Wednesday, 22 June 2016

Father's Day Temptation

It was Father's Day Sunday just gone, and with it came temptations to spoil my diet. On the Saturday we went out for an Italian, a starter portion of carbonara followed by calzone weren't exactly the healthy options, but then there's no point in paying to eat out somewhere special and then ordering stuff you're not fussed about, may as well just stay at home. I did pass over the option of a dessert, but that wasn't much of a hardship, desserts in Italian restaurants (and Spanish for that matter) are usually pretty mediocre. I don't drink coffee so the ever predictable tiramisu is of no interest and unless they have a good selection of proper gelatto then ice cream is a waste of valuable calories.  

On Sunday morning the kids gave me a large bar of Reece's peanut butter chocolate, which I've so far avoided opening. I love the stuff, but once it's open the chances are I will struggle to avoid eating it in one or at best two sittings. It was a nice day, so we took a picnic to Priory Park, the only problem being that I always end up eating more at a picnic lunch than I would normally. My typical lunch is a roll or sandwich and occasionally some crisps at the weekend, but I ended up adding not just crisps but some snack sausage rolls and a chocolate biscuit, then a little later in the afternoon we had ice cream from the cafe.

In the evening the in-laws came up for dinner, which of itself wasn't a problem, but I wasn't very happy with the volume of dessert my wife had bought. For four adults and two children we had a large cheesecake and a large chocolate fudge cake, each of which would give six generous adult servings. Add in berries and fresh cream and it was more than double the amount of dessert we really needed. I resisted, but made the point that going so far overboard with dessert was wasteful and doesn't make things easy for someone trying to diet.

Friday, 17 June 2016

Side Effects of CKD

One of the funny things about CKD is that until you get down to the final stages it has little in the way of external symptoms, this is one of the reason why early warning signs weren't pieced together in the development of my own CKD.
Around fourteen years ago I had an ultrasound scan to investigate a stomach problem and the technician noted my right kidney was very small, which wasn't actually as big a surprise as it might have been given my Mum had one kidney removed as a child and my brother was born with only one kidney (albeit his one kidney is apparently larger than typical). But that comment was tangential to what the scan was actually for.
Then around ten years ago a routine check at my GP's surgery had picked up that I was suffering from mild hypertension (higher than normal blood pressure), but it wasn't considered significant enough to treat because there was no link to my kidneys. Then a little while later I failed a medical due to protein being detected in a urine test, my GP investigated further but the conclusion was that there was nothing to worry about. These disparate pieces of information did not link together and therefore no steps were taken early that might have prevented some of the deterioration that followed.
It was only after I had a procedure to treat two bulging discs in my back and the hospital flagged concerns about my blood pressure that the problem was uncovered, unfortunately by that time I'd also experienced significant weight gain due to the back problems (there is a whole other story for another time about that).
The only direct physical symptoms of my CKD is the sporadic gout, which has been getting worse as my kidneys get worse. But whilst gout is linked to CKD plenty of people with gout don't have CKD, especially overweight men such as myself. The only other physical sign of my CKD is actually a reaction to the Ramipril medication which has left me prone to sudden bursts of cramp in my calf muscles, something a previous consultant confirmed was a not uncommon side effect. I have trained my body through force of habit to avoid stretching too quickly in a morning, instead I gently work my way into stretches, I'm careful not to bend over too quickly in certain ways or to spend too long sitting in certain positions. Of course sometimes it cannot be avoided, sometimes I'll turn a certain way in my sleep and wake up screaming as the pain shoots through my legs and I have to get up and stretch my calves or I'll end up in pain the next day. It's not something my wife impresses my wife who gets woken up a stupid o'clock in the morning.
But I consider myself lucky so far, there may come a time when I'll look back in fondness to the days when gout and cramp were the only side effects.

Wednesday, 15 June 2016

Back to the GP

Just under two weeks ago I received a letter from the GP surgery informing me they'd received the letter from the consultant (my copy arrived a few days later) and asking me to come in and discuss the changes. So I called up and asked for a slot in the late surgery that runs on a Monday, I had to wait a week but as it wasn't urgent that was fine.

The appointment turned out rather timely as I've experienced another stubborn bout of gout and although my magic pills (a.k.a. Colchicine) were helping I can only take 4 a day for three days before breaking for three days and starting over again. The upshot is that the attack has stayed under control without fully clearing (I  dread to think what it would have been like without magic pills), and as I cannot start taking Allopurinol until I get properly clear of gout I'm in a bit of trap. I'm fortunate that I have no shortage of magic pills as the 48 the Consultant prescribed in May have been boosted by 150 the in-laws obtained over the counter in Northern Cyprus. They've also offered to get me some more in August if I need them which will rather depend on how the Allupurinol performs. My current supply should last a year assuming that heavy attacks remain an exception and the less serious ones clear within a day and a half of treatment, but it is quite literally a pain to run out of them during an attack.

I discussed the gout with the GP and he suggested a five day course of Prednisolone steroids (40mg once a day), which I was actually going to suggest myself given it worked okay last year. He described it as "using a sledgehammer to crack a nut" but I'm not convinced as last year I needed two courses of the same, admittedly that attack was more severe but I wasn't using magic tablets back then so there was no mitigation already in place. My hope is the steroids will break the current three day on/off cycle and next week I will be able to start the Allopurinol. Other than that we talked about coming off the water tablet and that I need to keep an eye on my blood pressure as we may need to increase the daily dose of Amlodopine (Ramipril is maxxed out). He also suggested I may need to come back after I've been on Allupurinol a little while and I've made a note to self to get more consistent taking weekly blood pressure readings at home.

My weight loss has pretty much stalled, no gain, but I'm still hovering around the 115kg mark I was a month ago. I have made an effort to get back into the swing of things diet wise this week, but an attempt at a new exercise plan stalled with the gout attack, so once the Prednisolone does its thing I'll be restarting that.

Sunday, 12 June 2016

Musings on pre-Diabetes and dieting

After my GP's recent disclosure that I am at high risk of developing diabetes, I have defaulted into self-education mode, which has loud echoes of what I did when I was diagnosed with CKD. In some ways it is a shame that the NHS isn't a bit more proactive with constructive support, admittedly both my GP and consultant have encouraged weight loss and a healthy diet, but I am already attempting both to some success and it's pretty generic advice short on the specifics of what will deliver actual results.

It's still a bugbear of mine that in early appointments after my CKD diagnosis the (previous) consultant and registrars I saw debated referring me to a dietician and prescribing Orlistat but never did (although they never definitively ruled them out, it was more a decision for another time that never came). I even discussed Orlistat with my GP, but again without meaningful conclusion. It was only when my first phase of weight loss flat lined at 125kg that we skipped to the nuclear option of stomach surgery, although ironically that requires a referral to a dietician first. Without abdicating my own personal responsibilities; I suspect I’ve been hoodwinked by the schtick around the NHS getting serious on supporting health issues earlier when costs are lower.

The surgical option has been withdrawn from the table for now, but I still think I could benefit from professional advice on dieting that is tailored to me rather than the hypothetical Mr Average. Pre-diabetes adds an extra complexity to what is already a minefield of conflicting advice. I avoid adding salt where possible and reserve certain foods such as crisps and peanuts as occasional treats, I try to opt for low fat and low sugar options whilst being mindful that when either fat or sugar is reduced in many products the other is substituted to maintain palatability. I believe that many of the staples of my current diet such as bread, pasta and potatoes are much reduced in diabetic diets, but removing them from now is not straightforward, I need genuinely palatable alternatives that are capable of making me feel full need to take their place. Palatability is a major weak point in many diets, and substituting staples with alternatives that leave you hungry half an hour later is setting up for failure.