Category: Rehabilitation after ADR surgery

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.

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.

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. 

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 2^nd through 14^th: 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 3^rd, 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 5^th, 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 31^st through August 14^th: 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 23^rd through 28th: Trip to San Francisco

After returning back home from Stuttgart late on August 14^th, my first day back to work was 7 AM on the 15^th. 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?

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.

Four Years Post-Lumbar ADR Surgery
April 4^th, 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.

• 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 3^rd, 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.

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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.

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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.

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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.

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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.

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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.

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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.

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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…

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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.

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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.

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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!

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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 9^th… 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!

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Flying to Germany… Again
December 11^th, 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.

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.

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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!!!

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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!

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.

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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.

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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.

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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.

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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!

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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.

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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!

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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.

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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).

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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.

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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 23^rd, 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!

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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!

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 14^th. 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.

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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.

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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.

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Speaking of Karl-Heinz: on August 17^th, 2020, he missed his 70^th 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:

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Of course, food and desserts were also explored extensively:

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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…

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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?

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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.

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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.

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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.

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I also realized that Otto is still around!

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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…

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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!

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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.

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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.

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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.

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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 17^th, 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.

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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.

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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.

On July 2^nd, 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.

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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.

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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.

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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.

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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 7^th 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 17^th, 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!

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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….

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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.

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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???

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.

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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.

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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.

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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…

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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!

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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.

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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…

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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.

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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.

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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 11^th Anniversary

L5/S1 Lumbar ADR: 3 Years later and Still going Strong
My last update was posted on December 31^st, 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.

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 8^th, 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.

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Not counting the unspeakable madness that took place at the Capitol on January 6^th, 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.

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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…

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

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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…

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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!

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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 11^th Anniversary
April 1^st 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!