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.
Showing posts with label mitral valve. Show all posts
Showing posts with label mitral valve. Show all posts
Thursday, 8 November 2018
Tuesday, 24 July 2018
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.
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.
Saturday, 14 July 2018
Coronary Care (2)
So, for those who would like a little more detail around those hard facts in the previous post, some human biology. If you were not paying attention on that day in school where they did respiration and circulation you will need the following fun facts to help you understand my condition.
Lungs are MEANT to be air-filled sacs Ooh, you knew that?. The 'skin' of them (lining) is allowed to be moist or wet but it is intended that the big air-pipes coming in at the top, branch into the two lungs, then branch and branch and branch ever finer like the tiny twig-leaves of a tree or some bizarre rubber mould for a cauliflower head. All these tiny sub-branches and fine fine ends are still air-filled tubes in a healthy lung. When you breathe in the ribs and diaphragm drag this 'sponge' out bigger in all directions, and air rushes in to all the tiny pockets, nooks and crannies.
The heart is a fist sized, 4 chamber pump made of muscle. The two top chambers (auricles) are there to collect blood from round the body and then fire great charges of blood into the meaty bottom chambers (ventricles), stretching them like a very tough balloons. At the end of this 'whoosh' of blood, the auricle finishes its 'stroke', the blood flow stops and a one-way valve slams shut. This keeps the blood in the ventricle till its turn to 'fire', when the contraction fires all that blood into the main round-the-body artery (aorta) through another valve (aortic valve). The one-way valve to which I referred, between auricle and ventricle is called the mitral valve.
So, what has gone wrong here?
My lungs became temporarily NOT air-filled. Instead they quietly built a pool of thick, sticky "phlegm" which crept up on me, just feeling like " a bit wheezy". I am (was) a great one for avoiding the doctors and the medical people so I did not take myself off to the GP, being convinced that it was just man-flu and I'd recover. Then on June 17th, it all shut down. I'd been doing some fairly hard work in the morning, moving cattle-muck but I have no reason to think that had anything to do with this. Three hours later, that evening, I was suddenly unable to do anything - walk more than 30 yds, lift a tin of dog food, get the kettle on. I was banjaxed. When I tried I would quickly be stopped by lack of breath, my breath trying to come in great, wheezy, crackly gasps and my airways feeling like rough cardboard tubes. I could no more fill my lungs down to the diaphragm with "deep breath" than fly to the moon. Clearly a problem.
My heart, we have found in the course of all this medical investigation, has a slight pro-lapse of the mitral valve. That big one-way valve I mentioned? In one place on the rim of it, part of the edge 'farts' back into the auricle like a whoopie-cushion. It's not a disaster, it may have been there years, and it may have no relevance to this pneumonia but such leaks can make the flow of blood and liquids round the body much less efficient, so might have helped the build up of fluid on my lungs and my swollen ankles. This goes into the category of "noted". If work is needed then it may well be replacement of the mitral valve with a mechanical bit, but for now the team are going with the fluid reduction solution. THEN they will worry about hearts.
That's it for this one.
Lungs are MEANT to be air-filled sacs Ooh, you knew that?. The 'skin' of them (lining) is allowed to be moist or wet but it is intended that the big air-pipes coming in at the top, branch into the two lungs, then branch and branch and branch ever finer like the tiny twig-leaves of a tree or some bizarre rubber mould for a cauliflower head. All these tiny sub-branches and fine fine ends are still air-filled tubes in a healthy lung. When you breathe in the ribs and diaphragm drag this 'sponge' out bigger in all directions, and air rushes in to all the tiny pockets, nooks and crannies.
The heart is a fist sized, 4 chamber pump made of muscle. The two top chambers (auricles) are there to collect blood from round the body and then fire great charges of blood into the meaty bottom chambers (ventricles), stretching them like a very tough balloons. At the end of this 'whoosh' of blood, the auricle finishes its 'stroke', the blood flow stops and a one-way valve slams shut. This keeps the blood in the ventricle till its turn to 'fire', when the contraction fires all that blood into the main round-the-body artery (aorta) through another valve (aortic valve). The one-way valve to which I referred, between auricle and ventricle is called the mitral valve.
So, what has gone wrong here?
My lungs became temporarily NOT air-filled. Instead they quietly built a pool of thick, sticky "phlegm" which crept up on me, just feeling like " a bit wheezy". I am (was) a great one for avoiding the doctors and the medical people so I did not take myself off to the GP, being convinced that it was just man-flu and I'd recover. Then on June 17th, it all shut down. I'd been doing some fairly hard work in the morning, moving cattle-muck but I have no reason to think that had anything to do with this. Three hours later, that evening, I was suddenly unable to do anything - walk more than 30 yds, lift a tin of dog food, get the kettle on. I was banjaxed. When I tried I would quickly be stopped by lack of breath, my breath trying to come in great, wheezy, crackly gasps and my airways feeling like rough cardboard tubes. I could no more fill my lungs down to the diaphragm with "deep breath" than fly to the moon. Clearly a problem.
My heart, we have found in the course of all this medical investigation, has a slight pro-lapse of the mitral valve. That big one-way valve I mentioned? In one place on the rim of it, part of the edge 'farts' back into the auricle like a whoopie-cushion. It's not a disaster, it may have been there years, and it may have no relevance to this pneumonia but such leaks can make the flow of blood and liquids round the body much less efficient, so might have helped the build up of fluid on my lungs and my swollen ankles. This goes into the category of "noted". If work is needed then it may well be replacement of the mitral valve with a mechanical bit, but for now the team are going with the fluid reduction solution. THEN they will worry about hearts.
That's it for this one.
Coronary Care (1)
A quick change of pace here since the previous post. I am typing this using our laptop in the Coronary Care Ward of Sligo Hospital under the TLC of all the wonderful staff here who are trying to cure me of a savage attack of pneumonia. Just in case there are friends/rels who just want to know what's wrong with me and the latest medical stuff, I will do this a a series of 3, ever more waffly posts. This will also assure me that this "guest" broadband will allow me to type chunks in without blowing me out.
So I have pneumonia, which had been allowed to build up and get well established by mid June when it suddenly stopped me breathing for anything other than standing, sitting or very short, 20 yd walks. We went via the local GP system, got seen by Sligo Hospital back in June, back to the GP and then finally back here, referred in a bit of a hurry "You are VERY sick", on Monday evening. I am now on Day 6 of the team here trying to give me my lungs back. I am recovering but not very fast.
Meanwhile, because this was an unusual case which did not tick ALL the usual pneumonia boxes, I have also been thoroughly investigated in the heart dept and have been found to have a small prolapse in my "mitral" valve (big powerful valve between left auricle and ventricle. Discussions continue as to whether the prolapse needs fixing sooner/later and how much it had to do with the pneumonia. If it does need fixing, this will probably mean heart surgery and a replacement (mechanical) valve.
There you have it for now.
So I have pneumonia, which had been allowed to build up and get well established by mid June when it suddenly stopped me breathing for anything other than standing, sitting or very short, 20 yd walks. We went via the local GP system, got seen by Sligo Hospital back in June, back to the GP and then finally back here, referred in a bit of a hurry "You are VERY sick", on Monday evening. I am now on Day 6 of the team here trying to give me my lungs back. I am recovering but not very fast.
Meanwhile, because this was an unusual case which did not tick ALL the usual pneumonia boxes, I have also been thoroughly investigated in the heart dept and have been found to have a small prolapse in my "mitral" valve (big powerful valve between left auricle and ventricle. Discussions continue as to whether the prolapse needs fixing sooner/later and how much it had to do with the pneumonia. If it does need fixing, this will probably mean heart surgery and a replacement (mechanical) valve.
There you have it for now.
Subscribe to:
Posts (Atom)
