Wednesday, 29 November 2017

Rex, Pavlov and Automobiles

It’s now nine weeks since my surgery and I have built up to walking four miles a day. I do this in two walks; one in the morning after breakfast and one in the afternoon after my nap. The first walk is down the lane to the end and back. The second walk is down the lane to the old railway bridge and back, finishing up with a loop of the laneway. The laneway has a fairly steep hill. At first I was just glad to get to the top. Recently I have begun to stride out on the hill and have found that I still arrive at the top without getting out of breath. I’m delighted, for this is something that I wouldn’t have been able to achieve, pre-op.

Both of these walks are done with Rex. Sometimes we are also joined by T. I’m still trying to stop Rex chasing cars. I read online that this is a distorted hunting behaviour and as such is instinctive. No wonder it is proving so difficult to stop. When he is in car chasing mode he seems to take no notice of anything else. One of the online suggestions was that distraction by a loud noise could interrupt his chasing behaviour. I found an old whistle I had bought in a junk shop. It was a referee’s whistle with a pea inside it, called the Acme Thunderer. It was loud and shrill.

I waited till Rex was about to start his chase of a car and then gave him a blast on the whistle. He stopped in his tracks and looked very confused. I called him over. He seemed disorientated. I called him again. He came and I gave him a treat. Delighted with this success, I tried the whistle again later in the walk when another car came. Rex stopped in his tracks again. When I got home I told T what had happened. We were both delighted to have found a solution to the car chasing problem.

The next day I set out confidently on the walk with the whistle on a cord around my neck. After a while a car came. I gave Rex a blast on the whistle. He completely ignored it and raced away after the car. Confused, I wondered if I had blown the whistle at the wrong moment. Later in the walk another car came by. I blew the whistle again as loud as I could. Rex again completely ignored it, bounding away after the car and biting at its wheels.

I pondered the problem. I think it demonstrates that Rex is a quick learner. The first day of the whistle he was startled by the sound and that interrupted his chasing. On the second day he had learnt the sound and the whistle wasn’t a problem for him anymore, so he continued with his instinctive behaviour. I pondered further, remembering the story about Pavlov and how he had conditioned dogs by ringing a bell when they were being fed. Afterwards they would salivate at the sound of the bell, without any food being present.

Actually, when I looked it up I found that Pavlov had in fact never done this experiment. It is an apocryphal story that appears to have originated from a bad translation of one of his research papers written in Russian. He was a vivisectionist who used dogs in his medical experiments, many of which were pretty gruesome. What he actually reported was that the dogs salivated at the sight of his assistants white coats, because these were the people that fed them. He never used bells with the dogs.

Anyway, I decided I would try and teach Rex to associate the whistle with food. Each time I gave him something to eat I blew the whistle. At first he seemed a bit confused by this, but then he just wolfed the food down as normal. What I’m hoping to do next week is to start blowing the same whistle when Rex is about to chase a car. Hopefully his desire for food might override his desire to chase. I’ll have a pocketful of treats ready. I think it’s worth a try.

Thursday, 23 November 2017

Driving and Dental Surgery

Over the past week I have made the thirty mile journey up to Belfast three times; on two of these occasions I drove myself. I suppose I have been fledging, testing my wings to see what I can manage. I had to put a pillow against my side under the seatbelt, but I completed the drives okay. I took it steadily, after eight weeks off I felt a little rusty. I was tired and my side was sore when I got back home each time, but I was pleased with my achievement.

The first trip was for the sixteenth edition of The Squat Pen, part of the CS Lewis Festival. I am very thankful to my co-host Ray Givans who did much of the organising of the event. My contribution was mainly to the online publicity. We were in a new venue, the deconsecrated St Martin’s Church, which was an excellent space but in a rather out of the way location without parking nearby. All of the contributors gave great performances to a smaller than usual audience. Our special thanks go to Paul Maddern, who stepped in as our main reader when Fred Johnston pulled out through illness. Indeed November must be the illest month, as I had to step in and select the Desert Island Poem at short notice, after Mary Montague pulled out with a sore throat.

Second was for the AGM of Cancer Focus NI. This is a great local organisation that provides fantastic support for cancer sufferers and their families. Since my diagnosis in 2011 I have benefitted from a range of their services, including counselling and residential workshops on learning to live with cancer. Indeed, I have been an active member of the Sing for Life Community Choir since it was founded by Cancer Focus in 2013. I had put my name forward to serve as a Non-Executive Director and Trustee and I’m delighted to say that I was elected. I’m looking forward to helping to give something back to this important and much needed local organisation.

Third was for an appointment with Dr Mark Diamond for a dental implant at his specialist clinic on the Antrim Road. He is the most experienced implant dentist in NI, having done this work for twenty years, and his clinic is referrals only from other dentists. I needed to be there because I have some poor teeth. This is due to a combination of gum disease, inherited from my mother, and decades of poor dental treatment. I had been referred to him from my normal dentist because I had reached the end of treatment for the tooth in question, it had first split and then had been extracted.

The treatment began with my mouth being numbed by a series of injections. Then I had a panoramic scan done of my full mouth. Mark showed me the results. He could see exactly how much bone I had in my lower jaw and where the main nerve ran. This meant he could decide how deep to drill and the exact right size of implant to insert. The next step was he and his nurse putting on surgical gowns, gloves and masks. Then the surgical treatment began.

He first cut open my gum to expose the jawbone. Then he began to drill down into the jawbone. It sounds dramatic but you don’t feel anything. He used a long straight drill rather than the small one used to drill into teeth. It took a little while. He told me that I have a tough jawbone. And when the hole had been drilled deep enough, he screwed in a titanium bolt with a little torque wrench. It felt like someone doing DIY on your mouth. The wrench clicked as he screwed in the bolt until it reached the correct tension. The titanium bolt has a threaded top into which a removable cap is screwed. Then he stitched up my gum.

The implant bolt is left in your jaw for at least three months for the bone to grow strongly around it, before the next steps are taken. I drove home with a numb mouth and a short course of antibiotics to ensure there would be no infection. After a couple of hours the injections had worn off and my jaw was a little sore. I took a couple of co-codamol and rinsed my mouth with warm salty water. I’d have to eat on the other side of my mouth for a few days. But, in comparison to the other operations I’d had in recent years, this was nothing to make a fuss about.

Wednesday, 15 November 2017

Sleep and Sex

Over the past week I have been transitioning from sleeping upright against a pile of pillows to sleeping lying down. It’s not been easy going from ten pillows to just one. I had been sleeping upright for seven weeks and I’d got used to it. Sleeping flat seemed very odd; it felt like my legs were higher than my head. When I woke up after sleeping upright, my neck and legs were very stiff. When I woke up after sleeping flat, my ribs felt like I had been several rounds with a heavyweight boxer. I think it’s because the mattress puts more pressure on your ribs when lying flat and you also move around more in your sleep.

Anyway, I persisted and now I can sleep the whole night lying flat. Despite waking up with sore ribs every couple of hours, I managed to sleep my normal nine hours or so last night. It’s another good step towards normality. Although, I would normally go to sleep on my left side and I can’t do that because of the wound. In the morning I still get up straight away as standing up relieves the accumulated soreness of the night. As the activities of the day inevitably bring tirednesss and soreness, in the afternoons I still go for a nap but I don’t always manage to fall asleep. Sometimes I just rest for an hour or so.

In the sunshine on Sunday, T and I did a three mile loop walk around lanes from the house. Despite the route having several small hills in it, I managed it fine. My breathing already seems better than it was before the op.  I still take Rex on walks down the lane and back twice a day. I’m trying to stop him chasing cars but with limited success. My current strategy is to teach him to come to me when I call ‘here’ and to give him a treat when he does. When a car comes along the lane I shout ‘here’ loudly and once or twice this has interrupted his desire to chase and somewhat hesitantly he has come to me for a treat. A few times he stopped chasing the car when I called and chased his tail in circles in the middle of the road and another time he ran off madly across a field instead.

The blacksmith down the lane has got a new dog, a male short-haired collie called Glen. The first time they met Glen jumped up and placed his front paws around Rex’s neck and began to lick and bite him playfully. Rex eagerly did the same back to him. There was plenty of growling. Then Glen mounted Rex from behind and began to pump away at his arse with his little red willy out. After a while, Rex leapt on Glen from behind and began to pump away at him. But Rex didn’t have his willy out and was also pumping away at Glen’s thigh rather than his arse. Methinks Rex is a little more innocent than Glen, but he has discovered sex and each time we walk down the lane he keenly looks out for Glen. The blacksmith now calls them ‘the lovebirds’.

Tuesday, 7 November 2017

A Review with the Surgeon

Almost six weeks since the surgery and I was on my way to Belfast to see the surgeon for a review. It was the first time I had travelled that far since leaving hospital. Indeed, I was retracing my steps. I never really paid attention to it before, but a car journey is full of low level vibration, presumably from the road surface. Then you get jolts from potholes and braking and cornering. All of this irritates the wound. I placed a pillow at my side, between my torso and the edge of the seat, and this helped a little. It seemed a long way.

After five weeks at home, I feel I’ve definitely turned a corner. My recent improvement feels secure. I am now fully independent in the house, being able to manage my own washing, dressing and feeding. I make my own breakfast and lunch. T always makes tea. My morphine prescription has been reduced again to 20mg a day, in two 12 hour long-release tablets. This together with the Lidocaine patch and Paracetamol is managing the pain. I am walking for over an hour each day. But I am still unable to lie flat for any length of time.

When I was discharged from the Royal I was given a form for an X-ray. This was to be taken half an hour before my review appointment. We did as requested and then went to wait in Outpatients. As usual there was a delay. When I went in to see him, the surgeon had my X-rays up on his screen. He showed me the difference between today’s and the one taken pre-op. My left diaphragm was now fully down (the X-ray is taken on full inspiration) and my entire left lung appeared to be inflated. Previously my left lung was squashed up, as half of its space was taken up by my stomach. Now there was no visible difference between my left and right lungs.

Today’s X-ray looks very good, he told me. I asked him how much of the functioning of my left lung I would get back. He said that I would get a lot more than I had before but not 100%, as the mesh patch would not work as well as my native tissue. The exact change would be measured by the breathing tests I did annually with my Respiratory Consultant. He advised me not to do these for at least three months as they would be putting stress on the repair. He also told me that the main stressors on the repair to the diaphragm were coughing and straining on the toilet in constipation.

I took off my top and he inspected the wound. He pointed out the four large surgical scars on my torso to a junior colleague and said I looked like a surgical model. I didn’t ask if he wanted to book me in for any lectures. He told me that the wound was healing well but that I needed to be careful for six months as this is how long it would take for the intercostal muscles, which join the ribs together, to fully repair. He told me that my regular walking was very good and I could slowly increase the exercise I was doing. He also said that I could now start to drive again.

We drove back from Belfast around 4pm, the rush hour traffic was building up, my wound was sore and I was tired. I wouldn’t be rushing to start driving again. And even then I would begin with just some local trips. But this was another good step forward on my return to normality.