Monthly Archives: October 2019

Butler Pantry Update – 2

My butler pantry is turning out to be a major project pushing the limits of my carpentry skills but I am having such a blast! Once I got the trap door in, I spent a long time surveying the space and trying to figure out the best use for the planned shelving. I have several specific needs. One I need a place to put a variety of kitchen items that I use rarely but need to keep. This includes things like my husband’s juicer he uses to make fresh apple juice each fall from our apple trees and my lovely big red turkey roaster pan I use two or three times a year. There are quite a few of such things floating about in a disorganized mess on shelves in the basement. I decided on wide shelves around the top that I need a step stool to access but given how rarely I do need them will be fine.

My second need is for more pantry space. Because we live in the country, it is a long way to any grocery store so trips to town are trips to provision and I hardly ever buy just one of anything. I also am a die hard clearance bin and sale shopper. For example on yesterday’s doctor appointment trip I found brown rice flour at half price and I bought all five small bags. Things tend to get buried on our basement shelving. I need a whole range of sizes of shelves so I can see at a glance what I have lots of and what I am getting short on when I look at flyers and plan my shopping trips. I have planned lots of narrow shelves for holding cans and boxes and bottles.

The third need is for a place to store my vacuum and some assorted cleaning aids. They have no specific spot right now. They kind of get shoved into whatever spot they fit and then get tripped over. This is especially true for the vacuum which currently resides in front of my husband’s lab desk. I need to have designated a broom closet space.

My fourth need is a place to hang my indoor light for starting seedlings each spring. The basement is too cold and the space I used last season is now occupied by my husband’s indoor pond scum growing area. The space required is long and narrow. I will need to be able to have space to raise and lower the light. However since it will only be used a few weeks out of the year, I decided to put in a floating shelf so I can use the space the rest of the year for something else. This also means I need a plug. Fortunately the wiring we put in for a second set of outdoor plugs is right nearby so it was trivial to run a wire down through the floor and our family electrician will connect it with a junction box.

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With all those needs in mind I went on a careful measuring binge. I used a level and pencil to mark all the shelf lines I want and then measured again and again and adjusted. One thing I have to do is make sure there is no obstruction to movement up and down into the basement. The closer to the upstairs door, the higher the lowest shelf must go. I also used a nifty on line tool called a sagulator to plan supports and their placements. The result is a mess of lines and notes and crossed out lines where I adjusted the plan. Given all my storage and organizing needs, the space seems to get smaller and smaller. I do have a good plan though.

This also made me realize that I am going to need to put in some lighting so I can see. When the trap door is down and there is no daylight. that space is really dark. This led to a pause in the shelf construction to run wiring for a light. That is when I discovered that the farmer who added the the wall between the stair and the bathroom decided to do so using 2X4s and laying them flat to save space before putting on a 1/2 inch plywood layer on both sides. Very sturdy, of course, but that left me with the need to run wiring through the longer width of the 2X4. This turned what should have been a two cuss job into a seven or eight cuss job but it is done. The result (also waiting for the family electrician to do the final wiring) is in and looks very nice. I’ll be even happier when it has power!

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And I got myself another new tool. It is a fun little thing I saw on a youtube video called a “jig” it makes nifty little sideways holes which look much nicer and work much better for inserting screws sideways. It was extremely confusing to use at first because the directions made no sense to me. However I followed them faithfully step by step and it worked like magic on my very first try. I got a fine hole and used it. Such fun!

The final space is actually starting to look like a real pantry. I tried my vacuum and it sits perfectly in the new space I made for it. I even have one high shelf in place and it is now in use for storing my electric cord. I have a long way to go before the pantry is done but I am beginning to see some real results. I’m looking forward to getting a lot of stuff in my basement off the floor and some walking space and organization created. I must say though, I would not want to make my living doing this stuff. No one would hire me at an hourly wage and if I did it as a contractor I’d starve to death. I don’t move fast.

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Health Recovery Update

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Dick walking at his treadmill desk while speaking to a colleague via Skype. He is now walking one full mile each day and he has lost three inches from his waist. (The painting is one his mother did of him at age 19.)

Last week we drove to Dauphin Manitoba and hubby dearest has his fourth CT scan. He had two while in hospital in June right after his inner right carotid artery dissection with a mild stroke, one Sept 16 and then this new one October 16, exactly one month later as the interventional radiologist wanted. Today we saw our family doctor to hear the news and update on how things are doing.

STABLE!

The CT scan shows no change in the last month. We were hoping to hear healing but we got stable. However stable is good because stable means we continue on the current course. No risky stent procedure unless he develops symptoms. Nothing getting worse. This leaves us in a holding pattern for now. Most watchful waiting, or as the new buzzword is, “active surveillance”.

We also went over the medications my husband is on and the doctor suggested waiting an additional month before trying to remove another of the three high blood pressure medications he was on after leaving the hospital. The worst side effects Dick had (swollen ankles, being sleepy, sudden exhaustion, sudden scary drops in blood pressure) are mostly (not completely) gone but there have been some up and down fluctuations while tracking his blood pressure. The doctor does not want us to change anything until we have a better idea how getting rid of the third blood pressure med is going by giving his bodya chance to settle down before trying to remove the second one. The blood thinners continue at least until one year past the stroke or the artery has healed.

We are also being referred to another neurologist on an elective basis, just a check in so there is a neurologist in the loop, not because we need anything from him. We will be seeing the same doctor who makes regular trips from Winnipeg out to rural communities. This will save us some long drives into either Brandon or Winnipeg. If we do need to go to Winnipeg for stenting we will have a neurologist there who knows what is going on.

There we are. STABLE. Nothing changes. Nothing better but more important nothing worse. Life will go on as it is. Stable is fine by me. Maybe we’ll get healing next time.

Manitoba Storm

We knew the storm was coming. We knew it was going to be a bad one. We thought we were prepared. It was far worse than anyone thought it would be. I took a video from inside my front door once the storm started. I thought it was bad then. We were soon dealing with 100km/hr wind gusts (62mi/hr) and 100mm (4 inches) of water, mostly in the form of heavy wet snow. It was like a tropical storm with snow instead of rain. Being near to Lake Manitoba certainly didn’t help. Lake effect snow dramatically increased the amount of snow we saw. The flat open lake also meant those north winds came through unabated. It was brutal. We later learned that almost every power pole near the open water was knocked down.

At first it was kind of exciting and fun. When the very solid little house began making a heavy thump noise with the wind blasts, it stopped being fun. The power soon began flickering. It would go off and then come back on over and over again. We could tell the power would soon be going off for real soon so we got ready. I braved the blasting wind and got the generator out and set it up on the porch. Dick is not supposed to lift anything over 9 kilos (20 pounds) so meanwhile he went around unplugging appliances and moving as many things as possible onto one of three back up battery power systems with surge protectors. We fell asleep Friday night to the sound of the wind howling, and snow hitting the window.

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Dick woke me just before 7:00am. The power had gone off at 5:24am. The basement was filling with water. We have a home low on the water table and for a few months each year we live with the sump pump kicking in as often as every hour or so to once or twice a week. During this long dry summer our basement dried out completely. Once the heavy fall rains hit with their multi day/multi inch soaking, the pump started going about every two hours. It was so wet that the Red River Floodway was opened for the first time in fall since they built it in the 60s and that was before the storm. Now with snow falling and temperatures running about freezing, the ground already saturated and more melting adding water each minute we had water was coming in at a steady trickle. We fired up the generator and the pump went to work. We had to keep the pump running at least once every hour or face basement flooding. Our sump pump system is dual pumps. If one broke down we had a back up. I took comfort from that but I worried about what would happen if the generator stopped working. Even as I thought that the generator died. It took me a while to figure out the cap has to be set to “open” so some air can get in to allow gas to drain down. I knew that but not having used the generator since the 2018 tornado I had to figure it out all over again.

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Good thing we had our generator! (Note the chain and lock which turned out to be a good thing to have!) It worked just fine sitting on the deck by the back door. We made one mistake though. I thought we had about three days worth of fuel. I was wrong. We had only about 24 hours of steady running time. We began to worry about running out of gas and we cut down our time to once every two hours. We would empty the sump pit, let the fridge and freezer run until they stopped, run the space heater and make sure my cell phone and Dick’s iPad were charged up and then run the sump again and then shut down. This kept the house temperature at about 14C (57F) and the basement dry. We dressed in several layers and most important, our hats on. You lose the most heat from your head so a hat is an absolute necessity if you are trying to stay warm.

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Initially we had internet but soon that was cut off. The local tower has propane back up for twelve hours but after that, the tower shuts down. Cell service vanished and then the land line was gone. It was scary. The roads were closed all over the province, travel not recommended and my truck was stuck in the garage. I worried a lot about what it would mean if Dick’s artery decided to blow during the storm. There was no way to call for help and no way to drive out. Fortunately he was perfectly fine. Even so, I went outside and shovelled off the front and back steps three times to keep them open. I wouldn’t let him do any shovelling. He did not endear himself to me by pointing out that I am also of an age to have a heart attack shovelling snow. Note to husbands, not something to say, ever! I did heed his words and took only small shovelfuls of the stuff.

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By Saturday midday the worst was over. By evening the snowplow made it through opening the highway. Shortly after that the two front end loaders that clean the town and work for the RM arrived to finish the job in the town proper. We took a walk to look for damage and we saw trees down. We watched the snow removal crews. The snow was so deep even the big front end loaders were getting stuck and having to rock their out of the deep stuff. We checked on our neighbours and they checked on us. Everyone was safe and had a way to keep warm. The snow had the strangest bluish tint to it. I have only seen that color in glaciers before. It was lovely and eery at the same time.

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While we were out walking some strangers drove into town behind the plow. I saw a stranger go into our yard and stop and check out our deck. Good thing the generator was chained up! I had Misty with me so we raced home and the stranger saw me returning with the dog and he took off. I found out later that someone had stolen gas from a neighbour in town. Yes, it was an emergency. Yes, people needed help. However it is not right to just steal from your better prepared neighbours. I was glad I had my dog. She’s a sweet girl but she can look very intimidating. It seems when things go bad, bad people come out as well as the good ones. Was he up to no good or was he just curious? I’ll never know for sure.

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That evening, we settled in happier because the snow had just about stopped even if the wind was still blasting us. I felt frustrated with the lack of power, cell phone service and land lines. We wondered what was going on in the rest of the world. I think Misty picked up on our concerns because she was both much more alert and much more demanding of our affection. Between puppy hugs, I got to finish a novel. I started on the crewel embroidery picture I bought over the summer to have something to do with my hands just in case we had a storm. The cat was also unusually grumpy and demanding. The house was cold so that night he slept under the covers in my bed snuggled up against my backside.

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Sunday morning we got up to find we still had no power. Even in the tornado of 2018 we had not gone without power for as long. Through the night we had taken turns starting up the generator and running the sump pump. The house was cold when we got up and we felt miserable because we hadn’t showered in two days. With the generator we were able to have a hot breakfast with hot tea and coffee and that helped a lot. We then went out to join our neighbours as they started the clean up. Was there a lot of clean up!

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First thing was to get the truck out. It was Canadian Thanksgiving and I was supposed to meet my children and grandchildren at one of my sons’ homes and bring the turkey. My husband said we wouldn’t make it. I got my little electric snow blower to work off the generator and I cleared the drive. The Snow Joe is a brand new toy I had only got on the  previous Friday. I was very happy with how well it worked. Just before we left, we gave the last of our gas to our neighbours who had run out.

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We left for Neepawa and we had our Thanksgiving dinner. We also showered and got cleaned up while the turkey roasted. We bought two 20L jugs for gas and refilled our four 5L jugs and all the jugs the neighbours sent with us. As it turned out, the gas refills could have waited. The power came on just before we got home. Life is returning to normal now. The power is on. The house is warm. Cell phone service (which was never great to start with) is back to its semi reliable state. My landline makes a comforting dial tone when I pick up the handset. A few hours after that, the internet came back. As of this writing, some 18,271 homes are still without power. Crews from Saskatchewan, Ontario and our American neighbours in Minnesota are pitching in to help with the reconnection. 145 homes in the Rural Municipality of Alonsa, my neighbours, are still in the black.

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I learned some important lessons getting through this storm. Mostly we did very well but we did learn of a few holes in our survival plans. We need a lot more gas than I estimated. We weren’t the only ones who got caught without enough gas. Our little space heater is just enough in around freezing weather. For anything colder we will need to have that wood stove burning. We will be bringing in some wood and kindling and collecting newspaper and have the stove cleared and ready to be reattached and start burning now, not before we need it. We ran out of water and if the sump hole hadn’t been filling would have had a problem. As it was, we had no lack of water for the toilet but in winter the water doesn’t run. We also have to be wary of strangers. Some are up to no good. However most people are good. And the real heroes are the people who run the snowplows and get out there to fix those downed utility lines and clear the highways in terrible storms. There are crews of them who are being fed at our town’s senior centre with the kitchen. I have volunteered to help feed these heroes tomorrow. It’s the least I can do.

Update: In spite of the apparent ferocity of this particular storm it turned out to not be a record breaker for our area. Storms with higher winds and more snow have occurred in 1947 and three times in the 1960s. There have probably been other more severe storms prior to that that didn’t make it into the weather records because Manitoba was not really settled by White record keepers until the 1900s. This makes it all the more important to be prepared for extreme weather events because Manitoba is a place of extreme weather, especially extreme winter weather.

Butler Pantry – Part 1

This was not my idea. I got the idea (and the name) from this blog here. A Butler’s Pantry is traditionally a space off the main door preparation area where precious or expensive things are stored and kept under lock and key with the Butler holding the key. I have long chaffed at the empty space above our basement stairs. It was bland, dirty and impossible to reach to clean. Over all, just an enormous irritant in a tiny house where every spot is precious. I decided to try to make my own Butler’s Pantry and make this space useful.

In some ways I had an easier time than the people I got the idea from because that floor level ledge is right beside the outer wall of my little house and three 2X10″ inch wood beams. I used extra long wood screws and four hinges to attach a carefully trimmed chunk of 3/4″ plywood to the outer wall. I then created two 2X4″ supports on the opposite side into another pair of 2X10″ beams using heavy duty lag bolts. The result was almost immediately workable, much to my delight.

The board can go up out of the way to access the basement, or be relatively easily lowered to cover the staircase opening.

The very first thing I did once I had a floor that felt solid enough to walk on, was to finally finally finally clean the entire space. It was dusty and awful and filthy and I had not been able to safely get at it since we moved in. In the process of walking back and forth to scrub the walls and ceiling walls I could feel the 3/4″ plywood board creaking a bit. My next job was to start adding some reinforcements and additional supports. I added some extra 2X4″ supports so the board rests on those instead of all the weight on the hinges. I also added a top rail and a wood blocking bit so it can’t accidentally fall onto our heads while we go up or down. This got rid of the slightly wobbly feel and stopped any creaking. I am going to add some additional cross supports at the ends of the plywood to further stabilize it and maybe add a couple of more in the middle similar to how the original looks but without disturbing my hinges that work just beautifully. I also want to figure out some kind of pneumatic lift hinge support so I don’t have to squat and pull to lift floor out of the way.

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A few things became immediately apparent. I now need to plan the best way to put in shelving for my pantry. I can put shelves into all the spaces above head height as one goes up and down stairs and in that back section. I need to plan what height and depth of shelves will work best for what I want to put in this newly accessible space. I have quite a few items that I need to keep but rarely use. These include my big red turkey roasting pan for company dinners, my pot distiller and my pressure canner and boiling water bath canner. Those can go up high on top. I’d like box for my recycle sorting bag instead of leaving it hanging on the wall. I could really use a broom closet and a dedicated spot for my vacuum.

I also need to add a light. With the board down, the new space is really dark. I am going to add at least one electric plug when I put in the light. I have been thinking this space might work very well for my seedlings in the spring if I set aside one shelf dedicated to that purpose and install my grow light above it. If I do that, I definitely need at least one plug. And of course the entire thing needs priming and painting to match my kitchen. The plywood floor will need some nice cover, maybe some pretty linoleum with tiny flowers or something.

I fell asleep last night planning my shelves and plotting the best path for wiring. I want to have it all figured out by the time we have to make our next trip to a city with a hardware store. That way I can walk in with a list of supplies, stock up, and drive home ready to start. The garden is under the snow now, but I have a brand new project to keep busy with. What fun!

Winter Has Arrived.

If you are a denizen of the north this post is likely going to see rather silly and obvious. My travels south and discussions I have had there, have me thinking people who are not from the north might find it interesting to hear of our pre-storm prep.

Most of the winter preps were either completed or nearing completion. The weather advisories began Monday the warnings started last night compliments of Environment Canada.

Warnings

4:28 AM CDT Wednesday 09 October 2019
Snowfall warning in effect:

Heavy snowfall over Riding Mountains today.

A cold front pushing in from Saskatchewan will bring some rain, snow and cooler temperatures to these regions Wednesday. Most areas should expect only a few centimeters of snow accumulation with this cold front. However, cooler temperatures at the higher elevations in the Riding Mountains will lead to snowfall accumulations of 10 to 15 cm.

Travel outside of the Riding Mountains may be affected as well at times due to poor visibilities in snow and near freezing conditions.

Be prepared to adjust your driving with changing road conditions. Visibility may be suddenly reduced at times in heavy snow. If visibility is reduced while driving, slow down, watch for tail lights ahead and be prepared to stop.

Statements

4:49 AM CDT Wednesday 09 October 2019
Special weather statement in effect:

First taste of winter weather is coming.

A cold front pushing in from Saskatchewan will bring colder temperatures with some rain or snow Wednesday. This has led to some snowfall warnings being issued for the Riding Mountain area.

There is also a potential for accumulating snowfall from over the southwest corner of the province into the Red River valley and northwestward toward Berens River as a Colorado Low tracks north Thursday. Amounts could be in excess of 5 cm by Thursday night.

Currently, it appears regions in the Red River Valley and eastward will see a transition from rain to snow Thursday. However, exact position and timing of the transition is still uncertain, so the precipitation amounts and type in the forecast may change as the system develops.

This Colorado Low will affect Manitoba with snow and strong winds throughout the weekend. Travel will be affected.

Please continue to monitor alerts and forecasts issued by Environment Canada. To report severe weather, send an email to MBstorm@canada.ca or tweet reports using #MBStorm.

So what are our winter preparations?

The most important is provisions for heat. Cold kills much more quickly than heat. We have an electric furnace and so we must have hydro to heat our home. If the hydro electric power goes out, our furnace does not work. We have a 2000 watt generator that can run either our trailer, or 2000 watts worth of hydro in our little house. I have purchased and put aside enough gas (with stabilizer) to run the generator for seven days if we have to. We have two 600 watt oil heaters and two 300 watt heaters. Our generator can power them enough to keep us toasty warm in our tiny house in the around freezing level temperatures typical with Colorado lows.IMG_1815.jpg

We also have a wood stove for deep cold emergencies. The wood stove is disconnected, as you can see. If we hook up the stove our homeowner’s insurance is void because we are not insured for a wood burning stove. In fact, having it disconnected is requirement of our insurance. We only have it on hand in case we experience a prolonged power outage and it is too cold to survive otherwise. I also hesitate about using the wood stove because no matter how careful you are, if you burn wood, you get smoke in the house and I suspect my asthma would flare. Still having to use my puffers would be better than freezing to death. In our rural area a prolonged power outage lasting days or weeks is extremely unlikely but not impossible. Yesterday a local fellow delivered enough firewood to keep us warm even at -40C (-40F) for one week. If we don’t have to use this emergency back up heat supply, we will have a nice stack for backyard open fires with the grandkids for the summer. Obviously, I would have to do some tidying up before the stove is usable. The wood currently on the stove is for other things, not burning.

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Many of our local men are handymen who know how to do all kinds of stuff. They have had a big crunch going on because of the early storm warnings. The nice fellow who cleans chimneys and fixes roofs had already agreed to come by and do our chimney and inspect it and make sure it is safe. He rushed the job so he wouldn’t end up doing it after the roof was full of snow. Even as he finished sweeping up the soot he knocked out of the chimney, the snow had started. He was off to the next house.

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Other preparations include moving the snow shovel into the house. I made sure all our winter outerwear is inside and available. This includes boots, mittens, hats, winter jackets, long johns, snow pants, fleece vests, flannel shirts, extra blankets on the bed and everything else we Canadians require for the winter. We even have winter gear for the dog. Dogs only need winter gear when it is really cold and we’re not expecting that kind of cold so early but I am ready. The truck is full of gas and the winter tires inspected and ready. I tested the four wheel drive and it clunked in perfectly. We have enough of all our assorted meds to last well past when the roads are cleared.

We also have games and reading material ready in case the internet disappears with the power supply. I downloaded enough Kindle books to read for a month. I also bought myself a crewel embroidery kit in case I get so bored I need something to do for my hands.

Our water supply comes from a community well. The pump also requires electricity. This means if the power goes out we soon have no water. I have plenty of drinking water in bottles. My last chore is to drag one of my small rain barrels inside and set it up so we also have water for flushing the toilet and bathing.

Last preparations are food preparations. We have stocked up on extra milk, eggs, fresh produce, and our freezer and cupboard is well stocked with tea, cocoa and everything we might need to keep ourselves well fed and warm on the inside.

If this Colorado low follows the usual pattern for October up here in Manitoba, it will dump a mess on us and melt away and we will have a few more days of warm sunny weather and see the grass for a short spell before real winter sets in. Typically local kids plan their Halloween costumes to go over their snowsuits. That is when winter sets in for the season.

Winter is here. We’re as ready as we can be.

Tiny Home, Tiny Storage, Big Joy.

Our home is 480 square feet. (46 square metres) Depending on how such things are defined, we have a Tiny Home. One of the perpetual issues with Tiny Homes is not enough storage space. And yet to stay sane in a Tiny House, organization is critically important. Everything must have a place and everything needs to be in it. One of the least used spaces in a house is the top foot or so going up to the ceiling. So I decided to use it.

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I had two old fashioned one quarter inch plywood doors that started out as doors over a closet. While I was repainting, I had to rip the framing out around them and the framing broke. I stuck the doors in the garage and left them and put a curtain over the open closet instead.

After thinking a lot, I decided to convert the two old doors in four shelves by cutting them lengthwise. Since shelves “up there” are going to really show their brackets, I ordered some extra fancy brackets I liked from Amazon. The ones in our local hardware store were of limited selection and uniformly bland utilitarian. My wonderful neighbour used his table saw to cut the boards for me. I then repainted them with some leftover paint from the interior painting. Two shelves went up in the bathroom. My intention was to put in some pretty basket/box things so it looked nice like a magazine picture. What I didn’t know is my husband had been living with floor clutter he detested. I went to snap a picture of my new shelving and found he had already relocated all the bathroom clutter for me.

~ Hm, hubby dearest cleaning ~

~Hm, not exactly what I had planned. ~

~Hm, it does work even if it isn’t “decor” like a magazine. Okay it stays. ~

The second shelf is up much higher which gives the room a neat “staircase up” look instead of seeming crowded. Those fancy basket things I ordered will fit there on the higher shelf.

The third shelf solved one of my other little life joy reducers.

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We downsized almost everything we had and I discarded just about everything “sentimental”. I did keep a few very special things that bring me much joy and they have been sitting in a plastic box for nearly ten years. I wanted them out where I could enjoy them. One shelf fits very nicely over the TV on the wall of our bedroom. I quickly filled it before Hubby Dearest found things he wanted out from underfoot. Now, my precious few sentimental things are where I can see them and look at them and feel joy. Each one has a very special story and means the world to me. (Trump Bear is a late addition.)

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The fourth self went up behind Hubby Dearest’s treadmill work desk. He can do whatever he likes with it. I am hoping he declutters that space.

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Total cost was $32 for the brackets. Since I used leftovers, I am not counting the cost of the wood, screws, and paint.

My next project should be interesting. I am going to convert this space into something useful.

Stroke/Health Update – Carotid Artery Dissection with Pseudoaneurysm

Yesterday we met with the radiological interventionists via telehealth conference. This meant we could have a face to face meeting with the doctor without driving all the way to Winnipeg. It was a weird turn of events for us because years ago it was my husband set up the first ever working Manitoba telehealth link. The meeting went very well and it sure was nice not to have to drive two and a half hours to Winnipeg for it.

We first shared the clinical details of my husband’s condition which is, at the present time is he has no symptoms. The minor stroke symptoms have largely resolved. We are now working to lower the number of blood pressure medications he is on in a slow way while monitoring to make sure the blood pressure does not go back up.

We also got a radiological description of the kind, type and size of the dissection my husband had and why the second CT showed his is “worse” than it was before. We also learned that in some ways the dissection is actually better. This image shows the basic issue we are dealing with.

There is a blood clot sitting where the tear shows the blood running into the space in this image. The mild stroke my husband had is probably due to when the tear first happened and that clot was forming. Part of the clot got swept up in the bloodstream and ended up lodging in the brain farther up causing the mild stroke. That blood clot has shrunk. That is good news because the fact that it is shrinking means the artery is healing. The bad news is that the size and length of the blister like formation (often called pseudoaneurysm) within the artery wall grew a lot from when he had his first and second CT in hospital. It got both thicker (making the artery narrower) and longer.

The decision we have to make is whether to leave it alone and give it more time to heal or go for a stent. Such stenting is commonly done in cases where there is atherosclerotic plaques in the artery causing reduced blood flood as in this image.

Mayo Clinic Q and A: New treatment to open blocked carotid artery – Mayo Clinic News Network

However this is not the problem my husband has. In fact the CT and other tests he had done show he actually has almost no atherosclerotic plaques. Also because of the size and length of the “blister” he would need to have two stents put in a “pipeline” to fix it.

There is no doubt at all that the pipeline stenting works very well and is an excellent way to repair the damaged artery. The problem is this procedure is relatively high risk. The chances of this procedure causing a catastrophic outcome, like shattering the artery altogether or causing a huge stroke are, depending on what criteria you measure, about 5% (2-10%). In my husband’s particular situation, because of where the “blister” is, in a bendy part of the artery where it is hard to get good CT images, and the basket for catching clots can’t be deployed, we were told it is about 5-10%. There are also long term potential consequences such as the stent plugging up again, or breaking through the artery, and causing more damage over time.

Obviously, if the blood supply to brain is so poor it is causing symptoms, taking that risk is well worth it. Having a stent put in will probably fix it. The risks of the procedure are well worth the potential benefits compared to having not enough blood get to the brain.

What if there are no symptoms? In my husband’s case, he has no symptoms. Neurologically and physically he is perfectly fine. So should he take the risk of stenting or wait and give it more time to heal on its own? The risk is that the “blister” will continue grow and block the artery and cause a crisis down the road. He could die or have a major stroke before we can get to Winnipeg and get a stent put in.

After our discussion we, meaning my husband, the doctor and I, made a considered decision to do what my husband calls “watchful waiting” for now. The doctor wants to try to get a better feel for when and how the “blister” formed. Did it form after he got out of the hospital and now has stopped growing? Is it now healing after the whiplash setback? Has the “blister” been slowly growing the entire time and will it therefore continue to grow? In order answer to this question, we decided to have a fourth CT in two weeks. This is enough time after the first view of the “blister” to ascertain if the blister is growing or healing or staying the same. Until then, as long as there is no reappearance of any of the symptoms of the dissection we do nothing. If any of those symptoms start, we immediately get to the hospital.

After we had that visit, I had some words to use in a search of Pubmed and Google Scholar. I found some review articles on what to do. There just isn’t a lot of good large studies. Most doctors say go right in with the stent and fix it now in a controlled way. This approach is the absolute best for anyone with symptoms. However in people with no symptoms, if you choose to do nothing, the few studies suggest most of the time nothing happens or the artery heals completely or partially. People can walk around for years with that “blister” without a problem.

There is a very strong fear in the medical community that leaving it alone means you will have a high chance of some future uncontrolled catastrophe. Most of the medical literature on why one should go in and stent begins with that assumption. If you do nothing, the patient is going to eventually rupture and have a bad outcome. You must take the risk and do something now.

I then traced back to the original literature that says you must do something now or else. I learned something very important. That literature is based on assumptions that date from before widespread use of CT. Those studies also often mixed up the pseudoaneurysm with full aneurysms. Those studies also included very large defects, many so large you could feel them pulsing in the patient’s neck. Smaller ones are being found with CT no one knew were there before. So the old data on how extremely risky these ‘blisters’ are may not be correct for smaller ones. What few not very good studies there are suggest that these smaller ones usually stay the same, or heal on their own. We just don’t know. There is not enough data.

Doctors are not very good at sitting back and doing nothing. The whole profession revolves around going in and fixing problems. Doctors get sued more often for doing nothing than for doing something and having the procedure go wrong. It is also really hard for a doctor to hear that they risked their patients and caused unnecessary pain and suffering even death when they should have just left well enough alone. It is a good doctor’s worst possible nightmare.

In our case, we discussed the pros and cons. The doctor gave us lots of information. My husband assessed the information and discussed it with me. We asked a lot of questions. We decided to do nothing for now. I think if we had urged the doctor to go ahead and arrange the stenting right away he would have agreed to do that. I am also certain he agreed with our decision to wait. He is a good doctor who practices informed consent and respects my husband’s right to make his own informed decision about his own body. The decision is my husband’s and the consequences are his to live with. Whatever happens, it will not be the doctor’s fault.

Of course our decision may change given the results of the next CT. And, of course, if symptoms appear, the whole equation changes.

This is our decision. Your mileage may vary.

Update: Another article “Experience of a single center in the conservative approach of 20 consecutive cases of asymptomatic extracranial carotid artery aneurysms” from 2018 also supports the watchful waiting approach. In this article the author also points out older literature on why you should not wait is likely not applicable for the reasons I gave. Note this is a small study. More research is needed.