Friday, 21 April 2017

A (dog) walk in the park - Avebury

Let me start off by admitting that it's not a park, but Barney had a great day out and why ruin the name of a great series of posts?!

Avebury is a village in Wiltshire and the site of the largest stone circle in the world. The village is also the location of Avebury Manor and Garden, owned by the National Trust. We've visited Avebury before and looked around the Manor and Garden, but this time with Barney in tow, we restricted ourselves to a walk around the stones, followed by a trip to the cafe. Car parking is expensive at £7 per day, free for National Trust members, but for that you get to walk around the stones for no further cost. The village is a nice place to wander around, even if you're not crazy about Neolithic stones. Be prepared for it to be busy, despite visiting in March, we got just about the last parking space. Being a village there are all the facilities you'd need for a day out. 

Dogs are meant to be on leads around the stones, but Barney didn't seem to mind too much. He met lots of other dog owners who made a fuss of him, as well as a lookalike cockapoo. It's a nice place for a dog walk, if you don't mind them not being able to run free.
The view down the River Kennet to Silbury Hill
A section of the stone circle
Barney's not really one for history
Looking over towards the village
Village church

Sunday, 16 April 2017

Grittleton Gambol geocaching series

We used to be keen geocachers and then we got Barney. Since we got him in May last year, we've done a total of nine geocaches. However, now he's over a year old, we no longer have to limit the distance of his walks, plus I've reached the end of my physio on my knees and Andrew's settled into his new course of medication; it seemed like a good time to get back into the geocaching habit.

I love a circular series and found the Grittleton Gambol series about half an hour from home. Perfect. I thought I'd write a short blog post about it in case it's helpful for anyone else considering the series.

Name: Grittleton Gambol
First cache in series: GC179PC
Number of caches: 12
Distance: Approximately 3.5 miles
Location: Starts from Grittleton, Wiltshire

We parked on The Street in Grittleton to start the series. Although it was Easter weekend, we found a spot without too much difficulty. From here we headed past the church and out of the village to pick up the start of the footpath. 
The church in Grittleton
We found the first three caches easily and then retraced our steps back to the road.
The field we skirted to the first caches, complete with chicken coop

Barney, sitting pretty much on top of the first cache
From here we crossed over and headed out across the fields. The first section had been ploughed but luckily was dry due to the lack of rain recently, we then came to a planted section, but it seemed to have been planted with grass for silage, rather than crops. We kept to the footpath as far as we could tell and started on our way. It was a surprisingly large field and due to the length of the grass, Barney couldn't walk through it and had to bound over it. We picked up two caches on our way across.
Making our way across the fields
Looking back towards Grittleton
At the end of the field there was another cache in the series, but we'd actually picked it up on a previous geocaching trip in December 2014. After leaving the field, we turned left down the Fosse Way, an old Roman Road, now a byway. 
First bluebells of the year
Making our way down the Fosse Way
Towards the end we got closer and closer to the M4. At this point, we decided that we still had energy left in our legs and paws and made a detour up a nearby country road to take in another three caches ('Dealing with Witches - Holly Oak, Rose Oak and Ivy Oak). These were less fun than the Grittleton series, two of them positioned across ditches and surrounded with brambles. 
The view out to Littleton Drew from the last of the 'Dealing with Witches' caches
We retraced our steps after picking up these three and made our way down the larger road back towards Grittleton. There was a fair amount of traffic, but the road was wide enough that we didn't feel unsafe. 
Making our way up the road back towards Grittleton
A quick stop off at the penultimate cache to take in the fields
Back to Grittleton
We stopped for drinks and snacks at the nearby pub and then did the Church Micro in the village before heading home.
A stop off for much needed refreshments

So, compared with our plan at the start of the day, this is what we did:

Number of caches: 15
Distance: Approximately 5.9 miles. The map below from my GPS shows our route
Time: 3.5 hours, excluding pub stop
Terrain: Flat, combination of fields, byways and roads. Dry when we walked it in April, but I'd imagine it could be very muddy in parts
Wildlife: There were two areas with chickens, and one fox spotted in the distance
Facilities: The pub in the village, the Neeld Arms, looked good and allowed dogs

I really enjoyed this series, all caches were present and in good condition and none too difficult to find. Despite a few nettle, bramble and holly injuries I'd definitely recommend it.

Tuesday, 10 January 2017

December round up

How can it be 10th January already? I'm sure Christmas can't have been that long ago. 

December was a nice month, not just because of the long break at the end of the month, but that helps! Maybe everyone is just in a much better mood in December.

We caught up with a couple of friends who we hadn't seen for a few years at the start of the month. They've recently moved back to the UK from the Falkland Islands so we thought we should make the most of being half an hour apart, not 13,000 miles! We went out for lunch at their local, the food was good as was the company. I'm looking forward to doing it again.

Barney had a trip to the vet, he was neutered and had a couple of retained puppy canine teeth out at the same time. I felt awful putting him through it but he bounced back (literally!) really quickly. He was sent home with a cone of shame, but he couldn't cope with his head being so much wider that usual and kept clouting things, and my shins were starting to suffer, so we got him a recovery suit. He was much happier!
Sad puppy
Happy puppy!
I left Andrew and the recovering Barney alone for a couple of hours to meet a friend for lunch. She had a baby just over a year ago, but this was about the second time she's had some time to herself apart from to work. We spoiled ourselves with a trip to Pizza Express and have resolved to do it more often. 

Work was fairly quiet, which makes it a good time to catch up with admin. We had our Christmas lunch which was really nice. We always exchange Secret Santa presents over lunch, they varied from the useful to outrageous. Mine was a, "Leave me alone, I'm only talking to my dog today" top. How well they know me.

We had to miss one week of puppy school after Barney's op. He had been making good progress, but after being under virtual house arrest whilst he was recovering, he was like a thing possessed when we took him back. We're taking a month off in January as we're so busy and hopefully he'll calm down a little with being a month older!

On the whole, I really enjoyed Christmas this year. We spent Christmas Day at home, much as Andrew rolled his eyes at me buying presents for Barney, he enjoyed unwrapping them and adopted each of his toys in turn as his new favourite. We had a nice lazy day, got up late, did presents with a few snacks, threw some balls for Barney and then a mid afternoon Christmas lunch. What's not to like?!
Barney's Christmas robin already looking a little worse for wear
I'll only wear these antlers if I can have a biscuit, okay?
I can't even see now, my price has gone up to two biscuits
We went to see Andrew's family the following day. Barney got to meet Andrew's aunt and his sister and brother in law the first time. He's still not getting on brilliantly with Andrew's parents' dog, but things went slightly better than last time. He was very excited to meet all the new people, but at least he didn't disgrace himself. Andrew's father managed to wind him up by shaking a biscuit tin at him for longer than was strictly necessary, but we're trying to forget about that! We all had plenty of presents and were thoroughly spoiled and well fed.

By the 27th, it was time to see my family. Barney had met my parents and brother before, there were no other dogs and no-one shook a tin at him, so it all went very well. He injected just the right amount of fun into the day and he's been invited back, so he must have done well.
Can you tell I helped Mum unwrap her presents?

Now onto my final summary of progress against my plans for the year...

Read sixteen books
No progress in December, I'm afraid. I have almost finished my audio book I've been listening to for six months though. That gives me a final count of 6/16. Whoops.
Find one hundred geocaches
We're still at 534 finds, which leaves us at 46/100. Whoops again.

Meet up with an old friend
I met up with a number of friends over the year, it's been great and can just hope to find the time to do the same next year. 

Blog once a month
I published a couple of posts penned by Andrew about his cataract surgery saga. If you are interested, you can find them here and here.

Watch a new film once a month
We've been rubbish with films, but I can recommend a couple of good XBox One games! We watched 12 over the year though, so on average we hit target.
Take six day trips
No progress on this one, it's fair to say that Barney has changed how we spend our spare time quite significantly!

I'm already thoroughly enjoying January, so I'll keep up with my monthly updates. If nothing else, I quite enjoy looking back at what I've done over the month. I've not set any resolutions or the like for 2017, but am already hitting the gym with a vengeance and enjoying it. Fingers crossed that continues!

Friday, 6 January 2017

Cataract surgery - the retinal detachment we weren't expecting

This is the third in a series of posts by my husband following his cataract surgery in late 2015, hopefully it will be of use or interest to someone going through the same experience. You'll find the first post, about the consultation process and the second about the operation in my sidebar.

Travelling back from my in-laws on 27th December I started to get flashes of light when I moved my eye. Due to my previous retinal detachment I knew this wasn’t good news, so early on the 28th we were in A&E at the Bristol Eye Hospital. Due to the way Christmas fell that year this was a Monday but was the Boxing Day Bank Holiday. The place was deserted of staff but quite full of patients.

When we finally got to see a doctor she looked as if it was all she could do to keep her eyes open. She looked like she was hanging. She barely looked at me, got confused about which eye she was talking about and sent me home saying she could see no problem but that I should come back in a fortnight for a review. I knew there was something wrong but what can you do.

Over the next couple of days I still had my flashes and then the ominous black shadow appeared. On New Year's Eve we were back in A&E which was thankfully better staffed. We saw a doctor (coincidentally the one who had dealt with my complaint several months earlier) who quickly issued a verdict – “Go straight to theatre, do not pass ‘go’ do not collect £200.” I had a retinal tear and detachment.

That was how I found myself on New Year's Eve lying in bed in a private room waiting for my slot on the emergency surgery list. Apparently there had been a number of emergencies come in that day so it was a full list. Between patients the surgeon came to see me to assess what he had coming through. I asked him at what point would I get bumped to the next day's list as it was too late to operate. His reply was that his theatre team weren’t going home until all the patients on the list had been seen to. For all the faults within the NHS you have to admire the dedication and professionalism of the clinical staff.

It was late, I don’t remember how late, when I was wheeled back to my room. I was lying on my right side which is a position in which I would spend most of the next few months. The operation performed consisted of sucking out the vitreous humour and replacing it with a gas bubble. They then laser around the tear to “spot weld” it back in place. The bubble will hold the retina in place whilst the blood vessels reattach hence the posturing to keep the bubble in the correct place. This was the simpler of the two options and was performed under local anaesthetic and block. My original detachment had been treated with a silicone buckle stitched to the back of my eyeball and was performed in a lengthy operation under general anaesthetic.

As an added bonus whilst they were in there they cut away the rear lens capsule thus treating my PCO in that eye. Apparently it gives better results to do this surgically rather than laser but is too invasive to do alone.

Once back in my room I had to lie face down for an hour and a half, I assume to prioritise pressure direct onto the area around the optic nerve being the most critical area to get attached securely. At this point my lovely wife went home. She had been through a lot, always by my side and now she had to get to bed. For the first time since we met we saw in the New Year separately.  Rachel was asleep and I was too until woken by the fireworks at midnight.

I woke in the morning hopeful that I was going home.  They had said I would only need to be in for one night and I wanted to escape as soon as possible. My eye had other ideas though. When they removed the patch I could see absolutely nothing. Not light and dark, not movement – nothing. The consultant couldn’t see anything either and this was potentially not good news.  I had a clot in the front of my eye that was obscuring all attempts for him to see the back of my eye and whether the surgery had been a success. Added to this the pressure in my eye was also very high. “We can’t send you home like this….” This was a real kick in the guts.
The morning after
I was now started on hourly drops for the pressures and antibiotics. Doing this from 6am to 2am meant I had very little sleep despite spending 50 minutes out of every hour lying on my right hand side. 

At 2am in Friday night / Saturday morning the nurse came in for my hourly drops to find me rocking on my bed in agony. I begged her for whatever pain relief she could give me. A dose of paracetamol as well as codeine was given and still didn’t take it away. It helped though. My pressures had gone through the roof. I don’t know what the scale is but under 10 is “normal”, 10-20 is cause for concern and I was over 30.

The next morning I started a regime of regular tablets to take the pressures down. These had an adverse effect on kidney function so now I needed daily blood tests as well. I also had an oral steroid to take the inflammation down but this attacked the stomach lining so I had a third tablet to protect my stomach. In my sleep deprived state I was starting to lose track of it all and just resigned myself to their care.

I was kept in for a few more days.  At this point the pressure had come down but they still couldn’t see into my eye and I couldn’t see out. It is very scary when they shine a light in your eye and you can’t tell. They still couldn’t tell if the operation had been a success but there was little to be gained from keeping me in so I was released back into the wild. Being at home helped my morale greatly and after a couple of days I started to see light and dark and then colours. A few more days and I had shapes and could count my fingers.  Small things become great achievements.
Our homemade drugs chart
As I started to see more I became aware of the bubble in my eye. It consumed about 90% of my eye so the interface between bubble and aqueous humour (which slowly displaces the gas) was a dark shadow across the top of my vision. As images are inverted in the eye and then corrected by the brain this was at the bottom of my eyeball.

Depressingly as my left eye vision started to improve my right eye started to deteriorate with the PCO. It's not major but it takes the clarity away.

A week after release and I was back at the hospital for a check-up. Progress, I am told, is good. They can see in and the retina looks flat. Pressures are down but the inflammation is still there along with the clot. It's now a waiting game.

The steroids I took gave me terrible indigestion but have to be reduced gradually. I hadn’t really thought about how serious a medication they were. To be honest at the time they started I was in so much pain I would have taken anything they gave me just to make it stop. Every time I decreased the dose I was taking I had terrible withdrawal symptoms. I was absolutely wiped out each time and had stomach cramps. Googling it revealed that the steroids reduce the production of adrenaline and it can take up to four weeks to start again after you stop taking them. Knowing this didn’t make me feel physically any better but it did reassure me that there wasn’t something else amiss.

The horizon in my vision gradually dropped as the gas was absorbed. It was very off-putting because when you move your eye the fluid / gas “sloshed” in your eye and the horizon breaks into waves. It can make you feel quite sick. The gas was supposed to be completely absorbed in 4-6 weeks. Six weeks after the operation I was back at the hospital for a check-up and was discharged despite still having the bubble remaining. We didn’t see the consultant and weren’t filled with confidence by the doctor we saw but I was due to see Ms Bailey again, so wasn’t too concerned.
Gas bubble in the eye means no flying
9 ½ weeks after the operation the bubble finally disappeared. The final bit went quite quickly and then one morning it was gone completely. 

Mid March I saw Ms Bailey again and was given the all clear. She performed the PCO laser on my right eye and finally discharged me. From first operation to discharge ended up being four months. From Optician referral to discharge it was thirteen months.

At the beginning of April I had my long awaited post operative eye test. I could have done it earlier but I had to wait in order to get an appointment with an optician I trusted. I’ve had so many bad eye tests over the years that I am very selective about who I see as it is a complete waste of time if they don’t do it properly.

The results were good. I was given the all clear to drive without glasses. My official distance prescription is now +0.5 in my left eye and 0.0 with slight astigmatism in my right. This is a hell of an improvement over -14 in each eye. Ms Bailey said she was aiming for slightly short sighted in each eye but that it was difficult to predict exact results. I was very pleased. My reading prescription is +1.75 mid distance and +2.25 for close reading. I was prepared for it to be in the +3-3.5 range so I was again pleased. I got some “Office” glasses which are amazing for computer use. They are a bifocal split between the mid-distance and reading prescription so I can see computer screen and papers. I also got some standard varifocals. These took a bit of getting used to and the first pair had to go back and be adjusted as the vision zones were in the wrong places and I couldn’t see anything out of them. After the adjustment they were much better. I don’t like them for reading (a book or magazine) as the reading zone is so small but for reading labels etc. they are ideal.

So roughly fifteen months after being referred I can see again and get on with my life. It would be easy to say the whole experience was unnecessarily stressful and took too long but that would be too broad a generalisation. More specifically, the administrative side of the NHS is too bureaucratic and it's an uphill struggle to get anywhere. The clinical staff from consultants and nurses to porters and caterers are a fantastic and dedicated bunch. They work hard under difficult circumstances and I think we probably take them for granted. The NHS is undoubtedly under-funded. If extra funding went straight to the front line then I would happily pay more tax to support it. However, too much is absorbed by the administrative hierarchy and more is wasted in non-critical areas.

It's easy to get annoyed and exasperated by the NHS but remember that it isn’t the nurse in front of you who is to blame. She’s doing her best to treat your ailment and make you feel better.

Friday, 30 December 2016

Cataract surgery - the operations

This is the second in a series of posts by my husband following his cataract surgery in late 2015, hopefully it will be of use or interest to someone going through the same experience. You'll find the first post, about the consultation process, in my sidebar.

It took about a month for my surgery date to come through and it was a month later, 11 November 2015. After the uphill struggle to reach this point it suddenly became very real.

On the day of the surgery I took some diazepam tablets that my GP had given me. I had been told at the first pre-op assessment that if my blood pressure was high then they wouldn’t operate. Since I have high blood pressure coupled with white coat syndrome and the added stress of surgery it was considered wise to take something to try to calm me down. As it happened all it did was give me a blinding headache and make me sleepy.

On arriving at the hospital I was shown to a waiting room with seats around the walls. It was quite small and close to the operating theatre. I would spend most of the afternoon in this room. Paperwork was checked and double checked, I had an arrow drawn on my forehead to make it obvious which eye they were operating on and then my wife was told that she would have to leave.  

Whilst I waited for my turn I chatted with the other patients. They were all a lot older than me, having the surgery at the more usual time of life. Some were in for their second eye so were able to reassure the rest of us that it was painless and quite simple. When my turn came I was put in a wheelchair and taken through to the anaesthetic room adjoining the theatre. Once you are transferred from chair to bed it's suddenly VERY real and there is no going back.

Looking back the anaesthetic and nerve block are the worst parts of the whole procedure. An injection first to nub the outside of your eye. Relatively minor but needles do freak me out a bit. The nerve block was the traumatic part. You are already anaesthetised but you can feel the pressure as they push a small tube into your eye socket and around behind your eye. It feels like its being pushed into your brain and all you can think is “Are you not there yet?” Once they reach the desired spot they use a syringe to push the nerve block into place and you feel increasing pressure in your eye socket. It seems to take an age. After everything I’ve had done to my eyes I’m fairly robust and not squeamish about eyes but this was really very unpleasant.

I have to say that the nurses appear to appreciate that you are having a really bad day and are very sympathetic. Having a total stranger hold your hand and talk about the mundane really does help.

When its time to go you are wheeled through into the theatre. Its surprisingly small in there and really quite cold. I appreciated the low temperature as its easier to cope with than being too warm in these situations.

A drape is placed over your face which has a hole in so that only the eye to be operated on is visible to the surgeon. It's adhesive and sticks to your face around your eye. At this point you can see light and dark and some vague movements with the anaesthetised eye. I asked Ms Bailey to talk to me and give me a running commentary so that I had something to concentrate on and it gave me an idea of how far through we were. She was very good and her calm voice throughout put me at ease. She asked me not to talk back to her as this would make my eye vibrate slightly which, when viewed through the microscope she was using, would make it difficult for her to be precise.

A small incision is made with a scalpel and then the old lens is removed with a small suction device which crunches up the lens as it goes. It makes a fair noise and its probably best not to dwell too much on what its doing at the time. It takes a few minutes and then the new lens it ready to go in.

There is no change in your vision as the new lens goes in as your eye is still frozen. I had a few injections of an anti-inflammatory around my eyeball as I suffer from iritis and inflammation is always a risk.

A large cotton wool pad and a hard plastic protective cover are taped on and then you are wheeled out, back to the waiting room you started in. 

I was lost as the patch arrangement made it impossible for me to put my glasses on and with a -14 prescription I couldn’t see anything without them. Fortunately, I was able to work a mobile and call my wife to collect me.

I had a large bag of drops to take home with me. There was an antibiotic drop to keep it clear of infection, a dilating drop to keep all the muscles relaxed and an anti-inflammatory to ward off the iritis. They all needed administering at different intervals so Rachel had to draw up a chart so that we wouldn’t miss any.

Next morning was the moment of truth, the big reveal. It's quite daunting that you have to do this by yourself at home. There is little concrete guidance given. You may be able to see, or it may take a while for your vision to clear. At this point how do you know if it's been a success?

We sat in the en-suite and carefully removed all of the surgical tape securing the patch to my eye. Gingerly we removed the patch. I kept my eye shut whilst Rachel bathed it with some cooled boiled water to loosen the crust of tears and blood. It wasn’t a gory mess fortunately as Rachel “doesn’t do eyes”.

When I opened my eye I was very relieved to at first see light. There is always a worry in your head that you will open your eye and just see darkness. What I could see was blurry but straight away I noticed that the colour temperature of what I was seeing was much colder. With my right eye (as yet untouched) everything had a warm yellow tinge to it compared to my new eye. What the true colour should be is anyone's guess but my new world seemed brighter.

I went back for a check-up in a week and all looked good so I was able to start tapering the drops. My vision started to noticeably improve at this point with the vision in my new eye improving steadily. It was a new experience for me to be able to see without glasses as I had been first prescribed with glasses at the age of five and been dependant on them for many years.

Waking up and being able to see without the usual fumble on the bedside table for my glasses was quite exciting. Being able to see in the shower was quite liberating. Previously everything had to remain in the same place as there was no way of me telling shampoo from conditioner from shower gel once in the shower. Now I could see, albeit at arm's length.

I had wanted to keep working as much as I could (I work from home) so I optimistically removed one lens from my old glasses so that I could theoretically see with both eyes at a distance. This really didn’t work as the images (as I had been told they would) were very different sizes and it made me feel quite sick. 
It's surprisingly difficult to buy an eye patch without resorting to a fancy dress shop
I resorted to using either my good eye with an eye patch over the other, or covering my left with a cotton wool pad when I was wearing my glasses.  I had some +1 reading glasses from before the operation that I used when wearing contact lenses. I found these worked reasonably well for computer screen distance. I also bought some +3.5 glasses off the shelf from Sainsbury’s which I could read with although they did feel a bit strong as I had to hold whatever I was reading quite close.

With a combination of  glasses I managed to get around and to work, watch TV etc. although I did decide that this was a suitable point to stop driving. I had been driving up to this point as legally you only need to be able to see out of one eye. My right eye was good so the left gave me some peripheral vision if not clarity.

I was given strict instructions not to bend over, do anything strenuous or exert myself.  Anything that might increase the pressure in my eye was outlawed and Rachel strictly enforced this. It's surprising how little you can actually do if you stick to this regime. I don’t idle well but potential blindness is enough of a motivator to ensure compliance. On the day of the first operation I was given the appointment paperwork for the second cataract operation which was four weeks later.  After a very slow start it appears that once you are in the system things move along quite quickly.
Sometimes the obvious solution is the best
On the day of the second operation I was familiar with the set up and it went as it had before. We didn’t congregate in the waiting room this time but in one of the day wards on the floor below. We had more room but this also meant that we didn’t really speak to each other.

Once upstairs the anaesthetic block seemed to take longer and be even more uncomfortable that it had the first time. In the theatre it all proceeded as it had before and I was quite relaxed. Whilst I was waiting for them to prepare the new lens, after they had removed my old one, I started to feel a bit uncomfortable. I couldn’t put my finger on it but something didn’t seem right. This feeling got worse once Ms Bailey started to put the new lens in place. I could feel her manoeuvring it. The lens goes in through a small incision folded and then has to pop back to its normal shape once its in the lens pocket. I could certainly feel her trying to get it to reshape and settle.

Conscious of the previous instructions to not say anything I gritted my teeth and was pleased when she announced that it was in and all done. As I breathed a sigh of relief Ms Bailey administered the injections of anti-inflammatory into my eyeball.

I definitely felt that and gave an involuntary jump.  She noticed and asked if I could feel it. She was concerned when I confirmed that I could and I had been feeling for some time.  Another splash of local anaesthetic and she finished the injections and bandaged me up. I never did find out if she had subsequently had a few choice words with the anaesthetist but she wasn’t too happy.
All done
I left with a now familiar bag of medication to return in a week for a check-up.

The start of drops in my right eye coincided with the end of drops in my left. Unfortunately, my left eye took this as a sign that now was an ideal time for an outbreak of uveitis.  It’s a painful auto-immune condition which leads to an inflammation of the front of your eye. It is treated with the same drops as I had had post operation so the hospital gave me yet more of these and I started a different regime of drops into my left eye. This was familiar territory though.

At my check-up everything was proceeding well except that I was developing PCO in both eyes. PCO or Posterior Capsule Opacification is where, following cataract surgery, the rear wall of the lens pocket becomes clouded. The symptoms and effects are very similar to cataracts themselves. The treatment is to use a laser to cut a hole in the rear pocket wall which is so simple an operation that it's done in clinic as an out patient.  Ms Bailey said that once the inflammation in my eyes from the surgery and uveitis had settled she would do this before discharging me. So, I went into the Christmas holiday optimistic that the worst was behind me. How wrong I was.

The next post in the series will be up next Friday and will cover what happened next...