Wednesday, 16 May 2018

16:8 Washout

The 16:8 turned out to be a washout. I did it for a couple of weeks and saw no material improvement. I’ve decided to try and mix my regular diet up a bit instead. I’m aiming to replace my main evening meal with a bowl of soup a couple of evenings a week, and also switch out lunchtime sandwiches with a baked potato some days. Hopefully this will reduce down my refined carb intake a little. One thing I do need to get a handle on is grazing on sweets before dinner. I’m not bingeing, but the house is awash with sweets and chocolate which puts me wide open to temptation when I get home feeling hungry but with dinner usually an hour away at least.
I’ve also started walking to the station again in the morning, at least when weather and schedule permits. It adds at least another two thousand steps on to my daily count, and it comes before breakfast which in theory is good for digestion. Too early to tell if these moves will be successful, but I’ve less than three weeks to my next trip to the Nephrologist and I really want to get my weight down to at least 114kg by then.

Friday, 4 May 2018

Appointment shuffling and intermittent fasting

I should have seen the Consultant Nephrologist last week, unfortunately the appointment was cancelled, even more unfortunately I'd already had the pre-consult blood test. This means when I do get to see her in early June the results will be over a month old.

Outpatients tried to reschedule for the second half of May bu I rejected the proffered slot as it was late-morning. I always aim for early morning as the later the appointment the more delayed the clinic. Late morning is at least a thirty minute delay, by the afternoon it's over an hour. I'm not sure if it's too many appointments booked, not enough time per consultation, or maybe both? My consultations typically last five minutes; enough time to review stats, discuss symptoms and adjust medication if required. Some patients take much longer, possibly because their CKD is more advanced or they have complex needs. I arrive (on time), see the nurse for weigh-in and blood pressure, then I wait to see the Consultant.

It's probably a good thing the appointment was deferred, in the last few weeks my weight has ballooned to 116kg, my heaviest since the summer. I'm not entirely sure why, it's not down to bingeing, I suspect a combination of changes to my daily commute and mild indiscipline. Since I changed jobs earlier this year it's not practical to walk from the terminus to the office; I've maintained my lunchtime constitutional but it's not the same as the brisk morning walk I had before. Later this month Southern Fail are overhauling the timetable, which along with more clement weather, means I may be able to start walking between home and the nearest train station again. I enjoyed doing this last year when the weather was agreeable and my overall commute was easier.

I've also started experimenting with 16:8 intermittent fasting, which basically entails eating my normal diet but skipping breakfast on weekdays. The idea is to fast for sixteen hours then consume the calories for the day in an eight hour window. I fast from 8pm to noon the following day, but it's a matter of personal convenience, and this regime fits my working day well. The 16:8 fast is supposed to help the body into a ketosis fat burning state. I've been doing it just under two weeks and the results on the scales are inconclusive, though I feel less bloated. There potential downside is that my normal diet still has plenty of carbs in it, I've only excluded the ones I regularly consume at weekday breakfast. If there isn't a material weight loss after two weeks I'm considering further adjustments towards a 'keto diet'. A friend has utilised this successfully over the last couple of years, but he's single and doesn’t have kids, which makes meal planning simpler.  

A different form of intermittent fasting was the proposed diet strategy for the 'Constant Craver' group identified by a BBC backed weight loss study a few years ago. I did a self-assessment at the time and fell into the 'Constant Craver' category. This particular version of intermittent fasting was based around eating regularly five days but reducing to eight hundred calories on two days. That's unlikely to work for me (although I'm not entirely ruling it out), currently there's just a coupleof hours each morning when I feel hungry, the rest of the time I'm satiated.

As well as rescheduling the Nephrologist I've had fun rejigging other appointments. Last year the Consultant decided I should have a course of Hep B vaccinations to future proof my kidneys from potential infection, that means four jabs each a month apart with the third due next week. I've also been invited to my annual medical at the GP surgery (along with pre-review blood test). As usual it needed rescheduling (invites made by the surgery without my involvement strangely take no account of whether I can actually attend). It could have been worse the letter originally went missing before I even saw it, it was only when my wife asked about what was in it that I called and found out. It did eventually turn up, unopened, behind the sideboard in the dining room, but there was a very real risk I would simply have not turned up to the appointment. Ultimately it's all worked out, I've managed to reschedule the pre-medical blood test for the same day as the Consultant appointment and the medical itself to coincide with the final Hep B jab. It's a bit of a faff, but better in the long-run! 

Thursday, 29 March 2018

Presumed Consent

Recent movements on presumed consent have spurred me to action on this long-planned post. There’s a lot of waffle about the private members bill that recently passed its second reading being a historic event, it’s not, it’s symbolic rather than a practical step change.  
Few private members bills become law, this one is stronger than most in that it has cross-party support and is welcomed by the Prime Minister and the much-maligned Health Secretary, but there are still powerful religious lobbies who oppose its passage.
All this will actually do is bring England into line with Wales, by adopting a soft-opt out system that has yet to demonstrate a major uplift in donations from the deceased. One problem is that a key blocker for recovering organs remains in place; the donor’s next of kin can still overrule the presumption of consent, in fact this can happen now even where a donor has explicitly given their consent.
I’ve seen arguments that increasing life spans are part of the problem, that as people die at an older age there are less healthy organs available. I’m not entirely convinced. Because a donor was old donor doesn’t mean the organ isn’t viable, in some cases it will be true, but it depends on the donor and the organ. Kidneys tend to lose function naturally over time, but some organs like the liver are remarkably resilient. Besides a kidney that gives ten years free of dialysis is better than nothing, especially as medical science moves forward to longer term solutions.
A more fundamental problem this bill will not address is the required investment in the transplant system needed to drive up utilisation of donated organs. The Spanish system is considered a golden standard in this respect; time, money and energy have been spent on the systems and processes needed to drive up donation rates.
One intriguing argument is to allow people to sell their organs, though there’s an undoubted taboo about this which causes an instinctive recoil in some people. No doubt it goes on around the world, where it is associated with economic coercion and the exploitation of the poorest and most vulnerable. But there remains a utilitarian case around its efficacy in saving lives, the economic rationale is sound, and the ethics of free will are a counterbalance to allegations of exploitation. Still, breaking through such strong moral objections is a challenge.
My own personal views on presumed consent are conflicted. Once upon a time I believed it to be an oxymoron, accept this and you could presume consent for anything you like regardless of whether you were likely to get it or not. There’s a whole slippery slope of consequentialism for brighter thinkers than me to mull over. These days I’m not so sure.
I don’t like special pleading and given I’m likely to need a transplant in the next ten years or so, I could very quickly descend to that. So, I need a good argument.
There are obvious benefits of taking organs from dead people who don’t need them anymore and giving them to sick people who do need them, but expropriating stuff from people because they don’t need it isn’t usually associated with responsible authority. There is a crucial distinction, the organs have no intrinsic value to anyone other than the suitable candidate for transplant.
Whilst watching the first series of The Frankenstein Chronicles I was struck by an argument used by a Resurrection Man, you cannot steal a dead person’s body from them. This makes sense, they don’t own it any longer and it’s not part of an estate to be passed to an heir in the manner of a house or jewellery. You don’t keep Granddad’s vital organs on the mantelpiece. I’m sure some people will disagree with this, but outside of a few Indonesian communities I’m pretty sure they won’t keep the decomposing body around for very long.

Firing Blanks

After all my guff about posting more often this year I’ve reverted to form. Once work is done and family responsibilities are taken care of I just can’t be arsed to write. It’s not that there aren’t things I don’t want to put down, it’s just that I’d rather watch a tv show, read a book or listen to a podcast.
Anyway, I got the results back from my latest andrology test last month and I am finally shooting blanks. So pretty much twelve months after my vasectomy I am finally infertile. Does it feel any different? No. 
As far as my CKD goes there's not much to report. My weight has crept up to between 114 and 115 kg, it's hardly ballooning, but not heading in the right direction. This morning I had the second course of four hep B vaccinations that my Nephrologist recommended, the first course just over a month ago left my slightly groggy, but nothing today. I'm still waiting to hear back from the healthier living referral the GP was supposedly making back in December. 

Thursday, 15 February 2018

Monty Python's Parking Circus

Warning, the following is a long off topic rant about anti-social parking and how dealing with local authorities sometimes feels like living in a surrealist comedy sketch.

The area where my wife and I live suffers from anti-social and illegal parking. Most houses have some off road parking, but most were built before widespread car ownership and don't accommodate modern volumes. It wouldn't be too bad if households had a couple of cars each, but some have small fleets of five or more (more than they can physically drive), and that's without those who prefer not to use their off road parking, or the twats who use this residential area as a storage lot for their commercial businesses.

We have two driveways, one at the front, and one at the rear, both accessed via dropped kerbs. Both have suffered from obstruction by anti-social scum, the one at rear being particularly problematic. In July of last year my wife applied to Surrey Highways for access protection markings (H bar) across this rear dropped kerb in the hope it would deter pondlife, and in December it was installed. Access protection markings are advisory only, so have no legal value, but they 'advise' the existence of a crossover, and crossovers are protected by Section 86 of the Traffic Management Act 2004. Since the markings went in I've been regularly reporting obstructions to the local 'parking enforcement' team, which have been duly ignored until two weeks ago when I was astonished to receive two replies in succession.

Parking enforcement in Tandridge District is shite. Surrey County Council devolve enforcement to the boroughs and districts and some years ago Tandridge District Council (TDC) outsourced its enforcement to neighbouring Reigate & Banstead Borough Council (R&B). R&B runs token enforcement in Tandridge, a skeleton crew working primarily Monday to Friday daytime, cover more than twenty small towns and villages over ninety-five square miles. Report an offence and you'll get an email saying someone might look in 24 hours, apart from Sunday's when they won't bother. There's no worries about offenders being fleeced by over-zealous wardens hunting profits; parking offences aren't just widely ignored, the absence of enforcement means penalty charge revenue is so limited the 'service' makes a loss.

Local councillors are well aware of the problems and the general shiteness of 'enforcement'. I know because I used to be one and I'm still in contact with my former colleagues. Unfortunately, the district and parish councillors who favour meaningful intervention lack required influence, whilst the county councillor who has influence is mildly sympathetic but reluctant to go as far as meaningful intervention. His reticence is partly due to seeing it as low priority versus Surrey County Council's serious financial problems, but it probably doesn't help that local twats have become conditioned to getting away with their parking offences. The robust solution proposed by those committed to meaningful intervention is a residents parking scheme, but Surrey Highways doesn't want the hassle and there will be a contest between residents who want the problems tackled and residents who cause the problems. A half-way solution would to replace R&B with fit for purpose enforcement, using professional processes and staffing, this would pay for itself, but the inconvenience to offenders remains a political consideration. A couple of years ago the county councillor did support a scheme to reduce double yellow lines around the intersections, this would have freed up extra parking spaces, but it was repelled by residents who pointed out this would prevent access for larger vehicles like refuse collections (already a problem) and would make the area into one giant bottleneck.

So, back to the unexpected responses from R&B. Okay, they were so late as to be useless but it was progress surely? To my eye it looks like R&B has upgraded its reporting system, a cynic might note that the TDC contract comes up for renewal soon; but given that R&B has shown little interest in the contract I suspect that it's more down to the local parish council bunging some additional subsidy its way to try and get a little bit of attention. Whatever, it's welcome intervention, but a little pathetic given a fit for purpose enforcement regime wouldn't need a bung, fit for purpose regimes up and down the country make surpluses just by covering the basics.

However, the responses were eye opening, firstly they pointed out the obstructing vehicles had been removed, fairly fucking predictable given it took two or three days to investigate. But there were other dubious remarks. Both responses stated R&B couldn't enforce advisory markings, disingenuous sophistry given nobody was asking for this, the reported offences were crossover/dropped kerb obstructions which are enforceable. Also, one of the responses stated that they were not able to enforce partial obstructions, only complete blocking of the  crossover. This really did piss me off, as having repeatedly read Section 86 of the Traffic Management Act 2004 I know it does not make any such claims. As a former councillor I'm also well practised in spotting the tricks used by statutory authorities to shirk responsibilities.

I wrote back challenging both claims, and I even got a reply on the latter point (it seems the cheap wheeze conflating advisory markings with crossover obstruction wasn't worth defending). It said:

"Section 86 of the Traffic Management Act 2004 as amended does grant local authorities with Civil Enforcement Powers the power to issue a Penalty Charge Notice to vehicles which are parked adjacent to a dropped kerbs inside of a Special Enforcement Area. However, please be advised that partially obstructing or overhanging a dropped kerb is not an offence which local authorities are able to enforce. In order for the vehicle to be issued with a PCN, the vehicle would need to be parked adjacent to the dropped kerb. However, please be advised that partially obstructing or overhanging a dropped kerb is not an offence which local authorities are able to enforce. In order for the vehicle to be issued with a PCN, the vehicle would need to be parked adjacent to the dropped kerb."

It seems fair enough, until you read it carefully sentence by sentence:

"Section 86 of the Traffic Management Act 2004 as amended does grant local authorities with Civil Enforcement Powers the power to issue a Penalty Charge Notice to vehicles which are parked adjacent to a dropped kerbs inside of a Special Enforcement Area."

Yep, that's true, I've read the relevant section several times.

"However, please be advised that partially obstructing or overhanging a dropped kerb is not an offence which local authorities are able to enforce."

Hmmm... this is not so clever, the Act itself makes no such claims. It's hard to see how it could be, it would have to define what partial obstruction is, opening up a whole new can of worms.

"In order for the vehicle to be issued with a PCN, the vehicle would need to be parked adjacent to the dropped kerb."

This third sentence is consistent with the first one, but it contradicts the second sentence if you're interpreting them all literally. A vehicle overhanging or partially obstructing a dropped kerb is 'adjacent' to that dropped kerb if you understand the term 'adjacent' in its literal sense. Was I going mad? No. I went and checked in several different dictionaries, here's what the online version of the Cambridge Dictionary says:

So a car overhanging a dropped kerb is adjacent to that dropped kerb, it's physically impossible for it not to be adjacent. More expansive definitions of adjacent actually use synonyms such as contiguous and overlapping, which are even clearer on this point.

So what is going on? Is there some figurative or metaphorical reading of the Traffic Management Act 2004 which reconciles the mutually exclusive claims within R&B's response? Is it possible to be physically adjacent but simultaneously not physically adjacent for the purposes of R&B's claims?

If there is a special exemption for vehicles parked physically adjacent to a dropped kerb, but only overhanging or not completely obstructing, what is the objective definition of this? There has to be an objective definition, otherwise it gets too complicated. How does it work if you can get ingress or egress to a motorbike but not a transit van? Is that partial obstruction? Fuck knows! This the problem when logically inconsistent claims are made. Maybe reconciliation can be achieved by some legislation or statutory instrument omitted from the statement? Maybe R&B has been asked to go soft on parking offences, maybe that's why it's shite, and I'm unfairly maligning apparent indifference? But if that's true why not simply make it clear to the public there's no point in even reporting parking offences? The whole fucking thing is batshit.

Monday, 5 February 2018

CKD on BBC News

There's been a couple of interesting stories around CKD in the past week or so. There's this positive one about a guy who has developed a successful dialysis app that assists people in finding treatment whilst travelling. Then there's this not so positive one around the shortage of kidney donors, something that is especially prevalent amongst ethnic minorities.

Monday, 29 January 2018

Nephros Writes

Yesterday I launched my new blog "Nephros Writes". It's where I'm going to start publishing stuff about the stories and poetry I've been working on, along with occasional commentary and reviews of things I've been reading, watching and listening to. Basically stuff that up till now has largely resided in my notebooks or in half-finished drafts, and stuff that doesn't really belong on this blog which is mainly about my CKD and other gripes about the 'real world'. I started by republishing the poem I wrote back in October about CKD.