Tuesday, 15 January 2019

Square eyes

Jewish memorial
Jewish memorial, Dachau, December 2018
Many, many movies have been watched. On the weekend before Christmas Lola II and Mr M have a screening of a Christmas-themed movie, and this year it was Love Actually and I went all that way to see it. Then mostly on my wonderful huge TV screen at home: Leave No Trace, Bros: When the Screaming Stops, Swimming With Men, Phantom Thread, Bohemian Rhapsody (at the cinema), A Quiet Place, Hell or High Water and 20 Feet from Stardom. And some David Attenborough nature documentaries, both current and from long ago.

I've also worked out how to stream video from my mobile phone to the TV, so I watched the first episode of the American series Breaking Bad which Landrover Man loaded onto my phone, but when I tried to watch the second episode I couldn't take the unpleasantness of the content so I'm back looking for a quality episodic drama. All this screen time means I haven't done very much reading lately.

Something that has kept me hooked up to the computer is that I decided it was time to change all my passwords. While a specific app that encrypts and saves passwords would be the ideal solution, it's unlikely that I'd be able to use it at work, so I decided to do the job manually and it turns out that a) I have an awful lot of passwords, and b) it takes quite a lot of time to change them all. And it turns out that, annoyingly, some sites require you to have certain characters in your password, and some specifically forbid those characters. One site wouldn't even let me have a sequence of two numbers or two letters the same (e.g. 'gg' or '22'). I think I've very nearly finished them all, but this is a job that has to be 100% finished or I won't remember which ones I've changed and which I haven't.

Christmas and New Year came and went. I worked most of the time but also went to London because my cousin from Seattle was visiting with her son and other friends. I've been moving furniture around upstairs, but also in the Auditorium because of the carpet fitting. The carpet estimator came and was very helpful, so I have that to look forward to.

Actually there's quite a lot to look forward to - January and February are chock full of assignments, meetings, trips, visits as well as the usual badminton club nights and matches. The Buddhist group is running a four-week introductory course, and while they do that in the usual venue it was proposed that the regular members might meet somewhere else - so I offered my house. We've done this twice, and it has been rather lovely. I have also volunteered to join the committee that runs the group. I want to generate more social activity within this group, and hopefully promote its growth.

And a man came to service the boiler. The only reason I mention this is that he offered to check and bleed the radiators, and we discovered that the bedroom radiator essentially contained air rather than water, which neatly explains why it has been so cold in there. Very timely for the arrival of visitors this weekend, but reminds me how very obvious the solution to some problems are.

Tuesday, 8 January 2019

Lola II to the rescue

Excess goods in the kitchen awaiting disposal
Stuff, December 2018
I only took one day off work apart from Christmas Day, Boxing Day and New Year's Day, and spent three out of those four days away from home so I'm still very behind on reporting my pre-Christmas activity, and it's 2019 already! Happy New Year!

Lola II paid me a mercy visit for a day in December because I had (and still have) so many niggling jobs to be done and was finding it almost impossible to concentrate on making a start on them. She was very effective - not by doing anything much more than making it more interesting for me to do all these jobs, although she did come up with a few really useful suggestions.

We started by sorting out some of the stuff in boxes that have been in my hall for about a year, waiting for me to decide whether to take them to a car boot, or auction them on eBay, or give them away through Freegle, or sell them with shpock, Facebook marketplace or NextDoor. So many choices, so much procrastination. What I actually did with Lola II's support was take them to the municipal tip, where there is an Age UK shop. They took the good stuff and I sent the rest into landfill or recycling. There is still more to do on this front, but at least some of it has disappeared from my hallway.

Then we went off to the carpet shop to confirm my preferences for the Auditorium and find out why there were no online options to book a visit for estimation purposes. The man in the huge showroom was difficult to pin down - all his colleagues were away and he was responsible for the whole warehouse on his own - and he winced when I told him my postcode. With some difficulty he found someone to come out just after Christmas, in the evening, and I handed over a deposit. Result.

Lola I gazing at carpet salesman in showroom
Carpet salesman confused at why we would want to take a photo of him
Subsequently I received a call saying that there had been a mistake and unfortunately the estimate couldn't be done that day, but they would re-arrange a visit. Which they did, scheduling it for 9.30 a.m. on New Year's Day. So I had to rearrange it again.

Coming back to Leamington from the carpet showroom I left the car with the car wash people because of an unfortunate incident with some dog poo outside my garage. Lola II and I had lunch in a new steakhouse in town, returning to the car wash via the cake shop. The beef industry has coined the term 'surf and turf' in order to pair steak with seafood; the Lola department has found a better combination in 'steak and cake'.

In a nicely cleaned car I drove Lola II to an art supplies shop so she could buy something for this year's Christmas card manufacturing effort - despite this being a day all about me, I felt it was only fair to give her just a moment for herself. Then it was back home and more of my odd jobs until it was time to stop working and have some fun. We watched a film in the Auditorium, wrapped in a duvet because without any flooring or carpet the room is seriously draughty, and ate chestnuts.

Two rather large pieces of cake


Wednesday, 2 January 2019

What I've been reading

Image of the book cover

This is Going to Hurt
by Adam Kay
"Welcome to 97-hour weeks. Welcome to life and death decisions. Welcome to a constant tsunami of bodily fluids. Welcome to earning less than the hospital parking meter. Wave goodbye to your friends and relationships. Welcome to the life of a junior doctor."
I haven't done this for a long time - bought a book I haven't read in order to give it to someone as a present, and then read the whole thing very carefully trying to make it look like it hasn't been read. It's not a difficult book to read but the black humour of the subject matter is not far off what I would expect, even though my experience comes from very limited access to non-emergency inpatient care and a few years in diabetes. Why anyone intelligent and ambitious would train to be a doctor nowadays is a mystery to me - yes, after thirty years of unimaginable stress you could probably command a good income in private practice, but... thirty years??


Image of the book cover

The Circular Staircase
by Mary Roberts Rinehart

narrated by B. J. Harrison
"Wealthy spinster Rachel Innes is persuaded by her niece and nephew Gertrude and Halsey to take a house in the country for the summer. Rachel is unaware that the house holds a secret, and soon unexplained happenings and murder follow."
This was pretty good, published in 1908, and is a murder mystery novel when these were not a recognised genre. There were perhaps too many twists and interconnected plotlines for me, but I enjoyed listening.


Image of the book cover

The Angry Chef
by Anthony Warner
"Assembling a crack team of psychiatrists, behavioural economists, food scientists and dietitians, the Angry Chef unravels the mystery of why sensible, intelligent people are so easily taken in by the latest food fads, making brief detours for an expletive-laden rant."
The book by the chef whom I met in Birmingham in November when he did a talk to the Skeptics in the Pub. He was a good talker, and it's a good book too, which is a relief. And nothing in there that I disagreed with professionally either. I look forward to his next book coming out in January, which I believe will be about fat and fatness.


Image of the book cover

The Stars My Destination
by Alfred Bester

narrated by Gerard Doyle
"Imagine a future in which people "jaunte" a thousand miles with a single thought, where the rich barricade themselves in labyrinths and protect themselves with radioactive hit men - and where an inarticulate outcast is the most valuable and dangerous man alive."
I think this is a good book which I spoiled by listening with long gaps between short bursts. So I didn't entirely follow the plot. I should really listen again, but there are so many other books awaiting my attention!

Thursday, 27 December 2018

Munich and Dachau

Sides of salmon being smoked
Munich, December 2018
I worked on Christmas Eve, and then went north to spend Christmas Day and Boxing Day with friends, and back to work today. I'm a bit behind in relating what's been going on in the lead up to Christmas, but a week or two ago I went to Munich and visited the Christmas Market there with the same friends who went to Dusseldorf with me a year ago. Another friend who lives there was singing in a Christmas concert in a church, so we went to that too. The weather wasn't great - rainy and cold - but we enjoyed the food and drink, including the classic Bavarian specialities of sausage and cabbage. We also tasted Flammlachs, which was salmon hot smoked before our eyes, and which flavoured our clothing with fishy smoke for the rest of the trip.

Train tracks leading towards the entrance to the concentration camp
Gatehouse, Dachau, December 2018
I had a day on my own in which I went to Dachau, the site of the concentration camp. The trains were in a mess after a strike that morning so I didn't get there very early, and the site closed before I'd seen everything. It felt similar to my previous trip to Auschwitz - sanitised, sterile, recounting atrocities but without giving me any emotional connection. But I was feeling chilly wrapped up in my fleece, coat, scarf and hat in a heated building - I can't really imagine what it must have been like in thin clothes in the open air at this time of year.

Wrought iron gate: ARBEIT MACHT FREI

At work the main activity of note has been the delivery of another of our Carbs 4 1 courses to a group of people who were probably the most unruly of any I've ever had to manage. We coped somehow, but they didn't make it easy for us. To restore my faith, however, one of my patients last week unexpectedly gave me a bottle of wine for Christmas, which was lovely. So let's end on that note rather than the sombre thought of historical atrocities or the clusterfuck of our modern day political situation. Happy Christmas!

Dachau memorial representing bodies on barbed wire

Thursday, 20 December 2018

Parcelforce

Parcels whizzing past on a conveyor high above inward and outward parcel sorting
Parcelforce national sorting lines, December 2018
You may remember that a year or more ago I was selling dad's collection of post office-related ephemera. There's still a single box of it left, looking dolefully at me in my office whenever I allow it to enter my conscious field of vision. Most of the time, thankfully, it remains invisible.

Anyway, I received a significant amount of help in the valuation and auctioning from Jeremy, the Secretary of the Postal Mechanisation Study Circle - a group that really does what its title suggests. I had no idea how much interest there is in postal mechanisation until coming into contact with these chaps, although without parcels I can foresee the demise of the group as I can't imagine anyone from the email generation having the slightest interest in the idea of paper being sent physically from one place to another just for the purpose of communicating.

Mum receives the PMSC newsletter (ironically by email) and forwarded me an issue that mentioned a proposed visit to the Parcelforce site in Coventry, which is on my route to and from work. Knowing that the visit would only go ahead if enough interest was shown, I threw my hat in the ring to support the group and try to ensure that it would take place. And because I like going to interesting places, and this certainly looked interesting.

International sorting lines
There were only four of us in the end, so it was a good thing I volunteered. Our hosts had worked as engineers within Parcelforce for decades and were so enthusiastic that they had been the ones to reach out and contact the PMSC, not the other way round. We were given a brief Powerpoint presentation with the history of and introduction to the service and the site - the largest in the country, handling both national and international mail. Although Coventry airport is on the other side of the fence around the site it is no longer used for international parcel distribution, which is taken by road to and from other airports around the country.

We were all kitted out in steel toecapped boots and reflective jackets before going out to the buildings housing the sorting machinery. While the building and the conveyors for the national parcel mail were huge and impressive, the international depot was much more interesting. Both sites use really fast raised conveyors passing through an arch which reads the routing barcode on five out of the six sides of the box, and tips the parcel automatically down the correct chute for its destination.

The other PMSC visitors asked esoteric questions about the machinery and the software and the routing barcodes and labels, while I asked what happens when the machines break down, and what sort of contraband they discover. One of the people showing us round told the story of how much of the machine was destroyed when a parcel was misplaced, and how quickly it had to be repaired and replaced to avoid holding up the mail. He also had a picture on his phone of all the guns which had been discovered in international mail in one week - they filled a large table.

So an interesting trip to a place that I wouldn't have imagined visiting ordinarily, all thanks to dad's interest in Postal Mechanisation. Now I have to deal with that last box...


Friday, 14 December 2018

Not yet Christmas

Red poppies in the sunshine
Adhisthana, June 2018
Lots going on as usual. Here's a rundown of recent activity, not including trips to Parcelforce in Coventry and Christmas markets in Munich. Those will have to wait for another time.

LTRP

The new television is up and working! I had to phone a friend to help me lift it onto the table, and after I'd connected it all up it didn't seem to want to find the Internet or the sound bar. So, ostrich-like, I left it alone to see if it cured itself. I did have a look at the manual and fixed the sound bar by changing where the cables plug in, and miraculously it found the Internet without any further intervention, so all is well at the moment. Let's hope it stays that way.

So with that little project completed I have visited a carpet supplier of national repute and a local shop to have a little look at my auditorium carpet options. I just want a plain dark grey carpet, which I thought would limit the choices a bit, but even so there were seventeen different carpet options in the big shop which seem to be suitable, and no obvious way to choose between them. There is a free sample service so I asked for four samples to be sent, and we'll see how I get on. The local shop suggested just one option, which seems just as unsatisfactory.

Work

I went to an evening meeting about Pancreatic Exocrine Insufficiency, which wasn't very useful but there was a nice dinner and I sat next to a very chatty doctor. Diabetes is a disorder of the pancreatic endocrine system (insulin is an endocrine hormone), but the pancreas also produces enzymes as part of its exocrine activity. These are primarily lipase, amylase and protease to digest fat, starch and protein, and it seems that this function often fails in people with diabetes. Essentially the treatment of PEI is Pancreatic Enzyme Replacement Therapy, i.e. swallowing large capsules of enzymes along with meals and snacks so that they replace the enzymes that the pancreas is no longer producing. The main lecture was about symptoms and diagnosis rather than management, so I now know how prevalent it is in people with diabetes, but no more about what to do about it.

My Team Leader was also there, and she brought me up to speed on what is going on with the DESMOND Type 2 education programme in our region. I mentioned previously that the Clinical Commissioning Group is getting very 'hands-on' with DESMOND, and it seems that courses have a very poor attendance rate and keep getting cancelled in the main area covered by the NHS Trust I work for. Apparently the Trust's Clinical Director for Diabetes (who is also Clinical Director for another couple of specialities) had a very uncomfortable meeting with people from the CCG. I don't have a great deal of time for our Clinical Director because he seems to show no interest whatsoever in directing clinicians, clinics or anything else that is clinical, so this was a very interesting move on the part of the CCG. I don't know whether anything will come of it, but it's testament to my new Team Leader's dogged persistence that this meeting even came about.

Talking of the CCG and education: I had to attend one of the CCG's regular meetings about education for people with diabetes in order to present the results of my evaluation of our short Carbs and Insulin course, which we're calling CANDI (see what we did there?) This was one of the last times I had an idea at work before I became determined to have no more ideas, and it has resulted in a lot of work for me but not much progress. The results show that the people who attended got a lot out of it subjectively, but objective measures don't show much improvement. I then compared the objective measures of CANDI with those from a similar population who attended the longer 4-day carb counting course, and those were no better. What happens next is anyone's guess, but now that we have our tenacious Team Leader I suppose she will have to decide, so I've put it on the agenda for our next team meeting. Which is the day after Boxing Day when I will have even less than my usual motivation to talk about matters at work.

Badminton

Matches and club nights continue twice a week, My duties as Social Secretary led me to try and arrange a 'Not Christmas Social' in November so that we wouldn't get caught up in all the pre-Christmas shenanigans. I offered various dates so we could include the maximum number of people, and Friday 30th November was chosen. Unfortunately in the chosen venue, this night was already designated as a pre-Christmas shenanigan, so the event became the 'Not Not Christmas Social' and fourteen people came along and enjoyed themselves at a local pub. I had the best vegetarian option I think I've ever had in a pub (a pie with mash and veg).

and the rest

I can't remember exactly how it came about, but Lola II was interviewed for a project focussing on views and opinions and thoughts on childlessness from people who have consciously chosen not to have children. She passed the contact on to me, and this week I was also interviewed. It was very interesting and I'm still mulling over some of the things we discussed.

I went to see mum and dad and this time mum had a great job for me to do. Often the jobs I am called upon to perform involve either the computer or a ladder (there were jobs of those varieties on this visit too), but this time it was all about the sewing machine. As well as using the zigzag option to sew hems in shortened sleeves, we took down the kitchen blinds and shortened them by about a foot, cutting off the dirtiest part and revealing fresh fabric. It all went very well and they look great and it felt like we had really achieved something.

There have obviously been other activities at home and at work, but having ended the weight management effort my weight has obviously gone up by a kilogram. I knew it would because I haven't been feeling hungry lately and there have been celebratory meals and food provided during work events (which always leads me to overeat). Now what shall I do?

Thursday, 6 December 2018

Retreat

Salmon pink rose
Adhisthana, June 2018
I've been on another Buddhist weekend retreat at the same venue as before: Adhisthana in Herefordshire. There were more of us in the group this time, mainly because the weekend was promoted more widely. It started on Friday evening with supper followed by a gathering and ceremony, on Saturday morning after meditation and breakfast the group got together and then split into two for discussions, lunch, a walk, more meditation, dinner and another ceremony. On Sunday after meditation and breakfast we finished our discussion, had lunch, cleaned up and departed.

This time I ducked out of the ceremonies. The routine is that some passages are recited in Pali and in English, people are invited to make an offering at the shrine (a candle, incense, a flower) and matras are chanted. It doesn't suit me at all - I don't like the recitation or the mantras and I'm not going to make an offering. Last time I thought I'd just observe, but I sat there feeling a bit resentful, so this time I just avoided those bits of the programme.

It is an interesting time within the Triratna Buddhist movement. The movement used to be called the Western Buddhist Order, and was founded just over 50 years ago by an English man who was inspired by Eastern culture, religion and traditions, spent some considerable time learning about Buddhism, mostly in India, then brought his ideas back to the UK. He intended the WBO to provide a westernised version of the Eastern traditions and philosophies of Buddhism, so for example the Order does not discriminate between sexes and did away with the monastic tradition and the hierarchy of seniority. You could decide to become a Friend of the Western Buddhist Order, or if you felt enough commitment you could be ordained and be given a Sanskrit name, but you still live and operate in the world as you did before, albeit according to the ethical principles suggested by the Order.

The founder and leader of the movement was given the name Sangharakshita when he spent some time as a monk in India. He lived at Adhisthana ever since it was acquired as Triratna's headquarters a few years ago, and was buried there just over a month ago when he died at the age of 93. He wrote and published prolifically: poetry as well as learned and philosophical works on the subject of Buddhism, and many of his lectures and talks are recorded and available online. He was clearly a charismatic, visionary and pragmatic leader, and in only 50 years built a sustainable movement that seems robust enough to survive even now that he is gone. Quite an achievement, although some serious mistakes were made in the early days that are still causing a good deal of trouble today.

So visiting the Headquarters of the Order so soon after the death and burial of its founder and leader was interesting. While the end of his life was not unexpected, and leadership arrangements have been in place for some time, it still feels like a turning point - a 'weighty event' as one person put it. One of the leaders of our retreat was part of Sangharakshita's household for many years, and was happy to share his stories of coming into contact with and joining the movement in the early 1980s and his continuing participation up to the present day.

So where do I stand on Buddhism from a personal viewpoint? I went to the introductory course about 2½ years ago, and have carried on attending on Tuesday nights since then (whenever badminton hasn't interfered). We start with meditation, then a tea break, then a discussion on some aspect of Buddhism, which may be utterly esoteric or entirely practical. I sometimes meditate at home and usually enjoy it, and the meetings have prompted me to make some other practical changes to how I live and relate to other people. The group is planning to run another introductory course in January, and I have volunteered to host meetings at my house for those who don't want to attend the course.

There were a couple of reasons why I starting thinking about Buddhism 2½ years ago. With Mr A out of the picture I was determined to expand my social contacts, but going to the pub after badminton really didn't suit me, and the badminton social events that I organise are not very stimulating intellectually. I joined the music group and the Meetup walking group as well as Triratna, but the Meetup walks are no longer taking place and while I love playing in the music group the social contact hasn't extended beyond one afternoon a month. I was considering trying either the Buddhists or the Quakers, but went to the Buddhists because I have a longstanding friend who became a Triratna Order Member about 20 years ago, and I always puzzled over why he did it and what he gets out of it. He recommended the local group as one of a number of options.

To be honest, the social contact with the Buddhists has also been pretty limited: two hours weekly, of which most of one hour is silent meditation. But the discussions in the other hour have been worthwhile, and I feel much more comfortable with the whole ethos and philosophy of Buddhism than I did with Judaism, given that I don't believe there is a God. There are a few of us now who would like to work a bit harder at growing the group and doing a bit more than just holding the weekly meeting. I am finding the retreats to be an opportunity to relax and take some time out alongside like-minded people, and shed some of the cynicism and dissatisfaction with the terrible state of world politics at the moment. The effect wears off pretty quickly as soon as I get back into work, though.

Friday, 30 November 2018

Study day - Diabetes technologies

Purple allium flowers
Adhisthana, June 2018
The study day I recently attended was a good one, including many interesting and relevant presentations. It was organised by the Association of UK Dietitians (BDA) Diabetes Specialist Group, and focussed on diabetes technologies as well as some of the usual business when Diabetes Specialist Dietitians get together - whingeing about nurses and other colleagues, comparing notes on difficult patients, who has been asked the most ridiculous 'what can I eat' question, whining that the lunch provided is a bit carb-heavy while demolishing all the crisps and three puddings etc etc. A bonus for me was that two previous colleagues were also there and it was lovely to catch up with them, and there was also a Dietitian from a nearby Trust whose previous Team Leader is my new Team Leader. So we had a good exchange of views on that situation, too.

After the AGM, the presentations started with someone from Diabetes UK updating us on what they've been up to in the way of nutritional news. This included information and new videos about 'Diabulimia', which is a term often used (but just as often criticised) describing the practice of someone with Type 1 Diabetes withholding insulin in order to lose weight.

Then a doctor ran through all the current technologies available at the moment, including insulin pumps, CGM systems, Flash GM systems, sensor-augmented pumps, closed loop and artificial pancreas systems, and something called Diaport which delivers insulin into the peritoneal cavity. There wasn't really anything new here for me, but it was nice to appreciate that my knowledge is way ahead of many Dietitians who don't come into contact with these technologies in their usual work setting.

Quite a few Diabetes Dietitians are working at national policy level with Diabetes UK and the All Party Parliamentary Group on Diabetes. This year the old evidence-based nutrition guidelines from 2011 were updated with a new document, which has shifted away from nutrients (recommended proportions of protein, fat and carbohydrate in the diet) in favour of real foods. The overarching recommendations haven't changed: the first line treatment of Type 2 Diabetes should be weight loss of 5%, a Mediterranean style of eating, education and exercise. For Type 1 Diabetes it is still about matching insulin to carbohydrate intake to regulate blood glucose levels. The advice about prevention of cardiovascular disease is now aligned with the NICE guideline, and progress has been made on the thorny question of fat - is it in fact irrelevant, or should we still advise restriction? The conclusion is now that the quantity of fat is less important than the type of fat, and whatever level of fat we choose to eat it should be more unsaturated than saturated.

The 'James Lind Alliance Research Priorities' were also new to me - the ten highest priority research topics in various clinical areas, including diabetes. Not that it makes any difference to my workload, but interesting to see what questions are thought to be most important at this time. A couple of the priorities relate to diet, and one is the old chestnut about the role of fat, protein and carbohydrate in the diet for Type 2 Diabetes, and what the evidence tells us we should specifically be advising people to eat. This has been addressed by the finest minds in the UK Dietetic profession, and the answer is that we have no idea. Another question that still remains unanswered is what we would initially advise someone with Type 2 Diabetes who is not overweight.

Those same fine minds have also come up with a policy statement about low carbohydrate diets (defined as between 50g and 130g carbohydrate per day) in the management of Type 2 Diabetes. It was published in the week following the study day, and it's handy to be able to see a summary of the available evidence even if that evidence is scanty. Essentially, we can say that in the time frame of 12 months, adopting a low carbohydrate diet is as good as any other approach to improving blood glucose levels, and it probably works because restricting carb tends to result in a reduction in total energy intake and therefore weight loss. We don't have any evidence beyond 12 months because it seems to be quite a difficult diet to sustain.

The next presentation was all about trying to be more prescriptive about how to manage exercise with Type 1 diabetes. I have written about this before (June 2016), and said at that time that it's one of the most difficult aspects of diabetes. A Dietitian from Birmingham Children's Hospital has worked on this for a while, and come up with a spreadsheet that allows you to enter six parameters: what kind of exercise; what intensity; the duration; how long since your last insulin bolus; whether you want to reduce your insulin or increase your carb intake; and whether you use an insulin pen or a pump. It then comes up with its best guess (based on published evidence) on how to manage blood glucose, food and insulin before, during and after the activity. You can print that recommendation for the patient to try, but it may need adjusting subsequently.

The most interesting presentation was from a Dietitian involved with the DiRECT trial, which has attracted the largest amount of research funding that Diabetes UK has ever awarded. The trial is intended to follow up an earlier 'Proof of Concept' trial that suggested that Type 2 Diabetes could be reversed with rapid weight loss, and this time they want to try and find out how it works, how much weight loss is needed, how long does reversal last, who might benefit the most from this approach and whether it can be achieved in primary care. Weight loss is achieved through Total Diet Replacement for 12 to 20 weeks (the Cambridge Weight Plan meal replacement products) with weekly or fortnightly review, followed by structured food reintroduction with fortnightly review, and there is also support in increasing physical activity. Monthly monitoring and support is provided to stabilise weight and prevent weight regain for two years.


There were relatively few participants (n=157) and the trial is not yet finished, but early results are impressive. Of the cohort who managed to lose 15kg or more, irrespective of their starting weight, 86% achieved remission from their diabetes at 12 months, defined as normalised blood glucose results (there are ongoing discussions about the definition of remission). Results were better for younger participants, lower starting HbA1c results and when the duration of diabetes was shorter. Unfortunately this exactly defines the people I don't see - in secondary care we generally see people who have had Type 2 Diabetes for some time and whose medication regimes are escalating and/or who are starting to get complications.

The last presentation of the day was from the doctor who leads the Diabetes service at the hospital we visited over the summer, talking about interpreting the data that we are starting to see coming from all these technological wonder-gadgets. One key point: we often advise a minimum of 4 blood glucose tests a day, but the evidence suggests this can generally only get people down to an HbA1c of about 69mmol/mol (8.5%). The target is often 53mmol/mol (7%) which would take at least 8 fingerprick tests a day, and for anything lower than this you're looking at micro-management using a CGM and pump or artificial pancreas system.

It was an interesting and informative day, but I continue to remind myself that despite the worth of the ideas being presented, there is in reality a negligible chance of making any changes to the service we offer, given that nothing has changed even after the whole team's visit to London.

Sunday, 25 November 2018

What I've been reading

Image of the book cover

The Iliad
by Homer
"Homer has created a timeless, dramatic tragedy out of a single episode in the Tale of Troy - Achilles' withdrawal from the fighting and his return to kill the Trojan hero Hector. His characters are heroic but their passions and problems are human and universal, and he presents them with compassion, understanding, and humour against the harsh background of war."
All I knew about the siege of Troy was the story of the wooden horse, which isn't even part of the story in the Iliad. My recently acquired knowledge about this Greek heroic epic poem, however, is extensive. Firstly, given that the poem was originally transmitted entirely orally before eventually being written down long after it was first composed, 'Homer' is by no means an identifiable person. More likely, Homer was the name associated with the style of both the Iliad and the Odyssey when they were finally transcribed. Secondly and much more esoterically, the poem is written in iambic hexameter with 95% of feet being dactyls (DUM-diddle) and the remainder spondees (dum-dum).

The book I actually read is a prose translation that makes no attempt to reconstruct the poetic nature of the work, and it's been much more interesting to read than I was expecting. For instance, after describing exactly how each person meets his death in battle (where the spear or arrow or sword hits them and what the damage is), a brief biography is given, usually including where he came from, what his previous employment was, who his parents were and sometimes also details of his wife and children. This certainly slows down the narrative pace of the battle. The gods are portrayed as imperfect beings who operate much like any family in their preferential treatment of their favourites and unfair treatment of mortals they aren't keen on, although their ability to transform into other shapes and pass messages to humans and to skip back and forth between the battlefield and Olympus is decidedly godlike.

The poem actually describes only 51 days in the siege of Troy, a single episode resulting from a spat between the Greek King Agamemnon and his compatriot Achilles. A woman who was given to Achilles following some victory in battle is taken from him by King Agamemnon, and Achilles has an epic tantrum and refuses to fight any more. Eventually his best mate Patroclus borrows Achilles' armour, goes off to fight and gets himself killed, at which point Achilles goes utterly mental, culminating in him killing Hector, the best Trojan warrior and favourite son of Priam, the king of Troy. Achilles not only ties dead Hector's body to his chariot and drags it round the city walls in triumph and revenge against the killing of his best mate, but then drags the body around Patroclus's funeral site every day subsequently (the god Apollo protects Hector's body so it doesn't rot or get damaged). Eventually Achilles gives the body up to Priam in return for a ransom, and the book ends with Hector's funeral. Not entirely what I was expecting, but better than many of the 'classic' books I've been reading.


Image of the book cover

Becoming a Writer
by Dorothea Brande
"A unique and genuinely inspirational guide to creative writing, constantly in demand with writers and students of writing. She believes that there is such a thing as the writer's magic, that everybody has it in differing degrees and that it can be taught."
This is an old book, written in 1934, but also one of my older books, acquired and first read by me in 1988. It isn't about the technique of writing, plotting, character or any aspect of writing, it's about how a person becomes a writer - how to coax the material out of your conscious and unconscious brain, how to make sure your thoughts are successfully transferred to paper, how to avoid your style being contaminated by other authors - how to write, not what to write. I want to follow its instruction and exercises, but it's one more activity that I have to fit into the scanty 24 hours available to me every day. I'm working towards it, and when I start to see the light at the end of the tunnel I will definitely come back to this small book and its inspirational and practical advice.


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The Essex Serpent
by Sarah Perry

narrated by Juanita McMahon
"It is 1893. Cora is a well-to-do London widow who moves to the Essex parish of Aldwinter, and Will is the local vicar. They meet as their village is engulfed by rumours that the mythical Essex Serpent, once said to roam the marshes claiming human lives, has returned."
This is a recently published book which received a good deal of praise and sounded interesting in a Gothic sort of way. It wasn't bad but the narration was odd; sometimes the narrator delivered a sentence that seemed to indicate she wasn't familiar with English idiom. Again, I hoped for too much of the ending. It was fine, but not fully satisfactory in the way I want an ending to be.


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The Rose of Tibet
by Lionel Davidson
"A filmmaker is reported dead near Mount Everest. His brother, Charles Houston, is convinced he's alive and is determined to find him. He travels from India to the Yamdring monastery in the forbidden land of Tibet."
This is a bleak tale but told very well. It came from one of those piles of books that someone shows you to give you the option of taking any that you fancy before they are taken to some charity shop. Someone who knows more about China-Tibet situation in the 1950s would perhaps have a head start on feeling at home with part of the plot at least.


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The Prestige
by Christopher Priest

narrated by Simon Vance
"In 1878, two young stage magicians clash in the dark during the course of a fraudulent séance. From this moment on, their lives become webs of deceit and revelation as they vie to outwit and expose one another."
It's a confusing mixture of Victorian reality and science fiction, and I must have read it before because I somehow knew what was going on, which helped a great deal to untangle the prose in the first section. I've seen the film too, and I actually think the film is slightly better, which is unusual.


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The Three-Body Problem
by Cixin Liu (translated by Ken Liu)
"Beijing police ask nanotech engineer Wang Miao to infiltrate a secretive cabal of scientists after a spate of inexplicable suicides. Wang's investigation will lead him to a mysterious online game and immerse him in a virtual world ruled by the intractable and unpredictable interaction of its three suns."
The first book of an odd science fiction trilogy loaned to me by a friend who has spent some time in China, and who commends this book as conveying a sense of the original language. As someone who has never been to China I don't think I got as much out of it as my friend did, but I will still be going ahead with the next one.

Tuesday, 20 November 2018

Kitchen Goddess and Mega Marshal

Lola I posing at the kitchen hatch
Run Forest Run, November 2018
My last trip to London combined a study day for work, staying with Lola II and Mr M, and a gathering for mum's birthday. I'm writing about the study day separately, and because it's taking ages and I've been rather busy, I'll do a quick round of other news in this post.

Mum's birthday gathering was slightly marred by Lola II losing her handbag, but the story ended happily when it was handed in without loss. The following day I accompanied Lola II and Mr M to a Games Cafe in Richmond where we tried out three new games: Quirkle, Exploding Kittens, and Sushi Go! We liked Quirkle best.

Between then and now I had a busy week with the usual work, a District Council meeting on Monday evening, a car mini-service, chimney sweep visit and meditation on Tuesday, a trip to Birmingham on Wednesday evening, badminton club on Thursday evening and a match on Friday evening (we lost, but it was good fun with friendly opposition, which isn't always the case).

The Council meeting was about the proposed replacement of a decaying car park combined with the relocation of elderly Council offices. Many local businesses are dismayed at the 'parking displacement plan' and feel that shoppers will be put off by a potential reduction in car parking spaces in the town. Residents are also up in arms at the loss of 42 mature trees (although more saplings will be planted in their place) plus the failure of their planning proposal to follow the Council's own guidelines of including 40% affordable housing. By attending the meeting I achieved my aim of understanding what all the fuss is about while being depressed by the poor standard of debate and the attitudes and arrogance of the Council leader and officers.

The trip to Birmingham was much more fun: I went to a meeting of 'Skeptics in the Pub' at which The Angry Chef was speaking. As the name suggests he is a chef, and I have been following and been hugely entertained by his profanity-filled blog for some time. He writes very eloquently and at length about the rubbish that is promoted by celebrities and others aimed at telling people how and what to eat, or 'nutribollocks' as he terms it. I enjoyed the meeting a great deal - he talks a lot of sense backed up by proper levels of evidence, and I bought his book and he signed it for me.

Wooden award inscribed run-forest-run 2018 Mega-Marshal
This weekend was the fifth annual 'Run, Forest, Run' event in Surrey, where this year there were more runners than ever. Lola II and Mr M were marshalling out in the forest along with J from Family JJL&J, and another two J's actually did the 10k plus obstacle course. I was again put in charge of the kitchen, and apart from running out of bacon and teabags it all went very well. I was very proud to be awarded the 'Mega Marshal' trophy for services rendered to mass catering.

Weight loss has stalled, but it has remained 4kg below what it started at (rather than the 5kg I was aiming for), so I'm going to take that as a win. Nothing new with the LTRP except that I briefly went into a carpet shop and now I need to decide who to invite to estimate for the job and whether to choose wool or synthetic fibre (any opinions from readers would be very welcome).

The television saga continues - the price of the TV I am after did drop to a level where I was happy to buy, but by the time I got to the website in a secure WiFi zone there were no more in stock. Stock suddenly appeared a week or so later, but the website claimed that delivery was not possible to my postcode, and when I followed that up with the retailer we agreed that there was actually no stock and it was a website error. However, I guessed that the American phenomenon of Black Friday might influence prices, and so it did. The television appeared on the website at an even lower price on Thursday evening, I placed an order successfully, and all being well it will be delivered today.

Mr M, Lola I, Lola II and RFR organiser photobomb

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