How am I going to do it?…Two days and counting…Favorite Ireland photos…

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Tom was standing at the doorway to a house at the Connemara Heritage and History Centre and the Dan O’Hara Homestead.

Fascinating Fact of the Day About Ireland 
“The submarine was invented in Ireland.  John Philip Holland (29 February 1840 – 12 August 1914) was a Christian Brother from County Clare who invented the first submarine used by the US Navy and the first Royal Navy submarine– Holland 1”,

Over the past several weeks, while feeling awful due to side effects from several medications, I knew it was time to wean myself off of them. I’ve wondered how I would manage all the walking and being up and about all day and evening while on the upcoming Baltic cruise.

There’s no way I’d want to spend the days and nights in the cabin. Thus, over the past two weeks, I stopped two drugs, and today, I started reducing the dose on the third, a beta-blocker that is causing me to feel sleepy all afternoon and evening.  

A friendly little lamb at the center.

I’m already on two medications to lower my blood pressure which I’ll continue to take, but this third medication, bisoprolol, has a profound effect on how I feel all day. Also, my blood pressure and pulse are too low, further exacerbating weakness and exhaustion.

While in South Africa at my last appointment, the surgeon stated I could stop these two previous drugs, amiodarone, and bisoprolol by the six-month anniversary of the surgery coming up in six days. He didn’t suggest I stop the statin but based on extreme muscle pain caused by this drug. I decided to stop it.

At first, when I stopped the statin, I noticed an improvement in the pain in my arms and legs. About a week later, it returned, and it made me look hard at these other two drugs could also be contributing to the pain.
Thatched roof structures.

After reading the drug literature from the manufacturers and non-biased drugs, and prescription informational sites, I knew I’d better get off the two other drugs to begin feeling better.  


The side effects of all three drugs were similar in some ways, contributing to pain, muscle wasting, and weakness. This morning, I cut the heart-shaped pills into tiny pieces with a plan to taper over the next nine days taking ⅔ of a pill the first three days, ½ the second three days, and ¼ on the final three days, stopping entirely on the 10th day.
A footbridge was leading to a hut.
Cardicor (South Africa trade name), aka bisoprolol, is particularly dangerous to reduce the dose. Why didn’t the doctors warn me about this and getting off amiodarone, both of which may cause problems when stopping?

I am prepared for any possible side effects, and if necessary, I’ll slow the process even further. I am anxious to see how I’ll feel around noon today with today’s reduced dose. Usually, I can’t even keep my head up at noon, so tired from the drug I’d have taken at 8:00 am.  

However, I am also prepared that I won’t notice a significant improvement until it is entirely off. Why did I choose to do this four days before the upcoming cruise?  If I didn’t, I would be spending the better part of each day, sleepy and exhausted, in the cabin. I had to take the chance.

Dan O’Hara’s home in which he lived with his family.
In the interim, I’ll be checking my pulse and blood pressure every few hours during these next several days, ensuring I am not experiencing any difficulties. If I do, I can slow the weaning process over several weeks.

If I experience significant problems while weaning, I’ll immediately go back to the original dose and wait until we get to the UK at the end of the month when I plan to see a cardiologist for a checkup.  

Of course, I’m hoping that one day soon, I’ll feel better, but I’m not expecting too much. This has been a long, painful and challenging process over which I’ve had little control. I continue to walk but can’t seem to build much endurance in my current state of weakness.

Tom had to bend over to enter the stone house.
My packing is almost entirely done. Tom packed his clothing this morning.  Tomorrow, after the final load of laundry is done, and once the clothes we’re wearing are dry, we’ll finish packing our bags and weighing them.

Tomorrow, we’ll be back with the final expenses for Ireland and the wrap-up of our favorite photos. Please check back. 

 
Photo from one year ago today, August 6, 2018:
This may have been a huge matriarch we spotted from across the Crocodile River from the fence in Marloth Park. Be well. For more photos, please click here.

 

A stunning discovery…Everything has changed…

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In Madeira, Portugal, five years ago today, we wrote: “Nothing like a view from the veranda at dusk.”  For more details from that post, please click here.

Fascinating Fact of the Day About Ireland 
“The Royal Cork Yacht
Club, founded in 1720, is widely recognized as the world’s oldest yacht club.
The club plays host to Cork Week, Ireland’s largest and most prestigious
sailing event, held every two years and attracting boats and sailors from
around the world. There is still a very strong tradition of sailing in many of
our coastal towns, and you can either hire small sailing boats for your own use
or sign up to sailing courses in towns such as Schull and Baltimore.”

_______________________________________________________
In an effort to avoid complaining and becoming known as a “whinger” or “whiner,”  I haven’t disclosed here quite how bad my recent situation has been.  My painful legs and arms made walking or performing the simplest of tasks unbearable.

Yes, I walked everyday recording steps on my fitness tracker but each step took everything I could muster.  Also, I wasn’t noticing any improvement after all the walking up the hill, up and down the stairs, and throughout the house.

I’d mentioned this to Tom but didn’t emphasize how severe the pain was.  I didn’t want him to worry any more than he’d worried already.  As of several days ago, I was imagining life in a wheelchair along with an end to our travels.  Desperately, I tried not to keep mentioning it.
A summer rose in Madeira.
The only relief I had was when sitting or lying down.  When I was cooking or hanging laundry I could barely stand in one place.  I was trying hard not to let this get me down but I was teetering on the edge.

Each time we’ve grocery shopped or took off sightseeing, I could barely get my legs to move.  My arms and shoulders ached.  I did arm and shoulder exercises to no avail. Getting dressed took everything I had.

Each day I contemplated what we were having for dinner and how long I’d have to stand in the kitchen to prep the items.  I let carrots spoil when I couldn’t imagine peeling them while standing at the counter.  I know I could have asked Tom for help but good grief, it’s been over five months and I’ve needed to be more independent.  How would this ever improve?

I wrote to the cardiologist and he assumed something was wrong with my heart and I needed to make an appointment with a cardiologist.  But, my heart is fine.  When I’ve walked up the hill in front of the house my legs burned beyond description.  My pulse was exactly where it should have been.  I wasn’t out of breath any more than Tom would have been.  He’s very healthy!
Lush greenery, blue skies, and the sea create a colorful scene in Madeira.
At a loss, I didn’t know what to do.  Subsequently, I started reading the medical literature, kindle books, and reputable information by world-famous and highly regarded cardiologists and physicians…not public opinion, not forums, and not heart-related blogs.

After weeks of research, I discovered what I’d expected, that as much as 30% of patients stopped taking their prescribed statins due to side effects.  In the US, over 28% of people over 40 years old are on statins.  How much money Big Pharma has made!

Prior to the discovery of my cardiac issues, I was a stench naysayer about statins, having read volumes about them.  I’d pull out my statin “soapbox” from time to time (when appropriate) and express my views.

But, when suddenly I was a cardiac patient after triple bypass surgery, the first drug they gave me was a statin, comparable to a drug called Crestor in the US but known as Zuvamor 40 mg in South Africa.  
Rooftops, power lines and terraced hills are a common sight.
When I questioned the doctors expressing my aversion to statins during my followup appointments, who are often funded by “Big Pharma” they insisted the drug would save my life.  Frightened, while not feeling well, I acquiesced and took the daily dose.

Every day that passed, the pain escalated and I came to the conclusion it was the statins, for the very reason I was vehemently opposed to this class of drugs.  Conducting more research I discovered it takes 77 hours or more for the drugs to leave one’s system.

On Tuesday night, I took the last pill deciding I was done with statins.  If, and I mean, if, I believed that they’d protect my health, I might be worried about stopping.  But, after considerable research, I feel at ease knowing I am doing the right thing.


Please keep in mind my decision to stop statins in no way is a suggestion you do the same, nor am I soliciting any medical advice. Each of us must become well educated as to what works for us with the support of medical professionals you trust.
Banana leaves along the road.


That’s the keyword…”trust.”  I noticed in the medical report I received from the surgeon (upon request) that he stated I’d had a heart attack.  I did not have a heart attack and asked him to amend the report accordingly.


This morning, less than 77 hours since I stopped the drug, I got out of bed, hopeful.  Alas, after moving around I noticed an 80% improvement in the pain in my arms and legs.  I’m anticipating that as more and more of the drug leaves my system, I’ll continue to feel more relief.


This morning we grocery shopped and for the first time shopping since the surgery on February 12th, never once did I think about pain in my arms and legs.  Once back at the house I easily put away the groceries while Tom helped as usual.  


Previously, I had to pull up a chair to the open refrigerator to put things away.  Today, I easily bent over the under-counter fridge to load the vegetables in the drawer.

With few homes having clothes dryers, railings on verandas become clotheslines.

Am I taking a risk?  With no conclusive evidence that taking statins prevents heart disease, I don’t think so.  But, if I am taking a huge risk, quality of life is most important to me.  Living in a wheelchair due to side effects from a drug is no quality of life for me, especially for our lifestyle.

You may say, try another statin.  I appreciate the concern.  But side effects are many regardless of the brand name and even lower doses.  I’m done.  Done and happy to be so.

My legs are weak but now instead of walking gingerly and favoring the pain, I can begin to walk with confidence and finally build some strength.  No, I’m not totally 100%.  That will take time, especially at my age.  But, I will continue on this path with optimism and hope for the future. 


Thank you for listening…

Be well.  Very well.
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Photo from one year ago today, July 26, 2018:
This giraffe was having a “bad hair day!”  The hair on the female giraffe’s ossicones is usually short and straight up.  For more photos, please click here.

Finally, we found travel insurance…

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This photo is similar to a photo we posted a few days ago, but we couldn’t resist posting this alternate view.

Fascinating Fact of the Day About Ireland 

“Contrary to popular belief, and despite being the
Patron Saint of Ireland,
St. Patrick was not actually from Ireland. Born in Wales around 386 AD, he was
in fact captured by the Irish and sold into slavery, working as a shepherd in
the West of Ireland. Later in life, he returned to Ireland as a missionary,
helping to spread Christianity in Ireland.”
_______________________________________________________

It’s been difficult finding health insurance for me based on two factors; my age, 71, and my preexisting condition after cardiac bypass surgery.  The new policy requires 180 days to have passed since any surgery or medical treatment.  


This 180 day period will have transpired once the insurance goes into effect on August 11,  2019, the day we board the ship.  At that point, the waiting period is off by one day but, they have a two-day grace period which confirmation I received in an email from the company.

Lovely scenery even on a cloudy day.

These two risk factors made us fearful that we’d never find insurance for me.  We’d done hours of research and finally found a company and policy that works for us.  The company, UnitedHealthcare Global may be found at this link.


Today, after posting here, we’ll sign up and pay for the policy which will run from August 11th to November 8th, the day we arrive in the US where we’ll stay for a total of 83 days in three states.  


The coverage doesn’t cover stays in the US and thus we’ve decided to pay for the period ending November 8th when we arrive in the US.  Subsequently, we’ll purchase a one-year policy beginning on January 30th, when we fly to India.  This is an ideal plan for us.  Each year we’ll renew for appropriate periods excluding the US visits.

Across an inlet.

This gives me great peace of mind.  I was losing sleep over this, worrying we’d be traveling without insurance.  If you’re interested in pricing for this type of policy there is an app at their site which calculates many factors to determine your rate.  


We do not have to pay an “upcharge” for my preexisting conditions
The policy includes evacuation insurance.  The prices are lower than most and the benefits are many.

View of mountains and sea.  Such lush greenery which Ireland is known for, The Emerald Isle.

Soon, we’ll cancel our existing policy which does us little good at this point, especially as we continue to deal with their non-payment of my claims.  More on that later, when we know what’s going to transpire.


It’s another windy, rainy and overcast day.  Since the grounds around us are covered in vegetation and weeds, the pollen in the air is intense.  Both Tom and I are sneezing a lot.  


With only 15 days until we leave Connemara to head back to Dublin, we’ll be ready to be on the move.  We’ll spend one night in Dublin and two nights in Amsterdam and then…the Baltic cruise will begin.  

More cattle along the driveway from our house to the road could be mom, dad and, calves.

Both of us are excited about this upcoming change, looking forward to the cruise and the two months we’ll spend in four locations in England, living in the countryside, fulfilling one more of our travel dreams.


Happy day!

___________________________________________________


Photo from one year ago today, July 23, 2018:

A wildlife wonderland as seen from Marloth Park.  For more similar photos, please click here.

Climbing a steep hill…A milestone day?…

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Seafaring boat on dry dock.

“Fascinating Fact of the Day About Ireland”
“Croaghaun in Ireland is the second highest cliff in Europe.“

There’s a steep hill from where the house is located up to the long gravel driveway, which leads to the main road. Many times over these past two months, I wondered if and when I could tackle that hill.

I set a target date of July 4th. This date would be easy to remember due to its significance in the US as the holiday, Independence Day. The closer the date approached, I knew I was going to tackle it.

After walking inside the house for almost two months on level surfaces, with one flight of stairs to the bedroom level, I knew it was unrealistic to think the indoor walking was comparable to walking outdoors on rocky, uneven surfaces.  
Another waterway at low tide.

And thus, outdoor walking, albeit at a slow progression, is my new mission as an adjunct to indoor walking, which I must also continue. Once I can work my way to the road. Hopefully, I’ll feel confident in partaking in tours during the upcoming cruise from Amsterdam in another month.  

We’ll spend two nights in a hotel in Amsterdam and will surely want to walk around the historic city and explore the sights. My ability to walk for more extended periods is vital to this and other upcoming visits to various cities and countries.

After the cruise, we’ll be heading to England, mostly in and around Cornwall and (think scenery from Poldark, Doc Martin, and Broadchurch, all filmed in and around Cornwall and the further away, Bristol).

Certainly, while in England, we’ll take advantage of opportunities to walk into town, which is possible at a few of the four rentals, including a two-night stay in Southampton before boarding another cruise that will take us back to the US for a family visit.
This bird was identified as a Hooded Crow, or Grey Crow in Ireland, as determined by a friend (who lives in UK and Marloth Park), Lynne, who, along with her husband Mick, are expert birders.  Thanks once again, Lynne!!!

Being on a cruise requires a tremendous amount of walking and going up and down steps. It’s often quite a distance from the cabin to any of the venues we prefer overall; the cafe, the restaurants, the bars, the theatre, and more.  

During the first evening’s required “muster drill,” approximately five flights of stairs must be navigated up and down. Since I don’t have any visible signs of recovering, I’d prefer not to draw attention to myself by stopping too often to catch my breath or rest my legs.

When I first had this major surgery, I’d been told to expect 8 to 12 weeks for a full recovery. I’m sure some patients do accomplish this goal, but I haven’t been one of them.  
A cattle family lounging together on a hill
With the two heart surgeries and two leg surgeries, I may be slower than many others but then again, faster than others. It’s a personal thing predicated by many factors.
Also, today is the first day in many months I have not worn the bandages on my left leg. Recently, as my leg has healed, the adhesive from the bandage has been causing a tremendous amount of itching, keeping me awake at night.
 

This morning I took a shower, patted it dry, and put on Capri length pants to avoid rubbing the still-open wound. I’ll have to cover it when I go outdoors to walk, but for now, as I sit here in the comfy chair, preparing today’s post, it feels good to have fresh air on the leg after so long.

Small seafaring vessel.

The incision in my right thigh is still black and blue and feels as if it has needles in it. At night, I have to put a pillow between my knees to avoid the pain. (I no longer take any pain medication).

What else is still painful and uncomfortable? The incision scar in my sternum is itchy, feels as if it’s pulling the skin, and remains raised. The hardest part is having trouble bending over to pick up something from the floor or looking for something in the tiny under-the-counter refrigerator in the kitchen.

Although comfortable while sitting, the chair I use is low to the ground, and I have trouble standing up from it. My legs are still sore from the surgeries, and I don’t possess the leg strength I had in the past.
There’s not a lot of crime in Connemara. The police department in Carna is located in a tiny building. Police officers are referred to as “Garda” in Ireland.

From time to time, my heart does weird things; too fast, too slow missed beats.  These can be unnerving, but I’ve decided not to worry about it when I know this is not unusual during the first year post bypass.

Nonetheless, I feel pretty good overall. I can perform most household tasks, cook, do laundry and make the bed. Tom continues to be helpful, but now I make a point of doing things for myself.

In five days, it will be five months since the bypass, and now it’s three months since the leg surgeries. For the first time in my life, I haven’t pushed myself to do more and more. Taking it slowly works best in this game.

Nearby ruins.  Many such buildings are found in the countryside.

So, maybe today is a milestone day…no bandages for now and…I can walk up and down the steep hill, which I am currently doing each day, walking further and further. I’m grateful to be alive and remind myself of this fact every day, and each time I feel a twinge of discomfort.

Today, another rainy day, we’ll stay in and revel in a quiet Sunday, the views of the bay, the wildflowers blooming all around us, and a great meal for dinner after a tasty breakfast of scrambled eggs with onions and cheese.

Enjoy your Sunday, too!

                    Photo from one year ago today, July 7, 2018:
We were busy inside the house preparing for last night’s dinner party. But, we knew the mongooses had arrived by the high-pitched cackling and squeals. Tom always drops a few uncracked raw eggs on the ground to keep them around while we make up the bowl of six to eight eggs (depending on the size of the “band”).  For more photos, please click here.

Macronutrients…What am I doing in an attempt to avoid future heart issues?…

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A calf on a hill overlooking the sea.

“Fascinating Fact of the Day About Ireland”
Over 80% of Ireland’s people are Roman Catholic.”
         
Last night was one of those magical occasions when I slept through the night without awakening until 6:00 am. Tom didn’t do quite as well. But, we bolted out of bed, showered and dressed for the day, and made ourselves scrambled eggs with sauteed onion, grated cheddar cheese, and bacon.

I only had one piece of bacon and one tablespoon of cheese with my eggs adding one of those tiny cans of tuna on the side. This will hold me until I have my required protein smoothie sometime this afternoon.

An old abandoned building facing the bay.
Lately, with all the confusion and lack of good research on how much fat a heart patient can eat, I’ve been keeping track of everything I consume in the free app, Cron-O-Meter, found at this link.
 
I’m attempting to keep my fat consumption under 70 grams per day, protein at 120 grams (As recommended by the plastic surgeon. I’ll lower this after my legs fully heal), and carbs under 50 grams per day (all sourced from vegetables and fruits as mentioned below: avo and tomatoes).  
An occasional sunny day gets us out to take photos.

Note:  Carbohydrates provide four calories per gram, protein provides 4 calories per gram, and fat provides 9 calories per gram.

Thus, my macronutrients are as follows:
Carbs:  4 x 50 + 200
Protein: 4 x 120 = 480
Fat:   9 x 70 = 630

Total calories:  1310
This amount leaves room for a little red wine and an occasional snack after dinner, all of which will increase the above totals bringing it up to a maximum of 1500 calories per day.

Wildflowers are surrounding our holiday home.

Using this app enables me to keep easy track of the above macronutrients and adjust my diet during the day if I end up grabbing something unplanned. I continue to avoid all starches, grains, fruit, and sugar. Although I continue to enjoy tomatoes and avocados, both of which are the only fruits I consume.

My caloric consumption is an ample amount and yet will keep me from gaining weight. Not that I necessarily pay much attention to calories but based on my age, activity level, and current weight this caloric amount is sufficient.

Exciting rocks and seashells line the outdoor ledge of the window.
Perhaps this method won’t have a positive impact on my cardiovascular health in the long run. But add in, walking 8,000 to 10,000 steps a day, not sitting in one position too long, attempting to sleep well, and currently taking vitamins recommended by the doctors:  Vitamin C, CoQ10, Magnesium, Selenium, Zinc, and Vitamin D3. (Please see your nutritionist, dietician or doctor for vitamin doses).

I don’t know what else I can do other than keeping stress at a minimum which is more of a contributor to failing arteries than from diet based on what I’ve researched thus far. 
(These comments are not intended as medical advice.  Please see your doctor for recommendations befitting your medical health).
Stunning view of the bay from our garden.

The only stress I am experiencing now is the ongoing issues with the health insurance company and their refusal to pay, claiming I had a pre-existing heart condition (which I did not).  

Each time I get an email from any of the parties involved, I can feel my heart beating faster with frustration and anger over this unbelievable situation. I can’t wait until this is finally resolved. Each time I think this way, I get up, walk around the house and take lots of deep breaths.
As for today, we’re busy online planning our upcoming trip to the US in less than five months. The time goes quickly, and this has become a priority. Soon, we’ll report back with plans we’ve booked for November.
 
Have a stress-free and pleasant day!
Photo from one year ago today, June 11, 2018:
The rhino’s skin looks a little too large for their bodies. From this site: “Members of the rhinoceros family are some of the largest remaining megafaunas, with all species able to reach or exceed one tonne in weight. They have a herbivorous diet, small brains (400–600 g) for mammals of their size, one or two horns, and a thick (1.5–5 cm) protective skin formed from layers of collagen positioned in a lattice structure.” For more details, please click here.

Tricky situation…

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Happy on a hill.

“Fascinating Fact of the Day About Ireland”
“Guinness
Beer is widely popular in Ireland. It first originated in the country and can be found in Pubs and grocery stores.”
     
It’s challenging to decide on how to begin describing this dilemma. We encounter such challenges in our world travels and usually can figure out a solution. But, the situation we describe here today is challenging.

Picture this…we purchase SIM cards in each country we visit, resulting in our getting a new phone number each time we move to new lands. For us, this works well, avoiding the cost of paying for a US contract we’d never use nor want to use, based on international roaming.

Wildflowers in the garden.

As described in yesterday’s post here, based on the fact our international health insurance isn’t paying my medical bills, we are delivering the outstanding bills out-of-pocket, hoping to get reimbursed at some point which is highly unlikely.

We’ve been able to pay the outstanding bills using credit cards, for which we call the payee and provided credit card information over the phone, except for one.  Thus, this is the dilemma we describe.  

Pretty pink flower in the side garden of our holiday home.

The only way this particular provider will accept payment is through a bank transfer. This is well and good under normal circumstances. However, this morning our bank informed me they require verification of the wire transfer through a verifiable US phone number.  

We don’t have such a number, nor can we receive texts through Messenger on Facebook or locally on our Irish SIM card. For friends and family worldwide, this has worked perfectly. We do have a Skype number but cannot receive texts via this means.

Excuse the tilted photo taken while the car was moving.

When we arrived in the US, we’ve decided to purchase two Google phones. These phones can have a US number and be used at affordable rates for calling and texting worldwide. If we had those phones now, it wouldn’t be an issue.

However, we didn’t want to order the phones to be shipped to us to avoid the possibility of theft and high customs fees. While in the US, this won’t be an issue. We’ll order the phones to be delivered before arrival in the US to be shipped to our hotel in Minneapolis.  

Overcast day view of the Twelve Bens (mountains).

Upon receipt of the Google phones, we won’t ever need to purchase a SIM card again. One weird factor of these phones is that it is expensive for us to call one another. Subsequently, we can use Whatsapp at little cost using the included data plan we’ll select with Google, which may be around Euro 26.53, US $30 a month.

While living in the US before traveling in 2012, our Verizon phone bill with unlimited data, text, and calling was approximately Euro 199, US $225 per month.  If we had a US contract these days, we’d spend more than we can imagine.

Unusual markings on this cow who looks pregnant.

Another benefit of using Google phones is that as soon as we land in a new country, we can call Uber instead of grabbing an expensive taxi waiting outside the pier or airport. Plus, we’ll always have the availability of MAPS the moment we drive off in the rental car.

However, the above is a moot point. For now, we can’t receive a text, nor will our bank accept a phone number belonging to a family member. They will only accept a phone number in our name in the US.  

Her calf is suckling.

How will we pay this bill? I have contacted the payee’s billing department, asking them to suggest an option such as PayPal or, can we mail them a check? Our bank doesn’t handle BillPay payments outside the USA. But we can send a check to our mailing service and have them snail mail the payment, which seems to be our best option.  

We’ll see how this rolls out. We’ll report back.

Have a happy, healthy day!

Photo from one year ago today, June 10, 2018:
Mongooses stay close to one another, often seen grooming and cuddling one another. For more photos, please click here.

The health insurance debacle…Not everything is as it seems…

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What a face!

“Fascinating Fact of the Day About Ireland”
The Irish famine in the 1840s led to a population decline of two million people because of immigration and starvation.”

When we purchased our annual international health insurance policy from a company in the UK almost seven years ago, we’d hoped we’d never have to make a claim. The policy was issued for “major medical” only, meaning it covered hospital stays, surgeries with in-hospital treatment, and medication but not routine doctor appointments, urgent care facilities, or prescription drugs.

The co-pay for the hospitalization is Euro 1763, US $2000, per hospital admission. Since February this year, I’ve had three hospital admissions and four surgeries (two leg surgeries in one five-day hospital admission).  

At the time of the first admission, we paid out-of-pocket, the sum of ZAR 80000, US $5348, Euro 4715, for the estimated cost of the first visit to “theatre” for the angiogram including one overnight stay. At the time, the hospital’s billing department was diligently attempting to get our insurance company to pay, to no avail.

During the subsequent surgery, the cardiac bypass, the insurance company hedged for days but finally got their funding subsidiary to pay a portion of the hospital bill excluding all the doctor bills.  

Our insurance company was attempting to claim I had a pre-existing heart condition I hadn’t disclosed at the time of the application in 2012. This is simply not true.  

Sheep grazing on a hillside.

Sure I took a low dose hypertensive drug for a mild case of heredity high blood pressure, but I had disclosed this at the time of the application.  My blood pressure has been totally under control for the past 20 years, usually running around 110/68, certainly not a concern.

Besides, would we be traveling the world, often embarking on strenuous activities, if I had a known heart condition?  Hardly. We had no idea. We’d have taken immediate action rather than risk my having a life-threatening cardiac event had we known.

Then, on March 29, 2019, we visited the cardiothoracic surgeon for a routine post-cardiac bypass surgery exam at which point when he examined the condition of my legs, he immediately arranged an appointment with a plastic surgeon with excellent “wound care” experience.  

Within hours, I was immediately admitted to the hospital, having the first of two leg surgeries a few days apart.  But, before admission, we spent two very stressful hours, trying to get the insurance company to pay the required ZAR 130000, US $8690, Euro 7662. Here again, we had to pay out of pocket when the insurance company wouldn’t come through.

I spent hours on my phone attempting to get the insurance company to pay. Once again, they used all the excuses in the world to avoid paying. They said we should go ahead and pay out of pocket and later file claims, which we’ve done, again to no response.

Since we’d already paid the plastic surgeon’s bill out-of-pocket, in the above ZAR 130000, we had no outstanding bill with her. Plus, we’d paid the ZAR 80000 out-of-pocket for the first hospital admission to the cardiologist.

Two adult Connemara ponies and a youngster.

Remaining have been the bills for the anesthesiologist, surgical technicians, and most importantly, the cardiothoracic surgeon who’d performed the bypass surgery.

Need I say, dealing with the insurance company and their representatives to get these outstanding bills paid has been an outrageously stressful situation. When I was dealing with this, I could feel my heart pounding in dire frustration.

Why didn’t Tom handle this? We all have our specific skills. Negotiating and handling the endless flow of paperwork was simply not Tom’s forte, and it hardly felt like mine during recovery.

I recall being on the phone with the insurance company while I was in ICU for eight days and immediately upon returning to Marloth Park after the surgery when I was in rough shape for many weeks.

So, where are we now? With their refusal to pay they have claimed they are awaiting my medical records for the past 20 years which I have since verified are in their hands.

Now, bit by bit, bill by bill, we are negotiating with doctors requesting they accept a discounted payment from us. This is standard practice in the medical business when companies often deal with reduced fees for services, especially in the US for Medicare and Medicaid and national health insurance (NHS) as provided to citizens of the country of South Africa.

A beautiful sunset from the garden.

We’re almost done paying with one outstanding payment to negotiate, which we’ll hopefully resolve by tomorrow. At that point, we’ll submit a few more claims and wait and wait and wait…to see if the insurance company will ever reimburse us.

In the meantime, we’ve had no choice but to keep the policy in effect, although they doubled the premium after the surgery. No company will insure me other than Medicare in the US which I may have no choice but to re-instate once all of this is resolved.  

It is ill-advised to cancel the policy now until all of the claims are resolved or, we give up hoping to be reimbursed. While in the US in November, we’re considering signing me up for Medicare which doesn’t pay for any medical treatment outside the US but if I need non-emergency treatment, we can always fly back to the US for such treatment. If it’s an emergency outside the US…we’re in big trouble.

Many may say, “stop traveling and return to live in the US.” We have no interest in doing this. We have a lot of the world left to see and are not forfeiting the joy and happiness we continue to experience in our travels.  

If and when the time comes, we can no longer travel due to medical issues, we’ll decide at that time.  We now realize the delicate balance of life itself, more than ever, and how and why we should live it to the fullest.  

Many don’t get this decision but, we do, and in the long run, that’s all that matters. We’ll continue to update the progress on this frustrating situation as we continue. Right now, our focus is on healing, recovery, and putting all this stress behind us.

Have a pleasant day and evening wherever you may be.

Photo from one year ago today, June 9, 2018:

Water spouted out of his mouth after he took a big gulp of water. For more photos, please click here.

It’s over…

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Appealing view of clouds reflecting into the body of water.

“Fascinating Fact of the Day About Ireland”
The country’s major exports include food products such as potatoes, lamb and beef. They also export a large amount of zinc, lead, machinery, and pharmaceuticals. Their
imports include oil, aircraft parts, vehicles, and petroleum gases.”

Finally, the withdrawal is over. It took one more night’s sleep and three full days to recover. Yesterday was a nightmare. I was lethargic, agitated, and anxious. I couldn’t find a comfortable position as I lounged on the sofa all day and evening.  

Flowers are beginning to bloom all over Ireland as the temperatures are warm.

I ate more than I usually do in an effort to not only distract myself from my state of malaise but in an attempt to nourish myself with healthy foods. I drank no less than a gallon of liquids including herbal teas, spring water and two full mugs of my usual protein smoothie.

At least twice during the day, I fell asleep on the sofa and then in the evening when we attempted to watch the show “Victoria” using the HDMI cord from my laptop to the TV but I kept falling asleep.  It was only 20:00 hrs., 8:00 pm.

Taken through the dirty windshield glass, a family of sheep “movin’ on down the road.”

Off to bed by two hours later, I slept another eight hours awakening at 5:30 am. It was light when I went to bed and then again when I awoke. The curtains in the bedroom are thin and light-colored, and the morning sun easily awakens us each day.  

Oddly, there are 17 hours of daylight in Ireland which will only increase as we get closer to the summer solstice. From this site: “What is the Summer Solstice? IThe summer Solstice in Ireland and Britain– also known as Midsummer – traditionally takes falls on June 21 each year. It is the longest day of the year, i.e. when the sun reaches its highest position in the sky in the Northern Hemisphere.”

The colors on their fleece are meant to identify them from farm to farm. A post a few days ago mentioned: Set against backdrops of rolling green hills and mountains, farmers often paint their sheep. Besides pure identification of the sheep in Ireland, rams spread some color of their own during mating season. With a bag of dye tied around their neck, they leave their mark on the upper back of any ewe they mount.
As I lie in bed contemplating arising, I wondered how I’d feel when I stood up. The withdrawal symptoms after three months of painkillers, although considered relatively mild, were disabling for three days. I didn’t expect to feel better until five to seven days had passed.
 
As I stood up and made the bed (Tom was already up and about) I knew I was better. I’d done the same each of the past three days forcing myself to perform small tasks and it took everything I had. This morning, for the first time in over three months I could do so with ease.
Mom, dad, and the babies were sticking together. In some breeds, both the male and females have horns.

Of course, in Marloth Park, we never had to make the bed with the boys coming six or seven days a week to clean the house. It’s a big adjustment now without all this help.  The biggest issue is keeping the kitchen floor clean until Thursday when lovely Ann, our cleaner comes for three hours to do the entire house.

We were desperately needing to grocery shop today. We had no idea what we’d have for dinner when we’d depleted all the main dish items we’d purchased a week ago.  With the small freezer, most of which is taken up by our ice cube trays, we have little room to store meats for future meals.
This sheep was fascinated with us until we made a noise and then he ran off.

Subsequently, each week we’ll purchase two roasted chickens, one for shopping night and the other for the next night. Then, if we dine out once a week, we only need freezer space to store meats and chicken for the remaining four evenings.  

The fish guy comes once a week and most likely I’ll have the fresh fish that day for at least one night, while Tom has whatever we’ve made to last two nights. The food storage situation is merely one of those adjustments we need to make as we travel the world.

We’ve postponed our trip out of town that we’d mentioned a week ago. With the challenge of the past three days and our need to purchase groceries, we’ll save that for another day. Today, while out and about we’ll be able to take photos to share.  

Have a spectacular day!

Photo from one year ago today, May 20, 2018:

I sat at this table with Gail, Leslie, Pat, and Jeanine while we participated in the Royal Wedding Watch Party. There were others that attended the party but aren’t in the photo. It was a fun day! For more photos, please click here.

Pain killer issues…More discomfort…

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This morning view!

“Fascinating Fact of the Day About Ireland”
“Northern Ireland is governed by the United Kingdom, while the rest of Ireland is an independent nation.”

I deliberated over writing about today’s topic. There’s a certain amount of embarrassment and shame associated with withdrawal from necessary pain medication. We are not talking about non-medically prescribed addiction to opiates which is rampant in today’s world.

Patients often take opiates for medical issues, and when it’s time to stop, they cannot do so or choose not to do so and end up spending months, years, or a lifetime drug-seeking. In a desperate need to acquire more medication, crimes may be committed, relationships destroyed, and even death from overdoses. For more information, please click here for the Mayo Clinic in the US.

That’s not what we’re talking about today. Today, we’re sharing my personal experience over the past three months of taking a prescribed combination drug, Ultracet, which is described as follows: This product is used to treat moderate to moderately severe pain. It contains two medications: Tramadol (37.5 mg.) and acetaminophens (325 mg.), such as Tylenol or Paracetamol.

Although the dose of Tramadol is low, it is a scheduled substance* and considered to be an opiate, a class of drugs described as follows: “Opiate is a term classically used in pharmacology to mean a drug derived from opium. Opioid, a more modern term, is used to designate all-natural and synthetic substances that bind to opioid receptors in the brain. Opiates are alkaloid compounds naturally found in the opium poppy plant Papaver somniferum.”

*Scheduled medications are described as follows from this site. Please remember that we don’t profess to have any special education or knowledge on this topic. Please see your physician for assistance in this manner. However, I do have a story to tell with the hope it creates awareness and support for those who may have experienced similar issues. You are not alone.

Three months and one week ago, as most of you are aware, I had emergency triple coronary bypass surgery on February 12, 2019. Three of the four of my cardiac arteries were 100% blocked. Angioplasty was not an option.

With the necessity of taking veins from the legs with long incisions, inserting chest tubes and neck IV (PICC line), and opening the chest via another 30.5 cm, (12-inch incision) and then cutting through the strong breastbone. No ribs are broken during this procedure.

After surgery, upon awakening and discovering a tube in my throat (intubation), I was in agonizing pain in each area of my body involved in the surgery. At that point, I was given morphine to reduce pain, cause sleep and reduce the memory of the experience.  

No doubt, the morphine worked when it was added to my IV. Upon waking, hours earlier than expected, I remember asking using hand signals for pen and paper to write, “Take out the tube!  It’s hurting my throat.”  

They didn’t remove the tube. They gave me more morphine, and I slept for several more hours. This next time I awakened, the tube was painfully removed while I was awake. More pain.

Over the eight days in ICU, I was given pain medication via the IV in my hand, morphine for the first day and Tramadol, for the remaining time. By the time we went back to Marloth Park, 11 days post-surgery, I was still in an enormous amount of pain.  

In the first 24 hours back in Marloth Park, I pulled a muscle in my right chest in the middle of the night, and the overall pain was exacerbated by 100%. Although Tom provided professional caregiver attention, the pain was unbearable.  

I was sent home with a box of 60 Ultracet tablets with instructions “not to worry” about the drug since the low dose wasn’t addictive and wouldn’t cause any issues upon stopping.  

The doctor suggested I take two tablets every four hours or as needed.  I chose to take one tablet every six hours. It helped make me more comfortable but didn’t relieve the pain. I decided to “suffer it out” with this lower dose preferring not to take any pain medication if I could avoid it.

Then, less than a month after the bypass surgery, both of my legs became infected. After two surgeries, more morphine and IV Tramadol during the five days, I returned to the hospital for two surgeries, three days apart, on both of my legs. I was sent “home” with another 60 mg box of Ultracet tablets.

The pain in my legs proved to be more painful than the recovery from the bypass surgery, although it was a close second. I continued to take the tablets every six hours as I’d done previously. The pain continued, if not fiercely, even when I was instructed to be on total bed rest for almost a month. Walking was limited, using a walker from the bed to the bathroom or from the sofa.

Less than two weeks ago, we returned the walker to a kindly Marloth Park resident who loaned it to us. Thanks to Louise for posting a notice on the Marloth Park website and getting several kindly responses in minutes. I was instructed to start walking.

The pain continued since I still had a massive open wound in my left leg, which required debridement at the doctor’s office every other day, and I continued to take the Ultracet, never more than three tablets a day, one upon awakening, )

The pain continued on the long 26-hour travel day and for the next several days since we arrived in Ireland. Then, a miracle of all miracles, the leg began to improve. On Friday at 6:00 am, I took the last pain pill, knowing the pain remaining until the wound closes would be manageable. I still have two almost full boxes of Ultracet.

By Friday evening, something was wrong. I had the chills, my hands were shaking, I bordered on nausea although I could eat, and I had such a degree of malaise I could hardly move from place to place. It hurts to raise my arms. Walking up and down the steps took everything I had. I knew what it was after considerable research on reputable medical sites.  

I was in withdrawal, not unusual after such a long run of pain medications, including four surgeries, two hospital stays, and a long, difficult recovery. So what am I doing to get through this?

1.  First and foremost: Not taking more tablets to alleviate the symptoms. This would be the worse thing I could do. I put all the tablets away, knowing full well, I wouldn’t be tempted to take more. I want this over with, not prolonging it by taking more pills.
2.  Stay hydrated and eat – Somehow, drinking non-caffeinated herbal tea is comforting and an easy way to consume fluids.  Plus, it’s cool here, and the tea helps me warm up. We made a great dinner last night…yes, I obliged, and I had seconds a few hours later.
3.  Sleep – I wish I could sleep straight through until this goes away. But that’s not possible. Although I had two good night’s sleep on both Friday and Saturday nights and dozed off and on all day on the sofa, I still feel extremely tired and listless.
4.  Keep active – This sounds like an oxymoron when I mention sleep above. But, I’ve found doing light household tasks, cooking, laundry, and continuing the walking seems to help.  
5.  Keep a positive frame of mind – Easy to say, hard to do. But, this will be over before too long.  Based on the length of time I was on the medication and the dose, I expect the withdrawal to last about five or six more days. Today, it’s better than yesterday, which is encouraging.
6.  Tell loved ones about the withdrawal – For some reason, there is shame associated with the word “withdrawal.” There is nothing to be ashamed of for those who’ve taken the appropriate pain killers for medical reasons under the care of a physician. If I’d continued the meds when I no longer needed them, started “doctor shopping” for more, lying to family and friends, and many more damaging forms of behavior, this could be construed as addiction. Tom is supportive, as always, and will do anything to help me get through it, although I am forging ahead trying to stay active.

Why did I write about the personal situation? Take away the “shame” as mentioned above, and we’re hoping this post, even if it only inspires one person, will make it all worthwhile. We are all in this world, in this life together. Reaching out, regardless of the cause, may open our eyes to new possibilities.

Based on the worsening of the symptoms, we decided not to go out last night to the pub in Carna for drinks at the bar and dinner. Once I’m over this period, I’ll be ready to start “kicking up my heels” once again.  

Be well.
             
                             Photo from one year ago today, May 19, 2018:

There were many rainbows at the falls. For more photos, please click here.

A new day…A new dawn…Strength building…More favorite photos…

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A hornbill on a tree in our garden.

“Sighting of the Day in the Bush”

Already, the toad is gaining weight from the excellent nighttime pickings of flying insects near the light fixture.

Once again, this morning, we took off for Doc Theo’s office for our 9:00 am treatment on my leg. But this time, it was different. After appointments with him every two to three days to debride the wound in my left leg, remnants of the infections in both legs since the triple coronary bypass surgery in February, today, we finally made progress.

A giraffe was stopping by.

As he worked on yet another layer in the debridement process, he discovered under all the layers. He hadn’t been able to access it until now. There were four remaining stitches hidden under all the painful layers of skin.  

With considerable pain on my part and apologies for hurting me on his part, he removed the stitches, which looked like they were made of wire instead of some fabric. Tom held my hand as I writhed in pain as Theo carefully removed each of the stitches.

Tusker’s huge tusks. We haven’t seen him in many months and wonder if he was culled.

As soon as they were out, I’d already begun to feel some relief. He was thrilled to finally find these stitches, stating that they were one of many reasons my leg had failed to heal these past many weeks.  

I was attempting a nap in the garden when tusks got in the way.

He removed dead tissue with surgical tweezers and a scalpel to reveal what appears to be pink skin on the way to healing. We are so hopeful. He told me I could return to the cardiac rehab of walking several times a day but after not walking at all or when using the walker for the past several weeks, I am weak but not feeling frail.

Frank.

However, when we returned and walked five minutes without the walker, still tiptoeing on my left leg, I could feel how beneficial the walking would be. I set the alarm on my phone for every two hours when I’ll get up and walk for another five-minute increment. By the end of today, I’ll have walked 30 minutes.

The Mrs.

Tomorrow, I’ll walk for six minutes every two hours to work up to 36 minutes.  Within a few days, I’ll be able to walk 10 minutes every two hours to work up to 20 minutes twice a day, my goal before we leave here in 12 days. At that point, I should be able to walk through the various airports during layovers on our way to Ireland.

Once we arrive in Ireland and get unpacked, I’ll join a fitness center nearby to continue walking on a treadmill and begin strengthening my upper body using weights. Most likely, we’ll go to the fitness center two or three times a week, but I’ll continue walking each day.

Tree frog foam nest, made overnight above the cement pond.

Having worked out most of my adult life, I feel experienced enough to establish a safe and effective means of rebuilding my health and fitness. I am looking forward to feeling stronger after all of these surgeries and periods where I could barely use my arms or legs to help get me up from the sofa or bed.

Within a week of returning to the house in Marloth Park after the bypass surgery, I could stand on my own from a seated or lying position, using my legs for stability. But once, the leg infections worsened, I couldn’t use my legs to help me stand or my arms due to the painful chest after open-heart surgery.

The singing oxpecker atop a kudu’s back.

I bobbled and teetered when trying to get up but refused to let Tom help me. Bit by bit, I strengthened my upper body, enabling me to use my arms to aid in standing from a seated position.

Oh, the things we take for granted. I often think of those in much worse situations than I have been during this time, who are paralyzed or have no limbs to support them.  

Movie night in the bush.

Unfortunately, we humans know that everything is relative, and it’s our situation at any given time that comes to the forefront in our minds when we’re struggling to accomplish what usually would have been a simple task.

I am so grateful to be on the mend. Doc Theo says it may take three more months for my legs to heal entirely, and we’ll have to continue changing bandages every few days for months to come, but we can handle this. I’ll be wearing the compression stockings day and night for months to come.

A handsome male impala in the garden.

Being well, once again, provides sufficient motivation for me to do whatever it takes to continue to improve and, with a great sense of happiness and relief, to continue on our journey. 

By far, this has been the most challenging health-related period of my entire life, one I will never forget as I make a daily effort to be strong and fit and stay that way for as long as I am gifted with LIFE itself.

May your days be filled with appreciation for life.

Photo from one year ago today, April 29, 2018:

This is a common sight in Marloth Park on holiday weekends. It’s packed with tourists sitting in the back of a “bachie” which is Afrikaans for “pick up truck.” For more photos, please click here.