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.

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.

Wednesday, 29 March 2017

From tragedy comes hope

I came across this tragic story on Sunday night when I unwittingly crossed the Facebook timeline of a relative who is an acquaintance of the victim's mother. I find stories like this uncomfortable, it raises my worst fears for my own children, but this case happened on a road I have trodden probably thousands of times. The only positive is that this poor little girl has probably saved the lives of several other people with organ donation, something that her grieving mother must be commended for. At such an incredibly painful time it would have been understandable had she batted the question of donation away, that she didn't showed incredible bravery and is a fitting tribute to her daughter (the recipients also have a big sacrifice to live up to). With all the talk of presumed consent it's a shame the pond life responsible aren't having all their organs forcibly donated to more worthwhile causes. I'm sure there's a utilitarian argument for that somewhere.

Thursday, 23 March 2017

Woe is me (aka another of my boring moans about diet and fitness)


There’s been little movement in my weight since I started my Lent fast, minor fluctuations up and down. This week I shaded just under 111kg, but it wouldn’t surprise me if I’m a little over next week. I’ve stuck to the no chocolate commitment but I suspect I don’t eat enough of the stuff anymore for it to make a significant impact on my calorific intake. The focus probably needs to be on ‘extras’ like the cup of peanuts I have on Friday and/or Saturday, or the odd piece of cake. Lately I’ve found myself plugging the gap between lunch and dinner with a few crackers or a piece of bread when I get home from work, an apple would be better, although the calorie reduction is probably marginal.
The occasional days when I consume more calorific food and (alcoholic) drink may be more relevant, such as Saturday 4th March when to watch London Skolars versus Toronto Wolfpack. Great day out, but whilst hardly a binge, the presence of a real ale bar and a mixed grill down the pub afterwards involved significantly more calories than typical. Even then the weekly change in my weight was less than half a kilo which reversed itself without significant effort.
It probably hasn’t helped that I’ve had a few minor, sporadic flare ups of gout over the last couple of weeks, not majorly painful, but enough to cause noticeable discomfort on my daily walks. I treated with Colchicine last week and it seemed to do the trick. Unfortunately, the persistent heel pain I’ve suffered over the last few years is also quite bad, it’s been worse, but is definitely on the upward curve again. I’m not sure if it is plantar fasciitis or something else, either way given my age and weight it’s hardly a surprise. I did raise it with the GP nearly two years ago, the same time as my vasectomy referral, but as it’s small beer compared to the gout attacks I chose not to pursue the issue. With the weather (intermittently) getting better and the days getting longer I really want to be pain free so I can try jogging again, the same old problems of finding time remain, but I’ve got about six weeks to lose another two kilos and something needs to give.
But putting aside my narcissistic whinging about foot pain and weight struggles I have made a couple of attempts at doing something constructive that isn’t all about me. I’ve signed up to the Disability Support Network at work and I’ve also pre-registered for Kidney Research UK’s London bridges fund raising walk in July. The former is something I’ve been considering for a while but have been in two minds about because I don’t consider my CKD to be a disability right now, but I recognise it probably will be one day. The latter will be my first foray into actually raising funds to support treatment for CKD. I’ve added both to the growing list of topics I plan to write more about but may never find the time for!

Thursday, 2 March 2017

Diet Update - Lent is here!

I haven’t posted an update on my diet in awhile; mainly because there hasn’t been much to write about. I’m currently tipping the scales at 111.6kg which is pretty much where I have been for the last two months. My activity levels have been pretty good (step counting is good motivation even if step targets are arbitrary), although my diet has slipped slightly, no bingeing or anything that serious, but I’ve slipped in to the habit of having treats like chocolate or cake three or four times a week where previously it was once or twice a week.

My aim is to get down to at least 109kg for my next appointment with the consultant in two months time. Fortunately help is at hand, Lent started yesterday so it's no sweets or chocolate for forty days (I have to admit being extra naughty on Tuesday indulging in an extra large packet of Reece's peanut butter cups). I managed it last year, even after our parish priest shockingly announced that Sunday's don't actually count as fast days in Lent! I was all for writing to the Bishop to find out what was going on!

Monday, 27 February 2017

All About My Vasectomy!

Ok, so I said I was going to write something about my vasectomy experience, and as I had the follow up appointment last Thursday now is probably a good time.

The beginning
My wife and I decided some time ago we didn’t want more children. We have two happy, healthy kids and a modest but comfortable lifestyle, it’s enough for us. Kids are rewarding but maintaining family life whilst both working full time is hard. A vasectomy seemed the long-term solution to contraception. My Dad had one after my younger sister was born, and my brother-in-law had one a couple of years ago, so it wasn’t a ground-breaking decision, even for a practising (Cafeteria) Catholic.
Around the middle of 2015 I discussed it with a GP at my local surgery and he made the referral. I hoped it would be something that could be done quickly, but I struggled to find the right time as I was doing a stressful job I hated. Just over a year ago I took voluntary redundancy and got a less stressful job. I’m now much happier, my career prospects and work life balance are better and crucially it’s easier taking time off.
The run-up
After the referral I received a letter from NHS Choices explaining how to go online and choose a provider. There were two in my area; one was BMI Shirley Oaks, a private hospital in Croydon I’ve used before, the second was a GP surgery in Redhill which does outpatients appointments. Neither is great location wise, but BMI Shirley Oaks is easier. Due to my circumstances it was September 2016 before I actually booked an appointment.
The booking process was straight forward, but there is a lack of information about the medical process that follows; you simply book an available slot. I assumed, in the absence of alternative information, the actual procedure would be carried in that slot. So I booked a couple of days off work in October, Thursday for the appointment itself and Friday to recover (plus the weekend). It was only when the appointment letter arrived I found it was just a consultation. So I cancelled the Friday leave. Annoying.
The appointment came; I was seen quickly and professionally. I spent about ten minutes with the surgeon, the discussion was pretty much as I’d expected from reading the NHS website and covered similar ground to the GP. He asked if I had kids (yes), any medical issues (CKD) and explained the nature of the surgery and associated risks. He did a quick physical exam, jokingly asked if I wanted a circumcision too (no), and told me I would need to shave my scrotum before surgery. Then he pencilled me in for surgery under general anaesthetic on a Friday morning in January 2017. I then went to see a nurse who recorded my height and weight and informed me that if my BMI had been over 40 I would havebeen rejected for NHS funded surgery at that hospital, I inferred it could be done there privately which suggested bizarre healthcare rationing rather than clinical based commissioning.
I thought that would be it until the big day, I was wrong. The next week I received another letter with a date for a previously unmentioned second consultation. I thought it must be a mistake, but I was wrong, I needed pre-surgery tests. Annoying again. Fortunately it was between Christmas and New Year and I already had leave booked.  I went back to the hospital, saw a nurse, she took some swabs, went through the medical history form I’d completed at the first appointment, put me on an ECG machine for five minutes, weighed me again, and took some bloods (giving me matching arms as I’d had my regular CKD bloods taken at the GP surgery that morning). I never saw the results of these tests, but I was told NOT to shave my scrotum ahead of surgery as nicks might cause infection, if necessary it would be done in theatre (in the event I used electric clippers a couple of days before to ‘thin’ things out). 
The day itself: pre-surgery
I was told not to eat or drink anything after midnight the day before but I played safe and consumed nothing after 7 pm. On the day itself I was told to arrive for 7.30 am, so I got up 5.45 am and caught an early bus into Croydon and a bus back out to Shirley leaving myself good time. It was an absolutely freezing January morning and given my actual slot wasn’t till after 11 am I’m far from convinced I needed to be there so early. Mildly annoying.
I was quickly shown to a perfectly pleasant room and told a nurse would with me shortly to do check in. After 9 am the surgeon popped his head in to say hello, then about twenty minutes later the anaesthetist came and ran through some basic health questions. He asked why it was being done as a general rather than local, I told him it was the surgeon’s decision. He offered to switch to a local, which he said carried less risk. I considered this, but to be perfectly honest I preferred a general as I wanted to be asleep whilst they were fiddling around my undercarriage (yes I know they’ve seen it all before, but that wouldn’t make it any less embarrassing or uncomfortable for me).
Sometime after 10 am the ward sister came to see me, she answered a few questions such as how long I was likely to be kept in (basically until after I’d passed urine), offered me something to eat after surgery, and reiterated the advice in the appointment letter about not driving or drinking alcohol after general anaesthetic. She asked who was collecting me and I said depending on time it would be my Mother-in-Law or I’d get a taxi (which was true), and asked if someone would be at home afterwards and I said yes (which was a lie). My wife was taking the kids to my parents for the weekend, partly for a family birthday party and partly to give me a few days peace.
But I still hadn’t had a visit from the nurse to check me in. It was gone 11 am when two nurses rushed in offering apologies. There had been a mix up; they thought I’d been checked in by the night staff when I first arrived. So after spending three hours hanging around doing nothing I was speedily checked in, changed into a gown and ushered down to the operating theatre.
The day itself: post-surgery
I came around after midday in the recovery area. My senses came back pretty quickly and I didn’t feel any pain, I was just a bit hazy with temporary difficulty swallowing. After a short time I was moved back to the room and within ten minutes I was up and out of bed. Moving around was okay, I just felt very tender with a dull ache down below. Going for a wee was a bit awkward, not because of any physical restriction, but because the bandaging got in the way. My scrotum was held in a sort of string net jock strap contraption packed with surgical wadding, it kind of pushed everything upwards making aiming straight a little tricky (although my wife would say that’s not new).
I spent a few more hours in the room. Nurses came in and out to do checks, I was able get dressed, have some water to drink, and the ward sister came back to give some post-op advice such as when I could remove the dressings (next day in the shower). About an hour after surgery some tea and sandwiches arrived, which was much appreciated given I hadn’t eaten since the previous evening. I was eventually discharged around 4 pm (on the understanding that someone was home). It was too late for my Mother-in-Law to collect me, so I got a taxi home where aside from making myself cups of tea (I chose to follow advice about not drinking alcohol) and some dinner I basically spent the rest of the day watching television in bed.
I didn’t feel the need to take any painkillers, there was a constant low level ache, and occasional sharp spasms of pain when I moved too fast, but it was tolerable. My mobility was restricted, I shuffled around being careful not to make sudden movements, and I made sure I slept on my back. Most of all I was immensely grateful my son was away for the weekend given his habit of jumping on me when I’m lying in bed!
The days following surgery
I generally took things very easy for the next couple of days. I let the dressings come off in the shower the next morning. I did have a look at myself in the mirror, my scrotum was very red and hugely swollen which meant everything looked and felt very unfamiliar, especially when going to the toilet. I had two small nicks, one on either side, that had been sutured closed. I was advised to wear snug fitting underpants to provide support, which was not a problem as I usually wear briefs. For the first few days I wore a base layer under my trousers which added extra support, and also kept me warm as it was bloody freezing outside. I also wore a clean pear of briefs each night underneath my pyjama bottoms.
The next day I felt well enough to clean out the rabbit hutch and to meet up with a mate at the pub for a few drinks and something to eat. We bumped into an old acquaintance that used to play rugby league with us, upon learning of my plight he giggled each time I shuffled slowly past his table on the way to the toilet! Sunday I did very little till my wife and kids got back in the afternoon. My step count went through the floor!
Monday I went back to work. It was a little uncomfortable, mainly during the commute to and from the office. Fortunately there was no strike that week so Southern Fail merely offered its standard mediocre service rather than the ‘unfit for transporting cattle’ effort that sometimes (don’t) turn up. As I do a desk job there was nothing to stop me working and I didn’t even tell my colleagues what I’d done, but I doubt I could have done a manual job.  
It is difficult to describe the way I felt for those first few days. I was tender, I was swollen and things felt different, my scrotum was large and heavy like an overinflated water balloon. There was some pain, but it was not acute or chronic. I can best describe it as being in a state of hyper sensitivity, I think boys learn very quickly how sensitive their reproductive organs are and act accordingly, if the same sort of discomfort came from any other part of the body i.e. a stiff shoulder or a mildly sprained ankle, I would have simply carried on regardless. But the locus of the discomfort and infrequent bursts of pain when I inadvertently applied pressure to the area e.g. lying in the wrong position; meant I was constantly aware of it. There was also an annoying tendency for the areas around the two little scars to itch slightly.
It took a couple of weeks for the swelling to go down. But after four weeks it was completely healed, the sutures had disappeared and everything was back to normal. On Thursday, approximately one month after surgery, I went back to see the surgeon for a check-up. The consultation lasted about five minutes and he gave me a letter for my GP to arrange sperm count tests in May. In my case I hardly needed a follow-up; all it did is confirm everything is okay, but I understand it’s a necessary step as there may have been issues.
Conclusions
Was it worth it? I can’t tell yet, I still need to wait a couple of months before I get the all clear to say my sperm has been permanently restricted. I can say that it’s not as onerous as it seems. I think there is a natural and sometimes perfectly sensible tendency for men to be cautious when it comes to their reproductive organs. I certainly found the physical exam to be a little embarrassing, I was very self-conscious about the idea of a room full of people looking at my private parts even though I’m perfectly aware it’s just a job to them, so I’m grateful I was able to sleep through it. I feel no regret about having it done; providing it works the temporary discomfort is a small price to play for a permanent solution to contraception. The people involved were all thoroughly professional and treated me with respect and care, the only thing that could have been better is more clarity from the very beginning about the steps in the process, I had four different appointments not counting the original one with the GP, I also had contradictory advice about shaving my scrotum, and I probably didn’t need to be checked in four hours before surgery. But overall I wouldn’t hesitate recommending the procedure to others looking for a permanent contraception solution.

Friday, 24 February 2017

NHS Reform as Botched Quality Management

I’ve been following reports about the latest top down reorganisation of the NHS with interest, or I should say following those that made it over the wall  as the plans have been well suppressed. The secrecy is not surprising, top down reorganisations of the NHS usually fail to deliver the promised results and its status  as a deeply cherished national treasure constantly being circled by wolves makes it a highly sensitive subject. I don’t believe it does everything right, but it punches well above its weight and is struggling heroically with demographic changes and funding shortages.

Seems to me these proposed changes have some merit, at least in theory. There is evidence that focusing treatment into specialist centres can deliver better results than having more widely dispersed services. There is also evidence that moving certain types of medical care out of hospitals and into community care is beneficial. Let’s face it; as long as the required support is in place, most people would rather be in the peace and privacy their own home than hospital which is usually a busy places full of sick or dying people. Medical advances mean we often don’t need to stay in hospital as long as we once did, in the past minor procedures involved multiple days stay, now many  procedures can be handled as outpatient cases like my recent snip (which I must get around to writing something about).

The big problem is the availability of the necessary support. Most sensible people know that the resources to shift more patients out of hospital and into community healthcare simply don’t exist. As far as these plans go it's the ‘Elephant in the Room’. Both Government and NHS bosses  know full well that the NHS, England and Wales especially, barely has enough GP’s and other community healthcare professionals to cover existing demand. At the same time the related provision of social care services which is delivered by local authorities is on the verge of collapse due to years of Government austerity. Some improvements may be possible with tinkering around the edges, but it's wishful thinking to believe this can work without massive incremental investment in community healthcare and social care.

There is a fundamental lack of trust in the Government to do the right thing, it’s not helped by the fact that the leadership of the Conservative Party sends out ambivalent signals on the NHS. Whether it is ideological dogmatism over privatisation to the whiff of individual venality, trust is low. It’s not something to dwell upon here, but my own anecdotal experience as a former Conservative activist tells me  there is a clear divergence between the grassroots and upper echelons on this one. It is all reinforced by constant disingenuous responses from the Government that it's spending additional billions on the NHS, when a more truthful assessment is that any such money is simply plugging deficits, inflationary pressures and is probably just shuffled from elsewhere in the health budget. Similar claims around allowing local authorities to increase council tax to support social care are also mendacious. The Government's deliberate political decision to weight the pain of austerity away from the central portfolios, combined with raises to the minimum wage and the demands of an ageing population mean local government led social care system is already collapsing. 

This whole mess bears the hallmarks of the classic quality management clusterfuck. Way back in the day when I studied Management I was taught W. Edwards Deming’s mantra that you focus on quality and the rest follows, organisations that invest in quality and get lower failure rates, less rework, higher throughput as consequently long-term cost reduction. Conversely where the focus is primarily on costs any short-term saving tends to be followed lower quality and higher long-term costs. Over the last twenty years I’ve seen this play out in real businesses, I’ve seen incremental investments in quality deliver long-term benefits, and I’ve seen short term focus on cost cutting simply restack the pain for later (I was once partial to a confidential call where a “corporate superstar” exec suggested cutting a quality programme that had successfully demonstrated £8m per year of cost savings in order to save the £2m a year operational costs). 

Now the NHS is a special case, certain things don’t apply, for example fixing someone up now might only lead to more healthcare needs long-term, but that doesn’t mean some principles don’t apply. It’s still better to fix someone up properly today so you don’t have to do same thing again tomorrow, better for both patient and budget. The top down approaches to NHS reorganisation, and the Government’s reluctance to properly fund social care, repeat the same classic costs over quality stupidity. To make long-term beneficial changes there has to be genuine up front incremental investment in quality, not simply using accounting tricks to restack the deck chairs. There will of course be legitimate challenges to this, such as whether incremental investment is just throwing money at a problem, and there will be illegitimate opposition to it such as the brainless political fetishes around deficit reduction.

Perhaps it’s time to start resolving some of the fundamental problems? Such as admitting that healthcare and social care cannot really be separated, that attempting to shunt patient care into places where there simply isn't resources to treat them (or even worse where the Government's own policies has removed those resources) is just stupid? But most of all maybe we just need to be realistic about the fact that we don't really spend enough in this area and we should maybe reprioritise certain expenditure (I'd start with these sacred cows)?  

Thursday, 2 February 2017

More BMI Bonkers!

Another bonkers story about NHS health rationing based on BMI junk science. It appears certain NHS Trusts are rejecting joint replacement operations for obese people who have BMI over 35. They are supposed to go away and lose 10% of their body weight to be reconsidered. Having suffered from gout in the past I know that joint pain is a serious hindrance to leading an active and healthy lifestyle, but gout is sporadic rather than permanant, so God knows how those who need joint reaplcements are supposed to get around this problem.

I'm currently BMI 36 and could probably cheat under 35 by starving for a few days ahead of any medical, but at the start of 2016 I was close to 40. Losing 10% of my body weight (c.13kg) took a year to do and it certainly wasn't trivial, it took lifestyle changes including changes in physical activity. That's where the stupidity of this kind of rationing comes in, to get the treatment they need these people need to lead a healthier and more active lifestyle, but without that treatment they will struggle to lead a healthier and more active lifestyle. Plus if my experiences are anything to go by there will be little in the way of practical support to overcome the lack of acute treatment.

Saturday, 21 January 2017

Dangerous charlatanry? Why not automate it…


Another interesting recent article on the BBC about thedangers of NHS trusts using referral services to review GP referrals with the intention of delaying or blocking treatment to save money. Although not this specific process, I do have painful first-hand experience of a GP referral being delayed without proper clinical evaluation.
About six years ago, during the events that led to my CKD diagnosis, I suffered a bout of severe back pain. I went to my GPs who prescribed medication, wrote me a referral to the local NHS back clinic and recommended I try their resident (private) osteopath. I took my medication, I saw the osteopath who provided a little relief but couldn’t work miracles, and I waited for the back clinic appointment.
A few weeks later I got a letter back from someone, their job title was something like ‘Senior Physical Therapist’, saying they’d reviewed the referral and decided I wasn’t worth an appointment at this time, but I’d be put on some kind of pre-waiting list for a place on the official waiting list (which I think was some sort of wheeze to game the genuine waiting list target). This ‘senior’ healthcare professional had basically read the referral from the GP and overrode his decision (which was based on clinical evidence) without examining me or even making any attempt to discuss my clinical symptoms.
During this time my back got much worse, Tramadol, Gabapentin and Diclofenac could only take the edge off. I was hunched over like an old man, I couldn’t walk properly, I couldn’t sit properly, I had to sleep on the floor. If it wasn’t for the fact that I was able to work from home I’d have been signed off sick for a prolonged period (I worked sprawled out on the lounge floor). Due to the lack of activity my weight ballooned by 15 kilos, the consequences of which are still with me today.
I went back to the GPs, I saw the other partner, who read the referral by his colleague, read the half-baked response and assessed the consequences to me which were now well past the point of medication or basic physical therapy. He asked me if I had medial insurance, I did, he wrote a referral to a private consultant, a couple of days later I had an appointment (handily he did a satellite clinic nearby), a couple of days after that I had an MRI which showed I had two bulging discs pressing on my sciatic nerve. About a week after the private referral I had a short procedure to inject cortico-steroid into my spine and the improvement was rapid.
A month or so later I did actually make it onto the waiting list for the NHS back clinic, but by this time the worst was over, my private health insurance had dealt with the acute problem. So instead of being an assessment to treat the acute problem I eventually ended up with a course of physical therapy designed to help me recover from it. Don’t get me wrong, I am grateful for that physical therapy, it taught me long-term techniques for strengthening and protecting my back which are very useful whenever I have any twinges. But the issue remains that without private healthcare I would have been left to rot in crippling agony due to a non-evidence based pseudo-scientific approach from a so-claimed health professional. So that’s how I know it’s dangerous to delay or veto referrals from without clinical assessment. It may save some money, if the patient is lucky enough to go private, or if more likely, they are unlucky and they simply die (being dead is a quick way of cutting healthcare costs).
Now I quite clearly believe the NHS shouldn’t be using dodgy processes like this, but if it’s going to use them in the name of efficiency, there are cheaper and more efficient ways. Working in Business Intelligence I know tools and techniques which could automate the assessment of referrals. These processes are not based on the first hand clinical evidence (that’s the GP consultation), they are based on textual analysis of what the GP wrote, which is something quite different.
With just a little up front involvement from the sort of healthcare ‘professionals’ currently reviewing referrals algorithms could be developed to recognise the patterns that delay treatment and the patterns that progress it. Plug those algorithms into a text mining data science tool like RapidMiner and you have a cheap way of assessing thousands of referrals an hour. Sure, from a clinical perspective it’s just as dangerous and pseudo-scientific as the current referral review process but it’s much cheaper, more consistent and also more objective as a computer doesn’t care for such things as ethnicity, religion or personal persuasions.
So my question is if the NHS is going to use dangerous processes to be ‘more efficient’ and to ‘save money’ why not race straight to the bottom and go with outright automation? With my kind of solution the NHS could do away with most of the costs of the healthcare 'professionals' currently rejecting referrals and instead spend that money on productive treatment. It won’t help the people who need treatment who get their referrals rejected on dodgy grounds, but at least the money currently siphoned off to these charlatans could be used so less referrals get rejected overall?

Sunday, 15 January 2017

Fitness trackers and DNA testing


I was intrigued by a recent article on the BBC website about the efficacy of fitness trackers. I’ve been wearing a fitness tracker for about six months now and I’m pretty convinced about its benefits, it’s not that I think it’s some sort of a miraculous panacea, but I find it very useful for encouraging me to keep active. I keep track of my step count each day and if I haven’t been active enough I make an effort to put in a bit extra, or if I fall short one day I try to catch up the next. I also use it to log changes in my weight each week and to keep an eye on how much sleep I’m getting.
It is true that the majority of my weight loss in the last twelve months came before I started wearing a fitbit, but it would be wrong to take that as evidence that not wearing one is more effective that wearing one. I lost more weight at the start because at my starting point I was heavier and my overall fitness was lower, by the time I started wearing one I’d already significantly improved my basic fitness (from a very poor base line) and incremental improvements where always going to be more challenging. To go from homeworking most days to commuting was a step change in activity, but I can only walk to the office once in a morning, and back to the station once in the afternoon and I only get one lunchbreak to take a walk. So there are practical, physical restrictions on the scope for exercise, if not the effectiveness. What the fitbit has done is supported my ongoing progress, helping me to avoid slipping backwards.
One thing in the BBC article that did get my attention is the idea of genetic testing to aid weight loss. I’ve long had a suspicion that there are insights into my diet that could unlock more effective weight loss strategies, at least beyond the usual boiler plate of eat more rabbit more and do more exercise (not that such generic prescriptions are worthless, they’re just very limited). I like the idea of customised dieting advice based on scientific evidence; it’s a bugbear of mine that the various NHS practitioners I regularly come into contact with hassle me to lose weight, but without ever offering any practical, customised support. I don’t hold it against them, I understand resources are tight, but the official Government driven approach appears to be all stick i.e. sugar taxes and treatment rationing (including rationing based on pseudoscience like BMI), and no carrot i.e. making customised nutritional advice more readily available to obese people like myself. I can’t help but feel that the official approach to obesity related health could be more cost effective long-term with a bit more investment and focus short-term.
I’m seriously considering paying for a service like the one offered by DNAFit, I just need to find the one that will offer me the most useful benefit for the fee. What I really want is some customised guidance around what food/nutrition I should avoid and what I should favour. I’m not really interested in the “value added” parts of the products (value added being business speak for boosting profit margins by selling lower value bolt-on products at a price that suggests they are actually high value products); I don’t want recipe books, eating plans or exercise plans, I can work things like that out based on my own preferences once I have the underlying nutritional insight. Nor do I want to be flogged ongoing fitness services or be benchmarked against Olympic athletes, or any of the stuff that probably delivers the most profitable customers.
I’m really just looking for a company that will offer basic but comprehensive diet testing. I’m sure all the “value added” stuff might be useful if I was a fitness nut, or even if I was still playing organised sport like I was ten years ago, but these days it’s simply about being healthy and getting my weight down to 100kg.  But most importantly I want anonymity, whatever my test results are they need to be completely confidential. I don’t want them shared without me choosing to do so proactively, nor do I want the risk of being required to disclose them to some third party (such as an insurance company) at a later date simply because they exist. I know there are pretty good data protection laws in the UK, but that doesn’t mean a company cannot be hacked, nor does it prevent a situation where one day I’m legally coerced into sharing them. Ideally, I’d like the process to be completely anonymous, with my sample and the records from it destroyed within a sensible time frame.
I think I have some research to do, but this blog post lookslike a useful start

Saturday, 14 January 2017

Target hit, well sort of…


I had my Consultant appointment on Tuesday, and by some strange fluke I managed to weigh in at 111.2kg, which was a bit of a surprise as I’ve been pretty consistently weighing in between 112kg and 113kg in recent weeks. I’m pretty certain that 112kg to 113kg is my current stable weight range, so I’ve created a bit of a rod for my own back, when I go back in four months I’m going to need to be under 110kg, which means a loss of at least 3kgs, and that’s not helped by me being a bit naughty ever since Tuesday!
On the positive side my Consultant is happy with my progress, she says my stats are strengthening and showing definite improvement with the weight loss and the medication regime. The closer I get to the ultimate target of 100kg the more time I’m giving myself before I end up on dialysis and the transplant list. I’ve also been free of gout attacks for a long time now, which is a very physical sign of improvement.