Getting wired and plastered

Son of Ulf and Sidekick, May 2019

There's been some satisfying progress with the Lola Towers Renovation Project. The last remaining large indoor job within Phase 1 is to strip, plaster and paint the walls and ceiling of the main living room, stairs and upstairs landing.

Ilf removed all the wallpaper a while ago. That was a major operation, and one that I don't think he relished - the wallpaper was old and the underlying plaster crumbly. Then I chased both the electrician and the plasterer for a while before pinning them down on dates.

Bill the Electrician came with his assistant plus a lad on work experience, dug out new sockets and put in wiring for a second overhead light and switch, but left me with only one usable light and one socket in the room. He told me that the plasterer would find it much easier this way, and he'd come back afterwards and finish it all off.

My chosen plasterer was Son of Ulf, who previously did a beautiful job on the plastering for the kitchen and picks up extra work at weekends and in the evenings while working with Ulf in his day job. He has a Sidekick who is even younger than he is. They ate a whole packet of biscuits in about 15 minutes on the first day, and they made a terrible mess of my parquet floor downstairs. I supervised quite closely on the protection for the new carpet in the upstairs hall.

Electric Bill took his time for the return visit, leaving me with the single light and one socket in the room for a week or two - not that I wanted to use the room until I'd at least cleaned up the floor. When they returned they found that Sons of Ulf had completely plastered over one of the new sockets and they had to dig it out again with much complaining.

Ilf has come round to view the work with approval and, I think, a hint of envy. I have spent much of my spare time in the time since the job was finished in cleaning the dust and plaster residue from every surface in the entire house. It is a time-consuming and filthy job. I have contracted out most of the time-consuming and filthy jobs within the scope of the LTRP, but cleaning is one thing that I feel I ought to do myself. This may be because I don't (yet) employ a cleaner.

Ilf is busy for several months and gave me a date quite a long way into the future for the painting. I commented that I could probably make a start on the undercoat myself, and while he gave me a couple of tips I could sense that he doubted my competence for this task. Given that I'm having trouble finding time to simply clean the mess made by the plastering, I'm not sure he need worry about me making much progress before he's able to come back.

[On an entirely separate note, I was browsing some old blog posts in nostalgic mood and was horrified to discover that the Brexit referendum took place before I'd even seen the architect, let alone started work on the new kitchen. Politics has been grim for so long that it's hard to remember a time before Brexit.]

Libre update

While I was away in Brazil and for the last four blog posts, it's been quite an exciting time in the world of diabetes. The Libre flash glucose monitoring system, which a few short weeks ago was almost unobtainable, has now become very obtainable indeed.

There have been new (draft) guidelines that are much more inclusive than the previous ones, so that instead of almost nobody being eligible, almost everyone meets the criteria now. There has been a meeting attended by someone from the Trust who says we can go ahead and start as many people on it as we like, despite the guidelines only being in draft.

The situation is not completely relaxed though, because there is supposed to be some sort of monitoring and review of our patients to whom we give the Libre to make sure that it is having the positive effect that is claimed for it. Understandably the CCG does not want people to have a new and expensive bit of kit and then not get the benefit, which from their point of view involves a cost saving due to better blood glucose management reducing long-term health complications, and fewer prescribed blood glucose monitoring strips.

We are planning to use an online dashboard to collect information for us to review, whereby patients upload the data from their devices and we view lots of lovely graphs as well as recording auditable data. We can then report back to the CCG and support patients who are getting good results while recommending the withdrawal of the device from those who aren't using it or aren't getting any benefit or aren't using fewer strips.

And there has been a meeting with the suppliers, who gave us all a handset and sensor to wear for the next two weeks. I was delighted to be able to try some of the technology on my own non-diabetic body, although my nurse colleagues weren't very keen at all. We're all very used to looking at blood glucose results from our diabetic patients and being asked whether they are cause for concern without knowing anything about what is 'normal'. How high does blood glucose go after a high-carb meal when you haven't got diabetes? I was about to find out.

I managed to upload my data from the device (which wasn't anywhere near as straightforward as the suppliers led us to believe), and I even registered as a pretend patient with our service so that in theory I should be able to see my data both as a patient and as a Healthcare Professional. We all enthusiastically checked our glucose levels, and it has been mightily interesting. We used to say that without diabetes, fasting blood glucose levels are normally between 4 and 7 mmol/L, but we've never really known what a 'normal' post-prandial peak looks like, although pregnant women are set a threshold of 7.8 mmol/L one hour after a meal.

It turns out that our post-prandial peaks are often much higher than this - I managed to reach 12 mmol/L after a particularly nice lunch - but we do tend to come back down very quickly and stabilise within range. We also found that the sensor told us that we all drop below 4 mmol/L at some point in the night, which for someone with diabetes is classed as an unwanted night time hypo. The Libre license requires you to check blood glucose at hypo levels, but I couldn't check the 'real' state of affairs because I didn't have any blood glucose testing equipment, which someone with diabetes would have.

It was all going well and I was looking forward to seeing what happened when I played badminton, except that on Sunday night, after less than a week, the sensor came off when I removed my jumper. So that was disappointing, but it's also useful information to know that the glue isn't quite as sticky as we would hope. When I came back to work, I found that my nurse colleagues had become bored of the whole thing and had deliberately taken their sensors off after less than a week. More useful information about how patients might behave.

Then, about a week later, I was chatting to the paediatric diabetes team, and they told me that there was a stash of sensors in the department that I didn't know about. This time I put one on the other arm, and it has been behaving rather differently. It no longer shows overnight low glucose, in fact overnight is a very stable time when I sit comfortably around 5 mmol/L. So either there is a variation in the sensitivity from one sensor to another (Mr M's theory) or it matters which arm hosts the sensor because pressure on the sensor during the night is likely to confound its sampling.

So I did get to wear a sensor for badminton after all, and nothing whatever happened - no downward trend in the glucose level at all. Managing carbohydrate, insulin and blood glucose around exercise is one of the things that people who inject insulin find very difficult to manage, and the rest of us don't even notice.

I have three days to go on the second sensor, and in fact I'm now checking it less often and finding the results less interesting. The first group of actual patients with Type 1 Diabetes have now been given their sensors - unsurprisingly, everyone who had been invited turned up - and I think the second group session in June is already full. We anticipate that after this initial spike in demand everyone who wants one will have one, and we can go back to normal levels of patient apathy and non-attendance.

What I've been reading

Lord Hornblower
by C. S. Forester

"Horatio Hornblower must rescue a man he knows to be a tyrant from the mutiny of his crew - a dubious chore, but one that leads Hornblower, with the aid of his old love, Marie, to the glorious conclusion of his own battle with Napoleon."

Despite not understanding any of the nautical or military content as usual, it's still a good yarn. It's obvious he can't be executed because a) he's the hero and b) there are more books, but how does he escape? I spotted the twist at the end for a change.

Relativity for the Layman
by James A. Coleman

"A simplified account of the history, theory, and proofs of Einstein's revolutionary conception of the universe."

With an endorsement by Einstein himself on the inside front cover, this was written in 1959, before any space exploration had taken place. A fascinating historical snapshot as well as a lucid and comprehensible explanation of the General and Special Theories. It includes the question of whether there could be a star so dense that light couldn't escape from its gravitational field...

The Gun
by C. S. Forester

"It is the time of Napoleon. The Spaniards are fighting a desperate, protracted, bitter and merciless guerilla war. Into the hands of a guerilla band falls a remarkable cannon, an 18-pounder that transforms the rebels into a besieging army."

Not a Hornblower saga, this small book relates presumably an imagined course of events within the framework of Napoleon's campaign in Spain, with Wellington fighting on the English front. The hero of the book is the eponymous gun, and the tales of its journey, its use and its demise are perfect reading for the traveller.

A House for Mr Biswas
by V. S. Naipal

narrated by Sam Dastor

"Born into poverty, then trapped in the shackles of charity and gratitude, Mr. Biswas loathes his wife and her wealthy family, upon whom he is dependent, and longs for a house he can call his own."

A long rambling book telling the story of the life of Mr Biswas - he is consistently called Mr Biswas even when he is a child - who is from an Indian family living in Trinidad. He is often touched by tragedy, many times through his own neglect or incompetence, and usually comes off worst in financial deals throughout his life. The book ends with his early death at the age of 46, but I was left wondering what was to become of his family, as he had failed to repay the loan on the house which is due any day.

Amazonia part 2 and Paraty

Amazonia, April 2019

So my forest comrades had set off back to Manaus, and I was still in the Amazon jungle. My new companions were a young Israeli man and a Serbian couple who live in London, but they weren't in the same league as the friends who had just departed. This was the 'local homestay' part of the trip, and unfortunately it was the worst part of the whole holiday.

The local house we were to stay in turned out to be the home of one of Moses's brothers and his family. We were first taken to a local bar - not so much for our benefit I suspect, but because it was Saturday afternoon and Moses got to hang out with his mates. There was a football game going on which was joined by our football-mad Israeli, and it was interesting for a while to see people gathering, having a drink, there was a barber there cutting hair and I could glean a little from the TV in the background. But we were left there for a good deal too long before going back to the house for supper, which was chicken and rice again, and nice enough. There was virtually no interaction with the host family, however.

We were back sleeping in hammocks, but this time inside the house. By 7.30 p.m. it was dark, and Moses left us with a cheery wave and 'see you in the morning'. There were no chairs, and with no time to get to know one another I made a bit of an effort at conversation, but the other three didn't seem to want to chat, and the electric light went off at 8.30 p.m. After this second experience in a hammock I joined the dots - literally - and realised that my bites weren't necessarily from mosquitoes. Altogether I was glad to get back to the lodge for breakfast, even though it was now raining.

The next trip was to a local centre that contained the school that Moses had attended, which he said contained about 225 pupils, a shop, a doctor's surgery, a dentist and two churches. It was Sunday so the school was closed, there was a service going on in one of the churches, and there wasn't much else to see. After lunch the four of us went on another boat trip with Moses and saw more monkeys, birds and a quick glimpse of a snake before it plopped into the water. Despite the rain it was a three-shower day for me - I was hot, sticky, itchy, and yearning for a comfortable place to sit. I really would have been happy to go home there and then, but there was one trip more next day.

This time I went out into the forest with a different guide plus three Russians. Although we covered much the same ground as with Moses and saw many of the same things, there were still new experiences and lots to see. My main regret through the whole trip was not to have binoculars - the bird life was spectacular - and next time I'd take a cushion.

The trip back to Manaus was quick and efficient, and although this time it wasn't raining I still couldn't get a decent view of the Encontro das Aguas. Back at the hostel (soft chairs! bliss!) they let me hang out for a small fee to use the facilities because the flight back to Rio was at 2 a.m. I showered, repacked, went for a wander and bought some provisions for the flight, and was inundated by everyone's photos now that I was back in range of wifi. Ina and the unnamed Italian were still around so we chatted, and then the hostel called me an Uber and I was off to the airport. The driver was a P.E. teacher by day and driver by night - we couldn't communicate much but I can now add Uber to the list of transport options during the fortnight's holiday.

The next 15 hours or so were spent on the move. First the flight from Manaus to Rio with a transfer in Brasilia. Then I took a taxi from the airport to the busy and confusing coach station, where at least twenty different bus companies were offering tickets to various destinations, and where the maximum cocoa content of the chocolate in the sweet shop was 40%. Brazil's mass market chocolate really isn't much good considering that they grow their own cocoa beans. From the coach station it was a four and a half hour journey to Paraty in a comfortable air-conditioned bus. I was met at the bus station by T, my friend from school days.

Souvenir soup

We went for a short walk around the town before T said he needed to buy a few provisions and was it all right if we stopped at a supermarket? He had no idea what he was letting himself in for, and after I'd pestered him to death about all the unfamiliar fresh produce he excused himself and escaped outside to make a few calls while I continued to browse the shelves, adding a few more interesting soups to my previous haul. Then we drove back to his house, which was about 30 minutes out of town up the mountain. T was very pleased to receive my gifts of Branston pickle, Piccalilli and Heinz Sandwich Spread, and I was very pleased not to be carrying them in my rucksack any more.

Watching birds from the balcony

I went to bed early and slept late, relishing the comfortable bed and slightly lower temperatures, even though it was still very humid and not sunny. I'd hoped to do a bit of laundry, but it would never have dried and I didn't fancy wearing or returning home with damp clothes. We didn't do much that day or the next except chat, mostly about Trump, Assange, Bolsonaro and Brexit. T isn't planning to come back to Britain, but despite this he is extremely vocal about the state of the UK and its government and politics. I sat on the balcony overlooking the Atlantic forest, watched the birds and meditated a little.

Watching other birds from the balcony

T drove me to a local restaurant with a huge garden where I begged for a salad, after which we shared the traditional Brazilian dish feijoada, which is a bean stew with pork and beef in it, eaten in this case with rice and kale. It was delicious, but afterwards I found I was completely unable to eat anything else that evening or for the whole of the next day. It might have just been a reaction to the stress I'd put my body through. In the Amazon particularly I had been finding the heat, humidity and itching from the bites almost unbearable, as well as the discomfort of sitting on hard seats with no backs all the time.

I felt a bit more robust on Friday, and T had things to do, so I took a local bus into Paraty and joined a guided tour, where I was the only participant. The town was settled by the Portuguese in the 16th century, and prospered when it found itself on the route for export of gold that had been discovered further inland. When the gold started being exported via an alternative route Paraty continued to handle coffee and slaves, but today the historical town centre is preserved and the main trade is tourism and production of the local cachaça spirit. I wandered around a bit and found my first chocolate shop that had what I would describe as a decent selection, before catching the bus back to T's house.

Paraty house

That was the end of the trip bar the 24 hours it took to get home: T took me to the bus station for the coach back to Rio, I found a local bus from the bus station to the airport, and spent some of my remaining local currency in the airport on the most overpriced sandwich I think I've ever had. I couldn't sleep at all on the long trans-Atlantic flight and managed less than an hour during the 5-hour stopover in Paris. From Birmingham I caught the train home and walked from the station. It was freezing! And how welcome that was!

I was happy with how much I'd seen in two weeks in such an enormous country. There is plenty more if I should choose to go back - a notable landmark I chose not to visit is the Iguaçu Falls, on the border with Argentina and apparently more impressive than Niagara. The Pantanal wetlands in the south-west holds an enormous variety of wildlife, the historic towns of Recife and Salvador on the north-east coast sound interesting, and there's always Fortaleza where I have been offered a homestay, and the cities of Brasilia and Sao Paolo. Now that I've had the nasty yellow fever vaccination I ought to make the most of it. We'll see.

I haven't got any better at taking selfies

Amazonia part 1

Forest camp, Amazonia, April 2019

Without doubt, the middle section in Amazonia was the best part of the holiday. Not just because of the setting and the sights, but because of the people that I met. Seven of us were booked to start the organised trip at the same time, but four of us were there for three days, two for four days, and only me for the five day option.

But before that trip started I was collected at Manaus airport and taken to my accommodation that night: an actual hostel, the sort that proper backpackers use (although I had a private room, with en suite and aircon! Bliss!) At reception I was asked if I was a backpacker, and I didn't know what to say. Does a rucksack instead of a suitcase qualify you to be a backpacker? If so, then yes I am! If staying in a hotel in Rio and then a private room in a hostel disqualifies you, then no. They also took a photo of me at reception. I imagine it's handy in case you don't come back from some ill advised excursion that backpackers might choose to go on.

Teatro Amazonas, Manaus

There was still some daylight left so I wandered down to the port and the produce market, but it was hotter and even more humid than Rio, too late for much produce to be on display, and it didn't feel like a very safe part of town. It was also too late to explore the magnificent Teatro Amazonas opera house. I was told that the city was booming since President Bolsonaro had taken office because of industry incentives, but the centre was still shabby and didn't seem to be very prosperous. Then I had some packing to do, because I was going to leave a whole lot of stuff in the tour office while I was on my Jungle Adventure.

I was collected early next morning. The first leg of the trip was a 40 minute car drive out of town to the ferry which would take us across the 'meeting of the waters' (Encontro das Aguas) - where the black Rio Negro meets the brown Amazon and the waters don't mix. If it hadn't been pouring with rain then the boat's plastic windows wouldn't have been firmly lashed down and we might have had a better view, but I got the idea and it was fairly impressive despite the limitations. There are many good pictures on the Internet if you have a look.

The end of the road

On the other side a van was waiting to take us to the end of the road, which took about an hour. It did stop raining at this point, but no let up from the heat and humidity, and this was the last point for five days that I had a soft seat to sit on. At the end of the road we were taken by boat to the Juma Lake Inn, where lunch was waiting. Meals comprised rice, beans with chicken or fish and sometimes salad or vegetables or fruit. It wasn't fancy but it tasted fine. Not being a coffee drinker, I was limited to water - not just for this section of the trip but pretty much for two whole weeks, apart from a few bowls of Redbush tea towards the end (I had to use a bowl because T's coffee cups were too small).

I should introduce my Amazonian companions. My favourite by far was Thomas, a young Dutch graduate who had completed a law degree and was taking the opportunity to travel for a few months before moving to Amsterdam and getting a job. I am very much hoping to stay in touch with Thomas, but three days together in the Amazon may not be an indicator of a long term friendship. We'll see.

Ina and an insect

Then there was Ina from Austria who was a bartender and waitress, and her Italian travelling companion whose name I shall never know. When we were introduced I'm sure he said Jonathan, or John, but later I thought someone called him George, and elsewhere I saw it written as Schorsch, but by the time I realised I had no idea what his name was it was much too late to admit it. He was a reckless youth who had no sense of his own mortality. While we were loitering deep in the jungle watching what our guide was about to show us, he was wandering off the path poking a stick into holes in the hope of dislodging a snake, scorpion, spider or other potential hazard. While we watched, Ina said thoughtfully, "I think that he would definitely die first." Ina was lovely.

Crowns for the ladies

There was also a heavily tattooed Swedish man called Alex who turned out to have Type 1 diabetes. I discovered this when he took out an insulin pen and injected himself in a way that was very unlike how an insulin pen should be used. This turned out to be because he had left half his diabetes supplies on a bus in Bolivia so now he was rationing his needle use and the needle was a bit old. He also told us about being mugged after coming out of a tattoo shop in Columbia onto a quiet street a bit too late in the evening. "This is why they take your picture at the hostel," I thought.

All the above people were in the 20-30 year-old age bracket, but the last two in our party were 75-year-old travelling companions from Germany, Rosel and Rolf. They were game for the boat trips and jungle walks but drew the line at the optional nights in hammocks and came back to their beds in the lodge on those days.

Moses peeling Brazil nuts with a machete

Our guide introduced himself as Moses, and we found out more about him as the days went on. He was a local lad, born and raised on the river quite close by, with five brothers and two sisters. He had never left Brazil and his English was atrocious, presumably picked up from TV and tourists. I could make out about 70% of what he was saying and I'm pretty good at English; I can't imagine what the others managed to understand with English as their second language. He was a huge practical joker though, with a big grin which made up for his linguistic deficiencies, and he did know his stuff - where to find caimans and monkeys as well as other wildlife and plants. I had a substitute guide on my last day whose English was really good, so I could ask him some of the more complicated questions about the environment and climate change, but I wouldn't have swapped him for Moses the rest of the time.

The lodge is situated on a tributary of the Amazon, the Mamori river, next to Juma Lake. That first afternoon we went out piranha fishing, each with a makeshift bamboo rod, line and hook. Moses had a bit of trouble finding piranhas for us - the first two locations he tried were piranha-free, but the third was a winner. I caught a fish for the first and last time, and Moses helped me to put it back in the water. The three boys went mad for fishing and could hardly be torn away while one of them hadn't caught the biggest or as many as the others. We kept the largest fish, and they were cooked for us. Verdict: bony.

Caiman

Moses caught a small caiman and brought it back so we could see it properly. He reckoned it was about five years old, and when he opened its mouth you could see there was no tongue. That poor creature was passed from hand to hand for photographs until eventually it was allowed back into the river.

We went out again at sunset although it was too cloudy for a good view of the sun going down. On this little trip we approached a tree that was covered in roosting white egrets or herons and black cormorants. As we approached they all flew off, black one way and white the other. which made me recall drawings by M. C. Escher which I have now looked up (this one, and this one). The reflections and depth of the river also put me in mind of Escher's drawings of reflections in pools of water.

Larvae

We were invited to get up early next morning for a trip to see the sunrise, but again there was too much cloud for it to be a spectacular sight. We did see vultures perched and soaring, a hawk catching a fish, and pink and grey river dolphins - not much of them and quite a way off, but exciting enough for me, and some of the grey dolphins hung around in the river right in front of the lodge.

After breakfast we were taken for a forest walk, which allowed Moses to show us lots of the different plants, trees and animals but also gave him full rein to play as many tricks on us as he could manage. He pretended he was going to spike me with a huge thorn, and that he was going to throw a spear at Ina, and tried to frighten us with spiders, encouraged us to try climbing a tree, showed us how to use ants as insect repellent, made palm crowns for the ladies and bracelets for all of us, and sliced open coconuts to reveal fat white larvae that he skewered and 'cooked' using shavings from an oil-rich palm. We saw Capuchin monkeys high in the trees, an electric eel in a shallow stream, and many forest berries and plants and their uses.

The camp bedroom

That night was when five of us (plus Moses) were going to sleep in hammocks in the jungle. The hammocks were made of thick blanket material, smelled foul and were slightly damp due to the humidity and being kept in large sacks. Mosquito nets were loosely fitted over the top of these and hung to the floor. We strung them up under a thatched canopy, then were sent to fetch wood for the fire and help prepare the supper. It wasn't long before a large black caiman, the dangerous type, was circling by the shore, no doubt attracted by the bits of chicken Moses was throwing into the water.

Black caiman

Moses made us a tablecloth of woven palm fronds, constructed a griddle for cooking the chicken as well as staves to hold it up and to hold the pan of water for the rice. The dinner was surprisingly well cooked, and then we went out for a boat trip in the darkness, under a brilliant starry night sky. Moses caught three large fish with his torch and spear - he said the torch picks out their eyes under the water. We also saw a huge tarantula on a tree trunk.

Tarantula on a tree trunk

Back at camp the caipirinha cocktails started to flow, my nameless Italian demonstrated a pyromaniac tendency and nearly ignited the fire shelter roof, Ina started to sing and everybody was in fine spirits. The group bonded. We would never find such good companions, this was the best way to live, travelling stories abounded - mine from thirty years ago, but still, we could compare modern times with the olden days. No mobile phones, no Skype, no WhatsApp, no Internet - true isolation that's hard for the current travelling generation to imagine. I was reminded about what I love about travelling, and why I should do it more often, even while my old bones ached for something soft to sit on.

Moses tending the grill

I had done pretty well with my insect repellent up to this point, and had escaped with just a few random bites. The morning after the night in the forest I had acquired many, many more. With hindsight, that hammock was the culprit, no doubt harbouring all manner of biting insects, and the last few bites are still troubling me. At the time I hadn't considered this, and assumed that it was just a failure of my mosquito net. Anyway, I've had better nights' sleep especially as Alex had a powerful snore, but in the morning we cleared out and came back to the lodge for breakfast, after which I caught up with some sleep before our next outing, to a nearby house where a family made their living from their land. And, presumably, from their tourist visitors.

They grew produce of all kinds - mango and passion fruit, Brazil nuts, onions, cacao and a whole lot more. They had a small scale mill for manioc (cassava) flour, generally known as farinha, which when mixed with butter or oil makes farofa and is sprinkled on every dish. I'm sure that the bread at the lodge was made from farinha rather than wheat flour - it had that gluten-free cakey texture. There was mimosa, and biting ants, and I tasted my first Brazil nut straight from the tree.

After this outing and the first rain we'd had since getting there, sadly my four forest companions headed back for Manaus and further travels of their own. I was genuinely sorry to see them go. But I was staying for another two days, so I would no doubt meet alternative travel companions.

Moses, Ina, Nameless Italian, Thomas