Moving to Aargh 17 - Books

 We have a lot of books.  And we moved them ALL the past few weeks. 

Insert 7 - chimney sweep

The new stove needs a flue pipe of 18cm diameter, the existing galvanized steel pipe is 20cm. We'll insert a new inox 18 cm pipe into the 20cm existing pipe.  Before that the old pipe needs cleaning: sweeping. I guess it's never been done before. 

Bought a chimney sweeping set on a certain online store, €30, consisting of a brush, and 12 flexible rods that you can attach to eachother, to use it to clean the chimney, rotating the brush using an electric drill.

Closed the pipe off at the bottom with a very strong bag. You really don't want soot in your house. And so don't we. It's not a little, I think the bag contains about 550 g dirt.

Insert 6 - Metalfire Optimum - enclosure partly demolition

The old stove needs removing to make room for the new one. Very important: what size pipe is the chimney channel? The Metalfire needs an 18 cm diameter flue pipe, the existing channel is a 20 cm galvanized pipe. Two problems: 20 cm is too wide, and galvanized steel is not suitable as a flue pipe.

The engineer hopes there is a second tube inside this 20 cm one, that is 18 cm. 15 cm would be trouble. (15, 18 and 20 are standard sizes)

As it was...

Roasting Papaya and Tex

Take the front of the enclosure off:

Removed the old stove, there is a raised platform there, ladrillo and cement:

Also note: no insulation whatsoever.  That is bad. Walls and pillars need to be protected from a stove's heat.

Brittle cement, pebbles, and thus a hole in the floor:

The chimney flue pipe is a single 20 cm pipe, galvanized steel. Rubbish!

The good news is that there is no 15 cm channel in there, so we can just put a new 18 cm flue pipe in there, Engineer Jansen already is assembling a shopping list for 18 cm wide inox pipe materials. 

Also, the inside of the enclosure needs insulating the walls. Rockwool Firerock seems nice, semi-rigid rockwool panels 100x60x3cm. Comes in boxes of 10, for ca. €150. But more on that later.

Fill the gap in the floor with cement for an even level floor:

Leftover bits:

Oooh!

 

ON and off (part 11)

Vision goes down and up a little, just to be sure the inflammation in the eye has not returned: back to Urgencias 🙄.  

This time a doctor at urgencias who seems to be more experienced with eyes, she looked into the eye herself, and said there was no inflammation, and she would call Oftalmologia. She spoke with one of them, and said: you have chronic optic neuritis, you are on Nurane, capsules with ginkgo leaf extract + magnesium, which has vasodilatory properties to stimulate nerve repair, it is well possible what you experience is due to Nurane. There will be good and there will be worse days. 

Well, the good news is that there is no inflammation, but the "chronic" bit is really not good news.  New appointment with Oftalmologia for revision, OCT scan and field of vision. The OCT scan shows that indeed part of the optic nerve is no longer functioning. This means 40% of vision in the left eye has gone, and won't come back. General vision is still ok, as the missing bits are missing, they are not colored or flashing, and missing bits are filled in from the right eye. However, at the moment this condition is tiring, as it sort of feels like you have new glasses with a strong reading part.  And, reading with only the left eye is not possible any more.

Read a fellow patient idea: close your eyes, and sit in the sun. It helped her. Who knows.

(ON stands for Optic Neuritis.)  

Insert 5 - Metalfire Optimum - arrived

In Metalfire Optimum you can read about engineer Jansen's lust for a Metalfire Optimum insert wood stove.  After much deliberation an Optimum 700 was ordered, and it has arrived. The delivery service did not have a cart to lift the pallet up 10 cm, so they could not lift it up to the porch in front of the front door, which is 10 cm above street level. So, it was left outside, next to the porch, at street level.

Grmbll. What to do.

Engineer Jansen decided to buy coaster wheels that can carry this 200 kg heavy piece of equipment, and use some steel profiles to devise sort of a cart. The wheels can carry 650 kg divided among 4.

Well, it may look easy, but it cost all day, and given the engineer's condition it was rather exhausting.

1. Move the pallet

Here it is next to the front door, street level, note the 10 cm step up:

Wheels attached, such that when the bolts are screwed into the pallet the pallet is lifted a centimeter above the ground, resting on the wheels:

Rotated 90º, in line with the front door:

Rotated 90º, in line with the front door, wheels removed:

2. Now remove the stove from the pallet:

Attach steel profiles with wheels:

The profiles are 2 cm above the wooden beams the stove is on:

Tighten these bolts and you lift the stove:

Screws!

Well, that was the theory. The stove is placed on two wooden beams, but those beams are screwed onto the pallet with 4 long screws. The points of those screws were bent, as the cart they used bent them. So, engineer Jansen could not unscrew them. Bending the screws back did not work, not enough room.  Drilling the head of the screws off did not work either, it has cost the engineer one of his drill bits. Could not saw off the ends of the screws either. 

Decided to drill holes around the screws, and force lift the beams off of the pallet, then use the iron saw to saw through the screws.  That worked.

Here the contraption stands 2 cm above the pallet after tightening the bolts:

And wheeled it off:

3. Inside!

Engineer Jansen calculates drips and avoids mansplaining (part 10)

The (precautional) second course of antibiotics now runs almost 1.5 weeks, so 5.5 weeks antibiotics in total, 1.5 weeks still to go. Last week another round of blood was extracted from the engineer, to see if Borrelia (Lyme) can now be detected (no), and to see if IGM toxoplasmosis is positive, meaning an active infection with that (no). Good.

The past few days engineer noticed a slight degradation in vision in the left eye, like there was a slight mist, so back to Urgencias, again. Passing on to Oftalmología did not take long. Fortunately the doctor that knows the whole history. Off to puerta 5 for CV test (campo visual, field of vision). The engineer thought the upper half of his eye sight had degraded, the doctor saw in the results that the lower half had deteriorated.

Thinking about that, the engineer thinks that both she and he are correct. The whole field of vision has slightly deteriorated, meaning the lower half indeed got worse. But the upper half too. Only, the machine does not detect that because the engineer could still see those small light flashes through the mist.

[Field of Vision test: the inside of a 40 cm white hollow half globe is in front of your eye, then randomly displays tiny white flashes in random places on the inside surface, and you must press a button when you see the flash. So they know if parts of your vision are missing.]

Anyway. Look into the eyes: we see no inflammation activity (good!). That was a relief, because one of the engineers’ worries was that the inflammation was back. That can happen if it’s not Lyme after all, but something else, like an autoimmune thing, a fungus, …  

So far the cause is undetermined. Lyme, toxoplasmosis, rick-ettsia (ha ha ha) all negative, according to last week’s serologia. That is good too. (Lyme and rickettsia both are tick borne diseases.) A negative lyme test does not mean much, nor does it when positive, as they are insensitive and indecisive.]

Losing one eye is bad enough, the other eye may not go down that path (please), that would be catastrophic, hence this repeated visit to Oftalmologia via Urgencias. 

Verdict

“No inflammation, but we are going to give you 3 days of prednisolone intravenous 1 gram per day to try and speed up recovery” (Big single or a few doses of prednison or antibiotics are called “pulse treatment”)

“Come back in 10 days for revision, with OCT and CV” (an eye scan and field of vision)

Mansplaining in the Sala de Sillones 

Off to Urgencias, and the Sala de Sillones again, for the IV drip.

This time no pump, just an intravenous 500 ml bottle, with 1 gram written on it. Good. 

“No pump?”

“No”

“How long will it take?” (So engineer De Waal can plan his trip home and back)

“1.5 to 2 hours”

Drip

Drip

Drip

Engineer Jansen wondered after about 45 minutes that not much had been dripped into him. The first marker was reached, indicating that 100 ml had been used. Even though the bottle is sucked a bit hollow-ish. Hm. Remembering (chemistry lessons, titration) that one drop is about 0.05 ml he started counting and timing. 10 drops in 15 seconds. So, 40 in a minute, which is 40 x 0.05 = 2 ml per minute. 500 : 2 = 250 minutes, is 4 hours+. Hmpf.

Not wanting to be the mansplainer in the Sala, the engineer wondered what to do. 

As innocently and casually as he could manage, he asked the nurse, when she was near, how much time left?

“Are you in a hurry?”

“No, but it’s for the planning the return trip, else they have to wait a long time outside”

“1.5 to 2 hours left”

That is not the correct answer.

Certainly not after 45 minutes.

Asked the male nurse when the female nurse was away.

“I have no idea”

That is an honest answer, though meaningless.

Drip 

Drip

The engineer tried again. 

“This will take more than 3 hours still”

“Hmm”

“We can set it quicker”

She turned up the speed a bit, but that would still take 2 hours more, from this moment.

Half an hour later: Up! to 33 drops per 15 seconds, 132 per minute, is 6.6 ml per minute, meaning 25 minutes more.

That was the correct answer.

All in all the session took 2 hours 45 minutes. Without the engineer interfering (again!) it would have been 4 hours 10 minutes.

How can these people have no idea how long a drip takes? They do this every day!

PS

According to dr. Google Ad Interim, prednison and doxycycline do not interfere. Good.

The engineer quite agreed with himself.

PPS

They still have not called!

3 More Weeks (part 9)

Revision. Appointment at 12:40. We were there 2 hours before. Normally you are attended to sooner, but today is very busy. First a look with just the doctor headgear. Pupil widening drop, and another hour waiting for the drop to work. 

“Jansen”

Another man stood up and entered the room. Huh?

Engineer Jansen followed him and expressed surprise.

“Sanchez, not Jansen”

Ah. Sorry.

Patience.

Time passes.

More time passes.

“Jansen”

“Not Sanchez?”

“No”

More looking into the eyes. Up, down, left, right, etc etc

“Disc is much paler, inflammation is down.”

“We will stop treatment, as we see no more activity”

3 More Weeks

Engineer Jansen expected that attitude, and came prepared. His big goal for today was: obtaining the extra 3 weeks of antibiotics, as with the article patient. The article “Unusual presentation” has a quite similar patient, who gets 6 weeks of doxycycline in total, sees some improvement after 3 weeks, and more improvement after 6 weeks. Yet another article has a patient with 12 weeks antibiotics. 

Standard protocol in Spain is 2 weeks when Lyme is detected early, 4 weeks if later and the blood test detects Lyme.  The Lyme blood tests however, are very insensitive. Literature describes so many cases with negative tests, also with negative lumbar punctions (“spinal taps”). So far engineer Jansen’s Jansen tests were all negative.

The engineer now has had 3 weeks of doxycycline, and after that sneaked in the remaining 8 days of Cefuroxime that he got the very first day in Urgencias, so he was under treatment every day since, with just one day of that Cefuroxime remaining today. So, 4 weeks in total, though without visual improvement. 

“I really think it’s not necessary”

“I understand that completely, but borrelia/Lyme really is a nasty bacteria, it can hide and come back..”

“I lost one eye, that is quite a disaster, losing another eye would be a catastrophy.”

“3 more weeks of antibiotics probably will not kill me, but losing another eye would be, a catastrophy”

“We could do vitamins..”

The engineer looked really unhappy.

“This article…, they do 6 weeks, the other article 28 days IV Ceftraxione”

She gave in, even though she disgreed.

3 more weeks.

I wonder if they see many patients that interfere with their treatment like this.

(Sorry!)

Tomorrow Centro Salud in home village for extracting blood for the serologia tests. 

Together with engineer De Waal, for his followup blood tests.

Yes, toxoplasmosis IgG and IgM are both listed. Jolly!

Status

4 weeks in, the bad news is that there currently is substantial vision loss in one eye, the good news is that the inflammation has stopped.  Now hoping that vision improves in weeks or months to come, as with the article patients. 

Currently it means that more than 50% of the left eye's vision is blurred or gray. Reading with the left eye is no longer possible. Total vision still is more or less ok, as the missing bits are missing, don't have a color, and are not interfering. They're simply not there. The total image still is reasonably ok.  It’s not great, but I may have to accept it. It’s life. It could have been worse.

Toxoplasmosis or no? (part 8)

Reading up on the appointments in the Andalucia Salud app the engineer encountered the report of a serologia analysis. Interested as he is the engineer studied it. 

Attentive readers will remember that extracting blood from the engineer went rather chaotically, not the engineer's fault, of course. Saturday 16/8 a vial was taken to detect Lyme/borrelia, Monday 18/8 the engineer was called back to the hospital in the evening because "they did not have enough", no one knew how or what, and two vials were extracted at the request of the engineer, and to determine later what to do with them. Tuesday 19/8 was a revision appointment at oftalmologia, that evening they called that the engineer was to present himself at the Sala de Extracciones, without breakfast. 6 vials were taken. Bloody vampires!

Informe serologia, AST, IGG, IGM

Anyway, the Salud Andalucia App has the report on serologia above,  "Fecha de toma de muestre" is "18/08/2025 21:25", so this must be those two vials taken in the late evening that they were to see what to do with.

The last lines discuss "toxoplasmosis", or "cat scratch disease".  It has an IgG of 32,8, which means: positive.  

And "IgM: Muestra insufficiente". Hm.

Also, there is quite  high value for "Alanina Transaminasa" (AST).  An article on toxoplasmosis in dogs says:

"The biochemistry profile usually reveals abnormally high levels liver enzymes ALT (alanine aminotransferase) and AST (aspartate aminotransferase)"

The engineer combined the 3:

- high AST

- high IgG

- missing IgM

and investigated.

IgG, IgM

"IgG" tells if you were exposed to toxoplasmosis in the past. That in itself is no cause for alarm, as the majority of people has been in contact with toxoplasmosis. At the age of 70 the vast majority of people is positive for IgG.

If you have a current and active toxoplasmosis infection your "IgM" is elevated. But not: missing.

Damn! Blast!

Ocular Toxoplasmosis

Yes, toxoplasmosis can affect the eyes, and the symptoms can be quite what the engineer has. 

Toxoplasmosis is not a bacteria, it's a one celled critter that is difficult to eradicate, not sensitive to antibiotics, and can go in hiding in cysts, also in the eye, and resurface after many many years. 10-20 or more years. Not good news.

You get toxoplasmosis from cat scratches, especially from kittens, cat poop, eating raw meat that is contaminated with the cysts, eating (raw) vegetables that are contaminated in the field, or by contacting contaminated soil.

The engineer is not a cat lover, due to allergies, and avoids cats. Nor is he an avid raw-meat eater, being semi vegetarian.  Raw vegetables: well.. yes! Lettuce comes washed, radishes, too. 

                       AAAAARGHHH!

Jensen Test

For Lyme/borrelia there is a test called the Jansen Test (see The engineer researches optical nerve inflammation and optical discs, and finds Lyme (part 3).

Hilariously for toxoplasmosis there is the Jensen Test, according to dr. Google (Ad Interim):

Urgencias (again)

Another visit to Urgencias, to see if any of the other blood tests has a complete analysis of IgM. Passed on to Oftalmologia again, as they cannot access the serologia report of the other two blood extractions at Urgencias.

Not the eye doctor who ordered the serologia:

"You don't have toxoplasmosis"

"But the symptoms..."

"You don't have toxoplasmosis, you have optic neuritis"

"But the IgM is missing"

"hm. Go to your Centro Salud for a new serologia with this request (paper)"

Could make the appointment in the App straight away, for 13:28 the same day at the "Enfermeria".

Enfermeria

Ah, no, blood extraction is only Wednesday and Friday, and you need to talk to the doctor first. So, that is an appointment next week, Tuesday 16 Sep.

Rationale

The engineer well believes the ophthalmologist that he does not think toxoplasmosis is the cause. It has quite specific lesions in the eye. On the other hand, if those lesions are not yet there you may still have toxoplasmosis. The engineer does not trust missing numbers due to "not enough sample blood available". His eye is bad enough as it is, and no time can be wasted.

The engineer wonders if they have ever had a patient challenging them on IgG and IgM numbers.

And that Nobel prize committee still has not called. Maybe this afternoon?

PS

No immunodeficiency virus. Good.

More vision loss and no sinusitis (part 7)

25/8 What next

Hopefully a few quiet weeks, and an improvement of vision.

In two weeks the course of antibiotics runs out, and the next appointment is due. Also for the sinusitis with the Otorringología. If they decide to treat that sinusitis they may use an antibiotic that is also often used as the followup second course of antibiotics for Lyme: amoxicillin

11/9

Quiet weeks? Hm. The engineer noted a worsening of vision, so has visited Urgencias again.  They see the inflammation getting better, and the swelling of the optical disc decreasing. Still, vision loss. That is not good news.

11/9 Otorringología

The last time I visited one I was 5. Or 6. And lost my tonsils, because of ear infections that did not clear with penicillin. I remember nasty bitter yellow tablets. And a doctor presenting banana hard marshmallow sweets before hurting my ear, badly.  I still cannot stand those banana sweets till this day.

Anyway, the MRI had shown something they thought was sinusitis on the right, though the bad eye is my left, and made an appointment for Otorringología. Sinusitis is in a nasal cavity somewhere eh.. down there. No idea how you can have a look in there, or how to get there. But they do. They have a device called a "nasal endoscope", a flexible thing with a light and a camera.

Exactly like this.  With sections so they know how far down the engineer's substantial nose they are.  She spelunked down one side, and then the other side. Nothing interesting apparently. No treatment. Although the medical status suddenly has a nasal spray with corticoides. And she wants me to wash my nasal cavities with salty water with a special bottle. Hm. The engineer is not ecstatic about that prospect.

Anyway, no sinusitis, that is good.

11/9 Urgencias, again, directly after Otorringología

Vision has worsened, so a visit to Urgencias, again, after the otorrologia. Even though they share the waiting room, you need to go through Urgencias.

The whole circus. Eye drops, Optical Field, OCT

OCT Zeiss Cirrus 6000

Yes, your vision has deteriorated. We'll make an appointment with Neurologia in Almeria. Continue with the antibiotics.

There is not more that they can do, apparently.

Currently it means that more than 50% of the left eye's vision is blurred or gray. Reading with the left eye is no longer possible. Total vision still is more or less ok, as the missing bits are missing, don't have a color, and are not interfering. They're simply not there. The total image still is reasonably ok. 

PURPLE?? (part 6)

Angiogram with contrast 

08:00

Angiogram. First thought they wanted to draw more blood (these people must be vampires!), but no, it is an eye scan with a dye for contrast to visualize the arteries.  Not the elusive gadolinium this time, but a bright purple substance.  

Puerta 8 for the preparation. The engineer about now knows how this goes, first the machine to measure your eye, and make you read the letters. He asked for the eye drop himself, to avoid them thinking of this after half an hour, administering the drop, and having to wait yet another half an hour, giving them the chance to lose track.

The angiogram machine. Needle inserted into the engineer. A vial with purple stuff on the table.

"Is fluorescente?"
"Si!"

"Will make your pee bright yellow for a day (ha ha ha)"

Hm.

Look into the lens. Right, up, down, left, far left, a bit up, a bt down etc.

100 flashes later, all done. Lights on. Everything is purple! Nice.

We leave the needle in, in case the doctor wants another scan, with a different color (yellow).

The engineer almost asked if that will make you pee purple, but he held that back.

About 12:00 now. Engineer de Waal went for a box of cookies.

Busy day. The doctor could be seen whizzing about, and was sitting in her office while foraging for cookies.  

"I am awaiting the MRI results, expect them... soon"

The word "patient" obviously has something to do with the word "patience".

By 14:00, doctor appeared.

"X-ray all good"
"Serologia all negative"
"MRI all good"

"You have sinusitis on the right, does that not hurt?"

"no?"

"We will give you an appointment with the Otorringología for that"

"Continue with the antibiotics, come back in two weeks"

Unique!

Gave her two articles the engineer encountered while reseaching lyme and optic neuritis. Apparently ophthalmologists are not usually aware that Lyme can cause Optic Neuritis. 

1. Unusual Presentation of Unilateral Isolated Probable Lyme Optic Neuritis

"Lyme ON is an exceedingly rare ocular manifestation of Lyme disease (LD) and only a few cases have been published in the literature. Lyme ON is very rare but should be included in the differential diagnosis in unexplained cases, particularly in Lyme endemic areas."

2. A Rare Cause of Optic Neuropathy:

"The diagnosis of Lyme disease requires a high level of suspicion and only a minority of patients recall tick bites or cutaneous lesions."

"Although only a few cases of optic neuritis caused by Borreliosis have been described, Kubová et al. showed that, in patients with confirmed neuroborreliosis, 42% reported blurred vision or diplopia and 27% had delayed visual evoked potentials, meaning that optic nerve involvement in Lyme disease is probably more common than previously thought"

That engineer Jansen is quite unique is not news, but he must be an interesting casus, as they have an eye scan of him from March this year, and a quick Lyme suspicion after less than 6 months since that scan.  Maybe she can write an article!

(NB that is quick Lyme, not quick lime)

What next

Hopefully a few quiet weeks, and an improvement of vision.

In two weeks the course of antibiotics runs out, and the next appointment is due. Also for the sinusitis with the Otorringología. If they decide to treat that sinusitis they may use an antibiotic that is also often used as the followup second course of antibiotics for Lyme: amoxicillin

PS

Yellow pee? That, is, an, understatement.

PPS

Strange the Nobel prize committee has not yet phoned.

GADOLINIUM??? (part 5)

It's a good thing we dropped by Radiología on Friday for information on how and what, because the MRI is at 12:30, but you can not have breakfast. Or, nothing after 08:00. The clever engineer prepared a muesli breakfast the night before, set his alarm to 06:00, and survived that part of the ordeal.

Gadolinium

They make you sign a waiver, especially for the contrast dye. "Gadolinium" it said in the papers. Gadolinium? That's a rare earth metal. What..? 

Apparently gadolinium is the most paramagnetic substance on Earth, and is used as a contrast dye in MRI imaging. 

Still, eh.. gadolinium? Wiki has this to say:

"Gadolinium(III) ions in water-soluble salts are highly toxic to mammals."

ow. The engineer definitely IS a mammal, despite everything.

“However, chelated gadolinium(III) compounds prevent the gadolinium(III) from being exposed to the organism, and the majority is excreted by healthy^[9] kidneys before it can deposit in tissues. Because of its paramagnetic properties, solutions of chelated organicgadolinium complexes are used as intravenously administered gadolinium-based MRI contrast agents in medical magnetic resonance imaging.”

That's all good, then.

Wait what is this “majority” that is excreted?? What about the rest?

MRI

The RM (Resonancia Magnetica) is located in the cellar, down 1 floor, very atmospheric dungeon.

The waiver I had received apparently has a list of questions, but was printed so small that it was not legible for the engineer's current state of his eyes. Nor for the other engineer's state of his eyes. It's a list about metal in your body, and if you work in a metal workshop, if you have piercings, pacemakers, implants, etc. No, and his piercings the engineer already removed, as he's not that daft.

You have to undress, only keep your underpants on. The engineer had expected that and was prepared. And he had to wear a negligee. (ooh!)

It's a huge machine, big vertical ring, with a plank that you have to lay down on. Bzzz! Into the machine, with a needle in his arm. No idea what they connected, or what the gadolinium looks like.  Fantasised about bright green, or purple.  Probably just colorless.

Cage over your head, a squeeze ball switch to alarm the technians in case you get unwell, pads next to your ears, to dampen the noise and fix your head in place.

"Can you say now and then how many more minutes?" (it was supposed to be sort of 20 minutes)

"Just relax"

Well and noise it makes. A whole symphony of sirens, clicks, sawing machines, drills, whooping sounds, drones, ... Some parts were like a bad house track, some parts were almost Kraftwerk.

The engineer just stared up at a text on the cage he could not read. What do you do, can you breathe normally? Can I move my eyes? Better not. There are two minute holes, with a prism, so you can see the ring of the machine, and the technicians walking by. Not much for them to do, but watch engineer Jansen.

And engineer Jansen just stared up. The arm with the needle started to get stiff. Aha, they are administering the contrast now, apparently. 

On and on... drone, click, BZZ...

Started counting the "sweeps"

Lost count.

"This must be another 5 minutes"

"Or 2?"

“15?"

And how many times have I thought that?

Lost count.

Aargh, a beginning itch. Ignore ignore ignore!

They could have sedated the engineer, if the engineer was not such an adversary towards sedation.

How long is a minute, actually?

Well, inside an MRI machine time is different.

Just concentrate on staring up, and breathing slowly. 

I dared flex one finger of the hurting arm, making sure the head stayed still.

..

"Ready!"

The noise stopped and plank rolled out of the machine.

"Careful, you may feel slightly dizzy"

Slightly dizzy was a bit of an understatement, they needed to support the engineer walking back to the changing closet.

Let's ask dr. Google (Ad Interim) for an explanation:

Even read somewhere that the better your vestibular system is, the dizzier you are. 
Well, the engineer has a very healthy vestibular system.

"You must drink lots of water to flush out the contrast"

"The results will be sent to your doctor in 2-3 days"

The engineer sat on the chair a few minutes before taking off the negligee (ooh!), and be taken home. 

Still dizzy.

And the machine time was not 20 minutes, but about an hour. Not one of the engineer’s finest ones.

Patientce (part 4)

Today (August 20, Wed)

Today we have another appointment at Oftalmologia, at 08:30. You must come in, before the appointment, at 08:00, no breakfast, to the Sala de Extraciones to give blood.” 

Sala de Extraciones

"I have an appointment..."

"Please enter your Salud Andalucia card in the machine"

Nothing.

"Nothing"

"I'll check"

The common denominator with all this is: waiting. 

The word "patience" obviously has something to do with the word "patient".

Ticket "MDY", Box 1.

6 or 7 vials blood. 

"Estoy vacio"

Oftalmologia

09:15 The whole circus, again: eye drops, the machine to measure field of vision, the machine to make a scan of the inside of your eye, the machine to make another scan of your eye, and the machine that goes "bzzz!". They have a lot of machines here.

Three doctors.  Interesting case, obviously. 

Serologia: negativo.

All done, come back in two days.

Left home at 7:15, home by 15:00. These are long days.

Next (22 August, Friday)

08:30 

"ahh, mr. Jansen"

They already know me now.

Again, the circus with eye drops, machines, etc.

"Please go to planta 0 for a radiografia. To rule out TBC"

WE ARE BORG

RESISTANCE IS FUTILE

"Arriba!"

"Huh, what?"

I was supposed to step on the platform.

Bzz click

Bzz click

Listo.

Up to planta 1 again.

All done, come back on Monday, no breakfast, for an MRI with contrast. 

And Tuesday for an angiogram, with contrast.

An MRI?? 

Contrast?? 

They want a scan of the whole head, plus a scan of the optic area. 

The engineer suspects two things:

• they want to see more of the optic nerve, and whether it is affected
• they want to rule out things like brain tumors

"Have a good weekend!"

The engineer researches optical nerve inflammation and optical discs, and finds Lyme (part 3)

Recap

• With an inflamed optical nerve you usually have a headache when moving your eyes, I did not;
• Inflamed optical disc: “unilateral presentation is extremely rare”. I have that.
• Inflamed optical nerves are often caused by things like MS. That is: people with MS often have an inflamed optical nerve. I’m too old to start having MS, I think. The target group is women 20-40 years old. The engineer definitely is not that. (See impressive hairy chest photo in blog before previous blog.)
• “Unilateral papilledema can suggest a disease in the eye itself”.  Well, Lyme quite possibly.

An “optical disc” is a good thing to have as an engineer, no? He was not aware.

Monday August 18, 09:00 Oftalmologia for revision(!) of the past days. And interesting days they were. Fortunately the same doctor as last Thursday, and not the “lady” we experienced in March (different story).

“How are you?”

“Regular” (that means: not great)

Explained the hiccups with the prednisolone treatment, wondered why 40 mg was administered and not 1 gram, and if they had discussed that with him (no), and that I may have determined the cause (Lyme), not a virus, asked for a blood test, taking another week, and that antibiotics treatment was started as a precaution. 

“Was it the doctor at Urgencias who determined that?”

“No, me. (sorry)”

“Please give me the papers and wait outside”

“And room 5 for eye scan”

“Please come in again”. Two doctors, I think the department head, as she seemed to have the bigger authority, and the bigger office. Both eyes were thoroughly examined again with bright light, prisms, lenses, and atropine, then they sat behind the screen to happily browse through the CT scan images, discussing in their jargon. 

Jansen Test

Then they giggled, haha, the Jansen test! There appears to be a test for Lyme that is called the Jansen test:

Verdict

Anyway. The verdict: “we see activity in the scans that is consistent with Lyme, protocol determines:”

- standard treatment 2x100 mg doxycycline per day for 4 weeks

- lumbar punction to determine how far the infection has gone, to see if the treatment can be shortened to two weeks

- if severe: intravenous antibiotics 

Well, the engineer is over 65 and is not into lumbar punctions in general, so he declined. 

“Are you ok with that”

“Half”

“Stop the other antibiotics” (4 pills of 20 down, Cefuroxime)

“3 weeks doxycycline 100 mg 2x day” (should be 4 for late disseminated Lyme)

“Two hours after meals”

“Temperature reading 3x day, you must write those down”

“Come back this Wednesday for further consult”

Back home

We were on the way home around 16:30, almost home at 17:00, still in the car. 

Phone. Huercal Overa. 

“You must come back for giving blood for analisis, today!”

“We just got home…”

At 17:45 we left for the hospital again, arriving 18:30. Consulta 8. 

“There is nothing in the computer”

After some phone calls I suggested to just draw some blood and see what you do with it later.

“Ok”

That took more than 3 hours, and not without pressure from engineer De Waal, who had had more than enough by then.

We were home at 22:00. Poor dogs, all alone, and without light. 

Sandwich, to have before first pill, temperature readings for the report. 

Luckily the engineer had bought a new 7€ electronic thermometer (not the expensive 34€ infrared gadget), because the battery of the old trusted Philips thermometer ran out the next day. The Philips has a digit more after the decimal point, the engineer likes that. 

Tomorrow

Tomorrow we have another appointment at Oftalmologia, at 08:30. While typing this: call from Huercal Overa: “we don’t have sufficient blood from you. You must come in tomorrow, before the appointment, at 08:00, no breakfast, to the Sala de Extracciones to give blood.” 

Engineer De Waal almost exploded, engineer Jansen had a laugh.

🙄

PS

The engineer’s decision to skip that 1 gram prednisolone treatment and leave was correct, as is his Lyme self diagnosis, and everything else, in fact. Can the engineer please have the telephone number of the Norwegian Minister for Health? *)

PPS

What’s this about no breakfast then?!

*) if you understand this reference you have won A BIG PRIZE! A VERY BIGLY PRIZE!

Detective Eminent Doctor Engineer Jansen-Watson (part 2)

Well, today for 3rd and last dosis prenisolone.  While in the car on the way the engineer was pondering his latest blog entry, and wondered again about why they administered 40 mg prednisolone as an injection in the bum, and not 1 gram intravenously.

Also he remembered the phone conversation the doctor had with the neurologist, after the CT scan.

"No headaches?"
"No" 

I could sense their suprise. (Many people witn affected optical nerves experience pain when moving their eyes.)

The engineer researches optical nerve inflammation and optical discs, and finds Lyme

Reading up on optical nerve inflammation and optical discs:

The oftalmologist suspected: inflamed optical nerve, or Optic Neuritis, and prescribed the 3 days of 1 g prednisolone per day, intravenously. That is a wellknown treatment, to preserve the optical nerve prior to treating the cause.

After the CT scan the "efermedad actual" is: Papiledema, swelling of the optical disc (very typical for an engineer to have, an optic disc), which has a different course of treatment. 

Let's ask dr. Google AI, I guess that is dr. Google Ad Interim? Must be him (or her):

This suggests that 1 gram for papiledema is NOT the required treatment.

• With an inflamed optical nerve you usually have a headache when moving your eyes, I did not;
• Inflamed optical disc: “unilateral presentation is extremely rare”. I have that.
• Inflamed optical nerves are often caused by things like MS. That is: people with MS often have an inflamed optical nerve. I’m too old to start having MS, I think. The target group is women 20-40 years old. The engineer definitely is not that. (See impressive hairy chest photo in previous blog.)
•  “Unilateral papilledema can suggest a disease in the eye itself”. 

Well, Lyme quite possibly.

Elementary dr. Watson

What (possibly) happened: 

• The "enfermedad actual" now is not neuritis optica but papiledema. 
• I think they established that after the CT scan, in that phone conversation with the neurologist, because the optical nerve may not be affected.
• They decided to give 40 mg prednisolone in the bum.
• The paper still had 1 gram prednisolone per day, as prescribed by the ophthalmologist
• But, the ophthalmologist was never informed of the new "enfermedad actual'.
• The day after the CT scan, first day 1 gram treatment was a holiday, so oftalmologia was closed, and they did not communicate about engineer Jansen
• It now is the weekend, so no ophthalmologist around to discuss.
• And so they never changed or deleted the 1 gram per day.
• They blindly follow what is on the paper.
• Every step has another person, and they make mistakes because they don't think.
• Luckily Engineer Jansen still has a brain.

So there was dr. engineer Jansen in the chair awaiting the needle, but asked if he could discuss.

Doctor came, another one. (They have a lot of doctors here.) 

"My enfermedad actual is papiledema, not neuritis optica"

"But the ophthalmologist says"

"But after the CT scan it says papiledema, and 1 gram is not for papiledema"

"But the ophthalmologist says"

“I think they did not tell the ophthalmologist”

"And why else did they change to 40 mg after the CT scan?"

"I don't know. Did you not talk to the ophthalmologist after?"

"No, but I have another appointment there tomorrow. We were supposed to see him Friday, but they were closed for Maria Ascension Day"

"Dr. Google Ad Interim says: 1 gram is not for papiledema"

"But the ophthalmologist.."

"1 gram is a very heavy treatment, can we skip a day and see tomorrow?"

"Yes that is possible"

"Is skipping a day problematic?"

"3 days consecutive is standard"

"But will it harm to skip a day?" 

"I dont think so"

"I'll skip treatment today and talk to ophthalmologist tomorrow"

"OK" 

And what does she write on the Informe de Alta (release form):

"Patiente acude para continuar con tratamiento de prednisolona 1 gram (era dosis)  refere que no quiere poneria hasta hablar con oftalmologia porque no considera tener edema papilloma"

or:

"Patient comes to continue treatment with 1 gram of prednisolone (was the dose) and says he does not want to put it until he speaks with an ophthalmologist because he does not consider having papilloma edema."

She has swapped the enfermedades.

I don't have neuritis optica, I do have edema, and I don't need 1 gram for that.

I'm apalled. I understand now how medical mistakes come to be.

Tomorrow the ophthalmologist.

If they would not have been closed Friday we would have spoken with the ophthalmologist, and he probably would have cancelled the 1 gram treatment.  Now that has cost me two 1 gram sessions!