Payback time

Wales's regional lock-down started this evening, not that it makes as much difference to us as will the even stricter self-isolation I'll have to endure for two weeks before the operation (if it happens). We're well prepared, thanks to Clare's superb household management skills. Even so, there were a few things which I needed, plus some extra fruit, which took me out twice on shopping errands today.

After my first outing to the shops, I called in to the GP surgery for a blood pressure check. It was very high when I arrived as I'd been walking briskly, but soon settled down to just above normal. This is a great relief. Slowly, I believe I'm shaking of the chronic stress I have lived with, and am getting closer to finding a level of supplementary Doxazosin dosage that doesn't leave me feeling light headed and faint for much of the day. Clare's herb teas, foot massages and Reiki have all made a difference too. I've not taken my own blood pressure for months because the abnormally high level was worrying me too much, and probably helping to make things worse. 

Emma has asked me to do another week's worth of reflections to publish daily on the Parish Facebook page in a month's time. So nice to be asked again.

I did an hour's work on the novel before cooking lunch. I wish I could put in several hours a day, but if I sit for too long this has dire consequences for my wound which tends to break open, no matter what I do to avoid this happening. It's tiring, standing up to write for the length of time I need to, if I'm to make progress in finishing the job, and there are only a few places where I can perch a computer at a suitably ergonomic height to make it easy to type. Two days ago I spent an hour cutting up crab apples prior to cooking them. I expected my wrist to give me trouble yesterday, but surprisingly it didn't. After working at the computer using a mouse today, it was payback time. Now my left wrist hurts, no matter what I rub into it. Serves me right for overdoing it I suppose. I'll stop here for today.

Unfamiliar Lieder

A brief visit to the GP surgery this morning for a blood pressure check. Yet again in the surgery it raises a frown. When I get home, and sit comfortably in an armchair, the readings average out close to the desired norm. Chairs in the surgery have hard surfaces, and without cushion support, pressure on my perineum causes pain. The discomfort leads me to tense my thigh muscles to reduce this. It isn't even the fabled 'white coat syndrome' many people reportedly suffer from in a clinical setting. You'd think the diagnostic process would be attuned to this kind of issue by now. I believe It's only around a century since this was introduced into regular medical practise.

Clare went out early to the University Optometry School that she visits as a glaucoma patient. She volunteers there to be examined by student trainees for a few hours. We met afterwards at the Royal Welsh College of Music and Drama for lunch and then a recital of two dozen German Lieder sung by a group of a dozen students working with half a dozen accompanists. It was superbly executed, with some remarkable young voices in performance, and challenging accompaniments from masters of the genre, Schubert, Schumann, Brahms, Mendelssohn. Almost all were unfamiliar, but well chosen for their variety and beauty. Several songs were composed by Clara Schumann and by Fanny Mendelssohn. Their works are gaining recognition nowadays, having been attributed to the men in their lives for the past two centuries.

We then walked into the city centre aiming for our habitual tea and cake in John Lewis', but having got up early, for several days in a row, I ran out of the surplus energy needed to inhabit shops, and headed for home on the 61 bus instead, to lie low for the rest of the day. I'm having to avoid pushing myself to exhaustion these days. Open unhealed wounds drain one's energy reserves, like recovering from surgery, so they say. It's the Feast of St Paul's Conversion today, I was too tired to trek over to St Luke's for the evening Mass, and disappointed about that.

    

Not the date I hoped for

I went to the GP surgery this morning to have my blood pressure checked. It was high enough to put a frown on the nurse's face. I'm not surprised, and expect this to continue until I have recovered from the operation to come. It's always lower at home. As I have plenty of time, I take a series of readings and record the average. Displayed on a chart this data has the form of a classic hockey-stick curve. The first few readings are high, then they decrease and level out. Whether I include the first few or rule them out, the average is lower than the few readings a practice nurse has time to take. 

High readings are often explained away as due to 'white coat syndrome', the stress being in a surgery. I believe it's the poor quality of medical observation which gives only an impression of a person's condition. It's amazing to think what statistical conclusions are drawn by epidemiologists on the basis of such data reports. 

Medics acknowledge that a person's blood pressure varies according to environment and activity level. The way in which it is measured is bound to be a factor, and individuals will vary in response to having an inflatable cuff on an arm, which unintentionally produces discomfort and pain which impacts on the blood pressure reported. This is why I favour taking a series of readings over a period of time, whether over a day or in succession over half an hour, and then averaging them. For me the critical issue is how cope until the operation is done, without blood pressure putting me at risk.

Today the surgical team is meeting to plan operations and mine is on the list. I called the colorectal surgery unit to find out if a date had been arranged. My concern was that if it's early next week, as I'd hoped, the appointment letter might arrive after the date. This has already happened to me once recently, a result of the bizarre mail out practice of the Local Health Board. Mail from UHW Heath goes to Llandough Hospital before it's dispatched, and sending something on a Friday may mean the letter doesn't reach the sorting office until the following Tuesday. GP surgeries can and do use SMS and email to inform patients and remind them of appointments, but not hospitals. It's crazy!

Anyway, I spoke to one of the surgical consultants' secretaries, who was able to find information on my case. A letter had been prepared for sending, which she read to me. I was shocked at first to hear that surgery had been booked for 17th July next year, and expressed my incredulity and distress. On a second reading it turned out I had misheard her. The date is 17th January, more than a month from now. Any hopes I had of having this cleared up before Christmas were dashed. I just have to keep on coping and hope that my general health doesn't deteriorate in the meanwhile.

At least I know where I stand, at last, three months after my return from Montreux.

  

Pane-ful surprise

The past few days have sped by, occupied with office and shopping visits plus another visit on Tuesday from Clive Powell of double glazing specialists Secura Windows, who upgraded our house eleven years ago. New house insurance terms and conditions are insisting on higher specification front door security. The only way it can be achieved is installing a new door. The trade catalogue presents a bewildering array of styles, furnishing and glazing. Settling on an overall choice wasn't too difficult, as ever the devil is in the detail, getting a glazing design we think we can live with. It took a couple of days until we were both satisfied. Clive is very patient.

I made a phone call during his visit from the middle room, and turning around to face the window as I talked, noticed a jagged diagonal crack from top to bottom of the inner double glazed panel opposite. Such a strange co-incidence! Both Clare and I recalled hearing a sharp cracking sound, like a stone or a bird beak on a window, shortly before Clive arrived, but neither of us thought to investigate at the time, thinking it came from outside, from a neighbour's house. Clive said he'd come across this before in cold weather, though not very often. We were at least able to order a replacement there and then, knowing that he'd have the original information in his filing system from eleven years ago when the job was done.

Thursday morning a visit to the GP surgery for a blood pressure check, leading to an increase in dosage of the supplementary medication I was given last week, as it seems to have had no impact at all. The pharmacist said that getting a suitably effective dosage was still a matter of trial and error as every individual responds in different ways. Different physical constitution, metabolism, diet, environment, all play their part. It's amusing really.

   

Holy Week Monday

Having previously missed out on getting a 'book on the day' GP appointment by telephoning for one at eight o'clock, I walked to the surgery and waited for the doors to open, to get a 10.00am slot, to learn about findings from what was, in my opinion, an unsatisfactory 24 hours spent with a blood pressure monitoring device, during which it made many more efforts to take readings at odd times when it wasn't programmed to. 

After breakfast I returned to meet another doctor, not the one who'd commissioned the use of the device, and got the usual lecture about my systolic reading being too high, which I knew anyway, as it's been like that for years. He urged me to accept extra medication to treat the condition 'aggressively' to get that reading down, to avoid a fatal stroke or heart attack, and was evidently displeased when I questioned the value of the readings provided by the device.

I was surprised to learn that I've been on blood pressure medication for eleven years, since that fateful year when the closure of St James' Tredegarville church became inevitable, and I was left to pick up all the piece and dispose of the contents prior to sale, one of the most stressful times of my entire life. 

In all those years, I have never had chest pains, headaches, seizures of any kind, nor dizzy spells, nor the kind of physical symptoms associated with so called 'mini-strokes', only an occasional nose bleed. One or two early hypertension drug trials, not to mention statins did give me unpleasant side effects, and I had to insist on trying something else instead. I know my blood pressure is high, and have done everything I can to get it down naturally, weight loss, alcohol reduction, diet and exercise, relaxation. Little has changed. I'm a decade older, and blood pressure tends to go up anyway as you get older. You can't win. Nosotros somos todos mortales, like it or not. So why the big worry? 

The contemporary epidemic of longevity is resulting in a major medical, social and economic crisis. Doctors furrow their brows and write notes about problem patients no doubt, if you challenge their world view that more must to be done to prolong lives drawing to a close. Can they cope with the idea that life is a gift to be cherished and eventually relinquished naturally, not a mechanism to be maintained as long as possible? 

To be fair, it's not a digital equation. A stroke or a coronary, even if untreated may not end life but prolong it, with lengthy and expensive treatment and years of infirmity. So, reducing the risk is reducing the medical bill, maybe. The statistics are very complex, so risks and costs will, in any case vary, from person to person. Having a decent conversation about this range of issues with medics working hard to deliver a service in limited time slots is impossible. At least I can debate with myself in this blog.

Anyway, I conceded to a month's trial of a supplementary medication before I next leave for Spain, to get some idea if I'd have adverse reactions to the drug, before leaving the country. Our local pharmacy is opposite the surgery now, so I submitted the prescription immediately and had a interesting and quite reassuring conversation with the pharmacist. He's engaged on a research project into hypertension medication, and needed an opportunity to discuss with me the drugs I've taken for the past decade, as I'm a regular customer. Now it's a question of getting on with the new regime of pills, and seeing whether or not it makes any difference.

Meanwhile, back on the streets, I collected forty four items of litter walking to the surgery and back. The haul included several beer glasses carried away by drinkers and dumped some distance from the pub in question. Considering I walked the same route to church at eight o'clock yesterday collecting just ten items, the increase represents mainly Sunday leisure time consumption. Later I went to Pontcanna Fields, and collected a staggering eighty one pieces of litter, mostly from one large football pitch area. One particularly telling indication of the culprits was a line of half a dozen Lucozade Sports energy drinks just behind one pitch touchline, plus the plastic packaging which had held bottles together prior to sale. I try to avoid feelings of outrage at this defilement of public space by careless self-centred people whatever their age. I just feel a lot better when I can rest my eyes on a cleaned up sea of green.

At the end of the morning I had a call from Ashley to take him to Chepstow again, as a follow up from last Friday's visit. I picked him up from the CBS office with another batch of radios for inspection, and we went there and back again in three hours. Getting home from the office took far longer than I would normally expect. Traffic going out of two at four thirty was very slow moving. After an early supper I set off across town again for the evening Mass at St German's, and thankfully the roads were clearer and traffic was free flowing again. There were half a dozen of us at worship, and once more, I enjoyed expounding the scriptural texts freely and spontaneously, rather than preaching a prepared homily. It's not because I didn't have time to write one, but more that I wanted to explore spending time on the texts in situ with a small group of faithful people I know quite well. Will it make a difference?

    

Health check

This morning I visited my GP surgery for the periodic hypertension medication review which they do to keep an eye on my general health. The nurse weighs me takes a blood sample (usually with difficulty) and my blood pressure, which is always higher than when I take it at home. It may be my home machine is not as sensitive as the surgery's state of the art kit. The blood tests monitors for sugar, cholesterol and liver function. I learned recently that the latter is checked to see if prescribed medication is having side effects from long term use, over eight years in my case. So far so good.

Sugar is usually low as I consume little sweet stuff by choice of habit. This, plus changes in diet have led to weight loss, although exactly how much is hard to say, as I'm weighed with variable amounts of clothes on at each visit, and if I didn't insist on taking them off, shoes also. I check without clothes at home, to satisfy myself of progress. Now it seems I'm only 'slightly overweight'. I've noticed recently my blood pressure has been higher than usual, so this showed up as worryingly high in the surgery and that means a visit to the doctor before I go away. It's become an annual ritual, and has resulted in no change of medication so far. By the time I see him, it is unlikely to be quite as high. In fact, it dropped during the day, almost back to normal. 

Recently I've had a little 'grumbling' from small kidney stones, detected several years ago. They move a little, and for a while I am left feeling thick headed, as toxins don't filter out of the blood quite as efficiently, and my blood pressure goes up. Once the 'grumbling' stops, the blood pressure returns to normal and thick headedness goes away.  I've had no kidney discomfort all day, and my blood pressure is nearly what it should be, according to UK medical opinon. Not quite so bad if you're under a GP on the Continent, where slightly higher seems to be the accepted norm. Anyway, the more water I drink and regular exercise I get, things return to normal fairly quickly. I'm fitter now than for a long time, due to the amount of walking I do in Spain. I walk somewhat less here than I do there. A bad habit I need to break, a bad habit dependent on the weather, sad to say. I am most fortunate to be as fit and well as I mostly am, and as well as being grateful, I need to be sure to make the effort, at all times and seasons.

End of the afternoon, I went over to the University Optometry school and collected my first pair of prescription reading glasses for use with a computer. While I was n Spain I began to notice that in high contrast light situations my eyes were reacting unusually. I was seeing everything in what I can only describe as dappled light, as one ordinarily might experience looking at a river in sunlight. It was quite disconcerting at first, but I found that wearing my driving glasses helped. I discussed this with one of the team who said that it might be a consequence of too much computer screen time. They emit an extra amount of light at the blue end of the spectrum which strains they eyes. But, why recently and not years ago when I spent much more time working on computers? Then it occurred to me that in the past year, the three devices I most use all have brighter high resolution screens. Just working with the new specs for this evening had shown the difference they make.  

Work on the chimney stack removal slowed down during the second week, as only a few small jobs remained, like repairing the rendering immediately below the end ridge tile, where the stack had protruded, and sealing places where redundant flue outlets had been removed. The end ridge tile is a different colour and slightly smaller. It's made to metric rather than imperial measure standards, and the older matching ones are getting harder to find. It makes little difference, but it's part of the nearly 120 year old story of the house now.

Vibration from demolition work has opened new cracks in the rendering on our side, and caused some parting of rendered surface from brickwork. The wall surfaces are old,cracks may have been patched in its lifetime, perhaps as long as our lifetimes. The grey cement surface has never been painted. We've decided to see how well it withstands damp ingress over the winter, and then consider full repair and painting in white next spring. That'll help reflect more light into Clare's lovely green space.

This week the original cast iron guttering on our side will be replaced, depending on weather and workers. We've been told the end of August is a high demand time for days off in the building trade. 

  

Review of life

A quick visit to the doctor this morning for my annual 'hypertension review' which, I suppose, is to check if my condition has changed and if the medication is still doing its job. Some time ago, using a blood pressure measuring device at home, I discovered that the first few readings were invariably high., and then it levelled off. Whenever I went for a checkup at the surgery, the result of their measurements was generally similar, causing furrowed brows of concern, and another visit to schedule. Over the past year I have shed excess weight and changed eating and drinking habits, perhaps as a result of spending four months in Mediterranean lands. When you feel really well and fairly fit, what's to worry about? 

After my previous visit I indulged in a spell of obsessive behaviour and took my BP twice daily, before during and after our holiday in Pembrokeshire, taking readings multiple times and averaging them out after eliminating the highest and lowest pair, each time. I was satisfied with the outcome of three weeks' effort, and showed the chart I'd compiled in 'Libre Office' to my long suffering GP, who graciously accepted that it showed nothing to worry about. On average it's lower than it was a year ago, lower than when I retired, lower than when I was compelled to close down St James' church and clear the building with very little support from on high. Stress can certainly be very damaging to middle aged clerics at risk of forgetting to look after their health properly, and that was certainly the case with me five years ago. But you learn the hard way, don't you? 

The freedom of retirement has done me a power of good. I still take on responsibilities and enjoy the work I get asked to do, but the pressure and stress of obligation that goes with being a licensed office holder of the church, depending on it for accommodation and income, is no longer there. When I was younger, being provided for, not having to worry about money or shelter was a blessing, and all that was asked of me was that I should flourish in ministry wherever I was planted. I think I did my best, but as the decades rolled by, it became increasingly difficult to feel satisfied with my best, ever inadequate to a situation changing for the worse. I guess that's how family carers for highly dependent sick people may feel, when it seems nothing they can do will make their loved one better - hence the stress.

Three years into retirement I make every opportunity I can to support colleagues and congregations that need gaps in pastoral care plugging. I'm aware it's appreciated. Occasionally I wish there was something more in depth I could do, working with groups or individuals to grow their faith. Being available here and there as a locum pastor is a bit like being a bee or a butterfly flitting from plant to plant - an analogy I recall hearing from Ken Cracknell, an itinerant inter-faith theologian thirty years ago - I must remind myself that all that flitting around is a means of cross-pollination, bringing fresh insight while rehearsing ancient truth.. Whether that contributes to ultimate fruitfulness, we may never know.