Tag: blogger

Thoughts of the Week

It’s been however many weeks now in lockdown and, although easing a little, much of the entertainment (or at least unpleasant distraction) is watching our government muddle their way through things in farcical fashion.


Covid aside for a second, there was furore about the $26,000 (actually pounds but my keyboard doesn’t let me do a pounds symbol) or so salary limit on foreign workers, with critics accusing the government of not valuing the work of those on lower salaries. My gut reaction was to agree with the dissent until I heard another side to the argument – that workers below this salary cap can be more easily and more cheaply trained; not that the people and the jobs being done were at all not valued. I don’t like our government, don’t get me wrong, but it was a moment I had to check myself and remind myself that there is bias on both sides of the spectrum and there are always two sides to the story. This is something that we must all be wary of. Even when there is no attempt to deliberately mislead (and there are plenty of examples of that), the sheer strength of opinion almost took me to one side of an argument that, when one looks closer and puts aside bias, is not quite as simple as it seems.


I tried to remain measured when it came to Cummings. I really did. ‘If it was just a trip up to the house in Durham to isolate there’ I said, ‘then well I suppose I can understand that’. Of course, everyone now knows it wasn’t just that and to defend it is indefensible in itself. If you disagree you are hopelessly deluded or there’s something in it for you.
It is this sort of blatant disregard for accountability and flagrant shamelessness that we have come to know and love in politics in recent times, to the extent that even those who have practised it in the past have called Cummings and the PM out for it.


Our leaders are a bit like that naughty child at school. The one who constantly pushes his luck and plays up, each time emboldened when the consequences are far less severe than anticipated, the bluff of punishment having been well and truly called.


Not many succeed at this better than Donald Trump but, to me at least, it is obvious in our government too. Frankly I wouldn’t even trust Boris or anyone of his cronies to take a picture of me lest they run of with the camera. What surprises me is that some people are surprised. There are those who are now saying that this blatant refusal to be held to account in a position of power is a slippery slope. Of course this is true but what many don’t realise is that we’re half way down that slope already.


Enough of that. In other news, I’ve been reminiscing on my childhood Wednesday evening tv viewings (the slot just after the Neighbours/Simpsons power combo of my teenage years). Star Trek is not my favourite of the “Star” franchises. Despite the tangled and ill thought out mess of the recent Star Wars films, I favour the original trilogy above all else. Having said that, I did enjoy Patrick Stewart in the Next Generation, if not just for the outstanding potential for quotes. (“engage”, “make it so” etc). The new Picard series was something I was a bit sceptical of as reviews had, for some reason, been a bit cold. I have no idea why because quite honestly it’s brilliant. Clever, action packed, stylish, nostalgic and quite poignant so far, I am absolutely loving it. I genuinely don’t want it to end (although I will definitely finish the series, unlike my refusal to watch the last season of Lost, thereby somehow making it last forever in my head). Anyway, watch Picard, it’s awesome.


One final note, this week on cyclists. This lanky and lycra-clad species are a perpetual menace to me at the best of times. Let me be straight, I am never aggressive and am always safe when I drive but deep within me, I boil over with rage whenever I see one on the road. They are particularly irritating when strong in numbers, sitting lazily in packs across an entire lane and quite literally stealing 10 minutes of my life away from me. The rage is intensified all the more as they sail straight through a red light, presumably safe in the knowledge that they’ll just phase through any oncoming traffic without so much as a hair out of place (although is it just me, or are a lot of them not just tall and lanky but also quite prone to balding as well?). Either way, I don’t know if it’s the lockdown, the weather or both but there’s bloody loads of them out at the moment. They need to stop it. In the interests of balance, I will mention the one cyclist who waved me past him as the traffic light went green the other day. I was so shocked that he’d even obeyed the law enough to stop at the red light, let alone reveal some semblance of a conscience, so perhaps I didn’t thank him as much as I should have done. Regardless, he is in the minority. Get rid of them.


Ps. As a doctor, quite apart from the environmental benefits, I would say cycling is an excellent form of aerobic exercise, especially if you want to take the load off your knees and it should be unfalteringly encouraged.
W

Thoughts of the Week

What a bizarre few weeks under lockdown this has been. While much of my life has been fairly similar in terms of structure (ie normal working days etc) the content of those days has been very different. I am one of the lucky ones in this respect. Fortunately, what my life has lacked in terms of pubs and cafes and shops, it has made up for in other ways.
The excellently amateur online pub quiz has been a particular highlight on a Thursday and Saturday night. It is genuinely something I look forward to and is something the whole family gets involved in. I have also been playing on the PlayStation a lot (Divinity: Original Sin 2 for those who are interested – an extremely nerdy but very involved dungeons and dragons type game which is not my normal choice but which I am finding awesome fun). Coupled with that – and I really have been getting my geek on – I have started playing a real life dungeons and dragons story with a group of friends via Zoom. I’ve never tried it before and I have to say, it’s cracking fun. Great change to catch up with friends from around the country (and the world) apart from anything else.


That has reminded me of a Harvard study I read about once in which levels of happiness were measured and quantified. The outcome I remember was quite poignant – those who were the happiest weren’t the richest or the most successful necessarily but were the ones who had maintained close friendship groups for long periods through their lives. Something that is particularly relevant at the moment I think. With so many people separated and levels of mental health issues rising, we should all be seeking to solidify friendships above all else.


In the same vein, a recent YouGov poll found that 8 out of 10 people would prefer the government to prioritise health and wellbeing over economic growth and GDP during the coronavirus. 6 in 10 wanted this to continue beyond. In some ways, slightly meaningless because one might argue economic growth is intertwined with wellbeing. Just as above though, this may not always be the case. I do wonder sometimes whether we are hurtling forwards inexorably in the interests of progress and expansion at the expense of so many things, not least the world around us. To halt this chain reaction is far from simple of course but there may be no better time than now to reassess things.


With the muddle the government have got themselves in this week over the new lockdown rules, I am not holding my breath. While I have actually been defending their overall plan (something that I never thought I would be doing) the evasive way it has been presented and the obvious and unsavoury motivation behind it (that of political damage control and self congratulation) has been pretty farcical. Looks like the lockdown is not as stringent as it was but it is not lifted. And we are to “stay alert”. To come up with that sort of nonsense slogan really is a symptom that comes from a lack of cohesion and leadership. Spin on care home deaths, overall cases and misuse of the R number (see my latest medical article) are just a few of their misdemeanours. There is no doubt that the government’s overall mismanagement of this crisis (and I repeat, I actually think their current measures are appropriate and require people to just use a bit of common sense and stop being so precious) has been nothing short of rubbish. That this is in any way surprising to people is the biggest surprise of all from my perspective!
Keir Starmer looks to me to be the future (and had done for a long time). Such a furore and a to do for so long before someone sensible like him comes along is the biggest tragedy. It’s just a shame we will have to wait a long time for him to get hold of the reigns.


Talking of length (apologies for the tenuous segue), my hair has not been cut for a couple of months now. Most obvious are the sides of my head which are expanding outwards at a fair rate. I look like Nicholas Cage. Beanie hats now make me look legitimately like a surfer dude (at least in my own head). My beard is another matter altogether. It is wild even despite my own feeble attempts at trimming it. I am one of those vain types that normally gets my hair cut every 3 weeks or so, so I have taken this as a sign and an opportunity to grow my hair out. I have tried it twice before in my life. Both times were pretty bad and I didn’t get past the mid length stage. (In fact my first attempt coincided with my “digestives and nutella” phase at uni and so, with the extra weight I was carrying at the time, I don’t think I have ever looked more physically repulsive. I am determined for things to be different this time – with the barbers closed, I really have no choice. So far I have resisted offers from several people who fancy themselves as stylists and so will have to just let things take their natural course. I think this is the right decision.

2020 update

It’s a new year, a new decade and plenty is happening in the world. Having not updated the actual blog part of this site for a while, I felt it was about time I rectified that. 

The last time I mentioned anything about my novel, I was embarking upon the 8th draft. This weekend, I finished it. Big sigh of relief! It’s been a tough 6 or 7 months of writing and trying to fit it in between the other day job but I’m finally there and I’m feeling reasonably pleased with it. 

The main aim with this draft (and I wouldn’t have done another if I didn’t think it was necessary) was to streamline it a little more and give it some tension towards the end, which it was perhaps lacking. 

Without reading it, saying any more would be pointless so I’ll leave it there. Needless to say, I am now looking into finding some representation once more and I am hoping that the changes I have made will make the difference. 

I have many projects that have been backing up behind this one, so expect to see so more action on here for the foreseeable. I have some ambitions to publish something non-fiction next, but I’ve also got a couple of short stories lined up as well. For the time being, have a look at my latest dieting post in the medical tab. Worth a read if you’re feeling some of those extra calories!

Dark Pines

One of the most enjoyable novels I have read for a while. Perfectly paced, interesting characters and a genuinely good story. Also interesting, having just read a book on hearing loss, that the main character has to wear hearing aids. I didn’t plan that!

Love the author, Will Dean’s, bio as well… Having settled in rural Sweden, “he built a wooden house in a boggy clearing at the centre of a vast elk forest, and it’s from this base that he compulsively reads and writes.”

Good man.

Churchill’s Ministry of Ungentlemanly Warfare

Giles Milton paints an heroic picture of the incredible operations and missions carried out during WWII. An interesting read just after the Codemaker’s War as it deals with a lot of the same organisations from a very different angle.

 

Exercise

“Fit and fat is better than being unfit and thin.”

Forget pills, staying active is the best medication.
After-all, when it comes to being healthy, there is almost nothing else that comes near it in terms of its effectiveness.

There is a quote from a health promotion consultant called Dr Nick Cavill that seems to pop up more and more regularly these days – ‘If exercise were a pill, it would be one of the most cost effective drugs ever invented.’ When you look at the statistics, it is difficult to disagree.

There is strong evidence to suggest that exercise reduces the risk of the following conditions by the following percentages…

Coronary artery disease and stroke – 35%
Type 2 Diabetes – 50%
Colon cancer – 50%
Breast cancer – 20%
Osteoarthritis – 83%
Depression – 30%
Dementia – 30%
Hip fractures – 68%
Falls in older adults – 30%

These are not insignificant numbers as I’m sure you will appreciate. Exercise really is good stuff and also helps with self esteem, sleep quality and energy levels.
The government’s aim is for everyone to be doing around 150 minutes of moderate aerobic exercise each week. Moderate exercise is something that essentially causes you to breath faster, increase your heart rate and feel warmer – a good way to gauge it is if you are breathing too heavily to sing the words to a song. Examples might be going for a brisk walk or hike or playing a game of volley ball. Only half of us in the UK are reaching that target. It doesn’t take too much of an imagination to consider the effect it would have of all of us matching this target on the mortality rates for all of the conditions above.

It goes deeper than this though. We are a species that evolved as hunter gatherers, constantly on the move, but in world with televisions and remote controls, motorised vehicles, and robots that do your hoovering for you, it comes as no surprise that we are suffering from the effects of a sedentary lifestyle. As such, even if we are reaching our exercise targets, if we spend the rest of the time sitting or lying down (and the average person in the UK sits for 7 hours a day, 10 hours if you’re over 65 years old) then those benefits are lost or at least have less impact on the risk of adverse health conditions.

It is therefore key for us to move about every now and again even if we’re not exercising. The recommendation is that every half an hour, we should get up and move about for 2-3 minutes. Practically I know sometimes it may seem difficult but actually when you think about it, is it really? Sometimes only the smallest things need adjusting to achieve this, whether it be an agreement with your boss to get up and walk around the office once in a while or maybe even (as horrifying as this sounds) keeping the remote in the shed at the bottom of the garden. Essentially we’ve all got a bit lazy and our bodies are experiencing the consequences.

For those thinking, ‘well my knee hurts too much for me to do any exercise’, or ‘the local volley ball court is too far away,’ I’m afraid that’s no excuse. Remember, moderate aerobic exercise is anything that gets you breathing and increases your heart rate, so if your knee hurts, do some swimming or even some armchair aerobics, likewise if you can’t get to your local sports centre easily, go for a brisk walk down the road or around the garden for 30 minutes every day. There is a mode of exercise for almost everyone.

Why does exercise and activity help you may ask? Recently, research has revealed quite in depth benefits that we were previously unaware of. Much of this has to do with the anti-inflammatory effects of activity. At the cellular level, our bodies are in constant turnover. Each cell in our body has something called a mitochondria which is essentially a mini power plant. It is here that we produce energy to be used in various processes throughout the body. Each mitochondria will build up a charge and if we are not using energy, they stay charged. The longer they do, bits of charge will gradually escape in the form of ‘free radicals’. These free radicals are bad news and contribute to cell and mitochondrial damage, aiding the ageing process and generally making us less healthy. It is thought that this process causes microscopic inflammation throughout the body.

Activity and exercise helps by utilising this energy and preventing release of free radicals but also produces anti-inflammatory substances from muscle that help to mediate the inflammation at a cellular level. That is not to mention its effect in increasing insulin sensitivity of cells, reducing risk of conditions like diabetes, along with strengthening heart muscle to reduce average heart rates and contributing to lower blood pressure and cholesterol.

There is a lot of focus these days on weight loss when it comes to exercise. This is quite a damaging concept and is reinforced by many commercial diet plans and courses. Although it is important to maintain a good weight and avoid obesity, weight loss is not the be all and end all. There are two types of fat. Subcutaneous fat (sub – beneath; cutaneous – skin) is the stuff that pads out our waist lines and is the most visible. However, arguably far more important is the fat that surrounds our organs like the liver and the heart. This is called visceral fat (viscera meant ‘internal’ in latin) and build-up of this visceral fat has significant implications for our general health. Even if our exercise seems to be doing nothing to our subcutaneous fat, it will be having far greater effects on our visceral fat and this is very important. Therefore we mustn’t measure the success of our exercise or indeed any form of activity with weight loss. Fit and fat is better than being unfit and thin.

The Eye

“…fingerprints have approximately 40 individual features but the average iris has 256.”

What do the following celebrities all have in common? Christopher Walken, Dan Akroyd, Simon Pegg and Jane Seymour. It takes only a quick glance at the title of this article to ascertain that it must be something to do with their eyes. Well done though if you said that they all have ‘Heterochromia’, which means that each of their eyes are different colours. Regardless of whether or not one’s eyes have this rather exotic trait, these clever and intricately complex little organs tend to be a focal point and, at an individual level, one of our most vivid and emotive defining features.

They are thought to have evolved initially in single celled organisms that held light sensitive proteins. Over many millions of years, the process of ‘seeing’ became a reality through a mind-boggling transition into the eyes that we see today. Across the animal kingdom, there are many different types of eye and, as is the outcome of all evolution, the creatures they serve benefit in different ways depending on the environments in which they live.

Geckos can see colour 350 times better than us, bees have 5 eyes, most spiders have 8 and worms merely have a collective of light sensitive receptor cells. Not all eyes are structurally the same. For example, some vertebrates, including cats, have an extra layer of tissue behind the retina (the layer of cells that collects and processes light) called the tapetum lucidum. This reflects any light that has got through first time round and reflects it back into the retina again, giving rise to excellent night vision – very handy for catching unsuspecting mice. It also results in the eye-shine we see when some type of mammal is lurking in the bushes and served as inspiration for the ‘cats’eyes’ we see on our roads.

We humans must make do without these handy features and we are limited to just the two eyes. This is better than one though, as it gives us a perception of depth. To enable us to see, we must collect the light from around us and process it. Light bounces off everything (almost) and if we look towards something the light from this will hit our eyes. This light travels first through the cornea and second through the pupils (the holes made by the retractable fibres that make up the iris (the part that gives our eyes their colour). Here it hits the lens, a rounded clear organ that alters in size as we focus differently. This allows it to redirect light from different distances onto the back of the eye where the retina sits, so that it doesn’t produce a blurry picture. At the retina, the light is converted by different types of cells into nerve signals and the information is then taken via the optic nerve to the brain where it is further compiled into what we understand as ‘sight’. Interestingingly, because of the way in which the light is focused on the retina, the unprocessed image is upside down and back to front, so the brain must flip these back the right way round.

As doctors, the eyes are a useful thing to check when examining a patient because they can tell us a lot about a person’s health. Shining lights into the eyes causes the pupils to constrict and faults here can point to certain neurological conditions as can double vision and loss of visual fields. Looking at the back of the eye, we can sometimes tell if there is raised pressure in the fluid surrounding the brain, and at the front, there are characteristic appearances in or around the eyes of people who might have thyroid problems or high cholesterol. In babies, it is important to check for something called the red reflex, the normal red-orange colour of the eye when light is shone. Asymmetry here or a white reflection can sometimes point to something called retinoblastoma which is a type of cancer.

The most common eye examination one might receive is the visual acuity check. Using the Snellen charts, reading the letters on rows of ever decreasing size, we challenge ourselves to get to the very bottom level. The phrase ‘20/20 vision’ is often talked about, which essentially means we can see something at 20 metres that the average person would see at 20 metres. Outside the USA, we use 6 metres as a scale and if you wanted really exceptional vision, you would aim for something more along the lines of 6/7 (in other words you could see something from 7 metres that the average person would only be able to read at 6 metres).

If our vision isn’t quite up to scratch, we might need a correction and this is where glasses and contact lenses come in. Depending on which survey you read, between 69% and 77% of people in the UK wear glasses or contact lenses – so many that it is isn’t surprising that they have become somewhat of a fashion accessory!

More seriously, there are currently approximately 2 million people in the UK living with a level of sight loss that has a significant impact on their daily life. There are around 350,000 people registered as blind or partially sighted alone.

There are a plethora of conditions that can cause such sight loss.

  • In the UK, age-related macular degeneration is a major cause (a deterioration of the macula, a part of the retina, due either to the formation of deposits on the retina or to fluid build-up underneath the macula).
  • Diabetes is a big cause of sight impairment as well – it causes progressive damage to the blood vessels at the back of the eye and is known as diabetic retinopathy.
  • Glaucoma is a build-up of pressure in the fluid within the eye. Your optician will check your pressures by puffing air at the eye using a machine. As long as it is well controlled and monitored it can be treated with certain medicated drops.
  • Cataracts are a gradual clouding of the lens. When vision is too severely affected, surgery is an option to correct this.
  • Retinal detachment is an emergency and characteristically involves a sudden curtain of vision loss falling over one eye. It may be preceded by flashing lights and a sudden increase of floaters and needs an immediate trip to eye casualty.

Incidentally, floaters are small bits of debris that float in the eye and move around with a slight lag as the direction of gaze changes – these are common, and, except as mentioned above, are not normally something to worry about, though they can be very annoying. Unfortunately they are essentially untreatable.

As GPs, we often see a handful of more common and less serious conditions that could have been dealt with first by a pharmacist or managed at home. Red and gunky eyes most often represent conjunctivitis, while red swollen eyelids (blepharitis) or a cyst or stye over the lid can be treated with hot compresses, and a watering eye can be your body compensating for a dry eye, so try some lubricating drops. Most eye conditions do not need antibiotic treatment.

If your eye is painful however or if you are not quite sure, this must be reviewed, especially if it is red as well. There will be a local eye casualty (if you’re in the UK) that patients can call if they are unable to get to their GP. This may be where your GP refers you if they feel it needs more in-depth specialist review.

The following recommendations can help to keep your eyes healthy:

  • Don’t smoke – Unsurprisingly this causes all sorts of problems including macular degeneration and cataracts.
  • Make sure you wear sunglasses – it protects against harmful UV rays and makes you look awesome.
  • Get regular optician checks – apparently around 10% of the adult UK population have never had an eye check. Problems are not always immediately evident and so it’s best to get checked every two years at the very least, more frequently if you’re over 40.
  • Eat the right things – generally anything with lots of omega 3 fatty acids and vitamin A (also known as retinol which helps with night vision!) Examples would be oily fish, kale, spinach, peppers, oranges, broccoli and eggs.

So overall, eyes are pretty marvellous things and, more than that, they are deeply personal. One only has to look at the rising use of retinal scanning to realise just how individual they are -fingerprints have approximately 40 individual features but the average iris has 256. We only have two of them, so we must take the best care of them possible.

The Perfect Working Space

It was that bird’s-eye view that appealed to me, observing everything going on without being in amongst it all.

The discussion around where to write is somewhat of a cliché in the blogging world, but it is an interesting topic nonetheless. After all, finding the right environment to craft your literary masterpiece is an important decision and one of the first ones I had to make when embarking upon the novel.

I commenced the actual manuscript when I was living in London having just arrived from the leafy countryside of Yorkshire (full of awe-inspiring and quiet locations to put pen to paper). Although I knew I was leaving a menagerie of prime writing spaces behind me, I was confident that the urban mess of the capital would provide at least as many ideal spots, if not more. My assumptions were perhaps a tad naive.

There are some incredible spots in London, no doubt. In an ideal world I could head up to the top of the Shard and sit at my own personal desk looking out over the city each day, sipping on fine wine and eating a selection of luxury fruits served by quiet but efficient servers with perfectly ironed clothing and impossibly good looks. Thinking about it, that all might actually have been a bit too distracting.

In reality it took me several months to find a spot I was happy with. In my mind, I had envisaged a quiet and trendy cafe in some stylish backstreet with Hugh Grant types popping in for their morning Espresso every now and again. And I did find a few contenders. None of them however felt quite right. For a start, in some of them the coffee practically blew my head off producing hands so shaky that I had trouble hitting the keys of my laptop. This left me with an unacceptable typo rate. Added to that, the seats were often made of the finest wood which, although very pleasing to the eye, was not pleasing to the buttocks.

I shifted my attention the various museums dotted around and their respective cafes. These often proved far too busy and too far afield to be a viable option. Libraries seemed like a possibility for a while, but again, for me at least they seemed a little cluttered and obvious. I wanted somewhere a bit more exciting; somewhere different. I ended up gravitating towards Westfield shopping centre, near the BBC (now sadly relocated to a more central location). You may feel this would be busier than anywhere, but for a time, I sat in the rafters outside the cinema with a takeaway Costa and began happily typing away. It was that bird’s-eye view that appealed to me, observing everything going on without being in amongst it all.

Before long I found somewhere else and this was to be my main writing space for the rest of that year. It was a pub funnily enough, one of these gastro pubs attached to the shopping centre, complete with chaotic revelry on a weekend. Fortuitously, my week day schedule meant that it was practically empty at the times I wanted to write and their comfortable tables and chairs, coupled with just enough activity to be stimulating but not intrusive meant that I got a lot of work done. I even scored the occasional free drink as staff got to know me.

In the end, a writer’s space is very personal and of course everyone works differently. Take the famous authors for example. Roald Dahl had a tiny shed in his garden that he called the ‘Gipsy House’. I found a video on YouTube once showing him going through his set-up complete with armchair, blanket and what is essentially a wooden board he puts across his lap before he is ready to go. Apparently Charles Dickens preferred to work at his own desk which he shipped with him whenever he was going to be away for any length of time. Ian Fleming of course had a luxury retreat (the Goldeneye Retreat) in Jamaica which is fairly outrageous and JK Rowling apparently finished her final Harry Potter book in a Scottish hotel.

Since that year, I have written everywhere from poolside at a Spanish villa, in a cabin in the Canadian Rockies, and at various cafes in my hometown. Unlike the jobbing author who writes full-time, For me, the process of writing is almost that of a leisure activity. Working at a traditional desk feels too much like I am doing ‘work’. Having said that, writing the creative aspects of a novel are altogether different from going back over things and editing. Once I had reached this stage, the desk in my flat was more appropriate. Despite the obvious distractions that the home environment presents (PS4 and Netflix being the main culprits), sitting in the office and hunkering down to focus isn’t really that bad once you’re on a roll. For me, I prefer winter evenings, ideally when it is raining outside; far more of a cosy experience where one can put on several warm layers and reimmerse oneself in the story that is already set out. Working in the height of summer for me is not very productive; either that’s just me or the sign of an underlying thyroid issue.

I’m about to embark on the next draft so I suspect this is where I will do the majority of the work from now on, but of course if The Shard were to offer me one of their penthouse offices, that would be difficult to turn down.

One can live in hope.

W