‘Give us each day our daily bread’ … bread in a shop window in Lichfield (Photograph: Patrick Comerford)
Patrick Comerford
Sunday 28 July 2019
The Sixth Sunday after Trinity
11.30 a.m.: The Parish Eucharist (Holy Communion 2), Holy Trinity Church, Rathkeale, Co Limerick
Readings: Hosea 1: 2-10; Psalm 85; Colossians 2: 6-15, (16-19); Luke 11: 1-13.
‘Lord, teach us to pray’ (Luke 11: 1) … prayer books and prayer shawls in the synagogue in Porto (Photograph: Patrick Comerford, 2019)
May I speak to you in the name of God, + Father, Son, and Holy Spirit, Amen.
Language can be very amusing, but very difficult, at times.
There are times when the language of the Bible can almost hit us in the face.
For example, the language in our Old Testament reading (Hosea 1: 2-10) this morning is very direct, almost frightening, with its comparisons of a people being unfaithful to God with adultery, whoring and whoredom.
I imagine this is one of those Sundays when many rectors are glad that summer holidays mean they did not ask the Sunday School to act out the Old Testament reading.
When it comes to the Gospel reading, we are all so familiar with the Lord’s Prayer, that we often recite it by rote without noticing the significance and intention of each petition. Have you noticed this in your own prayer life?
Did you notice, as the Gospel was being read this morning, that this version of the Lord’s Prayer in Saint Luke’s Gospel is not the same as the familiar text we use, based on the version in Saint Matthew’s text?
Without looking, are you aware of the differences?
Apart from the fact that it is a little shorter, what else did you notice?
What is missing?
Is there a difference in emphases between these two versions of the one prayer?
In Saint Matthew’s Gospel, Christ teaches the Lord’s Prayer within the context of the Sermon on the Mount. But in Saint Luke’s Gospel, immediately after visiting the home of Mary and Martha in Bethany, Christ finds a private place to pray. It is then that the disciples ask him to teach them ‘to pray, as John taught his disciples.’
The disciples are already familiar not only with the prayers of Saint John the Baptist, but also with traditional Jewish prayers in the home, in the synagogue and in the Temple in Jerusalem.
So why did they ask Jesus to teach them how to pray?
As a rabbi and a religious leader, Jesus wais responsible for teaching his followers how to fulfil Jewish religious commandments, including the obligation to pray at certain times and in certain forms.
Then and now, a religious community has a distinctive way of praying; ours is exemplified by the Lord’s Prayer, which is a communal rather than individual prayer, expressed in the plural and not the singular:
Father, hallowed be your name.
Your kingdom come.
Give us each day our daily bread.
And forgive us our sins,
for we ourselves forgive everyone indebted to us.
And do not bring us to the time of trial.
We approach God in a personal way, as Father. We then bring before him five petitions that are not on behalf of me personally, but on behalf of us, on behalf of all.
Sometimes we miss out on the impact of the Lord’s Prayer because we are so familiar with it. But in the public worship of the Church we often facilitate people missing out on the impact of the Lord’s Prayer when we privatise it.
Many of us were taught to pray the Lord’s Prayer as a private personal prayer as children, perhaps even saying it kneeling by our bedside, hands joined together, fingers pointing up.
So often, in our churches, we encourage people to kneel for the Lord’s Prayer, as if this was now both the most sacred and the most personal part of the Liturgy, rather than asking them to remain standing and to continue in collective prayer.
Or, at great public events, such as synods and mission conferences, we invite everyone present to say the Lord’s Prayer in their own first language. In this way, a collective, public prayer becomes a private, personal prayer, detached from and ignoring where everyone else is at each stage in the petitions.
As someone with English as my first language, I often notice how others finish a lot later than we do – the Finns in particular, but even the Germans too. Each language has its own rhythms and cadences. And the cacophony and conflicting rhythms mean it sounds as if we are in Babel rather than praying together, collectively and in the plural.
The first two petitions place us in God’s presence (‘hallowed be your name’ and ‘your kingdom come’), the next two bring our needs before God, both physical (‘daily bread,’ verse 3) and spiritual (forgiveness, verse 4), and the final petition has an eschatological dimension, looks forward to the fulfilment of all God’s promises, in God’s own time (‘the time of trial,’ verse 4).
The ‘time of trial’ is the final onslaught of evil forces, before Christ comes again, but also refers to the temptations we experience day-by-day.
So there is a temporal and an eternal dimension to these petitions, even when we pray for ourselves in the here and now.
The privatisation of the Lord’s Prayer, even on Sundays, takes away from its impact and from the collective thrust of each of the petitions.
Jesus, when he is teaching us to pray, is responding not to one individual but to the disciples as the core, formative group of the Church. God is addressed not as my Father, but our Father, and each petition that follows is in the plural: our daily bread, our forgiveness, our sins, our debts, how we forgive, and do not ‘bring us.’
When we say ‘Amen’ at the end, are we really saying ‘Amen’ to the holiness of God’s name, to the coming of Kingdom, to the needs of each being met, on a daily basis, to forgiveness, both given and received, to being put on the path of righteousness and justice, to others falling into no evil or into no harm.
If we privatise the Lord’s Prayer, we leave little room for its collective impact to grab a hold of those who are praying, and we leave little room for our own conversion, which is a continuing and daily need.
And so, let the kingdom, the power and the glory be God’s as we pray together:
Father, hallowed be your name.
Your kingdom come.
Give us each day our daily bread.
And forgive us our sins,
for we ourselves forgive everyone indebted to us.
And do not bring us to the time of trial.
And so, may all we think, say and do be to the praise, honour and glory of God, + Father, Son and Holy Spirit, Amen.
‘Give us each day our daily bread’ … bread in a bakery window in Kournas, near Rethymnon in Crete (Photograph: Patrick Comerford)
Luke 11: 1-13: (NRSVA):
1 He was praying in a certain place, and after he had finished, one of his disciples said to him, ‘Lord, teach us to pray, as John taught his disciples.’ 2 He said to them, ‘When you pray, say:
Father, hallowed be your name.
Your kingdom come.
3 Give us each day our daily bread.
4 And forgive us our sins,
for we ourselves forgive everyone indebted to us.
And do not bring us to the time of trial.’
5 And he said to them, ‘Suppose one of you has a friend, and you go to him at midnight and say to him, “Friend, lend me three loaves of bread; 6 for a friend of mine has arrived, and I have nothing to set before him.” 7 And he answers from within, “Do not bother me; the door has already been locked, and my children are with me in bed; I cannot get up and give you anything.” 8 I tell you, even though he will not get up and give him anything because he is his friend, at least because of his persistence he will get up and give him whatever he needs.
9 ‘So I say to you, Ask, and it will be given to you; search, and you will find; knock, and the door will be opened for you. 10 For everyone who asks receives, and everyone who searches finds, and for everyone who knocks, the door will be opened. 11 Is there anyone among you who, if your child asks for a fish, will give a snake instead of a fish? 12 Or if the child asks for an egg, will give a scorpion? 13 If you then, who are evil, know how to give good gifts to your children, how much more will the heavenly Father give the Holy Spirit to those who ask him!’
‘Knock, and the door will be opened for you’ (Luke 11: 9) … a front door in Bore Street, Lichfield (Photograph: Patrick Comerford)
Liturgical Colour: Green
The Collect:
Merciful God,
you have prepared for those who love you
such good things as pass our understanding:
Pour into our hearts such love toward you
that we, loving you above all things,
may obtain your promises,
which exceed all that we can desire;
through Jesus Christ our Lord.
The Post-Communion Prayer:
God of our pilgrimage,
you have led us to the living water.
Refresh and sustain us
as we go forward on our journey,
in the name of Jesus Christ our Lord.
Hymns:
429, Lord Jesus Christ, you have come to us (CD 25)
619, Lord, teach us how to pray aright (CD 35)
509, Your kingdom come, O God (CD 29)
‘Is there anyone among you who, if your child asks for a fish, will give a snake instead of a fish? ’ (Luke 11: 11) … fish at a taverna in the harbour in Rethymnon, Crete (Photograph: Patrick Comerford)
Scripture quotations are from the New Revised Standard Version Bible: Anglicised Edition copyright © 1989, 1995, National Council of the Churches of Christ in the United States of America. Used by permission. All rights reserved worldwide. http://nrsvbibles.org
Material from the Book of Common Prayer is copyright © 2004, Representative Body of the Church of Ireland.
‘Padre Nuestro, que estas en el Cielo … Our Father, who art in Heaven’ … the words of the Lord’s Prayer in Spanish in the shape of a Cross (Photograph: Patrick Comerford, 2019)
28 July 2019
One of his disciples said to him,
‘Lord, teach us to pray’
‘Padre Nuestro, que estas en el Cielo … Our Father, who art in Heaven’ … the words of the Lord’s Prayer in Spanish in the shape of a Cross (Photograph: Patrick Comerford, 2019)
Patrick Comerford
Sunday 28 July 2019
The Sixth Sunday after Trinity
9.30 a.m.: Morning Prayer, Castletown Church, Co Limerick
Readings: Hosea 1: 2-10; Psalm 85; Colossians 2: 6-15, (16-19); Luke 11: 1-13.
‘Give us each day our daily bread’ … bread in a shop window in Lichfield (Photograph: Patrick Comerford)
May I speak to you in the name of God, + Father, Son, and Holy Spirit, Amen.
Language can be very amusing, but very difficult, at times.
There are times when the language of the Bible can almost hit us in the face.
For example, the language in our Old Testament reading (Hosea 1: 2-10) this morning is very direct, almost frightening, with its comparisons of a people being unfaithful to God with adultery, whoring and whoredom.
I imagine this is one of those Sundays when many rectors are glad that summer holidays mean they did not ask the Sunday School to act out the Old Testament reading.
When it comes to the Gospel reading, we are all so familiar with the Lord’s Prayer, that we often recite it by rote without noticing the significance and intention of each petition. Have you noticed this in your own prayer life?
Did you notice, as the Gospel was being read this morning, that this version of the Lord’s Prayer in Saint Luke’s Gospel is not the same as the familiar text we use, based on the version in Saint Matthew’s text?
Without looking, are you aware of the differences?
Apart from the fact that it is a little shorter, what else did you notice?
What is missing?
Is there a difference in emphases between these two versions of the one prayer?
In Saint Matthew’s Gospel, Christ teaches the Lord’s Prayer within the context of the Sermon on the Mount. But in Saint Luke’s Gospel, immediately after visiting the home of Mary and Martha in Bethany, Christ finds a private place to pray. It is then that the disciples ask him to teach them ‘to pray, as John taught his disciples.’
The disciples are already familiar not only with the prayers of Saint John the Baptist, but also with traditional Jewish prayers in the home, in the synagogue and in the Temple in Jerusalem.
So why did they ask Jesus to teach them how to pray?
As a rabbi and a religious leader, Jesus wais responsible for teaching his followers how to fulfil Jewish religious commandments, including the obligation to pray at certain times and in certain forms.
Then and now, a religious community has a distinctive way of praying; ours is exemplified by the Lord’s Prayer, which is a communal rather than individual prayer, expressed in the plural and not the singular:
Father, hallowed be your name.
Your kingdom come.
Give us each day our daily bread.
And forgive us our sins,
for we ourselves forgive everyone indebted to us.
And do not bring us to the time of trial.
We approach God in a personal way, as Father. We then bring before him five petitions that are not on behalf of me personally, but on behalf of us, on behalf of all.
Sometimes we miss out on the impact of the Lord’s Prayer because we are so familiar with it. But in the public worship of the Church we often facilitate people missing out on the impact of the Lord’s Prayer when we privatise it.
Many of us were taught to pray the Lord’s Prayer as a private personal prayer as children, perhaps even saying it kneeling by our bedside, hands joined together, fingers pointing up.
So often, in our churches, we encourage people to kneel for the Lord’s Prayer, as if this was now both the most sacred and the most personal part of the Liturgy, rather than asking them to remain standing and to continue in collective prayer.
Or, at great public events, such as synods and mission conferences, we invite everyone present to say the Lord’s Prayer in their own first language. In this way, a collective, public prayer becomes a private, personal prayer, detached from and ignoring where everyone else is at each stage in the petitions.
As someone with English as my first language, I often notice how others finish a lot later than we do – the Finns in particular, but even the Germans too. Each language has its own rhythms and cadences. And the cacophony and conflicting rhythms mean it sounds as if we are in Babel rather than praying together, collectively and in the plural.
The first two petitions place us in God’s presence (‘hallowed be your name’ and ‘your kingdom come’), the next two bring our needs before God, both physical (‘daily bread,’ verse 3) and spiritual (forgiveness, verse 4), and the final petition has an eschatological dimension, looks forward to the fulfilment of all God’s promises, in God’s own time (‘the time of trial,’ verse 4).
The ‘time of trial’ is the final onslaught of evil forces, before Christ comes again, but also refers to the temptations we experience day-by-day.
So there is a temporal and an eternal dimension to these petitions, even when we pray for ourselves in the here and now.
The privatisation of the Lord’s Prayer, even on Sundays, takes away from its impact and from the collective thrust of each of the petitions.
Jesus, when he is teaching us to pray, is responding not to one individual but to the disciples as the core, formative group of the Church. God is addressed not as my Father, but our Father, and each petition that follows is in the plural: our daily bread, our forgiveness, our sins, our debts, how we forgive, and do not ‘bring us.’
When we say ‘Amen’ at the end, are we really saying ‘Amen’ to the holiness of God’s name, to the coming of Kingdom, to the needs of each being met, on a daily basis, to forgiveness, both given and received, to being put on the path of righteousness and justice, to others falling into no evil or into no harm.
If we privatise the Lord’s Prayer, we leave little room for its collective impact to grab a hold of those who are praying, and we leave little room for our own conversion, which is a continuing and daily need.
And so, let the kingdom, the power and the glory be God’s as we pray together:
Father, hallowed be your name.
Your kingdom come.
Give us each day our daily bread.
And forgive us our sins,
for we ourselves forgive everyone indebted to us.
And do not bring us to the time of trial.
And so, may all we think, say and do be to the praise, honour and glory of God, + Father, Son and Holy Spirit, Amen.
‘Give us each day our daily bread’ … bread in a bakery window in Kournas, near Rethymnon in Crete (Photograph: Patrick Comerford)
Luke 11: 1-13: (NRSVA):
1 He was praying in a certain place, and after he had finished, one of his disciples said to him, ‘Lord, teach us to pray, as John taught his disciples.’ 2 He said to them, ‘When you pray, say:
Father, hallowed be your name.
Your kingdom come.
3 Give us each day our daily bread.
4 And forgive us our sins,
for we ourselves forgive everyone indebted to us.
And do not bring us to the time of trial.’
5 And he said to them, ‘Suppose one of you has a friend, and you go to him at midnight and say to him, “Friend, lend me three loaves of bread; 6 for a friend of mine has arrived, and I have nothing to set before him.” 7 And he answers from within, “Do not bother me; the door has already been locked, and my children are with me in bed; I cannot get up and give you anything.” 8 I tell you, even though he will not get up and give him anything because he is his friend, at least because of his persistence he will get up and give him whatever he needs.
9 ‘So I say to you, Ask, and it will be given to you; search, and you will find; knock, and the door will be opened for you. 10 For everyone who asks receives, and everyone who searches finds, and for everyone who knocks, the door will be opened. 11 Is there anyone among you who, if your child asks for a fish, will give a snake instead of a fish? 12 Or if the child asks for an egg, will give a scorpion? 13 If you then, who are evil, know how to give good gifts to your children, how much more will the heavenly Father give the Holy Spirit to those who ask him!’
‘Knock, and the door will be opened for you’ (Luke 11: 9) … a front door in Bore Street, Lichfield (Photograph: Patrick Comerford)
Liturgical Colour: Green
The Collect:
Merciful God,
you have prepared for those who love you
such good things as pass our understanding:
Pour into our hearts such love toward you
that we, loving you above all things,
may obtain your promises,
which exceed all that we can desire;
through Jesus Christ our Lord.
Hymns:
429, Lord Jesus Christ, you have come to us (CD 25)
619, Lord, teach us how to pray aright (CD 35)
509, Your kingdom come, O God (CD 29)
‘Is there anyone among you who, if your child asks for a fish, will give a snake instead of a fish? ’ (Luke 11: 11) … fish at a taverna in the harbour in Rethymnon, Crete (Photograph: Patrick Comerford)
Scripture quotations are from the New Revised Standard Version Bible: Anglicised Edition copyright © 1989, 1995, National Council of the Churches of Christ in the United States of America. Used by permission. All rights reserved worldwide. http://nrsvbibles.org
Material from the Book of Common Prayer is copyright © 2004, Representative Body of the Church of Ireland.
‘Lord, teach us to pray’ (Luke 11: 1) … prayer books and prayer shawls in the synagogue in Porto (Photograph: Patrick Comerford, 2019)
Patrick Comerford
Sunday 28 July 2019
The Sixth Sunday after Trinity
9.30 a.m.: Morning Prayer, Castletown Church, Co Limerick
Readings: Hosea 1: 2-10; Psalm 85; Colossians 2: 6-15, (16-19); Luke 11: 1-13.
‘Give us each day our daily bread’ … bread in a shop window in Lichfield (Photograph: Patrick Comerford)
May I speak to you in the name of God, + Father, Son, and Holy Spirit, Amen.
Language can be very amusing, but very difficult, at times.
There are times when the language of the Bible can almost hit us in the face.
For example, the language in our Old Testament reading (Hosea 1: 2-10) this morning is very direct, almost frightening, with its comparisons of a people being unfaithful to God with adultery, whoring and whoredom.
I imagine this is one of those Sundays when many rectors are glad that summer holidays mean they did not ask the Sunday School to act out the Old Testament reading.
When it comes to the Gospel reading, we are all so familiar with the Lord’s Prayer, that we often recite it by rote without noticing the significance and intention of each petition. Have you noticed this in your own prayer life?
Did you notice, as the Gospel was being read this morning, that this version of the Lord’s Prayer in Saint Luke’s Gospel is not the same as the familiar text we use, based on the version in Saint Matthew’s text?
Without looking, are you aware of the differences?
Apart from the fact that it is a little shorter, what else did you notice?
What is missing?
Is there a difference in emphases between these two versions of the one prayer?
In Saint Matthew’s Gospel, Christ teaches the Lord’s Prayer within the context of the Sermon on the Mount. But in Saint Luke’s Gospel, immediately after visiting the home of Mary and Martha in Bethany, Christ finds a private place to pray. It is then that the disciples ask him to teach them ‘to pray, as John taught his disciples.’
The disciples are already familiar not only with the prayers of Saint John the Baptist, but also with traditional Jewish prayers in the home, in the synagogue and in the Temple in Jerusalem.
So why did they ask Jesus to teach them how to pray?
As a rabbi and a religious leader, Jesus wais responsible for teaching his followers how to fulfil Jewish religious commandments, including the obligation to pray at certain times and in certain forms.
Then and now, a religious community has a distinctive way of praying; ours is exemplified by the Lord’s Prayer, which is a communal rather than individual prayer, expressed in the plural and not the singular:
Father, hallowed be your name.
Your kingdom come.
Give us each day our daily bread.
And forgive us our sins,
for we ourselves forgive everyone indebted to us.
And do not bring us to the time of trial.
We approach God in a personal way, as Father. We then bring before him five petitions that are not on behalf of me personally, but on behalf of us, on behalf of all.
Sometimes we miss out on the impact of the Lord’s Prayer because we are so familiar with it. But in the public worship of the Church we often facilitate people missing out on the impact of the Lord’s Prayer when we privatise it.
Many of us were taught to pray the Lord’s Prayer as a private personal prayer as children, perhaps even saying it kneeling by our bedside, hands joined together, fingers pointing up.
So often, in our churches, we encourage people to kneel for the Lord’s Prayer, as if this was now both the most sacred and the most personal part of the Liturgy, rather than asking them to remain standing and to continue in collective prayer.
Or, at great public events, such as synods and mission conferences, we invite everyone present to say the Lord’s Prayer in their own first language. In this way, a collective, public prayer becomes a private, personal prayer, detached from and ignoring where everyone else is at each stage in the petitions.
As someone with English as my first language, I often notice how others finish a lot later than we do – the Finns in particular, but even the Germans too. Each language has its own rhythms and cadences. And the cacophony and conflicting rhythms mean it sounds as if we are in Babel rather than praying together, collectively and in the plural.
The first two petitions place us in God’s presence (‘hallowed be your name’ and ‘your kingdom come’), the next two bring our needs before God, both physical (‘daily bread,’ verse 3) and spiritual (forgiveness, verse 4), and the final petition has an eschatological dimension, looks forward to the fulfilment of all God’s promises, in God’s own time (‘the time of trial,’ verse 4).
The ‘time of trial’ is the final onslaught of evil forces, before Christ comes again, but also refers to the temptations we experience day-by-day.
So there is a temporal and an eternal dimension to these petitions, even when we pray for ourselves in the here and now.
The privatisation of the Lord’s Prayer, even on Sundays, takes away from its impact and from the collective thrust of each of the petitions.
Jesus, when he is teaching us to pray, is responding not to one individual but to the disciples as the core, formative group of the Church. God is addressed not as my Father, but our Father, and each petition that follows is in the plural: our daily bread, our forgiveness, our sins, our debts, how we forgive, and do not ‘bring us.’
When we say ‘Amen’ at the end, are we really saying ‘Amen’ to the holiness of God’s name, to the coming of Kingdom, to the needs of each being met, on a daily basis, to forgiveness, both given and received, to being put on the path of righteousness and justice, to others falling into no evil or into no harm.
If we privatise the Lord’s Prayer, we leave little room for its collective impact to grab a hold of those who are praying, and we leave little room for our own conversion, which is a continuing and daily need.
And so, let the kingdom, the power and the glory be God’s as we pray together:
Father, hallowed be your name.
Your kingdom come.
Give us each day our daily bread.
And forgive us our sins,
for we ourselves forgive everyone indebted to us.
And do not bring us to the time of trial.
And so, may all we think, say and do be to the praise, honour and glory of God, + Father, Son and Holy Spirit, Amen.
‘Give us each day our daily bread’ … bread in a bakery window in Kournas, near Rethymnon in Crete (Photograph: Patrick Comerford)
Luke 11: 1-13: (NRSVA):
1 He was praying in a certain place, and after he had finished, one of his disciples said to him, ‘Lord, teach us to pray, as John taught his disciples.’ 2 He said to them, ‘When you pray, say:
Father, hallowed be your name.
Your kingdom come.
3 Give us each day our daily bread.
4 And forgive us our sins,
for we ourselves forgive everyone indebted to us.
And do not bring us to the time of trial.’
5 And he said to them, ‘Suppose one of you has a friend, and you go to him at midnight and say to him, “Friend, lend me three loaves of bread; 6 for a friend of mine has arrived, and I have nothing to set before him.” 7 And he answers from within, “Do not bother me; the door has already been locked, and my children are with me in bed; I cannot get up and give you anything.” 8 I tell you, even though he will not get up and give him anything because he is his friend, at least because of his persistence he will get up and give him whatever he needs.
9 ‘So I say to you, Ask, and it will be given to you; search, and you will find; knock, and the door will be opened for you. 10 For everyone who asks receives, and everyone who searches finds, and for everyone who knocks, the door will be opened. 11 Is there anyone among you who, if your child asks for a fish, will give a snake instead of a fish? 12 Or if the child asks for an egg, will give a scorpion? 13 If you then, who are evil, know how to give good gifts to your children, how much more will the heavenly Father give the Holy Spirit to those who ask him!’
‘Knock, and the door will be opened for you’ (Luke 11: 9) … a front door in Bore Street, Lichfield (Photograph: Patrick Comerford)
Liturgical Colour: Green
The Collect:
Merciful God,
you have prepared for those who love you
such good things as pass our understanding:
Pour into our hearts such love toward you
that we, loving you above all things,
may obtain your promises,
which exceed all that we can desire;
through Jesus Christ our Lord.
Hymns:
429, Lord Jesus Christ, you have come to us (CD 25)
619, Lord, teach us how to pray aright (CD 35)
509, Your kingdom come, O God (CD 29)
‘Is there anyone among you who, if your child asks for a fish, will give a snake instead of a fish? ’ (Luke 11: 11) … fish at a taverna in the harbour in Rethymnon, Crete (Photograph: Patrick Comerford)
Scripture quotations are from the New Revised Standard Version Bible: Anglicised Edition copyright © 1989, 1995, National Council of the Churches of Christ in the United States of America. Used by permission. All rights reserved worldwide. http://nrsvbibles.org
Material from the Book of Common Prayer is copyright © 2004, Representative Body of the Church of Ireland.
‘Lord, teach us to pray’ (Luke 11: 1) … prayer books and prayer shawls in the synagogue in Porto (Photograph: Patrick Comerford, 2019)
Ten years later, I still
have Sarcoidosis – but
it will never have me
Patrick Comerford
Ten years ago today [27 July 2019], I received the results from my tests and biopsies two weeks earlier. The results confirmed Sarcoidosis, and allowed me to begin looking at the options for treatment next week. But the good news that day was that the biopsies showed no tumours, no cancers and that there was no TB.
The symptoms had been there for at least a year or two, but I had only realised what the medical teams might have been looking for as I was sent for a battery of tests, one after another, in Saint James’s Hospital, Tallaght Hospital and the Beacon Clinic.
I had been living with sarcoidosis for a year or two, at least, but was also learning in those more recent months that I was living with a severe deficiency of Vitamin B12.
When the symptoms first started to appear, I simply thought that age was beginning to creep up on me. I never expected to play rugby or cricket again. But – as someone who never learned to drive – I began to miss out on regular walks that had kept my fit and healthy.
Hall Court, Sidney Sussex College, Cambridge … Sir Arthur Conan Doyle had his own brush with sarcoidosis (Photograph: Patrick Comerford, 2019)
As I was going through these tests, I was amused to find that Sir Arthur Conan Doyle – the creator of Sherlock Holmes and Dr Watson – had his own brush with sarcoidosis. Well Doyle did make Sherlock Holmes a student at Sidney Sussex, my favourite Cambridge college.
In 1926, Doyle introduced a patient with cutaneous sarcoidosis as a key figure in his plot for The Adventure of The Blanched Soldier. In Doyle’s novel, the patient is misdiagnosed with leprosy, but in many ways this highlights the varied presentations for sarcoidosis and the potential for a delay in the diagnosis.
Around the time I was being diagnosed, Dr Seamas Donnelly of the National Pulmonary Fibrosis Referral Centre Saint Vincent’s University Hospital, Dublin, wrote in The Irish Medical Times about the diagnosis and treatment of sarcoidosis, saying Ireland has one of the highest incidences of sarcoidosis in the world. And yet the specific cause of sarcoidosis remains unknown, although at Saint Vincent’s they have identified a specific pattern of genes associated with aggressive disease in sarcoidosis.
The symptoms include intense fatigue, and the lungs are affected in 90 per cent of cases, with discrete but well-formed non-caseating granuloma in up to 85 per cent of cases.
In my case, the symptoms include growths (granuloma) on my lungs, swelling in my neck, an irritating dry cough, sleeping difficulties, constant joint pains – especially in my knees and in my feet – that slow me down unexpectedly, small growths or marks that flare up on my legs or have left scar tissue on my nose, and bouts of fatigue that leave me tired and without full energy.
Sarcoidosis is a multi-system disorder, initially affecting young people in their 20s and 30s, which adversely affects quality of life. Dr Donnelly pointed out that while sarcoidosis does not feature prominently in the media in Ireland, more Irish people suffer from this disorder than from cystic fibrosis or cervical cancer.
Up to 30 per cent of patients show progressive disease, and mortality is the range of 1-5 per cent. In some cases, sarcoidosis is a chronic progressive disease, affecting the central nervous system, bone and skin.
My Vitamin B12 deficiency was a separate diagnosis, but came at the same time, and probably confused the symptoms I was presenting with.
Initially, I was on a course of Vitamin B12 injections every second day. Eventually this was reduced to one injection a week, and then once a month. Now the injections are needed every two or three months.
Vitamin B12 occurs naturally only in animal products, including eggs, meat and milk, and in a particular strain of nutritional yeast. And so, my deficiency of B12 can be traced directly to my vegetarian diet of almost 50 years, and my natural dislike for the taste of cow’s milk.
B12 deficiency is common among vegetarians and vegans who do not take B12 supplements. In vegans, the risk is very high because none of their natural food sources contain B12. One American study found blood levels below normal in 92% of vegans, 64% of lacto-vegetarians, and 47% of lacto-ovo-vegetarians who did not supplement their diet with B12 – although recent research suggests that these figures may even be higher than first suggested.
This deficiency is also very significant in parts of Africa, India, and South and Central America, where there are low intakes of animal products, particularly among the poor.
Vitamin B12 is found in foods that come from animals, including fish, meat, poultry, eggs, milk, and milk products and fortified breakfast cereals. Other sources include nutritional yeast, fortified soy milks, and fortified energy bars.
This condition is brought about by an inadequate dietary intake or impaired absorption of Vitamin B12. In serious cases, this deficiency has the potential of causing severe and irreversible damage to the nervous system, including sub-acute combined degeneration of the spinal cord.
Early and even fairly pronounced deficiency of B12 does not always cause distinct or specific symptoms. Common early symptoms are tiredness or a decreased mental work capacity, decreased concentration and decreased memory, irritability and depression.
Sleep disturbances may occur, because B12 may be involved in the regulation of the sleep wake cycle by the pineal gland, through melatonin. The neurological signs of B12 deficiency, which can occur without anaemia, include sensory disturbances due to damage to peripheral nerves caused by demyelination and irreversible nerve cell death. The symptoms include numbness and/or tingling of the extremities, impaired sense of smell, loss of appetite, disturbed co-ordination and, if not treated in time, an ataxic gait, especially in the dark when there is less visual reference, a syndrome known as sub-acute combined degeneration of the spinal cord.
B-12 deficiency can also cause symptoms of mania, psychosis, fatigue, memory impairment, irritability, depression and personality changes. Other symptoms include shortness of breath, which can occur when walking just a few yards and migraine headaches.
Vitamin B12 can be given as intramuscular injections. After half a dozen injections over the first couple of weeks, the body stores of B12 in the liver are refilled but have to be maintained for the rest of a patient’s life with monthly to quarterly injections.
Over the space of two years, I had batteries of tests in hospitals that have left me feeling tired, if not exhausted – lung tests in the pulmonary laboratory, three or four X-Rays on my lungs and on my knees, blood tests, consultations with specialists, consultants, nurses and dieticians, and a few overnight stays so that tissue samples could be taken from my lungs. At times, it was difficult to tell whether the waiting or the tests were more demanding.
But my GP and those he referred to me were quick in diagnosing my deficiency of Vitamin B12 and in putting me on a course of supplementary injections.
This deficiency and the regular injections I need were enough to cope with. But having to cope with Sarcoidosis too just made it all more difficult and more demanding. So I was glad to learn this day 10 years ago what was wrong. With all the prayers and support and love I received, and with the professionalism of my GP and the consultants, I began coming through to the other side.
Over the decade that followed those test results, I have continued to take an inhaler twice a day, take tablets twice a day, receive a B12 injection about once a quarter, and see my GP regularly.
I never received the remission from sarcoidosis that others have benefitted from. My dry cough persists, even if it is less noticeable and disruptive. But it seems there has been no change in the growths or granuloma on my lungs, no change in the swelling of my glands, and my lungs are functioning well.
Despite occasional flare-ups, I have learned to leave with the symptoms and have found other activities that may not be therapeutic but certainly help me to cope: long walks on favourite beaches, by a riverbank, a lakeshore or in the countryside, and paying attention to my prayer life, and to those I love and those who love me.
Walks on the beach, regular visits to Lichfield, Cambridge and Crete, and sunny afternoons watching cricket may not be part of what the doctors prescribe, but they are certainly good for the body and the soul.
I am grateful for the love and prayers and support I have received over the past decade. Life is not to be taken for granted. I may have Sarcoidosis – but it will never have me.
Saint John’s Hospital, Lichfield … regular visits to Lichfield, Cambridge and Crete may not be part of what the doctors prescribe, but they are good for the body and the soul
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