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Start September - Family and A Clinic

September 1-13, 2017
Written September 9+
Dear Diary and Friends and Family,

This is another "miscellaneous" diary - a record of mostly non-remarkable life events.  No grand travel, but a little trip.  No great drama - but one hospital visit.  Maybe just the sorts of things that need a written diary to provide any lasting memories and, in the end, that is what matters.

Marianne has been preparing for another art show at the Los Banos Library.  This was a successful charity event last year and she was asked to return, an encouraging sign.  Here are some quick shots of her new color palette, including an in-progress pair of shots that show the subtle difference between layers in her small wood panels.  I like the products more and more and, more important, she likes both the process and products.  (Show is October 19, in case you are passing through.)

d170901_02_hot.jpgd170901_04_mamo.jpgOtherwise, summer life in Fresno is determined by the weather.  Hot.  August ended and September started with days on end of highs above 100F and lows near 80F. However, I think we have passed this phase of 2017, and the incoming Fall phase features some of the best weather - warm, clear, and cool nights.  In the meantime, we cope by turning on air conditioning or, sometimes when that isn't practical, by visiting cool places, like Marianne's mom's pool and house.  A good deal, we get cooling and more Mamo stories - things worth remembering.

d170901_06_maxpenny.jpgWe have not been able to escape by traveling to the coast or the mountains, but Marianne's sister Babi and husband Ruben did schedule a rare get away.  They took up our suggestion for a couple of days down in Cambria, normally tens of degrees cooler in summer.  This time, however, even the Northern California Coast was suffering a heat wave, with temperatures approaching or even exceeding 100F.   (While they were gone, we were charged with light pet-sitting duty. Feeding and watering dachshund Max went just fine, but I am afraid hen care for Penny came up short.  RIP, after seven years in the family.)

d170907_02_lastview.jpgd170901_10_limb.jpgMy only other outside activity was as little yard work as I could get away with.  Mostly, this consisted of extra watering for roses, trees, shrubs, and bushes.  Both Marianne and I are getting tired of this three-times-a-week summer ritual, but even the roses seem to have made it past the worst of summer.  Our Chinese Elm showed its summer stress by shedding a limb from thirty feet up.  Glad it hit the gazebo and not my head.

Otherwise, my time had been taken up with preparing for introduction to the Google-sponsored "Baseline Study".  This is a medical research project in which Google subsidiary Verily joins Stanford and other medical research groups to track the condition of a large cohort of Americans, to see what large numbers might reveal.  I volunteered, was accepted, and scheduled for two days of testing on September 11 and 12. 

A week before, I received more details on what this testing would entail.  The "one and a quarter cup" blood sample stood out as a measure of how serious poking will be.  Sweat and tears will be analyzed, along with "other fluids". Then there will be the ECGs, with and without stressful exercise.  And some range of internal imaging.  The test protocol even calls for psychological exams.  Basically, they will be looking for anything that might be useful as a measurable precursor of disease.  Interesting, to be sure, but being reminded of everything that can go wrong with a 71-year-old (or any) body is sobering.  Oh well, it feels right to be tested for science.

d170907_06_drive.jpgThe best part is that my exams  for the Baseline Study, in Palo Alto, served as an excuse to go down to visit grandkids in nearby Monte Sereno.  The three-hour drive was as boring as usual.  I keep thinking there should be a more interesting route, but Marianne assures me, with 60 years of experience, that there isn't.  I believe her.

At the end of the drive, we jumped into Gabby's hectic mommy life.  Shortly after we arrived, it was off to pick up Sam and Ava at school.  A modern ritual.  I had to walk miles to and from school, in rain and snow, uphill both ways.  At least that's my memory, although I have no written record.
Then it was off to Ava's golf lessons and a quick drink and snack for the rest of us on the country club patio.  Nice pause for us and she does seem to enjoy golf.  After golf, it was soccer practice.  More exercise for her, while we headed back to the house for some chores.

d170907_14_thinker.jpgChore #1 was supervising homework for first-grader Sam.  Mom, Gigi, and Charley did their best to encourage thought and Sam tried, as well as any six-year-old can at the end of a long school day.

Speaking of a long day, our babysitting day was just starting.  Gabby and Mamal needed to celebrate a friend's birthday, so we offered to treat the kids to their dinner of choice: Pizza at Willow Street.  I think this is their go-to restaurant, as much for the color crayons and drawable menu as for the pizza and noodles.  Our salads were good too, and may have compensated for the country club beer, nuts, and pop corn.  Maybe.
The day ended, as it often does when we are on duty, with Gigi reading an evening story. A peaceful end to a nice day.  (As I write this diary entry, I note a record of very ordinary activities, but ones that warrant a record. Years from now, family will have changed.  Mamo.  Ava and Sam.  Even little Charlie.  Better to have too much recorded than too little.)

Friday started like any other school day: Ava and Sam bright-eyed and eager to head out. It is great that school time is happy time!

Our next activity involved family in a more challenging situation.  Two days earlier, nephew Spencer had been running on the track at his Carmel school when his right femur broke.  Just like that. No accidental trip. No warning.   One moment he was warming up for volleyball practice and the next he was on the ground in more pain than he had ever imagined.

d170908_10_ambulance.jpgThe ambulance came quickly and whisked him off to the local hospital.  By his own account, Spencer's two thumbs up were for his own benefit as much as for mom's (who took the picture.)  The doctors diagnosed that the leg had been weakened by a tumor on the bone itself and put the condition into the big league category, necessitating a longer ambulance ride up to the Stanford Medical Center.  The next day, his femur was strengthened with a metal "nail" (scary medical term) and the tumor had been re-termed a "bone cyst".  The surgeon was 99.9% confident it was not malignant, although calling a bone-breaker like that "benign" seems wrong somehow.

We caught up with Spencer and his mom and dad Friday morning, everybody looking pretty tired.  Understandable.  No need for parent pictures since it is pretty easy to remember how worn and worried everyone was.
d170908_16_pose.jpgWhile we were there, the physical therapist got Spencer up for his first lesson on the use of crutches. Then there was a session for basics of dressing and navigating home and school.  Living had suddenly changed. Through all this, Spencer judged that his "pain number" moved from 2 or 3 to 5 or 6, but he manged a smile for dad's picture with the occupational therapist.  Tough kid.  Cute, but tough too.
By the end of the day, we received word that Spencer and his parents were on their way home!  Mom sent her Facebook friends this picture of the patient dressed and ready to head out.  Congratulations!  Spencer has a lot ahead of him, but he is capable and has a super support team.  We will keep track.

After the hospital visit, Gabby treated Marianne and me to a very nice lunch, supposedly in payment for babysitting duties.  Heck, we would have paid HER.

Then it was back to kid activities.  Sam had a soccer practice session and I took advantage of the opportunity to practice my sports photography.  Hard to go wrong with a bunch of cute little boys running around with complete abandon.  Tomorrow there is an official game and we will see if play is any more organized.  (I doubt it.)


Marianne and I had evening babysitting duty again.  Darn.  She prepared one of the kids' favorite dinners:  breakfast. Not just any breakfast, but palascinta , the Hungarian crepe that serves for a meal any time of the day.  At least we all think so.  After that, it was tv time, a special treat not allowed on school nights.
Another day that ended well; Ava and Sam extra tired from a long day and Spencer back home, after a much longer day.  Gigi and Opa happy with our duties.

Saturday started slowly.  I went to my Starbucks "office" to work on pictures and this diary.  My normal travel routine.  I brought coffee back to Marianne, Gabby, and Mamal.  All part of the routine and sipping morning drinks around the pool, in perfect weather, can not be beat.

d170909_12_crowd.jpgd170909_02_ball.jpgBut the quiet time had its limits,  since Saturday is soccer day and both Ava and Sam had games scheduled and the crowds were ready. 

First up, were Ava's blue-shirted Tsunamis.  This year the team plays on a big field, with eight players, including a goalie guarding a pretty big target.   Ava and her cohort of eight- and nine-year olds have made great progress and have gotten beyond the chaos and clumping of past seasons.  Defense seems to be key and Ava did an excellent job at stopping yellow-shirted opponent.  Congratulations.
With no break between games, we moved to another field and another match. Sam has gotten more skilled, but games with five- and six-year-olds are, shall we say, less disciplined. The boys play with five players on the field, aiming at a small, unattended goal.

Much of the time, all ten kids were chasing the ball in a clump.   The enthusiasm was great and Sam and his friends seem to be having a good time, even if, at this age, crying breaks out from time to time.  The tears were all forgotten by the time of the team handshake.

After the two exciting matches it was time for a quiet afternoon.  Gabby did this better than the rest of us by taking a nap, a real luxury for soccer moms. Ava and Sam rested for no more than twenty minutes before they joined Gigi and Opa in the pool. We all stayed in the water to our limits.  For me, that meant a half-hour or so of tossing Ava and Sam on and off the blue pool pad. We all enjoy it, and I get exercise, but I had my limits. The kids didn't.  They continued jumping and swimming for hours.     

Our hostess got up from her nap and prepared a healthy veggies and tri-tip barbecue. This really is a resort worth visiting!

Gigi asked the kids if they had ever seen "The Sound of Music".  Nope.  So, we set up in the living room and asked Netflix to send us the fifty-year-old classic.  Three hours later, even Ava and Sam were ready to call it a day!   Another nice day.

Sunday.  A quiet start. I was first awake, like usual, and Ava was second, despite her late night.  I worked on a review of pictures from the day before while she created her own stories, for her own entertainment.  She's really very good at that.  Sam, on the other hand, crept awake after sleeping a full twelve hours. He's very good at that.

The whole day was so unremarkable that I didn't even take pictures!  Of course there was pool time, so I got at least a little exercise.  I also got a black eye from Sam's foot.  (Picture later?)  After that, it was a full turkey dinner, in celebration of Mamal's three-weeks-passed birthday.  Good excuse.  Great meal.

Finally, everyone was off early to bed, the kids because they had school the next day and me because of the pending days of medical exams. 

I was up early Monday and showered, and down the road to a Starbucks office close to the Stanford medical facility where I will spend the day.  It was strange, I felt like there was pressure to "do good" on these tests, even though the point is simply to take a snapshot of my current medical numbers.  No pass and no fail, but people still wish me luck.  An experience, in any event.

(On the way over, the radio had a moment of silence to remind us of events 16 years ago.  I recalled our experience of September 11, witnessed from far away, in what seems like two or three lives ago.  Good to be reminded.)

I have sent my detailed Baseline observations off to a postscript, just because I am unsure if they are of specific interest and they definitely don't "flow" along with a normal diary story!

d170911_10_poolmess.jpg After a full day of guinea pig duty, it was nice to settle in with the family.  I had considered swimming, but the weather was completely strange.  There had been a windstorm earlier that had destroyed some of the poolside furniture and had added a tree's worth of leaves to the water.  And there was more lightning and thunder showing up.  Swimming could wait for another day.
Instead, we settled into normal school day priorities: snacks first and then homework. Both kids come home hungry, or according to Sam "STARVING!". They both are good about homework with Ava doing her school work with no prompting.  A good sign.   As a first grader, Sam does not have much work to do, and it is a nice chance for retired teacher Gigi to provide some professional help and direction.d170911_22_stylin.jpg

Dinner was a replay of Sunday's turkey dinner.  Leftovers may be the best part of a big holiday meal!  Sitting around the table, we all explained our days, while Ava helped Gigi with a new hairdo.  Somehow, I don't think it will be a permanent feature.
Bed time comes early on school days.  Sam wanted a bedtime story, even though big sister passed.  She is getting too old?

d170911_26_watchin.jpgSam checked Gigi's Minney Mouse watch for the time and then headed to bed. 

Another nice day for everyone.

My Tuesday started like Monday: an early start to work on pictures and diaries at Starbucks and then on to Project Baseline testing.  (See below).

d170912_02_zenpair.jpgd170912_04_traffic.jpgI made it home just when the kids returned from school.  After a quick snack, they had the energy we expect of them.  Ava took a lesson in zentangle drawing from Gigi, always a good student-teacher pair. Sam and I went off to his room and one of his regular activities: "traffic".  He breaks out dozens of little cars, trucks, airplanes, and horses to create wild stories of how they all interact - normally by crashing violently.  Fun for him and I enjoy the time I get to spend with him. 

Then we went to more soccer practice - Sam's this time.  I took pictures, again, because that's what I do and since we will all want memories when these little guys quickly grow up.

Soccer practice is a family event for Sam, with cousin Reef on his team. Uncle Ali and Sam's two grandmothers watch from the sidelines, when they aren't busy chatting or reading email.
Sam, of course, is a star.  Mostly.  Our story, anyway.
Most important, everyone had fun.  (Derrick, on the right, wasn't nearly as grumpy as this shot might indicate.)

From practice, it was home for a quick soup and sandwich dinner.  Kids were off to bed at 8:00, normal for school days, and I'll admit I wasn't far behind.  Another nice end of the day. 

d170914_02_bkfstgoof.jpgWednesday started with kids' breakfast and goofy goodbyes.  Then we had an early stop at Marianne's favorite dentist.  Mamal managed to squeeze her in for a needed repair and we were off on the ride back to Fresno by 9am.

The drive was as plain as ever. That's both good and bad, I suppose.  We will miss the little grandkids, but not for long.  Gabby is bringing them over to Fresno for a visit with Mamo in just a couple days!

Stay tuned.

John and Marianne

Project Baseline
I had two days of tests for Project Baseline, and here is what happened on Day 1.  I arrived at the Stanford Medical Research lab in Palo Alto at 8 am, curious, but a bit nervous. My minder for the day was Luisa*, who spent the whole day being nice.  The study really does seem to value "subjects" and has determined that keeping us volunteers is best done by friendliness.  Probably true.

The first measurements were the same ones we all get during doctor visits (height, weight, blood pressure, etc.), except, since I was the only patient in-house, done much more carefully.  That too would be a theme for the day: careful measurements.  In any event, I passed these first tests- reasonable BP, pulse, etc.  No surprises.

Next came the blood draw, you know when the nurse sticks the patient and then fills a vial or two or three.  In this case, the stick was fine, but there were 33 vials to fill.  It was like donating blood at a blood bank.  I have no idea what all will be tested.  Another theme: I don't know WHY they are doing what they are doing.  I need to get better informed.

The day's third step was a medical history interview by nurse Donna.  Again, this was more than the normal doctor just asking: "How have you been since I saw you last?"  My own history is simple enough, thank god, not much to report in 71 years. But then I needed to report on all "first relatives": mom, dad, sister, and sons.  The boys were also easy as they are still young and healthy.  My sister's history was more complicated.  She had enough "medical history" for both of us, but I did my best to remember her struggles.  They still bring tears.  The hard part was coming up with mom's and dad's history.  Their causes of passing were remembered well enough, but what kid knows his parents full medical history?  To those who still have living parents: make note, someone will eventually ask.
Three hours in to the day, it was lunch time.  I had actually gotten a bit hungry, although I am not sure why.  It's not like I was spending time at the gym like I do many mornings.  At least it was a moment to remember a diary picture, even if it was a minor part of my day!

After lunch, we moved to testing unlike anything found at a normal doctor visit.  First, was a "biospecimen collection".  Ominous sounding, complicated, but painless enough.   Luisa and another nurse silently conducted an elaborate process of swabbing giant-sized Q-tips in a dozen places (behind ears, near nose, inside cheeks, on teeth).  Each sample required a new set of sterile gloves and a new sterile scissors to cut the swab into the test tube.  I have never seen such care to avoid cross-contamination.  Even speaking was not allowed.  The sampling was so interesting, I failed to ask what on earth the samples would be tested for.  (The background material I later read said these were samples of microorganisms for DNA analysis.  Why so many and why so careful, I have no idea.)

My last tests of the day were a pair of pulmonary function tests by Ricco. These measured lung capacity and the efficiency of oxygen transfer to the bloodstream. That much was easy to understand, although the process of breathing into a complex machine took some practice.  Once again, not a test my regular doctors would ever have had occasion to run, so it was interesting. I have no idea if I "passed", but I have to remind myself that it's all just an assessment - not really a pass/fail test.  Still, it seems like I should know.  That too was a theme for the day:  I should KNOW what my tests mean.

Jessica, my minder for the day,  started Day 2 with another friendly greeting and a quick transfer over to the echocardiogram laboratory.  Keegan and Yuki started with the echo machine, where they spent over a half-hour taking a couple of dozen pictures of my heart. Every once in awhile I would look at the screen, but it never looked like a heart, just bright and dark smudges.  Hopefully, they were able to make sense of things. (The guide book says they were looking for ominous problems such as bad valves, chamber holes, or an enlarged heart.  Keegan said they were not allowed to tell me what they found, but at least he didn't exclaim "Wow, look at THAT!")

The resting ECG was next, starting with careful attachment of the dozen probes.  "Careful" in this case meant shaving away hair, sandpapering skin, and degreasing with rubbing alcohol.  These are very careful folks.  The measurement itself was quick and, again, no exclamations.

At this stage, Keegan and Yuki shifted the probes a bit to prepare for the stress echocardiogram.  My blood pressure was just 113/68, and pulse in the mid 50s, so I must have really been resting.  Then, with probes attached, I was lead to the treadmill for the "stress". We started with a walking pace and gradually increased the slant and speed.  As I went along, I appreciated my regular gym visits, and even Keegan was impressed with an old guy.  (He didn't say "old", exactly, maybe just "someone your age".)  Eventually my pulse got to 150 bpm and BP "about 200", but my legs gave out (or I was just bored) and I called it quits. They moved me quickly back to the echocardiogram table and proceeded to take even more heart pictures, until I was no longer huffing and puffing. 

The next testing, "imaging", was done over at Stanford Hospital and Jessica joined me while Pat drove us over.  The first image was a chest X-Ray, to look at my "lungs, heart, blood vessels, and bones in chest and spine." Click, click.  No comments.  I wonder if I will ever get any information.

The next picture was a computed tomography (CT) scan of my chest.  (My testing guide said this was done to look for calcium in my arteries.)  The process was easy enough.  I laid down on a table and the table moved in an out through the whirring ring of X-ray sensors.  (Not the big, claustrophobic tunnel of an MRI machine.)

All this heart examination was a reminder that the heart problems really are a threat to long life.  I do hope they tell me what, if anything they found.

Back at the Stanford medical research lab, I was introduced to Taras, the eye doctor.  She took various pictures of my eyes and did the normal eye pressure test.  These were tests I was already familiar with but, once again, I have to say the Stanford doctor was as careful as anyone who has examined my eyes over the last half-century.  Once again, no immediate feedback, but a promise that I would receive whatever they eventually decide will be within their test subject feedback protocol.

At this point, Jessica took over for psychological and physical testing.  The pych testing consisted of five pretty simple questionnaires.  The stated purpose for this part of the Baseline research is to see what can be found of the connection between mental and physical health.  However, this was the only testing that seemed pretty cursory to me, so I wonder what can be found.  Oh well, "wonder" is all part of research.

My last lab-rat performance was "physical performance testing".  Jessica measured my grip strength, watched me balance on one foot for a minute, pace fast and slow, and walk for six minutes.  Nothing very strenuous, but I have to admit this might change over the next decade or so.  A sobering thought.

Jessica then reviewed the instructions for the study devices I would take home and, presumably, use for the next years.  First, is the Study Watch.  (**Pictures pending.**)  This gadget measures pulse, temperature, skin conductivity, and sunlight, more sensors than found on Fitbit or Apple Watch.  Unlike those commercial devices, the Study Watch provides the user no information beyond the date and time.  Consequently, I now wear two devices: my Fitbit on my right wrist and the Watch on the left.  Pretty geeky.

I also received a sleep monitor.  This disk-shaped device is placed under my mattress and measures something, exactly what I have no idea. At least once a week, data from the watch and the disk are synchronized with the Verily (Google) data base via the mobile-phone network "Hub". All very big-brother spooky, if I think about it.

Finally, Jessica handed me over to Sumara, her boss, for an exit interview.  I enjoyed this part, because Sumara said I was Stanford subject number 35, and they really were still in a learning mode about just how to proceed as they go for their goal of 1,000 subjects before the end of the year.  I noted that I could not imagine any improvement in friendliness and helpfulness, and apparent care when testing.  I did suggest that occupational history (exposure the chemicals or repeated stress, for examples) might be a useful part of medical history. This seemed to strike Sumara as an interesting suggestion, from a lab-rat specimen, especially. (She didn't say "lab rat", probably just "subject".)  I also harped on the need to provide feedback from the testing and the Study Watch in order to keep test subjects interested.  She said this has been a universal comment and they are working on it.

And that was it.  An interesting process.  Frustrating that no results are available - yet.  We will see.  (By the way, you too can go through this process, if you live close enough to one of the Project Baseline labs.)

* I have included nurse, doctor, and technician names, because I may see them again over the next years and this way I can impress them with my name recall. 


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