In our previous blog I wrote that on New Year’s Eve I did not feel very well. My injured left eye with two transplanted corneas started swelling up. My vision slowly started to deteriorate, and I developed an inflammation in the eye. In this situation I use more steroid eye drops, which unfortunately adversely affect the immune system but help to reduce the chance of rejection of a transplanted organ, in my case a cornea. One of the side effects is that you are more prone to infections and I came down with a nasty cold.

In the previous paragraph I stated that I have two transplanted corneas.

Let me explain how that is possible.
The cornea is referred to as the "window" to the eye or better the window to the world. The cornea needs to be clear, so light can pass through towards the back of your eye called the “Retina”. When a cornea through disease or injury is damaged, light can no longer effectively pass through it, resulting in reduced or no vision. With a Penetrating Keratoplasty (PK) corneal transplant the damaged cornea is replaced with a clear donor cornea. My original cornea was replaced using this procedure in 1994 a year after I injured my eye. Due to rejections of the transplanted corneas I had this transplant 7 times over the years.

With this procedure a circular disc from the center of the cornea is removed. From a donor cornea a similar shape is removed and is put into position and sutured into place with 16 stitches. This is a well-tolerated procedure, but the recovery can be quite long, up to twelve months. It is also not uncommon to have significant irregular curvature of the cornea because of the sutures and this limits the vision and in many cases a contact lens is required to achieve the best vision.

Recently a new version of corneal transplant is developed which uses only a very thin portion of the cornea for transplant. In this procedure the unhealthy, diseased, posterior portion of a cornea is removed and replaced with a very thin portion of the donor cornea. This replacement tissue is folded and placed inside the eye where an air bubble pushes it in place until it heals in an appropriate position. This transplant procedure is called “Descemet's Stripping Endothelial Keratoplasty (DSEK)”. Unlike the PK, the DSEK procedure utilizes a much smaller surgical incision and requires no corneal sutures. This usually results in more rapid visual rehabilitation and reduces the risk of sight threatening complications that may occur with the PK.

This new procedure was now for the 2nd time used on me on top of a donated cornea. The result is that I have a cornea implanted with the PK procedure and the second with the DSEK procedure.

After our return from Rio Dulce, Guatemala and two visits to my eye doctors I underwent my 9th corneal transplant on February 20, 2018 using the DSEK procedure. During the checkup the next day we had a big disappointment, the new cornea was only partially attached. During the remainder of the week the doctor used different procedures to accomplish the complete attachment. My glaucoma tube released too much of the air that was put in my eye to create sufficient pressure. Four days after the surgery he used a gel to block the tube and an expendable gas to maintain the pressure. During these days I had to lie 50 minutes out of every hour, flat on my back to keep the air bubble pushed against the new cornea. Finally, 6 days after the transplant, it showed that the new cornea had attached. The doctor warned me not to pop the champagne cork just yet, but the healing had started.

Although we still had a few rough patches, it now seems that my vision is slowly improving, and we can stick to our original plan to fly back to Guatemala on April 25, 2018.

My son loaned us his beautiful truck and we were able to drive around and have transportation for our very frequent doctor’s visits. This was the first time that we did not only have to do this for me, but also for Dorothy. She already had for some time problems with her back and her knees. During our first visit to the house of our son one on his English Bulldogs ran into the side of one of her knees. The doctor she visited advised her to start an intensive program of physical therapy. I started my old routine of walking 3 miles through the historic town of Gruene and it was fun. Three weeks after my corneal transplant the doctor allowed me to start swimming again and now I am completely back to my morning routine while spending time in New Braunfels, Texas. Waking up in the morning at 5:10, ready to enter the pool at 5:30, swim for 30 minutes, take a shower, go back to the RV to have a light breakfast, drop Dorothy off for physical therapy and take my 3 miles walk. On nice days we take the truck and drive into the Texas Hill country which is starting to become very beautiful with the blooming wildflowers.

If the weather cooperates, March, April and May are prime blooming months for the Texas Wildflowers. With its sprawling size and diversity of landforms, Texas offers a treasure of spectacular wildflowers. More than 5,000 species of flowering plants are native to Texas. The most known flower is the state flower the Bluebonnets which are in their glory starting in March all through April. Watching Texas’ prairies and hillsides light up with seasonal wildflowers is a delight for the sense. It is a farewell to the short-lived winters and a harbinger of the warmer days to come. This symphony of color has played an important role throughout the centuries, its blooms providing medicine, inspiration, and beauty to lift the spirits. The state’s capital city, Austin, is home to The University of Texas Lady Bird Johnson Wildflower Center, a research unit of the University of Texas at Austin, devoted to the preservation and use of native plants. The Wildflower Center is a botanical garden that demonstrates the beauty and importance of native plants. Water features, nature trails, display gardens, visitors’ gallery, café, gift store and award-winning architecture can be found, along with information on how to plant and grow wildflowers.

Bluebonnets are the most popular Texas wildflowers in central Texas. The Bluebonnets start blooming in the middle of March and usually peak about the second week of April. In the middle of April fields of the blooming flowers can be found everywhere and it is a beautiful sight. By the end of April, the Bluebonnets usually are fading away. A field that was filled with Bluebonnets can completely change over a few weeks’ time to a field of red and then a field of yellow. Texas Paintbrush wildflowers start blooming the same time as the Bluebonnets and bloom in the same areas with the Bluebonnets, side by side, from the middle of March through April. As the Bluebonnets and Texas Paintbrush are fading the Indian Blanket wildflowers come in to take over. You can usually see a lot of the Indian Blankets blooming from later in April through May. The Indian Blanket is a beautiful flower that is found along the highways. The yellow border on the flower varies from a wide yellow border to none.

We arrived in San Antonio, Texas in 1985 and it has always surprised me that this town with its very strong Mexican heritage gives so much attention to St. Patrick’s Day. They even go that far as dyeing the river green. San Antonio has many tourist attractions, but the crown jewel is the “Riverwalk”. The River Walk (also known as Paseo del Río) is a city park and network of walkways along the banks of the San Antonio River, one story beneath the streets. It is lined by bars, shops, restaurants, nature, public artwork. The River Walk winds and loops under bridges as two parallel sidewalks lined with restaurants and shops, connecting the major tourist draws from the Shops at “River Center”, to the “Arneson River Theatre”, to “Marriage Island”, to “La Villita”, to “HemisFair Park”, to the “Tower Life Building”, to the “San Antonio Museum of Art”, to the “Pearl Brewery” and the city's five Spanish colonial missions, which have been named a World Heritage Site, including the Alamo. The River Walk is used for any parade there is in San Antonio like the largest party in town “Fiesta San Antonio”, start of the Christmas Season, the many championships of the “Spurs” one of the best basketball organizations in the NBA and “St. Patrick’s Day”. We visited the River Walk on St. Patrick’s Day and had great Tex-Mex food with a couple of delicious Margaritas surrounded by all the green. How typical San Antonio Texas can be.

We are very grateful that after so many years of not being able to enjoy the most beautiful season in Texas we could be part of it this year. Unfortunately, sometimes “with the good also comes the bad”.

Just after we arrived back in Rio Dulce last year we received the horrible news that one of my brothers was diagnosed with a very aggressive form of ALS. ALS, or amyotrophic lateral sclerosis, is a progressive neurodegenerative disease that affects nerve cells in the brain and the spinal cord. A-myo-trophic comes from the Greek language. "A" means no. "Myo" refers to muscle, and "Trophic" means nourishment, "No muscle nourishment." When a muscle has no nourishment, it wastes away.

Motor neurons reach from the brain to the spinal cord and from the spinal cord to the muscles throughout the body. The progressive degeneration of the motor neurons in ALS eventually leads to their demise. When the motor neurons die, the ability of the brain to initiate and control muscle movement is lost. With voluntary muscle action progressively affected, people may lose the ability to speak, eat, move and breathe.

His life expectancy was so short that we decided to change our land trip through Guatemala and instead of 4 weeks made it 3 weeks and flew for one week to The Netherlands like we described in a previous blog. It was a good decision since we were still able to communicate with him and had a good time together. In the first week on January 2018 my so Robert visited him, and communication was not possible anymore. My brother was transferred to a Hospice and after very terrible suffering he passed away on March 12, 2018. It was a difficult week for Dorothy and me since we loved him so dearly.

This tragic event made us think a little more about our future and especially our future without our boat. Our past two sailing seasons were very much influenced by medical problems with needed surgery and a long recovery time. This year just before we wanted to leave the Rio for Belize and other waters in the West Caribbean my body rejected my corneal transplant and we had to go back to the USA. With now only our boat and our RV for our living space we started to develop a wish list where to live after our cruising days come to an end. It came as no surprise that we narrowed it down to a beach condo like we had in Miami Beach. Of course, a smaller version, closer to our children and at lower cost.

We concluded that the Texas gulf coast was a great place to start our search. We found that there is a significant different in the beach condo’s in Texas and South Florida: In South Florida no short-term rental; Texas Gulf Coast 90% or more short term rental. This means hardly anyone lives in a condo on the Texas Gulf Coast and uses the condo strictly as an investment property with very limited personal use. What further complicated our search was that due to labor shortage only very limited reconstruction was done after the horrible destruction by hurricane Harvey in August 2017. We found nice places, but it is very unsure when the units become available for permanent living, so it is difficult to make plans.

When we come back in Texas for the 2018 hurricane season we want to start using our RV to make trips through the USA. We sold our last vehicle in December 2012 just before left on our sailing adventure and have not had a vehicle since then. Most of the seasons my son Robert loans us a car or truck and in the 2 years he had nothing available we had a rental a car. Our friends Kurt and Kitty helped us to pull our RV from the storage location to the campground. We started our search for a towing vehicle and found that Texas is still the best place to find large strong trucks. We found a beautiful Ford F350 “King Ranch” with all the extra’s to make the perfect towing and traveling vehicle. When we were ready to make the purchase, we realized that we don’t need it until June/July, so we delayed our decision but know what we want and will look for when we return.

When I read my blog, I see what this trip is about and that is taking care of our health and troubles what to do with the time in-between the doctors visits and resting to recover. We love our retirement years which we expressed in an interview with a communication specialist of the Texas County & District Retirement System (TCDRS) one of the pension funds we get our retirement income from. This interview will be published in the Summer Edition of their newsletter. But it is clear why we enjoyed it so much, because we had a plan and that was sailing through the Caribbean and visit all the beautiful countries we came ashore. We do not have a plan how to spend our time in these recovery times. Doing too much will slow down the recovery but having too much idle time on your hands definitely leads to boredom. At the same time, we must be careful with our expenditures since living in the USA is a lot more expensive than the countries we visit. A good example is when I had to pay $20.00 for a haircut while the last haircut I had in Rio Dulce was only $1.25. We use a beautiful truck my son loaned me, but it uses a lot of gas and in the Rio a Tuk-Tuk ride into town is only $1.40 and a bus ride to the next closest city called Morales is $1.70 for a distance of 24 miles. In the USA everything can be done fast. A trip to the grocery store can be done in ½ hour while the same task in the Rio takes at least 2 hours on a good day, but the trip is fun with all the things you see and the people you meet.

We start to realize that a return to living in the USA will be hard to adapt to and we need a new plan how to live a fulfilling life. The future will show how we make this transition and we will write about it in our blogs.