Developments at work

Caldecott Park, Rugby, May 2015

Crack open the champagne - they've finally installed an alternative web browser on my work PC! I tried for an upgrade to IE long ago but it was incompatible with another application on the PC and had to be removed again. At the time I didn't think to ask for a different browser, and they didn't offer it, but a colleague mentioned the option and now I've got Chrome. It's such a treat to be able to see websites that aren't completely garbled, and more and more sites were just refusing to load at all with the ancient version of IE. Now I can update my yogurt document (don't ask - it's just a list of the nutritional content of various strawberry yogurts).

Another work-related thing is that I've volunteered to be a subject in a research project. On a day when I'm being a guinea pig, using an app or via a website I have to:

• weigh myself first thing
• collect and measure all my urine throughout the day
• put two small urine samples in a test tube on each occasion
• eat less than 1200 Calories in the day, comprising a normal breakfast, a carb-free meal, and a snack that's less than 200 Calories
• record everything that I eat and drink and any activity that I do as well as weight, urine volume and test tube numbers.

I've managed two days so far (it's not an every day thing) and it's actually quite demanding. The research is very relevant and all about a person's insulin response to food throughout the day - apparently there is measurable insulin in urine, which surprised me.

Then there's been our Teen course. I've written a lot about structured education, because it really is the key to managing diabetes. If you don't really understand the condition or how best to manage it (and it's quite a complicated business) then I don't see how you can expect to avoid having higher blood glucose than is ideal, and we know that this raises the risk of complications. But we find people are very reluctant to spend the time attending our structured education, and this is a particular problem with young people with Type 1 diabetes.

Most will have been diagnosed when they were too young to be expected to manage everything themselves, so if any education had been provided in the past it was probably aimed at parents. So we want to catch young people at a point when they are managing their own diet and insulin, to make sure they acquire all the knowledge that they need to stay healthy for the 50, 60 70 or more years that they may have ahead of them.

We decided we would try to attract 16-21 year olds, so we got together with the paediatric team to contact as many of this age group as we could. We did a mailshot and we encouraged people at their routine appointments to consider signing up, and ended up with 13 people who said they would attend. This seemed enough to justify putting on a course, so we cooked up a programme based on the usual version of our Type 1 Structured Education, but shorter, and including more that might be relevant to the younger audience - eating out, snacking, alcohol, drugs, festivals, travelling, sport and exercise, living away from home, that sort of thing.

As I wrote a while ago, only two turned up for the first week. The second week was scheduled on the same day as A level results are published, and one of our two attendees was due to get his results that day, so we agreed to skip that week and get them back the following week, covering everything in just two sessions seeing as how they were both pretty quick on the uptake. Only one of them came to the second session.

That solitary participant, however, gave us some good feedback and ideas about how we might attract more attendees if we tried again:

• offer food e.g. doughnuts/pizza
• start later in the day
• change some of the wording in the invitation letter
• arrange for transport from the city centre.

I'm not sure if we'll try this again, and it certainly won't be until next summer holidays, but it was a worthwhile exercise even if only one and a half people benefitted.

Sun + rain = camping + walking

Sudeley Castle, August 2015

It's been a rainy Bank Holiday weekend, although to be fair, some of Saturday wasn't bad. As I write, I hear muffled clapping, cheering and shouts of encouragement or triumph from the bowling greens, where we are reaching the end of a month of National Bowling action. Our period of exclusive entry to our little trio of streets guarded by high-vis-vest-clad doormen is nearly over.

In the past couple of weeks I've had quite a few evening appointments, including appearing on a panel for a different Diabetes UK local group from the one I used to attend until I'd had enough of their rudeness. The demographic was very similar - nobody under 50, a couple of opinionated and outspoken members, polite attention and some interesting questions. The panel consisted of two podiatrists, an optometrist, me, and a retired local GP who is fairly eminent in the Diabetes professional world. People were very interested in what the podiatrists had to say and much less interested in my contribution. I expect it's because someone's always banging on at them about food, whereas they have few opportunities to raise questions about feet.

I also enjoyed a weekend away camping with Lola II. The campsite was fine, including excellent hot showers but with fields mostly on a slope. I managed to find a relatively flat bit to pitch the tent before collecting Lola II from the station. We did a bit of campsite cooking and some eating out, but I'd brought quite a lot of salad ingredients, because a) that's what I had in the fridge, b) it's supposed to be summer and c) Lola II and I are both grappling with weight management.

We visited an old prison and a castle. The prison also contained a Cotswolds information centre, and Sudeley Castle (and Gardens) was staging an event including re-enactment of the period of Richard III, including costumes, armour, archery and music. The castle was home to Henry VIII's last wife, Katherine Parr, and she is buried there too - the only Queen of England to be buried in the grounds of a private home. There are gardens as well as the castle, and exhibitions on all sorts of aspects of historical interest. We were there for hours and didn't see everything - there was plenty to keep us occupied, and it was really hot.

On Sunday we met up with Landrover Man and Bee Lady for a lovely walk in the countryside. LRM can always be relied on to plan a route and guide us around it, thus saving endless hours of getting lost which would happen if I were in charge.

The Weather Gods had a hand in the loveliness of the countryside, providing torrential rain halfway through when we were in the middle of a field, far from shelter. I had been too lazy to bother wearing proper boots so I was in trainers, and could wring my socks out at the end, but it was worth it - not cold, and good to catch up with bees, farmyard machinery, sheep and septic tanks. I can vouch for the impressive improvement to the vista chez LRM and BL because we were sent 'before' and 'after' pictures of the septic tank cover.

So that was a good weekend away. For the Bank Holiday weekend I decided I had procrastinated long enough and it was time to put in a bit of effort into choosing and buying a car. So early on Saturday I got up and did a Parkrun instead. I find that buying a car (or in fact buying anything except food and charity shop clothes) is really difficult and fairly unpleasant, but I found one in the end and it's probable that the ordeal will be over in a month or so. The dreadful experience is too fresh to write about now, but I'm sure I'll manage to bring further vehicular news at some point.

Sudeley Castle again

What I've been reading

The Hound of the Baskervilles
by Sir Arthur Conan Doyle

narrated by Simon Vance

"Sir Charles Baskerville has been found dead. There are no signs of violence, but his face is hideously distorted with terror. Years earlier, a hound-like beast with blazing eyes and dripping jaws was reported to have torn out the throat of Hugo Baskerville. Has the spectral destroyer struck again?"

A good story - obviously I've read it before, but it must have been a long time ago because I barely remembered any details, let alone whodunnit. This Sherlock Holmes anthology is certainly living up to its promise so far.

The Man Who Was Thursday: A Nightmare
by G. K. Chesterton

narrated by Simon Vance

"Gabriel Syme is a poet of law. Lucian Gregory is a poetic anarchist. As the poets protest their respective philosophies, they strike a challenge. In the ruckus that ensues, the Central European Council of Anarchists elects Syme to the post of Thursday, one of their seven chief council positions."

This started badly and ended badly, but the middle was quite good. I didn't think I would relate to a story about anarchists, but I just substituted the word 'baddies', which worked well enough. The identity of the anarchist known as Sunday was revealed towards the end (it wasn't really a surprise), but after that the whole thing stopped making any sense at all. I got the impression that the author didn't really know himself how to finish it.

The Goshawk
by T. H. White

"This is the record of an intense clash of wills during the training of a great, beautiful hawk, in which the pride and endurance of the wild raptor are worn down and broken by the almost insane willpower of the schoolmaster falconer."

This is referenced extensively in Helen Macdonald's recent bestseller 'H is for Hawk', and having read that and unearthed this from my shelves it was obvious that I needed to read it. It's not quite as brutal as Macdonald makes out - she seemed to quote the worst bits, but even so, White has a tough time with his hawk and the hawk has a worse time with him. A classic for the aspiring austringer or falconer or someone like me who is a little bit obsessed with these birds; I don't think normal people would find much of interest other than to consider how things have changed since those difficult postwar years.

Guns, Germs and Steel
by Jared Diamond

"Since 1500, Europeans have, for better and worse, called the tune that the world has danced to. This book tries to explain why, and suggests that the geography of Eurasia was best suited to farming, the domestication of animals and the free flow of information. The more populous cultures that developed as a result had more complex forms of government and communication, and increased resistance to disease. Finally, fragmented Europe harnessed the power of competitive innovation in ways that China did not."

This was recommended ever so long ago, when I started my degree in 2007 and I've been looking out for it ever since. One of the lecturers was encouraging us to read around our subject, which is what I do quite a lot, so in return for this recommendation I provided him with a whole load of suggestions of other interesting books about science. In comparison with the books I recommended, this one is a dud as far as I'm concerned. The question the author sets out to answer is why Europeans tended to dominate the societies they met rather than being assimilated or even dominated by them, the simple answer being the title of the book. The discussion then becomes exceedingly anthropological, and I am not particularly keen on lengthy discussion about the development of farming and pottery or the spread of language throughout Austronesia. So read 'The Goshawk' if you are interested in birds of prey and read this if you are interested in anthropology, and avoid them both if you're not.

DESMOND

Peckover House, August 2014

"Another blog post so soon after the last?" I hear you cry. Well, I've been working on this one and another as yet unpublished post for ages, and I'm a bit busy for the rest of the week and the weekend, so here goes.

I have had a look back at the blog, and I can hardly believe that I haven't really explained what DESMOND is. Given that it has formed a large part of what I've been doing over the past 9 months or so, I'm surprised I haven't described the programme.

DESMOND is a nationally delivered structured education programme, designed to meet the criteria within the NICE guidelines for Type 2 diabetes, which has quite a lot to say about patient education:

1.1 Patient education

1.1.1 Offer structured education to every person and/or their carer at and around the time of diagnosis, with annual reinforcement and review. Inform people and their carers that structured education is an integral part of diabetes care.

1.1.2 Select a patient-education programme that meets the criteria laid down by the Department of Health and Diabetes UK Patient Education Working Group.

• Any programme should be evidence-based and suit the needs of the individual. The programme should have specific aims and learning objectives, and should support development of self-management attitudes, beliefs, knowledge and skills for the learner, their family and carers. 
• The programme should have a structured curriculum that is theory driven and evidence-based, resource-effective, has supporting materials, and is written down. 
• The programme should be delivered by trained educators who have an understanding of education theory appropriate to the age and needs of the programme learners, and are trained and competent in delivery of the principles and content of the programme they are offering. 
• The programme itself should be quality assured, and be reviewed by trained, competent, independent assessors who assess it against key criteria to ensure sustained consistency. 
• The outcomes from the programme should be regularly audited. 

1.1.3 Ensure the patient-education programme provides the necessary resources to support the educators, and that educators are properly trained and given time to develop and maintain their skills.

1.1.4 Offer group education programmes as the preferred option. Provide an alternative of equal standard for a person unable or unwilling to participate in group education.

1.1.5 Ensure the patient-education programmes available meet the cultural, linguistic, cognitive and literacy needs in the locality.

1.1.6 Ensure all members of the diabetes healthcare team are familiar with the programmes of patient education available locally, that these programmes are integrated with the rest of the care pathway, and that people with diabetes and their carers have the opportunity to contribute to the design and provision of local programmes.

So we offer group education delivered by trained and quality assessed educators with a curriculum that is written down. The only part that deviates slightly from the guideline is that I don't believe we are meeting the cultural and linguistic needs in the locality, but we're working on it.

The name DESMOND stands for Diabetes Education for Self-Management of Ongoing and Newly-Diagnosed. The syllabus content is prescribed, as are the Educator Behaviours in delivering the content. Educators are assessed on the manner of their delivery as well as including the messages that need to be delivered, because there is also a philosophy behind the curriculum. I do agree with this approach but I sometimes find it difficult to educate in the approved manner without sounding patronising.

During our delivery we are supposed to give as few direct answers to participants' questions as possible, because the emphasis is on self-management - if they have questions after the course we want them to be able to work out how to find the answers when we're not around. Of course, if nobody knows what is represented by the two numbers in a blood pressure measurement or how sulphonylurea medications work then we're going to tell them. But if someone asks "Is [food x] good for you?" as they often do, we are supposed to first throw the question back to the group, and encourage them to use the principles they've learned in order to work it out for themselves.

The course is delivered by two DESMOND educators either in one full day or two half days a week apart. After introductions and housekeeping, sessions include information about what diabetes is, causes, medications, monitoring, carbohydrates, calories, long-term effects and how to avoid them, other aspects of health associated with diabetes (cholesterol, blood pressure, smoking, depression), the annual review, physical activity, fats and overall food choices. Participants are encouraged and supported in recording their own results in a 'Health Profile', and at the end they are expected to create an Action Plan containing one thing that they are going to try to change or achieve as a result of the course, and how they will go about doing it.

My journey as a DESMOND educator started in October last year, when I attended the two-day course in London. The next stage is for educators to go away and practise educating, and within six months they are supposed to arrange a session when they are observed for half a day by a mentor and given feedback, and then the final quality assessment of a whole day's course, of which you deliver about half, alongside your co-educator.

There are some interesting assessment tools, including a 'beep score'. The assessor listens to a track in one ear that beeps every ten seconds, and marks down who is talking at the point of the beep - is it the educator, the participants, or is something else happening (an activity, or silence, or laughter)? A percentage score is calculated to represent the proportion of time that the educator is speaking, which needs to be less than the particular percentage threshold set for that session. Other assessment is more conventional - is all the content delivered, are the educator behaviours as they should be, are the learning objectives met?

I had my mentor visit in February, and my final assessment in June. Thankfully I passed, so I am now DESMOND accredited, but it's lucky that the assessors have some leeway in their assessment. My Physical Activity session has never been great, but it was dismal on this occasion - I think it has since improved a little. We are expected to devise our own action plan along the same lines as the participants, and I really should have a look at mine soon. Accreditation is periodically re-assessed, and you have to deliver a certain number of courses a year in order to remain accredited.

I do enjoy delivering DESMOND, and of course every group is different. I haven't had anything very difficult to deal with - the most challenging was probably one participant with mental health issues who spent some of the time asleep, and walked in and out of the room at random. He wasn't very disruptive though, as we could ignore him or include him as appropriate. Every now and then a participant tells us that they don't know why they have been invited to the group because they don't actually have diabetes - of course we have checked beforehand and they do have diabetes, but the way the programme is delivered means that they usually work this out for themselves as we go along. The most negative comments we get are generally those that say they wish they had been given the information earlier.

We were given extra funding for a year because we got very behind with our courses and waiting times became unacceptable, so I have been employed one day a week to help catch up. We have caught up and that funding ends in September, and I will actually be glad to go back to four days employment a week. In order to keep up my DESMOND accreditation I do need to deliver a few courses, which will be on top of my four days a week.

So from October I hope to have an extra day in the week for all the jobs that are hanging over me - much work around the house and garden, buying a new car, a dress for Sister D (the fabric has now been bought!) Or, more likely, I'll doss about as usual and nothing will get done. Place your bets.

Travel and work and badminton and running and shopping and cooking

Courmayear, February 2015

There's been another trip south, which is why there hasn't been much blogging action recently. I've been fully occupied all of one weekend on family stuff, and during the week there's been work and badminton and running and shopping and cooking, and the sole TV programme that I actually watch (The Great British Bake-Off) has started a new series. And I went out with work colleagues to celebrate my birthday, and met a friend while I was in London that I hadn't seen for more than 25 years. So blogging has had to take a back seat.

Lola II and Mr M and I ate well as usual during my visit. We decided to try somewhere we hadn't been before that offered Caribbean food from Trinidad. It was a fairly new restaurant and they were very keen to tell us all about the food, which had a more Indian influence than the Jamaican style food that's more commonly found. I had mutton, Lola II had chicken and Mr M had salt cod, and it was all very good indeed. Next day I wore my newly made dress for the Family Birthday Celebration (and I wore it the week before for the Works Night Out), and it looks so good and I was complimented so much that it all went to my head and I offered to make another one for Sister D. Using stretchy material it shouldn't take too long...

Badminton - the good news is that following rest and changing my mouse to the other side, my racquet arm is as good as new, possibly better. Running - I'm getting along OK, I'm nearly half way through a training plan leading up to this pesky 10k plus obstacle course that I've signed up to, but I have a feeling that the race will arrive before the end of the training plan... not that it matters that much.

Work - lots of interesting things and still many frustrations. We tried to entice as many 16 to 21 year-olds as we could onto a specially designed education course for Type 1 diabetes, but out of the thirteen or so who had verbally agreed to come, only two turned up (and for a period of about 15 minutes we thought it would only be one). One of the meter manufacturers has offered to sponsor a course that would include go-karting so as to attract the target audience, but I'm not sure if we'll take them up on it because we don't actually like their meter very much. The company that makes the meter we do like hasn't provided us with a rep since last December, otherwise I'd be very keen to put a bit of pressure on them to help us out.

Solitary holiday #3

Harrogate, July 2015

I liked Harrogate, despite the rain. The town was accessible and attractive, as were the people. Maybe I'll go again next year.

Monday

Despite the forecast it didn't rain all morning, and I ventured out to have a look round. The town is larger than I was expecting and I wandered about fairly randomly, just getting oriented. My first impressions were that the architecture is lovely, there's quite a lot of history reflected in the buildings, and there is no shortage of places to eat, often advertising local produce that looks rather tasty. And lots and lots of shops that I didn't go into. Maybe later in the week.

Like my Solitary Holiday two years ago, I thought I'd like to make another dress, but this time for me rather than for Lola II. My inadequate preparations for this holiday (as usual) meant I hadn't bought any fabric in advance, but I did do a bit of Internet research and discovered that there are two fabric shops within walking distance of my apartment. Two! The first was very small, very crowded, the member of staff I found was rather unhelpful and they didn't seem to have the range I wanted. The other one, however, was bright and airy and despite having less stock overall, they had more than one design in the jersey fabric I was looking for. And I got a whole lot of invaluable advice and information about sewing with stretchy fabric, using a fancy double needle, tips for putting in the zip, and an offer to help me get the hem straight if I couldn't do it on my own.

'Kursaal' or Royal Hall, 1902

Tuesday

Looking into the hall from a box

The rain held off for my outing today, which was to the Royal Hall. This glorious building was built at the turn of the 19th century as an entertainment venue for those coming to Harrogate to take the waters. At the time it was named the Kursaal, but was renamed after the First World War due to anti-German sentiment. At the turn of the 20th century it had deteriorated to the point of demolition, but was saved and restored to its former glory.

'Ambulatory' circuit, Royal Hall, showing doors to boxes

There happened to be an Open Day on Tuesday including a tour of the building. Apart from the wonderful decor, stained glass windows, interesting private boxes and the provision of a walkway all around the outside of the inner hall, the part of the tour that made the greatest impression on me was when we were shown where the rear balcony was. In its heyday, the smart folk of the time would have looked out over a rose garden, a tennis court, statuary and parkland leading up to the grounds of the Majestic Hotel. Now you can see only concrete yards, the bins, and the back of some of the halls belonging to the International Conference Centre.

Wednesday

Today's cultural outing was a tour of the Turkish Baths. Unlike the single spring in Tunbridge or the few in Leamington (now reduced to just the one there too), there are many sources of spa water in Harrogate, and with varying composition including waters containing sulphur, iron and magnesium. The first spring was discovered in 1571, well before Leamington's or Tunbridge's.

The Pump Room (which I visited after the Baths) was built on top of four of these springs, and the Turkish Baths was built just up the road in an absolutely enormous heavy-looking building that now houses the Tourist Information office, a large Wetherspoons pub, a nightclub and a Chinese restaurant as well as the Baths, which have been restored to nearly how they would have been originally but taking account of modern sanitary requirements.

Frigidarium, Turkish Baths

The fixtures and fittings are wood, tile, terrazzo and mosaic floors and glorious walls painted in the Turkish style. Heat is provided by a boiler in the basement, and we were taken through successive rooms from the 'cold' room, the plunge pool through three stages of heat including the steam room. It is still owned by the Council and in use today (although obviously not during the tour) and also offers other 'treatments'.

As the popularity of spas declined in England, lots of buildings were repurposed. The Victoria Baths became Council offices, a building originally built as a theatre or assembly room is now an Art Gallery. In more recent times the town reinvented itself as a conference destination and even hosted the Eurovision Song Contest in 1982 and the end of the first stage of the Tour de France last year. There are still quite a few reminders of Le Tour around town in cycle logos, small sculptures or features on buildings.

The original Pump Rooms, now split into several separate establishments

Thursday

This was supposed to be a mostly fine day so I planned to go to Harlow Carr, a Royal Horticultural Society garden. It can be reached on foot through the municipal Valley Gardens and Pinewoods, so that's what I did. I'm sure the gardens are very lovely and probably comparable with many other gardens I've visited and enjoyed. The main problem was the rain, which took much of the pleasure out of seeing plants and landscape, and then the battery on my camera ran out. Eventually I got so fed up of getting rained on that I gave it up and walked back, at which point the sun came out. Not for long, though.

Dinner was at a Turkish restaurant, where the lentil soup was particularly delicious.

Friday

Throughout the week at odd times here and there I've been working on the dress. Today I haven't planned anything else, so I had a good run up at the most difficult bit - putting the zip in. After two or three attempts I finally decided that the fabric is so stretchy that I don't actually need the zip, which made the business a whole lot easier and could have saved me three hours. I did some cooking, some reading, and I watched a film on DVD. Outside, it rained.

One of the reminders of the Yorkshire Tour de France

Saturday

There's a Parkrun in Harrogate just a few minutes walk from where I'm staying, so I did that. Compared with the lovely Leamington route around the golf course with its monster hill in the second kilometer, Harrogate's course is almost completely flat and just three straightforward laps around a field. It was gloriously sunny and I felt optimistic for better weather at last.

The dress is almost finished, but the final hem went very wrong when I kept running out of thread. The fancy twin needle works surprisingly well at producing a stretchy seam, but is fairly hungry for thread and misbehaves badly when deprived. I had to unpick the whole seam, and it was lunchtime, and I wanted to go to a particular pub for lunch which was near the fabric shop. So I put on the dress with its slightly unfinished seam to show the lovely ladies in the shop, and the moment I stepped out of the door it started to rain.

The pub was a good choice for lunch and the lady in the fabric shop was pleased that I'd come to show her the almost-finished dress. I finished it in the afternoon and then finished up my holiday with a performance of The Gondoliers in the evening, the first event of the Gilbert and Sullivan Festival being held in Harrogate through August. Lovely.

Sunday

More rain, obviously, but sunshine as soon as I got home and went indoors to unpack. That's life.

Waterlogged roses

I am on holiday again

Rugby School Old Quad

I sometimes wonder whether I can keep up with this blog. And then I remember that I've kept it going for 8 years, and I don't think I'll ever stop. I seem to have an almost irresistible urge to write about any mundane or irrelevant aspect of my life, and about 40 people are still reading. Shame on you, 40 people. There are more constructive ways of spending your life than reading this inconsequential stuff. But I suppose it only takes a few minutes to read each entry, and unlike when I was a student five years ago, when I thought it was entirely reasonable to produce a post every other day, nowadays I only manage one post a week if you're lucky. I am devoted to a few other people's blogs that appear far less frequently, so maybe this vanity publishing project will stagger on way beyond its natural lifespan. 40 people, I salute you for your tenacity.

Last week was pretty full on at work - I was supervising a student who wanted to do a little bit more active interaction with patients. There was nothing for her on Monday, but I picked out two patients on Tuesday that I thought would be OK. Unfortunately they were both interesting, unpredictable and challenging, and although she gave it her best shot, they proved a bit much for her. One of them was a bit much for me too. On Wednesday I had to do the ante-natal clinic, which luckily was fairly quiet. When I was advising one of the patients that she shouldn't be drinking too much milk, she told me she'd had advice from one of the doctors that she should actually drink lots of milk. One of my colleagues thinks this might be due to general iodine deficiency in the population, rather than the need for calcium.

But now I am on holiday, again! It's partly so I don't have to go to work on my birthday, and partly because I miscalculated the amount of annual leave I am entitled to, so I was a little extravagant in booking another week off so soon after the last epic holiday. Now I think I only have a week left (not counting the week already booked for New Year), so I have to choose between a) going skiing in 2016 but no days off between now and Christmas or b) a week before Christmas but no days off between New Year and the end of March. A difficult choice.

Anyway, I am in Yorkshire - Harrogate to be precise, on another Solitary Holiday. After Tunbridge Wells for two years in a row I am continuing the theme of Spa towns, and have taken an absolutely lovely apartment where I will spend time reading, writing, watching films and, with luck, sewing myself a dress. I may even go for a stroll around the town, if it ever stops raining. The forecast says that Thursday will probably be the least rainy day, which will be nice because that is my birthday.

What I've been reading

The Memoirs of Sherlock Holmes
by Sir Arther Conan Doyle

narrated by Simon Vance

"We are drawn into 19th-century London - hansom cabs, train rides, and foggy nights - where Sherlock Holmes astutely solves the most complex and perplexing cases of the day."

Nothing new to say about this - more stories, great narration, and it is at this point that Conan Doyle tires of his great creation and tries to kill him off at the hands of arch-villain Moriarty. It's surprising that an author would want to put an end to a money-spinner; these days if any sort of weak sequel to a blockbuster can be squeezed out it will not only end up as a trilogy of books, but the film version will split the last book into two separate movies to attract more cash into the coffers.

The Boys from Brazil
by Ira Levin

"Alive and hiding in South America, the fiendish Nazi Dr. Josef Mengele gathers a group of former colleagues for a horrifying project - the creation of the Fourth Reich."

I've seen the film so it's difficult to review the book dispassionately, but it's good. Ira Levin has written quite a few books that I've seen in their movie version, but based on this example I'd be happy to read the books. Usually it's the other way round - I've read a book, and if it's good then I'm extremely cagey about seeing the film. Even though I knew what was going on before it was revealed in the book, there was enough suspense (but not too much) and the characters are nicely defined.

Joy in the Morning
by P. G. Wodehouse

narrated by Jonathan Cecil

"Trapped in rural Steeple Bumpleigh, a man less stalwart than Bertie Wooster would probably give way at the knees. For in his efforts to oil the wheels of commerce, promote the course of true love and avoid the consequences of a vendetta, he becomes the prey of all and sundry. In fact, only Jeeves can save him."

The usual story full of misunderstandings, unwanted engagements, ludicrous plot twists but the requisite happy ending. Good old Wodehouse.

Elizabeth is Missing
by Emma Healey

"‘Elizabeth is missing.’ Maud keeps finding notes in her pockets with this message scrawled on it, but she can’t remember writing it. That said, she can’t remember much these days: the time of day, whether she’s eaten lunch, if her daughter’s come to visit, how much toast she’s eaten."

This was very disconcerting to read. It is written from the perspective of a woman with worsening dementia, and really gives a sense of memory loss and the difficulty that arises not just for the individual concerned but also the family, friends, acquaintances and almost everyone else that we come into contact with in daily life. Recommended.

H is for Hawk
by Helen Macdonald

"When the author's father died suddenly on a London street, she was devastated. An experienced falconer, Helen had never before been tempted to train one of the most vicious predators, the goshawk, but in her grief, she saw that the goshawk's fierce and feral temperament mirrored her own."

I was hoping for much with this award-winning bestseller: perhaps I hoped for too much. It was a lovely book, it's true, but somehow didn't live up to the hype. It did remind me about T. H. White's book The Goshawk, which I read when I was much younger and I have just found on my shelves, my copy dated 1990 - 25 years ago! I wanted to be a falconer then, and I still would like to, although I doubt that I will make that particular commitment any time soon. I haven't even joined the falconry centre this year, although I do hope to sign up again next year when perhaps I will have a bit more time. I'm always wishing for more time.

The Enchanted April
by Elizabeth von Arnim

narrated by B. J. Harrison

"A notice in The Times addressed to 'Those Who Appreciate Wistaria and Sunshine' advertises a 'small medieval Italian Castle to be let for the month of April'. Four very different women take up the offer: Mrs Wilkins and Mrs Arbuthnot, both fleeing unappreciative husbands; beautiful Lady Caroline, sick of being 'grabbed' by lovesick men; and the imperious, ageing Mrs Fisher."

I'm surprised by how much I enjoyed this book. It is so evocative of the best of Italy - the spring weather, the flowers, the scenery, and the type of solitary holiday that made me want to join them there and get away from the stresses and annoyances of ordinary life. I had no expectations of this book, having never heard of the title or the author, so maybe this is why it made such an impression. I loved it.

I need to calm down

Peckover House, August 2014

Here is a list of things that I wanted to blog about but which happened too long ago for me to even remember what was involved or what I did:

• Getting final accreditation as a DESMOND educator despite not meeting the assessment criteria for the session on physical activity
• Having tennis elbow and trying to do things to fix it, including not playing badminton for a month and operating the computer mouse with the other hand
• Going to a study day about 'Diabesity' (combination of Type 2 Diabetes and Obesity) and being impressed by just one of the speakers
• Attending a two-day course all about insulin pumps, including the opportunity to wear one for about 18 hours (I even took pictures)
• Camping for one night, then going to a lovely party, then staying for one night in a room in the college where I lived when I was doing university degree #1 in 1983-6
• Writing a letter of complaint to the college about a) breakfast b) parking and c) payment methods listed on the invoice
• Getting a plumber in who took all of 20 minutes to fix the problem at Lola Towers (so not that serious a problem really)
• Meeting some of the Research, Development and Innovation Team at work and getting a bit enthusiastic about projects that I really haven't got time for any more (see below).

As you might have deduced from the last blog post, things have become a bit overwhelming at work and at home. The work situation is exacerbated because of three factors: 1) one of our Dietitians has moved away and it is proving difficult to recruit a replacement, 2) a new service that has been planned for what seems like an eternity has suddenly popped into existence and needs a Dietitian to cover a new clinic, and 3) we have an unusually high number of candidates for our Type 1 structured education so we've had to schedule extra courses. And it's the season for Dietetic students to spend a week in Diabetes, which just adds to the pressure and workload.

My workload fits into half-day chunks, and previously I had on average about three half days during the week for admin, thinking time, planning, projects and generally catching up with stuff. At the moment I'm lucky if I get one half day on Friday afternoon, which is not the best time for doing anything that requires concentration or stamina. Most of my bright ideas will require time and effort to make them happen, so they've all been shelved in favour of the stuff that has to be done to keep the service going, and I'm only just keeping up with that.

I have pretty terrible teeth (bear with me, this is relevant) but I have so far managed to stop any of them falling out through fairly frequent visits to the hygienist. I had one such trip yesterday, and the hygienist commented that she could tell I was under stress because of the state of my gums. She has supplied me with all sorts of desperate measures to try and prevent further deterioration, but the prospect seems bleak. I don't actually know what the next stage would be in terms of treatment, but I'm guessing that extra appointments, cost and discomfort is involved. 

Like I said last time, there are people whose problems make mine seem utterly trivial - on the whole my health is good, I have a good job and an income and a home and really have nothing to complain about. What I really need to do is relax, do what I can do, and stop worrying. And go to bed earlier.

Seize the moment to blog

Garden rose, June 2015

It's no use trying to compose careful prose and produce a well-crafted blog post about some aspect of my work or leisure that has made me think of something clever or interesting. There's no time. I have a mountain of paperwork, a backlog from my holiday - I knew there was a reason that I only go away for a week at a time. Then I was away for another two days on a course (that I want to write about) and then my week was stupidly busy and I was away for another weekend. So I'll just bang out some words about anything that occurs to me and have done with it.

We have a problem with our plumbing at Lola Towers. Mr A told me last week that the hot water had stopped running, but then it started again. We put it down to polystyrene balls - a very long time ago, one set of incompetent plumbers allowed polystyrene balls to get into the water system. On reflection, we haven't had any trouble for quite a while, so when the hot water failed again when I got back from my weekend away, I sought the advice of a friend who had that very weekend suffered something similar. Following his advice we ventured up into the loft, where the header tank for the hot water turned out to be empty. That was Sunday night, and I wasn't about to call for an emergency plumber seeing as the cold water was running fine and it was an intermittent fault - by Monday morning the tank had filled again.

I am an organised person, and I have many lists that remind me of things that need to be done. I find it impossible, however, to manage to simultaneously do the things on the list that I find difficult; I can just about manage them one at a time - partly because of the difficulty, but also because I have very little time to myself at work due to multiple patients and full clinics and delivering training off-site, and because there is no mobile phone signal in my office. To make a mobile phone call I have to leave the building and stand outside the door, and then it's difficult to write things down, and I can't refer to my online diary because the computer's inside, and if there's no answer I can't leave my number for them to call back because there's no signal when I go back into my office...

So I try to achieve one difficult task a day, and there are many tasks waiting. On Monday it was a call to a solicitor, and today I managed to call the plumber. (There is also the problem of when to arrange for him to visit, as Mr A and I are both working full time at the moment). Tomorrow I need to call the accommodation we have booked for New Year, on Thursday I need to send a letter of mild complaint to the accommodation I stayed in on Saturday night (Lola II is helping to draft it), and you would not believe how dirty the shower is. And there's that huge pile of paperwork that needs sorting out or else my car will not have a parking permit in August, among other slightly less urgent issues.

Then on Thursday there's the second week of our current carb counting course, so I have to cook some carbs for them to count. That means baking a potato and cooking measured amounts of pasta and rice on Wednesday evening to take to work on Thursday. This is a) to demonstrate the change in weight of raw vs cooked food (rice and pasta increase in weight, baked potato decreases in weight but carbs are unchanged for both) and b) to encourage the participants to weigh/measure these hard-to-estimate starchy carbohydrate foods, so that they will know for example how many carbs are in a standard tray of takeaway rice.

And of course I want to keep up the running, and my elbow is pretty much better so I'd like to go back to badminton, and there's the clarinet choir which is staging a concert in a couple of weeks. And I need to buy a new car, and new trainers, and waste paper baskets, and a bedside lamp, and put the charcoal picture that I drew at Mr M's birthday event into a frame, and re-pot and rejuvenate my house plants, and now the 15-foot rose bush and the enormous wisteria need pruning. I've used weedkiller on the patio weeds, but they need to be cleared, and all the rubbish littering the garden taken to the dump. My email inbox is bulging with messages that aren't important enough to be dealt with straight away but not unimportant enough to be deleted, and I am well behind on reading my blog subscriptions.

At work I have a similar number of issues. I was determined with this change of career that I would try and avoid the frustration of being unable to change the world by keeping my head down and letting the world sort itself out. It turns out that I can't seem to do that. Before I went away to America, I wrote a very apologetic note to my manager, detailing three pages of projects that I have taken on but are being thwarted by various barriers: procedural, technical and human.

I want to have a Internet-enabled data projector in our education room. I want to create a website to support our very low carb lifestyle group. I want to be able to show web content to our patients that is blocked by the Trust, including social media and videos. I want to support a new 'transition' clinic for young people moving from the paediatric to the adult diabetes service. I want to be able to offer patients the option of very low calorie 'diabetes reversal' diets that include meal replacement products. All of these need someone else to do something or agree to something, but instead of getting these things that I want, I have been asked to cover an extra clinic in the community on a Tuesday afternoon, and - the horror! - three half-days of ante-natal clinic over the summer (one of my colleagues has left and there is a gap before her replacement starts). And I have stupidly followed up a very good idea from one of my colleagues which needs me to do even more organising and coordinating.

I appreciate that these are problems that some people would be happy to have in place of the real and serious problems that they are having to deal with, but we all would like an easy life, wouldn't we?