Wednesday, 17 January 2018

A reprieve of sorts

Okay, I had my Nephrology appointment last week and the result was something of a reprieve. I weighed in at 114kg, reflecting too many sweets and not enough exercise over the holidays, but the main thing was my GFR had gone back up to 31. Last time out it had dipped to 25, raising fears I was sliding towards failure, but the consultant now thinks my kidneys were 'too dry' when the previous test was taken. It doesn't stop the inevitable, but it pushes back the horizon and I’m grateful for that.
I had been a little worried the test results had been compromised. The day after bloods were taken I got a call from the surgery saying one of the four vials had been damaged in transit and 'could I come back for another test'? At the time I was on the M40 heading north for New Year, so that was a negative. Fortunately, it seems the damaged vial was one of the less important tests. My blood pressure is good, so my medication has been left alone, but I’ve been told to watch my potassium levels as they’re on the high side. The potassium may well be the culprit behind my muscle cramps and probably means the end of peanut based treats.
Whilst I was there I handed in my fourth semen sample for andrology analysis; twelve months on and I’m still don't waiting for the all clear from my vasectomy (although I do know my fertility is severely limited). 

Sunday, 31 December 2017

Looking forward, looking back

This will almost certainly be my last post of 2017, I'm currently back up North visiting my family for New Year. 

It has been a strange old year, certainly a busy one, hence the limited posts, and maybe it marked a turning point in the managed decline of my kidneys. The dip in eGFR reported in October was a sharp reminder my kidney function is on borrowed time, in a couple of weeks I’ll get my next set of numbers and we’ll see if has dipped again. My weight has pretty much flat lined around 113kg, not ideal, pretty much where I was ten years ago, but at least I’ve avoided ballooning to the kind of weight I was five years ago.

There has been the ongoing farce of my vasectomy. The same day I go to my next Nephrology appointment I’ll be submitting my fourth andrology test to try and clear up the little matter of non-motile sperm. The GP will also hopefully have received a response from the surgeon who carried it out.

There are lots of positives ahead in 2018; I have my new job starting in early January and I’ve started to get my shit together for a podcast project I’ve been planning for a while (more about that soon). I’m going to make more of an effort to post here; perhaps broaden the scope a little bit and more importantly tackle some of the big topics I’ve been mulling over like the implications of ‘presumed consent’ for organ donation. On the CKD front the GP’s decision to refer me to the ‘Healthier You’ programme could also provide the next much needed step change in my lifestyle.

Happy New Year!

Friday, 29 December 2017

My poem about CKD

I wrote a poem about my CKD back in October. It was my submission to a competition run by my employer’s Disability Staff Network Group (DSNG) to publicise ‘International Day for Disabled Persons’ on December 3rd. Unfortunately I didn’t win, I didn’t actually hear anything at all, I only found out who won yesterday when I did a bit of searching across the staff intranet.

I actually joined the DSNG at the end of February and I’m still waiting to hear back about upcoming meetings and events. To give credit where it’s due the mental health stream is very active; with workshops and drop-in sessions heavily publicised, but I suspect this is due to the efforts of a few committed individuals and overlap with the corporate health and wellbeing programme. To be fair, I don’t consider myself as ‘disabled’, although that may change when my CKD gets to end stage.

Anyway here it is:  

Forgive my words if they are terse
It's not the end, it could be worse
They try their best, I'm sure it's true
But it's all my kidneys they can do!

They were never right from the start
Now I fear they'll break my heart
And when their time is finally come
I’ll beg a donor for another one

No point in asking ‘Why’?
Will only send my BP high
No more gout I hope and pray
It can only spoil my day

So a rather sorry little tale
I'll horde the days until they fail
Till then I mustn’t worry
For dialysis I’m in no hurry

Wednesday, 27 December 2017

More BMI Batshit and ‘Healthier You’

The BBC carried another story yesterday about the misuse of Body Mass Index by NHS Care Commissioning Groups (CCG) to ration medical treatment. It pretty much repeats the points I’ve made previously about this being very far from sound medical practice and more importantly how it is self-defeating. People who could benefit massively from treatment languish in a catch-22 situtaion whereby they cannot receive it because their BMI is too high, but getting BMI down is handicapped due to deprivation of treatment, the whole situation being determined by politics rather than medical science.
For my own sins I weighed in at 114kg today, up 1kg on last week, this is pretty much down to a little overindulgence over Christmas, and taking less exercise over the last few days for the same reason. I’ve tried to be sensible, it’s been far from a binge, but there are so many casual calories floating around this time of year, and when I don’t have to get out for work there’s less natural opportunity to exercise (the weather has been filthy).
113kg is pretty much where I’ve been for most of the last year, so I expect that’ll be where I am when I weigh in at the hospital in just under a fortnight. I’m approaching this one with mixed feelings, I really want to know if my numbers have stabilised or if I’ve dipped again. I might get a bit of grief over the lack of progress with my weight loss, but that no longer worries me so much, especially as there has been a recent positive development.
My GP is referring me to something called ‘Healthier You’ which is the tagline of the National Diabetes Prevention Programme (NDPP). This aims to help people, like myself, who are at higher risk of diabetes, by developing diet and exercise changes. This intervention saves money for the NHS by following the ‘prevention rather than cure’ mantra, and could obviously have personal benefit to me. I don’t see I have anything to lose, the worst case scenario is it tells me nothing I  don’t already know, but the ideal scenario is it unlocks profound new practical insights or 'life hacks' I can use to restart weight loss.   

Thursday, 23 November 2017

Job success...

After my whining about the botched skills test last month; they only went and offered me the job last Friday. Admittedly, I didn't just moan at HR and they threw it me as placation, I had to interview first. But I was able to use inside knowledge to gen up on the possible questions which meant it went well. 

The head of the wider team I'm currently in wasn't best pleased with my decision to transfer, but he cannot compete with the salary offered. We're currently going through the most laborious and convoluted organisational restructure I've ever experienced (that's really saying something) causing him extra headache. I wasn't mapped into a role, but certain skills I possess are definitely wanted, which all but guaranteed me a role from the pool I was in. Now I'm leaving I'm taking those skills with me and they cannot be replaced short-term. It does mean I’m resolving the required headcount reduction, but that also means opportunity for voluntary redundancy is removed from that pool. A bit of a political minefield.

The boss suggested I might not be as happy in the new department, the culture isn't as positive as the one I'm leaving, and it might be a bit of a dead end personal development wise. He's right on all of these things, unfortunately staying put would keep me in a smaller pool, which is also a dead end for career progression. The new role puts me in a bigger pool, and although it may not be as intellectually stimulating, it is a step up the ladder and more importantly a substantial pay rise taking me back in the direction of where I was before I joined this employer. This was always the plan, I took a less demanding role than I'd had before with a longer-view to moving back up the ladder. 

Now I’ve just got to negotiate the fact that my second day in new role coincides with my first nephrology appointment of the new year, which I’ve booked off. Let’s hope that’s not an inauspicious start!

Tuesday, 24 October 2017

No defence for healthcare tourism

Not entirely convinced by opposition to measures designed to stop health tourism. To be clear nobody is going to be denied immediate critical care; you're not going to get thrown out of A&E bleeding to death if you cannot prove who you are. Seems to me the people who will largely be inconvenienced are those not entitled to 'free' treatment, which is pretty much the point, and almost certainly the source of the disgruntlement.

I know people wail about the bureaucracy of it all, but you do actually need some sort of administration to get most things done. Collecting basic identity information about patients is the necessary first step in all medical treatment. Every time I go to my GP or the hospital I'm asked to confirm my details. The first time I visit a new facility I'm asked to verify who I am. This is good practice, not because it prevents health tourists, but because it gives medical professionals access to information they need to treat you properly.

It's really not too much trouble for most people to verify who they are if they want ongoing healthcare. Admittedly, there may be some challenging circumstances, some patients have special needs, but binning off faux-moralistic preaching there are processes in place to deal with them. We may not have a utopian system, but it deals with millions of vulnerable people every year without bodies piling up in the streets (bodies blocking beds is far more common).

The real problem seems to be the myth of 'free' NHS treatment, which is precisely what attracts health tourists. Those who moan about denying 'free' treatment to ineligible patients too easily forget it's not really 'free'; someone always has to pay! People up and down the country have to work hard to fund the system, a system that is always, and always will be, financially challenged.

Monday, 23 October 2017

Not quite Priapus

I picked up the results of my third andrology test last week, the one I did in late September. The result was pretty much the same as the other two; I’m still showing traces of immotile sperm. This basically means I have low fertility, low enough to make conception very unlikely, but not completely impossible. With that in mind the GP is reluctant to sign off on the vasectomy, instead he’s written to the consultant for comment, and has given me a form for a fourth test.
Whilst it’s nice to indulge the notion that I’m just so damn fertile a vasectomy couldn’t stop me, it’s getting annoying now. I’m going to delay the next test till I hear back from the consultant. I was aware it didn’t always work, but I seem to be in the zone where it has pretty much worked but a small risk remains, the key is to quantify it and decide what comes next.
The real reason the GP wanted me to see me was to talk about the Nephrologist’s recommendation that we review my blood pressure medication and also get a Hep B screen and vaccination tied in with my January bloods. The Hep B screen is a pre-emptive measure is to protect me from risk of further kidney damage, but would probably need to be done in advance of dialysis anyway. Unfortunately, I haven’t taken any blood pressure readings since before my last nephrology appointment, so I need to do some and send them into the surgery so he can decide if action is needed.
Whilst I was there I also got my annual flu jab. As a member of an ‘at risk’ group I get a reminder every year, but last year I was able to get one at work from the occupational health team. This year work decided to cancel blanket (optional) inoculation of staff on the grounds that it’s unnecessary (basically a cost cutting measure with an epidemiological backstop behind it), although ‘at risk’ groups were encouraged to see their GP. The GP himself was most bemused to hear this, apparently this year’s strain is particularly virulent and my employer may come to regret the decision. So, there we go, I have been warned, but then I’ve been inoculated too!