Thursday, 5 October 2017

Sliding towards the inevitable

So, my appointment came and went three weeks ago now. After all my fussing about weight gain I ended up weighing in at 113kg, which was 2kg above my previous appointment, but pretty much where I’ve been for the last year.
 
As it was the Consultant didn’t give me a hard time, mainly because my eGFR has shown its first significant decline in a couple of years. She did warn me not to read too much into it, as individual readings can fluctuate significantly, but it does appear I’m starting to shuffle off the plateau. Her best guess is that I will need a transplant in somewhere between six and ten years to avoid dialysis.
 
It’s hard to predict this with any great accuracy, as the majority of my readings are stable and the amount of protein in my urine is relatively low versus my eGFR which apparently means I’ve got a chance of edging towards the furthest end of that timeline. The big danger is that I suffer some form of serious illness, which would accelerate the decline. Touch wood, no such thing happens, but it is something I need to be wary of.
 
I’ve known for several years that failure was inevitable, but I had hoped to delay it for as long as possible. Now I’m at the point where I know the clock is ticking and the challenges ahead are starting to crystallise. In an ideal world a close blood relative would offer me a kidney, as that would provide the best chance of compatibility, but as my Mum and my brother only have one kidney each; that just leaves my sister who has never been tested for kidney disorders or my Dad. I’d be worried about my sister being a donor if only because the odds of her having some form of disorder have got to be high, as for my Dad, I’m not sure about him either as he has suffered from heart arrhythmia in the past.
 
I suspect that my best hope will be from an anonymous donor; likely involving time on a waiting list, fortunately as I’m relatively young, strong and healthy this perhaps isn’t as risky as if I were older and more fragile. The target weight of 100kg will become of greater importance, the 13kg or so to that destination are proving stubborn, but five years ago I was over 130kg, so I know it is possible. I know medical science is moving apace when it comes to artificial and cloned organs, but I suspect that any breakthroughs will come too late this time round (but given my age it is not inconceivable I will benefit in the future). I may also need to re-evaluate my feelings on presumed consent for organ donation, now my life may depend on it!

Thursday, 31 August 2017

Hawking, Hunt and the NHS


A bit of a long post. On holiday the other week I was diverted by the hullaballoo over Stephen Hawking laying into Health Secretary Jeremy Hunt's plans for a seven-day NHS and creeping privatisation. The intellectual no contest between the world-renowned physicist and the political hatchet man is a noisy propaganda event; more interesting is the underlying clash of ideological* spectrum positions on the role of markets and privatisation.
The Conservative Party is always vulnerable to attack over the NHS, firstly it exposes core differences between rank and file. Secondly, it's a subject many blundering front line Conservatives lack sensitivity for, and thirdly, the spotlight often crosses the sleazier edges of the party. My opinion based on years spent as an activist, is that the bulk of Conservative members support the NHS as a state funded, state run and primarily state provided institution. However, this often coincides with an ideological antipathy towards big government, and tacit support for commerce and entrepreneurship. There are also legitimate concerns about getting value for money and a sustainable financial settlement for the NHS.
This means Conservatives are more open minded about the potential efficiencies from private sector involvement, things others see as taboo. They're not blind to potential dis-benefits, nor risks from rent seeking crony capitalism, but they're pragmatic about cost benefits. The upper echelons and therefore policy direction tends to be disproportionately influenced by the free market wing. They genuinely believe markets deliver benefits to the public (a.k.a. consumer) and offer arguments (of admittedly variable quality) in support. Finally, there is the tiny grubby fringe who associate with free markets, but are better understood as 'freebooters' whose espousal of public interest tends to be mere gloss for crony capitalism.
Nobody is against the idea the NHS should be properly resourced seven days a week, but the concept of a seven-day NHS is more than about having enough staff. At brief glance it’s clear current policies on NHS funding, local government/social care funding, Brexit/ immigration, and healthcare training are incredibly not consistent with sustainable resourcing. The idea of a seven-day NHS seems tied to the free market concept of healthcare as consumer service, and it’s hardly a great leap to see this as swaying towards private provision. However, the much-loathed Mr Hunt has been at great pains to claim the NHS should not be viewed as a typical consumer service (at least not for the consumer). Is this just more evidence of confused policy? The undertones of the freebooters and their clients are hard to ignore.
All this sets up the conflict with those, often on the left, with more statist ideological positions, who see the NHS as something that should be state owned, run and provided. As with Conservatives there are many positions, some strong arguments, some very weak arguments, and there are sectional interests (trade unions and professional associations may pitch themselves as ‘guardians’ of public interest but their members come first). They may be uncomfortable with cost benefit analysis when it comes to rationing emotive treatments. There is also the category error of mistaking virtuous intentions of healthcare workers with achieving the best use resources for patients.
Some opposition is based on misunderstanding of economic forces, be it confusion over the difference between markets and capitalism, or viewing inefficiency through the prism of the broken window fallacy i.e. defending unproductive practices because 'it's someone's job', or perhaps failing to understand healthcare wages are more constrained by monopsony than by competition. Emotive pleading is used to obscure the the tragedy of the commons style problem caused by breaking the link between consuming resources and paying for them. It's too easy to push responsibility for paying to abstract 'taxpayers', especially the conveniently nebulous 'rich', but ultimately shunning potential benefits on ideological grounds means someone else has to put in an extra shift.
I can see legitimate concerns in opposition to private sector involvement, I just happen to think they can be mitigated without throwing away potential benefits. I am aware efficiency destroys low productivity jobs (it's not clinical professionals who are really threatened), and I am aware those workers may face greater risks. But, there are better ways of mitigating this than wasting finite resources. The private sector is not guaranteed to be better, cheaper or more efficient than the public sector, but restricting provision to a monopoly ends any chance of reaping potential benefits and locks in the dis-benefits of public monopolies. Concerns about private providers cutting corners are moot, if commissioning bodies cannot manage contractual service levels there's no reason to believe they can manage internal ones. Conflicts over how commissioning bodies decide to spend their funds exist regardless of the profit motive.  
Public monopoly also enables political meddling, this may welcome for favoured specific political objectives. But enabling meddling is risky, it leaves the door open to populists and pork barrel deals. Such objectives are better managed through legislation or other governance. Some simply object on principle, they despise the idea of private organisations profiting from public funds, but this is naïve sentimentalism, there is no guarantee resources are distributed more justly under public provision, taxpayers still pay and in the absence of totalitarian revolution the fundamental basis of our economy and society remains unchallenged.
I subscribe to the view that organisations should stick to their core competencies, things they are good at, and let others handle the other stuff. From personal experience the NHS is good at providing essential clinical care, that's where its comparative advantage lies. If other organisations have comparative advantage in peripheral services that can benefit us all. We don’t expect the NHS to maintain its own private postal service because we recognise greater benefit comes from letting specialist postal services do it, so why not allow certain types of non-core medical services be handled by private specialists?
Strangely enough this whole conflict tends to overlook that privatisation and marketisation have always been a feature of the NHS. The bulk of GP services and dentists are provided by privately owned practices that contract to the NHS. Many hospital consultants combine public and private work. There doesn't appear to be a groundswell against these examples of privatisation, nor demand for clinicians to become indentured to the NHS. The nomenclature of provision seems to matter as much as the taxonomy; profits for Healthcare.PLC equals bad, profits for Dr X and Dr Y LLP goes unremarked.
Personally, I support the idea of an NHS funded by taxation, where clinical services are generally free at point of consumption to those who eligible (I don't support free treatment for illegal immigrants or health tourists beyond emergency medicine, because there is no such thing as free treatment and they bear no responsibility for costs). I don't believe private insurance is better or more efficient, the state is able to provide comprehensive society wide risk pooling in a way the private sector cannot. But healthcare will always be a finite resource and sustainability is a moral as well as practical necessity. That’s why private provision should be judged pragmatically on the objective cost benefits, not on subjective principles.
* I find the term 'ideological' uncomfortable as it's commonly deployed as a vacuous and unintentionally ironic pejorative to label those who hold opposite or contrary ideologies.

Tuesday, 8 August 2017

Every silver lining has its raincloud...


Haven't blogged in a while. Things are ticking over okay; my weight is stuck around 113kg after a few weeks of minor fluctuations. I have just under a month to try and get as close to 110kg as I can for my next nephrology appointment. My activity levels are pretty good and I've got some holiday over the next couple of weeks that should get me out and about.
I had my second hypothyroidism test ten days ago, whilst I was at the surgery I asked about the results of my second semen test in early July, the receptionist said the most recent test result (which was the one I wanted) had been tagged 'no action'. I said 'I'm not sure what that means', and she said 'neither do I, you'll need to ask a GP'. So last week I got a phone consultation. The doc called me back and says he's very sorry, but he couldn't understand what the results meant. To his credit he called the andrology lab which confirmed it had detected traces of what are known as non-motile spermatozoa. The lab also advised it had just upgraded its equipment (is there a vasectomy pun in there?) and it would be advisable for me to have another test. As it's better to be safe than sorry that's what I am going to do.
After the consultation I did a bit of googling and it turns out non motile sperm is detected after about a third of vasectomies. Pregnancy is highly unlikely from non-motile sperm, but not impossible, hence why doctors are nervous about giving the all clear when they are present. So, I’ve made a third andrology appointment, but I’ve done it for just before my nephrology appointment so I only need to attend the hospital once.
On the positive side I tested negative for hypothyroidism, although that means I lose an excuse for being a fatty and I also need to renew my annual NHS prescription certificate. Every silver lining has its raincloud...

Sunday, 16 July 2017

Getting jizzy with it!


It's been a couple of weeks since my last post. On Sunday 2nd I completed the Kidney Research London Bridges Walk, it was a good event and I really enjoyed it. I covered the seven miles in my target time of two and a half hours, a reasonable pace given it was a hot day and the route went through some of London's most congested pedestrian areas. Parts of the Southbank and Westminster Bridge took far longer than their physical distance suggests due to throngs of tourists and numpties blocking the pavements trying to take selfies against the backdrop of the Palace of Westminster. Also, on the narrow stretches of the northern Thames Path it was easy to get stuck behind gaggles of Sunday shufflers out for a lazy stroll.
I spent most of the walk listening to the Black Tapes Podcast, which I've become addicted to of late. Although I was nominally walking alone, and it was by no means a race, the other walkers helped me maintain a decent pace and I never risked losing motivation, which might have been the case had it been a random walk along the river. Factoring in my travel to the City Hall start, the walk itself, and the trip to Byron afterwards I clocked up a personal best 25.8k steps. I'm now looking for other similar activities, I know there are walking groups in my area, but my preferred modus operendi is a bit too anti-social for that, I might try and map out some local 5k routes I can walk/jog when I have time.
Last week was my 40th birthday, so my wife, knowing I'd taken a day’s leave, booked me an extra special treat... a trip to the dentist! It's not that I'm afraid of dentists, although I did have a couple of horrible experiences as a child, I just got out of the habit five or six years ago. The practice I was registered with wasn't convenient and as it's not always easy to register with a good NHS dentist I never got around to moving. So, after years of nagging, my wife took matters in her own hands and registered me with her dentist. It was about time; I'd been starting to worry about occasional pain twinges from a twenty-year old filling.
It started with the Hygenist giving my pegs a good scale and polish, they weren't too heavily scaled but what was there was stubborn. Afterwards the Dentist did a check-up and x-rays. Fortunately, nothing of real concern came up, the twinges appear to be the old filling pressing on a nerve, but the filling itself is sound. There was the option to drill it out, line it and refill it, but given it's a negligible issue I decided to leave alone for now.
On the 7th I gave my second semen sample to Andrology at East Surrey Hospital, so I should know this week if my vasectomy has the all clear. If I don’t get the all clear I’ve no idea what happens next. It will be a complete bugger if I have to have another procedure. Also, if my tubes haven’t been properly sealed up what the hell has happened? This week I need to arrange the second blood test for an underactive thyroid, I’ve held off renewing my NHS annual prescription certificate as if I do have hypothyroidism then my prescriptions should become free.
I’m hoping any treatment for potential hypothyroidism will help with my weight loss, but I’m not holding out great hope. The reading that triggered the whole inquiry showed only mild hypothyroidism and my brief reading around on the condition suggested weight loss is only likely with more serious hypothyroidism. I’m still kicking around 113kg, I briefly went up to 114kg after my birthday celebrations, despite high activity levels, but that was due to overindulgence. It just seems I’m in that zone where it takes a lot of activity to shift the dial down even slightly.  

Tuesday, 27 June 2017

London Bridges Walk 2017


I’ve signed up for Kidney Research UK’s London Bridges Walk this coming Sunday. I registered my interest in it a few months ago, and received an email saying I would be contacted when registration opened. Sadly, no such follow up happened, but I remembered to check back periodically and registration actually opened late last month. I don’t know whether they planned to contact me but I got there first, but it does make me wonder how many other people expressed an interest but never got contacted? Online registration is closed now, but people can still sign-up on the day for £10. 
It’s a seven mile walk across many of London’s iconic bridges. It might sound a bit anti-social but I’m quite looking forward to doing it by myself, I enjoy walking, but usually there’s a very functional purpose like getting to work. I don’t often get the time to go for a good long walk without any distractions, my wife has her own interests she’d probably prefer to spend the time on, and I know the kids would only complain about being bored or tired or more likely both after half a mile!
Kidney Research UK sent through the route map earlier today, it’s fairly familiar territory as I’ve worked in and around Central London for over fifteen years, and the course skirts close to both my current and previous employers. I’m going to try and put together a topical podcast playlist I can listen to as I make my way around, I haven’t found the right ones yet, but I know there are a variety of London podcasts out there covering the mix of culture, history and folklore I’m looking for.
I was also hoping to sneak a few crafty beer stops on route, but I rather fear the pickings are slim without taking too much of a detour. There are a few pubs along the route, but a few of them are shitholes or tourist traps, what comes from hugging the river. It’s probably no bad thing really, I’d only have about five minutes to neck a pint and have a pee, and no doubt once the seal is broken I’d spent most of the seven miles bursting for another! I’m also not sure how endearing it will be to more advanced CKD sufferers who have restrictive fluid intakes. Besides, afterwards I’m meeting up with the wife and kids for an early birthday treat at Byron Burger so I can save my 'dead' calories for that.

Is this gun loaded or not?


I spoke to one of the GP’s yesterday, it appears that my recent jizz in a bottle test was inconclusive. It is a little worrying that having been through the vasectomy process it may not have worked! I’ve got a repeat test at the end of next week, so I should know one way or another whether I'm firing blanks by mid-July.

Tuesday, 20 June 2017

Underactive Thyroids and Jizz Jars

I finally made it to the doctors a week or so ago to discuss the underactive thyroid result that cropped up in my recent annual medical. My first attempt was cut short by the NHS hack last month, the second attempt was an evening surgery appointment that got cancelled a couple hour before I was due to attend, till finally the GP surgery squeezed me into one of the last appointments in a regular afternoon surgery. Did I learn anything new? Not really. As my Mum has an underactive thyroid it is entirely likely I have the condition, but I don’t seem to have been hit by any obvious side effects; my weight is still hovering around 112kg which is as good as it’s been for years and any tiredness I feel is probably down to not getting enough sleep! So I’m having a retest done in July and will be going back to discuss treatment about ten days later.

Last week I dropped off my first semen sample to Andrology Services at East Surrey Hospital, so I should get an indication of whether my vasectomy has been effective sometime this week. I’m supposed to do another test in a few weeks time, but I’m hoping this set of results will be conclusive. In a nutshell I had to wank into a little glass bottle and then scoot straight over to the hospital with it in my shirt pocket (close to my body to keep it at a good temperature), where I simply handed over to Andrology. A somewhat comedic process, when you consider I was basically trying to get ready to go to work as well as avoid the kids who were getting ready for school at the same time.