War Room

Another not-really-a-post for now (sorry, no pictures) but I thought my family-followers might welcome a health/medical update and a few random jottings. If you have come on here looking for smallholder adventures, then I am sorry to disappoint you again. That version of Deefer-Dawg may well be back but for now she is still on holidays.

We have been in for two out-patients 'follow-up' visits this week, so I have some medical updates though, sadly, not yet that 'first prize' of a date for the heart surgery up in Dublin. That is the 'big one', the one that I hope will finally sort this breathlessness, fluid accumulation and congestive, ticklish cough and allow me to finally bounce back to full health and ability to do useful work round here. Meanwhile, I am still so short of breath that a walk down to the front gate to check the egg honesty box has me pausing at the lane to get my breath back. I can just about do the livestock rounds morning and evening (feed poultry, let them in/out) and I am OK getting coal and kindling from the carport in the fire bucket and getting the home fire(s) burning. That, though, is about the limit. Pathetic and frustrating.

So.... these out-patient appointments, then, one with the main 'heart' guy, the other with the respiratory lady. Regular readers may recall that previous visits in August involved the TOE (Trans-oesophageal echo-cardiogram) tube down the throat job which, in my case, necessitated a total knock-out sedative. That gave the docs the best ever pictures of the state of my heart damage including one important change.

Up to then 'we' had been talking about a replacement Mitral valve, either mechanical or pig spare-part. This is now no longer thought to be the case because my damage is a tear in one of the 'cusps' of the valve and can be fixed (they tell me) by sewing the tear, make do-and-mend style. The doctor here is, I know, in contact with the surgical team at St James's Hospital in Dublin (they don't do the surgery out West here, only the stents etc) so we are all just waiting on a date. Weeks? Months, After Christmas? Watch this space for updates.

The respiratory team, you may recall, had me in the 'Tardis' booth for some breathing tests (50% normal volume, if I remember right, and 63% flow)  but also gave me a sleep monitor pack for the one night, checking for sleep apnoea, snoring and other breathing problems. I saw a more junior member of the team this time but I noticed that there were some comments written on the notes by boss-lady. I may not have mentioned in here that the night chosen for the sleep-pack was not a good one for the coughing - there is a bit of a pattern here where too much walking around hospital corridors seems to stir up the congestive fluids and ensures I have a bad night.

I'd had to hand back the sleep-pack with a little hand written note in it explaining to the technician that she should ignore the 10 pm to 2 am period as the data would be rubbish;just go with the 2 am to 8 am bit where I slept like a log. They obviously didn't need this as their print outs show in great detail where I was asleep, with every breath a little stroke of the 'pen', and they can even tell whether I was sleeping on my left or right side, my back or my front.

In those 6 hours, apparently, I did not snore and nor did I have any full, stop-breathing, apnoea episodes but I did have a couple of what they call "sub-apnoea events", where your breathing slows right down but does not quite stop. However, when we discussed these and the coughing all agreed that it was not worth trying to 'cure' them while my heart valve is still leaking. Much more sensible to sort the valve, stop the back-pressure and congestion, get me into a steady state (I do pray that that means OFF the liquid intake restrictions and the diuretics!) and then look at it all again from the sleep-pack stage. Then we will know whether we still have a problem and can address that.

So we shook hands and said our good byes and promised to meet up again in 4 months which we all hope will be AFTER the heart op. We were half way down the corridor to the exit and suddenly heard our names being called - a nurse had been sent to chase us with one last easy option. My sub apnoea events, apparently, all show up when I am sleeping on my left side, so if I can sleep propped the other way (there are long-ways pillows, apparently) it might improve my sleeping comfort and be a "quick fix". I am happy to give it a try (I did last night) but my sleeping style seems to involve a lot of tossing and turning and I wake up every which way.

Finally, the non-medical news. The calendar eventually clicked round to the much heralded and eagerly awaited US mid-terms. Elizabeth, in particular LOVES her US politics and had been main-lining podcasts on the various 'races' House, Senate, State Governors and so on. That night was always going to be an all night vigil for her. She sets herself up a little "War Room" in the sitting room with the open fire lit, with a supply of blankets for her feet and the sofa equipped with lap-top and the i-phone, chocolate 'Mikado' biscuits and fancy crisps, plus tea on tap.

This is a US election and count, so she also had a little plan of the time lines for GMT (our local time, obviously) but also the "Eastern Time" equivalents in which the live feeds and pod casters tend to report. Polls close for some states at 7 pm (ET) which is midnight here, for example. Most states had closed by 23:00 (ET) which is 04:00 GMT. Hawaii and Alaska come along at 05:00 GMT but by then enough 'mainland' stuff has happened that our all-nighter has a clear picture of 'how it went', so she leaves me a little summary in case any interested parties should  call and goes off to catch up on some sleep with a request to be awoken with tea at midday. History will show that the Democrats took back the house and gained some good Governorships, plus got back one Nancy Pelosi as Leader of the House, but lost ground in the Senate.

And there you have it till next time.

TOE? I Slept Through It!

Plums coming ready and in need of making
into jam. I have started using the splits, wasp
damage and windfalls for the pigs.

I am hoping that this is the last mainly-medical post for a while, so normal small holder-y service should start to be delivered from the next post. Please bear with me (or just click on by). At least this one has some pictures in it as I finally managed to buy a lower capacity camera card and my camera is not struggling to find new pics among the 2000 images on the old one.

That sleep monitoring pack. It's job is to
spot snoring, sleep apnoea and any other
breathing problems while you sleep.

Two major medical procedures hanging over from the previous post then - the sleep monitoring and the Trans-Oesophageal Echo (TOE). Regular readers will know that I was not especially bothered about the former (I am well used to sleeping wearing all manner of wires, nostril pipes and packs strapped to me after my 2 weeks in Sligo Hospital) but I was scared to death at the latter. The TOE involves swallowing a rubber pipe containing an ultra-sound transducer and I was sure my very strong gag reflex would give the techies a problem or even be a show-stopper.

A miserable night wired to the telemetry. You can
only see the very top of the chest-pack and straps.
My (old) phone does not do 'selfies' so you have
to spark up the camera, point it at yourself and
guess where the 'trigger' is.

In the event, happily, things went completely the other way round, with the sleep pack having the issues and the TOE a breeze. We'd had an exhausting and full day on the Tuesday, involving probably way too much walking the long corridors of the hospital (7 hours), so my lungs were well stirred up and I was in for a bad night with the ticklish cough and having to keep sitting up to let the coughing fits subside.

The pigs are enjoying the windfalls.

None the less, with Nurse Elizabeth's help, we 'dressed' me in the equipment and off I went to sleep at about 10 pm. Cough....cough....cough....COUGH. I finally got to sleep at about 2 o'clock and slept till 6 o'clock, so when I stripped off the gear and packed it away in its carrying case I needed to leave the nurse/techie a 'love letter' saying she'd get nonsense results for the first 4 hours. Of course (wouldn't you know?), as soon as I'd taken off the gear, I slept like a babe round till 8 o'clock. Maybe we'll give that another try after the heart-op and when I am de-congested.

Fennel

The TOE on Thursday morning was nothing like the problem I had predicted or spent all that time worrying about. We had an early start that day, with an 0530 alarm and an 0630 depart here, to make sure we arrived at "Endoscopy" by 0800. I was quickly into a world of half a dozen nurses looking after me and later, the calming presence of the main consultant (I had no idea he'd be getting hands-on on this one) and I was making sure they all knew (probably to an irritating degree!) about the gag-reflex issue and my need for sedatives.

Everyone was very calm about this (re-assuring) and told me it would not be an issue (they had ways and means etc). I was fitted with a drip line for the drugs. They would wire me up to the telemetry and then worry about sedatives. In good time I was wheeled in my bed into The Room and made to lie on my left side, with my back to the big machine. The main man leant over me to adjust my position and that was all I knew. I woke about 45 minutes later in the recovery room with Elizabeth chatting to the man. I have no idea what the medics did - presumably turned on the sedative tap at some quiet signal before I had a chance to see the pipe and the thing I'd need to swallow.

A good haul of prezzies for the Birthday
Girl

I was delighted to have gotten away with it all so easily. There was not even any discomfort in my throat. If somebody had said "Ah yes, sorry, we didn't actually do anything..." I'd have believed them! After a suitable time I was allowed to stand up and walk to another room where we were given tea, a scone and a glass of water. I was a bit 'drunk' but Elizabeth was there to drive me home (interesting double-vision on the motorway!).

'Lady sized' border fork and spade.

This is the age of the Internet, so today, eaten up with curiosity, I was asking the Surfer if the House what she'd seen and heard that I'd missed. Not much in fact - she'd been sitting in the waiting area knitting, but at least she'd met 'the man' and been able to ask him some questions. She 'Googled' the TOE procedure and we could sit and watch some videos of the thing being done to other people (or cartoon drawings). Curiosity satisfied, but I was glad I'd not been shown that enormous pipe and then asked to swallow it. Our way was much better. They are wise and experienced professionals.

Posh Gin

What else has been happening? That problem ewe had one more dose of the cream slapped onto her bald, itchy patch and was last seen recovered back to healthy pink skin, all dried out and starting to turn grey where the wool had started to grow back  The weather had also turned colder and wetter, so the flies were less of a problem. I covered Elizabeth's birthday in the last post and am now able to bring you some pictures.

Small batch gin.

Another lovely gift arrived from UK friends (Thank you!), being a rather posh (small batch) bottle of gin of a brand which 'we' had not tried. This was 'Bertha's Revenge' and is based in part from spirit made from 'whey'. Beautifully smooth, says The Lady of the House. 'We' have also found some elderflower flavoured 'Fever Tree' tonic to go with, so gin drinking bliss knows no bounds.

We had a lovely visit today from archery friends, Con and Niamh, being fresh from a fun event they organise each year up at their holding, Celtic Games. They all dress up in the Celtic/Druid gear and they invite people to try archery, spear throwing, axe throwing and a low-impact version of quarter-staff fights (two contestants meet balanced on a big log holding either end of a pole and trying to throw each other off balance. If you fall off it's only a couple of feet to the grass. Nobody gets whacked or hurt).

Gladioli - sorry for blurred pic.

We had a lovely chat and caught up on the medical situation / recovery, ranging onto bee keeping and products like honey and bees wax.

Ah well, surely enough for now and, as I said, the last medical based post till the keenly awaited 'Big One' - the heart operation itself.

5 Week Clinics

Another wordy and non-pictorial post, I'm afraid, while I catch you up (if interested) on things recovery and medical. If not, skip 80% of the paragraphs. Today, 5 weeks out of hospital, the dates for my follow up clinics came round and the lovely appointments folk spotted that I needed to see both the main Coronary Consultant, but also my Respiration Consultant and, possibly, that we live an hour's drive away. They managed to arrange both clinics for the one day - one at 10 a.m. and the other at 2 p.m. Perfectly timed so that we even got a chance to nip out for lunch and a bit of shopping in between.

Regular readers may have worked out that I was a bit worried about these two clinics. I was looking forward to them but I was worried that they might not give me the answers or the progress I want and need. Would decisions be made on big issues like the heart valve replacement surgery? Would my state of (slow) recovery and ongoing congestion with fluid (weight gain) mean that I'd have to put up with another 4 weeks on a different drugs regimen while the medics watched and analysed? I was (am) getting very frustrated now with this light duties, inability to breathe well.

We all (over)hear (accidentally or deliberately) what friends and relatives say about us and some of the things hurt but some buoy you up. I love the "Big Fella" ones - "Strong as an ox!", "Great bull of a man". People admiring my work rate and complimenting me on a job well done. Those are the ones I want to be, not anything to do with shuffling around like an aul' man, wheezing. Those are the days I want back.

What a change! In a few (well 7) exhausting hours, I went from worries about lack of progress to a parachutist's "ground-rush" of too many things happening at once and dizzying up my head. I got a decision by the main man that my heart valve replacement will be SOON, plus a change in my diuretic dosing (to try to slow the fluid build up). He also booked me in for 8 o'clock Thursday morning for a Transoesophageal Echo*. The Respiration Consultant posted me straight off for a lung volume/function test and also set me up with a sleep monitoring kit which I am to wear tonight - all part of the investigation into breathing issues like snoring, sleep apnoea and so on.

The latter is a fascinating piece of kit with a box of tricks you strap to your chest and connect up to an oxygen saturation device on the end of a finger plus a pair of sensors up your nostrils and a tiny heat detector which hangs in front of your mouth like a singer's microphone and detects in/out breaths. With all that gear hanging off me, I have to try to get to sleep. The straps round your chest have 'stretch' detectors above and below your 'man boobs' to detect breathing. The box of tricks saves all your telemetry digitally and you hand the machine in to get the data downloaded and analysed.

*The former (the Transoesophageal Echo (TOE) one) frightens me to death. I may not have mentioned this before but I have a very strong gag reflex, so that anything put near the back of my mouth has me gagging myself into near nausea. It is a real problem at, for example, the dentist, where if they ever need to do an X-ray they try to slide a small flake of lead down between tongue and teeth, but right back to the back teeth. I cannot cope and start to gag. I think my dentist may have managed one X-ray since I have been in Ireland, but certainly no more. At the lung volume/function test mentioned a few para's ago, I had to bite down on a silicone rubber yoke like a SCUBA diving mouth-piece, with some bits inside my lips. That yoke didn't go anywhere near the back of my mouth, but was still a struggle.

The TOE involves swallowing a rubber tube with an ultrasound transducer at its tip. This allows the technicians to move the transducer up and down the oesophagus (your 'swallowing' pipe) which runs down behind, and very close to your heart. They can get much clearer 'pictures' of your heart at this range, than they can get from outside your chest, through the chest wall (a standard "echocardiogram") . When I heard all about this test and read the leaflet, I had the immediate horrors. Swallow a rubber tube? I was sitting in the corridor, waiting for a blood test, and gagging like a pro.

Luckily, I am not the first with this issue and the test team can cope - there are all manner of sedation, anaesthetic and anti-gagging techniques available to them - they just need to know in advance and make sure you have someone who can drive you home after the procedure. Thank you again, Elizabeth. Wish us luck for Thursday morning. Yes, I am amazed that I am facing open heart surgery with confidence and few fears and getting all wound up about a 20 minute chew on a rubber tube. Ah well, there's no accounting.

But that is surely enough medical stuff. More on all these stories in future posts. What else is going on. Happy Birthday to Elizabeth for yesterday. She had a lovely relaxing day and was delighted by a good spread of presents. High points were a lovely (huge) fine-china tea mug which says on the outside "There is England... and then" (on the inside) "...There is Faversham". Love the sentiment. Also up there was a copy of the new book by former Barack Obama staffer, Dan Pfeiffer, "Yes we (still) can".

Dan is one of the presenters of our favourite USA politics podcast, "Pod Save America" and the book covers 'Politics in the age of Obama, Twitter and Trump". The Woman of the House sat down with a series of  big teas (in the new mug) and had the book read by 3 p.m. Also in the mix were a very nice pair of "Kent and Stowe" lady-sized border fork and spade, a book of the best of (Irish writer/satirist) Flann O'Brien, some lovely boot-socks.

Elizabeth also finished the digging over of that huge flower bed. There is plenty work to do on that bed - levelling it off is a big job in itself - it then needs covering with weed proof membrane, replanting and then 'mulching' with 3 tonnes of gravel.

That is enough for this one.