The Ankle Report: My Low-Tech Fluid Monitoring System

Lately, I’ve found myself spending more time looking at my ankle.

I mean, why wouldn’t I?

It’s a great-looking ankle.

More importantly, it’s the only one I have left, so it gets 100% of the ankle-related attention around here.

But lately, I’m not admiring it purely for its aesthetic qualities. I’m checking it for edema and fluid retention.

My Built-In Fluid Gauge

As someone living with End-Stage Renal Disease (ESRD) and receiving dialysis, fluid is something I have to pay attention to.

My kidneys still have some function. I still urinate normally, so I don’t retain fluid in exactly the same way as someone whose kidneys have stopped producing urine altogether.

Still, I can retain more fluid than I should.

And one of the easiest places for me to notice it?

My ankle.

Gravity is very dependable. Fluid can settle into the lower part of the body, so I can look at my ankle and get a visual clue that perhaps I've been a little too enthusiastic with the beverages.

Apparently, my ankle has become a medical instrument.

No batteries.

No Bluetooth.

No subscription.

Just look down.

The Other Fluid Gauge: My Residual Limb

My ankle isn't the only place where fluid retention becomes noticeable.

I can also retain fluid in my residual limb, which creates an entirely different problem.

My prosthetic socket doesn't suddenly become more accommodating because I'm retaining extra fluid. If my residual limb changes volume, getting into the prosthetic can become more challenging.

The prosthetic basically says:

“Sorry, we're at capacity.”

So fluid management isn't just something I think about during dialysis. It can affect something as basic as putting on my leg and getting on with my day.

Then Winter Joins the Party

Winter brings another issue.

When the air gets dry, my skin tends to get drier too. Add fluid-related swelling and stretching into the equation, and I've noticed my skin can start cracking more.

So apparently my body has seasonal programming.

Summer: Watch the swelling.

Winter: Watch the swelling AND the cracking.

Excellent.

Learning to Pay Attention

Living with ESRD has taught me that sometimes the useful signs aren't dramatic.

Sometimes it's simply noticing that my ankle looks a little puffier than usual.

Or that my residual limb isn't fitting into my prosthetic quite as easily.

Or that my skin is behaving differently.

None of those observations replaces what my dialysis team measures or tells me. They're simply ways I've learned to pay attention to my own body between treatments.

And since I only have one ankle left, I might as well put it to work.

For now, I'll continue monitoring it.

Part ankle. Part fluid gauge. Still pretty good-looking.

Donna Woods Is Leaving—and Taking Requests for Phone Numbers

Today’s delivery for Mom was a large Chick-fil-A fruit cup and a coffee. I had already brought her International Delight French Vanilla creamer when she arrived, so that part of the operation was covered.

And who greeted me?

You already know.

Donna Woods.

The day room reminded me a little of junior high: a table of women gathered together and a separate table of men.

The women were chatting. The men were sleeping.

I felt a little sad seeing the men asleep while the conversation happened nearby. Of course, I was only seeing one moment of their day. For all I know, they’d already solved the world’s problems and were taking a well-earned break.

The women, meanwhile, still had business to conduct.

Today, I learned that Donna likes bacon, wants hot tea for the resident chat, and is leaving tomorrow.

That last detail caught my attention.

Donna has become part of my visits. I come to see Mom, and somewhere along the way I get a greeting, a story, a restaurant recommendation, or an unsolicited but welcome review of my footwear.

I’ve gotten used to seeing her.

Now she’s getting ready to leave, and she wants to stay in touch with Mom.

I thought that was lovely.

Then Mom volunteered my phone number.

Suddenly, I was involved in telecommunications planning without having submitted a proposal.

I told Mom I’d give Donna her number.

Donna said she would take both.

An efficient response. Why choose one contact when you can expand the network?

I am purposely trying to avoid giving Donna my number if I can help it. I enjoy our conversations, but I’ve heard the speed at which this woman delivers information. I’m not sure my phone plan includes that kind of coverage.

I could answer a quick call and emerge forty-five minutes later with updates on bacon, Pensacola, three former pets, and a person I’ve never met whose grandson apparently needs something.

Meanwhile, my original reason for picking up the phone would be lost to history.

But underneath my joking, I’m touched that Donna wants to keep the connection going.

We met because I was visiting Mom. A conversation became another conversation. Then she knew my name, asked how Mom was doing, and became someone I looked forward to seeing in the hallway.

Now she wants to make sure leaving the facility doesn’t mean losing touch.

I’m glad Mom has someone asking for her number. With everything she’s been through, I like knowing that someone she met here wants to call and hear how she’s doing.

I’ll miss Donna’s greetings and whatever subject she happens to be halfway through when I arrive.

I hope her next stop has good bacon, hot tea, and people who make time to listen.

As for the phone numbers, I think Mom’s is an excellent place to start.

Thailand Is Starting to Feel a Little More Real

For a while, Thailand has been an idea. Lately, that idea has started turning into actual planning.

I've been in contact with an expat in Thailand who can help me work through the logistics of getting to Hua Hin and figure out whether this could realistically work for me—and potentially for my mom as well.

There are a surprising number of moving pieces.

He's offered to help me find a condo in Hua Hin. I've already started looking at what is available, and my wish list isn't exactly small. I want something furnished, preferably three bedrooms, beachfront with an ocean view, and reasonably close to the hospital.

I'm discovering that those places actually exist without necessarily costing what a comparable beachfront condo would cost in the United States.

He can also help me figure out the appropriate Thai visa. That's one of those things where I'd much rather have someone familiar with the process help me than spend hours bouncing around the interwebs trying to figure out what is current and what was accurate three years ago.

Then there are the immediate arrival logistics.

He can arrange transportation from Bangkok airport to Hua Hin, which matters because I'd prefer not to land after a very long flight and start negotiating transportation in a country I've never visited.

He can also help arrange a temporary place for me to stay while I get situated and look at condos in person.

That makes a lot of sense to me. Pictures on the internet are wonderful, but I'd rather walk into a condo, look out the window and confirm that "ocean view" actually means I can see the ocean—not that if I lean over a balcony, look between two buildings and squint really hard, there's a tiny patch of blue in the distance.

There's also Mom.

We've discussed the possibility of eventually having her in Thailand, and this expat may be able to help arrange a caretaker. That would require more research and planning, but knowing resources are available makes the idea less overwhelming.

He even mentioned helping me get a Thai driver's license.

I'll pass.

I don't have an urge to drive in Thailand. I think I'll be perfectly happy using ride-share services, taxis, and other transportation. Somebody else can navigate the traffic while I sit in the passenger seat and look out the window.

Then There's the Big One: Dialysis

Everything else is secondary if I can't work out dialysis.

Today, I emailed Bangkok Hospital Hua Hin to ask what I'd need to receive hemodialysis there during an approximately 30-day visit to Thailand.

For me, this isn't optional travel planning. I need hemodialysis three times a week, so before I start getting too excited about beachfront condos and ocean views, I need to know that my medical care can continue safely and reliably while I'm there.

I want to know what records they need from my dialysis provider in the United States, how far in advance treatment must be arranged, scheduling, costs, payment requirements, and anything else an international dialysis patient needs to do before arriving.

Now I wait for their response.

If Bangkok Hospital Hua Hin can accommodate me for a month, that's a pretty significant piece of the puzzle.

Maybe 30 Days Is the Right Test

I'm not talking about getting on an airplane tomorrow and permanently moving to Thailand.

A roughly 30-day stay would give me a chance to experience Hua Hin as more than a vacation destination.

Can I comfortably get around without driving?

Can I find a condo I'd actually want to live in?

How easy is it to get groceries, go out to eat, and handle normal daily life?

Most importantly, what is it like going through my normal dialysis routine in Thailand?

Those are questions that YouTube videos, Facebook groups, blogs, and beautiful real-estate photos can't completely answer.

I need to experience it.

For now, many questions remain unanswered. But there are also fewer unanswered questions than there were a few weeks ago.

I've found someone on the ground who can potentially help with housing, visas, transportation, temporary accommodations, and care for Mom.

I've contacted the hospital about dialysis.

I've started looking at beachfront condos.

And apparently, someone is even willing to help me get a driver's license that I have absolutely no intention of getting.

One piece at a time.

Thirty days in Hua Hin might tell me whether Thailand is simply a place I'd enjoy visiting—or somewhere I could actually see myself spending a significant part of my life.

When Caring for Mom Becomes a Battle of Wills

When I'm sitting here writing posts for the blog, I often keep the Facebook Reels open in the background. Sometimes it's entertainment. Sometimes it's noise. And every once in a while, I come across something that hits surprisingly close to home.

Tonight, it was this Reel:

https://www.facebook.com/share/v/1Gg6CPpZ9D/

As I watched it, I thought, I'm experiencing something similar.

I've written before about my mother and her time in a skilled nursing facility. I've also mentioned that she wants to move into an assisted living facility.

After 56 years, she's had enough and wants some time away.

Meanwhile, I'm thinking about a different kind of change in my own life. My plan is what I call 6+6 — part of the year in the United States and part of the year in Thailand.

But before any of that happens, there are much more immediate decisions to make.

Assisted Living Isn't Free

Assisted living facilities cost money.

A bunch of money, I anticipate.

This week, I'm touring two assisted living facilities. I want to see what's available, understand what they provide, ask questions, and, of course, find out what everything actually costs.

Then comes the question of how to pay.

That's where things get complicated.

I have Power of Attorney over my mother's assets, which allows me to handle her financial matters and use her assets to pay for her care.

There's one problem.

My father has voluntarily declined to provide me with information about my mother's employer 401(k).

And that has created what may become a battle of wills.

Living Under the Same Roof Without Talking

I haven't spoken to my father in more than a week. It might be closer to a week and a half now.

Here's what makes the situation even stranger:

I still live in the house my parents both own.

My room is on the second floor.

Yet I haven't spent much time at home lately.

There has been dialysis. There have been visits with Mom. There have been recovery meetings. And I've been trying to find some fun somewhere in between it all.

Today was the exception.

Today, as I wrote in another post, my body essentially told me that I wasn't getting out of bed.

So I didn't.

I spent the day upstairs.

There is something sad about being in the same house as someone and having that much distance between us.

The Last Holdout

The entire situation is sad.

From my perspective, my father has gradually alienated the nuclear family.

For a long time, I was the last holdout.

I kept trying.

Now I'm reaching a point where my primary concern isn't winning an argument or proving who is right.

It's figuring out what happens next for Mom.

She has said what she wants.

I have two assisted living facilities to tour this week.

I need to understand the costs.

I need to understand the resources available to pay those costs.

And somewhere in the middle of all of this is a 401(k) that I still don't have information about.

So that's where this story stands tonight.

Mom wants assisted living.

I'm preparing to tour the facilities.

I'm thinking about my own eventual 6+6 life between the United States and Thailand.

My father and I aren't speaking.

And we're still living under the same roof.

Families can be complicated.

Money can make them even more complicated.

Add aging parents, caregiving, decades of marriage, Power of Attorney, retirement accounts, and decisions about where someone wants to live, and suddenly life starts producing storylines that even the Facebook Reels would have trouble making up.

Follow along to find out what happens next.

I have a feeling this chapter isn't finished.

Some Days Moving Forward Means Staying Still

In a previous post, I wrote about visiting my mother in the skilled nursing facility—spending time with her, seeing what her days are like there, and trying to navigate everything that comes with figuring out what happens next.

Today, I was supposed to visit again.

My body had other plans.

Today my body said, “I'm not getting out of bed.”

And I listened.

I didn't finally get out of bed until about 5:30 p.m. Eastern Time.

I was awake earlier in the day, and once I realized I wasn't going to make it, I messaged the family group text. I let everyone know I wouldn't be there and asked if the brother who was in the area could let Mom know.

They were there hanging out with her, so she wasn't alone.

Still, I felt like I was missing something.

I didn't get to hear from Donna Woods today—or try to keep up with Donna Woods. That's become part of these visits, too. There are the people I originally go there to see, and then there are the people I meet along the way who somehow become part of the story.

And that little community around Mom may be changing this week.

Her current roommate, Jenny, might be leaving tomorrow. If she does, Mom may be getting a new roommate.

Donna Woods may be leaving on Tuesday.

It's strange how quickly these temporary communities form. People enter a skilled nursing facility because something happened in their lives. They become roommates. They sit in the same hallways. They eat meals together. Families begin recognizing one another. Personalities emerge. Stories get shared.

Then someone gets better.

Someone moves.

Someone goes home.

Someone new arrives.

And the little world rearranges itself again.

Maybe that's part of what I've been watching while visiting Mom: life continuing to move even when, from the outside, it can look like everyone is standing still.

Today, I was the one standing still.

I always feel some guilt when I don't make it to see Mom. I want to show up. I want to be involved. I want to keep things moving forward.

But sometimes my body gets a vote, too.

Today it apparently had veto power.

So I stayed in bed.

Tomorrow begins another week, and it's time to push ahead again.

On Tuesday, I'm touring an assisted living facility as we continue exploring what the next chapter might look like for Mom.

The timing feels especially interesting now.

Jenny may be leaving.

Donna Woods may be leaving.

Mom may have a new roommate.

And I'm going to walk through a completely different place and try to imagine whether it could eventually become Mom's next home.

I’m not sure this facility is the right one. I don't know what Tuesday will bring. There are still questions to ask, things to see, decisions to make, and probably a few surprises nobody has thought about yet.

But that's where things are today.

Yesterday's plans change.

Roommates come and go.

People recover and move on.

Some days I visit Mom.

Some days my body tells me I'm staying in bed until 5:30 p.m.

And then another week begins.

So I get up, push ahead, and take the next step.