Labrador overnight guests

House guests last night - Fiki (white) and Khulu (black_

How can we remind the world of the unsolved question of Kashmir

Ophthalmology October 2

Diagnosis: Bilateral cataracts, bilateral macular degeneration
Visual acuity: 6/9 right eye, 6/9 left eye

OCT scan showed atrophy and mild subretinal fluid at the left macula, and retinal pigment epithelium disturbance with no fluid at the right macula. Both eyes are white and quiet and lens opacities were noted bilaterally. Geographic atrophy was noted at the left macula with some subretinal fluid. Retinal pigment epithelium disturbance was noted at the right macula with patchy hyperpigmentation. No treatment is indicated at present.

We have explained to him the risks and benefits of cataract surgery and the guarded prognosis due to macular degeneration. We have given him some information to read regarding cataract surgery and we will see him again in 2 to 3 months time with his decision......
------------------------------------------------------------------------------------
The 'Guide to cataract surgery' says nothing about the 'guarded prognosis due to macular degeneration', but since 95 out of 100 notice an improvement in their vision and only 1 in 1,000 experience a total loss of vision after surgery it is a good bet. The Guide says there isn't a point when the condition is 'ripe' or 'ready' for surgery, but it should be when it affects daily life. Though I can still drive, 6/9 is getting close to the margin, so I think I'll ask to go ahead at the next appointment.

With Jason Brooke, founder of the Brooke Heritage Trust today

With Maryam al-Khawaja

At Maryam al-Khawaja's press conference this morning, at Index on Censorship office. She is head of foreign relations for the Bahrain Center for Human Rights, but lives in Copenhagen. Her father, Abdulhadi al-Khawaja is serving a life sentence for freedom of expression offences, and her sister Zainab is awaiting sentencing for tearing up a picture of the King in front of a judge.

Maryam told the press conference that IS sympathisers are being recruited into the police and security services in Bahrain.

Great family party hosted by Lizzie Gimblett (nee Lubbock) and Robin today

Eyes wrong

Visit to St Thomas's eye clinic this morning where after various tests Dr N H  confirmed cataracts and macular degeneration in both eyes. 'Right eye doesn't look too bad' its 'predominantly on the left. Vision is now 6/9, just within the limit for driving. Surgery isn't recommended for the cataracts because so far the deterioration isn't serious enough to outweigh the minor risks, one in 20 patients experiencing some complications, some of which can be corrected by further suger.

Nothing can be done about macular degeneration. When pressed, the doctor said that the median time between diagnosis and blindness was five years, and that should see me out as I expect to step off in July 2016.

Haematology

Blood test this morning:

Hb                  105
PLT                347
Neutrophils         1.30
WBC                   3.11

The consultant was 'a little bit worried' by the trend of the neutrophil count, which has declined over the last three tests and is below the normal range of 2.2 - 6.3 10^9?L. Neutropenia, the condition of reduced neutrophils, means a greater susceptibility to infection, Dr M thought a bone marrow biopsy might be necessary, the previous one having been taken in July 2011, but first recommended cutting the hydroxycarbamide to five days a week to see if that would improve the neutrophil count, and arranged the next appointment for October 29.

Breakfast with Alan at La Ville Cario

At the Macmillan Coffee Morning last Fridqay

Macmillan friends

Meeting this afternoon in the Kosta cafe at King's College Hospital with Tracey, Alwyn and Pam, friends from the Macmillan site who like me have incurable cancers. We had an amazingly upbeat conversation about our treatment, prognoses and our families, and we agreed that it was useful to exchange experiences in person as well as  on macmillan.org.uk.  We agreed to meet again in a couple of months, next time in the Macmillan room at the hospital. 

EVAR, September 10

Today's scan of EVAR (Endovascular aneurysm repair) showing that the plastic aorta inserted in 2010 isn't leaking, It also shows the stent inserted in one of the renal arteries in June.

Virus crisis

Maurice and Diana's last day. Yesterday we went to Ham House in the morning, had lunch at the London Apprentice in Isleworth, then Strawberry Hill in the afernoon. Returned home to find my computer infected with a virus that was immune to AVG and apparently to all other anti-virus software. Maurice and I struggled to find a solution on the web, and the only site that claimed to have a solution we found was MiTechMate.com. As it was after 23.00 by that time we left the computer in safe mode overnight and returned to the problem this morning. The infected machine wouldn't connect to the web, so we opened a chat line with MiTechMate on the other computer in my office and apart from a difficulty in getting the site to accept my card payment, all was plain sailing. The contact at MiTechMate took control of the infected machine and removed all the infected files, at a cost of $65. I'm wondering whether to get a year's subscription at $130, or to take a chance that lightning won't strike twice.

Its disconcerting to find that there is some malware that gets past leading anti-virus packages such as AVG and AVAST.

King's College Hospital

Maurice and I visited King's this morning as part of the Day of Action on Alcohol Harm organised by the Royal Colleges, Alcohol Concern and the Institute of Alcohol Studies, Ms Jacqueline Green, Head of Stakeholder Relations, met us and took us to see Dr Michael Heneghan, Liver Consultant, Professor Heaton, Head of the Liver Unit, and Dr Will Bernal, Consultant, Liver Intensive Therapy Unit, We then moved to Todd Ward where we met Anne McKenna, Deputy Head of Nursing, Liver and Renal Surgery, and Natalie Huxtable, Matron, Liver. Then we attended the Liver Transplant meeting, where all the experts discuss the eligibility of candidates for liver transplants. King's is the largest and most successful centre for treatment of liver failure in the UK, and their available beds are full all the time, but the demand exceeds supply. After that we met Ian Webzell, Alcohol and Substance Misuse Clinical Nurse Specialist for a discussion on the post-operative treatment of patients with alcohol problems, a high proportion of whom relapse Nobody has a definitive answer to this problem, but there is universal agreement among NHS professionals that Government should be doing far more on prevention.

Everybody knows that the two main levers affecting consumption of alcohol are price and availability. Minimum unit pricing is a no-brainer, and the restoration of the alcohol duty escalator is another.  Local authorities should have stronger powers to control the proliferation of alcohol sales outlets, and all-night drinking should be reversed. What we need, as one of the professionals we met today underlined, was a commitment by the Government to reducing alcohol consumption on a par with the successful campaign against smoking of the last decade.

Maurice took the photograph: Ian Webzell is on my right, Dr Heneghqan on my left, and Jacqueline Green,  far left

Even more haematology

Haematology outpatients this morning below, with last time's and normal range. Platelets are within the normal range for the first time for ages, other values much the same as four weeks ago, outside the normal range but tolerable. Dr G was pleased there was no drop in WBC or Hb. He acknowledged that deciding the hydroxycaranide dose was pure guesswork so it was left at six times a week.

Blood tests Aug-14 Jul-23 Normal WBC 3.75 3.8 4.5 -10 Hb 108 108 130-180 PLT 388 470 150 - 450 Neutrophils 1.7 1.74 2.0 - 7.5

Optician, amd knee

Cataract and macular degeneration in both eyes diagnosed by optician today. Cataract in right eye can be dealt with surgically, she thinks, and is writing to the GP to refer me to King's accordingly. Macular degeneration is incurable and gets worse with time, but maybe I will be able to see until July 2016

GP telephoned this evening to inform me about the scan of my right knee. The cartilage between the bones is nearly worn out, and physiotherapy is needed to strengthen local muscles. Waiting list for physiotherapy at King's is 18 weeks

Oh well, can't be helped, as JW says.

More haematology

Notes from start of hospital stay May 14 to June 4 with pneumomia includimg 16 days in ITU:

Pneumonia etc

May 14, 2014 we both woke early and were up by 06.30, to have a cup of tea before going to King’s at 07.45 for the blood test required before every haematology appointment. Then back home for two more cups of tea and the newspapers before the haematology outpatients appointment at 10.00 which as usual turned into 10.45. The consultant Dr Aldawi said the platelets were OK, but haemoglobin was only just above the level where a transfusion would be needed. He wasn’t concerned about the slightly raised temperature I had the previous evening and at 02.00 that morning, or that I had coughed up bloody phlegm. He listened to my chest and said he couldn’t hear anything. But finally he ordered an x-ray which showed that I had pneumonia in my right lung., and Dr A said he would arrange for me to be given intravenous antibiotics. He left the consulting room for half an hour, and on his return said I would be admitted to the day ward All the cubicles were occupied and there was a further wait but when I was finally admitted it was clear they were not going to let me go. Lindsasy went home, returning at 15.00 with  washbag,  slippers and dressing gown, plus a sandwich, fizzy water and a tangerine.

At 16.00 the saline drip was replaced by 1200 mg Augmentin drip. Dr A said my kidneys weren’t working properly, as indicated by a rise in the creatinin reading from 108 to 180 since the previous blood test, but at the time this didn’t trigger an investigation of the renal arteries.

At 18.00 a nurse told me I would be g oing to Elf & Libra, a new ward for haematology patients, when they had a bed space available. !9.45 SATs were 85 so I was given oxygen. But they remained obstinately at around 90 and the next morning a consultant from Intensive Care fitted me up with a more intensive flowof oxygen which increased the SATs to 96. I had an infusionof anti-nausea medication and also of Meropinem.

Friday May 23 I was prescribed Furosamide to reduce water on the lungs, but still there was no suspicion of the renal arteries.

After that in intensive care my writing deteriorated and I can't read it.

Funny that it didn't occur to anybody that fluid retention was a problem linked to the kidneys. After five days out of hospital I was in a bad way and Lindsay called an ambulance on the Monday morning. After ECGs and scans of liver, heart and kidneys it was found that my renal arteries were both blocked, and the following day I had angioplasties and stenting which dealt with the problem effectively. I lost 10 kg over the next three days as the kindneys started doing their job of getting rid of the fluid.

Blood test July 23 (normal range in brackets):

WBC 3.8 (4.5 – 10.0)

Hb     108 (130-180)

PLT n 470 (150-450)

Neutrophils 1.74 (2.0-7.5)

All values are outside the normal range, but the one the haematologists watch closely is platelets (PLT). I take hydroxycarbamide which reduces the platelets, but also the haemoglobin. The dose is varied after each consultation to balance the two values. While I was in hospital I had a blood transfusion (2 units) which did increase the Hb from its previous reading of 8.5.

With Benny Tsedaka of the Samaritans and Felicity Devonshire, who organise his UK visits

Visit from Husain Abdulla, Sayed Ahmed asbd Ahmed Ali this morning

Visit from Saeed Shehabi and Jalal Fairooz this morning