Recovery from surgery

Wednesday 28 June 2017

“Steph, Steph, you can wake up now.”

I stirred and tried to slowly open my eyes.

“I thought Steph was a girl’s name,” she chuckled in a thick African accent.

I turned to my left.  My left eye was bandaged but with my blurry right eye I could make out a large black woman with a friendly smile.

“It is a boy’s name as well, but not often.”  My throat was dry.  “I sometimes go by Steven but my mother called me Steph.”

“I guess it’s more common in America?”

“Yes,” I replied.  “Where are you from originally?”

“Nigeria.”

“Ah… the East side or the West side or the North?”

“Lagos.  The West Side.”  She seemed impressed.

“The reason I know this is because I used to have a guy working for me who was from the West side who married a girl from the East side.  His family weren’t happy about it at the time but I think they get on fine now.”
    
I was in a recovery room in the middle of a line of beds.  I could see a couple of other patients, each one with a nurse in attendance.  Just then, the anaesthetist walked past rushing to his next operation.

“How are you feeling?” he asked cursorily.

“Well I’m still alive and my brain seems to be working, so all good.”

He smiled and wished me good luck.

I had been under for about an hour but it seemed like no time at all.

What felt like a few seconds earlier I had been on the operating table with my right forearm shaking uncontrollably as he inserted the cannula in my right hand.

“That arm is the one with the tremor,” I had told him.  I only occasionally have tremor but it is exacerbated when I am nervous or tired.  We had of course discussed my Parkinson’s medication and he had adjusted his anaesthetics accordingly. 
    
The first to be administered had been morphine which made me immediately light-headed.  My mother, a child of the sixties, has told me how she loves the sensation that an opiate gives her, but for a person like me who does not really like taking drugs of any kind, I had found it disorientating and unpleasant.

“Do you want me to count down from 100?” I had offered.  But I hadn’t heard the answer as the next drug, Propofol I think, was already entering my nervous system.  There had been no time for any final contemplative thoughts of the miracle of technology surrounding me, or of loved ones, or of what would happen next.  I was out cold.

General anaesthesia is one of the many wonders of medical science.  Broadly speaking we spend our lives in one of three states: awake; in REM sleep (i.e. dreaming); and in non-REM sleep (i.e. deep sleep).  Each has quite distinctive brain patterns and physiological characteristics.  Being under general anaesthetic is to be in a fourth state of being where the brain is essentially inactive but, unlike sleep, you do not wake up feeling rested.

The truly remarkable thing is nobody knows for sure how general anaesthetic actually works.  This is not really surprising given that nobody knows what causes consciousness itself, so it is all the more remarkable that doctors can seemingly switch consciousness on and off at will.  As with a lot of things in medicine, the drugs have been developed over many years largely through trial and error, and are now highly effective.

I wore an eye patch for the rest of the day and through the night.  My left eye is bruised, sore and blooded, but a bit of ibuprofen works wonders and I feel surprisingly good the next day as I write.  I need to regularly administer eye drops, protect my eye at night and be careful in the shower for the next week or so.  I will be off work for the rest of this week and most likely work from home next week.

Has it worked?  My eyes are still a bit blurry and I have a mild headache as my eye muscles adjust.  Perhaps my visual cortex is busy recalibrating itself to the change of sensory input as well.  From what I can tell so far, my field of good vision has improved but by how much I am unsure.

I will be seeing Mr A again in a week or two for a follow up consultation.  Whatever the outcome, I think I will be telling him I that I am not in a hurry to have more surgery.  I will be living with my new eyes, hopefully for the better, for the foreseeable future.

Eye surgery

Tuesday 27 June 2017

If you’re not too squeamish, enter “squint surgery” into a YouTube search.

I had been deliberating about whether to ask for local anaesthetic for this procedure to hopefully fix my double vision, but one look at a video was enough to convince me that general anaesthetic is definitely the way to go.

I am still a little nervous about the possible risks of general anaesthetic, but I need to get this problem fixed so that I can function normally behind the wheel and in the office.  It didn’t fill me with confidence when, at my last consultation with my eye surgeon, Mr A, I had to remind him that I suffer from Parkinson’s and that my medication may impact the choice of anaesthetic, and that he should probably discuss all this with the anaesthetist in advance.  Meddling with the delicate chemical balance in the brain is not something to be taken lightly.

Mr A told me the operation has an 80% chance of improving my eyesight.  As I head off to the hospital this morning I hope that I am not in the 20% – I don’t want to do this more than once.

London Bridge

Monday 5 June 2017
 
"Borough High Street exit closed" reads a sign as I walk through London Bridge underground station on my way to work.

It is a journey I make every morning, but this time the commute is sombre as I think about the terrible terrorist event that happened over the weekend; where three radicalised men attacked 55 people, killing seven of them in manic knife attack, and with the blunter instrument of a hire van speeding over London Bridge at 50mph.

This is the worst of humanity, not just because of the killing but because of the intention behind it - the intention to cause as much pain as possible in a frenzied eight minutes until the attackers were shot dead by police.

London Bridge and Borough Market are areas of London I know well. Indeed, I recall many years ago strolling along the south side of the Thames with Clara on our first date, under the red glow of the same bridge.

Of course this puts my own situation into perspective - I feel pretty rough today but it could be so, so much worse.

As I think about the unfortunate victims, I appreciate how lucky I am to benefit, in many ways, from the very best of humanity.

Fatigue

Saturday 3 June 2017

When I tell people I have Parkinson’s I get one of two reactions: a blank stare or a semi-blank stare coupled with some heartfelt sympathy.

Both reactions are completely understandable.  Only 1 in 500 people suffer from the disease and they are nearly all over 60 years old, so I normally have to quickly explain what it means.

For those who maybe had an uncle or a grandparent who suffered from Parkinson’s with its crippling and depressing effects in old age, there is of course sympathy but also some puzzlement as to why I seem so normal.

Young onset Parkinson’s, normally defined as having the disease under the age of 50, affects about 1 in 5,000 people.  In other words about 10% of Parkinson’s cases are young onset.  The progression of the disease is typically (though not always) slower in young onset cases, and sometimes with slightly different symptoms.  Dementia and other cognitive impairments are, thankfully, less common than in later onset.

So for example I get occasional tremors in my right hand but these are mostly suppressed by my medication.  I can sense the early stages of mobility difficulties but for day to day purposes can still walk and function normally.  I have constant stiffness in my right hand, arm and shoulder but that is not immediately obvious to observers.

In fact, by far the biggest day to day challenge I have is an invisible one: fatigue.

Fatigue is more than just feeling a bit tired.  It’s a persistent lack of energy and nearly constant desire for rest.  It ebbs and flows but, bit by bit, it is starting to pervade much of my life.

Getting through the work days is tough though still manageable, but I seem to have energy to do little else these days other than go to the office and rest at the weekends.  Recently I’ve taken to having afternoon naps on Saturdays and/or Sundays… so lovely!  I force myself to exercise and spend time doing things with the family but, honestly, mostly what I want to do is just laze around.

I scour Parkinson’s websites and chat forums for information and anecdotes.  It seems unclear whether it’s the underlying condition that is responsible for the fatigue, or the medication (probably a bit of both) but, what is clear, is that many people have the same problem, and it only gets worse.

It seems to me that the main reason many young onset sufferers struggle at work and ultimately end up stopping work is not mobility problems or depression, it’s simply the chronic fatigue.  There appears to be no silver bullet: no special medication or dietary adjustment.  No amount of caffeine can compensate for it.

I look at my mortgage statement and see that it still has a decade left to run.  I feel certain that the fatigue will get the better of me long before then…

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