Tuesday, 19 May 2015

Weekend in Rugby

So I went to Rugby for a weekend to mooch about and get to know the town. I had a surprisingly good time - I wasn't expecting to enjoy myself quite as much as I did. I put some of the enjoyment down to the fact that I planned in advance more than usual, checking out places of interest, food emporia and even booked a ticket to the theatre. The weather was cold but mostly sunny, and even when it wasn't sunny it didn't rain much.

Pub interior
The Merchant's Inn
On Friday night I started with some basic orientation and wandered about the town centre for a bit. There were a few places I was looking for, and I ended up eating chilli with a half pint of Doom Bar in The Bank. I wasn't intending to do much more, but on the way back I passed The Merchants Inn, which is renowned for its beer, and it was early so I went in for a cheeky one. They have a vast range of beers, including more than one type of mild! So I had a half of Moorhen Mild, which was very tasty. That's a very fine pub indeed.

I went into a supermarket that a patient had mentioned - it is amazing. It stocks all manner of Eastern European food, mainly from Poland but also from Latvia, Lithuania and Romania, and seemingly no UK brands at all unless they are sourced from these countries (so for example I think I saw a Polish version of a Kitkat). There was half a wall of different sausages in the self-service chilled cabinets down one side, and then another half a wall of more sausages on the other side ready to get sliced for you. There were many, many unfamiliar products and several that I couldn't identify at all.

Best of all, for the first time since our trip to Lincolnshire, I found the frozen curd cheese desserts we first tasted there. Lola II and Mr M have been into every Polish shop and supermarket in London and failed to find any; we have now found our source. What's more, I found the same desserts in a second, similar shop in town, and I reckon if I'd bothered to go into any others they'd have been there too.

Colourful fish-type creature
On Saturday I'd planned to go to the Visitor Centre, Art Gallery and Museum, which are all in the same building along with the town library. The Art Gallery wasn't bad, and along with its pictures it had quite an entertaining selection of papier mâché creatures. The Museum was just one room with stuff in cases as per any local museum, representing local industry. In Rugby this comprises engineering (various light and heavy engineering firms - Frank Whittle designed his first jet engine around here), telecommunications (including GEC), the railways, the cement works, and the game of Rugby including the manufacture of rugby balls.

Silver trophy in case
As might be expected, the game of Rugby features heavily in the tourist attractions of the town, including the Webb Ellis Rugby Football Museum and in the tour of Rugby School. The museum caters for the enthusiast, and I've never been particularly interested in the game, so the couple of rooms of memorabilia held little interest. I watched the film of how a rugby ball is constructed by hand - or perhaps how it used to be constructed by hand, it's probably all done by machine nowadays.

Chapel interior with pews and stained glass window
The guided tour of the school was much more interesting. Rugby School was founded much earlier than I realised (in 1567) in order to provide a free education for local boys in what was then not much more than a hamlet. It moved to its present site in 1750, which at the time was on the edge of the growing town, but is now very central as the town has expanded. The architecture is beautiful, much of its decorative brickwork designed by William Butterfield, but adorned with ivy and wisteria in a very attractive manner. I went on a tour of the main school site, although there are many other buildings belonging to the school scattered about the town. We went into the chapel, an (empty) assembly room with 19th century graffiti on the walls, a couple of courtyards, and one of the older classrooms which was a peculiar mixture of ancient books in bookcases, a blackboard, a jury-rigged data projector, a whiteboard, modern tables and a stained glass window featuring 18th and 19th century headmasters.

Statue of Webb Ellis carrying rugby ball
Obviously there is much emphasis on that cheating footballer William Webb Ellis who is supposed to have picked up the ball and run with it in 1823. In fact, he is probably unrelated to the development of the game, the attribution being made by another pupil long after both had left the school. Anyway, other notable alumni include Thomas Hughes (author of Tom Brown's Schooldays), Rupert Brooke, Neville Chamberlain, Lewis Carroll and Salman Rushdie. I'm thinking of reading Tom Brown's Schooldays again, although the tour guide's opinion is that the first part of the book is pretty uninteresting.

The weather was cold enough that I was now looking for a warming lunch. I'd had a cooked breakfast in a generic cafe, but a late lunch was planned at a well-regarded vegetarian restaurant called Summersault. I had a big bowl of cauliflower and fennel soup with a delicious bread roll that had a seam of real olives inside it.

I'd done a whole lot of walking around by now, so nipped back to the hotel to change before going to the theatre to see 'The Diary of Anne Frank'. I thought I'd have a nap, but realised I'd better set an alarm, which woke me in good time to get ready. The trouble was that I didn't get up straight away, so woke with a start 20 minutes before the performance was due to start. I got there just in time, and the performance was very good, especially of the young actor playing Anne, but I knew the story wasn't going to end well. If I'd delayed my visit by a week or two I could have had a less depressing experience with 'Hairspray'.

Sculpture of horn player in the park
Sunday started with an impressive vegetarian breakfast at Bacco Lounge. What I'd planned for the day was to follow the 'Path of Fame', a walking tour through the town featuring a whole lot of brass plaques set in the pavement to celebrate rugby players over the years. In the Visitor Centre they updated me with the news that all the plaques had been removed, but I could have a booklet with the route in it if I wanted. In fact this was fine, because I wasn't particularly interested in the sportsmen but the booklet had interesting information about the town. It pointed out features of buildings and I saw a few nice sculptures and public art and a couple of little parks.

I tried to do a bit of shopping over the weekend, but my poor shopping skills meant I managed only food and socks. Back at the Eastern European supermarket I treated myself to a stock of curd cheese ice creams as well as a pack of ready-made pierogi, sausage, smoked cheese and pickled herrings. I tried shopping for household goods but made little progress. So it was time to come home.

The weekend was pretty good, and certainly more fun than I had expected. I put it down to planning ahead, while acknowledging also that it was very fortunate that most of the time it didn't rain.

Tuesday, 12 May 2015

Segway polo

Line up of all the players + Coach
Fully accredited members of UKSPA, May 2015
A while ago when I was entering my 50th year and feeling somewhat over-wrought, I decided to make a list of things I'd like to do. A bucket list. I didn't assign any timescales, and I don't feel any particular pressure to achieve them all, particularly if they turn out to be difficult or expensive or unrealistic.

There were only twelve things on the list, and I achieved the first one last year when I first ran 5 kilometres. As I said at the time, and have been saying ever since, that should have been the end of it, but somehow I've carried on running. In a strange way I've started to experience what might be called 'enjoyment' - not generally while I'm running, but for most of the day afterwards. I've even signed up to Run Forest Run in November, which is 10k plus an obstacle course - an account of last year's race is here.

Now I have been able to cross another item off the list. This one feels a lot like an event from my teens and twenties: those of a certain age may remember a TV programme called 'Why Don't You Just Switch Off Your Television Set And Go And Do Something Less Boring Instead' (usually abbreviated to 'Why Don't You'). I used to watch this occasionally, but I remember one episode in particular. It featured a group of kids on unicycles, and I think they were playing basketball or something similar. When I saw that, I instantly wanted to do it. By an astonishing coincidence, the college I attended years later had a unicycling club, so I was absolutely thrilled to be able to realise that long-held dream.

I had a similar feeling when I first encountered the Segway. Unlike the unicycle experience, I can't remember exactly where or when that was, but it must have been after 2001 because it seems that is when the Segway was launched. So having a go on a Segway was an item on my list of things I'd like to do.

The Segway is prohibited from public highways in the UK, but is used for guided tours in several European cities. I think Mr A and I first saw this opportunity when we visited Bruges, but unfortunately the cost was so high that I didn't feel able to justify it, especially as we would have to do as we were told and follow the guide at a sedate pace rather than, for example, seeing how fast we could go backwards...

I mentioned this recently to Lola II and she egged me on towards Google, which led to the utterly unexpected but fantastic discovery that a) there is a recognised sport of Segway polo, and b) the centre for Segway polo in the UK is... my home county of Warwickshire. This felt like finding out all those years ago that the place where I happened to be living had a unicycle club. So of course, I had to find out whether I could give this a try, or whether like city tours, it was beyond my reasonable budget. I emailed the UK Segway Polo Coach, who replied very promptly.

At the time, they were offering interested parties like myself the opportunity to join in a training session with more experienced players, for 2 hours and not that much money. At the same time they were up to their necks in organising an international tournament. I couldn't fit in with the dates on offer before the tournament, so I went along to the event to see how Segway polo was played.

Four players in purple and black strip riding Segways, followed by sound recordist also on Segway
The BBC Click team plus sound man
It was held in Rugby, about 30 minutes drive from home, on a fairly cold and blustery day in April. The UK Segway Polo Association did a great job of organising it, and there were two teams of TV cameras, one from the Gadget Show on Channel 5 and one from BBC Click, who even entered a team into the competition. Although I wrapped up pretty warm it was really too cold to stay for the full competition, but I certainly got a flavour of it, and in a tiny roped-off section of the car park I had my first go on a Segway. For a machine that appears to be inherently unstable, it was remarkably easy to ride and steer. I'd say that anyone able to stand could easily get the hang of it within a few minutes.

So I got in touch with the Coach again after the tournament, and asked when we might be able to have a go - but things had changed. Due perhaps to the publicity, or from understandable concern about health and safety, he now wanted new players to undertake a training course before going any further, and this would now cost a great deal more than he had quoted me when I first enquired. While I thought I could get a group together and have a go for £20 a head, this seemed most unlikely for £120 each. We negotiated, and reached a very acceptable compromise. I canvassed the people most likely to be up for this kind of nonsense - my badminton-playing friends - and they responded with enthusiasm. So off we all went to the all-weather pitch at a local sports centre on Bank Holiday Monday.

First we had to sign what we referred to subsequently as 'the death waiver' - a fairly strongly worded agreement that we understood the high risk of serious injury or even death and we weren't going to blame the organisers. Then we started - first some drills around markers to practise speed, turning and stopping, then we were given our mallets to practise dribbling and hitting the ball. And then - the first casualty, with player, Segway and mallet ending up some distance from one another, and the player seriously winded. It wasn't a collision (all our other mishaps involved more than one player), but it was actually the worst injury, with a suspected cracked rib. He still played on for the rest of the session, though...

Eventually we were deemed to be skilled enough to have a go at a real game. Segway polo is played with a series of chukkas lasting 8 minutes. There are five players including one in goal - we swapped about because the goalie doesn't have as much to do as the others on the field. I was in one of the first serious crashes on the pitch, and the best tactic (developed with practice) is not to try to hang on but to part company from the Segway as gracefully as possible. I still landed pretty hard, but I was only the first of many. We weren't supposed to crash into one another, but we weren't very good at anticipating what other players were going to do, or looking in the right direction, or turning and stopping as quickly as we needed to, so there were plenty of incidents.

It was pretty difficult to score a goal, not so much due to the skill of the goalies but because were were all a bit rubbish at hitting the ball with the mallets in a predictable direction. The two sides picked at random were evenly matched, so at the end of what seemed like a very long time the score stood at 2-2 and we finished with a penalty shoot-out at an undefended goal. By this time, I was really tired and fairly sore - my collection of bruises is quite impressive, but not as impressive as those acquired by the player with the cracked rib.

Overall I enjoyed it immensely. Would I do it again? We'll see...

Lola I on Segway with mallet

Tuesday, 5 May 2015

Making plans

Skyscrapers towering over the water
Canary Wharf, March 2015
A significant event took place this week - Tech-boy over the road dealt with my PC! Mr A recommended him and made the arrangements, and he took my slower-than-a-snail laptop and reinvigorated it with a new hard disk and operating system. It now boots in real time rather than geological time and the little issues it had with launching various applications have mostly disappeared. My PC hero is the eldest son of one of our neighbours, keen on motorbikes, and Mr A has let him use the garage and helped with various matters relating to internal combustion engines and their associated motorcycles. He is also delightfully polite and helpful. I have given him more money than he strictly deserves (he was happy to do the job for nothing) on the basis that I will pester him at any time when I have technology-related problems.

The only slight impediment to boundless joy is the need to reinstall a few key applications and transfer a load of data over from the old hard disk. It's not going too badly, although I had forgotten how much I had tweaked and tailored the interface. Just when I need to do something (scan, print, edit photos etc) I realise that something is missing e.g. the printer needs installing or the software application isn't there. There will be many situations over the next few days and weeks that will catch me out. But on the whole it's a great improvement.

So two nights with no PC and then a sunny weekend meant quite a lot of work in the garden, filling rubble sacks with vegetation - one carload has gone to the dump already. The lawn is mowed and strimmed and further operations are planned, including the deforestation of the paved areas and possibly training the wisteria so that it doesn't take over the whole garden. I missed my opportunity to prune the rose, so it is forming a wall between our garden and the neighbour's that is now about 15 feet high. There's a lot of rose bush out there.

It has been raining quite hard on and off so I have put off the next stage of guerrilla gardening, and resolved to do a whole lot of the desk work that has been waiting along with further indoor spring cleaning. I have had a bit of a blitz and have cleaned many of the windows that have not seen soap and water since our house was painted, and that was a few years ago. It is still a novelty to be able to view the the scene of devastation that is the garden through clean windows.

Desk work included an assault on holiday plans, where dates and/or accommodation had not been finalised. Both are clearer now for holidays in May, June and July, there is already a firm plan for New Year and I'll look at a ski holiday for 2016 at a later date. Now I'm busy reading a travel guide book and websites with tourist information. I'm also spending next weekend in the town where I work, because I'm often talking to patients who assume I know all about the shops, cafes, restaurants and pubs in the area. So I'm going to have a good look around and get familiar with at least some of the local attractions.

It feels as though I have made a lot of positive progress on putting my life in order, which makes me feel pretty good.

Tuesday, 28 April 2015

Pump clinic

Snowy mountains, blue sky and white clouds
Courmayeur, February 2015
I am lucky enough to have a pleasantly varied job which includes so many different aspects of diabetes. I work with Doctors, Nurses and other Dietitians, we see people with Type 1 and Type 2 Diabetes who are on medications alone, medications and insulin and insulin alone, using fixed doses, varying their dosage by carb counting using multiple daily injections or insulin pumps. We see them for individual consultations, in my very low carb group and in group education sessions, sometimes in the hospital as outpatients, in a community clinic and at a GP surgery. And that doesn't include the courses, conferences, study days and meetings with colleagues. Not forgetting that I don't have to do things that I find less congenial, like ante-natal clinics or paediatrics.

One recent meeting was all about updating our service to increase our capacity to see patients who are using insulin pumps, all of whom have Type 1 diabetes (because you don't qualify for NHS funding for a pump if you don't have Type 1). Very few people stop using a pump after they have started, so obviously numbers are increasing, and more children are being started on pumps who then transition to the adult service.

In our service, adults have to attend our structured education before they can have a pump, because it's an expensive and sophisticated bit of kit and we want people to get the best out of it. There's no point having a pump if all you do is give fixed amounts of insulin three times a day with meals; you might as well use a straightforward insulin pen. The pump can give fractions of a unit of insulin; you can extend a bolus over a period of time; you can set up different rates of background insulin over the course of 24 hours; you can adjust the background insulin up or down by a percentage for a period to allow for exercise or illness and much more. So we want people to be able to count their carbs and make informed decisions about adjustments in order to get the most out of the equipment.

This means that our pump clinics contain patients who are generally the most knowledgeable and skilled in carb counting and insulin adjustment. Their level of knowledge and skill does vary, because for example the young people moving from paediatric to adult clinics may have been given pumps without the specialist education if they were too young at the time. But some may have had diabetes for upwards of 50 years; I have been a diabetes dietitian for less than two and a half years. This fact has made me wary of intervening with most patients in the pump clinic.

My colleagues tell me that there is more I could be doing in terms of helping people to use their pumps to manage their diabetes, but before I feel confident to do more I have asked for two things. The first is to attend some sort of insulin pump training for healthcare professionals, and the second is to visit a Diabetes department in a different Trust where they manage pumps, so I can learn from the Dietitian there.

My colleagues are more experienced than I am, but they still feel they could do with knowing a bit more about the range of pumps on the market. Our service tends to favour one particular pump brand, although there are a few others that we support because patients using those brands have moved into our area. So we are setting up an afternoon when the five or six main manufacturers will be asked to demonstrate their products one after another, and we will compare features and costs.

Then there is the way that our pump clinics are organised. With three different overlapping roles - Nurse, Dietitian, Doctor - there can be some duplication. For instance, in order to analyse whether any changes are needed, the data about blood glucose levels, carbs and insulin delivery stored by the insulin pump can be downloaded and manipulated on a computer, which is much easier to do than using the handset. It is also easier to spot trends using graphs, and rates of insulin delivery can be adjusted by drag and drop. But it makes little sense for the Nurse and the Doctor to download and view the same data each in their separate rooms, so they are thinking working together. With two Doctors and two Nurses per clinic it is clear how things might be organised for them, but there is only one Dietitian. I'm not yet sure what I will be doing, but maybe when I've seen what other services do I will come up with some ideas.

Monday, 20 April 2015

What I've been reading

Image of the book cover

Auschwitz: A Doctor's Eyewitness Account
by Miklós Nyiszli
"A Hungarian Jew and a medical doctor, Dr. Miklós Nyiszli was spared from death for a grimmer fate: to perform 'scientific research' on his fellow inmates as a research pathologist under the supervision of the infamous Dr. Josef Mengele."
My goodness, this book was difficult to read. The author describes what happened in Auschwitz, what he saw, heard and experienced, and it is more direct and real than any other account I have read. Of course we know what went on, but this brought home the cruelty and the scale of the killing - thousands upon thousands of human beings murdered every day, week after week, month after month. I could only manage to read about two chapters at a time. But we must remember these events, for although it seems inconceivable that such a crime could be repeated, it did happen once, and nobody then thought it conceivable until it was upon them.

Image of the book cover

Queen Lucia
by E. F. Benson

narrated by Nadia May
"England between the wars was a paradise of utter calm and leisure for the very, very rich. But into this enclave is born Mrs. Emmeline Lucas - La Lucia, as she is known - a woman determined to lead a life quite different from the pomp and subdued nature of her class."
Unfortunately the village is populated by shallow small-minded pretentious snobs, except for the lovely and sensible Olga who settles in their midst and brings a welcome dose of reality to the ludicrous 'romps' and dinner parties and garden parties with which the residents occupy themselves. There are some wonderful characterisations though, narrated to perfection. I particularly loved Mrs Weston in her bath chair with her long-winded accounts of who said what and when they said it. But Lucia herself is awful, and her friend and rival Daisy Quantock is just as bad, and Georgie Pillson not much better. Time will tell whether I am inclined to read more in the series...

Image of the book cover

Maid in Waiting
by John Galsworthy
"The Cherrells are cousins by marriage to the Forsytes. When Elizabeth 'Dinny' Cherrell's brother faces extradition to South America, falsely accused of murder, and her cousin is threatened by her mentally unstable husband, Dinny does everything she can to shield them from harm."
This is the seventh book of the nine in the series, and moves away from the Forsyte family, although Fleur still features. Galsworthy writes very sound women as well as men, and the women in this book are at least as important as the men, and much more interesting. It's also fascinating to read how upper class families of the day had access to powerful government officials if they knew the right people - the Home Secretary in this case - and yet complain how they are not given any special status in the eyes of the law: "... one must be careful not to give an impression of favouring privilege -" "I think that's so unfair," interrupted Dinny, hotly.

Image of the book cover

Thank You, Jeeves
by P. G. Wodehouse

narrated by Jonathan Cecil
"The manager of the building in central London has issued an ultimatum to either give up the music or clear out, and Jeeves resigns over Bertie's dedicated but somewhat untuneful playing of the banjolele. In high dudgeon, Bertie disappears to the country as a guest of his chum Chuffy."
I'm gradually working my way through the Wodehouse books - this is the first he wrote featuring Jeeves and Wooster, and it is heart-warming that the relationship between the two seems so strong and yet completely understated. Wooster is an ass as usual, and Jeeves saves the day, and they are together at the end and What Ho! all is well with the world.

Image of the book cover

A Study in Scarlet
by Sir Arthur Conan Doyle

narrated by Simon Vance
"Dr. John Watson, discharged from military service after suffering severe wounds, is at a loose end until a chance encounter leads him to take rooms with a remarkable young man. The arrogant, irascible Sherlock Holmes is a master chemist, a talented musician, and an expert on all aspects of crime."
I've invested in the Complete Sherlock Holmes in one audiobook - 58 hours of narration, and tremendous value when you have a yearly subscription. This is the first of all his books, and I've read it many times before, although it struck me this time that Mormons are portrayed very negatively indeed. I didn't check before I bought the whole omnibus, but Simon Vance is a fine narrator, so that's good.

Image of the book cover

The Girls of Slender Means
by Muriel Spark

narrated by Juliet Stevenson
"It is 1945; a time of cultural and political change, and also one of slender means. Spark's evocative and sharply drawn novel focuses on a group of women living together in a hostel in Kensington who face new challenges in uncertain times."
Not a long book, and I was a bit concerned about choosing it because I was so disappointed by Memento Mori, but it turned out well. It is set immediately after the war, when London was a mess of bomb damage, everything was rationed and people were somewhat traumatised. The description of a young ladies' hostel in Kensington was perfect, the characters drawn with care and attention, even if there wasn't much of a story to be told.

Image of the book cover

The Sign of Four
by Sir Arthur Conan Doyle

narrated by Simon Vance
"As a dense yellow fog swirls through the streets of London, a deep melancholy has descended on Sherlock Holmes, who sits in a cocaine-induced haze at 221B Baker Street. His mood is only lifted by a visit from a beautiful but distressed young woman - Mary Morstan, whose father vanished ten years before."
Second of the Sherlock Holmes books, and a little pedestrian in its pace and length. Darkly atmospheric though, reprising Holmes' violin playing and introducing his cocaine habit, Watson's eventual wife, and all sorts of exotic travelling types and natives of far-flung islands. The narrator really is good.

Image of the book cover

Arsène Lupin, Gentleman-Burglar
by Maurice Leblanc

narrated by B. J. Harrison
"Witty and urbane, Lupin stole from the rich through elaborate capers and gave to the poor in bursts of generosity. An inventive genius, a master of disguise and an accomplished actor, Lupin operates in the choice chateaux and salons."
I hadn't heard of this character, who might be described as the French Sherlock Holmes except that he is on the side of the baddies. It's not a bad read, and the great Holmes even makes an appearance in the last story - a little surreal, when one fictional character comments on another created by a completely different author.

Monday, 13 April 2015

Ten things

Outdoor tables and chairs under large umbrellas in the sunshine by the sea
Greece, June 2014
This post is pretty close to a rant. It's true that I have been feeling a bit stressed and the four-day weekend for Easter was very welcome. Normal service should be resumed very soon with calm, considered blogs of an informational and entertaining nature. I hope so, anyway.

1. Sensational media reports based on a flawed interpretation of a journal article or on something made up by a journalist or a celebrity

"Did you see the TV programme last week about how eating saturated fat is good for you? I've switched back to butter."

"I read in a magazine about how you will lose weight if you eat nothing at all after 5 p.m."

"I cut this article out of the newspaper about kale smoothies reversing diabetes."

"This website says that chia seeds will melt fat."

"The Daily Mail says that eating blackberries brings your blood glucose down."

"It says there's a new cure for diabetes."
FACT: It's all rubbish, ignore it. If you are overweight and want to reduce your blood glucose and improve your diabetes control, then eat less carbohydrate and lose weight. If you want to lose weight, you need to eat less, and ideally move more. The dietitian's job is to help you find a successful way to do all this, not spend half a consultation explaining how journalists are perfectly free to MAKE STUFF UP and are paid handsomely for it.

2. I can't possibly eat any less

The patient declares that there's no way they can eat any less than they already do. "I don't have any appetite," they say. "I eat like a bird. My two-year old grandson eats more than I do." The account they give of their daily diet consists of a small bowl of cereal for breakfast, half a tin of soup for lunch, and one slice of toast and a tin of sardines for supper. Between meals: black tea and coffee with sweetener. "I can't understand it," they say.

FACT: You are eating more than this, and you know it. Or maybe you don't know it. Either way, you're eating more than this or you wouldn't weigh 20 stone.

3. Artificial sweeteners

"Aren't they as bad as sugar? I read they cause cancer. They're full of chemicals, really bad for you. I wouldn't touch them."
FACT: Artificial sweeteners are safe. They're calorie-free. They're carb-free. THEY ARE FINE, STOP BEING STUPID.

4. Exercise

"I would lose all this weight if I could exercise, but I can't."

"I'd love to go out for a walk, but my back/hip/knees are too painful."

"My dog died and I put on 10 pounds."
FACT: exercise is incredibly good for us - it brings down high blood glucose levels, makes us feel good, strengthens muscles and helps stabilise joints - but the amount of calories burned by ordinary people who increase their activity level is about equivalent to a sandwich. If you're a typical overweight person you won't lose weight by exercise alone, and you'll probably reward yourself with more calories than you used up. But go out for a walk anyway, because the other benefits of activity are so worth it. And then start eating less.

5. Honey

"I've cut out all sugar, I don't have any now. I put honey in my tea and on my porridge instead."

"Honey's natural so it must be better than sugar."
FACT: Sugar is processed from plants by people; honey is processed from plants by bees and then people. Honey will have the same effect on your blood glucose and your waistline as sugar. Sorry to disappoint you, but YOU ARE DELUDING YOURSELF.

6. Fruit and fruit juice

"Fruit juice is healthy, isn't it? It's natural."

"I buy the fruit juice labelled 'no added sugar.'"

"I've stopped snacking on biscuits, and I'm having lots and lots of fruit instead."
FACT: fruit juice has more sugar in it than lemonade, and nearly as much as Coke or Pepsi. Why would a manufacturer need to add more sugar to a product that's already 10% sugar? Yes, whole fruit is better, but you're not helping your blood glucose levels if you have more than a handful at a time. And the 'five-a-day' message? Well, it's perfectly OK to have five portions of vegetables and no fruit at all.

7. 'Full of sugar'

"I stopped having ketchup on my chips - it's full of sugar."

"Those pasta sauces are full of sugar."

"I don't eat grapes or bananas any more; the nurse told me they are full of sugar."

"I have muesli now - cornflakes are full of sugar."
FACT: There's far more 'sugar' in your chips than in your dollop of ketchup, more in your large bowl of pasta than in the couple of tablespoons of pasta sauce, and no less in your bowl of muesli than there was in your cornflakes. It's all about the carbs. Grapes and bananas are fine, but have a handful of grapes or a small banana, not the whole punnet or a banana the size of a baseball bat.

8. The Menu Plan

"Just tell me what to eat."

"Can you just give me a menu plan?"
The lifestyle magazines are always printing "a menu plan for a week". We love them. I love them. If only we could just follow the plan to the letter, it would be so easy and we'd reap the promised benefit. But then we look through them - one muffin? Half a grapefruit? 300g kale? What do we do with the five other muffins that came in the pack of six, or the other half grapefruit, and I'm not allowed grapefruit anyway, and kale comes in 500g packs, and I don't like kale, and it's too expensive to eat all that fish, and I don't like fish except tinned tuna. What do I do in week 2 - just repeat week 1? My wife does all the cooking and we eat curry and chapatti not sausages and potatoes...

FACT: Menu plans are useless, and I don't have one for you. You'll have to work it out for yourself. Sorry.

9. "You're telling me I can't have..."

Honey. Rice. Sugar puffs. Fruit juice. Potatoes.

NO, I'M NOT TELLING YOU WHAT YOU CAN AND CAN'T HAVE. What I'm telling you is the effect that it will have on your weight, or your blood glucose. You can have whatever you like, whenever you like, because it isn't me that will put on weight or need to inject insulin, it's you. If you want to start the day with a Pepsi, that's fine, but if I were you, I wouldn't do it, like I wouldn't walk into the road without looking, or swim in the sea when there's a red flag flying. But if you want to, you go ahead.

9a. 'Good' and 'Bad' food

There is no such thing as good or bad food - nothing is forbidden. It's good to eat a lot of some foods and a little of others, and hey! it's bad to eat a lot of some foods and a little of others. Eat what you like, it's your decision and you will have to live with the consequences. My job includes making sure you are aware of what those consequences might be.

10. Low blood sugar

"I had to have a sandwich because my blood sugar was low."

"I can't sleep unless I have a glass of milk and a biscuit before bedtime."

"I need a snack to keep me going."
FACT: if you 'need' a regular snack then your insulin needs adjusting down. If you're not on insulin (or gliclazide or another insulin-stimulating medication) then you don't 'need' a snack, you just want one - you will never have low blood sugar. Grow up, you're not a toddler any more.

Tuesday, 7 April 2015

Drawing class

The class with their drawings
Drawing class, March 2015
Mr M's birthday was in February, and long before that date Lola II had been planning a surprise. Ever since they both went to a Members' Event at the British Museum and were encouraged to make a pencil drawing under the guidance of a drawing teacher. Lola II considered Mr M's drawing to be very fine, and it is now framed and hanging on the wall. So the surprise was to be a drawing lesson with this same teacher, Anna, but at their home and together with six other people, of whom I was one.

Anyone can tell you that keeping secrets is not my strong point. Admittedly I am better at it than Mr A or mum, who given a chance will be certain to say the wrong thing - I just find it very difficult to lie when faced with a direct question. Which is why I feel proud to say that I did not give the game away, even when asked a week before the big day by Lola II in the presence of Mr M: when would I next be in London? I said it was a secret, which was true.

The surprise had to include the provision of lunch, as Lola could not be seen to assemble food for nine people when Mr M was expecting to go out to a drawing class somewhere else. An online food order was delivered to me ahead of time and I brought it with me. There were also undercover assignations in a local cafe, secret bedmaking and no doubt more subterfuge that I was unaware of. Anyway, it all went swimmingly and Mr M was surprised and we had a full day of lessons, in which we were taught how to draw faces.

Drawing anything is pretty difficult. I am no expert, but I've had a go at drawing things (long ago, admittedly) and no face I've ever drawn looks like a human face, let alone the person whose face it is. After a day being taught how to do it, I think the drawings I produced are not bad, and with practice I can see how it could be possible to achieve a proper likeness. I had a fantastic time.

Before hints and tips
Same face, later
First we were given pencils and told not to judge our own work but to move on if things got sticky. We had a couple of warm-up exercises with the pencil, and then were given a slightly out-of-focus face to copy, and some charcoal. I've never used charcoal before, but it was such fun. Teacher commented on our work, and told us about tricks and techniques to use, and I produced a face. My first face belonged to a man, which was a pity because the picture I was copying was of a woman, but using the advice provided I remodelled it and suddenly it transformed into a female face. I still don't know how that happened.

After lunch we had a different face to copy, using pencil this time. That was fun too, and I drew a respectable face (the one in the picture at the top of the blog), but I love the charcoal one much more - in fact, I love it so much that I may frame it. Of course Mr M and Lola II drew lovely faces too, but this is my blog all about me. Oh all right, here's Lola II and her drawing, from pretty early on in the day.

Unfortunately we don't have a picture of Mr M and his drawing except in the group photo at the top. Happy Birthday Mr M!

Sunday, 29 March 2015

What I've been reading

Image of the book cover

The Heart of the Matter
by Graham Greene
"Scobie is a highly principled officer in a war-torn West African state. When he is passed over for promotion he is forced to borrow money to send his despairing wife away on a holiday. In her absence he falls hopelessly in love with Helen, a young widow, and his life is transformed by the experience."
There's no denying that Mr Greene is a very fine writer. His characters are minutely described, and so real that I can almost understand how a Catholic fears mortal sin. I can see them in my mind's eye, and a pretty unappealing lot they all are. And that's the only problem with this book.

Image of the book cover

Moon Tiger
by Penelope Lively
"The elderly Claudia Hampton, a best-selling author of popular history, lies alone in a London hospital bed. Memories of her life still glow in her fading consciousness, but she imagines writing a history of the world. Instead, Moon Tiger is her own history."
I'm puzzled at how good this book is. The narrator is dying. She has lived a full life, and describes some of it. She is not particularly likeable, she has been a poor mother and a challenging individual to friends and family, but for a very brief period during the second world war she is in love, and it is requited, and the reader understands and forgives her the rest.

Image of the book cover

Cover Her Face
by P. D. James
"On the same day as the St Cedd's church fete in the grounds of her home, Martingale, Mrs Maxie learns of her son Stephen's engagement. By the next morning, her new parlourmaid, Sally Jupp, is dead."
A proper old school detective story, with clues, suspects, motives, and opportunities to guess the murderer. I thought I had read PD James before, but I don't think I have after all. Maybe I'll try a few more.

Image of the book cover

The Lost Duke of Wyndham
by Julia Quinn
"Jack Audley has been a highwayman and a soldier. What he is not, and never wanted to be, is a peer of the realm. But when he is recognized as the long-lost son of the House of Wyndham, his carefree life is over."
Not a challenging read, but fine for the eternity of time between returning starving to the hotel after skiing and the dinner service. I'm nearly done with Julia Quinn, because although she writes quite nicely, the plots of the books I've read so far are awfully similar.

Image of the book cover

Homage to Catalonia
by George Orwell
"Orwell volunteered as a militiaman in the Spanish Civil War, and here he describes with bitter intensity the bright hopes and cynical betrayals of that chaotic episode: the revolutionary euphoria of Barcelona, the courage of ordinary Spanish men and women he fought alongside, the terror and confusion of the front, his near-fatal bullet wound and the vicious treachery of his supposed allies."
If there had been such things as blogs in those days, this chronicle would have been published in that format. It is of its time and very political, although he does describe very vividly what it was like to serve in this particular conflict, the vast gulf between idealism and pragmatism, and the role of journalism in misrepresenting everything that occurred. These at least are the messages that I took away; I have to admit to still being somewhat mystified about the different factions: Anarchist, Socialist, Fascist, Communist, and where the Government stood among all these parties.

Image of the book cover

A Dark-Adapted Eye
by Barbara Vine

narrated by Harriet Walter
"Like most families they had their secrets, and they hid them under a genteelly respectable veneer. No onlooker would guess that prim Vera Hillyard and her beautiful, adored younger sister, Eden, were locked in a dark and bitter combat over one of those secrets."
The second Barbara Vine book I've listened to, and another good one. It starts by declaring who has committed the murder, and then you spend the rest of the book finding out who was murdered and why. Unlike the classic crime fiction where you don't know who did it until the end, this is more of a 'whydunnit'. High quality narration as well.

Tuesday, 24 March 2015


Union jack bedding, curtains and lampshade
Mamas Inn Boutique Hotel, March 2015
Last weekend was the umpteenth birthday commemorative weekend that Lola II and I have spent together, and this year's host city was Nottingham.

The journey north was fairly straightforward apart from being stopped by a police car - my mistake was turning my headlights off when dropping off Mr M and forgetting to turn them on again. Trying to navigate through the city, Lola II's phone refused to find a GPS signal and my phone insisted on directing us to go the wrong way along one-way streets at every opportunity, which left me thoroughly traumatised, especially given the police incident. Eventually we reached 'Mamas Inn Boutique Hotel', and it was AMAZING.

David and Marina and poster: People who love to eat are always the best people
The owners told us they had bought it less than a year ago and decorated each room in the style of a city - ours was 'London' but there was Venice, New York, Tokyo, Paris and more. In our room there were Union flags on every item including bedding, curtains, dressing gowns, flip-flops, bath flannels, lampshades, waste paper bins and a wardrobe made to look like a red telephone box.

And the food. The food was also wonderful - the best B&B breakfast I've ever had. A bowl of fruit followed by perfectly cooked eggs, bacon, sausage, beans, hash browns and toast, and a tiny little choc chip muffin to finish. We tried the continental breakfast and pancakes next day. I can highly recommend Mamas Inn, and would go to Nottingham again just for the opportunity to stay there.

On Saturday we decided to go to Wollaton Hall and Deer Park. Although this was my first visit, the Hall seemed to me to be one of those places that you get taken to as a child and then becomes part of your childhood lore, drawing you back as an adult to revisit the wonders that made such an impression in those early days. My place of childhood wonders was the Natural History Museum in London, with its dodo and the reconstructed dinosaurs and the blue whale skeleton. Wollaton Hall's wonders, however, were much more eccentric and strange - the wall of animal heads, George the Gorilla, the tiger in the stairwell (or was it a lion? I forget). It seemed to exist in a time warp, slightly scruffy and reminiscent of the 70's.

Although there is no charge for entry to the Hall or Park, we decided to pay for a tour, and what a tour it was. The guide was astonishingly bad - Lola II struggled to actually understand what was being said, and I struggled to keep from laughing most of the time. She would talk about an aspect of the furniture or paintings or stonework or household staff, and we had no idea at all what she was talking about - she would wave in a general direction and we would look desperately around trying to locate the 'bushes', or the 'lions in the style of Venice' or whatever. The two best comments for me were firstly in the kitchen, where she encouraged us to pick up and handle the pies and meat - which were models made of plastic. The other was down in the cellar where she showed us the fresh water spring. "You can drink the water," she told us, "although I wouldn't. There was two girls on the tour the other day, and they drank some, but they was all right afterwards."

Dome and staircase
Council House
The weather was wintry, but we spent an hour or so walking around the Park and its environs before heading back to the hotel to get ready for the evening. I lived in Nottingham for a year and deliberately avoided going to a highly-rated Japanese restaurant just so that Lola II and I could go together. It was very good, and worth the wait.

After that we went to the cinema. I had looked in vain for anything more cultural, but there wasn't a single theatre performance or concert in the whole city on Saturday night, except at Rock City. So we went to the pictures.

On Sunday we decided to visit the city itself, and after visiting the best public toilets I've ever been to we had a tour of the Council House. This time the guide announced herself to be an accredited Blue Badge guide, but there was still a touch of the insane about her - Lola II thought she might be a frustrated actor. We met Mr M and other friends in the Galleries of Justice museum where we declined to take the tour but looked around the free galleries showing stuff about World War I and an confusing account of the detection and trial of a serial murderer. Then we had lunch, and cake, and it was time to go home.

Lola II and union jack picture, cushions and dressing gown

Thursday, 19 March 2015

PDR, VLC group and DUK PC

Tortoiseshell butterfly on pink flower head
Peckover House, August 2014
I haven't written much about work for a while, so here goes.

I had my annual Personal Development Review (PDR), I hosted our monthly Very Low Carbohydrate group, I went to the Diabetes UK Professional Conference in London, and of course there were the usual clinics.

It's going quite well, although I'm having rather too many good ideas. When I have good ideas I tend to get a bit obsessive, the ideas blossom and grow, they expand beyond the available space and instead of a tidy achievable project designed to meet defined goals I end up imagining the biggest, best, most complete and perfect solution to put an end to all conflict in the world. Then I realise it's totally unachievable and start to doubt whether I can do anything at all. I have a good deal of respect for people who can come up with a sensible and successful idea, put together a plan and then see it through into practice.

I'll give a small example - Carbs and Cals. This is a book, and much more. The author is a Diabetes Dietitian who got together with a photographer friend and took photographs of different portion sizes of various foods, then put them in a book with labels showing the amount of carbohydrate in grammes and the calories in each portion. It was the perfect solution to a problem faced by every person with Type 1 Diabetes and a lot of those with Type 2 - how much carbohydrate is in that portion? Carbs and Cals will show you.

The book was so successful that it has expanded to show Carbs, Cals, Protein, Fat and Fibre; there is a website, a phone app, flash cards, teaching resources and much more. One manufacturer in the diabetes world includes a copy of Carbs and Cals in the box with one of its blood glucose meters. Diabetes UK has lent its logo to the cover and sells the book via its online shop. I met the author at the conference last week. He is the nearest thing to an A-List celebrity in the diabetes world - every single person of the thousands in that conference centre would have heard of him and his book, but he seemed pretty modest and unassuming.

The point is, he came up with an idea and saw it through. He probably spent an immense amount of time and money on it, presumably found his own publisher, designer, editor, set up sales channels - and I can't tell you how much I admire and envy the talent and commitment he shows, because I think it is unlikely that he was given much time to do it at work - I don't know for certain, but I'm guessing he did it all in his spare time.

I want to create an online resource to support our patients who have taken on the very low carb lifestyle, and I am in the wild imagining stage. My idea has exploded to include more than a website: I am imagining a discussion forum, recipes, pictures, an app, published research papers, a blog, a secure section where people can record their blood results, live interaction with Dietitians, links to SMS text messages, Facebook, Twitter, Instagram, Pinterest, anything and everything. I need to scale back my ambition and make it achievable. At the moment I cannot access any of these elements from work, due to restrictions imposed by the IT department. Almost everything is blocked and my browser is so old that many ordinary websites can't be used properly.

This project is one of my PDR objectives, so at least I should be supported to do it in work time, although I expect I will have to put in a bit of extra effort if I want it to succeed. My other main PDR objective is to get more involved in pump clinics. Up to now I've concentrated on acquiring the basic knowledge that applies to the majority, but for a number of reasons, this is a good time to focus down on the minority who use CSII - continuous subcutaneous insulin infusion, or insulin pumps.

The number of pump users is increasing as more adults acquire them, and as those who were started on pumps as children transfer into the adult service. Every adult on a pump should be equipped with the skills to use the pump effectively, but it is not so clear cut with children. Anyway, because the general level of diabetes knowledge and skill in the adult population with pumps, I have rather left them alone and concentrated on less able people coming to clinics. But our pump service is set to expand, and there is quite a lot I could be doing to help and support pump users. More on this at a later date, I expect.

The conference. It turned out to be pretty difficult getting funding to attend the conference. I approached the dietetic and diabetes departments and every industry manufacturer and rep that came within two feet of me, which was bordering on humiliating and completely fruitless. In the end, a colleague managed to get a company to pay our attendance fee, but nobody would stump up for accommodation. We eventually had to apply for funding to the hospital's charitable funds, and I got an email 15 minutes before the end of my last working day before the conference letting me know the accommodation cost had been approved. I won't get any reimbursement for travel.

Apart from this, the conference experience was excellent. Being fairly new to diabetes I hadn't been to this event before, but in my old life I had staged a conference with my team and have been to many in this country and in the USA. This one had a lot more money spent on it by the Pharma companies exhibiting and sponsoring the talks than in the world of disability and visual impairment, which shouldn't really have been a surprise.

I saw too much to write about here, but the highlights included:
  • a heated 'debate' between one maverick Dietitian who is promoting a diet high in saturated fat, and the rest of the dietetic community who don't believe that the evidence is strong enough to support this approach
  • a session on exercise and Type 1 Diabetes (this is one of the most complicated areas I've encountered yet)
  • a very useful summary of pump usage given that I'm going to be focusing on this area, and 
  • links with various people who talked to me about whether and how their NHS employer allows them to use state of the art technologies.
So lastly, my low carbers. I started to worry that the group would fizzle out - a few people have left, either because they are successful or because they can't manage it any longer, which is why I'm so keen to create something online to help them. For this month's meeting I bought a cookbook of Low Carb Gluten Free Vegetarian recipes which source their protein mainly from eggs, cheese and tofu, and I reckoned the group probably hadn't cooked with tofu before. So I cooked one of the recipes (teriyaki tofu with broccoli), bought a few different types of tofu (firm, silken, marinated) for the group to taste, and printed a selection of tofu recipes. It was one of the most successful meetings so far. And they are all doing well, still losing weight and maintaining great blood glucose control.