Instagramming right along.

Dear Farmdoc's Blog followers and readers

My holiday from blogging continues. I'm having trouble getting back to it. I don't know when, or even if, I'll make a comeback. Time will tell.

In the meantime, I'm starting out with Instagram - which, according to its blurb [1], is a 'fast, beautiful and fun way to share your life with friends through a series of pictures'.

I'll be posting at least one photo each day. (I loaded my first two earlier this morning.)

If you have a smartphone, you can download the free Instagram app and then search for Farmdoc to find my photos.

Or on your computer, click here for big pics (scroll left for the newest ones), or here for littlies (no scrolling required).

If you have trouble with any of this, please email me and I'll do my best to sort it out.

Finally I hope you have a happy holiday - whether it's Hanukah or Christmas or something else.

I'll be having one. That's for certain.

With love and best wishes

Farmdoc.

Gilad's home!

Gilad’s home!
But at what cost?

His freedom’s worth the cost – whatever the fullness of time shows that cost to be.

P.S. The graphic is from the Jerusalem Post website.

Farmdoc’s first million

An important part of my post CABG surgery rehabilitation is exercise. Not that I’d been a couch potato preoperatively, mind you. But it’s now a matter of life and death. My cardiologist told me I should walk for 30 minutes per day – every day for the rest of my life. What I should’ve done was buy a stopwatch. But instead, I don’t know why, I bought a pedometer – an Omron HJ203 [1], if you must know. It uses accelerometer technology, so I wear it on a lanyard around my neck. (The instructions say it’d count my steps even if it was in my backpack; but I haven’t tried that.) Anyway having this whiz bang device, it was only natural I’d join the 10,000 Steps program, with data logging on the 10000steps.org.au website [2]. The aim, of course, is to log 10,000 steps (or more) per day. The 10,000 Steps program’s run by Central Queensland University’s Rockhampton campus, with funding by Queensland Health. There’s even an iPod/iPhone app for entering each day’s steps into a database. And it sends me an email if I forget to upload the steps for the prior day. Anyway I joined the program on 16.7.11, and yesterday I passed the milestone of a million steps – averaging 11,295 steps per day, which for me equates to about 8.8 km per day. I’m chuffed. And what’s more, I feel fantastic. I reckon it’s the endorphins flowing through my (old and new) arteries. So I hope this million’s the first of many, many to come.

2011 lambing begins

Our first lamb of the new season was born last Thursday.

It's a great time of the year - and a great time to be living on a farm.

CABG surgery plus four months

CABG surgery plus four months

It’s 16 weeks since 20.5.11 when I published the post before this one. In that time the blogosphere hasn’t been a major focus for me. I don’t know why. I seem to be tuned in to other matters. But today being the 4-month milestone since my CABG surgery, I feel the need to record some thoughts at this time. So here goes:

When I look back over the past four months I can remember everything, or at least almost all of it, in great detail. Yet I can’t really believe, and accept, it’s happened to me. Frequently I look at the long scar on my chest or the one on my left forearm to confirm that, yes, it did happen, and those memories haven’t been somehow artificially implanted into my brain.

Nowadays I am well – physically and psychologically/emotionally. I walk, and run, up hills as well as I ever did. Using a pedometer I ensure I walk at least 10,000 steps each day. (Since I started on 16.7.11 I’ve walked 562,728 steps total, at an average 10,231 per day.) Due to this walking, I’m up to date listening to the podcasts I subscribe to. For weather reasons I haven’t started riding my bike yet; though now Spring’s here I’ll start soon. I have no pain, no shortness of breath, no ankle swelling, no irregular heartbeat. In short, no cardiac symptoms. No, that’s not true; I have two, i.e. my heart beats stronger than before, and my resting heart rate’s 10% higher than before. Also I’m about 4 kg lighter. I’d like to put on 3-4 kg, but the 10,000 daily steps and the low fat/low sugar diet I’m on has so far prevented me doing so.

I take three prescribed medications each day, plus aspirin, fish oil and vitamin C. I still have a couple of medication issues; but they’re minor and, in the greater scheme of things, inconsequential. Anyway plans are afoot to sort them out.

I had blood tests on 19.7.11 and I saw my Launceston cardiologist on 4.8.11. He suggests review blood tests just before 24.11.11 when I’m due to see him next.

On 1.8.11, i.e. exactly 12 weeks postoperative, I resumed work in the clinic. (Before then, some work paperwork reassured me my brain was working properly.) During August I gradually built up my work, and from the start of September I’ve been back to full work. I’m content with the quality of my work, but (pun intended) my heart’s not fully in it. Having been on death’s doorstep, work’s less important to me these days. I’m curious to see if that’ll change in future. I doubt it will.

My darling family is my focus and my inspiration. Sweetheart Vivienne has stood by me and supported me – early on, literally on occasion. And my darling daughters and grandchildren have showered love and concern on me when in truth they don’t owe me anything. My darling sister Sue has been there for me too. Not to mention my friends and work colleagues. To offer you all my thanks is both insufficient and trite. But I do so anyway.

So, in summary, four months on, so far so good. Very good. When I wake each morning I consciously think how lucky I am to be waking up. And that the expertise and technology to save my life was available; and I had ready access to it.

My main aim for the next few months is to continue with my postoperative rehabilitation. I don’t know when it’ll be complete. But at some stage I’ll reach maximum improvement. I don’t think I’ve reached that point yet. Also, hopefully as the months stretch on I’ll become less obsessive about my health.

Other aims are to sell our Mole Creek property, and to begin planning our Musk Vale house which is across the road from darling Kate and her family. I can't wait to live there.

When will I post next on Farmdoc’s Blog. When I’m ready. Hopefully soon.

P.S. I should tell all those who’ve asked me, that my wedding ring was returned to me by hospital staff before I was discharged. I was so happy, and relieved, to have it back.

CABG surgery plus 11 days

This morning, in bed, I had another run of AF – the second since my hospital discharge. Like yesterday’s, today’s was not severe or long. And it responded quickly to Sotalol. As soon as my heart rhythm reverted to slow and regular (i.e. sinus rhythm) I had a shower. My first since being home. And I was strong enough to shower standing up. (In the hospital post-operatively I’d had two showers – both sitting in a shower chair because I didn’t have nearly enough endurance to shower standing up.) Minor progress – but progress nonetheless. Today Sweeetheart Vivienne, darling Meg and I went to a nearby café: Rue Bebelons [1]. Only 150 metres from our Melbourne home, but my first outing since hospital. It felt so good to sit there and drink coffee like a person who’s normal, i.e. not one who’s 11 days after CABG surgery. Otherwise my daily exercise and walking programmes continued. Late arvo darling Meg left us to travel home to Daylesford by train. Her 1½ day visit was a gem. As she is.

CABG surgery plus 10 days

Late yesterday afternoon I had a run of irregular heart rhythm due to AF – the first since my hospital discharge. I felt it in my chest. It was nowhere as severe or long as previous runs. And it responded in 10-15 minutes to a Sotalol tablet [1]. I wondered if a walk around the Melbourne Central shopping centre [2] a couple of hours earlier, had been too much. Especially as yesterday was a very emotional day for me. Anyway how wonderful to sleep in my own bed. With Sweetheart Vivienne beside me. And none of those mysterious nocturnal hospital noises. I slept through until 6 a.m. Then sporadically. The rest of today was a quiet day. I did my rehabilitation exercises. And I did my required daily 30 minutes of walking by gently treading the 35-metre corridor outside our Melbourne apartment – in two 15-minute stints, whilst simultaneously shortening my list of unlistened-to podcasts. Late morning darling Meg, laden with fresh produce, arrived to spend a couple of days with Sweetheart Vivienne and me. What joy for her dad. After dinner we watched a DVD movie called Bandidas, and then an episode from the third series of In Treatment. I can’t imagine a more enjoyable rehabilitation programme than this one.

CABG surgery plus nine days

Final blood tests done. Discharge medications received. X-ray films too. Outpatient cardiac rehabilitation (at The Royal Melbourne Hospital starting in a week) organised. Review appointments by cardiologist and heart surgeon fixed. Final physiotherapy and dietitian sessions attended. Patient Cardiocard received. Discharge Instruction Summary signed. Big bag of chocolates plus a card bearing Sweetheart Vivienne’s heartfelt (pun intended) words To the amazing team on the 5th floor. From Ross and his grateful family. Thanks! presented to the staff.

So…Farmdoc leaves the hospital. Reverts from a patient back to a person. Deliberately. Eagerly. Meaningfully.

Due to a 2 kg lifting limit, unable to carry his bags. So his long-time friend Peter – Melbourne’s best physician – carries them. Poignantly.

Met in the Admission/Discharge Office, then walked to the car, by darling Kate. Unforgettably [1]. Met beside the car by Sweetheart Vivienne [2] and darling Indi. Lovingly.

Home Sweet Home. A cliché. But a welcome reality too.

The first day of the rest of my life.

CABG surgery plus four days

The ICU staff must have been pleased with my progress because around lunchtime today I was transferred back down to the 5th floor cardiac surgery ward. I felt like I was on a 5th/7th floor yoyo. To the left of my 5th floor bed was a west-facing window overlooking the University High School oval where in 1970 as a junior doctor at the adjacent Royal Melbourne Hospital I’d run laps before work. Though then I was young and fit and now I was old and I could hardly walk, for some reason I thought that a good omen. Another good omen was that one of the 5th floor nurses introduced herself to me as Leanne. And she told me she was CEO of the entire Melbourne Private Hospital. She said she was working on the ward because of short-staffing. Even so, I was mightily impressed that the CEO was doing hands-on patient work. (It reminded me that in the old days when Bob Ansett ran Budget Rent A Car, he rostered himself and all his executives to work on customer contact jobs one day per week.) Anyway I told Leanne the story of my missing wedding ring. And she promised me she’d make enquiries. I was hopeful it’d be found. But today being Friday 13th, I wasn’t optimistic.

CABG surgery plus three days

I spent all of today in the ICU – under close medical and nursing scrutiny. I had a few runs of AF. But none rapid and/or long. I was in a single room. I slept most of the day. That two hours of earthquake AF last night knocked the stuffing out of me. I was exhausted. And because today was only the third post-operative day, I was coming off a low base of energy and endurance.

CABG surgery plus two days

My wedding ring had been taped on pre-operatively. I didn’t know who’d removed it. Or why. And, more importantly, I didn’t know where it was. At this critical time, when I needed to feel so connected to Sweethert Vivienne, the absence of my wedding ring seemed a major portent. But with two lower chest draintubes, arterial or venous lines in my left neck and right elbow and left groin, an indwelling urinary catheter, long scars over my midline chest and front of left forearm, heart pacing wires coming from my chest, 12 leads taped to my skin for heart monitoring, and doped up with strong medications I was clearly unable to engage in any wedding ring detective work. That would have to wait for later. By lunchtime Wednesday – 20 hours since I regained consciousness (or at least sustained memory of it), I was ready to be moved from the 7th floor ICU to the 5th floor cardiac surgery ward. The transfer occurred about mid-day. Just after I presented the ICU staff with a ‘thank you’ bag of Haigh’s Chocolates [1]. A few hours later – Wednesday mid-evening – I, my bed, the ward, and even the hospital, began to shake. Violently. Irregularly. And they didn’t stop. It turned out I’d developed an irregular heart beat, called atrial fibrillation [AF]. It’s a known complication of CABG surgery, occurring in 40-60% of cases, and due to heart swelling during the surgery. It resulted in my immediate transfer back up to the ICU. It took a while to be controlled. My heart rate was over 200 per minute for over two hours. Eventually it settled. Everything stopped shaking. And my anxiety dissolved away.

CABG surgery plus one day

As if through a fog, a haze, a cloud, my consciousness returned. When it reached a certain threshold, the first thing I did was make sure my four limbs worked. They sure did. Next I checked my cognitive function. How? By thinking of the years of Collingwood premierships in my lifetime. (For the benefit of infidels: 1953, 1958, 1990 and 2010.) Thus I’d escaped the known heart surgery complication of stroke. Great news. I also quickly noticed my endotracheal tube had been removed from my throat. This buoyed me further: the literature and films I’d seen pre-operatively were unanimous that waking up with a tube down the throat – causing gagging and preventing talking – was the most lingering post-operative memory. I could tell I was in the Intensive Care Unit. (The previous evening I’d visited the ICU for a brief familiarisation tour.) There was a big round clock on the wall in front of me. It read 4 o’clock. I didn’t know which day it was let alone if it was 4 a.m. or 4 p.m. My nurse told me it was 4 a.m. on Tuesday 10 May. (This was about 16 hours after when I thought the surgery began.) I lay there content. Or at least inert. In no pain. And then I discovered my wedding ring wasn’t on my left ring finger.

CABG surgery day

Yesterday mid-afternoon darling Emily drove Sweetheart Vivienne and me to the Melbourne Private Hospital [1]. A few minutes later, the paperwork had been done and we were in the ward. I had a chest x-ray and some blood tests. Then in the late afternoon we met my surgeon Mr Goldblatt. For the first time. In a gentle, unrushed and authoritative way, he explained to us what happens before, during and after the surgery. I quickly decided I had confidence in this man. Soon after, Sweetheart Vivienne left – with darlings Sue and Jeffrey who drove her home. Later the anaesthetist visited. During her stay the information flow was almost all from me to her. After she left, my arms, legs and chest were shaved. Then I showered, during which I scrubbed myself with iodine antimicrobial foam. Then I donned my pyjamas – the final symbol of my conversion from person to patient. Then I hopped into bed.

Today was CABG surgery day. I woke early. After a good sleep – courtesy of tablets. I had another shower including a further iodine foam scrub. And I donned one of those awful hospital gowns. No breakfast for me, of course. I was in the pre-operative fasting stage. The perfusionist (who was to operate the heart-lung machine keeping me alive when my heart would be stopped during the operation) called by. To bid me g’day. I remember saying I hoped he was in top form. And that he replied he was.

I was warmed by the thought that all day, three of our darling daughters would be physically with Sweetheart Vivienne. And the fourth – in the USA – would be with them in spirit.
Farmdoc’s Blog readers know my dad had clinical heart disease since his early 40s, and a heart attack killed him at age 56 [2]. (Then, in 1969, CABG surgery wasn't available.) Funny thing. All morning this morning I wasn’t Farmdoc. Nor was I Ross. I was Inigo Montoya – hero of the 1987 film The Princess Bride [3]. And continuously, as if on a tape loop, was Montoya’s oft-stated threat: Hello. My name is Inigo Montoya. You killed my father. Prepare to die. [4] The heart disease that killed my father, and that was afflicting me, was about to be conquered. Not by Montoya’s sword. But by Goldblatt’s knife. (That Sweetheart Vivienne’s my Princess Bride's also relevant, of course.)

Late morning a nurse came to give me a morphine injection. And that’s my last pre-operative memory.

CABG surgery minus one day

This afternoon at 2 p.m. I’m being admitted to hospital. Currently my world’s small. Focused in on myself. Which isn’t something I relish. But I suppose in the circumstances it’s inevitable. Beyond my solipsism, today’s Mother’s Day in Australia. So I’m especially thinking of my own mum, and the nearest and dearest mums to me. Not least Sweetheart Vivienne – who’s one of the best. Today’s also the first post Bin Laden Sunday. I can’t help but think our little planet’s a tad better off for that fact. Otherwise all else continues: football matches, political intrigue, celebrity worship, global warming, and more. Including the federal budget next Tuesday evening. But for me, it’s hospital. Speaking of which, I know that while hospitals are necessary institutions, it’s best to be a patient in one for as short a time as possible. Which is my aim in the days ahead. I don’t know when my next Farmdoc’s Blog post will go up. Hopefully soon. Stay tuned, folks.

CABG surgery minus two days

A quiet day today. A stroll to Victoria Market with Sweetheart Vivienne. A long chat with Sweetheart Vivienne and darling Emily over brunch. A look at some surveillance video then a quick 2-page report on its content and implications. A skype video conversation with darling sister Sue and brother-in-law Jeffrey. Then a visit to long-time friends Peter and Vonne. Busy, busy. So not much time to think about my hospital admission tomorrow let alone the surgery on Monday. It’s hard to know if I’m getting closer to these events or they’re getting closer to me. Whichever or both is so, I feel strangely calm about it all. Why ‘strangely’? Because I reckon I should feel anxious. What’s about to happen is big. Bloody big. But my mindset remains positive. Optimistic. Which is strange for the cup-half-empty bloke that I am. Tomorrow? That’s another day. Today I’m okay. Really okay.

P.S. Thank you to those who wrote such supportive and comforting comments on yesterday’s post. It’s trite to write it, but I’m sincerely grateful to each of you. Also to Sweetheart Vivienne [1] and darling Kate [2] for blogging about me so lovingly. What a support team I have. I am a truly blessed man.

Farmdoc rides again.

On Sunday I’m being admitted to the Melbourne Private Hospital. Then on Monday I’m having coronary artery bypass graft [CABG] surgery. It’s major. Seminal. Existential. For me. And also for my darling family and my friends. Even in some way for my acquaintances. So I need to write about it: to consider it. To weigh it. And of course to record it. What better way to do all this than Farmdoc’s Blog. So the journey begins. Actually, no. It began a year ago when I began feeling an ache behind my chest bone. It was exercise-related then. And it’s remained so since. At first I thought the cause was the hiatus hernia I knew I had. So I took Nexium. It helped. But not totally. Long story short, on 14 April I had a treadmill exercise test which showed I had a heart problem. Then on 27 April an angiogram revealed severe disease of all three main coronary arteries. Indeed so severe it wasn’t amenable to angioplasty. Therefore it’s CABG surgery for me. Given my family history, I’ve long thought coronary artery disease was in my future. For decades I’ve been trying to avoid it by attending to all the known risk factors. I may have delayed it. But I couldn’t outrun my chromosomes. With Sweetheart Vivienne I’ve been walking: 3-4 km each day. So I’m physically ready for surgery. I’m psychologically ready too. I’m focused and determined. Oh I expect rough times ahead. But I know I’ll get there. And so, it seems, do all the people mentioned above. I’m overwhelmed, and humbled, by their love, care, wishes, and in some cases prayers. I’m ready. Bring it on.

P.S. I hope to put up daily posts. The first few will be retrospective. They’ll cover medical matters. But more so my thoughts, my anxieties and hopefully my triumphs. I invite you to share my journey. If you’re up for it, to paraphrase the bumper sticker: Log on, sit down, buckle up and hang on. We’re going to hell and back. Farmdoc rides again!

The last post

Dear Farmdoc’s Blog followers and readers

The first post on this blog was way back on 21 April 2008 [1]. Three years ago tomorrow. Since then I’ve put up one new post each day. So today’s post is number 1,095. And for the time being at least, and maybe forever, the last post. There are three main reasons for this:

1. A post a day’s a big undertaking. For me anyway. I’ve enjoyed doing it. But in recent months it’s become more arduous. And less fun.

2. Last week I received some not-so-good health news. Currently I don’t know its full import. But whatever it turns out to be, I have much thinking to do. And I know I’ll think better without the pressure of a daily Farmdoc’s Blog post weighing on my mind.

3. Because of that news, Sweetheart Vivienne and I have decided to sell our Mole Creek property as soon as we reasonably can, and then move to Victoria near our darling ones. So we’re starting work on a new blog – as yet untitled – aiming to attract a purchaser. And most definitely I can’t maintain two blogs simultaneously.

In that first post I wrote that writing Farmdoc’s Blog would help me find out about myself ‘And if it also helps others, in however small a way, then that can only be a good thing’. I know I’ve achieved that first aim. The second one I don’t know about.

On 27 September 2009 I wrote a post about the Last Post. In a comment on it, darling Meg wrote ‘FD you gave me the fright of my life! I saw the words last post and I thought that you were henceforth taking leave from your blog’ [2].

Friends, the time’s come for me to take leave from this blog. I plan to put up one more Farmdoc’s Blog post in the next couple of months – when our new blog goes live. After then, who knows?

So there you have it.

Thank you for accompanying me on my journey.

Farmdoc.

P.S. I remain contactable at the email address in my Blogger profile.

Review Tuesday: 'Not your ordinary doctor'

Today’s ‘Review Tuesday’. A fortnight ago I reviewed The Pen & the Stethoscope – a collection of short stories all written by doctors [1]. As chance – or perhaps grand design – would have it, of the several library books I had on order, the one that arrived next for me was on a somewhat related topic. Not your ordinary doctor is a 346-page 2010 non-fiction book about doctors who’ve also pursued non-medical fields of endeavour [2, 3]. In most cases their non-medical fame (or notoriety) exceeded their medical repute; in other cases vice versa. Author Dr Jim Leavesley tells the stories of sixty ‘medical truants’ comprising doctors to royalty and national leaders; doctors in the arts; doctors who’ve been adventurers, inventors, athletes or politicians; and doctors who’ve been criminals. Several of their names are well known – including Aristotle, Keats, Maugham, Roget, Borodin, Conan Doyle, Chekhov, Gatling, Bass, Livingstone, Grace, Bannister, Montessori, Crippen – and some not. Only a few are Australians. Only a few are women. And only a few are contemporary. This is the eleventh book written by Dr Leavesley (who since 1986 has been an accomplished and loved ABC broadcaster) [4]. He writes nicely. But all too often excessive factual detail distracts from his main theme. Yet overall this is book’s fascinating. And its 16 cm square format’s refreshingly different. Though the cover photograph relevance escapes me. Ho hum.

Cheered up by 'The Australian Medical Dictionary'

Subculture. thefreedictionary.com defines it as ‘a cultural subgroup differentiated by…factors that functionally unify the group and act collectively on each member’ [1]. According to this definition, the medical profession’s a subculture – even though it’s not on Wikipedia’s list of subcultures [2]. One factor delineating a subculture’s a unique vocabulary. Medicine has one. Well, two actually. One’s the official one comprising orthodox medical terminology. And the other’s an unofficial one – that’s known to medical practitioners but not to non-medical people. In general its words, phrases and acronyms are irreverent at best, insulting at worst, and non politically correct always. Also funny. Very funny. Here’s a BBC article from 2003 explaining what I mean [3]. Segueing slightly on from there, is a list of words published in the April 2011 issue of Australian Medicine. Titled ‘The Australian Medical Dictionary’, it comprises definitions of medical terms [4]. But these definitions are funny. No – they’re hilarious. To me, anyway. I wish I had the wit to compose definitions like these. After the week I had last week, ‘The Australian Medical Dictionary’ has helped cheer me up. That’s for sure.

Call Yachol - a wonderful business

Today’s ‘Positive and Optimistic Sunday’. Indeed today’s the sixth consecutive ‘Positive and Optimistic Sunday’ post about Israel. No apology from me for that. All six topics are clearly positive and optimistic. None more so than today’s. Call Yachol is an Israeli call centre and outsourcing company [1]. Set up in 2008, Call Yachol’s the brainchild of psychologist Gil Winch. It’s unique in the world – because it employs disabled adults (aged 20-65 and with no cognitive impairment). Including more than a few Israeli Arabs. In Hebrew, Call Yachol means ‘able to call’, and also ‘able to do anything’. Which is precisely what the more than 100 disabled team members do. Conscientiously and effectively. Whilst having some fun along the way. And providing them with a sense of teamwork and accomplishment, and a boost to their confidence and self-esteem. This 4-minute YouTube video explains more about the aims, ethos and achievements of this inspirational enterprise [2]. Call Yachol competes for work on the open market – apparently very successfully. A society is measured by how it treats its weakest members [3]. Judging by Call Yachol and the international interest being shown in it, Israel measures up well. Exceptionally well. How positive and optimistic is that.
H/t Sweetheart Vivienne for alerting me to this wonderful business.