Category Archives: Thoughts

Some of my thoughts, ideas and other text based entries

A November Rose

A bit of an unexpected nice surprise during my recovery from heart surgery. I’m not entirely sure when I first noticed them, it was either just before I left for the hospital or the day I returned from the hospital with my sister. Anyway, back then the flowers were still closed and considering it was the start or even middle of October I didn’t really expect them to flower. Especially after a few night frosts in late October and early November I thought they would fade away. But they didn’t:

In mid November three of the five rose buds opened and started to flower, a nice view especially on the often grey and dull days. Cheered me up when I had a bad day during my recovery. Today is a nice and sunny day, so I thought I try to take a few pictures of them to share the joy.

Recovering from major heart surgery, the first month

Recovering from major heart surgery takes time, a long time. Related to this a little flashback to my first or second evening back on the ward in the hospital: The Martian with Matt Damon was shown on television. Early on he is hurt by a piece of antenna and operates on himself, pulling out the fairly large piece of antenna with some kind of forceps before stapling shut the deep wound. He then proceeds as if nothing had happened. Keeping in mind the state I was in I just thought, yeah right. Later on I mentioned this scene to one of the nurses and we both agreed that it wasn’t very realistic (the same applies probably to many action movies where the heroes operate on themselves).

But back to my own recovery after having been discharged from the hospital. As mentioned in the previous entry I had booked a private hire car for the journey home. This was definitely the right decision as completing that journey on a train would have probably completely exhausted me. One point to note is that the driver said he was going to drive extra carefully especially around corners and roundabouts when we told him about my operation, which I was very grateful for as it made the journey much more pleasant.

When we arrived home my sister took the luggage up to my flat while I waited downstairs. She then came back down again and we went on a short walk around a local pond close to my flat. While only short I think this was one of the most enjoyable walks I’ve done in my whole life. Walking outside in the sun (of course it helped that it was a nice sunny afternoon) after having been stuck indoors for over a week was just amazing.

Having my sister staying with me for the first few days at home (even though shorter than originally planned due to my longer than expected hospital stay) was certainly a huge help I was very grateful for. She provided companionship and helped me to figure out what I could and couldn’t do. It was also good to have someone helping to instill a bit of discipline during the first few days.

Now let me talk about a few of the areas I found interesting or challenging over the first few weeks of my recovery at home:

Sleep. You will need lots of it, yet still feel tired a lot of the time. I also found it difficult to get uninterrupted sleep, I frequently woke up during the night. At times I found it difficult to fall asleep again despite being tired, so I read something or surfed the Internet on my tablet for 10 to 15 minutes after which I was able to sleep again. I also noticed that I was sweating a lot especially during the middle of the night, this improved as my recovery progressed. I’ve been taking naps at lunchtime for many many years now, so I found it quite easy to do this during my recovery as well. If I can I sometimes even try to take several naps during the day.

Walking. One of the key activities you are told to do to aid your recovery is walking, something I was more than happy to do. I typically went walking twice a day, starting with a shorter walk in the morning. I kind of viewed this as a continuation of my daily morning run I used to do before my operation. During the first few weeks this was only a short 15 to 20 minutes walk around the estate, later on I expanded it to a 30 to 40 minutes walk along the canal (using part of the route I used to run). The second walk was at either lunchtime or in the afternoon, initially aiming for about a mile which I later expanded to 2 or even 3 miles. This walk I sometimes combined with a visit to the canal tearooms or lunch at a pub. One example was my first canal walk after returning home. One interesting area to be aware of is walking on flat ground versus walking up inclines. While I was able to walk fairly long distances on flat ground fairly quickly I did notice that I found walking up hills or even over a bridge challenging at times, especially if I started to tire after having walked for a while. To help me improving on this I included crossing a railway bridge at the end of my morning walk. I’m starting to see some improvement, but I think this will still take a while.

Housework. As mentioned in a previous post I had originally booked a domestic help to visit daily to help out with domestic chores. However, when the day arrived they were supposed to start (after my sister had left) they never showed up and my emails were never answered. I therefore needed another solution. While my sister was still with me we had figured out that I was able to do more than I had originally expected. Of course it took me longer, but I was able to prepare meals and with a few workarounds do my laundry (e.g. as I wasn’t able to carry the laundry basket I pushed it along the floor with my foot and I split hanging up the laundry into several manageable chunks interrupted by rest). My main concern therefore was cleaning the flat and changing my bed. Luckily I was able to find a local cleaning service (Merry Maids) who was able to send somebody around at quite short notice. We agreed that they would come around once a week for an hour and also change my bed. This worked out very well and I was very pleased with their services.

Shopping. This one luckily turned out to be one of my least worries so far. I had already decided to do pretty much all my shopping online at Sainsbury’s as I’m not allowed to drive and also can’t carry any heavy shopping. My only concern was that as I’m living on the second floor some of the delivery drivers might not be willing to carry everything up to the second floor (according to the Sainsbury’s terms and conditions they officially only deliver up to the first floor, anything further is at the discretion of the driver), but when I explained my situation so far they have all been extremely helpful and have even carried it into my kitchen. I’m very grateful for their help as otherwise it would have been a significant struggle. Still, I’m very much looking forward to be able to drive and carry my own shopping again in a few weeks time.

Time. Everything takes longer. I estimate that on average almost everything I did took me about one third longer than it would normally take. This is mainly for two reasons: either it takes longer because you are just slower in your movements and doing things or you need to break up activities into manageable chunks with rest breaks in between (like hanging up laundry as mentioned above).

Concentration and motivation. Something I found quite challenging in particular over the first few weeks was concentrating and finding the motivation to do certain things. I found it very difficult to concentrate on e.g. replying to emails or reading a book, so I fell behind quite a lot on what I had hoped to do over the first few weeks. Instead there was a lot of largely aimless surfing the Internet, visiting social media and watching YouTube videos. I even found it difficult to find the motivation to edit and post pictures on my Islay pictures photo blog, something I otherwise love to do. This started to improve after a few weeks but I found (and still find) it frustratingly slow.

GP and hospital visits when living out in the country. I live in a fairly small village several miles away from pretty much everything, which presents a challenge if you are not allowed to drive for several weeks. I still needed to visit my GP/pharmacy as well as having blood tests taken since I had been restarted on Warfarin. For my first visit to the surgery/pharmacy I took a taxi which turned out to cost £20 one-way, obviously something not sustainable. Luckily the West Berkshire community hospital also offered a blood test service and is serviced by a bus leaving only a few minutes walk from my flat. While the whole exercise takes me over two hours (instead of less than an hour when done at the surgery) the bus fare is only £6.40 return. I was also able to combine this journey with my daily walks by getting off the bus a bit earlier than I had to and walking the remaining distance back home along the canal. Similarly I found out that there was a twice-weekly bus service taking me close to the surgery/pharmacy, which I was able to use to pick up my prescriptions and combine it with a walk as well as lunch at a pub or cafe near the surgery.

Wound and pain management. While the wound and scar on my chest (23 cm/9 inch scar from the incision and openings from the chest drains) seem to have healed very well and cause me hardly any problems I found the pain and sensitivity in my chest and neck more difficult to handle. I don’t have any ongoing pain but the whole area is still quite sensitive and at times I have some very short-term pain in varying areas which luckily disappears again very quickly. It is nevertheless annoying and in a way frustrating as after some good improvements over the first few weeks progress seems to have slowed down. I’ve started to carefully reduce the amount of painkillers I take aiming to find the right balance between controlling the pain and weaning myself off the medication. As an interesting side note, during the first few weeks the sensitivity stretched into my chin area, something a mainly noticed while lying in bed when my duvet touched my chin. It wasn’t painful but a strange and unpleasant sensation and had to move the duvet away from my chin in order to sleep.

Mood swings, ups and downs. This I found (and still find) to be one of the most challenging aspects of the recovery. I have days where I feel great, positive and optimistic. On other days I feel horrible, tired, negative and pessimistic. The contrast between these days (it’s mostly days although it can also change during the day) is quite harsh and sometimes difficult to handle. On the bad days I try to be optimistic, thinking that the next day will be better, but that’s not always easy. On the good days I tried to preserve the mood as best as I can, hoping that the next day will be a good one as well.

Social interaction. This is an interesting area, especially as I’m single and therefore spend a large part of the day on my own at home since my sister had to leave. While I’m happy to entertain myself I must admit I do miss the social interaction of working in an office, the collaboration, the banter and generally interacting with people. I have to admit I got quite emotional when I received a get well card as well as a large dark chocolate (they know my tastes at the office…) selection from my colleagues at Verizon. As long as I am limited in my ability to get out (remember that I can’t drive at the moment and public transport is limited around here) I aim to utilise any other opportunity for social interactions including talking to my neighbours, the Sainsbury’s delivery drivers, people I might meet on my walks and anyone else really. I also use social media a bit more often, although I find it’s a limited substitute for real face-to-face interaction.

I think I’m going to stop here, there will probably be a follow-up post in early December about the second month of my recovery at home where I will cover areas I’ve missed here as well as updates to the topics above. My current goal is a phased return to work starting in mid-December, fingers crossed everything will go to plan. If you have any questions or feedback, well, that’s what the comments are there for.

PS: I wrote most of this entry using speech recognition software, a huge help as I sometimes still find it uncomfortable typing long texts on a keyboard.

Undergoing major heart surgery

Back in July 2012 I suddenly developed vision problems in my left eye. As my eyesight is very important to both my job and my personal life I decided to go to A&E at Basingstoke hospital. During their various tests they discovered that I had high blood pressure (which turned out to be the reason for my vision problems which were resolved when the high blood pressure was addressed) and that there was something not quite right with my heart. This post is about how the vision problems ultimately led me to major heart surgery and my experiences with the procedure.

Through an echocardiogram it was established that I had what is called a mitral valve prolapse, at the time with mild to moderate mitral regurgitation (or in layman’s terms, one of my heart valves wasn’t closing properly and blood was flowing back into the chamber). As there were no significant symptoms and impact at the time the cardiologist decided to annually monitor developments. During 2015 it was noticed that I was possibly also developing an irregular heartbeat. Following my annual echocardiogram in March 2016 things started to get more serious:

The mitral regurgitation had worsened and there were a few other signs my cardiologist, Dr Golledge, was concerned about. Both a coronary angiography and trans-oesophogal echocardiogram were arranged for June 2016 to take a closer look at the condition of my heart. During those tests it was established that the mitral valve prolapse had worsened to severe mitral regurgitation and that I had developed atrial fibrillation. I was referred to the Royal Brompton Hospital in London with a recommendation to repair the mitral valve prolapse with an operation (this procedure isn’t carried out in Basingstoke, hence the referral).

Throughout the first half of 2016 I also noticed more and more symptoms typically related to mitral valve prolapse (the very first signs were probably visible in 2015, but I didn’t really notice them at the time): My energy levels were reduced. I noticed increased swelling in my ankles, in particular towards the evening (it usually resolved over night, only to return the next day). When lying down for longer periods (in particular over night towards the morning) I developed a cough and breathing difficulties. When exercising I got out of breath increasingly easy, towards the end I even had to stop my daily morning run and resort to walking only (I had been running for 30-40 minutes every morning for over 30 years, it was quite a blow when I couldn’t do it any more).

In early August I had an appointment with Mr Anthony De Souza, the surgeon who would perform my heart repair surgery. He explained the procedure and outlined the risks and benefits of undergoing the operation. We agreed that proceeding with the operation was the best option and the wheels were set in motion…

As I had private health insurance with CIGNA through my employer Verizon I decided to pursue this route. After a few phone calls CIGNA confirmed that they would cover this treatment and in early September the date for the operation was agreed, Thursday, the 6th of October 2016 would be the big day.

With just over a month to go until the operation I had a lot to think about and to prepare. To start with I knew I was going to be off work for several weeks for the operation and subsequent recovery. I had already regularly updated my manager about what was happening, so I could now give him confirmed dates and we discussed coverage and other areas. I also read up on the procedure as well as recovery as much as I could from some excellent online sources as well as brochures by the NHS and the British Heart Foundation. Then there were a few practical things to consider: I learned that I wouldn’t be allowed to drive for at least six weeks and would be limited in how much I would be able to lift (the guidance is not to lift anything heavier than 10lbs/4.5kg for at least the first six weeks). For food shopping I decided to use the online/delivery route (several of my neighbours were using Sainsbury’s delivery, so I knew my area was covered). I also arranged for a domestic help to come in to help with cleaning, laundry, changing my bed and a few other things (more about that in a later entry). In addition I started to rearrange some of my furniture and set up at home to make it easier to reach things and avoid having to twist my upper body too much (again something outlined in the guidance about the post-operative care). I also bought a folding camping chair (rescued by the local Scouts from the things people had left at the Reading Festival) to leave on the first floor landing if I was struggling to climb the stairs (I live on the second floor).

Through all this I also had some brilliant moral and practical support from my sister Imke through email and long Skype conversations. Quite early on she also told me that she would take a week off work and come over to support me after I was discharged from the hospital. We agreed that she would come over the day before I was going to be discharged and we would travel back to my home together, where she would support me for a few days before returning to Germany.

Mid September brought the cardiac surgery preadmission clinic at the Royal Brompton Hospital. I travelled to London on what turned out to be the hottest September day for decades for an assessment of my health status to ensure I was ready for the operation. This included a detailed consultation with a nurse, a blood test, an echocardiogram and a chest x-ray. Everything turned out to be fine so nothing stood in the way of the operation going ahead.

Soon Wednesday the 5th of October arrived, the day of my admission to the Royal Brompton Hospital in London. I arrived just before lunch, the rest of the day was taken up by a few last tests and preparations for the surgery first thing the next morning. As my operation was scheduled for 8 o’clock in the morning I wasn’t going to have any breakfast, in fact it was no food after 9 PM and no water after midnight (if memory serves me right). After a shower with antibacterial soap it was time for bed although I didn’t sleep as well as I had hoped for, my nerves finally catching up with me.

Finally the big day had arrived, the day of my surgery on Thursday, the 6th of October. I had another shower with antibacterial soap and removed the hair from my chest and groin with a clipper I was given. After a short wait my bed was wheeled to the wing with the operation theatre, where I was transferred onto an operation table. Considering the rather nervous night I was very calm and just thought let’s do this (reminding me of a parachute jump I did once, where I was extremely nervous while boarding the plane and during the takeoff, but couldn’t wait to jump once the door was open at jump height). The anaesthetist gave me a first injection and within a few minutes I was gone.

I obviously don’t remember anything of the operation, which to my knowledge took about 4 to 5 hours. Mr De Souza and his team successfully completed the mitral valve repair, AF ablation and exclusion of left atrial appendage (for those interested in the exact treatment). My post discharge letter contains much more detail, some of which sounded quite scary to me as a non-expert, although to a highly experienced cardiac surgeon they are probably routine. After the operation Mr De Souza was so kind to call my sister to inform her of the successful operation, she then informed my manager to update my colleagues and also posted a note on my Facebook account for my friends.

Almost exactly 24 hours after the anaesthetist had sent me to sleep the recovery team started to wake me up again on Friday morning (this was slightly different than I had been told originally, the original plan had been to wake me up in the evening after the operation). I was back in a hospital bed with tubes, drains and cables connected to me seemingly everywhere. While I had known this before the pure number of them still freaked me out a little bit. I think I was given a cocktail of pills and injections by the nurse who was looking after me. I was also given a breakfast menu and soon it was time for breakfast in bed (I think I had scrambled eggs, toast, tea and porridge). It tasted very nice, which was a relief as in the information material I had read that some people temporarily lose their sense of taste. At least something that hadn’t happened to me.

Late in the morning the recovery team decided that they were happy and I was moved to the high dependency unit (HDU) to continue with the postoperative recovery. The time I spent in the HDU is a bit of a blur now, as I was still tired from the operation and you don’t get much sleep because of the nature of the environment (there is always some lights, various noises and other things disturbing you. This is not a criticism, it’s simply the way it is in such a station). Pills and injections continued throughout the day and night (some of the syringes are scarily huge!) while my chest drains and catheter were regularly checked. At times I was encouraged to get out of bed and sit in a chair to help with the recovery. For a while I was wearing some kind of breathing mask to help my lungs to get back to normal after the operation. During mealtimes I was pleased to find that I hadn’t lost my appetite and as already mentioned my sense of taste. Throughout the whole time the nurses were extremely helpful, for me in particular it was great that they explained as much as they possibly could about what was happening and why.

If memory serves me right it was late Saturday morning or sometime during Saturday afternoon that two of the nurses took me on my first short walk after the operation. It was only a short walk down the corridor and back, but to me it felt like learning to walk again and immediately completing a marathon. While you read and hear before about how tired and exhausted you will be it only really hits home when you actually experience it.

During Saturday afternoon I also heard the news I had been waiting for, my recovery had progressed enough for me to be released from the HDU and transferred to the normal ward. This included removal of the two large chest drains (a smaller one remains until the temporary pacemaker is removed) and the catheter. In particular the removal of the chest drains isn’t a pleasant experience, but the nurse did an excellent job to make it as painless as possible.

Mid Saturday afternoon I was transferred to the Sir Reginald Wilson Ward to continue my recovery. I was tired, battered and bruised (in particular my left arm was very colourful, I think it took three weeks to fully disappear), but another step in my recovery was complete. Having access to my smartphone and tablet again I sent a short email to my sister (I was too tired to call her) and posted a short update to Facebook to let my friends know about my progress. The responses almost overwhelmed me, there was so much support and kind words. A huge morale booster when I was feeling low at times.

The next few days a kind of hospital routine developed, driven by meals, medication, tests, blood pressure measurements, ECGs and progressively longer walks around the ward. The walks were interesting in a way as I was still hooked up to the temporary pacemaker and a smaller chest drain. This made walking and a few other activities a bit cumbersome as I had to carry both around with me. This in combination with the various tubes still coming out of my neck and arms sleeping also proved to be a challenge (not to mention the various bleeps and other noises you almost constantly hear from somewhere in a hospital. Again this isn’t a criticism, simply stating a fact). Washing/showering also proved to be quite a challenge: to start with I couldn’t get my chest wet because of the temporary pacemaker and the chest drain. Standing in the shower (I tried to use the chair in the shower but that didn’t really work for me), keeping my balance while lifting a leg to wash a foot and at the same time keeping the pacemaker dry was very tiring. Luckily a nurse was to hand to help me, something I would have never thought of needing for something as mundane as taking a shower a few months ago.

As my recovery looked to be going to plan and it seemed I was going to be discharged on the Wednesday or latest Thursday my sister booked her flight to London for Tuesday. Unfortunately my heart then decided I needed a prolonged stay in the hospital by taking a bit longer to fall into the correct heart rhythm. Until that happened I couldn’t be disconnected from the temporary pacemaker. This meant a few unexpected days in London for my sister, while she spent the late afternoons and evenings with me she used the days to among other things visit the Natural History Museum, the Horse Guards and the Royal Mews. While it wasn’t what we had originally planned it was great to have her around and I’m sure it helped with the recovery.

Throughout my time on the ward the nurses, doctors and various other support staff were exemplary. Everyone was extremely helpful, courteous and supportive. The doctors and nurses patiently explained why certain things were happening (or not happening for that matter), which I found very helpful to calm my nerves and get through the days.

I think it was the Wednesday when my heart finally fell into the correct rhythm, by Thursday my heart rate had picked up to a rate they were happy with, so on Thursday evening Mr De Souza decided that the temporary pacemaker and the remaining chest drain could be removed on Friday and I could be discharged on Saturday. At lunchtime on Friday the temporary pacemaker was removed, followed by the chest drain later in the afternoon. The relief and the feeling of freedom was immense. In the evening I took my first proper shower for over a week and also shaved off the ‘eight-day beard’ I had grown since last shaving just before the operation. Another huge step towards normality had been completed.

Various admin was completed during Saturday morning and after a last review with Mr De Souza at lunchtime I was ready to leave early in the afternoon. We used a private hire car for the journey home as travelling by train wasn’t really an option considering how exhausted I was and that I wasn’t able to carry any luggage.

More about the first few weeks of my recovery at home in another entry. To finish this entry I would like to again thank all the staff at both Basingstoke hospital and the Royal Brompton Hospital in London who helped me through this journey so far. Also thanks again for all the support from my friends, colleagues, family and in particular my sister Imke.

Better get the thermals out for summer 2016…

Oh dear, this doesn’t look good for this summer. My favourite weather forecaster journalist Nathan Rao is predicting the hottest summer ever (ok, for 40 years):

90 DAYS OF SUNSHINE: Britain set for hottest summer in 40 YEARS as the mercury rockets

That’s from the same guy who late last year predicted Coldest winter for 50 YEARS set to bring MONTHS of heavy snow to UK. We all know what happened with that. One of the mildest winters ever…

Two bird sightings on a nice afternoon out

One of my New Year’s resolutions was to have a at least one hour walk of some sort every Saturday and Sunday (unfortunately having a daily one-hour walk isn’t logistically feasible). While I have already failed that resolution for various reasons I’m still trying to achieve that goal when possible. Today I managed 1.5 hours at the Hosehill Lake nature reserve near Theale.

Among many other birds I spotted two birds I don’t think I have taken pictures of previously. I’m not sure if I identified them correctly, if I’ve got it wrong please let me know in the comments. I believe the first one is a Gadwall Duck, the second one I think is a Garden Warbler. As I said, if I got it wrong please let me know so that I can update the post.

(click on the picture for a full-size version)