on Ralf’s health and my work again.

I did make sure that I was home in time for Ralf's birthday, which also marks our first anniversary. We celebrated at home, of course, eating take-out from the same restaurant we went to after our wedding.

I also did my civic duty and went and cast my vote at an early-voting location in Orlando.

Hanging in There for Now
Life is difficult, life is hard. Wise words of my late friend Libby, who died in August 2020 after losing her battle with cancer. Life even gets harder when a global pandemic destroys any chance of normalcy. Getting screened for infection and having my temperature taking prior to getting to work has become the new normal.

I was hoping to be able to fly back to Germany around Christmas time because this is the first Christmas since the stroke, the move, the forever-changes. But as people continued to dismiss precautions, the virus has been on the rise, causing another lock-down that started in December in Germany, spanning over the holidays into the new year. COVID has also been spreading like wildfire throughout the US. Therefore, I wasn’t able to go. It was the first year ever where my mom had to spend Christmas alone. At least she has Bella... Despite all this, Ralf and I decided to get a tree after all, even though I really wasn't in a merry mood.

Karl-Heinz wasn’t allowed to leave his unit to stay at my mom's place for even an hour, but at least the staff in his unit organized some holiday events (photo was emailed to me from the nursing home administration).

Ralf continues to struggle, and it breaks my heart because he did EVERYTHING he was advised to do, but his life is still without much quality. The mainstream healthcare system is truly letting him down, and nobody appears to be able to help him. Other follow-up interventions included treatment for PTSD and anxiety, new medications, seeing a functional training coach, and other PT treatment (with micro-currents for the scar tissue). So far, every treatment has helped to address some pressing issues, but he still hasn’t found the “final piece of the puzzle” that would enable him to have true quality of life again.

At least we made it through this horrible year. Somehow. I am grateful for the outcome of the US election (after much drama), but it will be a long way to counter some of the damage done to this country.

For now, I will focus on the only thing I have some control over: my work. Due to the rise of the virus after Thanksgiving, I was issued equipment to work remotely.

Even though I am teleworking most days right now, I still get some hands-on activities here and there. I even created a thyroidectomy incision for a simulation, which significantly increased my appreciation of surgical suturing.

I also was fortunate to receive my first COVID vaccination on December 18th, with my second shot scheduled for January 11th, 2021. Maybe, just maybe, this could be the beginning of the end of this awful pandemic that has made tragic life events even more intense.

In this Update:

  • Getting the Simulation Lab Functional
  • Enjoying More Outings
  • Disaster Strikes Again

Getting the Simulation Lab Functional
As I mentioned in my previous update, the Simulation Lab I inherited was a… what can I say, hot mess! And since there was nobody to orient me, I just started with doing inventory to see what I was working with. It was mayhem! All my (very heavy) manikins were sitting on tables, my second CentraLine task trainer was AWOL, and the new group of internal medicine residents were about to start their rotation, needing the services of the Simulation Lab, in a couple weeks… No pressure here! Thank goodness for my strong connections to the adjacent National SimLEARN Center, where I borrowed two amazing Sim Techs to help me update and troubleshoot my equipment!

Even though things were a mess, it also gave me the opportunity to make this lab my own. I figured out things on the fly, identified my allies, found necessary resources, developed a grant proposal to replace much needed items, networked with a lot of departments and specialties to increase training opportunities and add to the curriculum, hunted down data to back-track utilization, and implemented a new tracking tool. Then I created post-simulation evaluation forms, sign-in sheets, and helped develop high-fidelity case studies. I am also working on the application to re-certify the Simulation Lab, which is due in October…

I can’t say I have been bored. My direct supervisor told me at one point that I accomplished more in three weeks than others in six months… Well, this came in handy when disaster struck later that month…

Enjoying More Outings

Since I now have a consistent schedule, where I am home in the afternoon, and with all weekends off, doing things on my days off has become much easier. Ralf and I have continued to have some outdoor adventures, despite the daily rain and steaming heat.

Disaster strikes Again

As it turns out, this awful year of 2020 is not done yet, as the next disaster occurred. On July 8th, my mom called me in the evening to let me know that Karl-Heinz was in the hospital. When she was looking for him to eat dinner, she found him undressed, on the floor, with altered mental status. She was trying to get him up but when that didn’t work, she called the neighbor for help, who in turn called the ambulance. It was so heart-breaking when she described to me on the phone what his symptoms were… I looked at Ralf and said “he had a stroke”. My mom didn’t even know which hospital they brought him to, so I googled the area and called to most-likely place. Even though they wouldn’t give me any information over the phone, it was confirmed that Karl-Heinz was in intensive care at their hospital. I gave the nurse I talked to my mom’s phone number, and a doctor called her within the hour.

What really upsets me about the German healthcare system is that it appears to be stuck in the 1960s. Nurses have no autonomy and limited scope of practice, and doctors are the “gods in white”. Family is not really included in the care, so nobody will give you information or explain things that can be understood by non-medical people. In fact, it wasn’t until the next day when I finally was authorized and able to talk to one of the doctors that I realized how bad Karl-Heinz’s condition was. And of course, I had to explain it to my mom, who still didn’t quite understand the magnitude of the circumstances. I made her cry, and it broke my heart. So, Karl-Heinz suffered a massive stroke, caused by a third-degree heart block that resulted in three blood clots that then traveled to the brain, bringing on the stroke. He had been unconscious for the first week, so when I arrived the following Monday, he didn’t even open his eyes.

I felt really bad when I had to let my new boss know that I had to go to Germany in a couple days. Even though I only started in the Education department three weeks ago, she was so accommodating, getting my FMLA filled out and approved within one day! I was even cleared to take my government laptop to telework, since I didn’t have much leave left. On Sunday July 12th, I was sitting in the Orlando Airport, mortified of flying international during this deadly pandemic, and worrying about possible quarantine when I got there.

And don’t think that United Airlines would leave the middle seat open: the flight to Frankfurt was packed! However, I booked Economy Plus on way there, so I was facing a wall ahead, and the lady next to me was a mother of a young child, so she was facing mostly the other way. There was also a sweet puppy on board, on her way to Italy.

When I arrived in Germany, I was so very anxious about what would happen next. I was standing in line at immigration, and when I handed over my Germany passport, the officer just wished me a good day!!! No questions about where I am coming from (a Corona hotspot!), so I grabbed my belongings and bee-lined to my connecting flight to Hamburg. Such a relief!

I arrived in Hamburg around 10 am, and after collecting my luggage, I was picked up by my mom and the neighbor’s son in law. It was so strange, since it was always my mom and Karl-Heinz who would great me at the airport. But not this time, not ever again… It takes about 1 ½ hours from the airport to Wesselburen, and after we arrived, I freshened up and drove to the hospital to see Karl-Heinz that afternoon.

It was bad. So bad. My mom was so lost as we were sitting at his bedside. Karl-Heinz wasn’t conscious but combative, so they had to restrain him. Staff wasn’t able to provide any hygiene care, and since the stroke caused significant dysphagia, he already had a PEG tube placed on day two. He also had a pacemaker inserted to fix the heart block. Stupid, uncontrolled hypertension! I always told him that this can have serious consequences if he doesn’t get his BP under control – but it is what it is, and even though I was angry on some level, I felt so very sorry for him.

I had less than two weeks to figure things out and put resources in place. My mom doesn’t drive and is pretty much dependent on others in that little town she never quite liked to live in. I needed to find a solution for her living situation since she can’t (neither does she want) to live in that house with that enormous yard that turns into a jungle during the summer. And Karl-Heinz – he will need a nursing home placement from what I could tell. What a giant mess!

First of all, the house was a disaster on its own. Little did I realize that Karl-Heinz was kind of a hoarder, so instead of throwing stuff away, he would throw everything in either the attached utility room or the garden shack. When my mom told me, I took a look and swallowed hard. How on earth am I going to clean this up? So, the handyman neighbor and I worked two days, emptying out the trash and sorting things out to be picked up by the waste company.

Before...

...After

Next, my mom was asking me if I could try to open the freezer. She said that she couldn’t get it open anymore, and so they left it like that for over one year!!! They just stopped using the freezer… It took me almost an hour to pry that thing open, with the aid of hot water and my old Udo Waltz hair dryer. In fact, I landed on my ass when the door finally popped open. What I found behind was solid ice. I mean, that thing had a solid wall of ice where the door used to be! So Udo Waltz and I got to work, and between the heat, a wooden spoon, and hot water interventions, I managed to defrost the freezer. It was still full of food, which had already expired for the most part….

We went to see Karl-Heinz every day in the hospital, and the following week he finally came around. But boy, this was awful. He was awake and alert but stuck in his own body. He can’t talk, can’t eat, is incontinent, and his right side is paralyzed. Whenever we came into the room, he would look at us, look at my mom, then his left hand came up, grabbing her hand, and so she would sit for the hour we were allowed to visit. When he finally was transferred to the neurology floor, he was well enough that his restrains could be removed. Baby-steps I suppose.

I know he was anxious, a busy body, while lying in that hospital bed. I brought him a heart: a red stress ball that I had squeezed all the way across the Atlantic Ocean. I put it in his left hand when we left, and he still held it when we came back the next day.

I was trying to figure out how my mom could get from Wesselburen to Heide without a car. It’s about 18 km, so taking a taxi was getting way to expensive with about 60 Euros/day. My mom is very insecure when exiting the train due to the giant gap between the train car and the platform, so even though this option was cheaper, it didn’t work. So, I found the number of a group of neighborhood volunteers, who help other with errands for a nominal fee. Luckily, there was one driver who agreed to drive her EVERY DAY to Heide, wait there for an hour, and take her back. What a relief!

Another stab in the heart came in the mail: Karl-Heinz got a ticket for driving over the speed limit, and in Germany, they always have a picture they mail you as proof. Here he was, behind the wheel, just a few weeks ago. Now I have to figure out how to sell his car because he won’t be driving it ever again…

In the meantime, I was still trying to get rid of empty bottles that I found in the shed and shack. In Germany, plastic and glass bottles need to be returned for a refund. I had bags, upon bags, upon bags I had to return – it ended up to be a total of almost 100 Euros in refund! Some bottles were so old, their content expired in 2013…

At that point, I overcame my fear of driving a shift stick in Germany, something I hadn’t done in 20 years!!! But after I got over myself, I was very happy that we were somewhat independent again.  

Then the biggest miracle happened: as I was calling nursing homes around the area, I ended up calling the Red Cross institution in Büsum, which is a cute tourist town right at the North Sea. My mom said, “don’t even bother, they won’t have anything open”, but I was desperate. I talked to that wonderful lady, explaining what had happened and what I was looking for: an assisted living apartment for my mom, and a nursing home placement for Karl-Heinz. The lady was a little hesitant but then said that they actually had an apartment becoming vacant, and there may be a place opening up in the nursing home as well!!! This was like winning the lottery, and I know that we were given an (unofficial) break – and I will be forever grateful! The next day, we had an appointment to look at the place and it is perfect! My mom loved the apartment AND she is allowed to bring the dog! Plus, I don’t have to worry too much because it’s assisted living, so my mom will have resources when she needs them. In addition, she can just walk over to the nursing home section, pick up Karl-Heinz in a wheelchair, and bring him on outings or to her place. Under one roof after all, so I consider that the best possible scenario based on the circumstances…

My last task at hand before I had to fly back home was trying to file a petition with the courts get control over Karl-Heinz’s financial assets. Because of my black-sheep brother, my mom didn’t want anything in her name. I was put as the sole heir of Karl-Heinz if he was to pass away. Apparently, nobody saw this scenario coming, and since there is no legal regulation in place, I have to now try and get a judge to give me the ability to sell the house and the cars. But that I will have to deal with after I return home for now…

Flying back home was hard. Leaving my mom behind with the situation made me feel like I am deserting her – despite the resources I managed to put in place. When she cried at the airport, it just tore me apart, but I had to get back home to Ralf and my (new) job as well. The airport in Hamburg was actually very safe: people in line for security were social distancing, everyone was wearing a mask and followed the rules. But as soon as I stepped of the plane in Orlando, all bets were off!!! Tourists with their kids everywhere, masks were worn or not, and many just jaywalked as they pleased. What a difference to Europe, where I actually felt relatively safe…

In This Update

  • Good-Bye Emergency Department – Hello Education!
  • Having a Predictable Schedule

Ever since I started writing this blog, I never missed an update. Until now. In fact, I missed two updates. Thinking of the words of the son of my dear friend Libby, who just passed away from chemo complications a couple weeks ago: “Life is difficult, life is hard”. The last few months have been brutal, putting me in a constant state of anxiety and depression. But I am trying hard to overcome this, the effect of this unprecedented pandemic has had on my mental health, Ralf’s setbacks, finding my way in a new job, then having to travel to Germany for a family emergency… it is just getting a bit much.

Good-Bye Emergency Department – Hello Education!
But let me start by recapping the month of June – my last weeks as ED nurse during this COVID-19 pandemic. Ironically, I got the new job as Simulation Coordinator already back at the beginning of March. However, due to the dire circumstances, I was on hold until June 22nd. I admit that after the first COVID wave somewhat subsided, things were less scary and dangerous during the first part of the month. It was about two weeks after Florida loosened the restrictions and opened the bars again, when almost overnight we experienced a consistent influx of sick Corona patients. I remember the day I was in triage, shortly before my transfer, where I was more exposed to COVID in this one 12-hours shift than during the past three weeks!!! It was scary! And those Covid patients weren’t old or compromised, they were in their mid-twenties! I remember that bartender who couldn’t finish a single sentence because he was so short of breath, with a fever of 103. I was locked in with that 27-year old guy for over an hour, doing blood cultures, EKG, and trying to keep him stable until I transferred him to the ICU. Same day, I cared for a 25-year old girl, who went to the bar with friends for a drink… and on and on it went. It was amazing to see the obvious pattern. So many people just got careless, acting as if the pandemic was over and there was no need for masks or social distancing. And I get it: I have been more than depressed with what life has become. I am mourning the freedom to go to the movies, or a restaurant, hug my friends, or go grocery shopping without fear of a deadly disease that has taken over the world. But I have seen the truth, the sick, the repercussion of letting your guard down. And it’s not just about me: what if I take that virus home to Ralf?


However, just as the second COVID-19 wave was taking off, I finally got to my new destination: The Education department as the new Simulation Coordinator – a job I was very much looking forward to! During most of my graduate education, I was fascinated by and focused on healthcare simulation. Now all the hard work finally paid off, and on June 19th, I worked my last day in the Emergency Department. This was a bitter-sweet moment: I always wanted to be an Emergency Nurse, and I consider myself very lucky that I got to open up a brand-new Emergency Department at the VA Hospital in Lake Nona in 2015. But now it was time to say good-bye…

Last Day in the ED!
Ralf was so excited for my new job, he got me flowers on my last day!

Fast forward to June 22nd, 2020: the day I was finally starting my new position as Simulation Coordinator at the VA Hospital in Lake Nona! Here’s to a new chapter in my nursing path! But I must say, the last day in the ED was quite emotional, and I will miss my patients and my peeps for sure…

First Day in Education

I admit, I was pretty nervous on my first day, not knowing what to expect. The good think is that I have been around the Orlando VA for so long that I know my way around – as well as a lot of people. What was “unique” about this position was the fact that the previous Simulation Coordinator had been gone for almost a year, and even before that, the lab wasn’t quiet utilized as intended. And the madness of the pandemic, when stuff was just taken from the Simulation Lab, never to be seen again, made my job an even bigger challenge.

Having a Predictable Schedule
With my new job came also a predictable schedule: Monday through Friday, 0800-1630, weekends and holidays off! I also got a government laptop to work from home if need be, which added a new layer of flexibility (extremely important feature as I found out in July…). So, Ralf and I went on some outings on my days off – and it was so much less stressful all around. No more fear of exposure, no more 12-hours shifts, coming home late… I didn’t realize how much of a difference this would make.

We explored the north entrance of the Lake Lizzie Preserve on a rainy day, then the south entrance the following weekend. We also went for a bike ride at Triple N Ranch, were I haven’t been in so long. It reminded me what outdoor adventures in Florida during summer time always have in common: LOTS of water, and lots of turtle activity!

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Oh, we also finally got out new juicer....

.... And new "pets"!

In this Update:

  • Life in Isolation
  • Running Again!
  • Happy Birthday - Pandemic Style

Life in Isolation
Even though Florida started their phase 1 of re-opening the state, Ralf and I decided to stay put. In fact, the virus is still out there and with people returning to their “normal” life activities, the spread of COVID-19 will continue to increase (in my humble opinion). Especially Ralf can’t risk getting sick, and it is already pretty nerve-wracking that I am his number one risk factor. When I go to the store (every 10 days or so), I make sure to wear my mask and stick to a “disinfection routine” to minimize the risk.

I can attest that the mandated isolation and restrictions were actually working in reducing the cases of COVID-19 significantly. In our ED, we still isolated and treated patients with certain symptoms “as-if”, but the actual cases of infected patients has gotten less and less. Still, I have maintained my decontamination routine at home by taking off all my clothes in the garage, showering in the guest bathroom, and washing all contaminated items separately. I do feel a little less anxious right now, though, given the reduced numbers of COVID patients (for now…). I am afraid of another wave coming our way as the restrictions are loosened ... Time will tell!

With that being said, being isolated from the world takes a toll on mental health and restricts what we can do in many ways. I admit that I actually mourn the loss of a world that will never be the same after this. It is hard to adjust to this new reality, and it saddens me that even simple tasks like going to the grocery store provoke anxiety and cause stress for me. I am also so sad that we wont’ be able to celebrate our wedding at the Wallaby Ranch in October as we had initially planned, nor do I know if I get to spend Christmas with my family this year. So Ralf and I have been trying to get some dear “outdoor-time”, which isn’t easy when State Parks and State Forests are actually closed…

Cabin Fever!

Running Again!
I am happy to report that I finally started running again! I ran/walked two miles, which may have been a little ambitious since my poor thigh muscles were on fire the next day. However, my back was not complaining at all, which is a victory…

Running again for the first time!

We also continued our garage workouts, but I admit that my motivation level hasn’t been very high lately…

I hope that by the end of June, things will get a bit more structured when my work schedule finally changes to bankers hours: yes, I finally got a start date for my new position! June 22nd is my first day as Simulation Coordinator!

Happy Birthday - Pandemic Style
May 26th happened to be my birthday, and since going out wasn’t an option, Ralf decided to pick up a three-course dinner from Nona Blue! Yes, restrictions have been partially lifted, and many restaurants offered limited dine-in options, but as I said earlier, we are not taking any chances… In any case, we dressed up, put some music on, and had a wonderful dinner at “la casa”!

Next month will bring Ralf’s official post-op follow up with Moffitt, and I will start my new job on June 22nd… Let’s see how it goes!

In this Update:

  • 2-Year(ish) Follow-up X-Rays
  • Being "Essential"
  • Trying for Some Normalcy

2-Year(ish) Follow-up X-Rays
Due to the shutdown of all non-essential services during the pandemic, I wasn’t able to get my 2-year x-rays done until now. I wasn’t all too worried that something was wrong, but it always gives me peace of mind to get confirmation. I haven’t sent my images to Dr. Desai yet but from what I can see, my ESP is exactly where it was before. Also, the disc space of my L4/L5 is well preserved, which means no signs of accelerated degenerative disc disease! The report stated the same, and since I have gotten all my x-rays there in the past, the radiologist reading my film had the comparison images available as well.

I wanted to add that even though my “old” back pain never returned after surgery, I have been feeling very sore and tight all over -  from my neck to my ankles, I am a knotted mess. Stretching has helped some, and I know I should be doing more rehab workouts, but I am so stressed and often so tired that I just don’t do it… working on it though.

So, here they are:

L5/S1 Close-Up

Being "Essential"
Working in an Emergency Department during a global pandemic has been so many things. Scary and unreal come do mind, actually. I am however grateful that A) I have a job, and B) I am physically able to do my job. But being repeatedly exposed to COVID can be mentally exhausting. It almost is a feeling of “doom” whenever I pick up a suspected COVID patient from the outside holding area to take him/her to an isolation room for bedside triage. Closing the door behind us, my co-workers would stay outside the glass door, ready to fetch something I may need. Being in that closed room for a considerable amount of time doing necessary patient care trigger thoughts of “what if”, but you still give your patient all you’ve got – they often are as scared as you are.

When the number of cases was starting to increase, the issue of having appropriate PPE came to light. When I got my first paper bag with my name on it in which I was supposed to keep my disposable N95 to be reused, I couldn’t believe it. The procedures for PPE use have changed multiple times as the crisis unfolded, and the VA showed great efforts to keep us safe. I was eventually fitted for a half-mask that is meant to be cleaned with soap and water. I learned the hard ways that wearing N95s really hurt your face after a while, but the red marks hopefully mean I got a good seal… Ralf also bought me some face shields for protection. I have been wearing my surgical mask for multiple days (gross!) but finally got washable face masks from Ebay, which I now use instead.

First issued N95 (under the surgical mask)
Upgrade to N95 half-face mask
Leaving a mark = hopefully good seal (ouch)
Thank-You Parade around the Orlando VA Medical Center by local law enforcement!

Trying for some Normalcy
A global pandemic like this is scary enough, but with Ralf’s recent hospitalizations and post-surgical issues, it adds an additional layer of anxiety (for both of us). We lost our primary care provider, who left the practice mid-March. Ralf also wasn’t able to establish care with the GI specialist. This was actually very disappointing because Dr. Lepane was assigned to his case during the latest hospital admission at AdventHealth Celebration, and we really wanted to get established with her for Ralf’s GI-related needs that have nothing to do with his cancer. However, she refused to take him as a patient, referring him back to Moffitt. She didn’t even talk to us directly but brushed us off through a middleman. Very disappointing indeed.

Regardless of all the anxiety, uncertainty, and fear, Ralf and I really tried to keep some sort of normalcy in our lives. Even though we got married in October, our unofficial anniversary has always been April 1st. That was the day I moved in temporarily to take care of Poncebear while Ralf was away for the weekend – and then I never moved out, lol. So when April 1st came around, Ralf clipped some branches from the plant that grows over our wall, right in front of our door. That was so sweet!

We also did a few light workouts out of our garage, where we have some equipment stored. Unfortunately, I just can’t get it together enough to be consistent right now…

Whenever I was off from work, we also went for long walks around the neighborhood. We are very fortunate to live in a safe, gated community with lots of lakes and walkways. Before the official lockdown, we also did a couple outings to Split Oak or Hal Scott Preserve but ever since the official lockdown, we haven’t left the neighborhood. Funny enough, we still got our gator encounters and examples of the “circle of life” away from the woods!

Freshly caught from a Village Walk lake

Easter 2020 was pretty much non-existent, even though I was actually off this year. Found this old picture and thought it pretty much sums it up:

We did have plenty of time though to really improve meal prepping and healthy eating. Due to the virus, all groceries are getting disinfected in the garage before entering the house, which is quite an operation! We also realized that we need a bigger freezer because we are running out of space. In addition, we ordered a gas grill online and managed to assemble it on our patio.

Overall, life feels very strange these days and I am sure the world will adjust but never go back to how things used to be, at least not completely. But at least I am going through this without a broken back, and my heart goes out to all those who suffer from crippling pain in the midst of a global shutdown.

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In This Update:

  • The Good
  • The Bad
  • Conclusion

Foreword
Let me just start by saying that I if I had my surgery scheduled for today instead of two years ago, it would have been a complete nightmare. Back then I was in so much pain that wasn’t able to work anymore. I was depressed, and I had no quality of life left. Making the decision to go overseas to have spinal surgery is scary enough, but having a global pandemic happen is an unforeseeable disaster I am glad I didn’t have to deal with. My heart goes out to all the people in severe pain, who have to live through this pandemic not knowing how this will affect their ability to fix their back, or when.

I am not going to lie, being an Emergency Department nurse during a global pandemic is petrifying! I am not so much worried about me getting sick but that I take this virus home somehow to infect Ralf. I wear all protective PPE at work that I can, but being locked into an isolation room with a very positive, very sick Covid-19 patient for 15 minutes while doing the triage and providing direct care causes a sickening knot in the pit of my stomach – which you push out of your mind until you did what you could for your patient. My peers and I are on edge, but we have each other’s backs and will care for our community with all we’ve got.

Best crew to work with, plus the medical director who stopped by

The Good

This 2-year update is not quite how I envisioned it, especially since I won’t have my follow-up X-rays until June (maybe), but gauging from how I feel, I would say that nothing has changed. After I have the images, I will send them to Dr. Desai in Cologne for review and confirmation, but that will not happen anytime soon.

Looking back at the past year, there is a lot I was able to do. As many of you know, Ralf and I have always been very outdoorsy people, so we continued to go on many biking adventures in various Florida forests and Wildlife Management Areas, and I never had any issues with my back, even if I had to carry my bike through bodies of unexpected waters. We also went tent camping in the Everglades, and I was riding 30 miles of muddy trails during a monsoon.

I also continued to advance through my workouts with Angela at her Crossfit Lake Nona gym. However, due to unforeseen circumstances, full-time work, and graduate school, I was not really able to truly establish a routine. Honestly, I envisioned myself being super-fit and able to do several pull ups which was one of my goals. Did that happen? Not really… Life appears to have a way to throw curveballs that can mess up all the good intentions and plans that were made. I don’t know about you, but 2019 really was an intense and pretty awful year.

We visited Key Largo in August of 2019 where we tried out sea-kayaking for the first time. This was truly a test to see how my back would behave since it required me to sit in a cramped space for over two hours while paddling and navigating the kayak through open water. I did feel a little stiff at the end but once I got out of the kayak and stood up, I felt great. Absolutely no pain or soreness. Definitely something we can repeat!

Another water activity Ralf and I started exploring involves a packraft. Ralf has gotten pretty serious with bikepacking, and a packraft is designed to be carried on the bike, which then gets strapped to the raft to continue via water ways. We received the pack raft also in August but due to what came next, we only took it out to the lake a couple of times so far. It’s a lot different to maneuver the raft compared to the sea kayak, but it appears to be a very fun activity for the future.

An impromptu wedding was also on the agenda, which ended up with just him and me in the courthouse. Ironically, the reason why we didn’t get married sooner was the difficulty of getting friends and family from around the world together at the same time. Ralf sometimes said, “let’s just elope…”, which is ultimately what happened!

Another major life-event was my graduation (finally) from my MSN Nurse Educator program in December. To be honest, with everything going on, I really didn’t want to go. However, here I was, getting my regalia on, taking pictures with Ralf in the driveway of our home because he was not able to come. At the arena, I ended up standing backstage with my group for 1 ½ hours before marching inside, just to sit for another 3 hours on a hard plastic chair. At least Ralf got to see me walk on livestream…

At work, I participated in various Emergency Management activities, such as retrieving a mock-victim from her car in the community and help with shooting a decon training video that required me to not just dress up in full gear but also tonrepeatedly kneel, lift and twist while transferring a mock-victim from the ground to a stretcher.

The Bad
Looking back at the past year, I must say it was awful in terms of certain life-events and stress but at least I was able to be there and do what needed to be done when it was most important.

Being able to go back to work as an ED nurse was one of my major goals, and it came to pass without issues. However, there has been a lot of negative energy developing in my department due to changes in leadership at the time. That in turn made going to work a very stressful time, but at least I got to care for my veterans again without physical restrictions.

Moving on to August: as it turned out, the Key Largo trip was the last time Ralf and I had normal lives. A few days after we got home, Ralf had a CT scan done that revealed stage 4 peritoneal carcinomatosis – a very rare cancer that grows in the abdomen and around all associated organs. This has truly been a life-altering shock, and it took me two weeks to pull myself together to come up with a plan. If you read my blog, you know the emotional roller-coaster we have been on. To make a long story short, against all odds, we found the only treatment option for his condition which was cytoreductive surgery with HIPEC (heated intraperitoneal chemotherapy). We decided to go with the Moffitt Cancer Center in Tampa, which is one of the top 10 cancer centers in the world. Lucky for us, Tampa is only 1 ½ hours away which made traveling there a lot easier.

It was so hard to focus on school in the light of Ralf’s diagnosis. All this happened just before my last semester of my MSN program, which entailed a 180-hour internship I had to finish while working full time. To be honest, I almost dropped the semester, but Ralf really wanted to see me graduate in December, so I pulled myself together and pushed on. I think the hardest part was to be away from home pretty much all the time, either completing internship hours or going to work. Ralf’s surgery at Moffitt was set for November 22, so I had to get everything done before that date – including getting married and finish school!

I don’t know how, but I actually managed to get everything done a week before surgery. I can’t even imagine what would have happened if my back was still broken – constantly on the move, pushing on. In addition, while Ralf was admitted at Moffitt, I got to sleep on a pretty flimsy cot for 16 days, which my back tolerated just fine despite the bend in the middle of the mattress.

Fast forward to February: Ralf was recovering so well, and we started to go on hikes and some mellow bike rides. Everything was going so well until mid-February, where he had a sudden episode of severe abdominal pain that didn’t subside, so I had to take him to a local ER. Having a rare cancer is scary enough but getting admitted to a hospital where the doctors and nurses have no clue is downright petrifying. After the acute pain had somewhat subsided, Ralf was discharged without a diagnosis.

Two weeks later, the same thing happened to him but this time the pain was so much worse! I took him to a different ED in a much better hospital where he was admitted again. Besides pain control, they wouldn’t touch him either but at least they had him transferred to Moffitt where he needed to be. The final verdict now is severe adhesions and scar tissue that is strangling his gut, which is an unpredictable complication we didn’t see coming, but we have a plan once the pandemic subsides.

During the last admission, I got to sleep on two different guest cots, and I must say Moffitt wins the price despite their flimsy contraption! That thing I slept on at AdventHealth Celebration was so hard, I woke up stiff and in pain – from neck to low back, stiff like a board. No, the pain was nothing like my pre-op back pain; it was just a result of sleeping on something too hard and uncomfortable. I came to realize that I am not 20 anymore either: ADR surgery restored my back but it can’t protect me from age-related aches and pains, I suppose.

Conclusion
So, what’s the overall verdict at 2-years post-op? Number one, life WILL happen – with or without a broken back. However, ridding myself of the disabling, crippling, soul-sucking pain enabled me to do what needed to be done and be a support for my husband, rather than a burden, when he needed me most. It also prevented me from having to file for disability and losing control over what’s important to me. My LP-ESP is still going strong and doing its job well enough so that I can do mine!

I haven’t really made an announcement, but I just accepted a new position within my hospital as Simulation Coordinator, and I am pretty excited about this opportunity! Everything I worked so hard for during my MSN program and beyond has paid off. I really love healthcare simulation, so this job is the perfect match. In addition, this position will give me bankers hours: 8 am to 4:30 pm, Monday through Friday, weekends and holidays off. That way I can be home with Ralf in the evenings, when he tends to be more uncomfortable, and we can also better plan our lives due to my predictable schedule. However, I won’t be transitioning until the pandemic is over, since my services are needed on the frontline right now.

Please stay home, stay safe, and stay healthy!

In this Update:

  • Enjoying the Outdoors
  • Ralf’s New Setbacks

I wasn’t able to write this update in time due to Ralf’s recent setbacks in his recovery. In fact, I am writing this while he is admitted (the second time within two weeks!) for unexplained, severe abdominal pain. It’s been a scary and frustrating time, a setback we didn’t see coming, and we still have to figure out how to proceed. It saddens me to no end to see Ralf in such agony, especially since the month of February actually started out nice!

Enjoying the Outdoors
Ralf has been into bikepacking events for a while now, and due to the ongoing recovery from his massive surgery, he wasn’t able to attend the annual Huracan 300 this year. So, we decided to get up early on the day of the event to pick up dozens of donuts and bagels and drive 2 hours to Ocala to see the other riders and friends taking off. Next year, same time, I hope to be able to take pictures of Ralf departing on his own bike to tackle the almost 400 miles of mostly off-road trails and roads around Central Florida.

The weather in February has been very nice but often cold. One outing we did was going for a hike at the Seminole Ranch Wildlife Management Area. The sky was blue, the sun was bright, but the temperature was rather chilly. As we entered the gate to the hiking path, I said to Ralf “the sun is out, no cloud in the sky but it’s pretty cold. That is perfect weather for sunbathing gators”… Well, just a few feet further up the trail, we ended up passing this guy… I rest my case!

The hike was great, and we saw a lot of wildlife (mainly birds). Ralf has been very conservative with his activities due to his recovery. And being outdoors like this is important to keep moving and take in nature.

Another great hike was at the Little Econ trail system in Oviedo. I really like this area, even though the likelihood to encounter other people is much higher here since it’s a popular place for the locals. The trails are not difficult but you have to pay attention where you are going to prevent stumbling and faceplanting accidents.

After a roughly 2-hour hike, we found a nice restaurant in Oviedo where we ate a tasty sandwich, then strolled through the neighborhood before going home. And then it began…

Ralf’s New Setbacks
About an hour after we ate the sandwiches, Ralf started to get abdominal pain, which started between the sternum and the belly button before spreading further down. The pain worsened throughout the night, I could hear him moan, toss, and turn. I put a heating pad on his belly, gave him pain meds – nothing helped. There was this baseline pain with waves of “cramping/grabbing” pain every few minutes. Around 5 AM, we decided that this is not getting any better and that he needed to go to the ER to help with the pain and to make sure nothing sinister is going on inside of his abdomen. I took him to AdventHealth East since it’s the hospital closest to us: Big Mistake! Even though the ER visit was ok, the admission that followed was an absolute nightmare! In the good news department, the CT scan done in the ER didn’t show a bowel obstruction. In fact, the scan looked pretty much like the baseline scan from December. Ralf was subsequently admitted for observation and pain management. He was in so much pain, it broke my heart.

So, when he finally got to his room, he ended up with a roommate (separated by a curtain like the 1980s), who was hard of hearing and had the TV blasting. Not a very healing environment if you are in severe pain. The staff ended up moving Ralf to a different room with a roommate that was not hard of hearing but that didn’t make any difference. In fact, it was the worst setup I could have imagined! It’s not about sharing a room, but if the other guy behind the curtain is obnoxiously farting, burping, and also blasting his TV (no headphones!!!) 24/7, the aggravation was inevitable! This guy didn’t even wash his hands after going to the (tiny, shared) bathroom.

I had to raise hell to get Ralf to a more private room because he was getting worse, not better. But that didn’t happen until the next afternoon. After bringing up my concerns to the staff, I was told (very compassionately) that we can always sign out AMA (against medical advice). Very nice, so not only are you putting a patient in severe pain and anxiety in this chaotic, dirty, and loud environment, your solution is to leave? In any case, things got better after Ralf was able to rest without constant disruptions and lack of privacy.

But I must say, the overall care at this hospital was absolutely horrible. No communication among providers, no critical thinking skills, no clue as to what the cause of this severe pain could be, or what it had to do with his specific kind of cancer…. A plan of care would be agreed upon but never executed, and nobody knew who was supposed to order what, and the list goes on and on. On top of that, they screwed up the billing so that the initial insurance claim was denied!

After the severe episode subsided, Ralf was finally discharged: with narcotics and no diagnosis! At AdventHealth East, they had no idea of the cause, which is beyond scary. In the meantime, I did some research and believe that severe abdominal adhesions/scar tissue may be the culprit. The problem is that adhesions don’t show up on imaging, so the only way to confirm them is to do a laparoscopic exploration. With that being said, we would only have that done at Moffitt with his original surgeon. However, throughout this entire ordeal, she has been less than reassuring and didn’t think we needed to come to Moffitt, which is not just disappointing but downright scary. Now Ralf lives in constant fear of a recurring episode without any idea of what to do or not to do. To be continued, I suppose.

The month ended on a nice note though, when I went with Bergie to a Spiritual Fair. That is something she would have taken her beautiful daughter to, who also enjoyed these events very much. Bergie and I spent the day together, attended a workshop, ate a late lunch, and later I got some puppy/kitty love at her house. Makes me always realize how much I miss our Poncebear…

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In This Update:

  • Ralf’s progress
  • Getting back into the Gym
  • Getting back to work

Ralf’s progress
Quick update on Ralf: recovery is still ongoing and steady, with intermittent set-backs that are mostly related to sudden belly pain, along with persistent nerve pain to his incision site. There are also two hard, sharp “fragments” inside the incision, just where the waistband sits, so we are in the process to have that checked.

Fatigue has gotten better overall, and he has been able to start light activities, such as bicycling around the neighborhood, slow jog-walk intervals, and banded/body-weight resistance training at the gym. I am so proud of him and all his has overcome!

Getting back into the gym
Speaking of getting back to activities: I also finally returned to the gym! I must admit, I was a little worried since I hadn’t worked out since last November, and I wasn’t sure how much of my progress had been lost. In fact, the empty parking lot across the gym has now a whole new building on it - still somewhat under construction but still!!! I wasn't here in that long?

To my surprise, I was pretty much able to pick up where I left of. I credit my “robust physique” to Angela’s customized programming and training, which built me up from the ground in such a way that my muscles (small and large) survived a prolonged “time out”. I can still do push-ups from the ground, a couple pull-ups (working on it!), along with weight lifting movements such as back squats and deadlifts.

Now, I've said it before, and I say it again: I am not trying to become an Olympic weightlifter or to win the Crossfit games, but I do believe that moderate weight training is important for long-term bone and muscle health. All the moves I do, the weight I lift/push/pull, and the distances I run feel good! No pain, only gain! I admit, though, that going to the gym is not the most enjoyable time of my day, but the strength and endurance that Angela’s training gives me enables Ralf and me to go on our adventures. And we have plans, lots of plans, for the future!

Getting back to work
With Ralf getting better and my own return to the gym, there also came the time to resume work. And sweet baby Jesus, the ED is as busy as it has ever been! My first day back was literally “Oh Hi! Are you back??? Super – Go open zone 15-18 (four high-acuity beds), I just placed two patients there..."Um, ok, I guess there is no time for a welcome-back party, lol!

I did get a very humbling “welcome-back present” though: a couple of days after I started work, I received an email from the VA Public Affairs Department. Apparently, I took care of a veteran just before I went on FMLA, and that veteran was so satisfied with my care that he wrote a letter to the VA about me. Next thing I know, a photographer appeared in the Emergency Department and took my picture to be published in the VA newsletter and Facebook page! That kind of feedback is so very heartwarming, especially since the crazy environment in the ED can make things very difficult. Being able to make a difference in other people’s lives is the best reward one could ever hope for!

Iris Appenrodt, MSN, RN, CEN recognition for going above and beyond in patient care.

Since one of the federal decontamination training events happened in January at the Orlando VA, I had the opportunity to get back into the decon suit and even participated in one of the decon training videos they were shooting! And no, this was NOT specifically related to the Corona virus…

One more stressor this month was related to the national examination to become a “Certified Emergency Nurse” (CEN) that was looming over me. From the day you pay for examination, there is a 90-day window during which the exam has to be taken, or your window of opportunity expires. I signed up at the end of October, thinking that I could study while Ralf was in the hospital. Well, that clearly didn’t happen! My entire focus was on Ralf, and I couldn’t’ even think about trying to study for a board exam!

So, comes January, the deadline approached fast. I had about two weeks now to pull myself together and cram for this 3-hour/175 question exam, which I was scheduled for the day before my deadline ended. I was so nervous that my shirt was soaked in sweat before I even entered the Pearson testing center. To top it all off, this was the same testing center where I took my NCLEX nursing board examination years ago to become a registered nurse. A pretty intimidating process, no matter what exam you are there for, I must say. After I was placed at a computer, I just did the best I could but I wasn’t at all confident when I clicked the “submit” button at the end. But what can I say, I actually passed!!! I even hugged the lady at the front desk check in! So now I am an “MSN, RN, CEN” – and I am also DONE with school or other examinations for a loooong time!

With that being said, work has been very, very stressful, and not being able to be home in the evenings when Ralf’s symptoms usually flare up has been emotionally taxing on the both of us. Those 12-hour shifts are long and draining, but until I get (hopefully) the new position in Education, we both will have to adjust. I am currently waiting for notification of an interview, so I am keeping my fingers crossed!

In this Update:

  • Discharge from Moffitt
  • Family and Graduation
  • Moffitt Follow-Up
  • Finally Ending 2019

Discharge from Moffitt

My last update ended with Ralf’s NG tube finally coming out and him starting to eat food. This is when the side effects of the chemo (even though it wasn’t a systemic infusion) became much more apparent: Ralf really started to suffer from nausea, food tasted nasty (metallic), and his heartburn was pretty intense at times. He also had trouble with delayed gastric emptying because the tumor piggybacked on the stomach’s blood supply, and some of that blood supply had to be removed along with the tumor. Immediately after the surgery, Dr. Dessureault had already told me that he will experience some symptoms because of this but that things will normalize with time. He was put on a medication (Reglan) to help with the emptying process, which has somewhat helped so far.

It took four more days before discharge became a possibility, especially since his oral intake was less than adequate. In fact, I was very worried how he would do at home, having only oral medication to help with the symptoms, especially at night. The nausea was so intense at times that I witnessed him vomit for the first time since I have known him! He would sleep a lot, preferably on his side, whenever the heartburn permitted him to be in that position…

On a positive note, I have slept/rested on this guest cot for over two weeks and my back has been fine! No pain or flare ups at all, which I am grateful for since one patient in the room is enough…

Being confined in this hospital room for so long really started to take a toll on us, especially mentally. So, after 16 days at Moffitt, we decided that we could risk going home at last. I packed up all of our stuff and loaded it on a wheelchair. Ralf is not allowed to lift anything heavier that a carton of milk since the HIPEC also slows down healing of healthy tissue and his belly incision is rather extensive. I picked up a busload of meds from the pharmacy to take home as well, including two boxes of Lovenox injections he needed to get in his non-existing belly fat for the next couple weeks every day. Finally downstairs, I got the car from valet and off we went to … Panera! Yes, after rolling off the parking lot, Ralf declared that he was in the mood for some tomato soup from Panera.

However, before our first “out of hospital snack”, we stopped by Lettuce Lake Park to take a victory picture:

So, guess what happened next? Ralf and I stopped by Panera on our way home (it takes us about 1 ½ hours from Tampa to Orlando), and he ate half a bowl of tomato soup plus a little baguette – and he felt ok! No nausea to speak off, no heartburn! He also said the food tasted almost normal! This pattern continued after being home: I cooked healthy, easy-to-digest foods I knew he likes, and he was eating well! Almost like a switch that was turned on! He only took Zofran for mild nausea twice, never touched the Phenergan, so all he really needed was Tylenol for discomfort, Cimetidine for heartburn, Reglan for the stomach, and Lovenox injections to prevent blood clots. I still need to get the empty sharps back to Publix for disposal since I don’t have a sharps container at home…

The next task at hand was going to the barber to have that humongous beard shaven off! It was way too far gone for Ralf to shave it off himself, so we went to a local barber to have it taken care off! He did feel so much less “fluffy” after J

With that being said, recovery has been a real challenge with lots of ups and downs. Until a couple of days ago, Ralf has been feeling pretty good overall. However, moving food through his digestive track is still a major issue. Severe fatigue is another one, which can hit him in mid-sentence without warning. We have been trying to do things and be somewhat active but with spells of sudden dizziness and fatigue, we need to stay close to home for the most part, just in case. Last Friday he tried out a fiber supplement to help with the digestive issues but that backfired badly! Instead of helping, the supplement caused extreme abdominal pain and tenderness. It has gotten better now, but the aftermath is still very evident, so Ralf kept rotating between laying down in bed and sitting in his recliner for days. I have been on medical leave since the surgery, which was great to take care of him at home. But in a couple days, I have to go back to work (at least part-time for now). Makes me pretty anxious…

Family and Graduation

We got discharged on Sunday, December 8th, and my mom and stepdad arrived from Germany on December 11th already! Would I have planned for this to happen? Absolutely not! But because my graduation was going to take place on December 13th, the tickets were long booked before we even knew of the cancer. That left me with 3 days to get the place ready, put up a little Christmas decoration, and the prepare the guest room.

Then it was time to go to the airport to pick up my family. Since Ralf’s tolerance for activity still varied a lot, he stayed home. Their flight was on time and they made it through customs/security in about an hour (that’s a record).

As I mentioned before, my graduation was on Friday the 13th (naturally), but since Ralf wasn’t able to attend, we took some graduation pictures together in our driveway. I was also honored that my German friend Renate agreed on short notice to come with us, since I needed someone to help navigate my mom and Karl-Heinz through the crowds.

I admit that I was sad that Ralf had to watch me walk on life-screen at home, but he texted me to say that he saw me walk in (with a serious face, obviously), and later the stage, which made me happy. This moment represented the conclusion of my graduate studies, and the fact that I was truly done with school was a huge relief.

Moffitt Follow-Up
The following Monday, my family and I took another trip to Moffitt for Ralf’s follow-up appointment. It was very emotional for both of us when we drove up to the valet parking lot. Lots of memories were made here, and I would rather not remember the struggles so soon.

Ralf had his blood drawn again, then we grabbed some lunch in the cafeteria (I am so familiar with), and finally headed for the appointment with Dr. Dessureault. We were quite nervous since this was the first follow up where we would discuss the next steps in treatment. But before that, Ralf had his 34 staples removed by the nurse (well, 33)!

Then the doctor came in: first, she removed the last staple that was stuck in the skin since the nurse didn’t want to torture Ralf anymore, then we talked. Overall, the surgery was a great success! Most tumor was removed, without sacrificing any organs. However, because this type of rare cancer is very unique and varies by patient, we will have to see where we stand by the end of March: Ralf got scripts for blood work (tumor markers) and CT of the chest and abdomen by the end of December, then again for the end of March. The doctor will compare both, the “new-you baseline” CT with the second follow-up studies to see how the cancer behaves. Hopefully the HIPEC chemo has taken care of the remaining cancer cells and and/or prevented additional growth. In such best-case scenario, no systemic chemo should be necessary, just observation. He does have some of the same tumors in his pleural cavity, but so far, it has not grown either. I have found a supplement (Afaya Plus) that is currently in clinical trials and has shown remarkable tumor-reducing properties, so Ralf is taking that as well. That, along with healthy eating, will hopefully be all that is needed to defeat this beast! We are very, very positive and hopeful that he will be alright!!!

Finally Ending 2019
Now it was time to get our Christmas tree! We all went to Lowes to pick the right tree together, then I returned with the Honda Element (has only two seats but most cargo space) to pick it up. This is the first year in many years that my mom and I decorated the tree together, since this was usually done before they arrived for the holidays in previous years.

We also went to the Wallaby Ranch in Davenport for their annual Christmas party. This was a milestone for us, since it was our goal to be able to go, even though it is half an hour away. It was so humbling to see Ralf’s old hang-gliding buddies hugging him, even crying at times, due to the joy of him being there. We had great lunch, but when the live band was playing in front of the mimosa stand, he had to excuse himself to snooze for an hour in his friend’s hooch. In fact, that was the main reason why we were able to go: he had a place to rest. I had one mimosa while watching the music with my family, but since I was the designated driver, that was it…    

I spotted a pooch that was so content and happy on mommy’s lap, I couldn’t resist taking a picture. Our Poncebear was with us last year as well, and he would have enjoyed this so much as well…

Fast forward to Christmas Eve: like every year, we spent Christmas eve at our house with family. In German tradition, that is when we celebrate Christmas and open presents. I also invited Renate and her husband Tom, since they are currently stranded in a hotel due to water damage (and contractor issues) to their home. Renate and Ralf are both from Stuttgart, but since my mom, Karl-Heinz, and I come from Hannover, we overruled! Poor Tom was a good sport and apparently very much enjoyed the food: Roulade, red cabbage, and potato dumplings!

We had a wonderful time, but we also miss our Poncebear so very much. When I opened the decorations for the tree, I found the bow he wore last year for Christmas… that made my heart ache, but now his bow is part of the tree every year.

On December 27th, Bergie and her friend Maggy finally came to visit! They are both from Iceland, and Bergie and I have been close friends (and co-workers) for years. They brought so much food, it was delicious! The “Viking Blod” I found at Earthfare? Not so much (supposedly an ancient recipe of a Nordic dessert wine that will grow hair on your chest). Again, it has been so great that Ralf got to enjoy getting together with friends at home, without having to travel anywhere. His endurance and energy levels have been fluctuation so much, it is just not possible to go anywhere like this right now.

Finally, 2019 is coming to an end - and 2020 hopefully will make up for the pain and losses we endured. In the late afternoon, we had early dinner with Renate and Tom at Chromas in Lake Nona. Since their hotel is just next door, their commute was zero, lol. Our home is less than 3 miles away, which made it a safe(r) choice to take Ralf for dinner. We have eaten here the year before as well, so it’s becoming sort of a tradition. They have a very nice outside area where you can watch a giant projection just across, showing Christmas trees and decorations, alternating with snowy landscapes.

The remainder of New Year’s Eve, we spent at home. Ralf had to go to bed in between while my family and I watched a German New Year’s Eve event on television (streamed from my iPad) but just before midnight, Ralf was joining the party to welcome the new year! This selfie kind of mirrors our families’ affairs: at tad discombobulated but functional, lol! Happy New Year!!!

On January first, my mom and Karl-Heinz were flying home in the evening. We spent the morning at our pool, since the weather was so nice. In fact, I believe that the perfect weather and relaxed atmosphere were the perfect start of 2020. I sincerely hope it stays that way!!!

As I mentioned earlier, I have to go back to work in two days. But before that I will do something I haven’t done since October: work out! I feel well overall, but I need to get back to the gym in order to not lose muscle, especially in my abs and back!

I also applied to a new position as RN Simulation Coordinator, which would also mean bankers hours. Let’s see what January 2020 has planned for us….

2

In This Update:

  • Internship/MSN
  • CRS/HIPEC Surgery at Moffitt

Internship/MSN The weeks leading up to surgery have been incredibly stressful, trying to get all my internship hours done, working full-time, while getting our home ready. The majority of my remaining hours was precepting first-semester nursing students at the long-term care facility at the VA. Besides the SimLEARN Center, this was my favorite activity, and on our last day, I got a thank-you card and chocolate from my students. I also got a gift for my recent wedding. I was very touched. I finished my last day of internship on November 15th, exactly one week before the day of surgery.

My first clinical group

In an effort to have room for all the books and other things, we bought a bunch of cabinets at Ikea the first week of November, which turned out to be an epic fail. The first smaller unit had holes that didn’t align, so we didn’t even bother to assemble the rest. Since we had them delivered, the freaking book cabinets needed to be picked up again. Still waiting for a refund but I deal with it when we get back home. At this point, I really didn’t care about shelving anymore.

What the hell...?

We also managed to get a cleaning service to help once or twice a month with cleaning. The guest room is ready for my parents to arrive on December 11th, I just need to inflate our king-sized guest bed. I also emptied the fridge, watered the plants, and paid the bills in preparation for our trip to Tampa for surgery.

With that extra stress of school gone, my panic attacks became more frequent as doomsday came closer and closer. On Monday the 18th, we returned to Moffitt for the pre-op appointment, which went pretty well.

We got the all-clear from Dr. Dessureault and the anesthesiologist and got instruction about the bowel prep and shower regimen to take home. Tuesday was mainly dedicated to tying up loose ends, washing sheets and towels, and packing for the trip. We drove to Tampa again on Wednesday to check into our hotel close to Moffitt. On our way, we stopped by the Wallaby Ranch for breakfast with Malcolm and Laurie, which was so nice. We had our “last supper” at Carrabbas that night in Tampa, followed by a grocery run at Publix (water, coffee, jell-o, and juice).

The next day, Ralf was already on a clear diet. We took a nice hike at Lettuce Lake Park across the street from our hotel before starting the bowel prep at noon.

That afternoon, Rachel and Mara also arrived in Tampa, where I had a room for them reserved as well until Sunday. At least Ralf was done with the prep early enough to say “Hello”.

CRS/HIPEC Surgery at Moffitt

This part of the update is rather lengthy but also the most intense, emotional, and challenging experience (both mentally and physically). The cancer diagnosis itself, along with the journey it took to get to this day can’t be truly expressed in words. I am writing this update sitting on the edge of Ralf’s hospital bed while he spends some time in that awfully uncomfortable recliner chair. Hopefully, his digestion is stable enough that he can be taken off TPN (nutrition through the IV/PICC line) to go home in a couple days. It’s been 11 days since his massive surgery, and I stayed with him in his room from day one. Staff rolled in a guest cot to sleep on, and I spent countless hours sitting next to him; sleeping at night was only in increments especially during the first week when Ralf was suffering from the horrible side effects of the nasogastric (NG) tube that prevented him from swallowing, causing constant pain, retching, and choking.

From a personal reflection point-of-view, I wouldn’t have been able to do any of this just two years ago: sitting, laying down on that cot, helping with showers, dressing, sitting hours at end connecting/disconnecting equipment… nothing at all! Ralf was there for me when I went through my chronic pain and disablement due to degenerative disc disease and subsequent ADR surgery, and now I am able to take care of him during this dark chapter. For that, I’ll be forever grateful.

Surgery Day:
After two shower-rinses with special prep wash, we left the hotel around 0530 and arrived in the pre-op area around 0550. Check-in was relatively smooth, and Ralf and I were taken back to his pre-op spot just after 0600, leaving Rachel and Mara behind in the surgical waiting room. Ralf changed into a paper gown, got hooked up to the monitor, IV access to left hand (took two sticks and two nurses), then we waited for anesthesia to come by to insert the epidural for pain control. We spoke to the doctor one more time, Ralf signed last consent forms, and after the epidural was in, I said my good-byes to my already mildly sedated husband. It was a very unsettling feeling to leave him there, as I was clutching a plastic patient-belongings bag with his clothing on my way out.

PRE-OP

I found Rachel and Mara in the waiting room, and we settled down for the wait. I was supposed to get text message updates from the OR nurse throughout the day, so I was having my phone on ringer and close-by. At 8:48 AM, I got the first message that Ralf was asleep, and the surgery had started. I was trying really hard not to think too much about what was happening in there, how he laid there completely vulnerable, someone calling “time out”, before the first cut was done. I was wearing his wedding band on my Ponce-necklace, hoping that my little family will remain together for many years to come. There were just so many variables, it’s scary and kind of unreal!

Ponce & Wedding Band


Rachel, Mara, and I settled in an area in the waiting room, where a lady and later an elderly couple joined us. Cancer brings people together I suppose, kind of joining a club. The lady’s name was Jennifer, and her husband was undergoing a lengthy prostate procedure. We shared our stories and talked about our husbands.

At 10:34 AM, I got another message “Patient is doing fine, proceeding well”, which in my mind meant they were making good progress. The elderly couple joined us around 12:30 PM. The husband had a last appointment at 5:00 PM somewhere, and they were looking for a more comfortable area to wait. I really didn’t want to leave the waiting area; I was just too nervous and wanted to stay close-by. At 1:03 PM, the message read “Patient is doing well, surgeon still working”… hmm, what is that supposed to mean? I wouldn’t think the surgeon would go to lunch… Then my thoughts went to “oh no, I hope they didn’t hit a roadblock, trying to debulk!” So, even though this made me a little uneasy, I tried to stay positive.

Around 2:10 PM, I agreed to go to the hospital’s cafeteria to get some quick lunch. However, just as predicted, at 2:17 PM, I get another text: “Please return to the surgical waiting area”! I turned around and speed-walked back to check the waiting area check in desk. There I was told that the surgery had been concluded and that they were now starting the HIPEC chemo! I was like “No, No, No!!! It’s too early!!! It’s only been 5 hours, that is not enough time!” I was devastated! I returned to my seat in disbelief. They hit a roadblock, they had to abort the surgery because it wasn’t much more they could do. At least that was my perception. Dr. Dessureault mentioned that this could happen, that’s why they don’t give a prognosis prior the actual surgery.

As I sat there, tears of panic appeared against my best efforts. Jennifer (her husband was still in surgery himself) got up to give me a hug and a tissue. Everyone was so nice as I sat there, clutching Ralf’s t-shirt that I took out of the belongings bag. Rachel and Mara were as concerned as I was. Longest two hours of my life! At 3:52 PM, I finally got the message that the it was done and that the surgeon was going to be out soon to talk to me.

I believe it was about 4:15 PM when Dr. Dessureault appeared and took me to a private room. Bracing myself, she said “all went pretty well, we got the bulk of the disease out with the greater omentum right at the beginning!” I had a wave of relief wash over me, and I eagerly listened to the rest of the outcome. Apparently, the majority of the tumors grew on the fatty sheet that covers the abdomen (greater omentum), and when they removed it, it came out in one large “pancake” mass with a weight of 9 pounds! Where on earth was this man hiding 9 pounds of tumor in his belly? They then proceeded to “clean up” organs that had disease, including the spleen she “picked pretty clean”. The fast majority of the remaining tumors were sprinkled like parmesan cheese throughout the peritoneal cavity and were small enough to be classified as category 1. Any tumors between 0 and 1 have the best chance of completely be eradicated by the HIPEC chemo, category 2 was not as good, and category 3 are related to poor outcomes. However, there was one area between the liver and the stomach they couldn’t quite get to enough, so this remained a category 2. But you know what? I take it! Considering the large extent of his disease, this was even better than anticipated! If all removed tissue comes back from pathology as low-grade, they will most likely only monitor Ralf to see where things go. If some come back as high-grade, there will be systemic chemo involved. However, a couple days ago, we got the confirmation that all disease is low-grade! Best possible outcome 🙂

He also has the small amount to tumor burden in the pleural space, but all this is to worry about another day. I was just thinking how Dr. Nair gave Ralf a tumor score of 39 (the highest possible), when in fact he was a 28 going into surgery. Not the best, but much better than Nair predicted. At UF Health Orlando, they wanted to take out part of his diaphragm, his stomach, most intestines, bladder… gutting him like a fish! This proves that second opinions with the best experts is absolutely crucial, especially with such a rare cancer!

I hurried back to the waiting area to let Rachel and Mara know the good news since they still thought Ralf had a bad outcome. Relief all around!!! It took another 45 minutes after I spoke to Dr. Dessureault before I was brought back to PACU to see Ralf. My poor baby had the (NG) tube coming out of his right nostril, which I didn’t anticipate beforehand. When I was leaning down to tell him that I was here, he kept softly saying “pain, pain, pain, pain”, breaking my heart in a million pieces! The anesthesiologist ended up injecting a hefty dose of lidocaine into the epidural to ensure that the space was all filled up with medication. That appeared to help, and I was able to share the good news with him. When Ralf inquired about his spleen, I was happy to tell him that it was still there. But he was so drugged up that most didn’t register until later. When it was time to call report for him to go to a room, I headed back to the waiting area sent Rachel and Mara back to the hotel with my car since I was definitely staying with Ralf.

PACU

Finally, around 6:30 PM, I got to his inpatient room on an oncology med-surg floor where Ralf was transferred to from PACU. He actually looked pretty good, with good skin color, considering what he just went through. Because he still was pretty sedated, he didn’t feel the NG tube as much, and the pain was much better controlled. Staff rolled in a guest bed/cot which most likely would just fold up and collapse if I weight significantly more than my 120 pounds. I was so exhausted but because Ralf was fresh out of surgery, he was closely monitored throughout the night, which meant that staff just constantly came in and out for tests and measurements.

The first day after surgery, Ralf was weak and dizzy, but the pain was controlled by the epidural (continuous Dilaudid) pretty good. There was so much stuff attached to him, capnography via nasal cannular coupled with the epidural, PCA, Foley catheter, continuous infusion of fluids, and the most hated NG tube. Getting up was a nightmare due to nasty waves of nausea and faintness. Besides, the recliner in his room was way to small and uncomfortable for him, and the bed too short. By day three, he was up and walking for the first time, which was a much better experience at this time.

First Sitting, Lots of Nausea
First Walk

Now that the anesthesia had worn off, Ralf started to really suffer the side effects of the NG tube. He had to sit up high – day and night- to prevent the tube of gagging him. After dozing off for a few minutes, he would jerk awake, choking, feeling like “drowning”. It was awful to witness, and it appears as if the low-intermittent suction wasn’t quite able to keep up with the secretions, making his stomach feel full and backed-up. He had to constantly retch-up mucus – day and night until his throat was sore as sandpaper. Therefore, a little basin and washcloth was always within reach. Not fun for someone who is used to be strong and independent!

At least his wounds were healing nicely, even though he was a tad shocked when he saw his incision for the first time, spanning from the sternum to the groin…

He also had several open blisters on his back where the Tegaderm dressing was securing the epidural but those have been healing well as well. Due to my background, I was able (and allowed) to provide a lot of patient care, including showering, handling the suction, going for rehab walks, woundcare, etc. myself, and after the first few days, I found the clean-supply room to get most items I needed to change linens and get clean towels. At one point, nurses started to tell me that I now could apply for a job on at Moffitt…

Recovery has been slow and agonizing, mostly because – you guessed it – the awful effects of the NG tube! Otherwise, his labs and kidney function have been very good from day one. The epidural was discontinued by day 6, and the Foley came out day 7. But the (slight) return of bowel sounds/function didn’t happen until day 10, so for the past week, Ralf had been infused with nutrition (TPN) through a newly placed PICC line. After all, he hadn’t had anything to eat or drink since the day before surgery…

Ralf’s Thanksgiving dinner vs. My Thanksgiving dinner...

The HIPEC chemo has had more detrimental effects on his GI function than I anticipated. And it wasn’t until the evening of day 11 that this hated tube finally came out! I was stalking the nurse to call the attending physician to put in the order and pull that sucker as soon as bowel function was confirmed. After that came to pass, Ralf took a nice shower and came out a new man!

He is still attached to the pole due to the TPN, but that is the last string attached. Ralf started eating a soft diet yesterday, suffered significant heartburn thereafter, but hopefully it will be better controlled tonight with Protonix and Famotidine. Our goal is to be discharged the latest by Saturday, which is three days from now... Fingers crossed!

But with all the hell that we (and especially Ralf) have been through, I am grateful at the prospect of many more years together filled with travel and adventures!

In this Update:

  • Current State of Affairs
  • Birthday AND Wedding
  • Training Whenever I Can
  • A Muddy Ride
  • Things that Made Me Smile

Current State of Affairs
I want to start with an update on the most important thing right now, Ralf’s upcoming surgery November 22nd and subsequent recovery. It’s been a very surreal time, and it has been very challenging to not let cancer rule our worlds completely. Since I decided to push on and get my MSN degree done this semester, I have been on a tight schedule: working full time 12-hour shifts on the weekends, doing internship hours either at the SimLEARN Center, the VA long-term care, or via online grading on most days off, and squeezing in some training days as well to not completely neglect my own rehab is taking its toll but I am almost there. The worst of all though is that I really want to spend more time with Ralf before the surgery, but I am always busy running around! I do need my job, income, insurance, and finish that damn degree but my heart wants to be home… can’t quite win there either way. Since this blog is aimed at monitoring the status of my back after lumbar ADR surgery, I would like to add that I could have never even attempted to do what I am doing right now. The crippled state I was in prevented me to put on my socks in the morning, so the stress and activities that I am currently subjected to would have been IMPOSSIBLE prior ADR. In fact, I am relieved that I am still progressing through my training with Angela, even though I have not been able to be consistent with going to the gym. But before I get into the rehab update, I am going to share one life-event we have been postponing for almost 10 years….

Birthday AND Wedding
When Ralf and first I met, I knew that he was “it”. We just belonged together and that became very clear early on. He, me, and the Ponce – my family! Looking back makes me realize how much we have shared and overcome throughout the last decade, including adventure racing, learning how to freedive, nursing school (twice!), Ralf’s tenure process, two hip surgeries, and my back-surgery journey. We always wanted to get married but having family overseas and just “life happening” caused us to keep postponing it. Now that we are facing the ultimate challenge, we decided that it was time to “tie the knot”, just him and me and the Ponce. Even though we lost our baby last February, he is still very much part of our small family, and we light a candle for him every night. October 21 marks now two special occasions: Ralf’s’ birthday and our wedding day! We started the day with cake and a candle, but then had to get ready for our next adventure: The Orange County Courthouse! We decided to not even bring witnesses, this was just between him and me, and the real celebration at the Wallaby Ranch will happen next year, same time, when he is all better. There we hope that all our friends and family will gather the way we always envisioned.So, standing in line for security in the courthouse is not a very glamorous process, and most people in line weren’t there to get married, that much was obvious. It was a tad bizarre when my flowers went through the scanner and Ralf had to take off his belt. But after this, it did get much better. The place where we signed our marriage license was not very busy, and the process was smooth. We then took a seat to wait for the ceremony to take place in a separate room, where another couple had just entered before us. There were television screens mounted throughout the waiting room, playing videos with various information, including a thorough introduction on how to get a divorce… that made us chuckle quite a bit. When the lady called us in, I was actually positively surprised: the room was nice and quiet, set up for bringing guests I suppose, and a little podium in the front where the clerk had us recite the wedding vows. Even though it was plain and simple, it was the perfect moment to me – after all, it wasn’t about the “where” but about “to whom” I got married. “You, me, and the Ponce – Always!”

After we said our “I do”, we decided to get out of downtown and back to Lake Nona to have a beautiful lunch at Canvas, including a couple of mimosas for me. Later in the evening, we had tapas at Chromas, sitting outside and enjoying the really nice weather. We debated going to the movies but settled on watching “Crawl” in the comfort of our home instead.  Perfect ending to our day – Happy birthday, Sweety!

Training Whenever I Can
So, as I mentioned earlier, consistent training has been difficulty due to the internship, doctor’s appointments, and work. I also missed some days where I was just too exhausted or depressed to go work out. However, despite all this, I actually made a lot of progress. I am now able to do a pull-up from hanging position, I started deadlifting to further strengthen my back, and I can do now multiple push-ups from the ground. It feels good, all the movements and exercises I do feel good – no pain at all. I know many (including myself) have a fear of injury due to the ADR implant, but I firmly believe that if the workouts are done right, they are extremely beneficial and will help my spine stay strong and healthy. It is when I stop moving for a while, sitting long hours in front of the computer, that I feel stiffness in my back (upper and lower). On the other hand, coming from a challenging workout always makes me feel better. Besides, I have the best workout-buddy I can ask for since Ralf and I often train together 😊

A Muddy Ride
Believe it or not, Ralf and I managed to also get one bike ride in this month. We didn’t go far, and hunting season limited our choices quite a bit, but we spent a couple of hours out at the Hal Scott Preserve. Since the trails were super wet and muddy, this turned out to be a messy adventure. Since Ralf is the much stronger rider, it was more a leisurely ride for him. But for me, I really had to push myself to not fizzle out!

Things that Made Me Smile
In all the madness that October had to offer, there were some precious moments that made me smile (besides my wedding). I had a really bad morning one day (it’s been an emotional roller-coaster, and there are many ups and downs right now), and when I got to work, I was really deflated. Then there was that veteran waiting for me to come in: I took care of him a several weeks back, and he came in that day to give me a Coast Guard challenge coin, complete with handshake! He thanked me for my service and my care, which really caught me by surprise. Getting a coin like that is a huge honor, and I kept looking at it throughout my shift, which lifted my spirits a bit. I don’t think he realized what good timing that was…

The other event that made me smile (and shed a tear, actually) was when I got to my internship site at the National SimLEARN Center the day after my wedding. I still have to complete the 180 hours of internship hours prior to surgery, so I had to push on. Around noon, my preceptor nudged me to the back offices to say “Hello to Susie”… , and when I turned the corner, there were decorations, a beautiful customized cake, a second cake, a gift bag, and a card!!! The card was signed by all the SimLEARN staff, who got together to surprise me that day! I don’t even work there, and they went out of their way to make my day a little more special! Here is a big THANK YOU to my friends Susie, Helen, Jennifer, Lugia, and the rest of the SimLEARN peeps!!!

The third surprise I got was an email from the University of Central Florida, College of Graduate studies: I completely forgot about that interview and the questionnaire I filled out sometime in the summer when I was picked as a “featured graduate student”. They only used a snippet of the interview where I talk about healthcare simulation, but I now can be found on UCF’s website and all their social media accounts, lol! Honestly, it is all a bit much right now, but I must say I am proud to leave my mark on this university before I graduate… and I will NOT be back!

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In this Update:

  • Cancer
  • Pushing On
  • Internship/MSN

Cancer
No, it’s not me but the most important person in my life: Ralf. It took me awhile to process what is happening right now, and it feels like living in the Twilight Zone. For those of you who have been reading my blog, you may remember our sea-kayak adventure in August, where Ralf and I combined a trip to Miami with a couple of nights in Key Largo. As it turned out, this was the last outing we did before our worlds completely shifted just a few days later. He has been having very vague symptoms of indigestion and intermittent bloatedness. I do have to say that he’s had intermittent GI issues for a very long time, but nothing major. It was mostly dismissed by doctors as food sensitivities and stress response. But something had changed over the last several months, with his symptoms being much more pronounced and frequent. He was seen by his GI doctor during one of those “episodes”, and do you know what she said? “Guys over 50 don’t have abs, it’s just gas. Let’s do a breath test at the hospital to screen you for bacterial overgrowth”. Really? That’s your diagnosis? Great! I really wanted a CT scan to see if there is some inflammation or maybe diverticulosis that flares up… something like that. So we asked our primary care provider to put in an order for the scan, and he did.

We returned home on Thursday, and Ralf had the CT scan of the abdomen done on Friday. The following Monday (August 12th) was the day before the move to our new place, so we were busy getting things ready and boxed up. Then the imaging center called to let Ralf know that his report and CD is ready for pickup. So he drove quickly to the center while I continued to pack. About 15 minutes later, my phone rings, and after I picked up, Ralf said he thinks he has cancer. Just like that. They just gave him an envelope with the report and didn’t even notify the physician first of the findings. I was so confused and scared, and when he came home, we read the report together. “Severe and diffuse peritoneal carcinomatosis”. I checked the name on the report at least three times because there was no way this was true. Ever! But it was. It is.

The following weeks have been pure hell. I had a resting heart rate of 120, and we found ourselves setting up appointments for more testing and to see a surgical oncologist at Orlando Health UF Health Cancer Center in Orlando. This whole process was (and is) just a complete nightmare, with PET scans being scheduled, then the order wasn’t right, then the machine broke. Incompetent and insensitive schedulers who make things even more stressful then this experience already is! And you have no choice but bumble along, test after test, appointment after appointment. I am just glad that I am not crippled anymore, I can’t imagine going through this with a broken back on top of it.

Fast forward to current affairs: we didn’t continue care at Orlando Health because they are just not able to provide the necessary care. Ralf’s cancer is so freaking rare, only two people in one million (!!) get this! There is a very complex, long, and invasive surgery for this type of cancer, and you really need a surgical oncologist who has a lot of experience with this. We had our second opinion done at Moffitt Cancer Center in Tampa, which is one of the top cancer centers in the country and decided to go with them. If all goes as planned, Ralf’s surgery will be on November 22nd, then 10-14 days in the hospital, followed by recovery at home. He is strong, we to this day go to the gym together, trying to keep some healthy routines going and keeping him as fit as possible to battle this beast! And he will!

I took this clip a few days ago at the gym, does that look like a cancer patient to you? Hell, no!

Pushing On
As I mentioned earlier, we are trying to not have this diagnosis take over all aspects of our life. It is often Ralf, though, who makes me go to the gym, even though I have missed several workouts due to circumstances. We went to Ikea to buy some furniture for our new place, we went on a 11-mile bike ride through Lake Nona, we hang pictures on our wall, and we even went to the Food & Wine Festival at EPCOT a couple of Sundays ago (thank you, Bonnie, for the tickets).

I am still working full-time in the ED but it has been hard. I have that little “ball of panic” that lives in my chest now, and when I get overwhelmed, it gives me palpitations and chest tightness. No, my heart is fine, just not the circumstances. I need to save all my time off/sick leave to be able to take off work after the surgery. Being able to work-out has been important, even though I often don’t feel like going. My back, arms, shoulder, and legs really have improved since I started training with Angela, and I just graduated to the “next phase” of my training. I said it in previous posts, I really don’t want to become an Olympic weightlifter but lifting and squatting is so important to bone and muscle health. So here I am, doing my first back squats… and they felt really good!

Internship/MSN completion
As if things weren’t intense enough right now, the universe had to throw in another level of stress: 180 hours of internship, to be completed by mid-November. That is while working full-time and coordinating appointments. After this semester, I will graduate with my Masters in Nurse Education. I initially wanted to drop this internship, but Ralf insisted that I see it through. If all goes as planned, I am actually going to pull this off, but it is taking its toll.

In this Update:

  • Water-Bound via Sea Kayak
  • Moving
  • Water-Bound via Packraft
  • Getting Ready for Hurricane Dorian

I am going to start by saying that I almost didn’t write an update for this month at all. This year has been emotionally draining, first with Ponce passing, then my dear friend’s daughter passing, while struggling with school and work obligations. I kept thinking how horrible 2019 has been for so many people, and that the year is not over yet….  Little did I know. I am not ready to share the gruesome and scary circumstances that came to light on August 12th, but we are facing the hardest challenge of our lives right now, and I am mentally and physically in a pretty intense state. And no, it's not related to my back (which is fine).

With that being said, on Ralf's insistence, I will try to focus on the good times we had this month, which was all about water.

Water-Bound via Sea Kayak
During the second week of August, my annual leave officially started, and Ralf and I decided to use this time before the move to our new place to travel to Miami – a four-hour car ride - to renew his German passport. Those pesky Germans make you go in person every 10 years, and this year was his turn. The process has usually been very painful and frustrating but I must say that the consulate actually did a pretty decent job processing the paperwork without adding more gray hair to my head.

Welcome to downtown Miami!

And this is the obligatory photo-op from the women’s bathroom of the German Consulate…

From the 22nd floor

Since we already made it all the way to Miami and had some time off, we decided to spend a couple of nights in Key Largo to do some sea-kayaking. We drove another 1 1/2 hours to what we expected to be this nice, tropical environment but were a tad disappointed. Driving into Key Largo was no different than driving into Cocoa Beach, a little run down, with lots of junk sitting around and adult stores down the street. Not the type of entertainment we were looking for….

But we made the best lemonade our of this lemon when we got a private tour arranged with an outfitter that rents out pretty nice sea kayaks. This was our first-time kayaking adventure, and I was a little concerned how my back would feel after sitting in one position in a tight space while using your feet to move the rudder. But kayaking turned out surprisingly more stable and manageable than I thought. Even getting in and out was not as difficult as I anticipated.

Our awesome guide Andrew took us through mangroves out into the Atlantic Ocean, where we spend 3 hours exploring. The water was clear enough to see the bottom, which is very different to being on a lake with much more murky water.

One special moment that I found very amusing entailed a couple of dolphins rounding up a school of herring. As we tried to paddle closer to the action, I suddenly found myself surrounded by bubbling water – kind of like a Jacuzzi – and something slapped me in in arm. Next, I see this herring jumping out of the water and right into my kayak! As the poor fella flopped around the bottom, all I was able to say was “fish!!!” I tried to catch it with my hands but that was easier said then done, especially while seated in a kayak. I used my paddle to prevent the herring from flopping away into the front while Andrew made his way over to me to snatch and release my distressed passenger. I hope the dolphin didn’t eat it after that, but I think it made it with most scales in place.

Another nice aspect of our stay in Key Largo was the nice restaurant with outside bar right at the water (marina) that was within walking distance, so we both could indulge in some adult beverages.

After a two-night stay, we drove back home – 5 ½ hours through multiple thunderstorms – to start preparing for our impending move to our new place.
When you see what you are driving into…..

... And there is nothing you can go about it! Oh, well... here comes the rain again...

Moving
Because our leases overlapped by over one month, we didn’t have to move within a day or so, which helped a lot. Nevertheless, moving is still pretty stressful, especially if you are moving out of a two-story town home. We both got our exercise in that way for sure. To save some time and money, Ralf and I moved a lot of the boxes, kitchen stuff, etc. over to the new place ourselves. Only the heavy and bulky furniture we left for Two Men and a Truck (there were actually three men, but who’s counting). They did a great job, and the main move went pretty smooth.

We still have to clean up the old place, but we are mostly done and ready to turn in the keys. I really, really like our new place, just the current circumstances prevent me from enjoying it much at the moment.

Anyways, all the activity between the long car ride, sea-kayaking, and then moving didn’t bother my back at all. Sure, I am sore after certain things (including running up and down two stair cases all day long), but nothing pathological or unusual.

Water-Bound via Packraft
Shortly after our main move, Ralf’s packraft finally arrived. Believe it or not, but this raft only weighs four pounds, folds up to small bundle to be carried on the bike, while being able to strap said bike to the front of the inflated raft to cover some distance by water – packrafting it is! Since our new living area is so nice and open, we were able to inflate the raft inside – much to the joy of Ralf!

The next day, we gave it a try at Moss Park on Lake Mary Jane. Since last year’s hurricane, the beach area of this lake has been permanently closed. So we just went on the side of one of the canals and put the raft into the water. Let me just say that paddling in a packraft is very different compared to a sea kayak. It’s more demanding on the biceps, and fighting currents and winds is also more of a challenge. But it was a lot of fun, and Ralf and I took turns until the incoming thunderstorm ended our first packraft outing.

A couple days later, we returned to Moss Park for a more extensive outing. A very funny moment came to pass when the ranger at the entrance eyeballed our half-inflated red raft in the back of our vehicle. She asked us if we were planning on going on the water, and we said yes. She then was quite worried and urged us that under no circumstances are we to launch from the side of the canal or any other unofficial place due to alligators (oops, we kind of already did that a couple days ago… oh, well). We were instructed to use the official boat ramp, located a little further up from where we launched previously. Since we didn’t want to cause any trouble, we parked by the boat dock, inflated the raft, and carried it over. And what do you think we found? The ONLY alligator, sunbathing in the middle of the boat ramp!!!

Ralf had to shoosh him away (I missed to film that adventure), and after the gator swam off into the canal, we were finally ready to get the raft into the water. This time, the weather held up nicely, so both of us were able to take turns and paddle all around the island located within Lake Mary Jane.

PS: the gator never returned….

Getting Ready for Hurricane Dorian (More Water)
Now that September is approaching, so was Dorian. We really, really could have done without a category 5 hurricane, snailing its way toward Florida’s east coast. To be honest, it wasn’t so much the hurricane (ain’t our first rodeo) but the impact on schedules and important appointments. Two years ago, Ralf, Ponce, and I stayed at the hospital because I had to work during the storm but this year, we were hunkering down together in our newly boarded-up home. It’s like living in a cave for five days… Getting these shutters up turned out to be a major project, and the bags of mulch were no joke either. Did I mention that it’s still super-hot and humid in Florida right now?

In addition, we just kind of plopped a lot of our stuff down all over the new garage. Now we needed to make room for two cars to fit. I suppose, the upside of Dorian was the motivation to get the garage organized and shelving assembled…

Garage before…

Garage after!

Today is Wednesday, September 4th, and Dorian came and left. Our friends who live closer to the coast got hammered by a lot of rain and wind gusts, but Orlando was spared for the most part...

I feel for those poor people in the Bahamas, who undeniably got the full wrath of this hurricane.

Since we didn't get to eat any of our hurricane foods, we are all set for the next one...

In this Update:

  • Getting Stronger!
  • Mind your Step
  • No more Grades!

Getting Stronger!
So, I can proudly announce that I have been working out (mostly) in a very consistent way! Even though my schedule continues to throw me curveballs here and there, I have been going to the gym at least twice a week (with a few exceptions). I have made slow but consistent progress, which I really wasn’t aware of at the time until my latest push-up day on 07/26: I started out with doing incline push-ups in late May using a box because I was too weak to do them lower. I have reduced the height/incline over time but on this day, Angela instructed me to only use one bumper plate. I wasn’t quite sure about that, but as it turns out, I got significantly stronger over the last two months!!!

Here is a short video of me doing push-ups on the box on May 20th….

… and here is the result of consistent training on July 26th!

I suppose, this would be already exciting for someone who just want to get in shape but to me, it is a freaking miracle! Before my lumbar artificial disc replacement (ADR) surgery, I would have fallen flat on my face and remained in that position if I attempted this move. But now, it feels great!

Angela also added a new move to my routine to further build up my shoulders and core: Prone Barbell Rows.

... which is an upgrade from the single-armed dumbell row...

Mind your Step
Ralf and I managed to visit a couple of wilderness preserves as well. However, this time we explored by foot rather than by mountain bike. You see, Florida summers are rather water-filled, and over the last few weeks we had so much rain that I was about to suggest to built another arch, just in case.

Our first outing was to the Seminole Ranch Conservation Area (not a place many people tend to go). It was pretty hot and steamy, but the jungle-like vegetation and beautiful wildlife (especially birds) made it all worth it. The trails weren’t very technical but they ended up to be flooded at times, which is nothing new, and this wasn’t the first (or last) time I was wading through ankle-deep puddles.

I am still laughing out loud when I remember the following scene though: As I am walking down my side of the trail, I see something colorful laying right in front of me.

Me: “Oh look, is that snake skin?”
*as snake is lifting its head*
Ralf: “Yeah, with the snake still in it!!!”

Turns out, this was a Pygmy rattlesnake, and they are indeed venomous. As I slowly step around the snake, Ralf steps a tad closer to make a positive ID. What he didn’t realize was that he was now standing in a fire ant hill! Let me tell you, these sneaky little bastards don’t bite one at a time, they all crawl on your ankle and bite at once, so you won’t know it until it is too late. I am still wondering if that was a joint operation between the ants and the snake…

Our second outing was at the Isles of Pines Preserve, which is only 10 minutes from our house. Not many people come here, so the trails were pretty overgrown at times.

This hike turned out to be a real workout: not only were the trails overgrown, but they were significantly torn up by pigs, in addition to the ground being soft and squishy, which is apparently a great way to exercise your ankles and calves…

But at the end of the trail awaits a gorgeous lake (Lake Mary Jane), so that makes it all worth it! However, my ankles were so sore the next day, I had a hard time climbing stairs!

No more Grades
Sooo, I turned in my evidence-based research paper on July 17th (45 pages of glory!), and on July 31st, I had to present my evidence in person in front of my peers at the University of Central Florida! It felt quite strange when I drove onto the College of Nursing campus parking lot, as I had done hundreds of times before, years ago during my BSN program.

I was pretty stressed out, even though it was my own research paper that I should be VERY familiar with, but still, I am (and always have been) a stress muffin!

Now the semester is over, I got my A (hallelujah!), and the next semester will be the LAST! Since it “only” entails my 180-hour internship that I have to complete on my days off, I am done with grades! The internship is Pass/Fail, so my GPA is what it is now! I am not saying this will be an easy semester but it takes the pressure off when grades are not an issue anymore.

Tomorrow, Ralf and I will take a trip down to Miami and the Keys for a few days. After our return, we will tackle a whole different monster: We-Are-Moving! Stay tuned!

In this Update:

  • 12-Week Workout Routine
  • Biking in Florida Summer
  • Mini-Deployment

12-Week Workout Routine
I made it to 12 weeks of continuous workouts, at least 2-3 times per week! For me, that is huge!!! The demands of graduate school, full-time work, and other obligations really made it extremely challenging to stick to regular workouts – much to my dismay! As a result, I was told that my arms look more toned, and I feel stronger. My low-grade backache is also under control, which I credit to the fact that the worst part of my studies is finally over and I don’t have to be glued to the laptop for endless hours. In fact, I just applied for graduation, FINALLY!!!

Intend to Graduate

Progress is slow but steady at this point, which is totally alright with me. I am not in a hurry. My back feels fine, and I am able to hip-thrust 100 pounds at this point. The key is to do the movements in a slow and controlled manner, adding weight in small increments. I certainly don’t want to be an Olympic weightlifter but adding weights is so important for healthy bones and muscles.

This is my “happy post-workout” face

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Biking in Florida Summer
Some would call us crazy to go biking in the wilderness during summer in Florida. Well, I admit, the heat index was about 107 degrees but as long as you take enough water, it can be done!

We went to Hal Scott Preserve, which is not too far from where we live. We were the only ones present in the parking lot though…

Only ones

Due to our now daily thunderstorms, the trails became rather ... interesting. For Ralf, it was an easy and casual ride – for me, not so much!

Trails went from….

… nice small gravel

Small Gravel

… to teeth-shattering large gravel

Large Gravel

… to grassy

Grassy

…to muddy

Muddy

…to wet

wet

… to “I guess I will carry my bike through the water”

Close-up

 I was pretty much toast after this outing but not in pain. That tells me, though, that my endurance and leg strength still need some work!

Mini-Deployment
Last week, my co-worker and friend Bonnie and I participated in a “mini-deployment” with the Director’s 50 Emergency Response Team. The two of us were sent to a close-by mall’s parking lot to assess, treat, and rescue a home-health nurse who got injured during a tornado and was waiting for us in her damaged car.

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I am pretty sure she was very glad that the damage to her car was just simulated and that she had the luxury of air condition while she waited. Here are some snapshots of our mission:

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 I am happy to announce that no VA nurse or federal property was damaged during this exercise, lol.

In this Update:

  • Sticking to my Workouts
  • Birthday Surprise
  • Biking at Charles Bronson (second try)

Sticking to my Workouts

I have mentioned this numerous times during the past year, and the struggle of sticking to a workout routine while working full-time in an ER, coupled with the demands of graduate school, are still an ongoing issue. However, I am finally able to say that I have worked out 2-to-3 times per week over the past seven weeks! Thanks to my personal coach Angela, I was able to follow a progressive workout routine that enables me to get strong and fit in a safe and consistent way. I am slowly increasing weights, moving from the baby-kettle bell (18 lbs) to the heavier version of 26 lbs for my goblet squats, or from the 35 lbs barbell hip-thrusters to 65 lbs. I can even do hand-stands again, lol!

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At this point I want to mention that I have had some lower back aching (!) going on that was quite persistent. I blame this on sitting in my chair for hours on end, hunched over my laptop, writing my masters’ thesis on healthcare simulation, whenever I wasn’t working. This is still going to be the case until the end of July, when I will finish my LAST class of graduate school. With that being said, I also think that my training with Angela is the reason that this backache has not taken over, and I am fully convinced that this will go away, especially after those marathons at the computer will have come to an end. That shows you, though, how important it is to KEEP MOVING!

I assembled a view pictures of my workouts to document what I have been doing. In the near future, Angela will add running to the mix, which I am really excited about!

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Birthday Surprise

Happy Birthday

Even though I have been super-extremely stressed, I made sure to be off work on my birthday weekend at the end of May to spend some quality time with Ralf. To my surprise, he booked us a trip to Vero Beach in a 5-Star resort hotel, with a room facing the ocean so we can see the sun rise in the morning! We even had our own cabana at the beach – with beach service! I guess I can say that I turned 44 in style… You did great, sweetie!

Suite
Sunrise
Cabana
Beach service

And we scored two very nice dinners, one paid for by his mom, and the other paid for by my mom as a birthday gift.

Dinner 1
Dinner2

Biking at Charles Bronson (second try)

I can clearly remember when we attempted to bike at this place last year. Epic fail! The trails were so muddy that it was like riding through syrup, and since I still had my old bike with the regular tires, I didn’t even make it past the 2-mile mark.

So, now we returned to do a re-trial: I now have my new mountain bike with plus tires, and due to lack of rain, the trails were mostly dry. HOWEVER, that apparently didn’t mean that riding those trails was any easier! The first part that was so muddy the last time was now all torn up and deeply rutted all over the place, which made it hard at times to see where I should be going.

Torn-up
Outing

One cool encounter was with a tortoise we crossed path with at the beginning of our ride. It was sitting right in the middle of the path, so we stopped to not startle it. Normally, tortoises will go the other way or retreat into their shell, but not this one! In fact, as I was deciding if I should just dismount and push my bike slowly past the (pretty big) guy, it started running towards me! And I mean, running! I have never seen a tortoise move so fast, and as it got closer I could actually hear him breathing. All I was thinking was “is he coming for me? I guess he is…”. And sure enough, the tortoise came all the way over and then stopped next to my foot. Maybe he was trying to say “happy birthday”? Well, this will remain a mystery…

Tortoise

Then we entered a segment of trails on a more hard-packed, level surface where we first encountered a free roaming bull (which made me worry about how he liked my bright-orange bike) and then a big flock of wild turkey that crossed the path by cutting us off. I found a gorgeous feather that may have belonged to an eagle. After miles of all this, we decided to explore one more segment of the forest, which ended up being loose sand. Considering that it was close to 100 degrees, this turned out to be major work, and we had to turn around and abort mission at that point. But overall, this time was a lot more fun than being “stuck in the mud”!

Victory
Sandy
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