Tuesday, 27 January 2015

Future holidays

A bench and a doorway in the sunshine
King's Lynn, August 2014
Every so often, I spend a week over the New Year holiday period with a group of friends at a large property somewhere in the UK (although one year we were in Ireland) - I have reported on this before (three times over the lifetime of this and the previous blog). Most of the previous holidays were arranged and booked by one particular couple. This year, during a weekend I spent meeting up with some of said friends including the couple who usually make the arrangements, I nobly volunteered Lola II to arrange another of the New Year shindigs.

Somehow it has turned out that the bulk of the work so far has fallen to me instead of Lola II. This is probably only fair, since she didn't have any say in the volunteering process. So off I went, getting people to commit to joining in, finding properties to house 21 people, discovering that the level of enthusiasm meant that we needed a bigger place, collating preferences for four different properties, and at last I hope we have reached a consensus on a suitable house for us. Now my fingers are crossed that it is still available, although we do have a backup option.

That took up quite a bit of time and headspace this week, alongside the usual badminton and work. So my outstanding jobs that are far less attractive (buying holiday insurance, breakdown cover, changing utility supplier, and - worst of all - clearing moss and mud off the hall roof and gutter) have been neglected, as they are likely to continue to be neglected until I have no choice but to knuckle down. The holiday insurance will probably be first, given that the date of the holiday is set and not far off now.

And on that very subject, I took myself off to the Snowdome to put in an hour's practice, so that my first turns on Italian snow are made with some confidence. It had to be at a weekend, so I thought I'd get in early on Sunday morning hoping to start before the main rush of the day, but no such luck, it was teeming. Quite a few were in groups being taught, so they weren't getting in the way too much, but no full speed zipping down the slope. It was still worth it, even though just for an hour on a tiny slope full of beginners. I came home buzzing with excitement and anticipation for my holiday, which is as it should be.

This holiday activity inspired me to consider what other plans I might make for the coming year, and I have two or three more ideas. One slight difficulty is that the lumbering hulk of bureaucracy that is the NHS manages annual leave for its staff through an electronic interface which deals in hours - in the current year, my allocation was around 273 hours, which includes Bank Holidays. I cannot assume next year will be the same because a) you get a different allocation when you work part time compared with full time, pro rata (last year I worked 6 months on 27 hours a week, and 6 months full time) and b) I have now completed 5 years service with the NHS, which entitles me to a few more days, and I can't remember exactly how many.

So now I have to a) find out how many hours I should get next year b) find out how many of these are taken up by Bank Holidays c) convert the remaining hours to days and thus determine what I can plan for. My current thinking is that it shouldn't make any difference about the part-time vs full-time working, because although my leave hours are reduced because of part time working, I will also need to take fewer hours as annual leave. It's complicated, but it's rather delightful to be considering some lovely trips over the next 12 months at this darkest, coldest time of year.

Sunday, 18 January 2015

Nothing much to report

Pink flowers against a background of leaves
Peckover House, August 2014
Nothing much has been happening that I can blog about. There's been badminton, a trip to London, a visit from a builder to look at the damp patches on the hall walls, an attempt at running which was curtailed by a very welcome phone call from Lola II, a second visit from the builder to look at the same problem in daylight, delivering a two-part DESMOND course, more badminton, renewal of the house insurance and another run - a proper 5k Parkrun this time. It was very cold - frosty and icy - and I cobbled together an outfit that I thought would do the trick. Only my elbows were cold, so I consider that a success, given that it started to snow at one point.

Nothing else of any particular interest, although the trip to London produced all the highlights: an urban fox jumping over the fence within a couple of feet of the window we were looking through, my first ever sighting of a jay (although my second sighting came within a week in a completely different location), and participation in the Gulloebl Chinema.

Work is still good, very good. I am practising and learning and practising some more, and reflecting on my performance and receiving and giving feedback. Some patients do very well, in which case their success comes from their own efforts. Some don't do so well, in which case I try to find a different way to help them help themselves. We discuss changing long-established dietary habits. "You're not going to tell me what to do, are you?" said one patient. "That's right," I replied. "You have to decide for yourself what you're going to do, because I'm not going to be there when you're faced with a choice."

The very low carb group is thriving - at least, those who attend seem to be getting on very well. I have had a quick look over my past blog posts, and I don't think I've written about the group before. It comprises all those people who have adopted the very low carb lifestyle to help manage their diabetes, and since September we have been meeting once a month to chat about various aspects of the diet - sometimes someone brings some food they've made for people to taste, we swap recipes, and we had a speaker talking about retinal screening at one meeting. My Broccoli and Stilton Soup was very well received, as were the cheese biscuits that one of the group had made.

I have been recruiting patients to the group at a fairly slow rate, and about half of them decide after the introduction that they aren't going to carry on, but we have about ten regulars now. Everyone is weighed and has their blood pressure measured, and one of our nurses is available to consult about medication changes. They seem to enjoy the meetings and, more importantly, most are enjoying the diet, losing weight, reducing medication and are keen to continue. Only one has dropped out so far, but may return now that the festive season is over.

I participated in a small meeting to discuss our pump clinics. An increasing number of people with diabetes are using insulin pumps, and our existing provision is inadequate, leading to lengthening waiting lists for clinic appointments. There were just four of us: the main diabetes doctor who leads on pumps, our two nurses and me. At the end of the meeting I felt that things were clearer than they were at the beginning, and that is such a rare event nowadays. It looks as though we have found a way to expand the pump service, and I may have a part to play which will also increase my knowledge and skills, which is just what I like.

Thursday, 8 January 2015

What I've been reading

Image of the book cover

The Lie
by Helen Dunmore

narrated by Darren Benedict
"Cornwall, 1920: A young man stands on a headland, looking out to sea. He is back from the war, homeless and without family. Behind him lies the terror of the trenches. Daniel has survived, but will he ever be able to escape the terrible, unforeseen consequences of a lie?"
It was quite a good book, and the parts about the experience on the front line in WW1 were dramatic, gruesome, and evocative. The parts about the ex-soldier rebuilding his life but unable to shake off the traumatic reliving of the experience were also good, but his relationships with the people around him were a little sketchy. It ended as it had to, but was a little unsatisfying. Which was a shame.


Image of the book cover

The Picture of Dorian Gray
by Oscar Wilde

narrated by B. J. Harrison
"After Basil Hallward paints a beautiful young man's portrait, his subject's frivolous wish that the picture change and he remain the same comes true. Dorian Gray's picture grows aged and corrupt while he continues to appear fresh and innocent."
Another classic of English Literature narrated by my US podcaster. I suppose there just aren't enough classics of American Literature that are out of copyright, but I wish there were. To be fair, he doesn't do a bad job with this one. It's interesting to be reminded that the picture in the schoolroom (not the attic) features alongside what I suspect was Wilde's main pleasure: writing about Art, Beauty, Love and the mores of the upper and lower classes in the late 19th century.


Image of the book cover

The Siege of Krishnapur
by J. G. Farrell
"In the Spring of 1857, with India on the brink of a violent and bloody mutiny, Krishnapur is a remote town on the vast North Indian plain. The sepoys at the nearest military cantonment rise in revolt and the British prepare to fight for their lives with what weapons they can muster."
Set only about thirty years before the publication of Wilde's book above, this is a very different kettle of fish. I wasn't sure what to expect - it was a birthday present - and I'd read most of the book before deciding that it is more of a historical account than a story. If I were familiar with the history of India then I feel sure this would have provided colour and life to flesh out any dusty historical account. As it is, I now know a little bit more about the history of India.


Image of the book cover

Love in a Cold Climate
by Nancy Mitford

narrated by Patricia Hodge
"Groomed from a young age for marriage by her mother, the fearsome Lady Montdore, Polly causes a scandal when she declares her love for her uncle, the lecherous lecturer, and runs off to France."
Outstanding narration of a great book - at last, my list of 'must read classics' has come up with something worth listening to. The characters all sound like real humans, even if raised in a social milieu quite different from anything I've ever experienced. Even though there isn't much of a story as such, in the hands of this author that doesn't matter - it's still fascinating and keeps me wanting to hear the next chapter, and Patricia Hodge reads superbly. It's the second of a trilogy, and I've already lined up the first to download soon. A sparkling, wonderful book.


Image of the book cover

In Search of the Edge of Time
by John Gribbin
"The phenomena now known as black holes were described as early as 1783 and dismissed as idle speculation - invisible stars sounded just too implausible to be taken seriously. It was only with the development of radio astronomy, relativity theory and mathematical models of warped spacetime that their true significance became clear. "
As is usual in a book such as this, despite the clear writing, I feel very clever at understanding it up to about halfway, and then wallow about, hoping something will come into focus by the end. It usually doesn't. But I liked the first half, and even though I didn't really grasp the full impact of the argument, it says that time travel is possible, although seemingly not practicable. It was published in 1992 which is a long time ago in particle physics, but again I don't have the knowledge to determine what has been confirmed, ruled out or succeeded by more modern theory. The statement I liked the best was that our Universe might actually be located inside a black hole.

Thursday, 1 January 2015

SGLT2 inhibition

Red dawn sky over frosty bowling greens and clubhouse
Bowling greens at dawn, December 2014
All around are signs that a new year has started - empty roads, silent stations, Mary Poppins on TV and a host of New Year blog posts. I've been sitting on this post for a while, and as I don't have much to say about 2014 or the New Year, you can have this as my first gift of 2015.

The Diabetes Education Club meeting I attended recently featured an eminent speaker on SGLT2 inhibition in the management of high blood glucose. This is a relatively new treatment, although he described its origins in the 1800's when, following the isolation of salicylic acid from willow bark, people were mucking about with all sorts of tree bark to find something similarly therapeutic. A substance was found in apple bark, but all it seemed to do was produce glucose in the urine (glucosuria). This didn't seem useful at the time and it was even thought to cause diabetes (a symptom of which is glucosuria), so it was shelved.

More than a century later, the reality was understood - this substance inhibits the action of sodium-glucose co-transporter (SGLT) molecules which carry sodium and glucose across a cell membrane. In the gut, SGLTs enable the absorption of sodium and glucose from food into the body. In the kidney, they transport sodium and glucose from filtered blood back into the circulatory blood, and prevent glucose from being excreted in the urine.

There are two types, imaginatively named SGLT1 and SGLT2. SGLT1 works mostly in the gut but is found in the kidney as well, and SGLT2 is mostly found in the kidney. SGLT1 is a high affinity, low capacity transporter, so it catches glucose very effectively but works quite slowly. SGLT2 is a low affinity, high capacity transporter, so it lets a lot of glucose cruise on past but works very quickly. You can imagine that SGLT1 is good for low glucose concentrations, while SGLT2 works best with high glucose concentrations.


One of the functions of the kidneys is to filter the blood and get rid of waste products in the urine. Glucose in the blood passes through the kidneys and is normally totally reabsorbed back into the body; glucose is not normally found in the urine of a healthy individual. When blood glucose concentration is higher than normal, the kidneys still do a pretty good job and can cope with nearly double the usual blood glucose concentration, but eventually their capacity is exceeded and glucose is excreted in the urine.

The original apple bark extract (phlorizin) did not differentiate between the two types of SGLT. The phlorizin molecule sticks to the SGLT transporter molecules in the kidney and gut in place of glucose, and blocks the transport of glucose. The effect in the kidney results in glucosuria, and in the gut it leads to impaired absorption of glucose, with the remaining glucose fermenting in the lower intestine and causing pretty nasty side effects. Phlorizin was also too easily digested to be an effective oral treatment, so modifications were made to the molecule to inhibit digestion and to make it more selective for the SGLT2 transporter. This has resulted in the new SGLT2 inhibitor family of 'flozins', including dapagliflozin, canagliflozin and empagliflozin which are licensed in the EU (and some others are available in other parts of the world).

We burn about 250g of glucose per day, half of which is used by the brain. Some of this glucose will come from our diet, and the rest will be synthesized internally. About 180g of blood glucose a day passes through the kidney in a healthy person, and more if the blood glucose concentration is raised. Inhibiting the action of the SGLT2 transporters eliminates more than 50g of glucose per day, thus lowering the remaining blood glucose level. Although not its licensed purpose, this obviously eliminates more than 200 calories a day too, and so this treatment, unlike many diabetes treatments, has the potential to contribute to weight loss as well.

One of the disadvantages of many diabetes treatments is the risk of low blood glucose or hypoglycaemia. SGLT2 inhibition only works if blood glucose is high, because of its low affinity for glucose. If blood glucose is low it simply doesn't work very well, so there is little risk of a hypo. It also uses a different approach compared with all the other types of diabetes treatments, so can theoretically be combined with any of them, although licensing for UK prescription depends on having results of specific trials with each. Another factor in favour of the SGLT2 inhibiting treatment is that if the drug is either not effective or not acceptable (i.e. the patient doesn't take it) there will be no glucosuria, in which case it can be stopped without further ado.

Of course there are disadvantages. If kidney function is not good enough to filter blood effectively then this drug will not be effective. And glucose in the urine is all very well as long as bacteria and fungi don't take advantage. The doctors report that female patients are generally pragmatic about identifying and treating urinary tract infections and thrush, but they say that the male patients tend to either overreact or ignore the problem until it has got so bad it can't be overlooked any longer.

There doesn't appear to have been any direct comparison of treatment with SGLT2 inhibitors compared with dietary approaches to lowering blood glucose. The trials that have been done are comparing treatments with placebo, where sustained weight loss has been about 2kg and reduction in blood glucose has been demonstrated either with improved HbA1c results or a reduction in insulin dosage or a slowing of diabetes progression compared with a control group. There is also a small diuretic effect, which probably accounts for a slight improvement in blood pressure as well.

Because the inhibition affects sodium (the 'S' in SGLT) as well as glucose there are possible negative effects on sodium balance in the body. Recently, I attended a doctors' meeting (by accident) where the doctors raised this issue, but also questioned the size of the effect on HbA1c given the small amount of glucose that is actually eliminated in this way, and wondered what else might be going on. I am not entirely convinced either by the claims made or by the scepticism of the doctors. All I know is that it is another possible treatment for raised blood glucose, and I'll wait and see how it all turns out. That's the beauty of the Dietitian's job - all observation, very little responsibility, mostly trial and error.

Reference: Tahrani, Abd A et al. 'SGLT inhibitors in management of diabetes'. The Lancet Diabetes & Endocrinology, 1:2, p140-151. http://dx.doi.org/10.1016/S2213-8587(13)70050-0

Sunday, 28 December 2014

Media binge

Three frilly pink roses
Peckover House, August 2014
It's been full steam ahead self-indulgent media binge for days, ever since we were 'sent home' early on Christmas Eve. That's the difference between working in the diabetes service and the dietetic department - in dietetics we had to stay as long as it took in case a tube feeding patient arrived at 4pm on Christmas Eve. Things are more relaxed in diabetes, although there's no reason why they should be, as people are newly diagnosed with diabetes right through Christmas, and need more support than a feeding tube ever did. It's just a different approach.

Anyway, I've done a bit of cooking, a bit of cleaning, a bit of tidying up and admin, and the rest of the time I have been immersed in a sea of entertainment - radio, TV, iPlayer, audio books, real books, podcasts, blogs, DVDs and CDs. Starting with 8 out of 10 Cats (TV), Carols from Kings (CD) followed by Guys and Dolls (CD), then there was a bit of Cabin Pressure (iPlayer radio) - the final two episodes sustain the high quality of the whole series, and I can thoroughly recommend it. Especially the one when they go on their safety training.

What next? I've been reading J. G. Farrell's 'The Siege of Krishnapur' which is a bit heavy going, and listening to all my usual podcasts, including Oscar Wilde's 'The Picture of Dorian Gray'. I caught up on iPlayer (radio) with David Sedaris 'Santaland' in which he relates his time as an elf at Christmas in Macy's department store in New York, and an episode of 'The Museum of Curiosity' from a few years ago on Radio 4. There was a blast of St Matthew Passion as an interlude, and then I got stuck into TV films: 'Nanny McPhee', 'The Snowman', and then 'White Christmas', which I find I have never seen - I assumed that I had.

In between all of this I managed to nip to the Pub Next Door for a cheeky gin and tonic. And, of all things, I went out for a run. I haven't been running since the clocks changed and it got dark and cold and wet and I started working full time, but a couple of friends somehow managed to get me fired up again, even though they don't run with me and one doesn't even live within 200 miles. The power of the Interwebs, who'd have thought?  I wasn't that much slower than before despite my two months off, but I felt decidedly shaky after the event. Muscles not used for a while, that sort of thing.

The media binge continued on Boxing Day with 'Cool Runnings' and 'Back to the Future 2', followed by media bingeing of a different kind - updating the badminton club website with new pictures from our Christmas do this year. 'Big Fat Quiz of the Year' (TV), a couple of episodes of iPlayer radio 'Concrete Cow', and onwards to Saturday with 'Sunshine on Leith' (DVD), more podcasts, more St Matthew Passion (it's very long). By the end of Saturday my legs were feeling as if they had both been smashed with sledgehammers. Dad always told me exercise is a bad idea. I've also got a feeling that I am coming down with something chesty and headachey, but we'll see what develops.

Saturday finished with an episode of the Italian crime TV series 'Inspector Montalbano' which Mr A has been addicted to for some time. I had nearly had enough of media by Sunday, but I still managed to finish the audio and the real books and squeeze in the movie 'August: Osage Country' (warning to Lola II and Mr M: not only is there Julia Roberts but there's a whole ton of conflict), listen to the rest of the St Matthew Passion (it's really very long indeed), more podcasts (including the Mayo and Kermode film review show on 5 Live), and more 'Concrete Cow' on iPlayer radio. At the time of writing I was thinking of actually leaving the house to go and see 'Paddington' at the real live cinema, but if it is swarming with kids like it was earlier in the day I'll be giving that a miss and perhaps shorten my jeans, which is a non-media job that has been displaced for the whole four day holiday shindig.

And then it will be back to the real world again.

Tuesday, 16 December 2014

Christmas parties

Table strewn with crackers, streamers, bottles, glasses and other party debris

If you're waiting for the post about SGLT2 inhibition (and I'm not sure why you would be), it's on its way, but things more exciting and noteworthy have been cropping up to postpone the pleasure. The last few days have produced anecdotes that made me think "That would be great for the blog", and I'm writing this when I should really be working on the family calendar, and I've got to go to town in a bit, so time is short.

Short anecdote about a patient first: it was the first appointment of the day, the patient was slightly early, and as we walk from the waiting area to my room I generally ask how things are going in a general, casual everyday manner. The patient said "Pretty good, I've lost a stone [14 lb, about 6.4 kg]."

That's a good start to a consultation. When we're sitting down, I follow up with "So tell me, how did you manage to lose all that weight?" The patient looked at me in an odd way, as if I were a little bit dim, and said "I just did what you told me to do!"

So that was a good start to the day.

Further anecdotes result from the slew of Christmas parties that I've been at - the second and third were on Friday and Saturday nights. The second party was at a large hotel and conference centre, where at least three different events were being held concurrently, parking was being marshalled, and we were met at the entrance by a couple of burly security men asking to look in our handbags.

"What can they be looking for?" I wonder. "Has there been violence with weapons in the past? Do I look like someone who is hiding a knife in her bag? Are they expecting jihadists?" My naive questions are answered as I join our party in the main hall. One of my colleagues greets me with "Did they search your bag? I can't take my coat off yet, I've got a bottle of vodka in my pants" and she showed me the bulge in the front of her dress. Not only was she aware of the measures being taken to safeguard the takings of the hotel bar, but she had gone to great lengths to bypass them. I last saw her as she was being helped from the dance floor.

I am regarded as a mixture between an alien and a prude because I always drive to and from these parties, along with my other non-drinking (usually pregnant) colleagues. A different approach to alcohol applied to the third Christmas party with a different team, who had decided to use the teenage principle of 'pre-loading'. We were invited to pre-party cocktails, where I found a couple of colleagues who had rather overdone it. We all made it to the venue (a Masonic Hall) but they didn't last long enough to have their starters before having to be collected and taken home by a husband - I found out later that they had been pre-pre-loading with wine at another colleague's house even before the cocktails.

With two out of nine of our party already down and out, we enjoyed the meal and waited to see what would happen next. It was entirely organised by and for the hospital staff and was fundraising for dementia care, so I was expecting a live band and a raffle alternating with the disco, as is usual at this type of event. Instead, a tall, flamboyantly dressed woman introduced as 'Sabrina' entered the room and started to dance and mime along to the music. A surprisingly muscular, thick-waisted, slim-hipped woman...

As drag acts go, this was a corker. Not too naughty, very funny, it had me grinning and clapping and laughing until my face hurt. After the first number, one of my colleagues, a lovely chatty lady now wearing party antlers, stage-whispered to her neighbour "I think it's a man dressed as a woman!"

She and I were first on the dance floor when the disco started, and for a change the DJ had adopted the approach of playing music that made people want to dance - surprisingly rare in my experience. I've only got one more Christmas party coming up, and I doubt that it will be better than this last one.



Wednesday, 10 December 2014

Offline

Greenery around a pond
Groombridge Place, June 2013
The week following Lola II's visit is a busy one. Work then badminton club #1 on Monday, work then a badminton match with club #2 on Tuesday, work then choir practice on Wednesday, work on Thursday then...

It’s a nightmare. Thursday night: no Internet at home. I’m off to badminton club #2 so I don’t mind so much, but when the Internet hasn’t returned on Friday night, it becomes serious. Mr A was at his work’s Christmas do on Friday night, which involved bowling, dinner and an overnight stay, all paid for (that’s the private sector for you) and I was looking forward to an evening to myself. I had various online jobs lined up, among them blogging and creating the family calendar, which is a fairly long and tedious process (although well worth it for the results in the end). So I had to phone the ISP.

Part of the pain of investigating the issue is that the Internet wifi router is in Mr A’s office, which is full to the brim with ‘belongings’. I imagine Mr A and I use different words to describe the contents of his office, but even aside from that, the overhead lights do not work and it is dusty; very, very dusty.

First of all, the operator in the ISP's call centre did not recognise our phone number. The address and post code did not help either. I started to imagine that our account did not exist, which would explain the lack of service, but when I fished out a bill (thank goodness I had printed the bill, otherwise things would have been even more difficult) and quoted the account number, my existence was confirmed.

So then: the usual tests on the router, for which I had to wear a head torch (no overhead light) and take time out to sneeze repeatedly (the dust) combined with picking my way through the ‘belongings’. And then find the phone (sneeze), to discover there was no dial tone. Although Mr A had recently managed to replace the batteries, I could not trust just the one handset, so had to unearth another (sneeze), but still no dial tone. So it’s the phone line that’s faulty, and I was given a timescale of two to four days for repair.

What can you do with no Internet? I could use my data plan via mobile phone, but the screen is so small and I can’t bear to type on it, plus the blogging account is different from my email account so there’s lots of logging in and out and trying to remember passwords. “I know,” I thought, “the pub next door advertises free wifi! I can go there!”

Of course it is Friday night, one of the busiest times for the best pub in Leamington, but I managed to find a spot to set up the laptop – unfortunately not near an electrical socket, so I had just an hour or two while the battery lasted. It would be rude to take advantage of the free wifi without buying a drink, so I treated myself to a pint rather than my usual half pint, on the basis that it would have to last a couple of hours. And then the computer wouldn’t connect to the Internet. Rebooting, ‘repairing’ the connection, ‘resetting the IP adapter’ – nothing. The battery was pretty much exhausted by the time I had finished trying, so I had no choice but to finish my pint and go home, still Internet-free.

So I resorted to sitting on the sofa and watching a film instead, which was fine but didn’t get the calendar done. On Saturday, it meant I had lots of time to clean the house, and I’d rented another carpet cleaning machine, this time checking that the plug was as it should be. Mr A collected the cleaned and shortened curtains, so they had to be adjusted and re-hung, and the carpet cleaning machine taken back to the rental shop, and then I couldn’t stand it any longer and went to the library for two hours to use their wifi for the bare minimum of tasks - uploading the last blog post, Facebook, downloading podcasts, and some cash needed transferring between accounts.

No Internet service on Sunday either, but not too bad because I was off to a lunch in the occasional series hosted by H&B oop north. Travelling by motorway on Sunday morning wasn’t bad at all, and I arrived early in order to impart some of my diabetes dietary wisdom. Unfortunately for the other guests, this meant that their attention was repeatedly drawn to the carbohydrate content of various snacks. It was a pleasure to mingle with such a pleasant group of people, though.

On my return – still no Internet. Things were getting desperate – I’d cleaned a lot of things in the house already, and eventually I was forced into writing Christmas cards. I don’t think I’ve initiated the Christmas card writing session in living memory; it’s one of the things that Mr A does. It made me think how useful it would be if the Internet were to disappear at the time of the Tax Return. Then we watched another film. Still no family calendar.

Monday – no Internet. To be honest, I wasn’t expecting any progress over the weekend, and the four days I’d been quoted wouldn’t end until Tuesday evening. There was badminton anyway, so I had no problem occupying myself. And by Tuesday, when I was bracing myself for a difficult conversation with the ISP call centre about why it hadn’t been fixed, it was fixed.

But there is no time for family calendars on weekdays; there’s barely time for blogging, and catching up with the four days missing from my online life. It will have to wait until next weekend.

Saturday, 6 December 2014

Two Lolas and a weekend

Lola II, waving
September 2014
Hello, Lola II here.

Every so often, Lola I comes over to help me do some of the jobbies that accumulate around the house. Last weekend I visited Lola Towers to return the favour.

Saturday


I’m having a lovely time at Lola Towers and I’ve only been here for 24 hours, there’s still another 15 to go!

I’ve been struggling a little to maintain the weight loss I achieved and so I gave Lola advance notice that I would need her help over the weekend. In return I received this proposed menu:
Friday night
Frittata + salad

Saturday
Breakfast = cereal or toast or poached egg
Lunch = game soup with matzah balls
Supper = stir fry (fish or chicken or turkey)

Sunday
Breakfast = egg + smoked salmon, or tomatoes if you'd rather, or cereal

How does that sound?
Lx
I responded that I was very happy with her suggestions and that I’d recommend her to my friends. I did note, however, that the absence of cake seemed odd. Visiting Lola, after all, is like a holiday and what kind of a holiday is it if you don’t have cake?

The courgette and bean frittata and salad were delicious, only slightly marred by the rancid salad dressing served with it (unfortunately just a touch older than Mother Nature intended when she invented oil...) This morning’s breakfast ended up being leftover frittata and salad and fresh dressing. Lunch? Add matzah balls to anything and I’ll wolf food down. Supper? Supper was absolutely was delicious and nice and filling, which is a crucial requirement to stop seconds and fridge picking later. The only addition was that we each bought a cake and shared them for dessert. Phew, it is a holiday after all.

Four out of five meals later, I must say it has felt very much like a detox retreat. Very healthy food, healthy portions, lots of filling vegetables and all cooked for me by Lovely Lola. It’s been lovely and I’m ready now for the treat of a delicious roast chicken lunch I’m expecting tomorrow, cooked by Mr M’s mummy at her place.

The primary goal for Saturday morning was to make a List. Not just any list, a Lola List. Lola’s lists are always clearly written, quite extensive and with items put in order of priority or timing. I think meals are added so that we can cross them off; I imagine she’s not really fearful of forgetting. My role when it comes to lists is to write things on them when Lola’s not looking - this time she got a star and a ‘very good’.

I’d say we got 90% of the planned jobbies done and even had time for a little sit down after lunch and a sing-song to help Lola practise for her Christmas Carol concert. Lola is singing alto so I had to sing soprano. Considering at one time I was thinking of singing tenor in a choir, singing at heights to shatter wine glasses had the unexpected result of me getting tooth ache! What’s that all about?? All I can think is that a nerve near my vocal chords area was affected by my unnatural exertions and transmitted its moaning message into my teeth, probably hoping for sympathy. Luckily all’s fine now and my career as an opera singer can continue on the same lines as it was before this traumatic experience.

The evening programme has so far been dictated by me. There’s a very good Doctor Who episode called Blink that I felt Lola I needed to see. I take my responsibility of ensuring she is kept up to date with popular culture very seriously. I mean if I don’t, who will? Who else will happily give an extensive blow-by-blow account of the latest doings and, to be frank, who else will Lola have the patience to listen to...  She might find herself in a pub quiz with success hinged upon getting one question right - “which Doctor Who character moves when you’re not looking at it?” My teachings could make the difference between team disaster and Lola being carried around on shoulders. She anticipated being scared by the episode and she was a bit. I think I helped by calling out that the people currently threatened with danger were going to be okay, although I was careful to clarify my point by adding that, well, they’re not going to be okay but they’ll be alright. Of course this didn’t really help Lola, other than distracting her for a moment from the TV tension.

We’re now sitting feet to feet on the sofa under a duvet, which always reminds me of the Grandpas and Grandmas in Charlie and the Chocolate Factory. Tomorrow’s excitement is Carpet Cleaning. We have the machine, we have the cleaning fluid, who knows what excitement is lurking!

Sunday


Breakfast of a mushroom omelette for me, smoked salmon omelette for Lola, and then we were down to Operation Carpet Clean. Shifting furniture was the priority to allow for hoovering. Meanwhile I was desperately trying to finish a scarf I’ve been knitting for Lola for probably well over a year. I had knitted myself one that stretched and ended up long and narrow and so, very cleverly, I made this one wide and short. Not so clever, it seems, since upon completion it clearly wasn’t going to stretch. We had a jolly good giggle when I showed her the finished product. The good news is that my attractive pattern looked very nice. The less good news is that I had added stitches onto rows that resulted in an interesting variety of widths throughout. I enthusiastically announced that no-one else would have a scarf like it, and Lola confidently agreed.

Plug with 2 very bent prongs
Back to Operation Carpet Clean: the machine was ready, the cleaning fluid poured in, the ‘before’ photos taken, the tension was mounting, all that was needed was for the wondrous machine to be plugged in and... the plug was broken! Disaster. All of Lola’s hopes and dreams, shattered by someone who had previously either driven over it or discovered, after bending two of the prongs with their bare hands, that they were better suited to be a strong man in a circus and kindly returned the machine to the shop before doing so. She told me afterwards that there was a lot of apologising and a refund, followed by a hastily scribbled note insisting that Lola should be given a discount when she does finally hire one that works. Other than Operation Carpet Clean having to be postponed, it’s been a really lovely weekend with the two Lolas together, as it always is.

And the roast dinner? As delicious as expected.

Lola I wearing a scarf and a smile

Sunday, 30 November 2014

Race report and news of Lola Towers

Rose bud with yellow rose behind
Groombridge Place, June 2013
The trip last weekend was to the darkest depths of Surrey, to assist at a 10k forest race organised by our friends. The race consisted of running 5k on road and forest tracks, then round an obstacle course including a river jump, then 5k back to the start. For a fleeting moment when it was first announced I considered actually working towards running the course, but I came to my senses and dropped that idea pretty quickly. I haven't been running recently - it's dark, it's cold, and I've got a lot of other stuff on my plate at the moment (as mentioned in one of my previous blog posts).

We headed south on Saturday and arrived in time to glimpse some of the immense amount of organisation that has been put into this little enterprise. Permission had to be gained from all sorts of different agencies including Highways, Forestry Commission, St Johns Ambulance and probably others, plus the advertising, timekeeping equipment, signage, clothing, T shirts, medals and prizes, catering and much, much more. Lists were very much in evidence - lists of runners, marshalls, equipment, tasks, schedules, phone numbers. There was a slight relaxation of organisational duties for a period on Saturday night, but the day of the race started at 6am with signage being put up.

Unfortunately it turned out to be one of the wettest days of the year, and didn't stop raining heavily for the whole of the race. The part of the obstacle course when runners had to jump across the river was usually just a bit more than a step over a bit of a stream, but the water level rose by at least a foot during the morning and runners were having to wade across a torrent up to their knees. When they returned to the start it truly looked as though they had been swimming rather than running, and some of the marshalls were in a similar condition.

Mr A and I had volunteered to be marshalls, and Mr A was put in charge of car parking while I was dealing with catering at race HQ. Mr A was clad head to toe in weatherproof motorcycle gear but I was thankfully indoors, serving up bacon butties, tea and cake. It all went very well, the St John's team weren't needed, and the home-made lemon drizzle cake went down particularly well - home-made by the organisers, not by me. They put such a lot of work into the event, but the turnout was good and despite the saturating conditions the runners seemed to enjoy it. There's going to be another one next year too; maybe I'll volunteer again.

Then on Tuesday, back at Lola Towers, the long-awaited fuse box replacement started. The electrician turned up exactly when he said he would, which is always a good sign, especially as I'd taken the day off work. He thought the job would take a day and a half, but knowing how unpredictable Lola Towers can be I wasn't surprised when the timescale started to slip. The installation of the new box took the first half day as anticipated, but one of the new switches kept tripping, suggesting a fault somewhere on one of the circuits. Electrician Bill spent the rest of the day a) narrowing down the possible location of the fault while b) ensuring that the heating would be operational at the end of the day, which it was.

On Wednesday he returned, and managed to improve things to the extent that the switch stopped tripping, but was still not happy with the test results, plus he had to do the bit of the job that entails connecting the gas and water supplies to the electrical earth. I had to go back to work so I didn't see how he got on, but at the end of the day we had a chat on the phone and he admitted he'd have to be back on Thursday. This has been an expensive week - the electrical job is going to cost a bit more than what was quoted, plus the car had its service on Tuesday and needed a new battery and two new tyres.

On the plus side, I got a lot done on my day off work. After twenty years I'm having the living room curtains cleaned for probably the first (or possibly the second) time, and then after twelve years of being temporarily tacked up I'm getting them shortened properly. I'm not even doing it myself - they were cleaned at a launderette and taken to a shop for shortening. That's the kind of mood I'm in.

I also went to another 'Diabetes Education Club' lecture at Warwick University - this is a bi-monthly evening event for Diabetes Healthcare Professionals. Last time it was my colleagues talking and demonstrating low carb items, this time it was all about Sodium-Glucose Transporter (SGLT2) inhibition as a treatment for high blood glucose. Want to know more? All will be revealed shortly.

Thursday, 27 November 2014

What I've been reading

Image of the book cover

Cat's Eye
by Margaret Atwood

narrated by Laurel Lefkow
"Elaine Risley, a painter, returns to Toronto to find herself overwhelmed by her past. Memories of childhood - unbearable betrayals and cruelties - surface relentlessly, forcing her to confront the spectre of Cordelia, once her best friend and tormentor, who has haunted her for 40 years."
After the experience of reading The Blind Assassin where I wanted to read it again as soon as I'd finished, this was a huge let-down. It's an account of a child growing up in Toronto, and there is no discernible story arc whatsoever. She goes to school, goes to college, has friends, marries, is a painter. Nothing to pique the interest, or hold any dramatic tension. Don't bother. And the audio editing is rubbish too.


Image of the book cover

The Island of Dr Moreau
by H. G. Wells

narrated by B. J. Harrison
"Adrift in a dinghy, Edward Prendick, the sole survivor of a shipwreck, is rescued by a passing boat which leaves him on the island home of the sinister Dr. Moreau - a brilliant scientist whose notorious experiments in vivisection have caused him to abandon the civilised world."
It's an oddly prophetic Victorian story that develops the theme of melding human and animal in a way that some consider similarly ethically dubious in our society - genetic modification. There's not much substance to the story, and in places it is pretty horrible in its description of animal cruelty and mutilation. The main character is pretty bland and the others seem exaggerated, but it's interesting for its insight into the imaginative thinking of the time.


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Mystery Mile
by Margery Allingham

narrated by Francis Matthews
"Judge Crowdy Lobbett has found evidence pointing to the identity of the criminal mastermind behind the deadly Simister gang. After four attempts on his life, he ends up seeking the help of the enigmatic and unorthodox amateur sleuth, Albert Campion."
Quite a good story and very competently narrated. Not really up to the standard of Lord Peter Wimsey or Hercule Poirot, but good enough to keep me interested. I wish I knew of a contemporary crime writer who could write something in the proper 'whodunnit' spirit but without the violence and gore that seems to be compulsory for anything set later than 1950.


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The Sum of All Kisses
by Julia Quinn
"Hugh Prentice has never had patience for dramatic females, and if Lady Sarah Pleinsworth has ever been acquainted with the words shy or retiring, she's long since tossed them out the window. But Sarah has never forgiven Hugh for the duel he fought that nearly destroyed her family."
A silly Regency romance because I couldn't face anything too heavy. All the others in this blog post are audio, which I listen to in the car. Actually concentrating on the written word at home seems too much like hard work at the moment.


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Cat Out Of Hell
by Lynne Truss

narrated by Mike Grady
"A cottage on the coast on a windy evening. Under a pool of yellow light, two figures face each other across a kitchen table. A man and a cat. The man clears his throat, and leans forward, expectant. 'Shall we begin?' says the cat..."
I've read the author's non-fiction classic 'Eats Shoots and Leaves' and enjoyed it very much, and this novel was in a '3 for 2' offer so I thought I'd give it a go. It's fine, and I enjoyed it. Not a timeless classic, but so very few books are!