Sunday, 31 December 2017

Looking forward, looking back

This will almost certainly be my last post of 2017, I'm currently back up North visiting my family for New Year. 

It has been a strange old year, certainly a busy one, hence the limited posts, and maybe it marked a turning point in the managed decline of my kidneys. The dip in eGFR reported in October was a sharp reminder my kidney function is on borrowed time, in a couple of weeks I’ll get my next set of numbers and we’ll see if has dipped again. My weight has pretty much flat lined around 113kg, not ideal, pretty much where I was ten years ago, but at least I’ve avoided ballooning to the kind of weight I was five years ago.

There has been the ongoing farce of my vasectomy. The same day I go to my next Nephrology appointment I’ll be submitting my fourth andrology test to try and clear up the little matter of non-motile sperm. The GP will also hopefully have received a response from the surgeon who carried it out.

There are lots of positives ahead in 2018; I have my new job starting in early January and I’ve started to get my shit together for a podcast project I’ve been planning for a while (more about that soon). I’m going to make more of an effort to post here; perhaps broaden the scope a little bit and more importantly tackle some of the big topics I’ve been mulling over like the implications of ‘presumed consent’ for organ donation. On the CKD front the GP’s decision to refer me to the ‘Healthier You’ programme could also provide the next much needed step change in my lifestyle.

Happy New Year!

Friday, 29 December 2017

My poem about CKD

I wrote a poem about my CKD back in October. It was my submission to a competition run by my employer’s Disability Staff Network Group (DSNG) to publicise ‘International Day for Disabled Persons’ on December 3rd. Unfortunately I didn’t win, I didn’t actually hear anything at all, I only found out who won yesterday when I did a bit of searching across the staff intranet.

I actually joined the DSNG at the end of February and I’m still waiting to hear back about upcoming meetings and events. To give credit where it’s due the mental health stream is very active; with workshops and drop-in sessions heavily publicised, but I suspect this is due to the efforts of a few committed individuals and overlap with the corporate health and wellbeing programme. To be fair, I don’t consider myself as ‘disabled’, although that may change when my CKD gets to end stage.

Anyway here it is:  

Forgive my words if they are terse
It's not the end, it could be worse
They try their best, I'm sure it's true
But it's all my kidneys they can do!

They were never right from the start
Now I fear they'll break my heart
And when their time is finally come
I’ll beg a donor for another one

No point in asking ‘Why’?
Will only send my BP high
No more gout I hope and pray
It can only spoil my day

So a rather sorry little tale
I'll horde the days until they fail
Till then I mustn’t worry
For dialysis I’m in no hurry

Wednesday, 27 December 2017

More BMI Batshit and ‘Healthier You’

The BBC carried another story yesterday about the misuse of Body Mass Index by NHS Care Commissioning Groups (CCG) to ration medical treatment. It pretty much repeats the points I’ve made previously about this being very far from sound medical practice and more importantly how it is self-defeating. People who could benefit massively from treatment languish in a catch-22 situtaion whereby they cannot receive it because their BMI is too high, but getting BMI down is handicapped due to deprivation of treatment, the whole situation being determined by politics rather than medical science.
For my own sins I weighed in at 114kg today, up 1kg on last week, this is pretty much down to a little overindulgence over Christmas, and taking less exercise over the last few days for the same reason. I’ve tried to be sensible, it’s been far from a binge, but there are so many casual calories floating around this time of year, and when I don’t have to get out for work there’s less natural opportunity to exercise (the weather has been filthy).
113kg is pretty much where I’ve been for most of the last year, so I expect that’ll be where I am when I weigh in at the hospital in just under a fortnight. I’m approaching this one with mixed feelings, I really want to know if my numbers have stabilised or if I’ve dipped again. I might get a bit of grief over the lack of progress with my weight loss, but that no longer worries me so much, especially as there has been a recent positive development.
My GP is referring me to something called ‘Healthier You’ which is the tagline of the National Diabetes Prevention Programme (NDPP). This aims to help people, like myself, who are at higher risk of diabetes, by developing diet and exercise changes. This intervention saves money for the NHS by following the ‘prevention rather than cure’ mantra, and could obviously have personal benefit to me. I don’t see I have anything to lose, the worst case scenario is it tells me nothing I  don’t already know, but the ideal scenario is it unlocks profound new practical insights or 'life hacks' I can use to restart weight loss.   

Thursday, 23 November 2017

Job success...

After my whining about the botched skills test last month; they only went and offered me the job last Friday. Admittedly, I didn't just moan at HR and they threw it me as placation, I had to interview first. But I was able to use inside knowledge to gen up on the possible questions which meant it went well. 

The head of the wider team I'm currently in wasn't best pleased with my decision to transfer, but he cannot compete with the salary offered. We're currently going through the most laborious and convoluted organisational restructure I've ever experienced (that's really saying something) causing him extra headache. I wasn't mapped into a role, but certain skills I possess are definitely wanted, which all but guaranteed me a role from the pool I was in. Now I'm leaving I'm taking those skills with me and they cannot be replaced short-term. It does mean I’m resolving the required headcount reduction, but that also means opportunity for voluntary redundancy is removed from that pool. A bit of a political minefield.

The boss suggested I might not be as happy in the new department, the culture isn't as positive as the one I'm leaving, and it might be a bit of a dead end personal development wise. He's right on all of these things, unfortunately staying put would keep me in a smaller pool, which is also a dead end for career progression. The new role puts me in a bigger pool, and although it may not be as intellectually stimulating, it is a step up the ladder and more importantly a substantial pay rise taking me back in the direction of where I was before I joined this employer. This was always the plan, I took a less demanding role than I'd had before with a longer-view to moving back up the ladder. 

Now I’ve just got to negotiate the fact that my second day in new role coincides with my first nephrology appointment of the new year, which I’ve booked off. Let’s hope that’s not an inauspicious start!

Tuesday, 24 October 2017

No defence for healthcare tourism

Not entirely convinced by opposition to measures designed to stop health tourism. To be clear nobody is going to be denied immediate critical care; you're not going to get thrown out of A&E bleeding to death if you cannot prove who you are. Seems to me the people who will largely be inconvenienced are those not entitled to 'free' treatment, which is pretty much the point, and almost certainly the source of the disgruntlement.

I know people wail about the bureaucracy of it all, but you do actually need some sort of administration to get most things done. Collecting basic identity information about patients is the necessary first step in all medical treatment. Every time I go to my GP or the hospital I'm asked to confirm my details. The first time I visit a new facility I'm asked to verify who I am. This is good practice, not because it prevents health tourists, but because it gives medical professionals access to information they need to treat you properly.

It's really not too much trouble for most people to verify who they are if they want ongoing healthcare. Admittedly, there may be some challenging circumstances, some patients have special needs, but binning off faux-moralistic preaching there are processes in place to deal with them. We may not have a utopian system, but it deals with millions of vulnerable people every year without bodies piling up in the streets (bodies blocking beds is far more common).

The real problem seems to be the myth of 'free' NHS treatment, which is precisely what attracts health tourists. Those who moan about denying 'free' treatment to ineligible patients too easily forget it's not really 'free'; someone always has to pay! People up and down the country have to work hard to fund the system, a system that is always, and always will be, financially challenged.

Monday, 23 October 2017

Not quite Priapus

I picked up the results of my third andrology test last week, the one I did in late September. The result was pretty much the same as the other two; I’m still showing traces of immotile sperm. This basically means I have low fertility, low enough to make conception very unlikely, but not completely impossible. With that in mind the GP is reluctant to sign off on the vasectomy, instead he’s written to the consultant for comment, and has given me a form for a fourth test.
Whilst it’s nice to indulge the notion that I’m just so damn fertile a vasectomy couldn’t stop me, it’s getting annoying now. I’m going to delay the next test till I hear back from the consultant. I was aware it didn’t always work, but I seem to be in the zone where it has pretty much worked but a small risk remains, the key is to quantify it and decide what comes next.
The real reason the GP wanted me to see me was to talk about the Nephrologist’s recommendation that we review my blood pressure medication and also get a Hep B screen and vaccination tied in with my January bloods. The Hep B screen is a pre-emptive measure is to protect me from risk of further kidney damage, but would probably need to be done in advance of dialysis anyway. Unfortunately, I haven’t taken any blood pressure readings since before my last nephrology appointment, so I need to do some and send them into the surgery so he can decide if action is needed.
Whilst I was there I also got my annual flu jab. As a member of an ‘at risk’ group I get a reminder every year, but last year I was able to get one at work from the occupational health team. This year work decided to cancel blanket (optional) inoculation of staff on the grounds that it’s unnecessary (basically a cost cutting measure with an epidemiological backstop behind it), although ‘at risk’ groups were encouraged to see their GP. The GP himself was most bemused to hear this, apparently this year’s strain is particularly virulent and my employer may come to regret the decision. So, there we go, I have been warned, but then I’ve been inoculated too!

Thursday, 19 October 2017

Recruitment ineptitude and IKM test claptrap

Going off topic again, but hell it’s my blog, and this deserves remarking upon even if just for sake of catharsis. I believe sometimes in life you come across stuff that is so shit it actually took a special effort to be that shit; this is such an occasion.

I recently applied for a different role with my employer, a small step up the hierarchy, in a different department, but at a level I’ve operated at before. It was in the area of data visualisation, a currently trendy niche of Business Intelligence (BI). I’ve worked in BI for years, and data visualisation has been a significant part of that. I’m actually pretty happy in my current role, and there are significant dis-benefits to moving, but unfortunately it is about the only way someone like me can progress upwards so I had to try.

The spec asked for experience of one or more of a bunch of BI tools, there are lots of these out there, they’re much of a muchness and if you can use one you can normally pick up others quickly. I’d used some, but not all of them; and as none were listed as essential that was a tick. The spec also asked for experience and knowledge of a range of areas that are tangential or peripheral to data visualisation and BI. I have such experience, they are specialist areas in their own right and I’m not a specialist in them, but I’ve worked alongside side such specialists for a long time so know the ropes, just not to their level of expertise.

All this I made clear in my CV and covering letter, and that got me through to the next stage, an IKM technical assessment. This is where things took a turn for the bizarre. The test was supposed to be focused on data visualisation, but it only very briefly touched on the subject. Instead there were highly detailed questions on three of the software packages, two of which I’m not particularly familiar with, and none of which are regarded as leaders in the data visualisation space (curiously the job spec does pick out the leaders and I do have experience of them). The rest of the test was highly detailed questions relating to specialist areas tangential or peripheral to data visualisation.

I strongly suspect this IKM test was never designed to be about data visualisation, I’d estimate that less than 10% of the questions were specific to that subject. Instead it looks like someone, not really knowing much about data visualisation, bodged together parts of tests intended to assess certain other specialist subjects and called it a ‘data visualisation test’. It could be that IKM doesn’t have a genuine data visualisation test, it is quite niche, or it could be that the recruiting department asked IKM to bodge together some sort of weird multi-specialism test (the questions were too detailed to be general knowledge, but covered too many specialist niches to be on any one specialism). Whatever the truth it took some effort to put together something this shit.

I’ve made my feelings known to both IKM and to HR, but don’t expect any response. I’m just pissed off I wasted my time. Either the job title and spec should have been changed to reflect the essential skills required (I am sceptical about the number of specialisms required, as they’d typically be spread over four or five specialist roles in  a data and analytics team) or the test should have been focused on data visualisation with less detail on tangential and peripheral roles. My annoyance is tempered by the fact that success in gaining the role would have involved moving to a less convenient location, in a department that has a bad internal reputation for being inflexible, bureaucratic and generally behind the curve. The grass was never going to be greener on the other side, but it was at least a stepping stone. 

Thursday, 5 October 2017

Sliding towards the inevitable

So, my appointment came and went three weeks ago now. After all my fussing about weight gain I ended up weighing in at 113kg, which was 2kg above my previous appointment, but pretty much where I’ve been for the last year.
As it was the Consultant didn’t give me a hard time, mainly because my eGFR has shown its first significant decline in a couple of years. She did warn me not to read too much into it, as individual readings can fluctuate significantly, but it does appear I’m starting to shuffle off the plateau. Her best guess is that I will need a transplant in somewhere between six and ten years to avoid dialysis.
It’s hard to predict this with any great accuracy, as the majority of my readings are stable and the amount of protein in my urine is relatively low versus my eGFR which apparently means I’ve got a chance of edging towards the furthest end of that timeline. The big danger is that I suffer some form of serious illness, which would accelerate the decline. Touch wood, no such thing happens, but it is something I need to be wary of.
I’ve known for several years that failure was inevitable, but I had hoped to delay it for as long as possible. Now I’m at the point where I know the clock is ticking and the challenges ahead are starting to crystallise. In an ideal world a close blood relative would offer me a kidney, as that would provide the best chance of compatibility, but as my Mum and my brother only have one kidney each; that just leaves my sister who has never been tested for kidney disorders or my Dad. I’d be worried about my sister being a donor if only because the odds of her having some form of disorder have got to be high, as for my Dad, I’m not sure about him either as he has suffered from heart arrhythmia in the past.
I suspect that my best hope will be from an anonymous donor; likely involving time on a waiting list, fortunately as I’m relatively young, strong and healthy this perhaps isn’t as risky as if I were older and more fragile. The target weight of 100kg will become of greater importance, the 13kg or so to that destination are proving stubborn, but five years ago I was over 130kg, so I know it is possible. I know medical science is moving apace when it comes to artificial and cloned organs, but I suspect that any breakthroughs will come too late this time round (but given my age it is not inconceivable I will benefit in the future). I may also need to re-evaluate my feelings on presumed consent for organ donation, now my life may depend on it!

Thursday, 31 August 2017

Hawking, Hunt and the NHS

A bit of a long post. On holiday the other week I was diverted by the hullaballoo over Stephen Hawking laying into Health Secretary Jeremy Hunt's plans for a seven-day NHS and creeping privatisation. The intellectual no contest between the world-renowned physicist and the political hatchet man is a noisy propaganda event; more interesting is the underlying clash of ideological* spectrum positions on the role of markets and privatisation.
The Conservative Party is always vulnerable to attack over the NHS, firstly it exposes core differences between rank and file. Secondly, it's a subject many blundering front line Conservatives lack sensitivity for, and thirdly, the spotlight often crosses the sleazier edges of the party. My opinion based on years spent as an activist, is that the bulk of Conservative members support the NHS as a state funded, state run and primarily state provided institution. However, this often coincides with an ideological antipathy towards big government, and tacit support for commerce and entrepreneurship. There are also legitimate concerns about getting value for money and a sustainable financial settlement for the NHS.
This means Conservatives are more open minded about the potential efficiencies from private sector involvement, things others see as taboo. They're not blind to potential dis-benefits, nor risks from rent seeking crony capitalism, but they're pragmatic about cost benefits. The upper echelons and therefore policy direction tends to be disproportionately influenced by the free market wing. They genuinely believe markets deliver benefits to the public (a.k.a. consumer) and offer arguments (of admittedly variable quality) in support. Finally, there is the tiny grubby fringe who associate with free markets, but are better understood as 'freebooters' whose espousal of public interest tends to be mere gloss for crony capitalism.
Nobody is against the idea the NHS should be properly resourced seven days a week, but the concept of a seven-day NHS is more than about having enough staff. At brief glance it’s clear current policies on NHS funding, local government/social care funding, Brexit/ immigration, and healthcare training are incredibly not consistent with sustainable resourcing. The idea of a seven-day NHS seems tied to the free market concept of healthcare as consumer service, and it’s hardly a great leap to see this as swaying towards private provision. However, the much-loathed Mr Hunt has been at great pains to claim the NHS should not be viewed as a typical consumer service (at least not for the consumer). Is this just more evidence of confused policy? The undertones of the freebooters and their clients are hard to ignore.
All this sets up the conflict with those, often on the left, with more statist ideological positions, who see the NHS as something that should be state owned, run and provided. As with Conservatives there are many positions, some strong arguments, some very weak arguments, and there are sectional interests (trade unions and professional associations may pitch themselves as ‘guardians’ of public interest but their members come first). They may be uncomfortable with cost benefit analysis when it comes to rationing emotive treatments. There is also the category error of mistaking virtuous intentions of healthcare workers with achieving the best use resources for patients.
Some opposition is based on misunderstanding of economic forces, be it confusion over the difference between markets and capitalism, or viewing inefficiency through the prism of the broken window fallacy i.e. defending unproductive practices because 'it's someone's job', or perhaps failing to understand healthcare wages are more constrained by monopsony than by competition. Emotive pleading is used to obscure the the tragedy of the commons style problem caused by breaking the link between consuming resources and paying for them. It's too easy to push responsibility for paying to abstract 'taxpayers', especially the conveniently nebulous 'rich', but ultimately shunning potential benefits on ideological grounds means someone else has to put in an extra shift.
I can see legitimate concerns in opposition to private sector involvement, I just happen to think they can be mitigated without throwing away potential benefits. I am aware efficiency destroys low productivity jobs (it's not clinical professionals who are really threatened), and I am aware those workers may face greater risks. But, there are better ways of mitigating this than wasting finite resources. The private sector is not guaranteed to be better, cheaper or more efficient than the public sector, but restricting provision to a monopoly ends any chance of reaping potential benefits and locks in the dis-benefits of public monopolies. Concerns about private providers cutting corners are moot, if commissioning bodies cannot manage contractual service levels there's no reason to believe they can manage internal ones. Conflicts over how commissioning bodies decide to spend their funds exist regardless of the profit motive.  
Public monopoly also enables political meddling, this may welcome for favoured specific political objectives. But enabling meddling is risky, it leaves the door open to populists and pork barrel deals. Such objectives are better managed through legislation or other governance. Some simply object on principle, they despise the idea of private organisations profiting from public funds, but this is naïve sentimentalism, there is no guarantee resources are distributed more justly under public provision, taxpayers still pay and in the absence of totalitarian revolution the fundamental basis of our economy and society remains unchallenged.
I subscribe to the view that organisations should stick to their core competencies, things they are good at, and let others handle the other stuff. From personal experience the NHS is good at providing essential clinical care, that's where its comparative advantage lies. If other organisations have comparative advantage in peripheral services that can benefit us all. We don’t expect the NHS to maintain its own private postal service because we recognise greater benefit comes from letting specialist postal services do it, so why not allow certain types of non-core medical services be handled by private specialists?
Strangely enough this whole conflict tends to overlook that privatisation and marketisation have always been a feature of the NHS. The bulk of GP services and dentists are provided by privately owned practices that contract to the NHS. Many hospital consultants combine public and private work. There doesn't appear to be a groundswell against these examples of privatisation, nor demand for clinicians to become indentured to the NHS. The nomenclature of provision seems to matter as much as the taxonomy; profits for Healthcare.PLC equals bad, profits for Dr X and Dr Y LLP goes unremarked.
Personally, I support the idea of an NHS funded by taxation, where clinical services are generally free at point of consumption to those who eligible (I don't support free treatment for illegal immigrants or health tourists beyond emergency medicine, because there is no such thing as free treatment and they bear no responsibility for costs). I don't believe private insurance is better or more efficient, the state is able to provide comprehensive society wide risk pooling in a way the private sector cannot. But healthcare will always be a finite resource and sustainability is a moral as well as practical necessity. That’s why private provision should be judged pragmatically on the objective cost benefits, not on subjective principles.
* I find the term 'ideological' uncomfortable as it's commonly deployed as a vacuous and unintentionally ironic pejorative to label those who hold opposite or contrary ideologies.

Tuesday, 8 August 2017

Every silver lining has its raincloud...

Haven't blogged in a while. Things are ticking over okay; my weight is stuck around 113kg after a few weeks of minor fluctuations. I have just under a month to try and get as close to 110kg as I can for my next nephrology appointment. My activity levels are pretty good and I've got some holiday over the next couple of weeks that should get me out and about.
I had my second hypothyroidism test ten days ago, whilst I was at the surgery I asked about the results of my second semen test in early July, the receptionist said the most recent test result (which was the one I wanted) had been tagged 'no action'. I said 'I'm not sure what that means', and she said 'neither do I, you'll need to ask a GP'. So last week I got a phone consultation. The doc called me back and says he's very sorry, but he couldn't understand what the results meant. To his credit he called the andrology lab which confirmed it had detected traces of what are known as non-motile spermatozoa. The lab also advised it had just upgraded its equipment (is there a vasectomy pun in there?) and it would be advisable for me to have another test. As it's better to be safe than sorry that's what I am going to do.
After the consultation I did a bit of googling and it turns out non motile sperm is detected after about a third of vasectomies. Pregnancy is highly unlikely from non-motile sperm, but not impossible, hence why doctors are nervous about giving the all clear when they are present. So, I’ve made a third andrology appointment, but I’ve done it for just before my nephrology appointment so I only need to attend the hospital once.
On the positive side I tested negative for hypothyroidism, although that means I lose an excuse for being a fatty and I also need to renew my annual NHS prescription certificate. Every silver lining has its raincloud...

Sunday, 16 July 2017

Getting jizzy with it!

It's been a couple of weeks since my last post. On Sunday 2nd I completed the Kidney Research London Bridges Walk, it was a good event and I really enjoyed it. I covered the seven miles in my target time of two and a half hours, a reasonable pace given it was a hot day and the route went through some of London's most congested pedestrian areas. Parts of the Southbank and Westminster Bridge took far longer than their physical distance suggests due to throngs of tourists and numpties blocking the pavements trying to take selfies against the backdrop of the Palace of Westminster. Also, on the narrow stretches of the northern Thames Path it was easy to get stuck behind gaggles of Sunday shufflers out for a lazy stroll.
I spent most of the walk listening to the Black Tapes Podcast, which I've become addicted to of late. Although I was nominally walking alone, and it was by no means a race, the other walkers helped me maintain a decent pace and I never risked losing motivation, which might have been the case had it been a random walk along the river. Factoring in my travel to the City Hall start, the walk itself, and the trip to Byron afterwards I clocked up a personal best 25.8k steps. I'm now looking for other similar activities, I know there are walking groups in my area, but my preferred modus operendi is a bit too anti-social for that, I might try and map out some local 5k routes I can walk/jog when I have time.
Last week was my 40th birthday, so my wife, knowing I'd taken a day’s leave, booked me an extra special treat... a trip to the dentist! It's not that I'm afraid of dentists, although I did have a couple of horrible experiences as a child, I just got out of the habit five or six years ago. The practice I was registered with wasn't convenient and as it's not always easy to register with a good NHS dentist I never got around to moving. So, after years of nagging, my wife took matters in her own hands and registered me with her dentist. It was about time; I'd been starting to worry about occasional pain twinges from a twenty-year old filling.
It started with the Hygenist giving my pegs a good scale and polish, they weren't too heavily scaled but what was there was stubborn. Afterwards the Dentist did a check-up and x-rays. Fortunately, nothing of real concern came up, the twinges appear to be the old filling pressing on a nerve, but the filling itself is sound. There was the option to drill it out, line it and refill it, but given it's a negligible issue I decided to leave alone for now.
On the 7th I gave my second semen sample to Andrology at East Surrey Hospital, so I should know this week if my vasectomy has the all clear. If I don’t get the all clear I’ve no idea what happens next. It will be a complete bugger if I have to have another procedure. Also, if my tubes haven’t been properly sealed up what the hell has happened? This week I need to arrange the second blood test for an underactive thyroid, I’ve held off renewing my NHS annual prescription certificate as if I do have hypothyroidism then my prescriptions should become free.
I’m hoping any treatment for potential hypothyroidism will help with my weight loss, but I’m not holding out great hope. The reading that triggered the whole inquiry showed only mild hypothyroidism and my brief reading around on the condition suggested weight loss is only likely with more serious hypothyroidism. I’m still kicking around 113kg, I briefly went up to 114kg after my birthday celebrations, despite high activity levels, but that was due to overindulgence. It just seems I’m in that zone where it takes a lot of activity to shift the dial down even slightly.  

Tuesday, 27 June 2017

London Bridges Walk 2017

I’ve signed up for Kidney Research UK’s London Bridges Walk this coming Sunday. I registered my interest in it a few months ago, and received an email saying I would be contacted when registration opened. Sadly, no such follow up happened, but I remembered to check back periodically and registration actually opened late last month. I don’t know whether they planned to contact me but I got there first, but it does make me wonder how many other people expressed an interest but never got contacted? Online registration is closed now, but people can still sign-up on the day for £10. 
It’s a seven mile walk across many of London’s iconic bridges. It might sound a bit anti-social but I’m quite looking forward to doing it by myself, I enjoy walking, but usually there’s a very functional purpose like getting to work. I don’t often get the time to go for a good long walk without any distractions, my wife has her own interests she’d probably prefer to spend the time on, and I know the kids would only complain about being bored or tired or more likely both after half a mile!
Kidney Research UK sent through the route map earlier today, it’s fairly familiar territory as I’ve worked in and around Central London for over fifteen years, and the course skirts close to both my current and previous employers. I’m going to try and put together a topical podcast playlist I can listen to as I make my way around, I haven’t found the right ones yet, but I know there are a variety of London podcasts out there covering the mix of culture, history and folklore I’m looking for.
I was also hoping to sneak a few crafty beer stops on route, but I rather fear the pickings are slim without taking too much of a detour. There are a few pubs along the route, but a few of them are shitholes or tourist traps, what comes from hugging the river. It’s probably no bad thing really, I’d only have about five minutes to neck a pint and have a pee, and no doubt once the seal is broken I’d spent most of the seven miles bursting for another! I’m also not sure how endearing it will be to more advanced CKD sufferers who have restrictive fluid intakes. Besides, afterwards I’m meeting up with the wife and kids for an early birthday treat at Byron Burger so I can save my 'dead' calories for that.

Is this gun loaded or not?

I spoke to one of the GP’s yesterday, it appears that my recent jizz in a bottle test was inconclusive. It is a little worrying that having been through the vasectomy process it may not have worked! I’ve got a repeat test at the end of next week, so I should know one way or another whether I'm firing blanks by mid-July.

Tuesday, 20 June 2017

Underactive Thyroids and Jizz Jars

I finally made it to the doctors a week or so ago to discuss the underactive thyroid result that cropped up in my recent annual medical. My first attempt was cut short by the NHS hack last month, the second attempt was an evening surgery appointment that got cancelled a couple hour before I was due to attend, till finally the GP surgery squeezed me into one of the last appointments in a regular afternoon surgery. Did I learn anything new? Not really. As my Mum has an underactive thyroid it is entirely likely I have the condition, but I don’t seem to have been hit by any obvious side effects; my weight is still hovering around 112kg which is as good as it’s been for years and any tiredness I feel is probably down to not getting enough sleep! So I’m having a retest done in July and will be going back to discuss treatment about ten days later.

Last week I dropped off my first semen sample to Andrology Services at East Surrey Hospital, so I should get an indication of whether my vasectomy has been effective sometime this week. I’m supposed to do another test in a few weeks time, but I’m hoping this set of results will be conclusive. In a nutshell I had to wank into a little glass bottle and then scoot straight over to the hospital with it in my shirt pocket (close to my body to keep it at a good temperature), where I simply handed over to Andrology. A somewhat comedic process, when you consider I was basically trying to get ready to go to work as well as avoid the kids who were getting ready for school at the same time.

Tuesday, 16 May 2017

Mixed Blessings

I had three medical appointments last week, two planned well in advance, the third a late addition at the GPs request. 

Early on Tuesday I had my regular check in with the Nephrology Consultant; having failed to lose any weight since my last visit (in fact I'd gained 0.5kg) I had some slight trepidation. It turned out my recent bloods had produced my best CKD results for several years and my blood pressure readings are also acceptable, so she was actually very happy with the progress. I explained I've been making efforts to maintain good fitness despite the flat lining weight loss, and she agreed this is definitely making a positive difference. So we’re sticking with the current regime and I said I’d talk to my GP about weight management (although I'm pretty sure the status report to my GP will include the usual weight based admonishments). 

Later the same morning I had my annual review at the GP surgery. The nurse was initially perplexed about why I was there even though the review had been initiated by the surgery, but things were quickly resolved. I also pointed out I'd been sent a further request to make an appointment with a GP to discuss blood test results, basically indicating something required the attention of a GP rather than a nurse (a similar thing happened last year, so I suspected another pre-diabetes flag). 

For the second time that day I was weighed and had my blood pressure taken, fortunately the results were consistent, although I'm now pretty certain my scales at home weigh c.0.5kg heavier than those at the hospital and GP surgery. Pretty much everything in the blood test was fine, cholesterol, liver function etc… It also turned out the HbA1c test that set off the pre-diabetes flag last year ago was now back in the healthy range, my improved activity levels probably reversing early stage pre-diabetes. There was just one exception; the thyroid part of the blood test was flagging a warning which needed to be discussed with a GP. 

So on Friday afternoon I went back to see the new GP at the practice. Unfortunately having managed to knock off work early to get there I found the surgery (in fact the whole local NHS Trust) had fallen prey to the much publicised cyber hack. So the GP couldn’t see my blood test results. Fortunately I was able to explain about the thyroid deficiency flag (that being the only issue flagged) and the GP briefly explained the symptoms of an underactive thyroid. She asked if I was aware I was suffering from any, which I'm not, and she asked if there is any history of thyroid problems in my family, and there is, my Mum has a problem. But as I'm not demonstrating any of the major symptoms of an underactive thyroid, and she couldn’t see my results, she decided not to start treatment but go with the usual next step of retesting in three months. We didn’t get around to talking about weight management, but she said she would call me on Monday to discuss things further, when the system would hopefully be back up. 

The problem with this situation is that it’s tempting to focus on the under active thyroid and retro fit my recent difficulties losing weight on to it. There are weight related issues with this condition, but it’s probably a convenient self-delusion narrative to follow when the truth is that losing weight is just very difficult to achieve even with sensible eating and exercise. Unfortunately nobody was home for most of yesterday, there were two calls from unknown numbers on my home answerphone, but no messages, and I didn’t receive a call on my mobile. So I’m going to give the surgery a call today, although I suspect they are trying desperately to catch-up from Friday.

Friday, 12 May 2017

The Chimp Paradox: a review

I've just finished reading the Chimp Paradox by Professor Steve Peters, a psychiatrist who teaches at the University of Sheffield, who is highly regarded in the field of sports psychology. I actually read it in two chunks, I started a few months ago, got half way through and decided to read some other things before coming back to it. That's probably a good clue to my feelings about it. It's not unusual for me to be reading more than one book at a time, and it's not untypical for me to pause part way through some of them because I feel like reading something else. Usually I pause non-fiction works because I want a short-term fix of fiction, or I've been temporarily gripped by a different book. A pause is a sign it hasn't entirely gripped me, but coming back to it is a sign that it's interesting or useful enough to warrant finishing.

The Chimp Paradox can loosely be described as a 'self-help' book, the first such I've ever read, and is based on a 'Mind Management' model that Prof Peters has developed to assist patients (who include big names in British sport) to better deal with the pressures they face. The idea is the model can help the subject better understand their own behaviour and impulses and manage them to make them to be more successful, confident and happy. 

At the core of the book is the idea that our personality can be split into 'human' (our rational selves) and 'chimp' (our emotional selves), and the ways in which these two interact influences the way we engage with the events we face. Essentially the book offers help on understanding how our inner chimp can disrupt us and offers strategies to managing it. I can see some interesting overlaps between this model and the 'System 1 / System 2' model outlined by psychologist Daniel Kahneman in his celebrated book Thinking, Fast and Slow (currently paused two thirds through on my bookshelf). 

I must admit I'm generally cynical towards 'self-help' books, but I picked up this one because it I thought it might be help my career development, it didn't make any screechy boasts to be a panacea (which seems typical of US published lifestyle coaching/self-help efforts) and it had some credible endorsements like Olympic cyclist Sir Chris Hoy. 

So what are my thoughts? Well, without wishing to sound flippant, a lot of it reads like formalised common sense and is pretty much in key with my own thoughts. It's a gross simplification, but I'd summarise the advice as don't taking headstrong, emotional approaches to problems, take a step back, a deep breath and think before acting. It was far from a waste of time, but probably not what I really need to push my career development. I think Prof Peters approach will be most beneficial to those suffering chronic stress or struggling to control destructive emotional patterns. It might have been more valuable to me a couple of years ago when I was under stress working in a dysfunctional organisation, but I'm in a better place now. However, the techniques espoused offer only partial mitigation to my previous situation, unequal power relations make challenging dysfunctional hierarchies extremely difficult and exiting is not trivial when you're financially dependent on sticking it out. 

Not a waste of time, almost certainly worth having as a backup should things get tough in the future, but maybe I need to find something more specific to my career development objective.

Tuesday, 9 May 2017

The Semen Test Farce

Some subjects are just ripe for comedy; the semen tests required after a vasectomy are a case in point.
I received two test forms from my GP a little while ago. Unfortunately, there were no further instructions; queue the first gag about what sort of instructions a man needs to have a wank! The forms specified a particular container, but not how to get one or where to submit it afterwards. So I called reception at the surgery and asked them; queue next gag about discussing wanking with a woman you don't even know!
Unfortunately, the receptionist was new and didn't know what to do (I'm sure there's another gag there somewhere). She suggested I discuss it with the phlebotomist when getting my bloods done the following week. What a bloody palaver (geddit?)! But at least I was getting somewhere, surely? So, I discussed with the phlebotomist, only she was new too; but she did tell me that semen tests usually need to submitted to the hospital lab within one hour of production. That's pretty useful to know.
I tell the phlebotomist I'm going to the hospital next week, so I could drop one off then. Sounds like a good idea, we concur. She tells me I can get the requested container from reception, unfortunately no further information comes with it. The day before I go to the hospital I think it might be a good idea to find out where to take my sample, I’m presuming it's where the blood tests get done? Hmmm, I better check the hospital website!
Oh dear, it’s a good job I did check rather than just rock up with a tub of jizz. It seems you cannot simply turn up in working hours like with blood and urine tests, semen tests require an appointment, well an appointment to hand the container through the hatch in the window. And lo, there's more useful information, don't wank or have sex for three days before you produce the sample and make sure you keep it warm (but not too warm)!
One call to the appointments line later and it turns out the earliest possible appointment is five weeks away! How useful would it have been to be notified of all this stuff with the forms? As the hospital is a thirty minute drive from home, in completely the wrong direction for work, and they only do tests before 2pm Monday to Friday, it's all a bit of a ball ache (boom boom)! Of course, I could have timed the test to coincide with my latest Consultant appointment, well if the process had been properly explained from the start! Now I need to arrange additional time off work to sort out!
Semen tests are funny. Not!

Tuesday, 2 May 2017

Seven days is all she wrote, a kind of ultimatum note

No this isn't a post about a Sting track, it's me mildly panicking that I'm just one week out from my next Consultant's appointment and currently weighing in at 112.7kg. Due to a combination of things, not least my daughter's first holy communion at the weekend, I've let my diet slip a bit in the last couple of weeks and hence a rise in my weight. So I'm desperately trying to get down to 111kg for next week.
I said after my last appointment I'd made a rod for my own back by unexpectedly weighing in at 111kg, and so it has proved. For most of the past four months I've fluctuated between 111kg and 112kg and it's been pretty difficult to get below no matter what I've done, in fact when I have dropped below 111kg it has been mostly fluke. So I've stepped up my exercise regime to try and hit 15 thousand steps a day and I'm trying to forgo alcohol and chocolate for the next seven days.
Next Tuesday I've also got my annual medical at the GP surgery (it says I'm seeing a nurse but last year I ended up seeing a GP) so I’m going to ask about a Wellbeing prescription, this is a scheme being offered in conjunction with the local authorities to help make interventions into issues such as weight loss, smoking, mental health etc. It will be interesting to see if meaningful help is available to assist my weight loss efforts, I’m trying not to be prejudiced but knowing how tight funding is in both the NHS and local authorities I’m a little cynical. My gut instinct is that it won’t lead to the expert help I’m really looking for, but is probably going to be generic, lowest common denominator advice. Still, it won’t hurt to ask.
As I’m going to be at the hospital on Tuesday I’m going to drop off my first semen sample to test if my vasectomy has been effective. I was supposed to do it a couple of weeks ago but haven’t had chance. Apparently, the sample needs to be at the hospital within an hour of being produced, which makes it slightly awkward. I picked up the correct bottle at the GP surgery this morning when I had my bloods done, so next Tuesday’s visit to the hospital is going to be a little different!

Sunday, 23 April 2017

Obesity and prejudice in the NHS

There's an excellent documentary currently available on BBC iPlayer looking at the prejudice obese people face trying to get treatment in the NHS. The mightily impressive Professor Rachel Batterham shines a light on some of the cutting edge medical science of obesity, breezily demolishing lazy tropes about fat people as she goes. Prof Batterham makes compelling arguments supporting increasing treatment of obesity, not just due to the positive medical outcomes but on the cold, hard economic basis that as expensive as intervention can be non-intervention is far more expensive in the long-term.

Along the way she highlights some of the counterproductive and even explicitly harmful approaches to obesity that give me concern. The lack of proper understanding of, let alone sympathy for, obesity from some medical professionals. The rationing of medical treatment on arbitrary BMI thresholds rather than case by case clinical assessment, the decisions that lead to Catch-22 horrors whereby sick people cannot access desperately needed treatments due to obesity, but are unable to meaningfully tackle obesity because they are denied those desperately needed treatments. There were some pretty disturbing examples of serious medical harm being done by NHS professionals deploying half-baked thinking or outright prejudice against fat people.

A key driver of prejudice is always ignorance. When it comes to obesity there will always be stupid twats who say things like 'it's your own fault your fat cos you ate too many chips'. In the programme professional gobshite Amanda Platell of Daily Wail fame pops up to represent said feckwittery. Now I don't deny there is an element of personal responsibility in obesity, but it's far from the simple dichotomy of the ignorant twat. There are fundamental issues around human physiology and sociology at play in the rise of obesity, which is why it is a growing problem globally. Humans evolved over hundreds of thousands of years but the recent shift to sedentary lifestyles and cheap and readily accessible calories took just a few hundred years. It shouldn't be a surprise to anyone who considers the issue seriously (who isn't a stupid twat) that modern life is incongruous with the way humanity evolved as a species (a recent blog post at Coppola Comment neatly addresses some of these themes). 

One of the most interesting parts of the documentary was a discussion with a representative of an NHS Care Commissioning Group (CCG) who attempted to defend healthcare rationing on the basis that it wasn't meant to be punitive (implicitly acknowledging it is), but intended to get people on the right health pathway (without acknowledging this is pure magical thinking). To be fair to the doctor in question he did at least step up to defend an unenviably weak position and it may be that unsympathetic editing made his arguments appear even more unconvincing, but I rather suspect no amount of turd polishing can make healthcare rationing look better than it really is. It appears a lot of the CCG's who use BMI thresholds completely bottled out of talking to the programme.

Towards the end Prof Batterham made a presentation to a group of CCG and GP representatives (including 'celebrity' GP Hillary Jones) on the serious science behind obesity, the hard economic case for medical intervention reinforcing why it is important to treat obese patients with dignity and respect. Again, giving credit where it's due the participants seemed to acknowledge the flaws in their past thinking, be it simple human prejudice or lack of professional awareness. But these are doctors; you'd expect them when faced with cool, rational and overwhelming evidence-based arguments to come round. Unfortunately it will always be harder to convince the proportion of the general public who are mindless, prejudiced twats. This is after all the post-truth era, and for the mindless twat 'you ate too many chips' is a personal truth that will always rank higher than any science. Let's just be thankful there are people like Prof Batterham leading the line against feckwittery! 

Saturday, 8 April 2017

Nightime peeing

Interesting story on BBC last week about how needing to pass urine in the night may be linked to excess salt consumption. For many years now I've found that most nights I wake in the early hours and find I need to wee, but it has become a little more noticeable over the last few years. These days I often find I wake again anytime between fifteen and thirty minutes before my alarm goes off, which is annoying as I invariably need to go when I wake, but that has only happened since I started my current job which requires regular early starts for the London commute.
I don't believe there there is anything unusual about waking in the night per se, the idea that it is natural sleep all the way through the night without waking is probably a modern myth. But I have pondered the issue of nightime peeing more since my GP warned about the risks of pre-diabetes and I subsequently read it can be sign of diabetes (I'm somewhat reassured by the absence of many other signs). I'd love to be able to sleep longer, I usually manage just over seven hours during the week and over eight at the weekend, but as hinted above this is due to daily routine rather than anything sinister. I do sometimes feel tired at work, but then staring at a computer screen for prolonger periods has that effect.
There are some obvious reasons for wanting to go for a wee in the night, firstly I'm getting older. Secondly, as a compulsive tea drinker I often drink a large cup in the evening not long before bed. Tea contains caffeine which is sometimes claimed as a mild diuretic, but as a regular consumer the effect on me is probably minimal. A third reason is that I always take a bottle of water to bed with me, which I sip from if I feel thirsty in the night, sometimes I hardly touch it, but every now and again I will consume the lot. But maybe a small contributing factor is the sodium bicarbonate tables I have been taking for for the last couple of years. I remember when the Consultant first put me on them, she gave me Furosomide so I would flush the salt out out first thing in the morning even though I laughed at the idea of needing any assistance going for a wee first thing in the morning! The diuretic tablets didn't last long as they only triggered gout attacks, but the sodium bicarbonate tablets have increased since then.

Wednesday, 29 March 2017

From tragedy comes hope

I came across this tragic story on Sunday night when I unwittingly crossed the Facebook timeline of a relative who is an acquaintance of the victim's mother. I find stories like this uncomfortable, it raises my worst fears for my own children, but this case happened on a road I have trodden probably thousands of times. The only positive is that this poor little girl has probably saved the lives of several other people with organ donation, something that her grieving mother must be commended for. At such an incredibly painful time it would have been understandable had she batted the question of donation away, that she didn't showed incredible bravery and is a fitting tribute to her daughter (the recipients also have a big sacrifice to live up to). With all the talk of presumed consent it's a shame the pond life responsible aren't having all their organs forcibly donated to more worthwhile causes. I'm sure there's a utilitarian argument for that somewhere.

Thursday, 23 March 2017

Woe is me (aka another of my boring moans about diet and fitness)

There’s been little movement in my weight since I started my Lent fast, minor fluctuations up and down. This week I shaded just under 111kg, but it wouldn’t surprise me if I’m a little over next week. I’ve stuck to the no chocolate commitment but I suspect I don’t eat enough of the stuff anymore for it to make a significant impact on my calorific intake. The focus probably needs to be on ‘extras’ like the cup of peanuts I have on Friday and/or Saturday, or the odd piece of cake. Lately I’ve found myself plugging the gap between lunch and dinner with a few crackers or a piece of bread when I get home from work, an apple would be better, although the calorie reduction is probably marginal.
The occasional days when I consume more calorific food and (alcoholic) drink may be more relevant, such as Saturday 4th March when to watch London Skolars versus Toronto Wolfpack. Great day out, but whilst hardly a binge, the presence of a real ale bar and a mixed grill down the pub afterwards involved significantly more calories than typical. Even then the weekly change in my weight was less than half a kilo which reversed itself without significant effort.
It probably hasn’t helped that I’ve had a few minor, sporadic flare ups of gout over the last couple of weeks, not majorly painful, but enough to cause noticeable discomfort on my daily walks. I treated with Colchicine last week and it seemed to do the trick. Unfortunately, the persistent heel pain I’ve suffered over the last few years is also quite bad, it’s been worse, but is definitely on the upward curve again. I’m not sure if it is plantar fasciitis or something else, either way given my age and weight it’s hardly a surprise. I did raise it with the GP nearly two years ago, the same time as my vasectomy referral, but as it’s small beer compared to the gout attacks I chose not to pursue the issue. With the weather (intermittently) getting better and the days getting longer I really want to be pain free so I can try jogging again, the same old problems of finding time remain, but I’ve got about six weeks to lose another two kilos and something needs to give.
But putting aside my narcissistic whinging about foot pain and weight struggles I have made a couple of attempts at doing something constructive that isn’t all about me. I’ve signed up to the Disability Support Network at work and I’ve also pre-registered for Kidney Research UK’s London bridges fund raising walk in July. The former is something I’ve been considering for a while but have been in two minds about because I don’t consider my CKD to be a disability right now, but I recognise it probably will be one day. The latter will be my first foray into actually raising funds to support treatment for CKD. I’ve added both to the growing list of topics I plan to write more about but may never find the time for!

Thursday, 2 March 2017

Diet Update - Lent is here!

I haven’t posted an update on my diet in awhile; mainly because there hasn’t been much to write about. I’m currently tipping the scales at 111.6kg which is pretty much where I have been for the last two months. My activity levels have been pretty good (step counting is good motivation even if step targets are arbitrary), although my diet has slipped slightly, no bingeing or anything that serious, but I’ve slipped in to the habit of having treats like chocolate or cake three or four times a week where previously it was once or twice a week.

My aim is to get down to at least 109kg for my next appointment with the consultant in two months time. Fortunately help is at hand, Lent started yesterday so it's no sweets or chocolate for forty days (I have to admit being extra naughty on Tuesday indulging in an extra large packet of Reece's peanut butter cups). I managed it last year, even after our parish priest shockingly announced that Sunday's don't actually count as fast days in Lent! I was all for writing to the Bishop to find out what was going on!

Monday, 27 February 2017

All About My Vasectomy!

Ok, so I said I was going to write something about my vasectomy experience, and as I had the follow up appointment last Thursday now is probably a good time.

The beginning
My wife and I decided some time ago we didn’t want more children. We have two happy, healthy kids and a modest but comfortable lifestyle, it’s enough for us. Kids are rewarding but maintaining family life whilst both working full time is hard. A vasectomy seemed the long-term solution to contraception. My Dad had one after my younger sister was born, and my brother-in-law had one a couple of years ago, so it wasn’t a ground-breaking decision, even for a practising (Cafeteria) Catholic.
Around the middle of 2015 I discussed it with a GP at my local surgery and he made the referral. I hoped it would be something that could be done quickly, but I struggled to find the right time as I was doing a stressful job I hated. Just over a year ago I took voluntary redundancy and got a less stressful job. I’m now much happier, my career prospects and work life balance are better and crucially it’s easier taking time off.
The run-up
After the referral I received a letter from NHS Choices explaining how to go online and choose a provider. There were two in my area; one was BMI Shirley Oaks, a private hospital in Croydon I’ve used before, the second was a GP surgery in Redhill which does outpatients appointments. Neither is great location wise, but BMI Shirley Oaks is easier. Due to my circumstances it was September 2016 before I actually booked an appointment.
The booking process was straight forward, but there is a lack of information about the medical process that follows; you simply book an available slot. I assumed, in the absence of alternative information, the actual procedure would be carried in that slot. So I booked a couple of days off work in October, Thursday for the appointment itself and Friday to recover (plus the weekend). It was only when the appointment letter arrived I found it was just a consultation. So I cancelled the Friday leave. Annoying.
The appointment came; I was seen quickly and professionally. I spent about ten minutes with the surgeon, the discussion was pretty much as I’d expected from reading the NHS website and covered similar ground to the GP. He asked if I had kids (yes), any medical issues (CKD) and explained the nature of the surgery and associated risks. He did a quick physical exam, jokingly asked if I wanted a circumcision too (no), and told me I would need to shave my scrotum before surgery. Then he pencilled me in for surgery under general anaesthetic on a Friday morning in January 2017. I then went to see a nurse who recorded my height and weight and informed me that if my BMI had been over 40 I would havebeen rejected for NHS funded surgery at that hospital, I inferred it could be done there privately which suggested bizarre healthcare rationing rather than clinical based commissioning.
I thought that would be it until the big day, I was wrong. The next week I received another letter with a date for a previously unmentioned second consultation. I thought it must be a mistake, but I was wrong, I needed pre-surgery tests. Annoying again. Fortunately it was between Christmas and New Year and I already had leave booked.  I went back to the hospital, saw a nurse, she took some swabs, went through the medical history form I’d completed at the first appointment, put me on an ECG machine for five minutes, weighed me again, and took some bloods (giving me matching arms as I’d had my regular CKD bloods taken at the GP surgery that morning). I never saw the results of these tests, but I was told NOT to shave my scrotum ahead of surgery as nicks might cause infection, if necessary it would be done in theatre (in the event I used electric clippers a couple of days before to ‘thin’ things out). 
The day itself: pre-surgery
I was told not to eat or drink anything after midnight the day before but I played safe and consumed nothing after 7 pm. On the day itself I was told to arrive for 7.30 am, so I got up 5.45 am and caught an early bus into Croydon and a bus back out to Shirley leaving myself good time. It was an absolutely freezing January morning and given my actual slot wasn’t till after 11 am I’m far from convinced I needed to be there so early. Mildly annoying.
I was quickly shown to a perfectly pleasant room and told a nurse would with me shortly to do check in. After 9 am the surgeon popped his head in to say hello, then about twenty minutes later the anaesthetist came and ran through some basic health questions. He asked why it was being done as a general rather than local, I told him it was the surgeon’s decision. He offered to switch to a local, which he said carried less risk. I considered this, but to be perfectly honest I preferred a general as I wanted to be asleep whilst they were fiddling around my undercarriage (yes I know they’ve seen it all before, but that wouldn’t make it any less embarrassing or uncomfortable for me).
Sometime after 10 am the ward sister came to see me, she answered a few questions such as how long I was likely to be kept in (basically until after I’d passed urine), offered me something to eat after surgery, and reiterated the advice in the appointment letter about not driving or drinking alcohol after general anaesthetic. She asked who was collecting me and I said depending on time it would be my Mother-in-Law or I’d get a taxi (which was true), and asked if someone would be at home afterwards and I said yes (which was a lie). My wife was taking the kids to my parents for the weekend, partly for a family birthday party and partly to give me a few days peace.
But I still hadn’t had a visit from the nurse to check me in. It was gone 11 am when two nurses rushed in offering apologies. There had been a mix up; they thought I’d been checked in by the night staff when I first arrived. So after spending three hours hanging around doing nothing I was speedily checked in, changed into a gown and ushered down to the operating theatre.
The day itself: post-surgery
I came around after midday in the recovery area. My senses came back pretty quickly and I didn’t feel any pain, I was just a bit hazy with temporary difficulty swallowing. After a short time I was moved back to the room and within ten minutes I was up and out of bed. Moving around was okay, I just felt very tender with a dull ache down below. Going for a wee was a bit awkward, not because of any physical restriction, but because the bandaging got in the way. My scrotum was held in a sort of string net jock strap contraption packed with surgical wadding, it kind of pushed everything upwards making aiming straight a little tricky (although my wife would say that’s not new).
I spent a few more hours in the room. Nurses came in and out to do checks, I was able get dressed, have some water to drink, and the ward sister came back to give some post-op advice such as when I could remove the dressings (next day in the shower). About an hour after surgery some tea and sandwiches arrived, which was much appreciated given I hadn’t eaten since the previous evening. I was eventually discharged around 4 pm (on the understanding that someone was home). It was too late for my Mother-in-Law to collect me, so I got a taxi home where aside from making myself cups of tea (I chose to follow advice about not drinking alcohol) and some dinner I basically spent the rest of the day watching television in bed.
I didn’t feel the need to take any painkillers, there was a constant low level ache, and occasional sharp spasms of pain when I moved too fast, but it was tolerable. My mobility was restricted, I shuffled around being careful not to make sudden movements, and I made sure I slept on my back. Most of all I was immensely grateful my son was away for the weekend given his habit of jumping on me when I’m lying in bed!
The days following surgery
I generally took things very easy for the next couple of days. I let the dressings come off in the shower the next morning. I did have a look at myself in the mirror, my scrotum was very red and hugely swollen which meant everything looked and felt very unfamiliar, especially when going to the toilet. I had two small nicks, one on either side, that had been sutured closed. I was advised to wear snug fitting underpants to provide support, which was not a problem as I usually wear briefs. For the first few days I wore a base layer under my trousers which added extra support, and also kept me warm as it was bloody freezing outside. I also wore a clean pear of briefs each night underneath my pyjama bottoms.
The next day I felt well enough to clean out the rabbit hutch and to meet up with a mate at the pub for a few drinks and something to eat. We bumped into an old acquaintance that used to play rugby league with us, upon learning of my plight he giggled each time I shuffled slowly past his table on the way to the toilet! Sunday I did very little till my wife and kids got back in the afternoon. My step count went through the floor!
Monday I went back to work. It was a little uncomfortable, mainly during the commute to and from the office. Fortunately there was no strike that week so Southern Fail merely offered its standard mediocre service rather than the ‘unfit for transporting cattle’ effort that sometimes (don’t) turn up. As I do a desk job there was nothing to stop me working and I didn’t even tell my colleagues what I’d done, but I doubt I could have done a manual job.  
It is difficult to describe the way I felt for those first few days. I was tender, I was swollen and things felt different, my scrotum was large and heavy like an overinflated water balloon. There was some pain, but it was not acute or chronic. I can best describe it as being in a state of hyper sensitivity, I think boys learn very quickly how sensitive their reproductive organs are and act accordingly, if the same sort of discomfort came from any other part of the body i.e. a stiff shoulder or a mildly sprained ankle, I would have simply carried on regardless. But the locus of the discomfort and infrequent bursts of pain when I inadvertently applied pressure to the area e.g. lying in the wrong position; meant I was constantly aware of it. There was also an annoying tendency for the areas around the two little scars to itch slightly.
It took a couple of weeks for the swelling to go down. But after four weeks it was completely healed, the sutures had disappeared and everything was back to normal. On Thursday, approximately one month after surgery, I went back to see the surgeon for a check-up. The consultation lasted about five minutes and he gave me a letter for my GP to arrange sperm count tests in May. In my case I hardly needed a follow-up; all it did is confirm everything is okay, but I understand it’s a necessary step as there may have been issues.
Was it worth it? I can’t tell yet, I still need to wait a couple of months before I get the all clear to say my sperm has been permanently restricted. I can say that it’s not as onerous as it seems. I think there is a natural and sometimes perfectly sensible tendency for men to be cautious when it comes to their reproductive organs. I certainly found the physical exam to be a little embarrassing, I was very self-conscious about the idea of a room full of people looking at my private parts even though I’m perfectly aware it’s just a job to them, so I’m grateful I was able to sleep through it. I feel no regret about having it done; providing it works the temporary discomfort is a small price to play for a permanent solution to contraception. The people involved were all thoroughly professional and treated me with respect and care, the only thing that could have been better is more clarity from the very beginning about the steps in the process, I had four different appointments not counting the original one with the GP, I also had contradictory advice about shaving my scrotum, and I probably didn’t need to be checked in four hours before surgery. But overall I wouldn’t hesitate recommending the procedure to others looking for a permanent contraception solution.