Miscellany… A mixed bag of random noodlings with no real home.

Hospital Hygiene Problems…

I have a major problem when in hospital – staying clean.

The hospital does not have any wheelie-friendly bathrooms, with low-level suites, for example, leaving me with only the option of being given a bowl of water and a bottle of Hibiscrub at my bedside.

The same problem extends to shaving, and cleaning my dentures, and for the latter I insist on a sink with hot running water, to the annoyance of the staff who prefer to give me a small basin of water or, even, to take them away “for a bit of a scrub”. Er, no. Never gonna happen.

Shaving is way down my list of priorities when I’m ill.

And during my last stay – and this was in a hospital that obsesses about infection control – I watched as it all went belly up.

I’d always assumed that the bowls for patient washing were subject to the same sterilisation procedures, between patients, as pee bottles, but that turned out not to be the case at all. What they got was a quick rinse under the tap. I mentioned this to my Community Nurses – that’s apparently standard procedure.

Not exactly great for infection control. Once I realised that, I refused all future offers of a bowl and stuck to a sketchy splash and dash in the wash-basins in the toilets, figuring that my own grubbiness was preferable to picking up someone else’s bugs.

And the bowls themselves didn’t inspire confidence, being well-used and slightly fuzzy plastic. Frankly, my kitchen bowls are in better condition once the fused surface of a plastic bowl is abraded, it becomes a roosting-place for bacteria and should be treated accordingly.

For example, at every dressing change I wash my leg and the ulcer with a bactericide, but before starting I sterilise the jug and the mug I use with Milton, and the bucket is lined with a plastic bin bag (the heat used in the manufacture of plastic bags ensures that their inner surfaces are sterile – or, at least, sterile enough).

***

The Heart of the Matter…

After years of worry, being told I don’t have heart failure – if I believed it, which I don’t** – should have come as a relief. It didn’t, as the alternatives are likely to be worse.

**See the previous post for all the reasons why not.

In an attempt to find out how much worse, I Googled “can heart failure symptoms mean something else?”. First up was one of my principal go-to websites, The Mayo Clinic but, while they threw a few more symptoms at me which I have but hadn’t associated with HF, all they had to say about alternative causes was “Although these signs and symptoms may be due to heart failure, there are many other possible causes, including other life-threatening heart and lung conditions.”

That’s not exactly cheering, though it does confirm what I’ve known – despite the “reassuring” literature I’ve been given (screw reassuring – tell me the truth!**), HF actually IS life-threatening.

**And the British Heart Foundation’s TV ad “Heart failure doesn’t mean you’re going to die.” Er, yeah, it kinda does, though some people can rumble on for years.

The Mayo’s response sort of set the pattern – yes, there are serious and potentially fatal alternative diagnoses for my symptoms, but no-one is saying what they are.

So I went through my symptoms one by one and every single one brought me back to – yep, heart failure.

So as I said to my idiot GP, if it looks like a duck, walks like a duck, and quacks like a duck – it’s duck, FFS!

I have all the symptoms of HF. There’s just one – is my liver enlarged? – that I’m unsure of.

If, as is being claimed, the echocardiogram I had the day I was discharged has failed to confirm heart failure, then it needs to be repeated. An MRI scan will also confirm the diagnosis, if it’s right – it doesn’t need to be an invasive test though I’m coming, grudgingly, to the conclusion that I might have to submit to one, but it will not be the one with a 24% risk of stroke. That level of risk is far too high for a diagnostic procedure. Hell, if it was life-saving, I’d still think twice – better a good-looking corpse than a live vegetable.

***

Food for thought…

As I’ve mentioned, salt is banned from my diet – in theory anyway. Thing is, the average person has three meals a day, plus snacks. I don’t.

I mostly have one meal a day, in the evening (I’ve covered the reasons for this extensively – basically, if I eat during the day, I can’t stay awake), so the possibility of my having excessive salt in my diet is effectively zero. I reckon that having a little salt with my single meal will do me no harm at all.

I’ve also made a new batch of Harissa, with more herbs and less pepper, plus a little salt. It needs tweaking – more chilli and mint – but it’s still good and, sprinkled onto a plate of canned sardines twice a week, makes a tasty, heart-healthy, lunch.

As for snacks, I have one a day, to help me sleep. I’ll either take a tub of cottage cheese to bed with me, or a couple of slices of home-made fruit cake – either will send me off in minutes.

The Heart Failure Denial nurse – as she will henceforth be known – got very sniffy about the potassium content of LoSalt. Potassium can adversely affect the heart, it’s true – it can even stop the heart – but the prospect of anyone being able ingest enough LoSalt to harm themselves is remote. And “can”, as I keep telling my doctor, is not the same as “will”! I already take a potassium supplement – it benefits heart function in sensible amounts, and it’s the work of moments for me to calculate the amount of potassium chloride in, say, a teaspoon of LoSalt, and adjust my 100mg supplement accordingly, or omit it altogether.

The key to a safe and sensible diet, in heart disease as in anything else, is moderation. Just don’t eat too much of any of the allegedly hazardous foods – and the chlorides of sodium and potassium are particularly important – and you’ll be fine (and never forget that all forms of animal life on this planet, including you, need salt to survive). I don’t eat salted nuts, or crisps, but if I did, they’d be the first to go. I’d sooner put the salt on my meals, it would benefit me more as well as bringing me more pleasure.

I’m still supposed to be on a high-protein diet, that was confirmed in APH, Not entirely sure why, but I don’t care much either – the fact is since putting meat and fish back into my diet I feel much better, so I shall continue with it.  One thing I want to do – the idea came to me in hospital – is modify my hake and Spanish butter bean dish to include crisp-fried streaky bacon. The flavour should be amazing.

***

Endgame…

If, as the Heart Failure Denial nurse claims, what put me in hospital was my COPD – and I don’t buy that – then it means that end-stage is very close, if not already here. And yet my COPD monitoring gives the lie to that. My SpO2 (oxygen level), is around 91-93% (several points down on what it was prior to my recent crisis – not a good sign). If I was in end-stage it would be in the 80s and I’d have oxygen at home, not just in hospital.

But, whatever the truth of the situation, I need a “living will”. If they fuck up and kill me in hospital – and the bastards keep trying – or I just die naturally, I really do not want to be resuscitated. Dying once is enough for anyone. Likewise if I suffer a disastrous stroke – just let me go.

Similarly, there are some forms of treatment I want to avoid, and these, too, need to be formalised. The relevant paperwork is available online and can be downloaded. I recommend the following as a good place to start, though I don’t know yet which I’ll use (probably the last one, I think):-

http://www.ageuk.org.uk/Documents/EN-GB/Factsheets/FS72_Advance_decisions_advance_statements_and_living_wills_fcs.pdf?dtrk=true

 

http://www.christie.nhs.uk/booklets/402.pdf

 

http://www.euthanasia.cc/lw.pdf

I have no family, I’m the last of my line, so any decisions I make are mine alone. If you, on the other hand, are minded to make such decisions but have family, it is vital to discuss your intentions and get everyone in agreement and, even then, at crunch time, there may well be friction, disagreement, even litigation. There are times when I regret not having family – this will not be one of them.

NB: I have a suicide kit comprehensive enough to take me beyond all hope of recovery, and I’ve said I’ll use it if life, through pain or disability, becomes too much of a burden. Frankly, that point has been passed on the pain front at least, but my horrendous experience of two weeks ago, when I almost died from pulmonary oedema, has radically changed my view on suicide. If I could be sure of going cleanly and quietly, I’d be gone by now, but the thought of being tipped back into pulmonary oedema terrifies me – it is a hideous way to go and it’s a prospect that I cannot – I will not – face.

And, on that cheery note, I shall leave you for now. Smile

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