Friday, 16 March 2018

I do stuff and stuff gets done

Piste in the morning after snowfall
Trois Vallees, France, March 2018
I've been away and then very much over-committed in the evenings. Work is mildly annoying, skiing was great, badminton is similarly great, and meditation is OK (we've had a change of group leader and I'm having to get used to a different style). Ilf has varnished and painted a whole lot of stuff, plus he kindly switched my fridge door round and did a few other small jobs. He's due to be back again next week to finish the painting, after which there will be tiling. I have visited a tile shop and had a very entertaining conversation with one of the employees who I hope will be guiding my tile choices - now I have to measure the kitchen, which perhaps with hindsight I should have done before going to the shop.

That's all for now. Life is hectic.

Two skiers in the sunshine

Tuesday, 27 February 2018


Seville, November 2016
Another successful Gulloebl Film Festival has taken place chez Lola II and Mr M, with the usual high quality films and hospitality. My favourites this time: Grosse Point Blank (which was much more funny than I remember), and Best in Show (which was just as funny as I remember). My contribution was to drive mum and dad over to join in - the first time they have been to the house for quite a long time.

Meanwhile, the LRTP continues with Ilf varnishing stairs and kitchen doors and painting kitchen skirting, walls and ceiling. It all looks beautiful. I have, at last, felt able to just sit and read a book for an hour or two without the nagging feeling that I should be doing something. Of course there are still plenty of things I should be doing, but at least I can relax some of the time.

I have made an investment in buying a ski helmet and ski boots. The procedure for fitting the boots included measurements, a certain amount of trial and error, and experimenting with different manufacturers. Sadly the ones that fitted best were plain black and white rather than the blue and electric pink ones with furry lining. The inners were softened by heating and moulded to the shape of my feet. I've been wearing them around the house with rags tied around the bottom to protect my lovely floors, and the fit seems perfect. I'll be trying them out in the field next week on my second ski trip of the year.

The main thing bothering me at themoment is entirelymyown fault. In a distracted state I looked at my laptop keyboard and wasmildly dismayed at its filthycondition. So Iremoved the space bar and did a fair amount of cleaning witha small paint brush. Canyou see what has happened since then?

Wednesday, 21 February 2018

What I've been reading

Image of the book cover

by Louis Sachar

narrated by Kerry Beyer
"Stanley Yelnats has been unjustly sent to a boys' detention center, Camp Green Lake in Texas, where the Warden makes the boys 'build character' by spending all day, every day, digging holes: five feet wide and five feet deep."
It's a book for young adults but I enjoyed it hugely. I think I've been subjecting myself to works of quality for too long, so an easy read with a great story, good writing and plausible plot is unexpectedly pleasurable. All my reading should be fun; I have let it become too worthy.

Image of the book cover

The Sleepwalkers: A History of Man's Changing Vision of the Universe
by Arther Koestler
"A thought-provoking account of the scientific achievements and lives of cosmologists from the Babylonians to Newton."
I thought this would be an interesting history of astronomy from the viewpoint of someone writing in 1959, and I also remember finding it interesting when I read it in my teens. It is, however, dense, academic and enormous, covering the lives as well as the work of Copernicus, Tycho Brahe, Kepler and Galileo in immense detail but giving Newton not much more than a couple of paragraphs. I had a marathon journey home from Italy which gave me the chance to do some prolonged reading, otherwise I'm not sure I could have finished it.

Image of the book cover

The Assassin's Prayer
by Ariana Franklin
"The King of England has ordered his Mistress of the Art of Death - anatomist and doctor Adelia Aguilar - to accompany 10-year-old Princess Joanna on her thousand-mile journey to marry the King of Sicily. They must take with them the legendary sword Excalibur."
The fourth and last book of this series - last because the author died after writing this one. It's pretty good, but not as good as the previous ones, and there's much less of the anatomy and forensics which contributed a lot to the appeal of the first books.

Not much reading in two months, but my current audio book is an epic tome lasting more than 48 hours and I'm only half way through. Spending a week on holiday puts me in arrears with my podcast listening too, so books take second place until I've caught up!

Tuesday, 13 February 2018


Purple flowers with yellow centres in the sunshine
Spain, November 2016

It's getting ridiculous how I spend my Tuesday off running around like a mad thing Getting Stuff Done rather than enjoying some time to myself with a book and a cup of tea. Not that there aren't plentiful cups of tea, but usually accompanying at least one other activity. Unlike Saturdays, when I try to have at least a bit of a break.

Last Tuesday felt particularly hectic:
  • Set the alarm to wake up, because...
  • Dropped the car off for an oil change and service, highlighting problem with tracking and/or steering
  • Bought some milk and posted a letter on the way home
  • Cooked mushroom and egg on toast for breakfast (this is a treat for a day off)
  • Made four lunches for the rest of the week from interesting buckwheat pasta bought on holiday
  • Contacted AEG customer support to enquire about certain operations of new microwave oven - did it over the web but should have phoned because response has not been forthcoming
  • Phoned chimney sweeps and then realised this would have to wait because...
  • Planning how to buy ski boots and this is more urgent than chimney sweeping
  • Arranged to meet friend in Birmingham for lunch (less urgent than ski boots)
  • Ordered ski helmet for collection at the weekend
  • Lunch consisting of leftover soup and salads
  • Garage called to inform me that one tyre was damaged to the point that I was fortunate it hadn't exploded
  • Three more phone calls for various enquiries and appointments
  • Started writing blog about insulin pump training day
  • Cleared utility room ready for disassembly of cupboard in order to enable fitting of stopcock push-button valve
  • Changed keysafe combination for kitchen fitters (I have a different combination when I'm expecting tradesmen)
  • Scheduled future plans for replacing bathroom radiator
  • Shopped for plastic tubs on the way to collect the car
  • Came home and organised more kitchen stuff into new plastic tubs
  • Drove to B&Q to buy a shelf for the kitchen
  • Drove on to work in order to attend meeting for patients on insulin pumps who are not achieving their aims, but the time had been changed so I missed the first two hours
  • Drove on to meditation with Buddhists. We are looking at the archetypes who comprise the Mandala of the Five Buddhas, and to be honest the discussion is not doing much for me, but the meditation is good and it's nice to have company for some of the day.
Not every Tuesday is this busy, but most of them are. I used to wonder how I managed to work full time, but I must have done all this stuff at the weekends. Since that Tuesday I've had a whole week followed by another Tuesday. Plumber Ulf came to sort out the stop tap business and while he was here he changed my bathroom taps and pipes so that it now takes less than a day to fill the bath. There's been badminton, I collected the ski helmet, and I've also done a lot of floor waxing and polishing so the living room is lethal when wearing socks. And at the weekend the soul of the television was stolen with a quiet 'pop' and faint smell of burning. It was about 15 years old, so fair enough.

In between all this I've still been going to work, but there's very little new to report on that front. Patients continue to be interesting but impossible to write about, I enjoy delivering the group education as well as the one-to-one consultations, but I'm always happy to go home at the end of the day.

Wednesday, 7 February 2018

Another insulin pump

Butterfly on leaf
Krakow Botanical Gardens, July 2016
There are a number of different insulin pumps available on the UK scene - unfortunately one fewer than there were last week, as one company (Animas) has withdrawn from the pump market. We support three different pumps in our service, although the majority of people use one particular brand (Roche). A training day was offered by Medtronic, one of our less used suppliers, and all three of our nurses, one doctor and I attended to learn more about how the pump is used and about some other associated products.

It's a 'tubed' pump, which means that a tube carries the insulin from the reservoir in the pump down to a cannula inserted subcutaneously. [Tubeless or 'patch' pumps (like the Omnipod) are mounted directly onto the skin with the cannula on the underside of the pump.] A blood glucose monitor communicates with the pump, and an insulin calculator is integrated into the pump rather than the monitor. The main consequence of this is that the pump has to be accessible for anything other than a preset bolus amount - the other brands we use can stay hidden under clothing as all their functions can be operated from the blood glucose monitor alone.

Aside from this one drawback, I like the Medtronic pump. It has potential beyond just being an insulin pump because it can be hooked up with an integrated Continuous Glucose Monitoring (CGM) system. This allows for anticipation of low blood glucose (hypoglycaemia) and the pump can actually suspend insulin delivery for up to 2 hours ('low glucose suspend'). It can do this automatically or with user input, with or without alarms, day or night. This has been shown to prevent hypos without leading to high blood glucose afterwards.

'Low glucose suspend' kicks in when blood glucose is within 3.9 mmol/L of a user-selected 'Low Limit' and predicted to drop to less than 1.1 mmol/L above the low limit within 30 minutes. So if the user selects a low limit of 3.4 mmol/L, insulin can be automatically suspended if 4.5 mmol/L is predicted when blood glucose is 7.3 mmol/L, as measured by the CGM sensor which is monitoring glucose levels through another cannula. Insulin is restarted either when the user intervenes, or when blood glucose is predicted to rise 2.2 mmol/L above the low limit within 30 minutes, or after a maximum of two hours. I started to argue about why the user-specified low limit couldn't be the actual prediction (4.5 mmol/L) rather than 1.1 mmol/L below it (3.4 mmol/L), but our tutor wasn't following my argument so I had to abandon that line.

We looked through the pump's menus, set up two basal patterns, set temporary basal rates, entered blood glucose levels, delivered different types of bolus and generally learned about all the different settings. We were shown different cannulas and inserters and stabbed ourselves with those, and then looked at the reports that can be produced, both with and without the associated CGM trace. They left this bit until the end, and I would have preferred a bit more time to work out what the reports featured, where the most useful and important information could be found, and a bit more practice at interpreting the tables and graphs.

The chap leading the training day was a healthcare professional who works for Medtronic and goes out to patients to start them on pumps, review, or troubleshoot. He also has Type 1 Diabetes himself, and uses a Medtronic pump. Occasionally he would throw in some personal experience about how he would manage a situation himself. Nobody, and I mean nobody that I have met through our diabetes service (or elsewhere) treats their diabetes in the way that he does. "But if I don't do it like this I'll have a higher HbA1c [i.e. worse control], so why wouldn't I?" he said. True, but he is in a bit of a unique position, understanding his diabetes and how the pump works as he does. And he seems more motivated to manage his diabetes than almost anyone I've met.

[For those who know about the numbers, he tested his blood glucose about an hour before lunch, it was 7.1 mmol/L with no active insulin on board and he gave himself a bolus of less than one unit of insulin. "My target is 5.5, I've got the technology, so why not?" he said.]

This company is aiming at development of the technology beyond the 'low glucose suspend' option. They have plans for a 'hybrid' system that will adjust basal insulin all the time according to CGM results, not just when blood glucose is dropping. Bolus insulin for food will still be down to the user, which distinguishes the hybrid from the 'artificial pancreas' level of technology (which does exist but is still too experimental for mainstream use).

At the end of the day we were also reminded of another bit of kit that the company produces, which consists of a cannula that can be worn for up to three days (like a pump or CGM cannula). This one, however, is designed for manual injections, so its function is to enable someone to give all their multiple daily injections for three days through the one device. The obvious benefit of this device is fewer skin-piercing injections; the downside is that by the end of three days the effectiveness of insulin injected in the same spot can fade a little, and the risk of developing lipohypertrophy ('lipos', or fatty lumps) is higher.

The sales pitch suggested that this is a device that would benefit everyone, but would it benefit someone who is doing well and doesn't mind multiple injections? Such a person would be moving their injection site around, wouldn't risk lipos and wouldn't experience the decrease in the effectiveness of their insulin. Balanced against that is the benefit of reducing the unpleasantness of multiple injections. It's difficult to judge the psychological strain of many injections compared with one cannula for three days, but so far I haven't started pushing this device to patients.

Friday, 2 February 2018

Ski Folgarida

Racks of skis with a mountain and blue sky behind

It was a great holiday, run by the Ski Club of Great Britain. I discovered that this organisation originated from a time when keen Britons lived in ski resorts, and the Club linked them together so they could visit each others' resorts and ski together with local knowledge. Times have changed, but the focus is still on higher ability and more technical skiing (and snowboarding). I joined one of their holidays in 2014, and this was a similar one that also included three days instruction. On the other three days we were supposed to be guided by a Ski Club Leader, but he turned out to be an instructor too and so we got instructed on all six days, and often more by the Leader than by the official instructor.

The Italian resort Folgarida is a long way from Milan airport with more than three hours on the bus to the hotel, which was right on the piste but well away from the village, which meant they tried hard to put on entertainments in the evenings. One night there was a pianist/singer, another night we had a local cheese and meat tasting, but I missed much of the evening activity because after dinner I'd generally had enough and went to bed.

There were 14 of us including the Leader, and what an interesting group of people they were. A pilot, an economist at the Bank of England, a Forensic Psychologist, a BP executive, a retired owner of a children's nursery who had previously been a ballet dancer, a retired photographer, a BBC website editor, a couple of retired lawyers. Mealtime conversation was a great deal more stimulating than what I'm used to at work. I got on well with most, but not at all with two of them.

The skiing went well - I was initially put in the more advanced group, but I switched for the last two days because the numbers worked better and it got me away from one of the people I didn't get on with, which is when I discovered I didn't get on with the second one. Unlike the previous Ski Club holiday we weren't forced off piste all the time, but did a very little bit of off piste much more successfully than before. One of the highlights was a long quiet gently sloping run through the woods, another was the opportunity to have one's picture taken at the start of a World Cup downhill slope, and a third was an interesting local liqueur called 'Bombardino'.

As always I made a trip to a local supermarket where there was no interesting chocolate, so instead I bought some interesting pasta with a recipe for local dish 'pizzoccheri'. I also bought some of the delicious cheese and salami from the hotel cheese-and-meat tasting. The food in general was good, with a couple of oddities thrown in. We were given menus each evening to choose the following evening's dishes without much explanation, so one of my main meal choices turned out to be three very large (~250g) pieces of cheese, accompanied only by a teaspoon of honey and a teaspoon of mustard. The cheeses were very tasty, but not what I would have chosen for dinner had I known. On another night the 'grilled cheese with caramelised onion' turned out to be just that - a small browned onion on a plate next to two slices of cheese that were slightly melted. Luckily I hadn't chosen that option.

At the end of the week my skiing ability was rated exactly the same as it had been four years ago, which surprised me because I feel a great deal more competent now than I did then. Then another 13-hour journey to get home, where I have been feeling a little sad at the lack of interesting people and their stories, but happy that I have another ski trip planned for six weeks' time.

More snowy scenary

Sunday, 28 January 2018

To Do and Have Done

Sunshine and cloud obscuring mountains and slopes
Probably Madonna di Campiglio, January 2018
I am a very task-driven operator. My lists rule my life. Having said that, it would be a shame if I couldn't relax while there are still things on the list still To Be Done, and I am very mindful of the fact that there will always be things on the list still To Be Done and sometimes you have to let them wait a day or two while you have a rest.

I have obviously been crossing quite a few things off the lists recently, the most notable being the word 'kitchen'. The building inspector has signed off the project and I've received a 'Completion Certificate' which I have duly filed. He didn't ask any questions, had a quick look outside and inside and the whole thing took no more than five minutes. There are still issues with the utility room tap, access to the stopcock, and the telescopic rails for the oven, but I have arranged for Kitchen Ylf himself to visit and advise. Ulf has been very helpful with suggestions of why the tap may have a problem and how it might be resolved.

Tester pots for kitchen paint are waiting for me, and Ilf has given me a few ideas about where I could look for wall tiles. He's booked for decorating towards the end of February. Cleaning and putting things away continues, but I'm getting there. The garden is in a right state with building debris littering the lawn, but the weather is too horrible at the moment and I'm not going out there until it gets a bit warmer.

Away for a week skiing - blog post to follow...

Sunday, 14 January 2018

Last snags

Carnivorous plants at the Krakow Botanical Garden, July 2016
Now that most of the LTRP (Kitchen Instalment) is done, I've returned to my previous dilatory habits, and the frequency of blog posts seems to have returned to previous levels. However, I was delighted to spend my first weekend in the new kitchen, although I'm still cleaning utensils and deciding where to put things. The new saucepans are wonderful, but the ovens are somewhat harder to operate than they should be.

It turns out that I keep a surprising amount of stuff in the kitchen, but I'm weeding out a few bits and pieces. One new project I'm thinking about is to sell stuff in the local car boot sale. One of my badminton-playing friends regularly attends a car boot to sell his plants, so I'll have a look when the 'season' starts in May.

Last Tuesday was fully booked with the boiler due for a service, building inspector coming for the final sign-off, laundry to do and hoping to go for a walk with a friend. The boiler man was first and he was a delight - very enthusiastic about my brand of boiler and showed me how to deal with error codes. Then he helped me move a sofa from the living room into the kitchen.

When the building inspector hadn't turned up by lunchtime I phoned the department, where an idiot of a man wasted quite a lot of time by looking up addresses that weren't mine but eventually said that there was no record of any scheduled visit. So I made another booking for next Tuesday, but by this time it was too late for a walk because of the requirement to do laundry when I took the opportunity of washing all the sofa covers too.

I got a call from the kitchen Ylfs to say that all the missing parts had arrived, and Team Ylf could either visit on Friday or not until February. So on Friday they made more dust and finished constructing cupboards and the sink in the utility room, plumbed in the washing machine and adjusted the plinth below the dishwasher so its door would open. They were unable to come up with an answer to the problem of the inaccessible stopcock.

After they went I celebrated with a load of laundry and a load of dishes, but discovered that the hot water pressure in the utility room is too low for the tap to work properly. I don't know if this is a problem with the tap itself, the installation or the plumbing behind it, so I have contacted all parties to ask them for their suggestions.

Friday, 5 January 2018

New year, old friends

Spiky pink flowers
Krakow Botanical Gardens, July 2016
Now that all the building work is finished with only a few things left on the snagging list for the kitchen people, there really isn't anything much to write. I sent a couple of messages to the kitchen company, but so far they haven't responded. I had a lovely ten days off work, but only three of them at home.

For Christmas I was in Nottingham with very old friends. We had nut roast for Christmas dinner and Boxing Day lunch was at the boating clubhouse by the side of the river. The sun was out, but it was jolly cold.

Between Christmas and New Year I did some more kitchen shopping - lampshades, bar stools, wine glasses - and went to Steve's funeral. It was worse in the anticipation than the reality, and a few light moments helped me to stay composed, especially when the organist and the congregation parted ways for a couple of verses of 'Abide With Me.'

I spent New Year in Cambridge with other old friends. This was a slightly longer trip with activities that included walks, pub lunches, evening dinners, games, shopping and even an interlude to play badminton. Lola II and Mr M were also present (except for the badminton and shopping day), and provided key elements of the games activity. We visited a bird reserve and saw migrating swans, we were prevented from reaching one of our pub choices because of extensive flooding, and I bought saucepans!

Both Lolas and Mr M catered for thirteen at the New Year's Eve dinner. There were supposed to be fifteen, I'd multiplied all the recipes up to sixteen and then two didn't come, and we had so much food that we didn't even serve two of the courses (salad and fruit). And I'd made a mistake with one recipe and doubled the amounts, which didn't help with the surplus food situation. It was most convenient having bought saucepans because we could use them to take away some of the leftovers, which we then had for lunch next day with mum and dad plus enough for my lunches for the rest of the week.

My last day of holiday was Tuesday, when I collected my new spectacles (they are so similar to the previous pair that nobody has noticed so far), and admitted defeat with the weight loss plan and bought new trousers from the charity shop. I treated myself to a trip to Ikea where I bought more useful kitchen stuff including bins for recycling that fit perfectly under the sink, which makes me very happy. I'm planning to restock the freezer with soup over the weekend, and I have a list of things to cook that use the new kitchen facilities - toasted cheese, jacket potato, poached egg - not complicated dishes, just things I've been missing.

Friday, 29 December 2017

What I've been reading

Image of the book cover

Beyond the Pyramids: Travels in Egypt
by Douglas Kennedy
"With an acute eye for the unusual, the interesting or the plain absurd, Douglas Kennedy takes us on a continually surprising tour beyond the pyramids, to a place where Bedouin in an oasis watch American television; where monks in the desert are computer literate; and where an entire community of Cairo's poor has set up home in a cemetery."
Quite interesting, written in 1988 and presumably I bought it (in 1990 it says on the flyleaf) because I had been to Egypt around that time. Because of my current de-cluttering frenzy it is going to the charity shop next.

Image of the book cover

A Guide to the Good Life: The Ancient Art of Stoic Joy
by William B Irvine
"Readers learn how to minimize worry, how to let go of the past and focus our efforts on the things we can control, and how to deal with insults, grief, old age, and the distracting temptations of fame and fortune. We learn from Marcus Aurelius the importance of prizing only things of true value, and from Epictetus we learn how to be more content with what we have."
This is not my normal reading fare. When it was lent to me by a good friend I have to admit feeling a little apprehensive - how long before I could decently return it unread? or would I have to pretend to have read it? But I thought I ought at least to have a go, and nobody could have been more surprised than I was at the truth I found inside. I knew nothing about Stoicism or any of the other ancient schools of philosophy and I'm definitely no philosopher, but this book lays it all out in very practical terms. At almost every page the messages tallied with my own 'philosophy of life' - an approach that I've adopted through trial, error and bitter experience to try to live the best life I can, minimising negative emotion and focusing on achieving equanimity. I laughed out loud when I turned the page and the chapter heading was "Negative Visualization - What's the Worst That Can Happen?" because I use that technique all the time. Imagining worst case scenarios can really help me to both move forward and also to appreciate life. The Buddhist group has a similar approach, but this book just put it all into language that I can truly understand rather than concepts derived from untranslatable Sanskrit words. I can give the book back with a clear conscience - in fact, I'm buying my own copy. So much for de-cluttering.

Image of the book cover

Small Island
by Andrea Levy

narrated by Andrea Levy
"It is 1948, and England is recovering from a war. Gilbert Joseph was one of the several thousand Jamaican men who joined the RAF to fight against Hitler. Returning to England as a civilian he finds himself treated very differently. Gilbert's wife Hortense, too, had longed to leave Jamaica and start a better life in England. But when she joins him she is shocked to find London shabby, decrepit, and far from the golden city of her dreams."
I was apprehensive about a book read aloud by its author, because authors are not always good narrators, but she does a terrific job. It's taken a long time to read, but it's been worth it.

Related Posts Plugin for WordPress, Blogger...