Procedure failed

Booked for a gastroscopy today, to check for any potential problems with leaky internal blood vessels - a common side effect of cirrhosis.
I've never been good at the dentist probing the back of my mouth. I was also unable to tolerate the naso-gastric (or NG) tube after my liver resection surgery.
So I was pessimistic about the success of this procedure, which involves a tube the thickness of a biro down your throat and into your stomach. I had a long chat with the endoscopy nurse.
We decided to go for it on the understanding that she would stop if it became clear I was distressed. Into my veins went a nice big dose of midazolam sedative and I drifted off to sleep. The last I remember of a normally 5-10 minute procedure was the teeth-guard about to go in.
45 mins later I wake up back on the ward to find they had been totally unable to intubate me. Despite being completely out of it on the drugs I had reacted in some way that they got no further than my mouth, let alone my throat or oesophagus. Hope I didn't swear or hit anyone! I don't know, because the amnesiac effect of the drug means I have no recollection at all.

My notes now say 'Mrs S was unable to tolerate the procedure. For discussion at HpB MDT meeting tomorrow with scan and biopsy results'. So, I don't know where we go from here. It's possible another scan instead of the endoscopy. I should get a call Wednesday afternoon.

Back home. I've eaten nothing since 9pm Monday and nothing to drink since 11am today so I'm starving and thirsty. Time to refuel. Pancake day.

Clues

This post links to:
http://stevechamberlin.blogspot.com/2011/02/i-get-by-with-little-help-from-my.html

T & I used to go to festivals, not music festivals but orienteering festivals. In 1983 our then 'club' was responsible for the car parking of an annual international event called the JK or Jan Kjellstrom http://www.jk2010.co.uk. Around 4,000 runners attend this most years. Here is a little yellow VW at the start of the day.

As a student I also use to drive one of these (below)for the university team. BUSF stands for British Universities Sports Federation. They had an annual event too.
That's me! And T peeking out of the back.

Transplant man

Transplant man has been allowed home 24 days after receiving his new liver.

Diary
After last weeks 'fasting' day for the biopsy, and this week's 'fasting' morning for the CT I've lost 2 lbs in weight. I'll have to pig out over the next few days to regain the lost lbs as I have another 'fasting' day next week when it's Nil by Mouth on Tuesday.
1 1/2 hour walk with K and Basil-the-dog

CT scan

Six-monthly CT scan today as part of the ongoing monitoring for cancer recurrence. A relief to find I only have to drink water this time, not the delightful anise flavoured cocktail from previous scans. I still have an IV injection of the stuff, but can pack away the swizzel stick, ice and slice of lemon for another 6 months.

Everything goes ok apart from (1) first radiographer can't get IV in so second radiographer tries on my other arm. Pincushion time. And (2) for a few minutes after the IV hits the back of my throat my mouth, tongue and throat go fuzzy and tingly which is disconcerting as a classic sign of early allergic reaction. Once the IV stops flowing it eases a little, and with plenty of fluids after I feel ok again. Last time I had an upset tum, this time tingles. Hope I'm not building up an allergy to the stuff as this is on repeat twice yearly for the indefinite future. 2 weeks for the results.

New liver cancer leaflet

The British Liver Trust has put the new liver cancer leaflet that I helped review on their website at
http://www.britishlivertrust.org.uk/home/the-liver/liver-diseases/liver-cancer.aspx

Once on the site you can click on 'Download Liver Cancer LCZ 0311.pdf' to view.

It's even in one of my favourite colours!

They've kindly sent me multiple copies and some other leaflets to take to my GP surgery.

Tuesday
Cleaned out woodburner.
Spent some time squished behind the TV cabinet sorting out a tangle of plugs and cables. TV plug, aerial cable, freeview box plug, DVD plug, CD plug, ipod docking plug, Xbox plug. Abdomen a bit sore for a while later, but not too bad and no stiffness

X marks the spot

Took the biopsy needle site dressing off while having a soak in the bath. First reaction was eek what a nasty purply bruised mess. Then realised it was a purply felt pen X done by the radiographer as a guide. Doh!

Stiffness diary.
No tablets now for 5 days.
Friday: Laying around for 6 hours and being brought meals to my bed = no stiffness!
Saturday; Feeling rough and headachey. Slight stiffness in the knees
Sunday: Feeling better. No stiffness apart from legs late evening after sitting on the sofa too long.
Monday: Up early for work shift. No problem. No stiffness. Short walk in the afternoon including some hilly bits. No stiffness later.

Ow, ouch, zzzzzz

Friday was biopsy day. Nil by mouth from Thursday night, procedure at 10am.
Reported to ultrasound department at Macclesfield for 9.30. Change into gown and, most important, final toilet visit!
Tiny room crammed with trolley bed, machine, consultant radiographer, second doctor 'observing', and department radiographer. Almost total darkness (so the screen is brighter) makes it bit scary! I still haven't been taken through the consent form but the radiographer insists that what he is about to tell me is far more important than anything on the form, and makes me extra nervous by telling me the procedure is my choice and all the things that could go wrong. He gets to the 'might need surgery to repair' bit so I ask if that's done at Macc and he says no, North Manchester. Hmmmm. 'I can tell you're nervous' he says. 'Too right, mate'.

So we go through 20 minutes or so of him finding the best spot and me holding my breath on demand. Then it's local anaesthetic time. Three jabs, each going deeper in, and the 2nd has me going ow, ouch (hence the 3rd!). He tells me off for flinching and I'm thinking well you see what it feels like to have a needle like that into your liver mate. Then quick tugging sensation and it's all done.
Only not quite - 'I'd like to do a second' he says. 'Oh sh*t', says I, out loud. How good is the sample you have? 85% says he. Good enough for me, says me, thinking I'm not doubling the risk of a 1 1/2 hr trip to North Manchester while I bleed out in the ambulance thanks, for the sake of that last 15%.

Off we go on the trolley. It's impossible to get your bearings staring at the ceiling but I do notice it's up in the lift and that the ceiling tiles are filthy. I ask the trolley man which Ward, and he apologises it's wherever there is a spare bed. Turns out I'm on the 'old lady' ward and he was embarrassed to have me think he was implying I'm shunted there purely on age grounds!

I think some of the local anaesthetic has found its way round my system, as I feel nicely dozey by now and ready for some zzzzzzz
I'm supposed to have blood pressure and observations every 15 minutes but 45 go by with not so much as a 'hello'. So press my buzzer. They have my name on their white board, and my notes, but no idea where I magically appeared from or what they are supposed to do! I explain I should have observations every 15 mins for the 1st hour, every 30 mins for the next 2 hours, 1 hourly for 2 hours and then 2 hourly til discharge. Anyway, sister devises her own plan which is 1/2 hourly the whole time! Who needs silly old nursing guidelines?

I ask about fluids, as I've been without for 12 hours now and feeling dehydrated. Answer comes back no food or drink til you go home - whaat? As my BP slowly drops due to dehydration and a headache starts (I'm pretty sure its lack of fluid not an internal bleed as I have no pain or even the tiniest discomfort - radiographer must have picked an ideal spot after all) I sneak drinks from the bottle I brought and start to feel better. I also sneak nibbles on a few raisins.
Downside of drinking again is the need for the loo and it's impossible to deal properly with that lying down!

Dr S comes to see me, which is a nice surprise. I ask him about post procedure and he says I can get up at 4pm and eat and drink and go home - yipeee.
4pm visit to the loo makes the whole world in general a much nicer place. Now I have to wait for hospital tea-time which is 5.30. Under cover of my book I eat the sandwich I had brought in, and polish off the rest of my water. Tea is a 3-course NHS meal - actually it was ok. And then I can go. I dont have to be officially discharged as I was never officially admitted. I realise I never had a wrist band or any ID.

Next on the list is 6-monthly CT on Thursday next week. This is where you get to drink a gallon of Pernod flavoured iodine before the procedure followed by feeling as sick as if you had drunk a gallon of Pernod!

Now the going gets tough

I stopped the anti-inflammatories yesterday. The inflammation levels from the biopsy tomorrow need to be unaffected by them. Also the plan was to take them for a week and the week was up. Then check on blood results (which I have) and then see how long I can manage without the medication before things get unbearable. It makes sense to abstain for a week before going back to Dr L as repeat blood tests will see if I revert negatively without the medication as quickly as I responded positively to it.

Problem is, Doctor L is predictably booked up and can't see me for 2 weeks.
OK I managed for 7 months without any, but now I've had the benefit of less pain and more mobility it's going to be tough mentally to go backwards even knowing I can just about cope physically.

10.45pm: Going to bed. Creeping around like an arthritic cripple! Legs have been iffy all day and now I can only crawl upstairs. Arms and shoulders are going. Disconcerting is the effect on my throat and neck - lots of muscles in your neck apparently. Nil by mouth now until after the biopsy. Nite nite.

Positive blood test results

Picked up my set of results from the pre-biopsy bloods taken yesterday. They all look fine for the scheduled biopsy on Friday.

They also look positive after a week on low dose anti-inflammatory meds. My paranoia about jaundice is totally unfounded. Bilirubin has dropped and is well within normal levels.
Something called alanine aminotransferase or ALT has been consistently high since tests were started last June. When the liver is damaged it releases ALT into the bloodstream, which makes levels go up. I'd been advised by the consultant that mine will always be high because of the cirrhosis damage. However, after a week of the meds, my level has gone from a high of 84 down to 35 where the laboratory's 'normal' range is 10-50. I take back my comment from yesterday where I felt things weren't going in the right direction. Most autoimmune conditions respond to this type of medication, so Friday's biopsy results may shed further light on whether we're dealing with an autoimmune version of hepatitis (hope not) or an autoimmune version of arthritis.

Tuesday: Good nights sleep.
Wed: Stiff neck and shoulders on waking. Managed a work shift before taking meds. Training session at the office pm, plus taxi service for J, so more local driving than usual today.

Bloods today

Back to the hospital this afternoon for the set of blood tests pre-biopsy. Liver function, full blood count, clotting rate', blood type and cross match, etc. They were only done 3 weeks ago, in preparation for the biopsy that never was. But I guess procedures being what they are, I have them done again just to be sure. Results will be on the system by tomorrow, Wednesday.

Timing will be good for a peek at a selection of the results to see if the 7 day course of anti-inflammatories has had any effect. Things like the ALT whose levels reflect inflammation and damage to the liver cells. I want to check the bilirubin level, the one that rises with jaundice. I may be paranoid but to me my skin is more Dulux pale 'Easter Morning' than flesh pink!

Work called to advise me that the sheltered housing where my Thursday client lives has a stomach bug going round and they don't want to put me in a vulnerable position of catching the virus just before the biopsy. So no work on Thursday and thanks Pam for forewarning me!

Sunday night: Rubbish sleep. Fluey again, with weird dreams and very restless.
Monday: 5mg tablet. Better sleep, but still weird dreams that wake me 3 times.
Anti-inflammatory works for about 7 hours instead of 24 now, from mid-morning after I take it to early evening. Energy levels low. This isn't the way to go and I'm due to stop tomorrow anyway and refer back to GP.

Discovery

In 2005 I was invited onto the committee of volunteers setting up a brand new 'Heritage' centre in the town with the aid of a large Lottery Grant. We were generously given, for a peppercorn rent, a small ground floor unit within a 19th Century cotton spinning mill fronting the canal. You can see the depth of the walls by looking at the windows in the photo. First job was to totally refurbish the room, including the construction of a mezzanine floor. We needed exhibition space and space for a small number of sale items; local history books, walking guides, maps, postcards, etc.
My responsibility was to organise the transfer of 5,000 photographic prints, dating from the 1890s to present day, into digital format so that they could be available by public access computers.
Being on the committee also got me involved in the group of 40 or so volunteers who staff the centre each weekend.
Here is a photo of the ground floor. It's a bit distorted as it's a 'still' version of the 360 degree panorama. There's a small mezzanine with the computers upstairs.



Over the years I gradually withdrew from the monthly volunteer shift, and from the committee, but have jealously guarded my role as photo archivist and printer!

On Saturday my friend K was due to be there as a volunteer, but was away due to family bereavement. So I stepped in and for the first time for about 4 years did an afternoon shift.

Friday: 5mg tablet @ 11am. Mobile and pain free day. More energy than usual. Clearer head. Meeting at work to review health and take on another client. Good nights sleep
Saturday: Sleep in til 11am. 5mg tablet. Afternoon shift at the Discovery Centre. Still mobile and well enough to cook evening meal. Good night sleep.
Sunday: Sleep in til 11am. 5mg tablet. Mobile on getting up but feeling tired today. Visit the garden centre and pot up some spring daffodils. Sleep on sofa for much of the afternoon. No pain or stiffness but very tired all day. Maybe did too much Thurs/Fri.

Doctor's diagnosis

Went with T to see my GP yesterday. Apart from a home visit just after surgery when I was worried about fluid retention and a couple of phone consults about my work 'sick note' I realise I haven't seen a doctor (as opposed to consultant at the hospital) since I had the liver resection over 4 months ago.
The doctor we saw is well respected within the practice, but hadn't seen me as a patient for years. He admitted he had spoken with another GP who knows me and updated himself. Said my 'story' made his hair stand on end.

Sorry Dr L, you don't really look like this!

Knowing that each appointment slot is brief T had summarised my history in a business-like way onto one A4 sheet.

Dr L thinks my aches and pains are more likely polymyalgia than the cirrhosis. Standard treatment for this is the same as for most autoimmune conditions - steroids. Just the thing Dr C advises not good for dormant viral hepatitis! Dr L's plan is I take steroids for a week and then stop taking them and see how long I remain pain free. Yes there are potential risks that if I came to rely on the steroids it might compromise the hepatitis. On the plus side steroids dont compromise cirrhosis. If I rely on painkillers I'm more likely to damage the liver further and risk internal bleeding. It's a risk assessment situation. After 8 months of living with these debilitating symptoms whilst recovering from surgery and trying to get back to a normal life balance, I'm happy to live with this risk. I'm due another set of pre-biopsy blood tests on Tuesday 22nd Feb, and these should show if the steroids have started to reduce the inflammation.

Stiffness diary
Wednesday: Averagely active day including 2 hours at work. Shoulders, neck and hands stiff and sore. Took half dose tablet pm. Excellent night sleep.
Thursday: Neck and hands slightly stiff on waking. Flew down stairs no problem at all, hurray! Tablet at 11am. By 1pm no stiffness at all except slightly in right hand. Low energy levels but feel brighter and less 'foggy'.

Still in remission

AFP blood test results are back. Six weeks after surgery the cancer tumour marker had dropped an amazing 149 points and at 3 was well within the 'normal' range of 0-10.

Three months later it's dropped further to 1.

Great news.

Stiffness diary

Monday: feeling tired and uncomfortable all day. Very bad night, had to take painkiller @ 2am

Tuesday: Still stiff and tired. Not going to Tai Chi today. Appointment with GP tomorrow to discuss ongoing symptoms (clearly unrelated to cancer) of muscle weakness, joint pain, flu like fatigue, feverishness and generally feeling unwell.

Still mobile and pain free

24 hours after taking a strong anti-infammatory I still feel good, so time to go for a walk taking advantage of some pain free mobility. We've had a lot of rain, and the mill weir at Waulkmill has a loud roar:

We carry on so that I can have a look at the field boundary hedge-laying work T & fellow Kerridge Ridge conservation volunteers have been up to.

This ongoing project involves the conservation of natural and historic man-made features in the landscape including the repair and maintenance of rights of way and field boundaries and management of meadow and woodland. The volunteers, all previously unskilled, have been trained by the British Trust for Conservation Volunteers. I think the hedge looks pretty good and will last about 15 years before needing more work instead of the annual autumnal 'flail' cut from a tractor. A properly 'laid' hedge also gives much needed habitat for small mammals and birds.

In the photo below you can see a bit of the 'hedge' they started with, made up of uprights (as in foreground). The upright stems of the hedgerow shrubs are reduced in thickness by cutting away the wood on one side of the stem. Each stem is then laid down along the length of the hedgerow and in between stakes are driven into the line of the hedge. These vertical stakes give the finished hedge its strength. New growth at the bottom is encouraged and the sheep will no longer be able to push through holes.

Stiffness diary

Sunday am: Hands have swollen overnight, painful knuckle joints again. Neck, upper shoulders and collar bone area stiff again. Legs lacking muscle tone. Anti-inflammatory effects lasted about 36 hours.

Happy birthday

Tried to find a nicely embarrassing photo. Preferably with knobbly knees. Had you raided the dressing up box? Nice shoes!!!

Happy birthday big brother from your little sister.

Walking the way to health

"Walking can give you more energy" says the guide for this 2 mile walk.

With two Book Club friends completed this circular route today, finishing with nice lunch at the canalside cafe. Took about 1 1/2 hours, further than I have been for a while.

Stiffness diary
Completed the walk at 12 noon.

Took very very strong anti-inflammatory (that I'm not prescribed!) at 2pm.

8pm. Still fine. Let's see what tomorrow brings as judging by the Tai Chi experience this muscle stiffness is taking 24 hours to kick in.

8am Saturday. Awake 18 hours after taking the ant-inflammatory; no stiffness. Fall asleep again till 11am, minor stiffness in right ankle joint and left hand. Minor stiffness in neck. Apart from that very good 21 hours later.

Suggestive that a decent anti-inflammatory that wont harm my liver or re-activate my Hep B would keep my pain and mobility levels to relatively normal.

'Story' now online

Email from the British Liver Trust to say my 'story' has now gone onto their website.
www.britishlivertrust.org.uk/home/the-liver/liver-diseases/liver-cancer/real-story-fionas-story.aspx

For the last 4 months I've been a member of 2 online cancer forums and 2 online hepatitis forums.
I've met some lovely people amongst the 3,000+ members on the cancer forums, but though some have secondary liver tumours, nobody else has primary liver cancer.
On the hepatitis forums, which have around 2,000 members, I've been in contact with 2 people treated for HCC liver cancer - one in the US and one in Australia.
47,000 are diagnosed with breast cancer in the UK each year and many women write breast cancer blogs. Compare that to 3,400 diagnosed with primary liver cancer (about 1% of all UK cancers) and I've yet to find another blogger (although I do follow 2 transplant blogs neither are cancer patients).
In spite of the Liver Trust website there is relatively little patient experience information and support for HCC. Long term survivors telling their stories online seem to be rare. It seems a combination of no standard "chemo" or "radiation" treatments for HCC, like there are for other cancers, and the small number of survivors makes for a lack of information resources.

The success of treatment for all cancers is usually measured in 5 year survival rates, being the period at which it is less likely to return.
Of the 2 people I've 'met' online diagnosed with HCC one has survived 3 years but has a recurrence and the other has survived 5 years with zero recurrence. I've not yet met anyone online who is a >5yr survivor.

Survivor (1) had a resection in 2007 of a 6cm x 12cm tumour (about the size of a large pear). Sections 2 and 3 of their liver were removed (that's about 1/4). Like me they have compensated cirrhosis. Their AFP was elevated 20 months later but it was 3 years (2010) before identifiable new tumours appeared. By 2011 there are 5, and as they are spread throughout the liver resection is not an option. Treatment is TACE chemo.

Survivor (2) had a resection in 2005 for a 1.5cm tumour (grape size same as mine). All of section 6 removed. Compensated cirrhosis. Slightly elevated AFP consistently. No evidence of a recurrence after 5 years.

A 3rd resection patient on a cancer forum had surgery in 2008 for a 22cm tumour (Very large Fibrolamellor - longer than a banana! But not HCC)
Mets in lung 2009; Recurrence within 2 years in lymph node 2010; Removal of lymph node 2011.

Of 2 others whose blogs I follow. (1) has survived 3 years on repeated treatment for metastatic liver cancer (primary is colon). Current treatment regime is SIR Spheres (a form of radiation used in the US but not so common in the UK)

and (2) Has liver mets from a 2009 diagnosis of bowel cancer. Palliative.

Stiffness diary
9am. Legs ok but feeling a little weak. Neck more mobile. Shoulders and upper back ache slightly but not too bad. Thumb joints on both hands painful.

Evening: Have driven around 20 miles today. Also ate not very healthy slice of cream cake (with client) and small MacDonalds salty fries. Felt very unwell in bed - feverish and aching all over. Painful shoulders, knees almost completely seized up.

Woke up Friday morning and everything has cleared up!

Waiting 11 months for THE CALL

Since stealing his quote to put at the top of my home page I've been a follower of a London man waiting for a liver transplant. Today I logged on to my emails to find that he has blogged about receiving THE CALL. He posted at just after midnight that he expected to be in theatre from around 7am this morning for a liver transplant.
8pm: Update on David K's blog. Transplant successfully complete. Patient under sedation in ICU.

Stiffness diary
9am. Legs fine again after yesterdays Tai Chi. Upper back and shoulders quite stiff but bearable.
4pm. Neck and shoulders very stiff. Left side of jaw aches, difficult to open mouth. Puzzling over why, decide it's because this morning I used my teeth to pull off one of those plastic tear off security strips that go right round a lid to secure it before first opening.
8pm. Did some warm-up arm and shoulder exercises mid afternoon but am now pretty much seized up in my neck. Can turn a little way to the left but not at all to the right.

Tai Chi

On impulse decided to join my neighbour Val at her weekly Tai Chi class this afternoon. Sadly it's not on a gorgeous beach like this, just our local Methodist church hall!

5pm. Back from an hour of my first Tai Chi. The warm up exercises are lovely, I can feel my shoulders and arms free from stiffness. But the routine of 'forms' has me completely lost! Trying to co-ordinate arm movements and leg bends is like that rubbing your tummy while patting your head thing. They do have lovely names, like 'parting the wild horse's mane'. Lower back and thighs ache by the time I'm home due to the bent leg posture but worth going again next week and checking out some You Tube videos of the exercises. Oh, and we did do something like that pose in the photograph, which might be called the Intercept and Punch.

Stiffness diary, Monday
Left shoulder where it meets the clavicle is stiff and painful when I go to bed Sunday. Painful in the night, still painful and difficult to move Monday morning. Soak in hot bath, no improvement.
1pm. Drove around delivering photo orders (long story, but see http://happy-valley.org.uk/discover/picarch1.htm if you want) Shoulder stiffness easing.
5pm. Feeling OK. Only residual pain in shoulder.
7pm : Pain back in left arm only this time in the area round the biceps. Lifted an averagely heavy skillet pan, but with right arm.
Night/Tuesday early morning: Right knee around what I think is the popliteal tendon. Left hand knuckle joints.
Tuesday. Stiff around the knee but otherwise ok.
4-5pm Tai Chi
10pm. Stiff legs and left shoulder, but not as bad as anticipated. Off to bed.

Apple cake

T was born and brought up in this house with large garden including the big apple tree, as in photo below.

The tree was substantial enough to support a swing. See below J at about 10 months with T's mum who he called Granne (Anne with 'g r' in front).

Every autumn the tree was harvested for its cooking apples. And every November 5th

(Gr)Anne would bake a cake with the apples known by the family as Bonfire Cake.

For many years I had a copy of the recipe, spreading further copies around friends as it was unusual and delicious.

Last Autumn we were briefly inundated with windfall apples from friends. Time to get baking. Could I find the recipe? Hell, no.

So we invented our own. It's definitely lacking some of (Gr)Anne's ingredients, as she included dried fruit and you couldn't distinguish the apple pieces. But we think ours still tastes pretty good. J likes it slightly warm with a cup of tea, and T likes it as a pudding with custard.

Apple Cake

Ingredients as for basic Victoria sponge;

4oz butter (I use cheap unsalted supermarket own-brand not margarine)
4oz caster sugar
4oz self raising flour
2 eggs
2 teaspoons bicarbonate soda
1 teaspoon cinnamon
2 medium Bramley cooking apples or 3 desert apples.
Demerara sugar for topping

Blend the butter and caster sugar until pale and creamy. Mix the bicarbonate of soda and cinnamon into the flour and then gradually mix the flour and beaten eggs into the butter/sugar. Peel and core the apples. Chop into sugar cube size bits. Fold into the cake mix until evenly distributed.
Grease a 10"x9" cake tin and spoon the mixture in. Sprinkle with a generous topping of demerara sugar. Bake Gas 4 (350 F) for 20-25 minutes or until the top is golden and a skewer inserted comes out clean. Cut into squares.

We've also made this with pears instead of apples. It's a bit 'wetter' and has a milder flavour. The quantity of bicarb might seem high but it helps raise the mixture like a sponge cake as the fruit makes it moist.
Yesterday my brain was thinking 'sponge cake mixture' as I prepared things and I absent mindedly greased my 2 shallow round Victoria sponge cake tins instead of the deeper rectangular one. I'd also started spooning in the mixture before my brain clicked into gear, so decided to carry on. It turned out well, and nobody minded the triangles of cake instead of squares!

Stiffness diary
Wake in the night and find my neck really stiff and throat painful. Sleep for 12 hours and struggle to get out of bed. Find it painful to bend to put socks on.
Take a painkiller.
Better by 11.30 am, background aches only.
12.30. Shopping trip to supermarket. T pushes trolley. Feel fine, only slight ache in upper back
3pm Rooting around in cupboard lifting out photo albums
4pm Legs stiffening
Typing on PC/cooking
6pm. Shoulder joints and left elbow painful.