Being Up-titrated !

You know how I love new words, well …

… back in July, after a Facebook post about my medication increase, a good and learned friend commented: “Great, you’re getting all the added benefits of up-titration (as we call it in the trade)“. I have to admit this was ‘foreign language’ to me. So, eagerly looking it up I found a very clear and helpful definition courtesy of The Cleveland Clinic in Ohio, US. Here I quote: “Titration is a way to limit potential side effects by taking time to see how your body will react to a drug. In titration, the medication is started at a low dose. Every couple of weeks (or so) the dose is raised (‘up-titrated’) until the maximum effective dose (‘target dose) has been achieved …”

In my research I also came across these guidelines, entitled:

The NHS Protocol for Titration of Beta Blockers for Heart Failure:

How to use:
• Ensure patient has stable mild to moderate HF
• Start with low dose & double dose at not less than 2 weekly intervals
• Aim for target dose or highest tolerated dose (some beta blocker is better than none)
• Monitor heart rate, blood pressure, & clinical status (especially signs of breathlessness, swelling, body weight increase)
• Blood test to check kidney function 1-2 weeks after initiation

Advice to patients:
• Explain the benefits – given as much to prevent worsening HF as to improve symptoms &
increase survival
• Temporary side effects may occur during initiation/up titration phase
• Advise patient to report any increasing breathlessness, fatigue, swelling or weight gain, but stress that it can usually be managed by adjustment of other medication; patients should be advised not to stop beta-blockers without first consulting the clinician
• Consult clinician in the event of persistent weight gain occurring

What became immediately obvious and heartening to me is that my brilliant personal cardiac nurse, Michelle, carefully employed ‘best practise’ in my treatment, following protocols described above to the letter. This I’ve appreciated enormously, considering the potential side-effects of the particular medication in question, listed in the package leaflet:

Common side effects can include headaches, dizziness, feeling light-headed, weakness, fatigue, cold hands & feet, sickness, diarrhoea or constipation

Serious side effects could include shortness of breath (especially when exercising), swollen ankles/legs, chest pain, irregular heartbeat, wheezing, tightening of chest (which can be signs of lung problems) yellow skin or whites of eyes turning yellow (signs of possible liver problems), sleep disturbances, depression, muscle cramps.

Thankfully, I can report that side effects have been minimal – some light-headedness (days within each dose increase, but short-lived) fatigue and some sleep disturbance – but none of those other ‘nasties’ mentioned above occurred in the 5-month long process between mid-March and August when the ‘target dosage’ of 10mg daily was successfully attained. The outcome in my case it seems is that ‘up-titration’ has facilitated maximal tolerability (10mg) to the Bisoprolol Fumarate.

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REFLECTING on this experience it occurs that over many, many years I’ve been the beneficiary of what may be termed “spiritual up-titration”. I’m finding a “stretched similarity” with the phenomenon formally known among theologians as “sanctification” – that long, slow (and in my case, painful) process beginning at ‘conversion’ in February 1967 and continuing to this day, with the intention of transforming me into someone more resembling Jesus Christ.

Oh, I acknowledge there have been loads of set-backs, and lots of static (even stagnant) periods, due to my propensity for poor choices, selfishness, laziness, rebellion and other unsavoury characteristics. So, clearly I’m not talking ‘quick fixes’ here, nor suggesting anything that produces instant maturity. As one of my favourite Christian authors teaches in his classic work, “A Long Obedience In The Same Direction”. Eugene Peterson typically identifies in this work a major problem for travellers on the Way – which is both spiritual and cultural. “Everyone is in a hurry”, he writes, “the persons I lead in worship, among who I counsel, visit, pray, preach and teach, want shortcuts … they have adopted the lifestyle of a tourist and only want the high points“.

All that said, I can testify that, step by step, little by little, line upon line there is a metamorphosis occurring – I may not be what I should be, but most certainly I am not what I used to be. I simply love the description shared by St Paul in one of his letters in our New Testament. Writing to the church at Corinth he declares: “And we all (i.e. believers) with unveiled faces, beholding the glory of the Lord, are being transformed into the same image from one degree of glory to another. For this comes from the Lord who is the Spirit.” – 2 Corinthians 3:18.

That’s exactly it – the process of being transformed (up-titrated, even ?) from one degree of glory to another. I find it not without significance that the word translated ‘transformed’ here is the exact word translated ‘transfigured’ in the amazing account of Jesus’ Transfiguration – literally ‘metamorphosed’ – such is the magnitude of the change taking place in Christ-followers as they co-operate with the Spirit of God.

Other translations have:

“…we are becoming more like Him with ever-increasing glory …” – International Standard Version

“… our lives gradually becoming brighter and more beautiful as God enters our lives and we become like Him …” – The Message Bible

“… we are being transfigured into His very image as we move from one brighter level of glory to another …” – The Passion Translation

I’m mindful of similar Bible passages which speak of God’s purpose in this way – here are a couple of examples:

“God knew what He was doing from the very beginning. He decided from the outset to shape the lives of those who love Him along the same lines as the life of His Son. The Son stands first in the line of humanity He restored. We see the original and intended shape of our lives there in Him.” – Romans 8:29 from The Message Bible

“My dear friends, we are now God’s children, but it is not yet clear what we shall become. But we know that when Christ appears, we shall be like Him, because we shall see Him as He really is.” – 1 John 3:2 from the Good News Bible

There’s the “target dose” (if you like) – Christ-likeness, which will be fully realised when we finally behold him. So, now it dawns on me that I share precisely the same hope as the psalmist, who exclaimed excitedly: “As for me, I shall behold Your face in righteousness; when I awake, I shall be satisfied with Your likeness” – Psalm 17:15

OH, YES – I’m being up-titrated !!

Me And My Pacemaker – our growing attachment

Here I have attempted to write a personal narrative expressing the goodness of God over recent weeks. I believe this will serve me in two ways: first, by becoming an aide-mémoire, second, by providing therapeutic properties for my heart and mind.

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Symptoms

Breathlessness, significant energy loss, a chest infection and throaty cough, ‘prickly skin’ (but no rash) at night – all conspired, along with my wife’s insistent bullying, to constrain me to call my local surgery asking for a GP appointment. Not as simple as it sounds while in the icy grip of a global pandemic, which has played havoc with social norms, especially relating to the National Health Service. Unsurprisingly my first attempt met with, ‘If you want a telephone appointment you will need to phone at 8am on Monday’ – (this was Friday morning)

Obliging, at the stated time on Monday (14/12) I called the surgery, only to hear an answering machine, repeating, ‘Your call is important to us, please wait for the next available agent’.  More than 20 minutes pass, and I’m on the brink of hanging up when the phone is answered by a real human being. I briefly explain the symptoms. I’m advised there are only telephone appointments because of Covid-19 and I’ll be put on the list for a slot between 9 and 12. I ask if I may have a more precise time, which I’m told is not possible as the GP cannot predict how long each call may take. I seek re-assurance that I’m on the list and this is given.

Consultations

A doctor I didn’t know called around 10.30am and we talked for 30 minutes or so. I was asked to give blood at the Keepmoat Stadium (Doncaster Rovers FC) which I did that afternoon. Early the following morning (15/12) I read these remarkable, and pertinent, words among my allotted Psalms of the day: “My flesh and my heart may fail, but God is the strength of my heart and my portion forever” – Psalm 73:26 … they were accompanied with a special sense of peace.

The surgery contacted me a day later, asking me to go in to discuss my blood results with Dr Umapathee, and to have an ECG. Thankfully I was free to do so. After many searching questions and a thorough examination, Dr Uma indicated that he thought we were dealing with “the beginning of heart failure”. I could hardly believe this, in spite of having seen the above-mentioned Scripture verse the previous day, but Dr Uma went on to say he would arrange for me to speak to a Cardiologist, and to get a Chest X-ray. In fact this was done very quickly – a telephone appointment made with a Cardiologist for Christmas Eve, and a Chest X-ray scheduled for New Years’ Eve.

I must admit the next few days were a bit of a blur, as Sue and I talked together, chatted with friends and sent out requests for prayer. We received many encouraging messages of support on social media, and during my devotions through this time several passages of Scripture stood out to me. As I approached my 69^th birthday (Sunday 20^th Dec) I was moved particularly by phrases which spoke of being ‘even more fruitful’ and of ‘still bearing fruit in old age’.

Wired For Evidence

On Monday 21^st I received a call from the Cantley Health Centre asking if I could collect a 24-hr monitoring device. Unknown to me Dr Uma had also requested this on my behalf. I was able to collect it that day and was ‘wired for evidence’ at around 4pm. The pendant-shaped device was hung around my neck and attached by several wires to my chest area. This meant I didn’t manage much sleep during that night due to considerable discomfort.

I returned the monitor, as agreed by 3pm the day after. Then, for the next few hours, we drove to friends and relatives delivering Christmas presents, and on the return journey diverted to Sainsbury’s to do some shopping. Moments after arriving home I was called by Sarah Ashurst of Broomwell Healthwatch, Manchester. She explained that they received results from 24-hour monitoring devices, and after studying my results she was extremely concerned to see abnormal patterns which suggested I had “entire heart block”. She had tried contacting me for a couple of hours and urgently advised me to get to A&E at the Doncaster Royal Infirmary immediately, taking an overnight bag. Within 30 minutes of her call we were on our way.

A&E and CCU

I registered at A&E around 7.15pm, but Sue was unable to stay due to Covid-19 restrictions. It looked rather busy, and I wondered how long I’d have to wait. After around 45 minutes it came to mind to investigate if my ‘results’ had come through from Manchester. When I mentioned ‘entire heart block’ to the receptionist she took me straight away into the treatment area. My ‘notes’ were being typed up by a staff member, who, after ascertaining more details, allocated a trolley and quickly had me wired up for an ECG. Minutes later I was wheeled through to the Resus. Department, where I was fitted with a cannula and put on a monitor. It was clear they were acting with appropriate urgency and care.

Lots of questions and readings later I was administered a ‘potion’ intended to increase my heart rate, which they were extremely worried about. Around 10pm the senior consultant, Dr Singh came around and said, “You are very lucky, they have a bed for you on the Coronary Care Unit (CCU) and you will be transferred there shortly.” By 11pm I was installed in a 3-bed bay on CCU (also Ward 18). Two of the beds were already occupied by elderly ladies. I was not permitted to use the toilet facilities, even though they were opposite my bed, but handed a bottle to relieve myself – perhaps the most difficult manoeuvre in the entire drama !

Questions and more questions, wires, monitors, comings and goings, buzzings, bleeps, ringings, groans & coughs from the other patients. A drip was set up to keep me hydrated. I was offered food at 12.30am, so opted for a cheese sandwich with crisps and a cup of tea. Throughout the night I was observed every hour – BP, temperature, pulse, oxygen sats, with little or no sleep possible in between, until 5am when the observation regime changed to every 2 hrs.

Introduced to my Pacemaker

After the day shift started around 7.30am there was a noticeable increase of activity. Russ introduced himself: “I’m the nurse who will be looking after you today”. I was provided a basin & water for ablutions, then a breakfast of cornflakes & tea. The regular observations continued until the morning’s main event – the doctor’s round. Arriving at the foot of my bed around 10am the young-looking consultant informed me that I was to be fitted with a pacemaker, and hopefully there would be a slot available that day, if not I would be kept in until Wednesday, after the Christmas break. This obviously focussed my mind and prayers ! I enquired about ‘entire heart block’. He explained how the upper & lower heart chambers had stopped talking to each other. “What caused this”, I asked and was told it was ‘wear and tear’. “So you’re telling me I’m getting old ?’ I quipped, then ‘Don’t worry, I can take it !’ – the consultant smiled wryly and simply moved on !!!

An hour later information came through that indeed a slot was available that afternoon for me to have the procedure. “You’re a very lucky man” was the nurse’s comment as she broke the good news. I learned later that a senior Cardiologist would be doing the procedure. Apparently Dr Gill Payne was called in to do a similar procedure for a local Councillor and had agreed to fit me in ! I would describe this as ‘divine’ rather than ‘luck’.

After this confirmation I was prepared for Cath Labs. given a strong anti-biotic to prevent infection, and by 1pm I was being fitted with a pacemaker after a local anaesthetic. The atmosphere in theatre was totally relaxed throughout with constant conversation and lots of banter among the team. We chatted about various subjects: comments on the procedure; questions about family, about favourite music – e.g. Dr Payne asked; “Who is the world’s greatest guitarist ?”

After 30-40 minutes I was back in CCU, but not permitted to leave the bed for an hour or so. My first ‘adventure’ was to the loo opposite, which I found an immense relief. Then it was off for a chest X-ray to confirm all was well. The only really negative moment of my stay in hospital was a 40-minute wait for a porter to return me to CCU after the X-ray. After a sandwich and some fruit, I was told that I would be moving to another bay (4 beds) with a couple of elderly men. During the move I discovered my mobile phone, which I thought I’d left at home, as I was unable to locate it the previous evening, and was able to make contact with Sue. We exchanged texts for quite some time. The move did make for an easier night, with only occasional disruption (every 4-5 hours for observations)

Christmas

The next day was Christmas Eve. Breakfast was offered and I enquired if there were eggs on the menu – only to be given a bit of a stare by the care assistant. “Oh sorry, it’s not the Hilton is it, we’re at DRI aren’t we?” I laughed. I’m not sure it went down too well (sometimes you can’t tell when a person is wearing a mask !) There was talk of going home, but it seemed I would have to wait for the doctor’s say so. After waiting until around 10am the staff nurse came in & told me I could contact Sue to come for me, as I was being discharged. The doctor didn’t need to see me after all, and in fact I could have gone home the previous evening. After Sue arrived we gave the Unit a Christmas gift, a tin of biscuits. We were home for midday. As I was unable to connect to the internet while in hospital, I spent ages just looking at messages of support on e-mail and social media, being amazed and uplifted to read so many messages from family, friends and acquaintances.

Now, questions turned to what to do about our plans to visit family in Chesterfield for Christmas Day. Already plans had been re-shaped because of the Covid-19 pandemic, and the restrictions of living in Tier 3. This was certain to be a Christmas like no other. A decision was then made easy for us when a near-neighbour came round and offered to provide Christmas Dinner for us, due to a change in their own circumstances. It was a no-brainer – we would cancel our proposed visit to Chesterfield (not that I felt up to travelling !) Later, on Christmas Eve afternoon I was really blessed by the showing on TV of my favourite film, Shadowlands – remarkable for the performances by Anthony Hopkins and Debra Winger.

Christmas Day, although unusual, was a great blessing – remembering the reason for the season through carols; exchanging gifts with Sue; chatting and drinking with neighbours, Linda and Stuart, who came round to us; eating a lovely Christmas Dinner, provided by Jackie and Steve, and delivered straight to our door; watching ‘Call The Midwife’ – along with other very restful things.

Family

Though prevented, by restrictions and health considerations, from seeing either of our children (Mark or Miriam) over Christmas, nonetheless we were really blessed by Mark’s brief visit with two of the grandsons – Oliver & Jacob – on 29^th December as we celebrated Oliver’s 12^th birthday. They didn’t stay long, but it was so refreshing to see them. Then, on New Years’ Day we got to see our daughter, Miriam, with her husband.

Epiphany

A Christian Feast on Wednesday 6^th January which commemorates the visit of the Magi (wise men) to see Jesus – I posted about this Bible story on Facebook: “Reason took them to Jerusalem, but revelation led them to Bethlehem“. This year Epiphany coincided with the start of England’s third major lockdown, another attempt of the UK government to stop the spread of the virus. My readings in the Psalms included Psalm 27, which starts with, “The LORD is my light and my salvation…” and the stand-out verse was v.13, which states: “I remain confident of this: I will see the goodness of the LORD in the land of the living.” I took great encouragement from those words with their ‘prophetic significance’.

Onward And Upward

Writing this final section three weeks after the pacemaker was fitted I can say that it has made an immediate difference to my quality of life. Although I’m only very slowly getting used to it, and still feeling some discomfort, I have not had any breathing problems, and have been taking regular walks around the village (and on Tuesday 12^th January even further afield) with my energy levels rising each day.

I was asked the other day: “How are you feeling now you’ve had a few days to reflect?” – well, I’m feeling greatly relieved, superbly relaxed and enormously grateful … yes, I am so grateful:

• to all who offered prayer and support;
• to the wonderful staff at Doncaster Royal Infirmary’s A&E and CCU departments;
• to my long-suffering wife for her unfailing support;
• to the Lord for restoring me to health through the amazing work of the NHS

And finally … thanks to all who managed to read this far – you’re true heroes !!

Living In The Aftermath

Several months ago my wife & I handed over our cherished foster child to another carer. He’d lived 12 months with us. An extremely energetic little soldier, he’s battled through seemingly insurmountable difficulties in his short life. Months before coming into our care (August 2018) he was fighting for that life. We feel so privileged to have contributed to his recovery and early development. Writing is something of a catharsis for me and I hope my readers will understand, even forgive, for posting this raw piece on social media. I could designate it: “my bitter sweet symphony”.

DISTRESS – The Bitter

Reading in the Psalms pulled me up sharply days after his departure, accurately describing my feelings (as only Scripture can do, when we discover it reading our hearts) – “I am distraught…” moaned the psalmist, and I responded, “Me, too”. Here’s why:

Yes – distraught that we had to prematurely terminate the placement, and let him go.

Yes – distraught that my wife’s health – an injured hand (that made handling a strong toddler too painful to manage) and experience of severe chest pain – contributed largely to the placement ending

Yes – distraught by a 14 month dither within our legal system – preventing earlier movement towards adoption.

Yes – distraught by the abruptness of it all once we’d reached the decision that we simply couldn’t carry on – a decision I’d assess as among the worst in my life, and which has haunted me since.

Yes – distraught by his absence from our home, whilst seeing/hearing/feeling him all around and remembering many scenarios we’d been through together

Yes – distraught by subsequent reflections – a sense of failure, of abandoning, even betrayal of such a vulnerable child, of letting everyone down – perhaps most of all, of not fulfilling what I believed to be a ‘special’ assignment – and failing to find strength in God to carry on !

Along with this distress other thoughts surfaced, as if from nowhere – painful recollections of my past failures to see through specific assignments/projects – leaving me utterly broken inside, and mindful of a bitter lament I wrote some years ago:

https://stryka66.wordpress.com/2013/10/25/a-lightweight-laments

So, yes, “I am distraught…” does capture this miserable episode, with tears a-plenty, resonating with yet another Psalm, where the writer emotes: “I have mingled my drink with weeping”. I can only liken this to the grieving process, comparable with numerous bereavements over the years. An emotional roller-coaster of grief, anger, confusion, disappointment, regret, and forlorn hope. Hope that we may get back to ‘yesterday’ – but forlorn, because it’s just not going to happen. A further aggravating factor must be mentioned here: that well-known human propensity for wanting to take control, to be a Mr Fixit, and organize a way out – which, in this case, has only served to feed the grief.

DISCLOSURE- The Sweet

All of this ‘stuff’ occurred around and within me at the same time as reading through the Gospel of John. Working through the last 8-9 chapters, which detail Jesus’ intimate, emotionally-charged last moments with his disciples, it slowly began to dawn on me that, in a small way, my feelings might well mirror in miniscule form what transpired 2000 years ago, as the Father loved and gave the Son, and as the Son gave His life for our sake. Especially, I pondered how the Father had observed at such close quarters:

– As Jesus’ life developed (30 years in almost total obscurity) before blessing him with affirmation (in Whom I am well-pleased) and anointing of the Holy Spirit (without measure) over a relatively short period of public ministry

– As the insults began to fly – “He’s insane…He’s demonized…He’s a trouble-maker…He’s a glutton & wine-bibber…He’s the friend of tax-collectors and sinners…and so on…”

– As the envy, anger, hatred of the religious establishment grew, leading to plots to get rid of him, many of which failed miserably

– As the betrayal by Judas, the arrest in the Garden, the subsequent trials (before Annas, Caiaphas, Pilate and Herod unfolded

– As the scourging, mockery, abuse of the Roman soldiers kicked in – purple robe, crown of thorns.

– As He’s ultimately condemned to death by crucifixion

How was the Father affected by such treatment of His beloved Son. What was His response to those heart-rending words spoken from the Cross: “My God, my God, why have you forsaken (abandoned) Me”

What did this do to the loving heart of the Father ?

I recalled a song heard many years ago, and reflected that this was what singer/songwriter, Dallas Holm was attempting to capture when he wrote the following lines way back in the 1970s:

God, it must have broke Your heart to send Your Son away
Knowing all the time the final price He’d have to pay
Left His home in glory and became a common man
And because He did I am what I am

Now I am a man and have a baby of my own
I wonder could I send my baby off and all alone
To help someone, somewhere, somehow to set some captive free
Could I do the same for Him who did the same for me

Yes, how did the Father feel as the Son laid down His life, surrendering His being in those dying words: “Into Your hands I commit my spirit”, as He watches the spear pierce His side and how that mutilated body, marred beyond recognition, is removed from the cross, carefully wrapped in grave cloths, with embalming spices, and laid lifeless in a borrowed, garden tomb for 3 nights in eternity.

Well, we’ll never know or understand fully – BUT as these thoughts poured over my hurting soul, I did fleetingly wonder if what I’ve been experiencing may conceivably have afforded a tiny glimpse into the heart of the suffering Abba (daddy).

(The amazing image of the cross in the ruins of Notre Dame Cathedral – 16 Apr 2019)

 

Another Wave

It’s 3 weeks since my brother passed away and I miss him like crazy.

The grieving process for me has been deep, as waves of sadness sweep over me at unexpected moments, and for no apparent reason other than they’re inside & need to get out.  Of course, the ability to express grief through writing has been immensely important and therapeutic, which is why I’ve not hesitated to share my experience through Ready Writer – also I guess if it can help one other person on their painful journey, then the exercise will be doubly worth-while.

This morning, during early devotions, another wave crashed onto the shore-line of my broken heart. As it surged over me, somehow I was able to recall and hang on to words which have been sustaining me during this period – “Into my grieving I weave …” Here’s a link to a previous post entitled: Into-My-Grieving

Now, reading in the Psalms has proved such a solace over many years, and today was no exception, for Psalm 107 ministered deeply, bringing re-assurance of God’s ‘enduring love’ and the knowledge that He delivers from distress those who call on him in trouble – the refrain of verses 6, 13, 19 and 28.

Furthermore, verses 29, 30 of the Psalm spoke directly to my heart with the following words: “He stilled the storm to a whisper; the waves of the sea were hushed. They were glad when it grew calm, and he guided them to their desired haven” – reminding me of Jesus as He stood in fishing boat on Lake Galilee and ordered wind and waves: “Be muzzled” – Oh, the peace my Saviour brings.

If that was not sufficient I also found my way to some incredible words of Celtic Daily Prayer (in Book Two) as follows:-

Declaration of Faith

Lord, I will trust You, help me to journey beyond the familiar and into the unknown

Give me the faith to leave old ways and break fresh ground with You

Christ of the mysteries, can I trust You to be stronger than each storm in me ?

I determine amidst all uncertainty always to trust

I choose to live beyond regret, and let You recreate my life

I believe You will make a way for me and provide for me, if only I trust You

I will trust in the darkness and know that my times are still in Your hand

I will believe You for my future, chapter by chapter, until all the story is written

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I believe God’s sustaining grace is enough and more than enough.

Changing to another metaphor, I’m profoundly grateful that the Good Shepherd is with me even as I walk through this dark valley.

Thank You, Jesus

 

 

 

 

 

Any Room ?

Please stop and ask yourself

“Do I make space for what really matters”

OR is it a case of :

No room for the Baby at Bethlehem’s Inn,
Only a cattle shed,
No home on this earth for the dear Son of God,
Nowhere to lay his head.
Only a cross did they give to our Lord,
Only a borrowed tomb,
Today He is seeking a place in your heart,
Will you still say to Him “No room”?

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O Lord, in my heart there’s a welcome for You,
Gladly I now would say,
‘Come in, blessed Saviour, my heart and my life
Henceforth would own Your sway.
Long have You waited and long knocked in vain
Outside my heart’s closed door;
O cleanse me from sin, then dear Lord, enter in
And dwell there forever more’

~~~~~~~~~~~~~~~~

“Behold I stand at the door and knock …”

An allegorical painting entitled: “The Light of the World” (from the 1850’s)

by English pre-Raphaelite artist, William Holman Hunt

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“Let every heart prepare Him room …”