Coming Home

Excellent progress to report here, I am pleased to say, and I am 99.9% certain to be going home this afternoon. I have the "taxi" (Hi Elizabeth) booked for 3pm - hoping she turns up with a pair of jeans or some other outdoor trousers - and I am just waiting for some paperwork. They send you out of here with a very thorough wad of instructions telling you how to cope in the "Cardiac Re-hab" environment, listing all the drugs you are on and how to manage them, what follow up clinics you need to attend to and what you need to get your GP practice to do (blood tests etc). You can't leave until you've had your de-brief and been handed your paperwork. A big sign in the corridor says "We will try to get you away for 11 am, so that you can  get to the pharmacy". They tell me it's usually more like 3 pm.

This 'going' home thing was first mentioned by the main doc on doc's round yesterday morning. I was paying close attention to their chat and suddenly heard him say "...and we need to get him on to an out-patient drug regime". He then turned to me and said "Would you LIKE to go home, Matthew?" (as if there might be a doubt!). They changed my diuretics about and declared that the "steroids have worked their magic". I had lost 14 kgs in fluids by then and my ankles were well down - I can see tendons, veins and bones "rippling" under the skin. My lungs feel amazingly clear, so that I actually struggle to recall how BAD we were when we first came in. The team just needed to get the Respiratory Doc back in for a final consult, to make sure she had no pressing reason to keep me in, and I could be cleared for take off.

Resp-Doc was excellent. She swung by mid afternoon. She is a lovely lady and more than willing to show me X-rays and the "salami slice" pictures of the CT scan while explaining the illness to me and the process. I love all that technology anyway and am quite knowledgeable (in an 'A' level / 'Leaving Cert' kind of way) on human biology. She was able to click on the 'salami slices' at the top of my chest and then slide down through the images, that dark circle is the single windpipe.... now see how it has divided in two, now see the dark area, that is clear, air filled lung and this, surrounding it is the fluid. "How much fluid would that actually represent, Doctor?" About 2 litres, she said. Scary stuff. That scan was a week ago, so back in the bad old days. Good to know all that fluid has pretty much been 'widdled' out now in my 14 kg.

So where am I, as I hop in the car this afternoon and get to see the farm again, be with Elizabeth, let the dogs go mad sniffing me and finally get to meet the 2 Help-X students, Flora and Emma. Well, not quite fixed is the answer. My lungs, though clear of fluid do have a few weeks of healing and recovery to do, in which I must take it easy and just do gentle stuff about the place, certainly until I have had a follow up clinic with Resp-Doc in 4 weeks time. I have a small collection of meds to keep taking at home, including managing the 'taper' off of the steroids over the next few weeks. I have to carefully manage my fluid intake, sticking to 1.5 litres a day and weigh myself every morning, keeping a careful eye on any 'big' (e.g. 1 kg) increases which might mean that my heart is back to its former inefficient "fluid build up in the lungs" behaviour.

Then there is the elephant in the room, my "regurgitating" mitral valve which will eventually have to be replaced. This is serious, major surgery (obviously) and has to be done in Dublin or Galway (in and out in a week, if you are lucky). The plan is to get me completely stablilized on all this fluid thing and 100% clear of any problem infections, where upon I may go on a waiting list or, I am told, may just get a letter one day asking me to present myself at Dublin at 09:00 on what ever date. More on that in a future post, I presume.

So, sorry no pictures in this one. I will make sure I get round the farm thoroughly before the next post and promise you loads of lovely pictures. That'll be Friday. For now this patient has a need to pack up his stuff and clear the locker and a Re-Hab debrief to attend. Bring it on you drugs experts. Talk to you soon.

Finally, a paragraph choc full of praise and immense gratitude. This to the whole team here, who have been 100% brilliant from the first Receptionist and the Triage Nurse I met at 7 pm on that first night, though all the stages - nurses, doctors, porters, caterers, phlebotomists - to the guy who is about to do my de-brief and the nurses who will presumably wish me well on the way out. Also my ward-chums. It was pure pleasure to meet you and talk to you. And to all the expressions of support, visits and good wishes face to face, by letter, verbally and via social media. Thank you so so much. It really helped. I will never forget you.

An Ultra-Sound Guided Pleural Aspiration

A shapely turn of ankle? Looking more like

ankles and less like white pud'ns after 12.2 kg

of fluids drained out of me.

Medical Notes: (For those who weren't paying attention on that day in human biology class). On the big tough left hand side of the heart, at the top, a collecting chamber called the left auricle collects fully oxygenated blood coming back from the lungs. When it contracts, this blood is forced down into the bigger, meatier left ventricle, through the one-way mitral valve. The ventricle then contracts and whooshes this blood onward up the huge artery, the aorta (serious plumbing here, this one can be 2 cm+ diameter) through another non-return valve.

Another customer for the hospital?

In a healthy heart, this job of pushing all your blood up through the next one-way valve, leaves each chamber empty and with very little pressure, ready to fill again from up stream. My problem is that the prolapse on my mitral valve allows a small amount of blood to stay put in the chamber (or return to it) which means back pressure onto the lungs. It's this back-pressure, that forces the fluid out across the lung membranes into these pools and accumulations the doctors have been trying to clear. With good success, I should say - 12.2 kg so far.

The Help-X lasses cooked 'Madeleines'

Progress report: Today I am done with antibiotics, so no more infection. I am still being checked every day for electrolytes after the water-draining 'diuretics', and today I had to take a couple of big, 'Smartie' sized potassium pills. The physio comes every day and takes me a for a walk round the corridors, wired to a 'sats' (Oxygenation saturation) monitor, and has me doing exercises to keep me in condition - the stronger and fitter the better, apparently, if I am to go under the knife for this valve replacement surgery.

Potatoes 'dauphinoises' under construction,
Help-X style

Meanwhile, in the course of all these X-rays and the CT-scan, the main doc discovered some pools of fluid outside the lungs but inside the ribs, among the 'pleural' membranes, so he engaged a new doc, a 'Respiratory Specialist' onto the team  She needed a sample of this fluid for the labs, so I got new procedure, an Ultra-sound guided pleural aspiration. Basically a bigger needle stuck in between the ribs far enough to get its tip into the liquid that they could draw off 20 ml of the stuff. They watch their own progress on the ultra-sound.

Other than that, we just chug on enjoying the lovely hospitality, working hard to get well while patiently losing all this fluid and trying to get my breath back. It's working. I noticed today that I could blow my nose like a proper 'Care' - a good aul' ripping snort requiring plenty lung volume.

Elizabeth takes up the sourdough baton, and
'Reginald' gets a new home and well fed.

Back in Roscommon, I must say again how grateful and delighted I am at the current 'cover shift' on the farm, Mainly Elizabeth but also the 2 Help-X lasses, Emma and Flora. I am trying my hardest here not to be patronising, but I guess I had fallen into that trap a bit - they are MY livestock and I am the only person who'd look after them 'properly', so I'd better set Liz up with lists of detailed instructions and training etc. Of course they are just sheep, pigs and birds, and as long as you remember to give them all water and food and a safe home anyone can mind them. So the 'Woman of the House' took over back in June when I went crock, and everybody survived. I will quickly (and rather shamefully) confess, that I even wandered round after her and checked a couple of times, but each time there was fresh water in the pigs trough or feed in the feeders and I came away happy.

"The Bumbles", 4 Buff Orp chicks hatched
under these 2 hens, plus the dark chick snuck
in by Elizabeth.

By now, 4 weeks or so in and it has all settled down. When Elizabeth comes up on the visit she brings 'Farming News' and pictures - plenty of anecdotes just like I would do when it was my job. Who's hatched, who the fox has tried to snatch, when the Guinea fowl went to bed, which babies are thriving, which need help. We somehow had a dark chick hatch in the current, volcano-shaped goose nest (some brave chicken gone in there 21 days ago to drop one) which needed rescuing because the geese were never going to accept this one into their family. Luckily, we had a little group of new-hatch Buff-Orps under 2 hens in the Tígín. With a bit or effort and persistence, she managed to sneak this little dark baby into the family and now, 'The Bumbles' are out and about and away, possibly our last broody this season. She also, single handedly, moved all the sheep from East Field to the Orchard, where the herb layer was getting a bit tall to even be called grass (plantains, docks, silverweed, pine-apple mayweed, buttercup). This is good. They can graze that down for a week and we will be able to get the girls back on it with the mower and then we will be able to SEE these 4 tiny goslings trying to follow the Mums and Aunts through the long grass.

Finally, just another huge thank you to everyone who has sent me supportive messages and good will - friends, rels and family on Twitter, Facebook, by word of mouth through Elizabeth,from the village, by post from UK. You name it. I am feeling very supported and looked after. Thank you everyone.

8 Kilogrammes

The iconic Ben Bulben seen from the ward windows

We're still here and feeling very grateful for the huge out-pourings of support and get well messages especially all over Twitter and Facebook.Also the ones called in to Elizabeth from friends, rels and people around our superb village. (She brings me a check list each day and calls them out to me. It's great!) They're all much appreciated and make me feel very cared for and looked after. Thank You.

That big screen in my "private" room (OK,
single bed bay) which became the place to watch
the World Cup England game

This end, I am behaving myself, taking all the meds and willingly submitting to all the treatments and investigations, so I am recovering fast enough for the doctor but slowly by my own normal standards for just a 'cold' or a 'man flu'. They all tell me that a pneumonia is another whole species of 'sick' and I now believe them. My thing was the accumulation of fluids on the lungs and in the tissues generally (mainly the ankles due to gravity). I am here 8 days and have lost 8 kg now, which is a whole new lease of life on the breathing.

Telemetry

As I go through the recovery phase, I also move around the place and gain and lose technological gear. At my most wired, when first in here, I counted 15 lines and wires including the 10 leads connected to my chest and extremities from the heart monitor, the oxygen or nebuliser line, oxygen saturation to a handy finger tip, blood pressure, fancy spiral "push" for my diuretics, etc. I get some of these tests still but that is at the periodic nurse's rounds.

The 'Airvo' oxygen pump.

I am now in the 6-bed, lower intensity bay and have just one machine 'permanently' connected to me, that being the "Airvo", supplier of heated and wetted oxygen to my nose. This is a fine piece of kit now that I have the heat turned down. When the nurses first gave it to me it was a hot afternoon and I just wanted to go lie down on some cold concrete or something. The air-con was on, so my bod was comfortable, but then I got this 'desert' wind coming into my nose, heating my head up and making me sweat into the pillow.

Hospital jewelry. My drip line

Ah well, we put up with it, and it was only the next day when I happened to comment, that one of the nurses said "Oh, you don't have to have it THAT hot, let me turn it down a few degrees!" Bliss. The only other brush with new tech lately was when I was done CT scan. This is a fancy-pants X-ray machine shaped like a thin flat do-nut which they slide you through. The X-ray 'gun' or receiver whizzes round your chest as you slide, 'salami slicing' an image which is then much more useful diagnostically than a straight chest X-ray.

I will hear nothing bad about the food, which has been
excellent throughout.

So, pretty much it is all going well and I can't imagine I will be  in here too long. There is only one question I would LOVE the answer to and I don't think I will ever get that one due to the total lack of engagement with the docs for 6 years. How did this huge "aggressive" pneumonia creep up on me so sneakily. In the morning I felt as right as rain and was actually doing 3 hours of heavy work (beef muck) without a bother on me. 3 hours later, early evening, I suddenly couldn't walk 30 yard without leaning on a fence gasping for breath. It is as if something hit a trigger point and just let go, like a modern car deciding to pre-emptively slow you down to 56 mph because it has detected a brake-bulb blown. Whoa! You need to get some help.

Sorry about the pics in this one - taken on the Android so not of the usual quality.