A trip to the surgeon

On Thursday I made a trip to the Renal Clinic to speak to the surgeon about getting a fistula placed in my arm to set me up for haemodialysis.

It started off with a visit to the ultrasound department for a scan of both of my arms. Unfortunately the results weren't good; in the words of the surgeon my ‘veins are rubbish’! Only one vein was potentially suitable and that was borderline, and given it was on my dominant arm it was immediately ruled out. So, she suggested I consider peritoneal dialysis, but having previously thought carefully about it, I told her it’s not something I want to do given the restrictions it would place upon my active lifestyle. So, I will need to have an AV graft, this obviously carries more risks, but I think the trade-off will be worth it given a standard AV fistula is off the table.

The surgeon also suggested I should be placed on the transplant list immediately, to give me the best possible chance of a transplant before I need dialysis. Unfortunately, IT issues meant she couldn’t see my medical records, so had no view of the work-up that has already been done to get me on the transplant list. Inability to share information properly seems to be a common issue in the NHS; my regular treatment is via a satellite Nephrology clinic hosted by my local NHS trust, whereas the Renal Clinic is provided by a different non-local trust (which also makes getting to the Renal Clinic a total pain). More worryingly, she didn’t even have access to the treatment provided by the NHS trust that hosts the Renal Clinic.

The upshot is that I am going on the waiting list for an AV graft and there needs to be some sort of paperwork done to get me on to the transplant list for a kidney. Apparently, I need a referral letter from my Nephrologist, but perhaps more importantly the surgical team need to be able to access it. My Nephrologist was at the Renal Clinic that morning, but she had her own list to deal with, which is separate from the surgeon’s list. I’ll be seeing her in about a month’s time, so hopefully this can all be expedited then.

This coming Tuesday I will be going back to the dialysis centre at Crawley, I’m not quite sure what for, given that I have already had an ‘education session’ there. Hopefully, it won’t just be a re-run of the same material I’ve been presented with at that clinic and at the Renal Clinic.

The surgeon also raised the issue of my weight, and that I should try to lose weight if I want to avoid any related challenges to getting a transplant. I obviously agreed with her, but made the point that this isn’t as easy done as said, and explained the efforts positive and negative I’ve already made over the last decade plus. The fact that actual medical support has been rather underwhelming, and my previous tactics for weight loss are increasingly ineffective is a stumbling block (I think there’s a whole other post here). 

Back at the beginning of my diagnosis, the original Nephrologist suggested to my (then) GP I be put on Orlestat, but the suggestion was ignored. I did get a referral to a dietitian at one point, but that was a waste of everyone’s time, when I told the surgeon the dietitian had basically told me to eat yoghurt for breakfast and printed off some generic fact sheets from the NHS website, she just laughed and said that’s ‘what they do’ and that basically dietitians are ‘still stuck in the 19th Century’. Anyway, I have emailed my GP and got an appointment to discuss what genuine medical support might be available. My experience over the last decade has left me with low expectations, the NHS talks big on obesity, but rarely seems to deliver. Maybe I’ll be pleasantly surprised, if they refer me to a dietitian again, or one of their talking shop support groups I’ll politely decline, I just don’t have the bandwidth for messing around.

And so we move on, if not necessarily forward!    

Hiatus Over

After a near three year hiatus I’ve decided to start blogging again. A lot’s happened between then and now, and some of those gaps I’ll try to fill in future posts. There was never a formal decision to stop blogging, it was just time constraints as I put my life back together post divorce (I’ve hidden away some of the posts dealing with this period as nothing good will come from raking over them).

This blog was originally intended to document my journey with Chronic Kidney Disease, so that seems a good place to start. I’ve now reached end stage and I’m working with the renal replacement team on what comes next. Next month I will be meeting the surgeon to discuss having a fistula created to facilitate dialysis, but I’ll elaborate on this in a future post. From a health perspective I’m generally well, or as well as can be expected given my prognosis. Fitness wise things are not quite so great, having managed to get down to 100kg, my weight has crept back up to 110kg over the last couple of years. I still try to keep active, but it’s a challenge balancing everything. I’m determined to get things back on track over the next few months.

From a personal relationship perspective things are good. I’ve been with my partner over three years now, we’ve just come back from a fantastic weekend away in Somerset where we were looked at engagement rings. Our relationship isn’t without its challenges, we both have lots of commitments, busy careers, our own health issues etc, but what’s great is that we really value the time we spend together, whether it’s trips to interesting places (Canterbury, East Anglia, Istanbul, Valencia, Wells etc), visiting our respective families or just chilled weekends doing dog walks and trying out recipes.

My relationship with my son remains strong, there have been some ups and downs, but he’s doing good. He’s changed schools this academic year which has recently boosted his engagement (the old school had a big reputation it sadly failed to live up to) and after a couple of years away he returned to his old rugby club last season and is really getting back into it. The situation with my daughter has been a bit more bumpy, we’ve gone through phases where our relationship gets better only for it to take a set back, but I remain immensely proud of her, despite her own challenges which disrupted her studies she did really well in her GCSEs, she’s now at college, has a steady boyfriend and is working part time.

Professionally things are solid, my position as a development team lead was made permanent and there’s a good team dynamic going on. I’ve got some pretty demanding projects in-flight which brings a certain level of stress, but they’re growing me as a leader as well as developing my technical skills. 

Outside of work I don’t get as much time as I’d like for extra-curricular activities; I did write, record and release the first episode of an audio drama on Youtube a couple of years ago, but the second episode has been pending ever since. More recently I purchased an action camera so I can record some of the cool places my partner and I visit, so I’m going to try my hand editing and uploading some of that footage in the near future. I’ve no desire to be a professional ‘content creator’, I already have a busy career, but I do like the idea of sharing the stories and places I find interesting.

At the time of my last post I’d recently moved into my new flat and renovations were underway, barring a few snags they are pretty much all done now. I’ve almost entirely renovated the place and I’ve done a lot of the work myself, with some help from my partner and my parents. It’s been tough but learning new or enhanced DIY skills has been really rewarding; not forgetting that being ‘handy’ has saved me a lot of money I can put to other things. 

 

Anyway, I think that’s enough for today.

Steady as she goes

So, I'm writing this having recently returned from a short break in Turkey with my son, and in general things are looking pretty good.

I completed on my flat purchase in June. I'm now fully moved in and renovations are in progress, it was always a fixer upper, but I'm enjoying the chance to put my mark on the place. I got my deposit back on the old flat and I was even able to sell on the washing machine and fridge that I had to provide for myself (there was a hilarious moment when a prospective new tenant was viewing the flat and the agent tried to spin it as a special feature that the landlord was providing the built in hob and cooker but the tenant had to provide the fridge and washing machine). I heard they were putting the rent up to £1,100 a month which is shocking for such a pokey little place with rather limited appeal.

Career wise my secondment as team leader has been extended whilst they sort out making it permanent, I'm still not sure what that means pay wise, but I'm guessing I will keep the higher duty pay I got when I moved up. I'm settling in to the role, and I've decided not to pursue my interest in Data Architecture as it's not the right move for me, there's a possibility I may look at product management in the future, but for now I'm happy.

My health and fitness is holding up pretty well, I'm hovering around the 97-98kg mark depending on how well I eat in any given week but I have plans for improvement. With the moving and the holiday I haven't run or been to the gym as much I'd like recently but I'm making an effort to get back into it. 

I've been sent an invite for renal replacement education at St Helier Hospital next month to walk me through the process of transplantation, it's still early days, but they're getting me ready for the journey. Apparently I missed an appointment in July, primarily because I didn't know anything about it. I've already had a session with the dialysis clinic down in Crawley, but ideally I'd want to do home dialysis when the time comes.

In my last post I mentioned how I'd met someone through dating and there were signs it might develop into something more. Well, I'm glad to say it has, we've built some momentum in our relationship and it's been fantastic sharing intimacy and trust with someone again. Forming a new relationship in your 40's is different, we're fully formed as individuals in a way we wouldn't have been had we met earlier, but I think we're both optimistic about a long-term future together.

My relationship with my son continues to go well, there's been a slight improvement in my relationship with my daughter. Last month she came to my birthday dinner with my parents and my girlfriend which was a positive development. I've started looking for other ways in which I can invite her into my life without putting too much pressure on her. 

Overall the future looks bright right now.

August Update

It’s been a while since my last post, and quite a lot has happened in between, so I’m going to break it up into three posts, one for each month.

After coming back from my trip up North to see family, I had a busy week at work, where I finally started to get my head around my new role. Then I went off to Spain with my son for a week and for then he stayed with me for most of the following week as I saw out the second week of annual leave.

I had my annual medical with the practice nurse on 9th August, everything was okay. Obviously my kidney function is still shit, but it’s a stable kind of shit, and my blood pressure was good which means the Bisoprolol Fumarate the Nephrologist added is doing its job (I found out it’s a beta blocker, which I hadn't realised, and was a little surprised by given my previous resting pulse was 50-60 bpm). I was 3kg lighter than last year, although my good cholesterol had gone down a little and my bad cholesterol had gone up a little. As a random bonus she offered me a pneumonia vaccine, as I’m apparently eligible for one, and I figured given the winter of discontent the UK is facing I’d take it!

I explained to the nurse how my weight loss has plateaued, probably due to my diet being too heavy on carbs, and my concern about how much protein I should be eating without overloading my kidney. She made an appointment with the practice dietician for September. I’m not holding out for that much as previous referrals for weight management have gone nowhere;  I’m pretty sure that shifting from carbs to protein will improve my fitness regime and help me lose weight, but I don’t want to wreck my kidneys in the process. 

Like the physio I saw a while back (which went nowhere) the nurse suggested I protect my knees by swimming rather than jogging, but the reality is swimming doesn’t have the same impact (no pun intended). I realised I hadn’t run a single 5k in 2022, the furthest I’ve managed being 3k, so I decided to do the whole couch to 5k programme again to rebuild stamina. The early weeks were pretty straightforward given I’m not starting from scratch, but it did set up the pattern I needed. I also bought a new pair of running trainers from Decathlon, their unpronounceable own brand, to replace my worn out Nike. Decent trainers and strapping being the key to injury prevention.

The week in Spain was relaxing, the hotel in Salou was nice, there was a decent choice of food and the facilities were good, although it is noticeable that things are more expensive than they used to be (partly inflation and partly the shite exchange rate). Being up on the Costa Dourada the ubiquitous local beer was Estrella Damm, but I made an effort to try as many different beers as I could (it’s a hard life sometimes) and actually became pretty enamoured with Lemon Damm, a kind of shandy beer which went down a treat of a baking hot afternoon.

We spent a few days on excursions, one to the local waterpark, one to the nearest city of Tarragona, and one up to Barcelona. The plan was to go to Tarragona on market day, to see if we could find any knock off football kits, as it was, the clothing market was pretty meh! But the indoor food market was stunning, which was just as well, as we had to hide inside for an hour to avoid a massive thunderstorm.

Once the storm cleared we took a walk down Rambla Nova to find the Roman amphitheatre. A little disappointingly we couldn't go inside as I forgot to bring a payment card with me, and the ticket office wouldn't accept cash, fortunately most of the site is visible from the park that surrounds the ruins. As we were heading back into town we came across a parade for a local festival, we couldn't really avoid it due to the sounds of the marching band and a man at the front firing a small cannon every twenty metres! After stopping for lunch I took a quick look at the cathedral, but I didn’t get chance to go around as my son was starting to get ratty from all the walking and wanted to go back to the hotel.

The following day we took a coach trip up to Barcelona; I’ve been a couple of times before, so had already visited the big attractions like Park Guell, Las Ramblas and Sagrada Familia. I had hoped to go to Sagrada Familia again, but there wasn’t time on this excursion. In the afternoon we visited Camp Nou to do a tour of the football stadium. I’d last visited about twenty years earlier, during the off season, that time it was less busy and also a lot less commercialised, but my son really enjoyed the experience. 

The final week of my leave, when we got back to England was pretty chilled. The weather was decent so we did a bit of swimming and played some football in the park. For the final week of his school holidays my son went off to Turkey with my ex and his sister and I headed back to work.

Going Backwards

So, summer has been and gone and as autumn rolls in I find myself with some work to do.

Firstly, on the podcasting/writing stuff I do have a plan to get things going again. I know I keep saying this, but with things settling down into a routine I can see some opportunity to fit this in over the next couple of months. 

Diet wise things have gone pear shaped, or rather I've gone a bit pear shaped. Although I managed to keep a lid on things over my holidays, since mid-August my weight has crept up from 108kg to nearly 110kg. This is very disappointing, especially as it's not down to bingeing, it's just a general relaxation in habits; a couple of beers too many times a week and a chocolate bar on too many days. What it has taught me is that I really cannot slack off, ever! My metabolism simply does not allow for any complacency. I have started a new diet, a week in and it hasn't made any difference yet, but I need to give it till the end of September before I hit panic. The goal now is to end the year at 107kg.

Fitness wise I have been managing a 5k run most weeks, with some shorter runs if time allows. I do walk the dog at least once day, often two of three times a day, so I'm getting cardio in. However, my right knee is seriously fucked now, running is genuinely painful, if I can't get it suitably warmed up then it's incredibly difficult and I've found myself abandoning runs half a kilometre in due to the pain. Walking up and down stairs is painful, at certain times walking anywhere is painful, I can wake up with an ache simply having slept in a certain position. I have contacted my GP surgery for a non-emergency consultation and I'm waiting for a response but given the horror stories in the news I'm not hopeful. 

I'm still resistance training three to four times a week with bands and free weights, so my core strength is pretty stable, I could do with more intensity in my training, but it's hard as I'm usually fitting it in later in the day, when I've already done work and family stuff, and my energy is waning. With a bit of rejigging I might be able to do it earlier in the day sometimes. I probably also need to start using the exercise bike to replace the running I'm no longer able to do.

Work has been pretty busy, but the return to the office has been slower that I initially imagined, I have been in once, and I will probably start going in once a week from later this month, but it's likely to be November before I'm in a stable pattern of twice weekly office attendance. This is assuming we don't have another lockdown in late autumn/early winter.

CKD wise I have my next telephone appointment on 28th September, I am a little worried about this, given the last telephone appointment never happened as the doctor was unable to reach me on either telephone number despite no calls being logged that morning on either number. I did check at the time they have correct numbers, so assuming it goes ahead this will be my first direct contact with a specialist since November 2019!

Thoughts on the Fast 800 Diet

Having picked up Michael Mosley’s Fast 800 book a couple of months back I finally got around to reading it at the end of June. I’ve been toying with trying intermittent fasting for a while now, so this was kind of research. The approach centres on fasting, basically reducing calorific consumption down to 800 calories a day, with some additional elements of time restricted eating, basically eating within a certain ‘window’ of time each day to promote ketosis.

The recommended plan is a period of rapid weight loss (the Fast 800) by consuming just 800 calories a day for between two weeks and two months, followed by a less restrictive regime of intermittent fasting, whereby you fast a few days per week, and eat normally but healthily on the other days (the 5:2 diet). However, it accepts that sticking to Fast 800 for several weeks may not be practical or even advisable for everyone, so there is a degree of flexibility. Slower, but less intense weight loss options that are recommended include just doing the 5:2 or adding additional fast days without going the full Fast 800.

I decided that the full Fast 800 was unlikely to work for me, the severity of the restriction would be difficult to maintain, particularly at weekends. But fasting a few days a week, and doing time restricted eating on non-fast days was probably manageable. So, for the past two weeks I’ve been fasting around 3 to 3 and a half days per week. Basically, I’ve been fasting on Monday, Tuesday and Thursday, keeping my calories down to around 800. On Friday’s I’ve been fasting up until the evening but not sticking to 800 calorie limit (although still consuming less than a normal day). On Saturday, Sunday and Wednesday I try to consume all meals within an eight-hour window, typically noon till 8pm, although I have drunk the odd beer after this time. I chose these days because I’m in the office Monday, Tuesday, Thursday, Friday which helps restrict potential for snacking or large meals, whereas Wednesdays and the weekend have more temptations. 

   

So far, it’s gone pretty well, during the early fast days I did feel tired in the afternoons, and occasionally light headed (‘keto flu’ apparently), but it has gotten easier. I do feel mildly hungry for most of the day, but not as bad as I thought I might. The results are also encouraging, before I started I was weighing (on my scales) between 116.2kg and 116.8kg, this morning I was down to 113.0kg. I suspect the rate of loss will taper off, but if I can get town to between 111kg and 112kg for my next consultant appointment on 30^th July I will be happy. After that I’ll consider moving to 5:2 plus time restricted healthy eating as a possible long-term pattern. It will also help that we’re going to attempt to change our diet as a whole family, so out with sweets and highly refined carbs and in with more complex carbs and fibre.

Not dead...

Very busy lately, so no time for blogging. I had my latest appointment with the consultant about a month ago and my numbers were stable. My weight was just under 115kg about the same as three months before, and around where I've been stuck for probably six months.

As far as I'm aware I'm still on the waiting list for the evening instances of the 'Healthier You' pre-diabetes clinic, I'll eventually get round to blogging about that malarky.

I had my final Hep B vaccination shots a couple of weeks ago (I got a last minute appointment and they threw in a flu jab as a bonus), so now I need to have a screening done with my next set of bloods in December.

16:8 Washout

The 16:8 turned out to be a washout. I did it for a couple of weeks and saw no material improvement. I’ve decided to try and mix my regular diet up a bit instead. I’m aiming to replace my main evening meal with a bowl of soup a couple of evenings a week, and also switch out lunchtime sandwiches with a baked potato some days. Hopefully this will reduce down my refined carb intake a little. One thing I do need to get a handle on is grazing on sweets before dinner. I’m not bingeing, but the house is awash with sweets and chocolate which puts me wide open to temptation when I get home feeling hungry but with dinner usually an hour away at least.

I’ve also started walking to the station again in the morning, at least when weather and schedule permits. It adds at least another two thousand steps on to my daily count, and it comes before breakfast which in theory is good for digestion. Too early to tell if these moves will be successful, but I’ve less than three weeks to my next trip to the Nephrologist and I really want to get my weight down to at least 114kg by then.

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! 

Fitness trackers and DNA testing

I was intrigued by a recent article on the BBC website about the efficacy of fitness trackers. I’ve been wearing a fitness tracker for about six months now and I’m pretty convinced about its benefits, it’s not that I think it’s some sort of a miraculous panacea, but I find it very useful for encouraging me to keep active. I keep track of my step count each day and if I haven’t been active enough I make an effort to put in a bit extra, or if I fall short one day I try to catch up the next. I also use it to log changes in my weight each week and to keep an eye on how much sleep I’m getting.

It is true that the majority of my weight loss in the last twelve months came before I started wearing a fitbit, but it would be wrong to take that as evidence that not wearing one is more effective that wearing one. I lost more weight at the start because at my starting point I was heavier and my overall fitness was lower, by the time I started wearing one I’d already significantly improved my basic fitness (from a very poor base line) and incremental improvements where always going to be more challenging. To go from homeworking most days to commuting was a step change in activity, but I can only walk to the office once in a morning, and back to the station once in the afternoon and I only get one lunchbreak to take a walk. So there are practical, physical restrictions on the scope for exercise, if not the effectiveness. What the fitbit has done is supported my ongoing progress, helping me to avoid slipping backwards.

One thing in the BBC article that did get my attention is the idea of genetic testing to aid weight loss. I’ve long had a suspicion that there are insights into my diet that could unlock more effective weight loss strategies, at least beyond the usual boiler plate of eat more rabbit more and do more exercise (not that such generic prescriptions are worthless, they’re just very limited). I like the idea of customised dieting advice based on scientific evidence; it’s a bugbear of mine that the various NHS practitioners I regularly come into contact with hassle me to lose weight, but without ever offering any practical, customised support. I don’t hold it against them, I understand resources are tight, but the official Government driven approach appears to be all stick i.e. sugar taxes and treatment rationing (including rationing based on pseudoscience like BMI), and no carrot i.e. making customised nutritional advice more readily available to obese people like myself. I can’t help but feel that the official approach to obesity related health could be more cost effective long-term with a bit more investment and focus short-term.

I’m seriously considering paying for a service like the one offered by DNAFit, I just need to find the one that will offer me the most useful benefit for the fee. What I really want is some customised guidance around what food/nutrition I should avoid and what I should favour. I’m not really interested in the “value added” parts of the products (value added being business speak for boosting profit margins by selling lower value bolt-on products at a price that suggests they are actually high value products); I don’t want recipe books, eating plans or exercise plans, I can work things like that out based on my own preferences once I have the underlying nutritional insight. Nor do I want to be flogged ongoing fitness services or be benchmarked against Olympic athletes, or any of the stuff that probably delivers the most profitable customers.

I’m really just looking for a company that will offer basic but comprehensive diet testing. I’m sure all the “value added” stuff might be useful if I was a fitness nut, or even if I was still playing organised sport like I was ten years ago, but these days it’s simply about being healthy and getting my weight down to 100kg.  But most importantly I want anonymity, whatever my test results are they need to be completely confidential. I don’t want them shared without me choosing to do so proactively, nor do I want the risk of being required to disclose them to some third party (such as an insurance company) at a later date simply because they exist. I know there are pretty good data protection laws in the UK, but that doesn’t mean a company cannot be hacked, nor does it prevent a situation where one day I’m legally coerced into sharing them. Ideally, I’d like the process to be completely anonymous, with my sample and the records from it destroyed within a sensible time frame.

I think I have some research to do, but this blog post lookslike a useful start…

Target hit, well sort of…

I had my Consultant appointment on Tuesday, and by some strange fluke I managed to weigh in at 111.2kg, which was a bit of a surprise as I’ve been pretty consistently weighing in between 112kg and 113kg in recent weeks. I’m pretty certain that 112kg to 113kg is my current stable weight range, so I’ve created a bit of a rod for my own back, when I go back in four months I’m going to need to be under 110kg, which means a loss of at least 3kgs, and that’s not helped by me being a bit naughty ever since Tuesday!

On the positive side my Consultant is happy with my progress, she says my stats are strengthening and showing definite improvement with the weight loss and the medication regime. The closer I get to the ultimate target of 100kg the more time I’m giving myself before I end up on dialysis and the transplant list. I’ve also been free of gout attacks for a long time now, which is a very physical sign of improvement.

Suspicious Scales

I'm not entirely sure what I'm doing right, but if my bathroom scales are to believed, I hit the 111.5kg mark this week. That leaves three weeks to get rid of the remaining 0.5kg to hit the overall target of 111kg. The interesting thing is that I haven't been trying exceptionally hard, albeit I've been generally disciplined in my eating (the odd Xmas chocolate aside) and have maintained moderate alcohol consumption (no drinking at all during the week). My step count has been pretty good apart from the days when I was forced to work from home due to train driver strikes.

This relative success following a period of stagnation is making me nervous that my scales are faulty, even though they are a fairly new digital se, so it will be interesting to see what my parents scales say at the weekend. The alternative theory is that I've hit a purple patch where the combination of calories and exercise is good for weight loss.

Tomorrow we're heading up to my hometown for Christmas, so the opportunity for overeating and not exercising will increase significantly. The key thing will be making sure I take a good walk each day and go easy on the sweets!

Quick update

Just a quick update. I weighed in this morning at 113.6kg and there are exactly six weeks to go till my next consultant appointment. If I can manage a loss of 0.5kg per week I'll make it to 111kg.

No doubt it will be tough. I'm going to need to avoid Christmas temptations and really put in some physical efforts. I've raised my steps target to 11k per day and I'm committing to jog three times per week form now on. No alcohol on school nights and no chocolate on weekdays. I'm also going to start a vitamin supplement alongside my prescribed mediation. It's going to be an interesting six weeks!

BMI, healthcare rationing and casting of runes

No posts for a while, nothing much to say. Recently my weight has been fluctuating between 114kg and 115kg. Everything has pretty much plateaued, my activity levels are good but not exceptional, finding time to fit in extra exercise is challenging. Weekends over the past few months have been taken up by DIY (painting fences, painting the garage, replacing guttering etc…) and just recently with various family commitments. Now the weather has turned the idea of going for a jog in the cold, wet, dark evenings is not one that fills me with joy.

My diet has slipped into what I'd describe as a normal pattern. I'm not pushing hard to cut out calories like I did earlier in the year, but at the same time I am showing self-restraint in what I eat and drink. Sweet things are restricted to a couple of times a week and to normal sized portions. Compare that to 12 months ago and the difference is significant, back then I would eat a chocolate bar most days, and sometimes I would have more than a single serving of a sweet or chocolate on the same day.

That step change means I'm not too worried about the Christmas season, I know I can moderate myself when temptation is all around me, although I’ll need to be tough with the inevitable influx of office mince pies. The big question is whether having achieved a level of stability the time is right for another push? I have about six weeks till my next consultant appointment in early January and it would be good to hit 111kg at that. That's around half one pound a week, achievable but challenging given the season and the fact I’m starting from a lower calorific intake than at the start of the year. It would bring my total weight loss for the year months to around 14kg, over half way in my battle.

One significant positive from the whole exercise is that my BMI is now around 36 when it was tipping 40 at the start. I don’t personally hold much faith in BMI as it’s got more than a whiff of pseudoscience about it, but it’s a pseudoscience that is increasingly being used in the rationing of NHS treatment.

I recently arranged to have a vasectomy a.k.a. “the snip”. The NHS has contracted the procedure to a private hospital and I was told at the initial consultation a BMI over 40 would have seen me rejected. As I actually got the initial GP referral over a year ago, but couldn’t get suitable time off work, I would probably have been declined had I proceeded immediately. It needs to be stressed this isn’t a rule based on genuine medical science, the hospital will still carry out the procedure on people with a BMI over 40, but they have to pay privately. This seems a bit of a nonsense as the procedure is non-emergency under all circumstances, it isn’t particularly complex, and there isn’t a massive waiting list (I was able to obtain appointment slots easily). 

Surely in this day and age there must be more sensible ways of rationing treatment (if rationing must occur at all) than the arbitrary application of pseudoscience? What next, NHS treatment allocated on the basis of casting of runes?

A new approach needed

The consultant appointment came and went, the last ditch effort to lose weight failed, I stuck to the no alcohol or chocolate ban for two weeks, but it didn't really make any difference. In the end I weighed in at 115.6kg, half a kilo heavier than I did four months earlier. Ultimately it made no difference to my stats, my CKD remains stable (c. 28% kidney function according to the consultant) and my medication remains unchanged.

After that I kind of let things slip a little, having failed to make the weight loss I slackened off on the diet, not massively but just enough. It didn't help that the day after the appointment I was giving the eulogy at my Grandfather's funeral and wasn't in the mood for abstinence. So this week my weight is up again to 116.4kg.

I now need to rethink my approach, as the current one isn't working: eating a generally sensible diet with moderate consumption of alcohol and occasional sweets; combined with regular moderate exercise. There are a couple of levers, the first one is to change my diet again, I know it's too heavy on carbs, particularly refined carbs like bread and pasta. I mainly eat white bread (usually unsliced bloomers, ciabatta, baguettes etc., not that it probably makes any difference from sliced packet bread) as I've never been too keen on brown bread finding it a bit dry and cardboard like, but there are some artisan style brown breads I've tried and enjoyed, the question is figuring out whether switching will make have a material affect? It's actually quite difficult to get clear guidance on whether switching bread and pasta is materially beneficial. The other options are to switch away from bread altogether for some meals, perhaps having weetabix or muesli for breakfast instead of toast or soup at lunchtime, the only concern being whether these will fill me up sufficiently to avoid snacking or having to go with portion sizes so large they defeat the objective. It may simply be a case of try and see.

The second lever is more exercise. This is not as easy to affect. I have my morning walk from the station (instead of taking the tube), and I have my lunchtime constitutional, but after that it becomes more difficult. I try to slot in walks/jogs in the evenings, but these are not easy. With two young kids and their various activities (after school clubs, homework, feeding, bathing and getting to bed) as well as the day to day chores that need to be slotted in finding a suitable half an hour and time for a subsequent shower is not as easy as it sounds. Too soon after a meal and it's uncomfortable, push the meal back and it's going to bed with a full stomach and inevitable indigestion. Jogging/running has never been my thing, even back before the kids, when I played rugby league and went to the gym several times a week. I now find heels and ankles can hurt afterwards. There is also no gym or swimming pool close enough that I could take advantage of it. sufficiently to justify a membership.

It's given me something to think about, but I can’t mull it over for too long as I need to get some momentum back up.

Special Measures

Well, my plan to get down to 111kg by my next visit to the consultant on 13th September is completely in tatters. This morning, with two weeks to go, I weighed in at 116.1kg, basically 1.5kg heavier than I was 4 months ago. It's not that I have been especially bad with my diet or exercise, I just haven't been disciplined enough overall.

The lack of progress is a combination of daily 'extras' like ice cream and/or a couple of beers, particularly whilst I was on holiday in August, and a few 'bad' days like my cousin's wedding or Saturday's challenge cup final where I ate more or drank more than I would normally. It's not like I've been on any mad benders or have binged on food, it's just that there haven't been enough days where I've burned off more calories than I've consumed. I can get away with those occasional bad days if I keep the days with 'extras' to a couple of days a week, unfortunately I haven't done that.

So my new target is 113kg. That is basically 3kg in two weeks, very challenging but not impossible. I'm working on this basis that I can shock my system back on track by cutting out chocolate and alcohol for two weeks, and adding a regular evening walk/jog to my routine. I still do my daily morning and lunchtime walks, and I follow my late breakfast and no morning snack routine at work, but I suspect that my body has simply normalised to this so I need to increase the work rate to get benefit. I think it will be an important milestone to break below 114kg.

The Flatline... again!

Staring to get a little nervous about my diet again, I've stabilised at 114.6kg, but I'm now half way between my four monthly visits to the consultant and need to get some downward movement. I've set myself a target of 111kg by the next appointment on 13th September, that works out at one pound per week. It's a challenging but realistic target. 

I need to be more ruthless tackling unhelpful patterns which have crept in, such as sticking to my diet on most days but then having days when I'm not so good. The diet works best when I'm in a regular meal routine and I don't get too hungry because the gaps between meals are too long, which only tempts me to snack. Bad days mostly involve a handful of peanuts whist waiting for dinner or 'extras' like an ice cream after dinner or a couple of beers midweek. 

The early part of July had several days when I was too indiscipline, on Saturday 2nd we went out for tapas and as we tend to order too much food I end up feeling compelled not to waste it. The next day we went to a garden party at the in-laws, for some reason I thought it was going to be a barbecue, but instead it was a mid-afternoon light buffet which turned out to be the worst possible combination. Firstly, it was too close to lunch which meant I wasn't really hungry, secondly (and rather unusually) there wasn't really enough food so when I was hungry there was nothing left. Thirdly, as it was a warm afternoon I ended up drinking the equivalent of five pints which is atypical. So instead of a regular meal I ended up with a slice of pizza, cookies and beer! Then came my birthday, I didn't particularly go overboard, but there were sweets and cake. Fortunately things have settled down in the last couple of weeks.

I got the Fitbit for my birthday, so now I'm keeping better track my exercise. The good news is that I am averaging over 10k steps a day, but it does confirm I'm not getting enough intense exercise and also not enough sleep/good quality sleep (a mixture of recent hot weather and kids waking in the middle of the haven't helped). I've been taking Allopurinol for over two weeks now without any severe gout reaction, although I did take two magic tablets a day for the first fourteen days. At the moment I'm trying to make sure I squeeze in a walk every lunchtime and plan to restart the jogging regime I abandoned in June due to gout. I'm also hoping that the two weeks holiday I have booked in early August will increase my activity levels as I get out from behind a desk.

Slippage

Well it had to happen given the temptations laid in my path, my weight loss inevitably started to go backwards last week. When I got on the scales on Wednesday I was 115kg up 1kg. Fortunately, the gout attack has significantly receded, although there is still a small amount of pain in my left foot (ball of the big toe and heel) it hasn’t got significantly worse for about a week. The course of steroids didn't finish it off and I still needed another cycle of magic tablets early last week, but at least things are now settling down now. I’m planning a final cycle of Colchicine this weekend in the hope I will be able to start Allopurinol early next week.

I have been trying harder with the diet this week, albeit temptations are everywhere. One of the downsides of my current workplace is the culture of bringing in cakes and sweets to share on a near daily basis. This piece on the BBC about "office cake culture" is a rather timely example of the problems I face. Most of the time I resist, but yesterday I did indulge in one of the donuts a team mate procured to celebrate his birthday. It didn't help that the boxes were stacked right next to my desk ensuring a steady waft of sugary smells in my direction.

Talking of birthdays, it's my own next week. My wife is treating me to a fitbit, which is something I've been looking at for a while. I'm keen to start recording just how many steps I'm taking daily, and use it as motivation to increase, particularly by fitting in more lunchtime walks. Now I just have to decide whether I take in cakes next week, or whether I just let the day pass quietly (my preferred approach to my birthday).

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.

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.