Making tough decisions...It's rarely easy...More favorite photos...

 
Two barn owls in the rafters at the Mugg & Bean in Lower Sabie.
 "Sighting of the Day in the Bush"
Ms. Bushbuck resting in the garden.
These past three months have required we make a number of difficult decisions.  No doubt, everyday life, whether one travels or not, requires serious decision making from time to time.

Many decisions are insignificant in the long run, such as deciding what to cook for dinner and others, are life-changing.  For us, the bigger decisions seem to be the easiest to make when it becomes a choice of choosing a,b, or c.
Female lions lounging in the shade.
But, there are those falling somewhere in the middle that seems to be the most difficult to navigate when the outcome can manifest in several different ways.  When it comes to medical issues, at times, we find ourselves stymied.

Most recently, a decision hovering in my mind has been, do I reduce the fat in my diet with the unproven notion that a low-fat diet reduces heart disease?  Or do I go with the three doctors opinions, all highly competent professionals, that reducing fat in my diet won't have a bearing on the future state of my cardiovascular system?  
Dinner in Kruger National Park when friends Lois and Tom visited when we'd gone on a nighttime game drive.
For me, not necessarily for everyone, heredity was responsible for clogging my arteries beginning 20 or 30 years ago during which time I always ate a very low-fat diet in an attempt to keep my weight under control.  

Most of the family members on my mother's side of the family were grossly overweight and had type 2 diabetes both of which are significant risk factors for coronary artery disease.  I saw their health fail as a child and decided in my teenage years I'd never become overweight and, I didn't.
A cute bunny on the road in Kruger National Park.
On a low-fat diet, I was nearly starving myself for many years, always hungry.  Now by consuming a low carb, higher fat, sugar-free diet,  I'm seldom hungry and can easily control my weight and avoid diabetes.  

I consume healthy fats such as avocados, olive oil (in moderation), fatty fish, dark chocolate (without sugar), certain nuts (moderate amounts, not including peanuts or cashews), whole eggs and small amounts of full-fat dairy products.  I do not eat fried foods or foods swimming in oils or trans fats.  Medical science supports this way of eating.
A pair of hippos and a pair of cape buffaloes.
But, some family members are trying to convince me to eat a low-fat diet.  If I do so, the pain in my spine will return since a low carb diet, for me, had greatly reduced inflammation and subsequently, chronic pain.  If I do so, it could further damage my cardiovascular system.

After considerable research lately and weighing the pros and cons, I unhesitatingly decided to stick with my current eating plan, one which the doctors condone is best for my long term health.
The only squirrel we've seen in South Africa.
In the past 24 hours, another decision faced me.  Although this may appear to be in the "little significance" category, it became a major decision for me. The doctor suggested I start walking to increase the blood flow to my legs and possibly reduce the healing time.  

I totally agreed with this premise when logically it made all the sense in the world.  So, yesterday, upon returning to the house, I started walking for five minutes once every two hours, setting the timer on my phone for both and walking and the waiting times. 

A nyala, the first we spotted in Kruger.
During the first five minute walk, I found I had to walk tiptoed on my bad left leg due to my inability to place the foot flat on the floor due to the pain.  It felt as if the wound was tearing open if I tried. 

After the second five minute walk, I noticed the wound was oozing through the bandage and also through the compression stocking.  By the third five minute walk, it began bleeding and was exceedingly painful.

A decision had to be made...do I continue walking or do I hold off and give the wound more time to heal? Walking is vital for my cardiovascular rehab but the wound needs to heal.  It became a dilemma which I found comparable to my diet dilemma...ultimately, which is better for the long haul?

More nyala in Kruger.
For the remainder of the day, the pain was awful and my left foot started to swell, which rolled into the night and I only slept for a few hours. With that, another aspect entered the dilemma...lack of sleep is detrimental for both wound healing and cardiovascular health.  Swelling is detrimental to healing.

This morning, we made the decision...no walking until it I can do so with less pain.  Tomorrow morning we return to Doc Theo.  We'll discuss these concerns with him.  Sure, I could have called him but it wasn't necessary.  

If I told him the pain was unbearable while walking, the foot has begun to swell and the wound was leaking into the compression stocking, he would have said, "Don't walk for now."  Decision making is not always "rocket-science."

So today, as they say, "A few steps forward and a few steps back."  I am hunkered down on the sofa in the living room, feet propped up on pillows where I will stay put for the day, hoping to reduce the pain and swelling and speed up the healing time.

So we wait. In 11 days we leave for Ireland. We've booked our flights and we're going, regardless of the status of my leg, another "big" decision we had to make when we arranged the flights. 
 
Have a great day!                                                                 
                    _________________________________________
Photo from one year ago today, April 30, 2018:
Adorable baby Danie with his loving and attentive mom, Okey Dokey.  He never stopped smiling and laughing the entire time they were visiting.  They'd planned to visit us over the weekend but Danie was sick and it was best we didn't get together.  For more photos, please click here.

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

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 day 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 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 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 type of 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.  
Attempting a nap in the garden when tusks get in the way.
He removed more 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 I walked five minutes without the walker, still tiptoeing on my left leg, I could feel how beneficial the walking will 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 the walking on a treadmill and also 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 was able to 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 subsequent to open heart surgery.
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...those who are paralyzed or have no limbs to support them.  
Movie night in the bush.
Unfortunately, us humans know...everything is relative, and it's our own situation at any given time that comes to the forefront in our minds when we're struggling to accomplish what normally 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 toughest 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.

We're baaack!...WiFi working again we're ready to say hello!...More favorite photos...


A parade of elephants on the dry sands of the river.
"Sighting of the Day in the Bush"
Mr. & Mrs. Hornbill eating seeds off the veranda table.  We weren't able to put up the birdfeeder with monkeys nearby and placed the seeds on the table when they banged at the window with their beaks to remind us to feed them.  
After we returned from yesterday's appointment with Doc Theo (yes, he comes to work on Saturdays and Sundays when necessary), the WiFi was back on.  But after posting that the WiFi was down using my phone before we'd left, I decided to leave well enough alone and not do a post after all.

I was reeling from the pain after he'd removed the dead skin from my leg, using surgical tweezers and what looked like a razor blade.  It was painful then and painful afterward and is still painful this morning.  
A majestic waterbuck.
But, today, I won't move from lying on the sofa with my legs up in hopes the little bit of swelling will go down and the discomfort will diminish.  Oh, dear, there's only 13 days until we fly to Ireland and between the flying time, various layovers and driving to the house, it will be an over 24-hour travel day.

Fortunately, as mentioned a few days ago, we booked business class for me which will only be of significance during the 10 plus hour night flight when I'll be able to lay down in my seat.  I'd imagine there will be some type of opportunity to raise my legs on a few of the other flights.  There are three flights in all.

Last night, we didn't go out to Jabula for dinner.  There's no way I could have walked the steps or the ramp to get to the restaurant or sat with my legs down during dinner. 
Another parade of elephants crossing the bone dry river several months ago before the rains.
Instead, we piled our plates with the tasty hot takeaway meals we'd each ordered and sat on the bed watching shows on my laptop during dinner and afterward.  Louise had brought over two oversized bed trays which have worked perfectly during this "feet up" period which by Wednesday will be four weeks ago.

Hopefully, by this upcoming Wednesday, I'll feel well enough for our planned dinner at Jabula with friends Uschi and Evan who we haven't seen in weeks.  Actually, most recently many of our friends have been traveling or at their "other" homes and we've been less social than ever.  

In a little over a week friends, Kathy and Don and Linda and Ken will return to Marloth Park to see us a few more times and say our goodbyes.  We will surely miss them after spending many wonderful times together in these past almost 15 months.
Blooming Bird of Paradise.
They've been such great friends before the surgery, during my hospital stays and have stayed in close touch almost every day while recovering back at the house.  

Then, of course, there's been regular communication and many visits by many of our MP friends beside Kathy, Don, Linda, and Ken;  Lynne and Mick, Janet and Steve, Uschi and Evan, Louise and Danie, Okey Dokey and family, Dawn and Leon (owners of Jabula), Leslie and Andrew and many more.

A special thanks to another Louise who loaned me the ideal walker which I've used since the leg surgeries and will continue to use until we're ready to leave.  It's been such help during this challenging time.
Sunset over the Crocodile River from the veranda at Ngwenya Lodge.
Many thanks to our friends, Facebook friends, and family in the US and other countries who have stayed in close touch as well, via email, phone calls, and text messages on Messenger.

Yesterday afternoon, I finished logging the balance of the month's worth of receipts that had accumulated since the end of January when the heart condition was discovered and I lost interest in entering the info onto our spreadsheet.

I have a huge pile of medical receipts from all four surgeries I've yet to log.  As it turns out, our insurance company has yet to pay the balance of many of the bills.  As a result, we will have to pay them out of pocket and deal with the insurance company in some legal manner.  
Willie loves making eye contact when I talk to him.
In the US, we can deduct medical expenses off our taxes if it exceeds 7.5% of our adjusted gross income.  If we have to pay more of the bill and don't get reimbursed for the claims we've made out of pocket so far, we'll be able to deduct the expenses.  

Subsequently, we are saving every receipt which we plan to pack and keep on hand until filing for 2019 taxes which will be in about a year from now. I'd considered scanning everything but its easier to be able to make organized piles of the receipts than placing them on my computer as a scanned document.

Sometimes, in a rare instance, the "old" way, not the technological way, is a little easier.  We'll see how it goes.
Suckling baby kudu and her mom.
Today, Tom will cook a nice Sunday dinner; bacon wrapped whole chicken breasts (pounded for thinness) stuffed with sauteed garlic, mushrooms, onions, and mozzarella cheese, rice for him and cooked veggies for me on the side..  Sounds wonderful.  Tom has become quite the cook.

Have a pleasant Sunday dinner whatever it may be, wherever you may be.
______________________________________

Photo from one year ago today, April 28, 2018:
Scar Face's right eye is above the injury but may have been affected.  He came to visit for many months and then suddenly he was gone.  We sadly wondered if he was one of the warthogs that had been culled from the park.  For more photos, please click here.

No post today. WiFi outage...

Sorry, we can't post today.
A fiber line broke and the entire area is out.
Back tomorrow!

No whinging, please...Another holiday in South Africa...


The boys toasting to the events of the evening, the night we celebrated Rita's birthday.  From left to right; Danie, Leon, Tom, Gerhard, and Ken.  What a fun night we had!
"Sighting of the Day in the Bush"
Tom tossed out some cut banana peels to the kudus and one landed on Big Daddy's head between his massive horns of which he was well aware.  After eating these pellets he made his way to a tree using the branches to "sweep" off the wayward piece of banana peel.  It took him a few minutes to resolve the issue but once it was done, he walked away shaking his head a few times.  Sorry, Big Daddy!
OK, here's more medical talk.  For those of you who are "sick" of it, I apologize.  For those of you, many who write frequently if I don't report anything, here's an update.
Us girls had our hands on the top of our heads for some reason.  From left to right; Louise, Dawn, Me, Linda and Rita, the birthday girl.  Kathy and Don sadly missed this party when they were away.
In yesterday's post, I mentioned that  Dr. Theo had redressed the bandages on my legs including lathering on a double dose of that painful honey based cream which "eats" dead tissue and scabs, leaving a pinkish wound in its path which ultimately is quicker to heal in that particular state.

After we left his office, we headed to the local pharmacy to have my zillions of heart-related medications refilled for the next six months. In about three months, I'll place another six-month refill with the online pharmacy I've been using since the onset of our travels, Progressive Rx.
Visiting dung beetle minus his ball of dung and his partner.
By sending them an email of the prescriptions bottles/boxes with the labels intact they can refill any non-scheduled prescription.  Their prices are reasonable, generally lower than any pharmacy in the US or Canada.  Their customer service is very good.

Zebra and two impalas sharing the lush greenery.
But, the request for refills must be sent in months in advance since their processing time is slow and the package often doesn't arrive for six weeks.  This may not work for many seniors and others who may not be able to pay in advance when the prescriptions won't be received quickly.

The slow arrival time has been the case, particularly for us, when receiving prescriptions while in other countries when the package has to go through customs and be approved for import.  
The chicks from several months ago had certainly grown.  Here they are, still hanging out with Mom and Dad.  Dad is in the back with the black feathers.  Youngsters and females have lighter colored feathers.
That is another reason we don't wait to place an order.  Also, that's a reason why narcotic prescriptions cannot be shipped.  We don't use any narcotic medications so that isn't an issue for us.

Yesterday, when we submitted the multiple prescriptions to the pharmacist, we expected they wouldn't have the amounts we needed on hand.  However, they would order those they couldn't fill for our pick up on Monday when again we have another appointment with Doc Theo, after tomorrow's (Saturday's) appointment as well.
Not Willie but Son of "Dad & Son" who visit every so often. "You got any of those pellets for me?"  Of course, we did.
I knew as I was in for a tough night after he applied the cream especially when he warned me to expect a fair amount of pain.  He wasn't kidding.  A few hours after we returned to the house, I was practically climbing the walls.  

Every four hours, I took the pain meds but couldn't seem to stay on top of it.  By bedtime, after I distracted myself for a couple of hours while we watched a few episodes of Ray Donovan on Showtime, I knew I was in for a tough night.  
It was a dreadfully hot day when I made eight pumpkin pies for our Thanksgiving dinner in the bush.  The temp was 40C, 104F and I had trouble with the dough rolling properly in the humid heat.  Thus, I made all of them with a thick crust, all I could manage in the heat and humidity  They tasted good anyway, so they said.
Overall, I may have slept three or fours hours but surprisingly, I don't feel tired today.  The pain is now about 50% of what I experienced last night and I expect to sleep better tonight.

Isn't it funny how everything is worse at night such as pain, worry, fear, and grief?  It seems our defenses are down as we attempt to free our minds of the day's activities and thoughts.  Here's a link to the connection between pain and sleep that provides useful information.


Another fun gathering at Frikkie's Dam on a Sunday.
I've found that the less I complain, the better I feel.  It is so easy to get caught up in a vicious cycle of "whinging" (as "they" say in regard to "complaining" in both the UK and Australia) to a spouse or other member(s) of the household.  When I have severe pain, I tell Tom about it but generally try not to bring it up again, at least until a day or so has passed.

If complaining reduced pain, it certainly would be worth doing.  But, it doesn't...and all it does for caregivers, family, and friends, is add to their own anxiety about your illness and their own feelings of hopelessness in trying to relieve your discomfort.

Two Big Daddies head butting for dominance.
Believe me, if Tom could take away the pain, he would.  And it's his good attitude that rubs off on me aiding in reducing the healing time required to get well.  Also, he never questions or minimizes the extent of my discomfort when I do mention it.  I take great pleasure in getting well, not only for me but for him as well.

Bush-tailed bushbaby at Jabula's veranda one Saturday night.
Tomorrow morning we'll head back to Doc Theo for another dose of the cream and new bandages (they're called "plasters" here in South Africa).  We'd made a reservation for dinner at Jabula for tomorrow evening but will wait and see how I'm feeling before we go.  We can readily get take-away if necessary but we'll miss the socialization we so much enjoy at this fun establishment.  

When we first arrived in Marloth Park we couldn't get enough biltong.  After several months, we'd had enough and stopped buying it.  Maybe one more time before we leave?
That's it for today folks!  Tomorrow is another holiday in South Africa, Freedom Day, (click here for details), and if as many tourists come to Marloth Park as during other holidays, we expect our wildlife friends won't be stopping by as frequently as they have this week.  We'll see how it goes.

Happy day, happy Friday, happy weekend!
______________________________________

Photo from one year ago today, April 26, 2018:
A good-sized turtle crossing the road by our house.  For more photos, please click here.

A local resident with a venomous snake bite rushed to hospital...More favorite photos...


Rhino mom and baby.
"Sighting of the Day in the Bush"
A bushbuck, duiker and several helmeted guineafowls, sharing pellets in our garden.
A few evenings ago, we heard sirens in the area.  As it turned out, it was the Marloth Park Securicon ambulance transporting a local victim of snakebite to the hospital in Nelspruit, the closest private hospital in the area where I recently had four surgical procedures.
Impalas the water hole in Verhami Dam in Kruger National Park.
Apparently, according to a post on Facebook, the resident or tourist was bitten by a stiletto snake in their garden which according to the African Snakebite Institute is as follows:  

"The Stiletto Snake (Atractaspis bibronii), previously known as a Mole Adder, is a highly venomous but harmless-looking snake that accounts for numerous snakebites during the summer months in Southern Africa.
More impalas at the Verhami Dam.
This fossorial snake spends most of its life underground where it hunts for other snakes and lizards. It does come to the surface, usually in the early evening, and especially after rain. To effectively bite within the limited space of burrows, the Stiletto Snake has particularly long fangs which it can protrude independently and ‘stab’ its prey. 

Whereas most snakes can open their mouths up to around 170 degrees, this snake can only open its mouth as wide as 55 degrees. If gripped behind the head, the Stiletto snake just protrudes a fang and twists its head sideways to inflict a bite from a single fang.

Here is a photo (not ours) of the stiletto snake:
A stiletto snake often appears to be one of many harmless snakes.
The venom of this snake, though not generally considered potentially fatal, is potently cytotoxic causing severe pain, swelling, blistering and in many cases tissue damage. Many victims lose a digit. As there is no antivenom, doctors can only treat for pain, rehydrate the patient and then wait a few days to see how extensive the tissue damage is. 
A southern ground hornbill in Kruger National Park.
In a paper on the treatment of stiletto snake bites, Tilbury and Branch caution doctors not to resort to surgical intervention in the first few days following a bite, nor to lance blisters, as early surgical intervention seldom has a good outcome. There is no evidence that the early administration of antibiotics has any benefit.
Rhino resting under the shade of a tree.
This snake is quite difficult to identify and is often mistaken for one of the harmless snakes. There are a few features one can look for in order to identify a Stiletto snake. The body and belly may be the same dark brown to blackish color but in many areas, the body is brown to blackish and the belly white."

Certainly, this incident and others serve as a warning to local residents and visitors to Marloth Park.  At night, anytime we're entering or exiting the car, I always remind Tom and any friends with us, "Watch out for snakes."
A fish eagle scouring the area for her next meal.
Oftentimes, snakebites at night are a result of not watching where one is walking in the dark and then stepping on such a snake.  It's imperative to use a flashlight or small LED keychain light when going from house to car and back.
Rhino on the move.
We haven't heard how the victim of the bite is doing but we'll continue to watch for any report that may be posted on Facebook in the next few days and report back here.

This morning, once again, we headed back to Doc Theo in Komatipoort for further treatment on my legs, particularly my left leg which has been the biggest concern.
Rhino hanging out with warthogs.
After he'd slathered the wound with the burning honey based cream and re-bandaged it on Tuesday, keeping me awake all night as it dissolved the dead tissue, the improvement was visible but not as much as we would have liked.

Again, this morning, he slathered the cream on both legs and within about 30 minutes, the burning began as it had on Tuesday.  Today and tonight will be long as I deal with the constant burning sensation.
Boat and trailer stuck while attempting to cross the Crocodile Bridge on its way out of Kruger.  That day, we had to drive all the way to the Malelane exit which took us an additional three hours.
However, knowing the product is working and is not a result of some other issue, the pain is tolerable.  Again, I'm taking the Tylenol/Paracetamol-based pain medication every four to six hours to keep the discomfort at bay.  It does seem to help.

Not much is required of me today.  If I'm able I'll get back to work on logging more receipts/expenses today on the spreadsheet.  This is more of a hassle than one would expect when I have to convert each receipt's amount from rand (ZAR) to US dollars and enter the correct amounts on the appropriate worksheet in the Excel workbook.  I'll be thrilled to be done.

May your day be pleasant.
______________________________________

Photo from one year ago today, April 25, 2018:
The well-equipped modern treatment room was the most sophisticated we'd seen in years with the latest and most professional equipment.  We have both been to Dr. Luzanne many times in this past year.  For more details, please click here.