Daisy’s renal function

I took Daisy, our 15-year-old cat, to the vet to have her long sharp front claws trimmed. She had taken to jumping up on the bed every morning, expressing her desire for food and attention by scratching my forearms hard enough to make them bleed. The vet recommended a geriatric health screen. Daisy was kept in the clinic all day for blood and urine tests, and the results showed that her renal function was somewhat impaired. I agreed to another blood test to assess the extent of the problem.

Renal (kidney) failure is very common in older cats. The many possible causes include urinary infections and ingestion of poisons. In many cases no specific cause can be found, though I wonder if processed food is implicated, for example cats fed on dry biscuits may get too much salt and not enough water. Our own cats certainly love dry biscuits, but I have always limited their intake, and fed a mixed diet with moist canned food and fresh meat, poultry or fish. The symptoms of renal failure can include increased thirst, increased urine volume, loss of appetite and weight, vomiting, diarrhoea, and general weakness. It is sometimes associated with other conditions such as anaemia, hypertension and hyperthyroidism.

Although diet is an important aspect of management, according to my reading there is some controversy around this. The standard prescription foods are low in protein, but some experts recommend feeding plenty of protein from fresh high-grade animal sources. Medication may delay progression of the condition. Adequate fluid intake is important, and severe acute cases may need parenteral fluids. Some specialised centres even offer renal dialysis and kidney transplantation.

Daisy’s second blood test showed that her renal function was “borderline”. She appears very well and has none of the symptoms listed above. After a long discussion with the vet we agreed not to initiate drug treatment or a special diet at this time.

I was about to leave the clinic when I checked on her claws and found that they had forgotten to trim them, so she was taken back to have that done. It had turned out a very expensive manicure; I could have tried to do it myself at home, though I am sure she would have scratched me.

Whether investigation of Daisy’s renal function has been worthwhile, only time will tell. Both in veterinary and in human medicine, screening for disease has pros and cons. Sometimes it does pick up a serious condition for which early treatment is desirable and even life saving. But modern tests are so sensitive that they often detect very minor abnormalities, prompting further investigations which can involve a great deal of discomfort, anxiety and expense and usually prove to have been unnecessary. On several occasions I myself have had blood results, X-Rays or biopsies reported as “borderline” or “suspicious” that eventually turned out to have been false alarms.

Daisy lying back

Blondstar: Thinking inside the box

My beautiful new yellow Honda Jazz RS has various high-tech features that were not present on my previous 10-year-old model. These include “keyless entry with remote central locking and immobiliser” which, despite studying the manual, I have found hard to understand. Judging by the posts on the internet forums for Jazz owners I am not alone in this. I read one story about a person being locked out of their car after leaving the keys inside.

After returning from a drive one night, my husband and I had only just got out of the parked car when I decided to go back and move it forward, to make more room for a neighbour’s vehicle. Leaving my husband to wait on the pavement holding my handbag, which contained the key, I popped back in and repositioned the car slightly. I switched off the engine and opened the door, but heard a series of alarming bleeps. I concluded that I should not have been driving without having the key with me. I retrieved it from my handbag and attempted to lock the car but this did not work. Then I tried various things which made the situation worse: the side lights and all internal lights came on and I could not switch them off, nor could I start the engine, and the bleeping continued whenever I opened the door. It was getting late and I dared not leave the vehicle unlocked overnight with its battery running down. I rang the AA.

The AA officer arrived by midnight, having had a long journey from another part of Auckland, and informed me that I had left the vehicle in Drive instead of Park. He was admirably kind and polite, but I was mortified and felt like an elderly version of Blondstar. Because of my fixed assumption that the problem involved the “keyless entry with remote central locking and immobiliser”, I had never thought to check for other obvious explanations.

How many mistakes, misunderstandings and lost opportunities result from being stuck in a certain mindset and failing to consider the alternatives? For example I have known several people whose serious medical conditions – for example brain tumour, Parkinson’s disease, hypothyroidism – remained undiagnosed until a late stage, because their symptoms were assumed to be due to a recurrence of the depression from which they had suffered in the past. Conclusions based on past experience, preconceived beliefs or assumptions are often correct but sometimes not, so it is a good idea to think “laterally” or “outside the box”.

Incidentally my Jazz was back in good form the day after its traumas.

car

“Across a Sea of Troubles”

Following on from my previous post about Writing a medical memoir, here is a short extract from my new book Across a Sea of Troubles.

***

“I don’t feel very well,” said my husband Brian, and slumped down on a nearby chair. His eyes were rolling upwards so that the whites were showing, and his face was very pale.

I said “I’ll call the ambulance.”

“No.”

It was a fine spring night and we were on Devonport Wharf, having just got off a late ferry from downtown Auckland. We had been attending a ballet performance of A Midsummer Night’s Dream with my mother, Clare, in celebration of her recent 91st birthday. It had been a pleasant relaxing evening and Brian had seemed perfectly alright at the theatre, but now he looked very ill indeed.

Again I proposed the ambulance, and again Brian refused, insisting that he wanted to go home. I looked around for assistance but we were alone on the wharf, my mother having gone on ahead to her own house with some neighbours we had met on the ferry.

I helped Brian onto the bus which took us halfway home, and while we slowly walked the rest of the way, I supported him as he swayed from side to side and had to keep stopping to rest.

At last we reached our house. I turned the key in the front door. As it swung open, Brian fell against it and collapsed unconscious in the hall.

I rang 111. The operator asked me a few questions and told me to check the pulse in Brian’s neck; it was around 200 beats per minute and irregular. She said that help was on its way. Meanwhile Brian had woken up and I sat beside him on the floor until the St John ambulance arrived.

The two ambulance officers helped Brian to move onto a couch, inserted a venous cannula into his arm, and ran an ECG which showed fast atrial fibrillation with left bundle branch block and ischemic changes. After making a telephone call they put up a drip and started an infusion of amiodarone, a drug that slows the heart rate and is used for the control of cardiac arrhythmias.

Brian, having a medical background, was apparently taking a detached interest in the proceedings. But when it became clear that preparations to take him to hospital were underway, he said “I’m not going.”

The senior ambulance man told him “You’re probably going to die if you don’t, mate.”

Brian continued to refuse, until I kneeled at his side and begged him to accept any treatment which might save his life. Then he suddenly said “Oh, alright.” Afterwards, he told me that he had not felt any pain or distress and would not have minded dying.

The local fire brigade came to help carry Brian down the garden steps and into the ambulance, and we set off on the first of the six urgent visits to North Shore Hospital that I was to make over the next few months.

***

Links to book: Smashwords, Amazon US, Amazon UK.

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Writing a medical memoir

Regular readers of this blog will know that in 2015 my husband Brian had a near-fatal heart attack, and that this was followed by a whole series of medical and surgical emergencies affecting our family. I had spent many years working on the medical staff of hospitals and hospices, but experiencing serious illness from the perspective of patients and relatives was very different.

After recovering from the traumas I decided to write a short memoir about them, and this is now available on Smashwords, Amazon US and Amazon UK under the title Across a Sea of Troubles. The first part tells the story of what happened, and the second part is a review of various topics including life event stress, the mind-body connection, post-traumatic syndromes and the role of  the carer.

I wrote this partly for myself as a way of coming to terms with things. Whether it has actually been therapeutic I am not sure – revising the manuscript involved rather too much focus on painful memories. So even if it still not a perfectly finished book, I have decided to publish it and move on. I hope it will hold some value for people who are coping with illness, whether as patients or relatives or health care professionals. But as always when publishing something new, I feel apprehensive about its reception: have I revealed too much personal information about myself or others? does it come across as morbid and self-pitying? is the medical information accurate?

A memoir can be defined as “a record of events written by a person having intimate knowledge of them and based on personal observation”. In contrast to an autobiography, it describes one particular aspect of experience rather than a whole life. Naively perhaps, I have always tended to assume that both memoirs and autobiographies are historically accurate. So I was a little shocked to be advised on one on-line site that it is acceptable, even desirable, to alter the facts to make them more interesting or inspirational for the reader. Although I did wish there were more positive aspects to my own story I resisted any temptation to embroider the truth, and wrote it exactly as I remember, checking all the dates from my diaries. So, rather than one of those books about “illness as a precious gift that transformed my life” it is an honest account of a rather gruelling sequence of events. Here again are the links for Smashwords, Amazon US and Amazon UK. I will share a short extract in my next post.

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Sugar

 

Guidelines for “healthy eating” come and go. At one time we were advised to avoid fat, now it is said that certain fats are extremely valuable. There are conflicting views about whether such foods as meat, dairy and legumes are good to eat. But one thing on which most of today’s experts do agree is that sugar is extremely bad for the health, and contributes to diverse forms of chronic disease.

Many authorities are now telling us to give up refined sugar completely, although a moderate intake of naturally occurring sugars such as fructose in fruit is okay. I don’t presume to question their advice, which is based on good evidence from large population studies. But there are always individual exceptions to general rules – consider for example the case of my friend Jenks.

Jenks is about to celebrate his 104th birthday. A widower, he lives alone and independently in his own house in England. Every year he flies, on his own, to New Zealand to visit his daughter. He cannot walk very well, but otherwise he is in good physical health and is not overweight. His mental faculties are intact and he uses the internet to keep in touch with the outside world. He has a calm and cheerful temperament.

Jenks has a hearty appetite and has loved sweet foods all his life. In England, besides the main meal of the “meat and two veg” variety which is delivered to his home each day, he eats plenty of processed cereals, biscuits and cakes, fruit juice, fruit tinned in syrup, milk chocolate, cakes and sweets. He takes sugar in coffee and tea. He also enjoys cheese and wine.

His daughter has been keeping a record of his diet while he is staying with her in New Zealand, and here is a typical day’s entry:

Breakfast: Apple juice, Muesli type cereal with milk, Toast and jam, Coffee with 1 sugar, Nectarine

 Mid-morning: Coffee with 1 sugar, 2 sweet biscuits

 Lunch: Bread, crackers & cheese

 Afternoon: Tea with 1 sugar, Cake, Biscuit

 Dinner: Fish & chips, Passion fruit, Chocolate, 2 glasses wine.

In between meals he will have eaten nibbles of sweets, dried fruits and nuts. He has a secret stash and tucks in on demand. 

Most people who ate like this every day without taking any exercise might be expected to become obese and diabetic and die from heart disease long before the age of 104. But not Jenks. Perhaps, as my late mother-in-law was fond of saying, “It’s all in the genes”.

On turning 70

Today was my 70th birthday. I had been dreading this particular milestone, despite telling myself that it is pointless to feel defined on the basis of age, and that I know plenty of people who are still going strong not only over 70, but over 80 or 90 or even 100. Despite my misgivings I don’t feel any older than usual this evening, and I had a lovely day including lunch with friends at a seaside restaurant in the glorious sunshine of our New Zealand summer, and a big bouquet from husband Brian.

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Ageing has many negative aspects, but also some positive ones. Ideally, it is said to be a time of contentment, enhanced wisdom and spirituality, liberation from old constraints and perhaps a chance to start something new. I’ve ordered a book called 70 things to do when you turn 70, no doubt full of inspirational ideas along these lines. For myself I have few ambitions at present, though having just finished the memoir that will be described in my next post, I do hope to write more books. And in my next life I would like to learn to fly. Meanwhile I appreciate being in happy circumstances and good health – having finally grown out of the severe migraine attacks that blighted most of my adult life is a huge bonus. It is a relief to be free of the responsibilities of paid work, and seldom having to do anything unless I want to, although I still feel an obligation to spend my time on something “useful” and am not comfortable with a life of pure leisure. The free travel pass is very nice too.

Mind that wish!

My dear friend and mentor Beata wrote this delightful story about the Law of Attraction.

The Way I See It

Three years after her divorce my friend has found her perfect partner. Perfect in every detail, she assures me; exactly as she had specified him in advance. Didn’t I know, she wonders, that if you really, really wanted something, provided it wasn’t going to harm others, you just had to order it and wait for it to arrive?

Aha. She was talking about the Law of Attraction, without knowing its official name, the process that allegedly uses the power of the mind to turn into reality whatever is in our thoughts and wishes. Of course. I suddenly remembered when I had first come across this idea many years ago, and the ways in which it worked – or didn’t. At the time I was working on a popular magazine, reporting on whatever was trendy, noble or downright weird, and one day I was told to investigate the revival of – wait…

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