It’s about quality of life

As hinted at in my previous post, after a couple of nasty infections, my dad’s in his final days.

At the time of writing he’s being made comfortable. He’s not in any pain and he doesn’t really have the strength or inclination to eat or drink, other than a couple of spoons of mashed up weetabix he had yesterday and enough water to keep his mouth and throat from drying up. He barely has the strength to lift his head or even open his eyes.

This doesn’t mean he’s asleep though. I was talking to a doctor by the foot of his hospital bed earlier in the week and I’d mentioned my MS in passing. The doctor had started telling me about a disease modifying drug he’d read about in the BMJ: “Ock… Ockra…”

“Ocrelizumab?” I ventured.

He looked surprised, “Yeah – that’s it.”

Having MS sure makes you do your homework.

For some reason, my dad chose this moment to lift his head and eye us suspiciously; he lifted his right hand like an imaginary gun and shot me twice before nodding back off.

Good old Dad, he’s had a long life, he has never done any harm to anyone  and he still has a sense of humour.

Now, I’ll lay my cards on the table: I’m an atheist. Plenty of people have tried to convince me otherwise: evangelists, jehovah’s witnesses, you name it, but it’s like water off a duck’s back to me now. I’ve considered the evidence and I’d say I was solid in my (non-) belief. It’s not like I can say I wasn’t taken to church as a kid or anything. I’ve done it all. I’m even a Sunday school drop-out.

It comes from having a vicar as a dad.

I lived in vicarages for the duration of my childhood until I was within grasping distance of my teenage years, and then we moved into my gran’s old house and that’s where we settled.

Dad gained a job as the first full-time chaplain in the newly built local hospital, building the role up from scratch.

I don’t meet that many people who remember him in this role as it was a long time ago. The ones that I do, however, always take pains to tell me what a lovely man he was and how he had time for absolutely everyone.

He really found his vocation in life, and made it his mission to keep his finger on the pulse of all the staff as well as the patients.

Whether it was meeting or sharing jokes with the cleaners (or the ‘pink panthers’ as he called them, due to their pink uniforms), the consultants, or the mortician (who memorably tried to get the measure of my dad by inviting him to a post-mortem, expressing surprise that he hadn’t fainted during the experience), he listened to them all, and he let them all unburden their stresses, complaints, fears and sorrows onto his shoulders.

He respected no social hierarchy. We were all human. We were all made equal. We were all loved.

I remember him telling me that he’d been to see a patient who’d listed wicca as their religion. I’d expressed surprise that he’d been to see someone who wasn’t a christian. He put me right – it didn’t matter what your religion or lack of religion was, we all need someone to listen to us and that was why he was there.

When I was diagnosed with MS, I had, and still largely do have, a light-hearted attitude towards the disease and everything it throws at me. I guess it’s my way of dealing with it. No matter how breezily I’d mention anything to do with it to Dad, he’d always take me off-guard by stopping whatever he was doing, removing  his glasses and giving me his full attention.

He was retired medically in the early ’90s. A dodgy ticker wasn’t being helped by the stress of his job. He’d had pressure from management at the tail-end of the Thatcher years. He said they sat in offices away from the rest of the hospital and their main concern seemed to be balancing budgets above all else. He felt that his was a role that had no empirical value in their eyes, though I’m pretty sure one or two of the senior management team sought him out when they eventually needed him.

I also remember that he’d found it especially hard dealing with stillbirths and bereaved parents at a time when he’d become a grandfather for the first time.

Years of happy retirement followed in which he became a devoted grandfather to 6 and, in the last year (to his enormous glee), a great-grandfather. When my mum (who was born into a typical methodist mining family) died 12 years ago, on her encouragement, he ‘crossed the Tiber,’ and joined his friends in the Roman Catholic church. This was a move that eventually and inevitably led to him achieving ordination as a catholic priest, teaming up with an old hospital colleague at a church in a working class suburb of town. He retired for a second time only a handful of years ago.

Despite being a non-believer, my upbringing means I’ve always found it very familiar and easy to talk to clergy. Thinking about his last rites, I’d mentioned to my dad that I was going to talk to a priest, and in a feeble whisper he told me it wasn’t necessary. His short term memory had already been blown to pieces by his recent illness, so I assumed it was similar to him telling me about self administering his own communion after his second retirement, but no – the priesthood had been there already.

“He’s all signed off, the Monsignor came to see him… let me see… ten days ago,” the local Dean informed me at the end of the phone, and then in a beautiful turn-of-phrase that made me choke back the tears, “he’s had his passport stamped, and he’s ready to fly.”

It must be a phrase that my dad is familiar with because when I told him I’d heard his passport was stamped, he managed a smile. Then following the Dean’s advice to give reassurance that it was OK to go, and for him not to worry about who or what he might be leaving behind, I added “when they call your flight number, just go for it Dad, just pick up your bags and go straight to the gate, OK?”

“OK” came the whispered reply.

He’s back in his care home now. The hospital where he’d worked has done everything they can for him, and he’s now being treated by nursing staff who visit daily and the lovely living saint who is his main carer. It’s a surrounding that he’s familiar with, that doesn’t involve beeping equipment, the groans of other patients, the pink panthers with their mops and brushes, or having his blood pressure checked at regular intervals. He can be lulled to sleep again by the night trains rattling past to destinations unknown on the nearby railway, something he’s loved for the past couple of years.

The future and the wellbeing of the planet has always seemed to me to be on a knife edge with global warming, the ongoing mass extinction event that is the human race, and now the era of Brexit, Trump and the rise of populism across Europe. Dad’s left such a legacy to be proud of, he has touched so many people’s lives, and we need more people like him. More people to redress the balance of an off-kilter world. More people to heal the human spirit.

It’s about quality of life after all.

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Yes – I was a porker of a baby and I remember that monkey

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Pass the parcel

A week or so ago, I stood at the end of my elderly dad’s hospital bed while he squinted at me and asked “Daddy?”

Just a couple of hours earlier, he’d been rushed from his care home with pneumonia and possible sepsis, and ‘conscious’ moments like this were fleeting and rare. A few days previously, he’d been wide awake, taking several attempts to record a wedding message for my niece. While my eldest daughter held up her iPhone, he amiably stumbled over the details. He managed it more-or-less in the end, with many a chuckle between takes.

I didn’t know either of his parents; both of them had lost their lives in the years before my birth. With my dad’s milky blue eyes struggling to focus on me, I suddenly recalled a photograph from the 1930s of my grandad playing with his son – his only child – in the sand of a Suffolk beach. It felt like he was in the room – a presence handing Dad over in a game of familial pass-the-parcel, saying “Here you go: We brought him into this world, you’re seeing him out.”

Since then, my dad’s rallied a bit. He’s responded well to antibiotics and he’s been moved into a ward with other semi-conscious old men. It’s still early days and he still has a mountain to climb. Whether that climb has an end point that involves falling off a cliff or dozing in front of daytime TV with his care home cohort remains to be seen but the latter’s looking more likely now.

All in all, Dad’s bucked the trend. His parents died in their 60s and he’s overcome a history of high blood pressure, heart problems, and more recently, diabetes and Parkinsons, to come within grasping distance of his 90s.

When he was my age, he was fit and healthy, a former cross country runner, and a fairly active dad with no apparent sign of the health problems to come. Of course, I can see the many parallels between the pair of us already – we both have a compromised neurology after all.

I know any straight comparisons between us will involve lots of negatives for me in terms of balance and mobility, dependence on catheters (a sure fire way to bring microbes on board), a now thankfully distant history of cigarette smoking (including the odd dodgy one), a desk job and the lack of exercise that comes with it, and the timebomb that is antibiotic resistance. I’m not 100% sure how my pescatarian diet and the fact that I have only a dash of semi skimmed in my tea and low fat marg on my toast offsets all that, but it might be high time for me to knuckle down and set about safeguarding my future.

It’s just that right now it’s impossible for me not to imagine a day when I might confuse my daughter for my mum.img065

Let’s get physio.

Here’s a video showing a typical minute in the life of my calf muscles.

Yesterday I added to my Panini sticker book of health professionals by seeing a neurophysiotherapist for the first time. It was mainly about leg pain and my twitchy calves, but also about my general clumsiness, fatigue and my general state of affairs.

My fasciculating legs are a remnant, along with my doublevision, of my last BIG relapse in 2008. While other symptoms have fallen by the wayside or make occasional quick unannounced visits like an unwelcome relative (I’m talking about you, vertigo), my painful legs have been a problem for the last decade. I’m not saying the twitches are painful in themselves, but there’s a correlation: the more painful my legs are, the twitchier they’ll be.

I reckon seeing a physio is one of the best healthcare experiences you can have, as it’s pretty hands-on. It’s just nice to hold someone’s hand, even if they are jerking your arm around. I had my balance, my range of movement, my reflexes, and what sensations I was (or wasn’t) feeling assessed. Most importantly, I got to talk everything out, relaying everything I’ve been through from day one, to someone who genuinely listened.

It also helped me get my head round things. I’ve been using the word ‘pain’ as a box ticking exercise; it’s a convenient way to describe an unpleasant sensation, but it’s not pain in a conventional sense. If it was the pain of a headache, burn, tooth or even a bad back, I could rationalise it, no matter how intolerable – my pain threshold is pretty high (ask my dentist).

This is the pain of extreme discomfort; the pain of an itch you can’t scratch or the ache of an amputee’s phantom limb. At its worst, it’s torture.

I was asked to describe the way my legs feel, and after thinking for a while, I said they feel charged; they have an electricity about them. I’m pretty sure if I listened carefully enough I’d hear the crackle of static or the hum of an overhead power-line. If they wake me up in the night, the charge builds up over a period of about 20 or 30 seconds before discharging in a spasm. Only one leg at a time will be a problem. If I gently touch the sole of my foot or my calf muscle when they’re at their most sensitive, they’ll recoil in a hyper-reflexive instant.

Again, I thank my lucky stars for MS nurses because it’s only this year when I mentioned my legs in one of my nurse appointments that anyone has taken them seriously. Even my neurologist has dismissed them in the past as a twitch that everyone gets (really?) just like a twitching eyelid.

At least now I can take baclofen a couple of hours before I go to sleep and combine these with stretches and exercises to ease my way into the land of nod. I also have a series of follow up appointments with the physio to look forward to.

Post script:

After writing the above, a mildly arthritic big toe joint has decided to flare up. This is causing me no end of agony from the attached leg alone. When I saw the physio, it was after a fairly comfortable morning of working from home, so typically, I couldn’t demonstrate the worst case scenario. Today’s a different matter, it’s like my whole leg from the knee down is on fire. My reflexes are kicking in every time my foot touches something, making it pretty hard to walk. I’ve taken my baclofen early, and I’m taking ordinary painkillers for the toe, so fingers crossed I’ll get some sleep, but I’m not holding out too much hope.

Feeling the heat

Well, last week was a scorcher.

So much so, that I gave up on Fathers’ Day activities halfway through the afternoon and went to bed for a bit. The following day, I dressed for work, drove my youngest to school, and then turned round and headed back home I felt so rough.

Again, I had an hour’s kip during the afternoon. After this I felt brave enough to step outside into our south-facing garden with some crazy idea about hanging out some washing.

Stepping out of the back door, I felt sure, was pretty similar to stepping off an aircraft in Saudi Arabia.

I turned round and went back in.

I felt so fatigued, dizzy and achey that I even Googled to see if I’d given myself cyanide poisoning. I’d made elderflower cordial, and elderflower and gooseberry jam a day or two previously and the stems apparently contain cyanide (in the same sort of way that apple pips do).

To a paranoid, heat-addled, MS-scarred brain like mine, it’s pretty amazing how similar the symptoms of MS and elderflower-induced cyanide poisoning are.

Tuesday, I was pretty much right as rain, so I ventured back to the office knowing that I could leave any time I needed to, and on Wednesday I’d booked a day off anyway to attend school sports day.

My youngest daughter’s school sports day involves a lot of standing up and moving from one event to another. The weather reports said partial cloud.

After two and a half hours of hanging around in full burning sunshine, I ventured back to my car that I’d helpfully parked about a mile away.

It was then that I found it was incredibly hard to walk in any meaningful foot-in-front-of-the-other kind of way. As I was the first one out of the school gates, I wondered what the other parents thought of my stumbling feet; feet that felt like they were made from bags of sand, and legs that felt like they were wading rather than walking.

At least I’d had the forethought of deliberately parking somewhere shady. Slumping into the driver’s seat, I allowed myself a rare emotional moment – probably no more than a few seconds, but enough to release the weight of what I’d bottled up – before turning the key in the ignition and just getting on with the rest of the day.

When I eventually got home there was a letter from Big City Hospital waiting for me. It was my neurologist to say the results of my recent MRI were back. It showed new lesions, apparently.

Now here’s the interesting thing – my neuro’s exact words look designed to set my mind at rest: ‘a small number of small new lesions compared to the scan of three years ago’. For someone who proof reads as part of their job, the use of the word ‘small’ twice in the same sentence stuck out like a luminously sun burned neck. The scan of three years ago that he mentioned had itself shown no new activity since the previous scan when I was first diagnosed, so these are the first new lesions on a brain scan of mine in nine years.

Anyway, my neurologist didn’t think this ‘necessarily need prompt a change in treatment’, but he’s asked that I come in to see him anyway ‘to discuss’.

Hmmm… all well and good if I’m being summoned to ask questions and set my mind at rest, but there’s also a little part of me that feels a little worried.

Just keep swimming

Well, I’ve just returned from a family holiday to Florida. It was 90% Disney just like the last time we went. Both my wife and my youngest are big Star Wars fans, so my youngest had a light sabre battle with Darth Vader and my wife got a hug from Chewbacca among the many highlights. If anything, it was just nice to have a fortnight away in 40 degree heat.

The return trip was a bit arduous though as it involved a faulty aircraft and a four hour wait on the tarmac in Philadelphia.

Phew!

Needless to say, sitting in such cramped quarters for such a long time while the captain repeatedly switched the plane off and then on again, is not good for me and my MS. I don’t sleep on flights anyway, I find it impossible, and for the six hours after the 2am take-off I think it’s fair to say I suffered a bit.

Anyway – I now know the following:

  • I like warm / hot weather. I’ve been suspecting this on previous holidays but now it’s official. A few years ago I would’ve said the opposite, but it’s far more pleasant to take it easy and carry around a t-shirt, shorts and sandals than jeans, coat, pullover etc. I feel much better for it.
  • Disabled loos in the places we visited seem to be an add-on to the existing gents as extra wide cubicles. This means that even if you feel justified using them they’ll be used by the general public anyway if the others are engaged. There doesn’t seem to be the same stigma around non-disabled usage as at home.
  • How to swim.

So there you go, all things I . . . hold on a minute – what was the last one again?

Yes, that’s right, I’m so proud of my older teenaged daughter, who succeeded where so many have failed, by patiently and good naturedly curing me of my 45 year deep-seated phobia of water and swimming pools. I’ve faced up to some pretty scary things in life both generally and (especially) as an MS patient, but my fear of swimming is right up there.

“Think back to the dawn of time and of all the millions of people who have ever died. How many of them drowned in a swimming pool?” she smiled as she persuaded me to doggy paddle a handful of metres to the edge of our villa’s pool.

Without batting an eyelid she skillfully turned me from someone who panicked each time I slightly lost my balance into someone swimming the backstroke, breast-stroke and even the crawl (with my head underwater the length of the pool), within an hour.

I ended up tiring myself out making up for lost time. Every day afterwards I gave myself a big grin by double-checking that I hadn’t forgotten how to do it.

The next step, I feel, is working out how to breathe and swim at the same time, so I might be looking at taking extra lessons now that I’m back in Blighty.

The thing that amazes me though, is how easy it was to take that extra step and stop panicking. Once I realised how I naturally float, I was away. I did the starfish float, I tried to get my bum to touch the floor of the pool and failed, I even held my breath and tucked my knees into my chest and let myself roll in the water.

Why on earth didn’t I do all this years ago?

Also when I mention it to others, I find that most people I know haven’t really made it to the next rung of the ladder. I suddenly seem to be in the middle of a sea of people who aren’t that proficient at swimming. When I jokingly mentioned the fact that I like swimming backstroke because I can actually breathe, a workmate agreed and said in the event of a ship going down he’d backstroke to the lifeboat for that very reason.

Is it difficult to progress as a swimmer, then? Is it because most people don’t swim regularly enough to have built up a stamina for it? All these years I’ve been labouring under the misapprehension that everyone is as good as Ellie Simmonds or Steph Millward albeit a good deal slower.

Of course, my daughter and all her friends haven’t reached a lifetime of apathy yet, so they’re all fantastic swimmers apparently.

So why have I spent a lifetime as a non swimmer? Well, I mainly blame moving house from Manchester to the rural redneck backwater of East Anglia for a few years as a kid; my crippling shyness at the time, coupled with an inexperience of swimming pools, particularly freezing open air school ones and the fact that goggles didn’t seem to have been invented in the late 70s / early 80s. Also, the lack of encouragement from teachers and parents.

Various family members did attempt to teach me to swim, but they tried to do so while up to their chest in the balmy sub-tropical waters of the North Sea. Claiming, while I steadfastly kept my arms crossed and my feet anchored to a pebbly beach, that their sadistic dads and uncles did the same to them so why wouldn’t it work with me? Or they’ve dangled the ten-year-old me by the ankles off the ends of piers for fun – memories I’ve obviously repressed until now.

Even as a teenager, I pulled an outstretched hand (and the fully track-suited swimming teacher attached to it) into the deep end of the school pool after thrashing around in a panic when a float torpedoed from my slippery grasp.

If I can keep on swimming in an environment I’m comfortable with, it could be just the exercise I need. The local MS Society branch have a pool meet-up one evening a week in a special school within walking distance. Here they obviously have hoists and the like for those with mobility issues but also a nice warm pool. So I might explore that option if it’s suitable. Also, the local authority where I live have nice friendly looking teachers who do group and one-on-one sessions for adults.

Until then I’m looking forward to my next holiday – camping in Cornwall – and yes, I’ve made sure there’s a pool.

Carbon brainprint

I’m quite happy with the fact that, as a family of four (six if you include Fluffles and Fudge our guinea pigs), we’re pretty good at recycling. Our youngest even has the job title of Recycling Officer to encourage her to weed out things that could be added to our recyclable waste.

On top of the fortnightly ‘black bin’ collection, there’s a fortnightly ‘blue bin’ collection for the usual recyclable materials and a ‘green bin’ collection for garden waste, which includes guinea pig bedding and poop.

I also have an allotment, so a lot of raw vegetable kitchen waste and cardboard gets added to a caddy and taken to the compost heap. I re-use our jam jars for my home made jams (rhubarb jam currently in production), before they’re added to the glass recycling.

Every regular black bin collection day, our landfill waste fills only about half a bin, which I think is not bad for a family of four (six).

It pains me, therefore, at the amount of waste having MS generates.

On the bladder front, I use approximately six catheters a day which come in individual hard-plastic screw-top sheaths. These need disposing of, and to do this I have some black granny-scented ‘nappy sacks’, there’s also associated wet wipes and hand gel. The only things I can recycle here are the info leaflets, the plastic bottles the hand gel comes in and the cardboard box that contains the catheters. Also the larger cardboard box and brown paper packing that the cardboard boxes are packed in when they’re delivered. The majority goes to landfill.

Medication-wise, I’m currently injecting Copaxone seven days a week. The syringes are supplied in plastic cases with peelable seals. The seal is somewhere halfway between plastic and paper and is (as far as I know) unrecyclable, so gets sent to landfill. The plastic cases are pretty much the same plastic that supermarkets use for fruit and the like, so they can go in the blue bin, as can the cardboard box the syringes get supplied in and the cardboard box the cardboard box comes in, when it’s dropped off at my GP surgery every month. Although, there’s that many luminous “chillcare” labels and cellophane invoice wrappers attached to this box, I’m unsure how much I’m contaminating the recycling with this when I dispose of it.

Of course, once I’ve done with them, the syringes are popped into a yellow, plastic sharps bin, that I drop off at the GP when it’s full and ask for them to dispose of as medical waste.

The company that supplies my Copaxone, rings me once a month to arrange delivery. Each time they ring I have to make a conscious effort to remember to ask them not to supply a new sharps bin as each one can last several months until full. If I don’t, they supply a new one by default.

Last month I forgot to ask and a new unnecessary one arrived. I’ve added this to what I consider to be my ‘accidental backlog’ because the GP surgery won’t take it and neither will the pharmacy over the road (I’ve asked) and I can’t contemplate chucking it in the bin.

So that’s sharps bins full of used syringes and approximately half a metric tonne of used catheter waste in bags and any other associated medication packs (inter-Botox solifenacin blister packs, for example) either going straight to an incinerator or landfill because of my MS.

So how is all this offset?

The only thing I can think of is that every now and then I work from home as a necessary adjustment, saving 20 miles worth of petrol each time, and the Botox injections have cut down the catheter waste and toilet flushes considerably. Other than that I’m struggling a bit, so I’ll just have to concede that these things are unavoidable and make a concerted effort to reduce waste further in every other aspect of life.

Friendly fire

I think it’s fair to say that I think about my MS every hour of every day.

While I don’t like for it to define me in any way, you can’t help it sometimes. I leave work every day at 3pm, for instance, and apart from a colleague with ME, and another who’s not quite in remission yet from cancer, everyone else in the office works till 5.

But I’ll always be surrounded by a cloud of symptoms, invisible to everyone except me. I still have the diplopia gifted to me by my 2008 relapse and a little noise creeping into my vision courtesy of a scarred optic nerve. I get swimmingly dizzy doing up my shoelaces sometimes and goodness knows why there aren’t bruises peppering my elbows and knees, the number of times I’ve walked into walls and the like.

Last night I woke up at 5am and decided I wouldn’t be able to go back to sleep unless I went to the loo. This turned out to be a bit of a palaver, mainly due to the fact that our bedroom is cluttered with suitcases and holiday packing ready for two weeks in Florida from this weekend. Added to this and the general grogginess of sleep is that I get some spasticity in my arms and legs when I get up and my balance is not the greatest it’s ever been.

So I did quite well to get to the bathroom and back unscathed.

Last night I dropped back off to sleep straight away. What happened next I blame on a vasterbottensost cheese and malt whisky nightcap. I slept soundly and deeply, but dreaming that I could no longer walk and needed a wheelchair to get about and a stairlift to get upstairs.

It seems that my under fire neurology is now targeting my unconscious life. I’ve always been free of MS in my dreams until now.