Sunday, August 31, 2008

Dream Kitchen-An Employee Lunchroom Redesigned

Kitchen "Before" Picture-Here is the "before" photo of the employee lunchroom. Notice the large black door and small refrigerator.

Here is the "After" photo.

Several months ago, I shared with you a home that I staged for a client. The post was called, "Designed to Sell." The home, after my staging, sold in only 28 days, compared to the ten month average for homes in the area.

Since that time, I wanted to share an exciting project that I recently completed. I was contacted to consult with a client on an employee lunchroom. At the present time, the space was used strictly for employees to eat their lunch. The client indicated that she would like to have a stove in there since they frequently have clients at the corporate offices and after a few days, ordering in sandwiches can get a little old. From there, our project began.

I started the project off with a tour of the facilities to see what finishes were currently used throughout the corporate offices as well as colors and current design. I wanted the lunchroom to be modern yet reflect the traditional style used elsewhere in the company. I spent three hours on the consultation, finding out who uses the lunchroom currently, how many clients they will be cooking for, how many people will use the lunchroom during the peak summer times when the interns are there as well as how people actually use it-where do they sit, how are the tables grouped, etc. For me good design begins with a kitchen that functions well; once that is achieved, then I plan out the design aspect. The client also specified that we needed to keep the existing flooring and wallpaper.
For this kitchen, I made the space planning, organization and design decisions. I selected the kitchen cabinets, added an island to serve as a buffet for serving food to the clients, added overhead lighting on the island and under cabinet lighting for cooking. I selected a cherry cabinet to match the cabinetry used elsewhere in the corporate offices. My design scheme was brown (as in the cabinets and furniture), gold (countertops, tablecloths and lettering), orange as the accent color and brushed aluminum for all of the finishes. I worked with the client on the finishing touches and selected three rug options and gave her my first preference as the ones that are shown. I selected the picture frames to pull the design over to the lunchroom side and the flowers/vases for the center island. While fresh flowers are always preferred, fresh flowers for the lunchroom on a weekly basis were cost prohibitive so we went with silk to give it some punch. I guided the client’s design choices for the chairs. She wanted to add the chairs and I suggested a modern, graphic, circular design with the colors of the kitchen. She then sent me pictures of the chairs prior to ordering and I gave her the thumbs up. We also had to deal with the door in the center of the kitchen. I suggested painting it the same color as the wallpaper so it would blend and visually disapper. Instead, the client was able to have a piece of steel cut and placed over the door. I think that was the right decision.

One of the keys to this design for me, was customizing the lunchroom for this company. I did this by:

  • Adding a monogram to the kitchen island; this is the first initial of the company name. I felt leaving the kitchen island bare was a mistake. I thought about using the company logo, but that would have been too impersonal. This also keeps this kitchen from looking like every other kitchen. Instead, I suggested adding the letter “E” in gold to the island. I looked through the fonts on-line and decided on this Edwardian font.

  • Using the company slogan on the wall. I asked the client if they had a slogan that was used in their corporate materials or in their handouts. I suggested adding this to the wall. This kept the lunchroom feeling “corporate” as opposed to a restaurant area. She ordered and installed the slogan on the wall. This was no easy task and I think she did a beautiful job. (We are still waiting for the period to arrive to complete the sentence.)

  • The fruit bowls on the table. This company supplies fruit for their employees. We added new fruit bowls at every table to personalize the area.

  • Glass tops and tablecloths for the tables. The client wanted glass tops made for easy clean up. She wanted tablecloths that were washable but it was cost prohibitive to have them made. I suggested she use pinking shears and cut them to size, which she did.
Functional choices included:
  • Under cabinet lighting is not only beautiful but allows the employees to read the directions for cooking.

  • The towel bar was installed on the kitchen island as a place for them to dry after the kitchen has been cleaned up, let’s say after food has been cooked.

  • On the right side of the kitchen, near the refrigerator, is the coffee pot. Coffee accessories are located in the drawers below and paper plates and silverware are located there as well, so employees will have easy access to them when using the microwave.

  • Recycle bins located in the center island for easy clean up. The center island also houses pots and pans for use on the stove across from it.

  • Under cabinet lighting is not only beautiful but allows the employees to read the directions for cooking.
  • On the sink, there is a hot water dispenser on the left and a built in soap dispenser on the right side, to minimize countertop clutter.

This kitchen could not be done alone. By working together with the client, we were able to achieve a great kitchen. Some things were changed along with way. Initially, we didn’t think there would be enough room in the budget for the stainless steel appliances and thought we’d have to choose white. At that time, we had white subway tile for a backsplash. The client however was able to negotiate some great deals, and got all of the appliances for only $3,300. The client acted as the general contractor on this project, working with the cabinet maker, having the stainless steel backsplashes cut to size, installing the lettering on the walls and shopping on-line for the fruit bowls and chairs ( for the lunchroom. She also found the table and mirrors that were used with the upholstered chairs and swapped out the existing hardware for that to match the cabinets. She worked tirelessly on various aspects. The sink was donated from their manufacturer however the hot water dispenser had issues and it took several installs to get it right. The ice maker leaked and required service calls to fix that. The backsplash was installed and then re-installed when an additional outlet was required.

There were also some glitches along the way, the biggest one being the cabinets. I selected 42 inch cabinets for the kitchen and that’s what the client ordered. 36” cabinets were delivered however. Since they were custom cabinets, a decision was made to work with the 36” inch ones, and add crown molding to the top and over cabinet lighting on top. This solved the problem and it still looked great.

All in all, a great project. This is a $60k kitchen that was done for $22k excluding labor. Most of the discounts were on the cabinets, since the company manufactures them along with the sink. The steel that was used to make the sinks, was cut for the backsplashes and for the door. But the project is only a success if people use it. I suggested that they have a kick off party and cook for the employees using the new stove. Interestingly enough, the employees started using their laptops in there, are having meetings in there as well as eating in there. Most interesting, was the item that employees used the most, the ice maker. We did not identify this as a need so it was interesting to note how many employees use this feature. And a kitchen that is used, is the best kitchen of all.

Sunday, August 24, 2008

Medical Update III- Home

Dear Son was released from Big Academic Medical Center yesterday. The EEG was much better, as expected, so he could go home. While it still had some abnormalities, it was much improved. I can now breathe a sigh of relief, even if it's only a temporary improvement. Ped Neuro Doc suspects the antibiotics are the reason for the improvement. Regardless, it is still good news.
Dear Son is resting well. We are glad to be home. It is a good feeling that he should be able to start school on Thursday, provided he continues to improve. Ped Neuro Doc did a really nice job overseeing Dear Son's care. Despite the fact that they were low on techs, he managed to get the EEG completed so we would not have to make a return trip later this week.
I am happy that we have a lot of good news to celebrate. Thank you for all of your prayers and concern for Dear Son.

Friday, August 22, 2008

Medical Update II

On Wednesday, Big Academic Medical Center started Dear Son on Zosyn and Vancomycin via the IV. On Thursday morning, I noticed that Dear Son was bright red and had Red Man Syndrome, a common adverse reaction to Vancomycin. He has had this before and I remembered it once I saw it. They started him on Benadryl to counteract that and things began to improve. Last night they were able to wean him off of all oxygen and he is breathing on his own. Today, they stated that they will switch him to oral antibiotics and see if he tolerates it. He will continue this for 12-14 days. They stated that the pneumonia is most likely an aspiration pneumonia or a non-MRSA pneumonia. He opened his eyes today for the first time since he was admitted although he is still sleeping the entire day. The good news is that they expect that we are probably out of the woods regarding the pneumonia; his fever is gone and the antibiotics appear to be working. He still has a pretty good pnemonia, so it will take time to get rid of it totally.

Today they will begin the extended EEG monitoring. Typically, when Dear Son has an infection, it will lower the seizure threshold so more seizures will present. In Dear Son's case, he was having seizures prior to the pneumonia so I can not say that I noticed more due to the pneumonia. Conversely, once an antibiotic is started, it can have the opposite effect by decreasing seizures since the antibiotic will raise the free portions of the seizure meds thus increasing the medicine levels which can make them more effective thus reducing the seizures. The problem arises when the antibitotic is finished, seizures will go back to their previous levels.
So essentially, we expect that the EEG may be better, although the effect may only be temporary.

They expect that he will remain in the hospital until we get the EEG issues resolved. He'll be monitored through Monday and then once the EEG is read, we'll take it from there and can possibly get released.

Thank you for your concern and I'll keep you posted the best I can.

Wednesday, August 20, 2008

Dear Son Medical Update

Since my last post, Dear Son continued to have seizure issues. It was difficult to determine whether or not the Felbatol was actually working and during his seizures, he began yelling, getting very hot and turning red, almost as if he were going to explode. A decision was made to cut the Scopolamine patch in half last week. Since that time, he strugged with his secretions and choked quite a bit. In addition, we attempted to increase the Felbatol to see if it might result in an improvement of the seizures. It seemed initally as if it might be helping however I could never be confident in my decision as to whether or not it was really effective.

In the interim, we were waiting for a hospital admission to do another EEG. Big Academic Medical Center is down to two techs right now so an admission was not in the cards until next week. In the meantime, Dear Son continued to choke and began running a fever today. I contacted Ped Neuro Doc and he suggested I take him to the ER for a chest x-ray and labs. I did that and they confirmed that Dear Son has aspiration pneumonia in his right lung (lower lobe and up into the middle). They started him on Zosyn and Vancomycin via the IV along with some chest PT. We will most likely be there a week or so until the antibiotics run their course. We still need to address the seizure issue so I really can't be sure.

I'll update when I can. In the meantime, I need to get back to the hospital.

Thursday, August 14, 2008

What Happened to the Easy Days of Summer?

It has been a long and stressful summer. It was good to take a break from blogging and I am happy to return. What I thought might be an enjoyable summer, proved to be pretty challenging to say the least. Dear Son had taken a turn for the worst.

Since June, Dear Son continued to have significant medical issues. Perhaps one of the first issues is that of the Scopolamine patch. As you may recall, the Scopolamine patch was prescribed in April to assist Dear Son with his nighttime choking. The Scopolamine patch has worked wonders and virtually eliminated all nighttime choking episodes. Some of the side effects of the patch, have to do with delayed emptying of the stomach and delayed motility. The reduced urination and bowel movements continued to be a concern much of the time. We were aware of these effects and continued to monitor them.

As summer progressed, Dear Son's seizures began to increase in frequency and intensity in July. In addition to the increased seizures, he began to get very hot, his face turning red and yelling out or screaming with his seizures. In addition, he began to have seizures at school. While the patch was extremely effective at controlling his nighttime choking, it did not allow him to sweat. The heat and high humidity this summer put Dear Son at risk for heatstroke before we figured out what was occurring. With the patch, he was not able to sweat therefore unable to cool himself down. As he began to overheat, his face turned red and he began to yell out from the pain. After some conversations with his pediatric neurologist, he realized what was occurring and from that point forward, I needed to keep him out of the sun and more importantly the heat.

This proved to be a fairly tall order. Since he could no longer be outside on very hot days, he was unable to attend summer school for many of the extracurricular functions. This was the first year that they had an afternoon program full of fun activities for the kids to do after their half day at summer school. This program was only on Tuedays and Thursday and would allow me to work on those days. We had paid in advance for these program, $30 to $40 per day and had to cancel most of them due to the high heat or his inability to tolerate the heat or humidity on those days; all nonrefundable. It was more important to be safe. The down side was that it made for long days and not as much fun. They had a full staff to assist these kids and they were able to take them places that I could not manage on my own. Since he was not able to attend these functions, I had to cancel work on these days.

On the days he was home, I tried to take him for walks. June was the first month I could really begin to exercise again after my back surgery so I was anxious to continue walking. Trying to keep Dear Son out of the sun in July, the hottest month of the summer, so he didn't sweat, proved to be a nearly impossible task. Since his morning feeding (via the g tube) takes nearly three hours, I had to get up pretty early so it would be finished so we could walk before the high heat and humidity set in. I worried constantly about the heat and his inability to sweat. I took extra water, cooling packs and a wet washcloth to cool him down. But his issues would not end there.

Summer school ended towards the end of July. Dear Son's seizures continued to get worse. Not only was he having some pretty significant seizures but he was also having many smaller seizures throughout the day. I was worried he might be seizing all day but I wasn't sure. They were small with his hands shaking at times however they were occurring so often throughout the day that I could no longer keep track. He also began having some larger seizures that had me concerned. The scopolamine patch made managing them more challenging as well. Due to the delayed emptying of the stomach, his seizure meds would remain in his stomach longer and take longer to be processed. This was not helpful when he was having some major seizure issues. His pediatric neurologist was on vacation most of July and that only added to the mix. Once he returned from vacation, Dear Son was admitted to Big Academic Medical Center and hooked up to an EEG.

After twenty four hours, we had an answer. Dear Son was seizing twenty four hours a day. The problem with that was that our options were fairly limited. Dear Son has intractable seizures and is already on fairly heavy doses of nearly every seizure medicine. He also has a Vagus Nerve Stimulator implanted. He remains somewhat unusual in that while other children's seizures might be controlled with a VNS or one or two seizure medications, he needs them all. (We have tried repeatedly and unsuccessfully over the past few years to take him off of some of them and his seizures increase as soon as we attempt to decrease them.)

It was determined that we had two options: 1) to give him Ativan via the IV to stop them or 2) to start him on Felbatol. The problem with the first option was that it was short term. While they may be able to stop them with the Ativan, I wouldn't be able to continue that at home, therefore, it was strictly a short term solution. It was then decided that a trial of Felatol would be in order.

Felbatol, is a third line medication that has serious side effects, namely aplastic anemia and liver failure, both of which can be fatal. Felbatol is only used when other medications have failed and when the risk of the seizures outweighs the serious side effects. It can also increase levels of some of the other medications, making it problematic. On the plus side, it can sometimes work fairly well. With virtually no other options, a trial of Felbatol was started. I googled Felbatol looking for any horror stories and found none. I did find a helpful review on however and that made me feel somewhat better. I also found a few reviews in which patients stated it was the best seizure medication they ever tried in terms of seizure control.

After the first day or so on the Felbatol, his seizures seemed to decrease a bit however that was short lived. The seizures returned with a venegance and Dear Son had some of the most intense seizures I had ever experienced. Adding to the seizures, he was getting very hot, and at times it looked like he might explode. That's the only way I could describe it. I was certainly rattled by these and it was challenging to manage this. If I was slightly late with his meds, he'd have a big seizure. The problem was, they were so unpredictable. I was also very tired, managing these throughout the day and at night. I also had to be careful that I was allowing enough time between feedings with the delayed stomach emptying and then when he'd have these seizures, I was worried the meds wouldn't be processed fast enough to help him. To top it off, I hadn't had a weekend off in over a month and I was exhausted. Dear Son's Dad had been working a lot and I hadn't had a break. Finally, I called his Dad and asked him to take him for a few days so I could relax and get some much needed rest.

It has been a little over two weeks since he's been on the Felbatol. For the first week and a half, I can't say I saw many changes or improvement in his seizures so I was not convinced it's working. I met with the pediatric neurologist yesterday and discussed our remaining options. At this point, he can admit him and give him a bolus of steroids via the IV to try to get control of them. The other option is to do a drug induced coma where he would be intubated and deeply sedated in hopes that they could get the seizures stopped.

All in all, some tough choices. On a brighter note, he seemed to do much better today. What happened to the easy days of summer?

Note: Dear Son is sixteen years old and suffers from a progressive neurological disorder and intractable seizures due to a random mutation of the ARX gene.

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