Thursday, 22 December 2016

Suspicious Scales

I'm not entirely sure what I'm doing right, but if my bathroom scales are to believed, I hit the 111.5kg mark this week. That leaves three weeks to get rid of the remaining 0.5kg to hit the overall target of 111kg. The interesting thing is that I haven't been trying exceptionally hard, albeit I've been generally disciplined in my eating (the odd Xmas chocolate aside) and have maintained moderate alcohol consumption (no drinking at all during the week). My step count has been pretty good apart from the days when I was forced to work from home due to train driver strikes.

This relative success following a period of stagnation is making me nervous that my scales are faulty, even though they are a fairly new digital se, so it will be interesting to see what my parents scales say at the weekend. The alternative theory is that I've hit a purple patch where the combination of calories and exercise is good for weight loss.

Tomorrow we're heading up to my hometown for Christmas, so the opportunity for overeating and not exercising will increase significantly. The key thing will be making sure I take a good walk each day and go easy on the sweets!

Tuesday, 29 November 2016

Quick update

Just a quick update. I weighed in this morning at 113.6kg and there are exactly six weeks to go till my next consultant appointment. If I can manage a loss of 0.5kg per week I'll make it to 111kg.

No doubt it will be tough. I'm going to need to avoid Christmas temptations and really put in some physical efforts. I've raised my steps target to 11k per day and I'm committing to jog three times per week form now on. No alcohol on school nights and no chocolate on weekdays. I'm also going to start a vitamin supplement alongside my prescribed mediation. It's going to be an interesting six weeks!

Monday, 28 November 2016

BMI, healthcare rationing and casting of runes

No posts for a while, nothing much to say. Recently my weight has been fluctuating between 114kg and 115kg. Everything has pretty much plateaued, my activity levels are good but not exceptional, finding time to fit in extra exercise is challenging. Weekends over the past few months have been taken up by DIY (painting fences, painting the garage, replacing guttering etc…) and just recently with various family commitments. Now the weather has turned the idea of going for a jog in the cold, wet, dark evenings is not one that fills me with joy.

My diet has slipped into what I'd describe as a normal pattern. I'm not pushing hard to cut out calories like I did earlier in the year, but at the same time I am showing self-restraint in what I eat and drink. Sweet things are restricted to a couple of times a week and to normal sized portions. Compare that to 12 months ago and the difference is significant, back then I would eat a chocolate bar most days, and sometimes I would have more than a single serving of a sweet or chocolate on the same day.

That step change means I'm not too worried about the Christmas season, I know I can moderate myself when temptation is all around me, although I’ll need to be tough with the inevitable influx of office mince pies. The big question is whether having achieved a level of stability the time is right for another push? I have about six weeks till my next consultant appointment in early January and it would be good to hit 111kg at that. That's around half one pound a week, achievable but challenging given the season and the fact I’m starting from a lower calorific intake than at the start of the year. It would bring my total weight loss for the year months to around 14kg, over half way in my battle.

One significant positive from the whole exercise is that my BMI is now around 36 when it was tipping 40 at the start. I don’t personally hold much faith in BMI as it’s got more than a whiff of pseudoscience about it, but it’s a pseudoscience that is increasingly being used in the rationing of NHS treatment.

I recently arranged to have a vasectomy a.k.a. “the snip”. The NHS has contracted the procedure to a private hospital and I was told at the initial consultation a BMI over 40 would have seen me rejected. As I actually got the initial GP referral over a year ago, but couldn’t get suitable time off work, I would probably have been declined had I proceeded immediately. It needs to be stressed this isn’t a rule based on genuine medical science, the hospital will still carry out the procedure on people with a BMI over 40, but they have to pay privately. This seems a bit of a nonsense as the procedure is non-emergency under all circumstances, it isn’t particularly complex, and there isn’t a massive waiting list (I was able to obtain appointment slots easily). 

Surely in this day and age there must be more sensible ways of rationing treatment (if rationing must occur at all) than the arbitrary application of pseudoscience? What next, NHS treatment allocated on the basis of casting of runes?

Wednesday, 21 September 2016

A new approach needed

The consultant appointment came and went, the last ditch effort to lose weight failed, I stuck to the no alcohol or chocolate ban for two weeks, but it didn't really make any difference. In the end I weighed in at 115.6kg, half a kilo heavier than I did four months earlier. Ultimately it made no difference to my stats, my CKD remains stable (c. 28% kidney function according to the consultant) and my medication remains unchanged.

After that I kind of let things slip a little, having failed to make the weight loss I slackened off on the diet, not massively but just enough. It didn't help that the day after the appointment I was giving the eulogy at my Grandfather's funeral and wasn't in the mood for abstinence. So this week my weight is up again to 116.4kg.
I now need to rethink my approach, as the current one isn't working: eating a generally sensible diet with moderate consumption of alcohol and occasional sweets; combined with regular moderate exercise. There are a couple of levers, the first one is to change my diet again, I know it's too heavy on carbs, particularly refined carbs like bread and pasta. I mainly eat white bread (usually unsliced bloomers, ciabatta, baguettes etc., not that it probably makes any difference from sliced packet bread) as I've never been too keen on brown bread finding it a bit dry and cardboard like, but there are some artisan style brown breads I've tried and enjoyed, the question is figuring out whether switching will make have a material affect? It's actually quite difficult to get clear guidance on whether switching bread and pasta is materially beneficial. The other options are to switch away from bread altogether for some meals, perhaps having weetabix or muesli for breakfast instead of toast or soup at lunchtime, the only concern being whether these will fill me up sufficiently to avoid snacking or having to go with portion sizes so large they defeat the objective. It may simply be a case of try and see.
The second lever is more exercise. This is not as easy to affect. I have my morning walk from the station (instead of taking the tube), and I have my lunchtime constitutional, but after that it becomes more difficult. I try to slot in walks/jogs in the evenings, but these are not easy. With two young kids and their various activities (after school clubs, homework, feeding, bathing and getting to bed) as well as the day to day chores that need to be slotted in finding a suitable half an hour and time for a subsequent shower is not as easy as it sounds. Too soon after a meal and it's uncomfortable, push the meal back and it's going to bed with a full stomach and inevitable indigestion. Jogging/running has never been my thing, even back before the kids, when I played rugby league and went to the gym several times a week. I now find heels and ankles can hurt afterwards. There is also no gym or swimming pool close enough that I could take advantage of it. sufficiently to justify a membership.
It's given me something to think about, but I can’t mull it over for too long as I need to get some momentum back up.

Thursday, 1 September 2016

Special Measures

Well, my plan to get down to 111kg by my next visit to the consultant on 13th September is completely in tatters. This morning, with two weeks to go, I weighed in at 116.1kg, basically 1.5kg heavier than I was 4 months ago. It's not that I have been especially bad with my diet or exercise, I just haven't been disciplined enough overall.

The lack of progress is a combination of daily 'extras' like ice cream and/or a couple of beers, particularly whilst I was on holiday in August, and a few 'bad' days like my cousin's wedding or Saturday's challenge cup final where I ate more or drank more than I would normally. It's not like I've been on any mad benders or have binged on food, it's just that there haven't been enough days where I've burned off more calories than I've consumed. I can get away with those occasional bad days if I keep the days with 'extras' to a couple of days a week, unfortunately I haven't done that.

So my new target is 113kg. That is basically 3kg in two weeks, very challenging but not impossible. I'm working on this basis that I can shock my system back on track by cutting out chocolate and alcohol for two weeks, and adding a regular evening walk/jog to my routine. I still do my daily morning and lunchtime walks, and I follow my late breakfast and no morning snack routine at work, but I suspect that my body has simply normalised to this so I need to increase the work rate to get benefit. I think it will be an important milestone to break below 114kg.

Monday, 25 July 2016

The Flatline... again!

Staring to get a little nervous about my diet again, I've stabilised at 114.6kg, but I'm now half way between my four monthly visits to the consultant and need to get some downward movement. I've set myself a target of 111kg by the next appointment on 13th September, that works out at one pound per week. It's a challenging but realistic target. 

I need to be more ruthless tackling unhelpful patterns which have crept in, such as sticking to my diet on most days but then having days when I'm not so good. The diet works best when I'm in a regular meal routine and I don't get too hungry because the gaps between meals are too long, which only tempts me to snack. Bad days mostly involve a handful of peanuts whist waiting for dinner or 'extras' like an ice cream after dinner or a couple of beers midweek. 

The early part of July had several days when I was too indiscipline, on Saturday 2nd we went out for tapas and as we tend to order too much food I end up feeling compelled not to waste it. The next day we went to a garden party at the in-laws, for some reason I thought it was going to be a barbecue, but instead it was a mid-afternoon light buffet which turned out to be the worst possible combination. Firstly, it was too close to lunch which meant I wasn't really hungry, secondly (and rather unusually) there wasn't really enough food so when I was hungry there was nothing left. Thirdly, as it was a warm afternoon I ended up drinking the equivalent of five pints which is atypical. So instead of a regular meal I ended up with a slice of pizza, cookies and beer! Then came my birthday, I didn't particularly go overboard, but there were sweets and cake. Fortunately things have settled down in the last couple of weeks.

I got the Fitbit for my birthday, so now I'm keeping better track my exercise. The good news is that I am averaging over 10k steps a day, but it does confirm I'm not getting enough intense exercise and also not enough sleep/good quality sleep (a mixture of recent hot weather and kids waking in the middle of the haven't helped). I've been taking Allopurinol for over two weeks now without any severe gout reaction, although I did take two magic tablets a day for the first fourteen days. At the moment I'm trying to make sure I squeeze in a walk every lunchtime and plan to restart the jogging regime I abandoned in June due to gout. I'm also hoping that the two weeks holiday I have booked in early August will increase my activity levels as I get out from behind a desk.

Friday, 1 July 2016

Slippage


Well it had to happen given the temptations laid in my path, my weight loss inevitably started to go backwards last week. When I got on the scales on Wednesday I was 115kg up 1kg. Fortunately, the gout attack has significantly receded, although there is still a small amount of pain in my left foot (ball of the big toe and heel) it hasn’t got significantly worse for about a week. The course of steroids didn't finish it off and I still needed another cycle of magic tablets early last week, but at least things are now settling down now. I’m planning a final cycle of Colchicine this weekend in the hope I will be able to start Allopurinol early next week.
I have been trying harder with the diet this week, albeit temptations are everywhere. One of the downsides of my current workplace is the culture of bringing in cakes and sweets to share on a near daily basis. This piece on the BBC about "office cake culture" is a rather timely example of the problems I face. Most of the time I resist, but yesterday I did indulge in one of the donuts a team mate procured to celebrate his birthday. It didn't help that the boxes were stacked right next to my desk ensuring a steady waft of sugary smells in my direction.
Talking of birthdays, it's my own next week. My wife is treating me to a fitbit, which is something I've been looking at for a while. I'm keen to start recording just how many steps I'm taking daily, and use it as motivation to increase, particularly by fitting in more lunchtime walks. Now I just have to decide whether I take in cakes next week, or whether I just let the day pass quietly (my preferred approach to my birthday).

Wednesday, 22 June 2016

Father's Day Temptation

It was Father's Day Sunday just gone, and with it came temptations to spoil my diet. On the Saturday we went out for an Italian, a starter portion of carbonara followed by calzone weren't exactly the healthy options, but then there's no point in paying to eat out somewhere special and then ordering stuff you're not fussed about, may as well just stay at home. I did pass over the option of a dessert, but that wasn't much of a hardship, desserts in Italian restaurants (and Spanish for that matter) are usually pretty mediocre. I don't drink coffee so the ever predictable tiramisu is of no interest and unless they have a good selection of proper gelatto then ice cream is a waste of valuable calories.  

On Sunday morning the kids gave me a large bar of Reece's peanut butter chocolate, which I've so far avoided opening. I love the stuff, but once it's open the chances are I will struggle to avoid eating it in one or at best two sittings. It was a nice day, so we took a picnic to Priory Park, the only problem being that I always end up eating more at a picnic lunch than I would normally. My typical lunch is a roll or sandwich and occasionally some crisps at the weekend, but I ended up adding not just crisps but some snack sausage rolls and a chocolate biscuit, then a little later in the afternoon we had ice cream from the cafe.

In the evening the in-laws came up for dinner, which of itself wasn't a problem, but I wasn't very happy with the volume of dessert my wife had bought. For four adults and two children we had a large cheesecake and a large chocolate fudge cake, each of which would give six generous adult servings. Add in berries and fresh cream and it was more than double the amount of dessert we really needed. I resisted, but made the point that going so far overboard with dessert was wasteful and doesn't make things easy for someone trying to diet.

Friday, 17 June 2016

Side Effects of CKD


One of the funny things about CKD is that until you get down to the final stages it has little in the way of external symptoms, this is one of the reason why early warning signs weren't pieced together in the development of my own CKD.
Around fourteen years ago I had an ultrasound scan to investigate a stomach problem and the technician noted my right kidney was very small, which wasn't actually as big a surprise as it might have been given my Mum had one kidney removed as a child and my brother was born with only one kidney (albeit his one kidney is apparently larger than typical). But that comment was tangential to what the scan was actually for.
Then around ten years ago a routine check at my GP's surgery had picked up that I was suffering from mild hypertension (higher than normal blood pressure), but it wasn't considered significant enough to treat because there was no link to my kidneys. Then a little while later I failed a medical due to protein being detected in a urine test, my GP investigated further but the conclusion was that there was nothing to worry about. These disparate pieces of information did not link together and therefore no steps were taken early that might have prevented some of the deterioration that followed.
It was only after I had a procedure to treat two bulging discs in my back and the hospital flagged concerns about my blood pressure that the problem was uncovered, unfortunately by that time I'd also experienced significant weight gain due to the back problems (there is a whole other story for another time about that).
The only direct physical symptoms of my CKD is the sporadic gout, which has been getting worse as my kidneys get worse. But whilst gout is linked to CKD plenty of people with gout don't have CKD, especially overweight men such as myself. The only other physical sign of my CKD is actually a reaction to the Ramipril medication which has left me prone to sudden bursts of cramp in my calf muscles, something a previous consultant confirmed was a not uncommon side effect. I have trained my body through force of habit to avoid stretching too quickly in a morning, instead I gently work my way into stretches, I'm careful not to bend over too quickly in certain ways or to spend too long sitting in certain positions. Of course sometimes it cannot be avoided, sometimes I'll turn a certain way in my sleep and wake up screaming as the pain shoots through my legs and I have to get up and stretch my calves or I'll end up in pain the next day. It's not something my wife impresses my wife who gets woken up a stupid o'clock in the morning.
But I consider myself lucky so far, there may come a time when I'll look back in fondness to the days when gout and cramp were the only side effects.

Wednesday, 15 June 2016

Back to the GP

Just under two weeks ago I received a letter from the GP surgery informing me they'd received the letter from the consultant (my copy arrived a few days later) and asking me to come in and discuss the changes. So I called up and asked for a slot in the late surgery that runs on a Monday, I had to wait a week but as it wasn't urgent that was fine.

The appointment turned out rather timely as I've experienced another stubborn bout of gout and although my magic pills (a.k.a. Colchicine) were helping I can only take 4 a day for three days before breaking for three days and starting over again. The upshot is that the attack has stayed under control without fully clearing (I  dread to think what it would have been like without magic pills), and as I cannot start taking Allopurinol until I get properly clear of gout I'm in a bit of trap. I'm fortunate that I have no shortage of magic pills as the 48 the Consultant prescribed in May have been boosted by 150 the in-laws obtained over the counter in Northern Cyprus. They've also offered to get me some more in August if I need them which will rather depend on how the Allupurinol performs. My current supply should last a year assuming that heavy attacks remain an exception and the less serious ones clear within a day and a half of treatment, but it is quite literally a pain to run out of them during an attack.

I discussed the gout with the GP and he suggested a five day course of Prednisolone steroids (40mg once a day), which I was actually going to suggest myself given it worked okay last year. He described it as "using a sledgehammer to crack a nut" but I'm not convinced as last year I needed two courses of the same, admittedly that attack was more severe but I wasn't using magic tablets back then so there was no mitigation already in place. My hope is the steroids will break the current three day on/off cycle and next week I will be able to start the Allopurinol. Other than that we talked about coming off the water tablet and that I need to keep an eye on my blood pressure as we may need to increase the daily dose of Amlodopine (Ramipril is maxxed out). He also suggested I may need to come back after I've been on Allupurinol a little while and I've made a note to self to get more consistent taking weekly blood pressure readings at home.

My weight loss has pretty much stalled, no gain, but I'm still hovering around the 115kg mark I was a month ago. I have made an effort to get back into the swing of things diet wise this week, but an attempt at a new exercise plan stalled with the gout attack, so once the Prednisolone does its thing I'll be restarting that.

Sunday, 12 June 2016

Musings on pre-Diabetes and dieting

After my GP's recent disclosure that I am at high risk of developing diabetes, I have defaulted into self-education mode, which has loud echoes of what I did when I was diagnosed with CKD. In some ways it is a shame that the NHS isn't a bit more proactive with constructive support, admittedly both my GP and consultant have encouraged weight loss and a healthy diet, but I am already attempting both to some success and it's pretty generic advice short on the specifics of what will deliver actual results.

It's still a bugbear of mine that in early appointments after my CKD diagnosis the (previous) consultant and registrars I saw debated referring me to a dietician and prescribing Orlistat but never did (although they never definitively ruled them out, it was more a decision for another time that never came). I even discussed Orlistat with my GP, but again without meaningful conclusion. It was only when my first phase of weight loss flat lined at 125kg that we skipped to the nuclear option of stomach surgery, although ironically that requires a referral to a dietician first. Without abdicating my own personal responsibilities; I suspect I’ve been hoodwinked by the schtick around the NHS getting serious on supporting health issues earlier when costs are lower.

The surgical option has been withdrawn from the table for now, but I still think I could benefit from professional advice on dieting that is tailored to me rather than the hypothetical Mr Average. Pre-diabetes adds an extra complexity to what is already a minefield of conflicting advice. I avoid adding salt where possible and reserve certain foods such as crisps and peanuts as occasional treats, I try to opt for low fat and low sugar options whilst being mindful that when either fat or sugar is reduced in many products the other is substituted to maintain palatability. I believe that many of the staples of my current diet such as bread, pasta and potatoes are much reduced in diabetic diets, but removing them from now is not straightforward, I need genuinely palatable alternatives that are capable of making me feel full need to take their place. Palatability is a major weak point in many diets, and substituting staples with alternatives that leave you hungry half an hour later is setting up for failure.

Wednesday, 25 May 2016

Politics, CKD Humour and New Challenges

A couple of weeks ago my fellow residents ejected me from the local parish council (civil parish, not church), bringing down the curtain on a short and relatively undistinguished career in local politics. Nobody is mourning the passing of my (lack of) political ambitions, least of all me. I voluntarily chose to vacate my seat on the district council last year despite a good chance of retaining it and this year I eschewed the opportunity to move to a safe parish seat despite the high risk of not being re-elected  (a process dubbed the "chicken run" before the 2014 Croydon local elections when senior Conservatives shifted themselves out of risky wards). But at least now I get to tell people I have retired from politics to spend more time with my remaining kidneys.

I did enjoy most of my time in local politics, it opened up new perspectives, developed new skills, and I learned a lot about how politics actually works from the inside; the good, the bad and the ugly. Politics can be a dirty business, but that's not solely down to the minority of politicians who are warped by the (often limited) power they receive, but also by sections of the electorate only too willing to be diverted by trivia or indifference. Now it's time to focus on some new challenges.

Monday, 23 May 2016

A Moment of Truth


So the moment of truth came when I stepped on to the hospital scales and weighed in at 115.2kg, a 9kg loss since my previous appointment in January. My consultant was pleased and despite the flu and gout that plagued the months in between my kidney function was stable, with eGFR up 1 point at 28. So for now I’m holding my own and the more weight I lose the better some of the readings will get, although nobody is pretending there will be a fairy tale ending to CKD.
I explained about the gout attacks and it was agreed I could ditch Furosemide given it was probably doing more harm than good, and in her own words she doesn’t want me getting down to 100kg only to have worn out joints. I still need to take the higher dose of sodium bicarbonate, and if I feel like I’m retaining water I need to start taking the water tablets again. Fortunately to the best of my knowledge I’ve never suffered water retention, either that or I have and just haven’t realised it.
I got a prescription for Colchicine (a.k.a. magic tablets) which pretty much took care of the current attack in three days. I’m now waiting to be fully clear so I can start on a low daily dose of Allopurinol, although I’ll also need to take a couple magic tablets every day for two weeks to mitigate against a new attack when I start. At the moment the swelling is gone from both feet and I’m taking decent walks, but there is still a little residual pain in a couple of joints I want to clear (also my in-laws are going to bring me back some more magic tablets from Northern Cyprus in a couple of weeks so I won’t risk running out at a crucial point).
In the afternoon I saw my GP for my annual check, most of the blood readings (kidney function aside) weren’t noteworthy but did warn that I’d flagged for pre-diabetes and needed to look at my diet and weight. I explained about the weight loss programme to get down to 100kg so I make the transplant list when the time comes, he seemed tiny bit surprised we were looking at that outcome already, but didn’t challenge it when I said it was inevitable at some point. I just need to carry on with what I’m doing, there is no other treatment needed.
So now the challenge is to fight complacency on the diet front, I have slipped a little lately, not massive binges, but a little less disciplined than a couple of months ago. Getting rid of the gout and the better weather should enable more exercise, I’m thinking of treating myself to a fit bit for my birthday which will hopefully act as challenge to my activity levels.

Sunday, 15 May 2016

Diet Update Week 15 – Mixed Blessings


It's been awhile since I posted an update, this blog has temporarily been relegated to the furthest back of back burners (it has always been a low priority).
The good news is that I hit my target of 117kg about a month ago, my reading on Wednesday, on a brand new set of scales put me at 114.9kg. My next visit to the consultant is this coming Tuesday morning so it will be interesting to see what the hospital scales say (I also have a session with my GP in the afternoon). 115kg seems a bit too good to be true. Although I'm pretty much sticking to my diet, I've started allowing myself a little more leeway such as treating myself to chocolate a couple of times a week post-Easter fast. I've also tended to drink less alcohol lately as I'm worried it could be aggravating recent gout attacks, although I've been a moderate drinker for years so it's probably negligible in terms of calories removed from my diet.   
The bad news is that my general heath has been pretty rubbish for about two months now. Over Easter I had bout of flu, and I'm not talking about "man-flu", on Easter Sunday I crawled in to bed at about 5pm with a full on fever. This is despite the annual flu jab late last year. I never get flu, but this year it hit me like a locomotive. It took weeks to fully get over it, even after the worst had passed I went through several weeks of feeling run down, tired and lethargic. The mucus cough wouldn't shift, I couldn't sleep properly, I experienced ear infections and temporary deafness.
The next problem has been a chronic attack of gout that has lasted for over three weeks now, albeit with fluctuating levels of intensity. First in my right foot and currently in my right foot. I haven't allowed it to stop me, but it has been terrible for mobility, I've had to reduce my morning walks partly to manage pain and partly because I was taking too long to get to the office. I made a decision last week to temporarily suspend my water tablet (and consequently the sodium bicarbonate it's intended to counteract), I'm fairly certain this didn't cause the attack, but it's probably prolonging it as raised uric acid levels are a common side effect. It hasn't helped that I've exhausted the stash of colchicine I brought back from Turkey last summer, I'm not a big advocate of 'self-medication' but I stick to the usage limits and it's very handy when a Turkish pharmacy will sell you 50 tablets for £2 without a prescription (an NHS prescription 12 tablets for £8.40, but getting a convenient appointment is the difficult part).
I can spot the signs that gout is impending but I've never been able to work out the trigger, if indeed there is any one specific trigger. This time I noticed that the initial flare up came after eating a meal containing chorizo sausage, and there was a noticeable spike in pain the two weeks later when I ate chorizo again. However, I've eaten chorizo many times without getting gout, there are probably other commonalities I've missed, and there have been other spikes in this current attack where chorizo is nowhere to be seen. It’s all a bit mystifying, I’ll have plenty of things to talk about with the docs next week.

Thursday, 10 March 2016

World Kidney Day


Today was World Kidney Day, a day aimed at awareness of kidney health. Hooray! How do I know this, well because I stumbled across it by accident when I was searching again for an article I read a couple of weeks on the BBC website about a breakthrough in 3D printing of human organs.* If the BBC’s own search capability wasn’t so crap I’d never have found out about World Kidney Day, or at least not today (in case you’re wondering I found the article via Google). It’s quite funny really, given my own rather obvious interest in kidney issues that I had to stumble across a major initiative by accident, maybe I need to sign up to a few more resources to keep in the loop?

* I’ve been meaning to write a post about how encouraging some of these medical breakthroughs are to someone like me who is likely to need a transplant in the future. I’m fortunate to be living at a time when such developments are happening, and be at a point in my life (and disease) where such things could bring meaningful benefit). A subject I’ll hopefully have time to revisit in the next few weeks

Diet Update Week 6 – Steady Progress

Week 5 was positive with a 1kg loss, which was a relief after the disappointment of the previous two weeks. Week 6 was flat, but I wasn't too concerned as I didn't expect much due to having a big family meal out on Sunday (Mothering Sunday). So at latest reading I'm down to 120.6kg, my lowest since I started the diet, with total weight loss over six weeks a shade over 4kgs. My next visit to the consultant is nine and half weeks (wasn't that the name of a dodgy 1980's erotic movie?), so I'm aiming at 118kg for that appointment, with 117kg a stretch target, but given the natural slowdown in diet results and the upcoming Easter season 118kg will be tough enough to achieve.

I still haven't had the GP letter calling me in for the medication review, but I'm okay about that as long as the diet is working. I'm a couple of weeks off the end of my current prescription and I'd rather make changes at the same time as I get my repeat rather than have out of sync prescriptions. The new schedule will include a water tablet in the morning, something I'm going to have to manage carefully, it's not as if I have any trouble needing a pee first thing, besides every time the kids wake me in the night I end up going to the loo and I definitely don't want to be caught short on my morning commute. I really do need to find out more about the effects of diuretics before I start, I've already read they're unsuitable for people with gout, a condition I suffer from occasionally. The water tablet is to counteract an increase in my dose of sodium bicarbonate, my consultant is aware the existing dose is already having a negative effect on my blood pressure, so I'll be switching to taking in the morning alongside a water tablet to flush the salt out of my kidneys as quickly as possible. One thing I definitely do need to do is start taking more regular readings of my blood pressure so I can judge what the effect is.

Thursday, 25 February 2016

Diet Update Week 4 - Flatlining


Another disappointing week for the diet, with a loss of just 0.3kg. My body seems to have adjusted to the reduction in calories way too quickly, either that or the structure of my diet is wrong.
I’m still eating breakfast when I get to work (2 piece of toast with low fat cheese spread) which cuts out the inevitable craving for a mid-morning snack if I eat before leaving home, I have a sandwich for lunch, some days I may have some fruit in the afternoon, on Friday’s I’ll have a small packet of crisps, but most days nothing else. I eat a main meal in the evening, and maybe once a week I’ll have a desert afterwards, but other than that I don’t eat sweets or deserts. Maybe I should try having soup instead of a sandwich, but whether that will see me through till dinner without snacking is a big question.
I probably also need to find some way of getting more exercise in, but that will be tricky. Getting to the gym on a regular basis isn’t realistic given I’m now office based. My morning walk is good, but isn’t enough, so I’m going to have to try and fit some jogging in at the weekend.
I got my copy of the letter from the consultant to my GP at the weekend, so I’ll probably get a letter to come and see the GP for follow up next week. As expected there was a recommendation that I consider bariatric surgery although the wording is far softer than the rather direct conversation I had with the consultant. I’m hoping that as well as the obligatory tweak to my medication this might finally get me a referral to a dietician.

Wednesday, 17 February 2016

Diet Update Week 3 - Diet Blues


Bad week for my diet well strictly speaking it was a bad week for diet results rather than my actual diet. I’ve been pretty disciplined with what I’m eating and with my portion control, I’ve started walking the last section of my morning commute instead of tubing it, I take the stairs instead of the lift at work, and I’ve even given up all chocolate for Lent. Despite this I still managed to put on 1.3kg, going from 120.7kg at the end of week two to 122kg this week. I had feared something like this would happen, it’s happened before, I genuinely try hard, do the right things, but the scales still decide to move in the wrong direction. I’m trying not to be disheartened, I'm going to stick to the plan, ultimately I'm still 2.3kg lighter than I was three weeks ago when I started.

Friday, 5 February 2016

A Weighty Matter


One of the most important issues I face is getting my weight under control. For most of my life I’ve struggled to keep my weight down, there have been periods more successful than others, but it really doesn’t take much for me to pile on pounds. Going back ten years when I was still playing low level amateur rugby league, training two evenings plus two or three gym sessions a week, my weight was in the region of 107kgs – 112kgs (17 stone to 17 ½ stone). That isn’t great for someone of my height (a shade under 5’10), and I far from fittest of forwards. By the time I got married eight years ago I was tipping the scales at 114kgs (18 stone), but things really got out of hand around four years ago when I injured two discs in my back and months of enforced inactivity saw me rapidly balloon to over 135kgs (21 stone).
The treatment for my back problem ultimately led to my CKD diagnosis when the hospital advised my GP to investigate my high blood pressure (although earlier warnings of CKD had been missed). Weight was one of the things my first consultant nephrologist immediately picked up on, there was talk of prescribing Orlistat and referring me to a dietician, but these were never followed up even after I raised them independently with my GP. Improvement in my back problem probably masked the issue slightly as my weight did start to drop over the next couple of years without any special effort on my part until it flat lined at around 125kg.
The consultant I’ve been under for the last couple of years suggested bariatric surgery from our first meeting, but again there was no official recommendation to my GP, not even a referral to a dietician. I find it interesting that despite consultants repeatedly writing to my GP advising on new medication schedules none attempted to instigate a process to assist my weight loss. My current consultant tells me this time she will be recommending bariatric surgery, but I haven’t seen the letter yet. Should I need to get on the transplant list in the next few years I need to be down to 100kgs, somewhere I haven’t been for the best part of fifteen years and even then a range I’ve only managed for two or three years out of the last twenty.
I don’t want sound like I’m abdicating responsibility for my weight issues to the doctors, the issues are deep and long standing, but I strongly suspect a referral to a clinical dietician would have been just as helpful as tweaking my pills. Yo-yo dieting hasn’t worked out so good for me and the moderate but regular levels of exercise I try to fit into my busy home and (largely sedentary) work life mean I’m probably relatively fit for an obese man, but there’s limited prospect of me suddenly discovering an athletic streak. I don’t believe it’s the case that I have a horrendous diet, yes I like sweets and beer, but I don’t binge on them. I think I generally have a slow metabolism and professional help figuring out what foods and eating patterns work best could be a major step, a referral for bariatric surgery may be enough to kick start the journey.
In the mean time I have kicked off a new crash diet structured around my new job and enforced by the fear of dying before my kids reach adulthood! In the first week I've dropped 2.6kg from 124.3kg to 121.7kg, but the first week of a new diet regularly over promises. Let’s see how things go from here…

Saturday, 30 January 2016

Mortality in Focus

The scariest thing about my recent GFR reading is that it brings thoughts of my own mortality into sharp focus. From the moment I was diagnosed with CKD at the wrong end of stage three, I realised the odds of me making it to 80 were on the low side, but as long as my GFR readings were stable I put it to the back of my mind and got on with life. But this new realisation that unless my readings plateau again I could be looking at transplant listing and dialysis in three to four years has started me thinking deeply about the long term consequences of my condition.

The analyst in me has started doing the numbers; the average life expectancy for a patient on dialysis is just five years, although it’s not uncommon for some to live twenty or thirty years on dialysis. The average transplant lasts around ten years though some end up receiving several over the course of their condition. These numbers are also improving with developments in medical science and recent breakthroughs in cloning organs open up real potential in the next few decades. But it’s still very scary.

What petrifies me most is the impact on my family, I desperately want to see my children grow to adulthood. The thought of leaving them without a father, of missing the key milestones they have ahead, threatens to crush me. Behind not being there at all is the pressures it will place on them when my condition develops significant complications like dialysis, I’m sure we’ll cope, but the older my kids are and the more financial security we can get in place first the better.

But my initial researches do leave plenty of room for hope, life expectancy on dialysis appears to be heavily dragged down by the fact that many people entering the process are advanced in years and have other serious health complaints like heart disease. Thankfully I’m relatively young, my health is good excepting the CKD, I don’t smoke, I’m a moderate drinker and the only currently identified barrier to transplant listing is my sizeable weight, something I’m now determined to tackle. My occupation is also one that with reasonable adjustments (if required) should be maintainable on dialysis. All things considered there are many people in far worse predicaments out there and I need to focus on getting the most from life now whilst preparing for what the future might throw at me.

Thursday, 28 January 2016

A Beginning


I’m starting this blog to document my personal experience of living with Chronic Kidney Disease (CKD) (CKD), my thoughts on the impact the condition has only my life and that of my family. A sounding board and a record of my journey to maintain a normal life for as long as possible.
I am a man, in my late thirties, living in Surrey with my wife and two young children. I was diagnosed with Stage 3 CKD around three and a half years ago with an GFR around 30. It wasn’t as big as surprise as it may have been for some people as there is a history of kidney issues in my immediate family and I’d known for several years that one of kidneys was unusually small although there were no a side effects to set alarm bells ringing. Since the diagnosis I’ve been on medication to reduce my blood pressure with visits to the nephrology clinic very four months.
The reason for starting this blog now, and not three years ago, is that in January 2016 I was advised by my consultant nephrologist that my GFK has now fallen to 27 and if it continues to trend down I could require dialysis and transplant listing in as little as three to four years. Up to now my CKD has had little negative impact on my life; apart from taking my pills, cutting back on salt, but sadly failing to get my weight under control, but now most substantial changes are required to ensure I see my kids grow to adulthood.