Saturday, 18 November 2017

Not the LTRP

White flowers against a background of greenery and branches
Krakow Botanic Gardents, July 2016
All this building activity reminds me of university time when I was learning new things every week, but the desire to blog about the building work all takes up an awful lot of time. I used to have plenty when I was a student, but nowadays not so much.

In case you hadn't noticed, I let the tenth anniversary of my blogging pass without note in the summer. I held no expectation that I'd keep going this long, although I knew that writing is something I enjoy and hoped that blogging would satisfy that urge. There's lots of room for more writing once I 'have more time' (retirement?) including some fiction, perhaps. Or there are the notes of my year of volunteering in Israel, which I planned to turn into a book thirty years ago but never got round to. And I've got a plastic bag of stuff from primary and secondary school days that is begging to be examined - I bet some of it would be blogworthy.

Anyway, the two weeks without days off and the LTRP and extra nights of badminton matches and music group and a trip to see mum and dad have worn me out, with a bonus night of disturbed sleep about a particular patient that I can't even write about, but he/she made me so troubled and disturbed and ANGRY that I couldn't sleep. I didn't even go to badminton on Monday of the second week. Delivering my courses I was getting confused about what I'd delivered to which group.

There's still quite a lot of high level activity around diabetes education following the awarding of a large pot of money to the commissioners who are trying to work out how to spend it. In examining this problem they have realised that they don't know what they are already paying for. Naturally enough they asked someone in the hospital finance or business department how their existing funding is spent, and this person addressed the issue by completely ignoring it until one of the doctors realised what was going on and called a meeting. Thankfully I didn't have to go, but my colleague reported that it went quite well and may have given us a further brief reprieve.

There is another meeting about diabetes education that I will have to attend; they have set up all sorts of 'Task and Finish' groups to try and work out how to spend this money, and have appointed a project manager, so it is possible that all the grant will be spent in finding out how bad the situation is, and no money will be left to do anything about it. In the meantime there are rumours about what will happen when NHS Commissioning is dissolved again, this time in favour of GP Alliances. Fear not, I will let you know exactly how this goes, if it ever happens.

Patient education for Type 2 diabetes has all but ceased with the departure of my Dietitian Team Leader colleague and another member of that dysfunctional team. Courses were cancelled such that there has been only one course delivered between last August and January next year, and it was delivered by me and the ex-Team Leader to only four participants. There are various conspiracy theories about why this should be - when I offered to deliver more I was told that there wasn't really a waiting list. Meanwhile the commissioners are looking at the thousands of people being diagnosed with Type 2 diabetes who are eligible to attend the course and may well wonder why only four people have received any education in six months.

Then out of the blue came the bombshell that one of the people who hasn't delivered a course for about a year has won an award as Educator of the Year, which makes me laugh but everyone else is furious. Hard on the heels of this news is the further update that another member of that team is leaving, although there is a rumour that a new Dietitian Team Leader has been appointed. Nothing confirmed has reached me, though.

I attended a very useful talk about Eating Disorders and Diabetes delivered by the psychiatrist who leads the service for this area. It was an evening meeting in a posh hotel with dinner, and the audience was a mix of doctors, nurses and dietitians but I was the only Diabetes Specialist Dietitian and there were no dietitians or nurses from the main hospital or from the community diabetes service. The other dietitians were from the weight management service, and they told me that a) their psychologist screens patients who have been referred onto the pathway to bariatric surgery but does not treat any eating disorders that are uncovered, and b) while this Eating Disorders service exists for people with diabetes, there is a much lower level of service for people who don't have diabetes. At least they have access to a psychologist - we don't in the adult diabetes service.

I learned about the three main types of eating disorder: Anorexia Nervosa, Bulimia Nervosa and Binge Eating Disorder, and these are even more prevalent in the population of people with diabetes. Damaging behaviours include purging, laxative abuse and excessive exercise, but with diabetes comes the additional option of insulin restriction, combined with the increased need to focus attention on food and blood glucose that is not necessary for people who don't have diabetes. The existence of Diabetic Ketoacidosis (DKA) which is one effect of insulin restriction also hugely increases the risk of mortality in the diabetic population with an eating disorder.

The service consists of a psychiatrist, a nurse and a dietitian. I'm quite keen to see more of what they do, so will try to set up a visit. Maybe they will come and talk to the diabetes dietitians once we have some again.

Enough of work. The music group is still a lot of fun, but I really need to do some saxophone practice. And having managed by borrowing in previous years I feel obliged to get myself a Christmas jumper for the concert, not least because the church is freezing. Sounds like a hardship, but it's the sort of clothing I'd enjoy wearing at any time of year so not a problem.

The trip to dad and mum, while tiring, was a delight because dad is so much better. The stent that drains excess fluid from his brain was opened to its fullest extent at the last appointment, which could have had adverse side effects but in fact has restored him to nearly his previous state of health. He's still deaf and wobbly on his feet but at least he's talking and showing an interest in what's going on around him. He even asked me how the building work was going. I told him that in future if he's naughty we now have an on/off switch.

Otherwise there's a distinct lack of reading going on except audio books and podcasts in the car.

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