Salad Days

RUSTICSalmon-3

There is a rather wonderful TV series called Boston Legal, in which an attorney called Alan Shore suffers from an intermittent inability to form comprehensible sentences. He opens his mouth, and a stream of complete gobbledegook issues forth. This both alarms and amuses, of course, and after investigation, it is put down to stress and labelled ‘word salad’.

Why am I telling you this? Because for a number of years now, OH has been suffering from a mild form of the same affliction. As in Boston Legal, this both alarms and amuses, and since it appeared to be getting worse, he gave in to my nagging gentle and sensitive persuasion, and went to talk to the doctor about it. And as with the fictitious Alan Shore, it was initially put down to stress, a diagnosis with which OH did not entirely agree1.

A couple of consultations later, however, with me in tow quoting from my ever-growing list of salad options, and he was scheduled for an appointment at the gently euphemistic “Memory Clinic”. I think the consult that did it was the one with our lovely lady GP whose lips twitched as I read out examples such as “Oh, fuck, I’ve put the Bishop into the tea trolley”, which meant “Oh, dear, I’ve put the used teabag receptacle in the dishwasher”. Well, of course it did 2.

Since then he has come out with such gems as “Quick – there’s a folded albatross!”, “Isn’t that a boating upside-down arch?”, and “We could get the cowgate back to the trickle”3. I’m getting quite adept at translating these things, by the way.

And so we went to the Memory Clinic, where OH was put through his paces and would have passed with flying colours had he not tried to be clever when the doctor asked him to list 30 animals in a minute. His downfall was trying to do it alphabetically, but when he got to ‘flamingo’, he was informed that a flamingo was not an animal, which threw him because of course it is, as any scientist will tell you. He ploughed bravely onward, only coming unstuck again with ‘parrot’, which meant that instead of a perfect 30, he scored only twenty-eight4.

As a result of this he was sent for an MRI of his brain, to see if his TIA episodes had resulted in any damage. The MRI, thankfully, was clear.

And so, on our return to the Memory Clinic, OH was asked if he suffered from sleep apnoea, because apparently, this too can result in forgetfulness and language problems5, and he was referred for a sleep study at Papworth. There he was given a monitor to wear overnight attached to a finger, which – although he approached it as one might approach a venomous snake – he dutifully put on and went to sleep, only to wake in the morning to find it coiled up neatly on the bedside cabinet, with absolutely no memory of having put it there. Apparently, this happens quite a lot. Anyway, they had enough data to see that he did indeed have sleep apnoea, and in spades. According to the print-out, he’d been having 50-odd episodes an hour.

This is classed as ‘severe’ sleep apnoea (Oh, really? You do surprise me!).

Now, the problem is that OH is a little claustrophobic. He hates being closed in anywhere (although he deals with lifts surprisingly well), and in particular, he freaks out when thing are attached to his body, like blood pressure monitors, slings, braces … and CPAP masks. He did take one home to try, but his stress levels shot up up just thinking about it. To see him merely holding the box in his hands, you’d think it contained three tropical centipedes, a handful of scorpions and a Brazilian Wandering Spider in a particularly foul mood.

To his credit, he did put it on and lay down, and he did this on three successive nights. I think he worked his way up to about twenty minutes before ripping it off with a small scream and throwing it away from himself. Papworth were philosophical, and said, well, he could try a mouth guard designed to keep his lower jaw pulled forward a tad?

I got the impression that OH agreed to this only because it meant they took away the CPAP box (goodbye, assorted life-threatening arthropods!), but I knew that a mouth guard was not going to stay in his mouth much longer than the time it takes a Mediterranean mosquito to decide that I look like an all-you-can-eat buffet.

And so it was.

So after multiple visits to our local GP, two to the Memory Clinic, and three to Papworth, we are not much further forward, although we do now have the reassurance that he doesn’t have dementia, major memory loss or anything much wrong with his brain. But the Salad Days continue. A nice, solid, non-NHS sling we’de ordered from the internet6 was due to arrive today, and he blithely told me that ‘Your new string will purport the transfer to the here today’.

I suppose now you want to know what ‘rustic salmon’ is all about, don’t you?

No guesses? Well, I must admit I was a bit stumped by that one myself.

Here’s what happened. We were walking back to our hotel in Rome a couple of weeks ago, when we turned into a small, deserted piazza in one corner of which stood a little booth like the ones you see at the entrances to car parks, only this one had an armed carabiniere officer stationed inside it. We wondered why, because there were no shops, no embassies, or anything else which looked remotely military. Then as we turned to look at the buildings behind us, OH exclaimed with sudden inspiration: “There you go – that explains it! It’s a rustic salmon!”

And I turned to see a large building with a small sign, which read:

‘Synagogue’.

1 – His immediate reaction was to get instantly annoyed, wave his arms about and say – in a voice of a noticeably higher pitch and speed – “STRESSED? I’M NOT STRESSED! I DON’T GET STRESSED!!”

2 – Yes, she did laugh, but only after we’d both given her permission. We said: “Oh, go on, you can laugh. We do!” And she did (but only a little).

3 – 1 – “Quick, there’s a pedestrian crossing!”
2 – “Is that the bridge (we are looking for)?
3 – “We could get the vaporetto back to the station” (a vaporetto being a Venetian water-bus, and yes, we were in Venice at the time).

4 – He is aggrieved about that to this day.

5 – ‘No,’ he said, confidently, ‘I just go to sleep, and then I wake up in the morning – unless I get up for a pee’. ‘Yes’, I said. ‘He does. Sometimes I think he’s dead’.

6 – See previous post.

Jeffie’s Neurologist

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We popped down to the Queen’s Veterinary Hospital at Cambridge University yesterday to see Jeffie’s neurologist, Paul Freeman. We didn’t take Jeffie along because we were only going to view the scans and x-rays which had been taken when he was seen there, but which for some reason we didn’t get to see at the time.

It felt strange walking into reception without a dog, and knowing we weren’t even there to collect one. I almost felt like a fraud. So I buried myself in my Which Digital Camera? magazine, because another thing we were going to do was visit the Campkins photography shop to see if we could get me a new camera.

And the time went by. I read all the latest reviews and discovered that since I last bought a one, something called a Compact System Camera had appeared in large numbers, and that I wanted one.

We were given some tokens by the receptionist for a hot drink from the machine, and passed a minute or two selecting and following instructions after which we drank the strangest cappuccino either of us have ever tasted1.

More time passed. Canon and Nikon were metaphorically ditched, and I learned that Sony cameras were well respected and that Olympus were not only still being made but were strong contenders. I also learned that something mysterious called the Micro Four Thirds systems was raising the game.

And eventually, OH said: ‘Do you know we’ve been here nearly an hour?’

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I went up to the desk and relayed this information to the receptionist in a polite ‘how much longer?’ kind of way and she checked our appointment time and who we were here to see, and looked horrified that we hadn’t been seen yet and rang through to find out what was going on, and a few minutes later the neurologist came through apologetically and ushered us into a consulting room. It seems he was just about to ring us to find out if we were coming or not, because his pager had fallen off somewhere and he’d never got the message that we had arrived.

Ah well. There then followed a most interesting session with him showing us the x-rays and MRI scans and explaining what all the things we could see thereupon actually meant.

My eye was immediately drawn to a bulging disc, but in fact it was an old problem, quite calcified and unlikely to be causing his symptoms because a) he doesn’t appear to be in pain judging by the way he throws himself about and leaps into the car like Zebedee, and b) it isn’t compressing anything. This was in the cauda equina2 area, but most of the bulging is in the safest position, which is downwards, and the nerves are not being pinched. We discussed his demeanour, his playfulness, and lack of any obvious signs of pain, plus the fact that he is in fact on anti-inflammatories as a kind of empirical ‘he’s nearly thirteen years old, he must hurt somewhere‘ solution. Personally, I haven’t seen any sign of any difference in him since he’s been on them, but I’m willing to trust my vet on that one.

There are also a few bone spurs, most noticeable in the thoracic region, but again, not of a type to cause a problem, and not in a place where they might cause a problem. ‘It’s something you see in old dogs’ he said. Fair enough.

I wish I’d thought to ask if I could snap a couple of pictures off the screen to show you, but the sad fact is that I didn’t, so you’ll have to make do with some random pictures.

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Anyway. It was lovely of Mr Freeman to give us an appointment just to go and see the scans and to make time to explain everything thoroughly for us. I have to say that our experiences so far with the Cambridge vet school have been outstanding, and this afternoon gave us a new appreciation for exactly why the cost of an MRI is so high. Not only do the machines themselves cost an absolute fortune3, and animals need to be anaesthetised while inside them, but because the area they cover at any one time is so small, it can take a long time to get the information you need. You have to first determine which area is worth looking at by clinical examination, then take some x-rays to narrow it down, then set up your MRI to make ‘slices’ at predetermined intervals through the tissues. Each slice examines a two-dimensional area, so that, for instance, to examine a short section of spine properly4, you might need about fifteen slices – which all take time, both to produce and to analyse.

For Jeffie, today’s visit will make absolutely no difference at all. For us, it was reassuring to know that we had done, and were doing, all that was reasonable. He is an old dog – thirteen years old in a few months – and there is a limit to what one should do, I think, if the benefit does not outweight the risks and stresses involved. What we hope for Jeffie is that he will continue to enjoy life in his own idiosyncratic way, despite his ‘Dogzheimer’s Syndrome’ and his wobble issues, right up to the day we find that he has peacefully slipped away from us in his sleep. It’s a rare thing, but when it happens to an oldie whose issues are known and are being addressed, it’s a real blessing.

1 It must have been cappuccino because it said so on the pod. Tell me: why do coffee machine manufacturers assume that anyone who wants cappuccino or hot chocolate also wants to compromise their pancreas and rot their teeth? What is wrong with being allowed to add sugar by choice?

2 Cauda Equina literally means ‘horse’s tail’ and refers to a section of spinal cord with nerve roots branching out all over the place.

3 Pet Plan insurance is our friend.

4 In the ‘through the tube’ direction, not with the animal flat on his side.