Friday, 4 May 2018

Appointment shuffling and intermittent fasting

I should have seen the Consultant Nephrologist last week, unfortunately the appointment was cancelled, even more unfortunately I'd already had the pre-consult blood test. This means when I do get to see her in early June the results will be over a month old.

Outpatients tried to reschedule for the second half of May bu I rejected the proffered slot as it was late-morning. I always aim for early morning as the later the appointment the more delayed the clinic. Late morning is at least a thirty minute delay, by the afternoon it's over an hour. I'm not sure if it's too many appointments booked, not enough time per consultation, or maybe both? My consultations typically last five minutes; enough time to review stats, discuss symptoms and adjust medication if required. Some patients take much longer, possibly because their CKD is more advanced or they have complex needs. I arrive (on time), see the nurse for weigh-in and blood pressure, then I wait to see the Consultant.

It's probably a good thing the appointment was deferred, in the last few weeks my weight has ballooned to 116kg, my heaviest since the summer. I'm not entirely sure why, it's not down to bingeing, I suspect a combination of changes to my daily commute and mild indiscipline. Since I changed jobs earlier this year it's not practical to walk from the terminus to the office; I've maintained my lunchtime constitutional but it's not the same as the brisk morning walk I had before. Later this month Southern Fail are overhauling the timetable, which along with more clement weather, means I may be able to start walking between home and the nearest train station again. I enjoyed doing this last year when the weather was agreeable and my overall commute was easier.

I've also started experimenting with 16:8 intermittent fasting, which basically entails eating my normal diet but skipping breakfast on weekdays. The idea is to fast for sixteen hours then consume the calories for the day in an eight hour window. I fast from 8pm to noon the following day, but it's a matter of personal convenience, and this regime fits my working day well. The 16:8 fast is supposed to help the body into a ketosis fat burning state. I've been doing it just under two weeks and the results on the scales are inconclusive, though I feel less bloated. There potential downside is that my normal diet still has plenty of carbs in it, I've only excluded the ones I regularly consume at weekday breakfast. If there isn't a material weight loss after two weeks I'm considering further adjustments towards a 'keto diet'. A friend has utilised this successfully over the last couple of years, but he's single and doesn’t have kids, which makes meal planning simpler.  

A different form of intermittent fasting was the proposed diet strategy for the 'Constant Craver' group identified by a BBC backed weight loss study a few years ago. I did a self-assessment at the time and fell into the 'Constant Craver' category. This particular version of intermittent fasting was based around eating regularly five days but reducing to eight hundred calories on two days. That's unlikely to work for me (although I'm not entirely ruling it out), currently there's just a coupleof hours each morning when I feel hungry, the rest of the time I'm satiated.

As well as rescheduling the Nephrologist I've had fun rejigging other appointments. Last year the Consultant decided I should have a course of Hep B vaccinations to future proof my kidneys from potential infection, that means four jabs each a month apart with the third due next week. I've also been invited to my annual medical at the GP surgery (along with pre-review blood test). As usual it needed rescheduling (invites made by the surgery without my involvement strangely take no account of whether I can actually attend). It could have been worse the letter originally went missing before I even saw it, it was only when my wife asked about what was in it that I called and found out. It did eventually turn up, unopened, behind the sideboard in the dining room, but there was a very real risk I would simply have not turned up to the appointment. Ultimately it's all worked out, I've managed to reschedule the pre-medical blood test for the same day as the Consultant appointment and the medical itself to coincide with the final Hep B jab. It's a bit of a faff, but better in the long-run! 

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