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.

Tuesday, 16 May 2017

Mixed Blessings

I had three medical appointments last week, two planned well in advance, the third a late addition at the GPs request. 

Early on Tuesday I had my regular check in with the Nephrology Consultant; having failed to lose any weight since my last visit (in fact I'd gained 0.5kg) I had some slight trepidation. It turned out my recent bloods had produced my best CKD results for several years and my blood pressure readings are also acceptable, so she was actually very happy with the progress. I explained I've been making efforts to maintain good fitness despite the flat lining weight loss, and she agreed this is definitely making a positive difference. So we’re sticking with the current regime and I said I’d talk to my GP about weight management (although I'm pretty sure the status report to my GP will include the usual weight based admonishments). 

Later the same morning I had my annual review at the GP surgery. The nurse was initially perplexed about why I was there even though the review had been initiated by the surgery, but things were quickly resolved. I also pointed out I'd been sent a further request to make an appointment with a GP to discuss blood test results, basically indicating something required the attention of a GP rather than a nurse (a similar thing happened last year, so I suspected another pre-diabetes flag). 

For the second time that day I was weighed and had my blood pressure taken, fortunately the results were consistent, although I'm now pretty certain my scales at home weigh c.0.5kg heavier than those at the hospital and GP surgery. Pretty much everything in the blood test was fine, cholesterol, liver function etc… It also turned out the HbA1c test that set off the pre-diabetes flag last year ago was now back in the healthy range, my improved activity levels probably reversing early stage pre-diabetes. There was just one exception; the thyroid part of the blood test was flagging a warning which needed to be discussed with a GP. 

So on Friday afternoon I went back to see the new GP at the practice. Unfortunately having managed to knock off work early to get there I found the surgery (in fact the whole local NHS Trust) had fallen prey to the much publicised cyber hack. So the GP couldn’t see my blood test results. Fortunately I was able to explain about the thyroid deficiency flag (that being the only issue flagged) and the GP briefly explained the symptoms of an underactive thyroid. She asked if I was aware I was suffering from any, which I'm not, and she asked if there is any history of thyroid problems in my family, and there is, my Mum has a problem. But as I'm not demonstrating any of the major symptoms of an underactive thyroid, and she couldn’t see my results, she decided not to start treatment but go with the usual next step of retesting in three months. We didn’t get around to talking about weight management, but she said she would call me on Monday to discuss things further, when the system would hopefully be back up. 

The problem with this situation is that it’s tempting to focus on the under active thyroid and retro fit my recent difficulties losing weight on to it. There are weight related issues with this condition, but it’s probably a convenient self-delusion narrative to follow when the truth is that losing weight is just very difficult to achieve even with sensible eating and exercise. Unfortunately nobody was home for most of yesterday, there were two calls from unknown numbers on my home answerphone, but no messages, and I didn’t receive a call on my mobile. So I’m going to give the surgery a call today, although I suspect they are trying desperately to catch-up from Friday.

Friday, 12 May 2017

The Chimp Paradox: a review

I've just finished reading the Chimp Paradox by Professor Steve Peters, a psychiatrist who teaches at the University of Sheffield, who is highly regarded in the field of sports psychology. I actually read it in two chunks, I started a few months ago, got half way through and decided to read some other things before coming back to it. That's probably a good clue to my feelings about it. It's not unusual for me to be reading more than one book at a time, and it's not untypical for me to pause part way through some of them because I feel like reading something else. Usually I pause non-fiction works because I want a short-term fix of fiction, or I've been temporarily gripped by a different book. A pause is a sign it hasn't entirely gripped me, but coming back to it is a sign that it's interesting or useful enough to warrant finishing.

The Chimp Paradox can loosely be described as a 'self-help' book, the first such I've ever read, and is based on a 'Mind Management' model that Prof Peters has developed to assist patients (who include big names in British sport) to better deal with the pressures they face. The idea is the model can help the subject better understand their own behaviour and impulses and manage them to make them to be more successful, confident and happy. 

At the core of the book is the idea that our personality can be split into 'human' (our rational selves) and 'chimp' (our emotional selves), and the ways in which these two interact influences the way we engage with the events we face. Essentially the book offers help on understanding how our inner chimp can disrupt us and offers strategies to managing it. I can see some interesting overlaps between this model and the 'System 1 / System 2' model outlined by psychologist Daniel Kahneman in his celebrated book Thinking, Fast and Slow (currently paused two thirds through on my bookshelf). 

I must admit I'm generally cynical towards 'self-help' books, but I picked up this one because it I thought it might be help my career development, it didn't make any screechy boasts to be a panacea (which seems typical of US published lifestyle coaching/self-help efforts) and it had some credible endorsements like Olympic cyclist Sir Chris Hoy. 

So what are my thoughts? Well, without wishing to sound flippant, a lot of it reads like formalised common sense and is pretty much in key with my own thoughts. It's a gross simplification, but I'd summarise the advice as don't taking headstrong, emotional approaches to problems, take a step back, a deep breath and think before acting. It was far from a waste of time, but probably not what I really need to push my career development. I think Prof Peters approach will be most beneficial to those suffering chronic stress or struggling to control destructive emotional patterns. It might have been more valuable to me a couple of years ago when I was under stress working in a dysfunctional organisation, but I'm in a better place now. However, the techniques espoused offer only partial mitigation to my previous situation, unequal power relations make challenging dysfunctional hierarchies extremely difficult and exiting is not trivial when you're financially dependent on sticking it out. 

Not a waste of time, almost certainly worth having as a backup should things get tough in the future, but maybe I need to find something more specific to my career development objective.

Tuesday, 9 May 2017

The Semen Test Farce

Some subjects are just ripe for comedy; the semen tests required after a vasectomy are a case in point.
I received two test forms from my GP a little while ago. Unfortunately, there were no further instructions; queue the first gag about what sort of instructions a man needs to have a wank! The forms specified a particular container, but not how to get one or where to submit it afterwards. So I called reception at the surgery and asked them; queue next gag about discussing wanking with a woman you don't even know!
Unfortunately, the receptionist was new and didn't know what to do (I'm sure there's another gag there somewhere). She suggested I discuss it with the phlebotomist when getting my bloods done the following week. What a bloody palaver (geddit?)! But at least I was getting somewhere, surely? So, I discussed with the phlebotomist, only she was new too; but she did tell me that semen tests usually need to submitted to the hospital lab within one hour of production. That's pretty useful to know.
I tell the phlebotomist I'm going to the hospital next week, so I could drop one off then. Sounds like a good idea, we concur. She tells me I can get the requested container from reception, unfortunately no further information comes with it. The day before I go to the hospital I think it might be a good idea to find out where to take my sample, I’m presuming it's where the blood tests get done? Hmmm, I better check the hospital website!
Oh dear, it’s a good job I did check rather than just rock up with a tub of jizz. It seems you cannot simply turn up in working hours like with blood and urine tests, semen tests require an appointment, well an appointment to hand the container through the hatch in the window. And lo, there's more useful information, don't wank or have sex for three days before you produce the sample and make sure you keep it warm (but not too warm)!
One call to the appointments line later and it turns out the earliest possible appointment is five weeks away! How useful would it have been to be notified of all this stuff with the forms? As the hospital is a thirty minute drive from home, in completely the wrong direction for work, and they only do tests before 2pm Monday to Friday, it's all a bit of a ball ache (boom boom)! Of course, I could have timed the test to coincide with my latest Consultant appointment, well if the process had been properly explained from the start! Now I need to arrange additional time off work to sort out!
Semen tests are funny. Not!

Tuesday, 2 May 2017

Seven days is all she wrote, a kind of ultimatum note

No this isn't a post about a Sting track, it's me mildly panicking that I'm just one week out from my next Consultant's appointment and currently weighing in at 112.7kg. Due to a combination of things, not least my daughter's first holy communion at the weekend, I've let my diet slip a bit in the last couple of weeks and hence a rise in my weight. So I'm desperately trying to get down to 111kg for next week.
I said after my last appointment I'd made a rod for my own back by unexpectedly weighing in at 111kg, and so it has proved. For most of the past four months I've fluctuated between 111kg and 112kg and it's been pretty difficult to get below no matter what I've done, in fact when I have dropped below 111kg it has been mostly fluke. So I've stepped up my exercise regime to try and hit 15 thousand steps a day and I'm trying to forgo alcohol and chocolate for the next seven days.
Next Tuesday I've also got my annual medical at the GP surgery (it says I'm seeing a nurse but last year I ended up seeing a GP) so I’m going to ask about a Wellbeing prescription, this is a scheme being offered in conjunction with the local authorities to help make interventions into issues such as weight loss, smoking, mental health etc. It will be interesting to see if meaningful help is available to assist my weight loss efforts, I’m trying not to be prejudiced but knowing how tight funding is in both the NHS and local authorities I’m a little cynical. My gut instinct is that it won’t lead to the expert help I’m really looking for, but is probably going to be generic, lowest common denominator advice. Still, it won’t hurt to ask.
As I’m going to be at the hospital on Tuesday I’m going to drop off my first semen sample to test if my vasectomy has been effective. I was supposed to do it a couple of weeks ago but haven’t had chance. Apparently, the sample needs to be at the hospital within an hour of being produced, which makes it slightly awkward. I picked up the correct bottle at the GP surgery this morning when I had my bloods done, so next Tuesday’s visit to the hospital is going to be a little different!

Sunday, 23 April 2017

Obesity and prejudice in the NHS

There's an excellent documentary currently available on BBC iPlayer looking at the prejudice obese people face trying to get treatment in the NHS. The mightily impressive Professor Rachel Batterham shines a light on some of the cutting edge medical science of obesity, breezily demolishing lazy tropes about fat people as she goes. Prof Batterham makes compelling arguments supporting increasing treatment of obesity, not just due to the positive medical outcomes but on the cold, hard economic basis that as expensive as intervention can be non-intervention is far more expensive in the long-term.

Along the way she highlights some of the counterproductive and even explicitly harmful approaches to obesity that give me concern. The lack of proper understanding of, let alone sympathy for, obesity from some medical professionals. The rationing of medical treatment on arbitrary BMI thresholds rather than case by case clinical assessment, the decisions that lead to Catch-22 horrors whereby sick people cannot access desperately needed treatments due to obesity, but are unable to meaningfully tackle obesity because they are denied those desperately needed treatments. There were some pretty disturbing examples of serious medical harm being done by NHS professionals deploying half-baked thinking or outright prejudice against fat people.

A key driver of prejudice is always ignorance. When it comes to obesity there will always be stupid twats who say things like 'it's your own fault your fat cos you ate too many chips'. In the programme professional gobshite Amanda Platell of Daily Wail fame pops up to represent said feckwittery. Now I don't deny there is an element of personal responsibility in obesity, but it's far from the simple dichotomy of the ignorant twat. There are fundamental issues around human physiology and sociology at play in the rise of obesity, which is why it is a growing problem globally. Humans evolved over hundreds of thousands of years but the recent shift to sedentary lifestyles and cheap and readily accessible calories took just a few hundred years. It shouldn't be a surprise to anyone who considers the issue seriously (who isn't a stupid twat) that modern life is incongruous with the way humanity evolved as a species (a recent blog post at Coppola Comment neatly addresses some of these themes). 

One of the most interesting parts of the documentary was a discussion with a representative of an NHS Care Commissioning Group (CCG) who attempted to defend healthcare rationing on the basis that it wasn't meant to be punitive (implicitly acknowledging it is), but intended to get people on the right health pathway (without acknowledging this is pure magical thinking). To be fair to the doctor in question he did at least step up to defend an unenviably weak position and it may be that unsympathetic editing made his arguments appear even more unconvincing, but I rather suspect no amount of turd polishing can make healthcare rationing look better than it really is. It appears a lot of the CCG's who use BMI thresholds completely bottled out of talking to the programme.

Towards the end Prof Batterham made a presentation to a group of CCG and GP representatives (including 'celebrity' GP Hillary Jones) on the serious science behind obesity, the hard economic case for medical intervention reinforcing why it is important to treat obese patients with dignity and respect. Again, giving credit where it's due the participants seemed to acknowledge the flaws in their past thinking, be it simple human prejudice or lack of professional awareness. But these are doctors; you'd expect them when faced with cool, rational and overwhelming evidence-based arguments to come round. Unfortunately it will always be harder to convince the proportion of the general public who are mindless, prejudiced twats. This is after all the post-truth era, and for the mindless twat 'you ate too many chips' is a personal truth that will always rank higher than any science. Let's just be thankful there are people like Prof Batterham leading the line against feckwittery! 

Saturday, 8 April 2017

Nightime peeing

Interesting story on BBC last week about how needing to pass urine in the night may be linked to excess salt consumption. For many years now I've found that most nights I wake in the early hours and find I need to wee, but it has become a little more noticeable over the last few years. These days I often find I wake again anytime between fifteen and thirty minutes before my alarm goes off, which is annoying as I invariably need to go when I wake, but that has only happened since I started my current job which requires regular early starts for the London commute.
I don't believe there there is anything unusual about waking in the night per se, the idea that it is natural sleep all the way through the night without waking is probably a modern myth. But I have pondered the issue of nightime peeing more since my GP warned about the risks of pre-diabetes and I subsequently read it can be sign of diabetes (I'm somewhat reassured by the absence of many other signs). I'd love to be able to sleep longer, I usually manage just over seven hours during the week and over eight at the weekend, but as hinted above this is due to daily routine rather than anything sinister. I do sometimes feel tired at work, but then staring at a computer screen for prolonger periods has that effect.
There are some obvious reasons for wanting to go for a wee in the night, firstly I'm getting older. Secondly, as a compulsive tea drinker I often drink a large cup in the evening not long before bed. Tea contains caffeine which is sometimes claimed as a mild diuretic, but as a regular consumer the effect on me is probably minimal. A third reason is that I always take a bottle of water to bed with me, which I sip from if I feel thirsty in the night, sometimes I hardly touch it, but every now and again I will consume the lot. But maybe a small contributing factor is the sodium bicarbonate tables I have been taking for for the last couple of years. I remember when the Consultant first put me on them, she gave me Furosomide so I would flush the salt out out first thing in the morning even though I laughed at the idea of needing any assistance going for a wee first thing in the morning! The diuretic tablets didn't last long as they only triggered gout attacks, but the sodium bicarbonate tablets have increased since then.