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Wednesday, August 17, 2016

Haiku on Game/ Play/ Tonight/ Wander


Commitments complete
Entering new phase of life
Still some games to play

A new game begins
Pen, ink, paper, and my thoughts
Dare I write haiku

A new Game of Thrones
Excited, opened the box
Dragon, sword, and dice


The filth of very small minds
Degrading our play

Playing at haiku
Writing absolute rubbish
Leaves no impression

You can play at life
Or grasp opportunity
Make a difference


Are you free tonight?
May I make a pass at you?
Just like the old times

Free pass to movies
Every theatre tonight
Full of violence

Magic show tonight
International wizard
Pulled peace from a hat


No more the expert
No more need to huff and puff
I wander through time

Just meandering
So happy just to wander
Breathing and feeling

Birthday reflection
Wandering through memories
Of all the good times

Friday, August 5, 2016

Haiku on Try/ Storm/ Fool/ Carpet


Try not to worry
But don't worry about it
Even if you do

Trying is doing
Even if you don't succeed
Doing is trying

A try in Rugby
A touchdown in NFL
Set up goal kickers


A perfect mind storm
Crazy thoughts come at random
Turned into a film

He stirred and stirred
Till the outcome was achieved
Storm in a teacup

Seventy percent
We humans turn to water
When there is a storm


Played the fool all day
To mask his inner sadness
Fooled around at night

If you fool yourself
You may lose your only friend
In a twisted maze

A word of advice
Never try to fool yourself
Mirrors never lie


She could smell carpet
As he entered her domain
Needs cleansing, she thought

In trouble again
Carpeted by headmaster
Only verbal this time

Old Turkish carpet
Intricate peacock design
Proudly hand woven

Transverse Myelitis and Diarrhoea

This is not a pleasant topic to address in public. In addition, I am not sure how many of you with the various forms and expressions of Transverse Myelitis will share my experience. So you will have to decide whether this is relevant to you or not.
Diarrhoea is unpleasant at the best of times. We all get times when we pick up an infection from food, be it Escherichia Coli (E. Coli), or the more serious forms of Salmonella. These are fairly easy to deal with in the sense that you take the prescribed medication, and perhaps something to calm the gut, and within 24-48 hours you know you are on the mend, but have decided you will not return to a particular restaurant, or will take more care with your own food preparation.
However, when you are handicapped it is all more difficult to manage. The recurrent urgency to go to the toilet means you have to plan journeys around your knowledge of where toilets are likely to be, and then you may want to be close to a toilet so you can get there in time. Travel and public gatherings become difficult, and we all have that sense of relief when we see a handicapped toilet sign, knowing that we will not have to wait in a queue.
I did write a book chapter (Chapter 4 in ‘Taking Charge’) about my own spectacular experience in the early days of my first hospitalisation (, but that was a ‘one off’ experience after escalating treatment to deal with several days of constipation. What I did not realise then, but do now, is just how problematic toileting can become every day when you are handicapped, when you have lost normal sensation from the waist down, and find difficulty not just with getting to a toilet, but also the whole business of undressing and cleaning up. I did not realise just how anxious the whole thing can make you, and how that has an impact on socialisation.
I have always been a very physically fit and healthy person. I have been fortunate to have had the formal training to become a doctor. In addition, I have had the good fortune to be married to a Dietitian. Between the two of us we have been able to solve most of life’s day to day problems. However, something new has entered my life in the last year that has made it more difficult, and now stops me from attending many public gatherings. I have always been able to eat anything. But recently, I seem to have developed a food sensitivity.
The first thing I noticed some years ago prior to getting TM, was that I seemed to be a bit sensitive to milk, and this stopped when I began using lactose free milk. In the main it meant using lactose free milk on my morning cereal, but gradually over the years seems to have become more serious. I became aware of being sensitive to lactose in ice cream, and then lactose in certain cheeses. Now I have to be aware of anything containing lactose. I am not claiming it has been caused by TM, and most likely it is part of the aging process. But it sure makes life difficult when you are handicapped.
In the last year, I seem to have had more frequent episodes of diarrhoea, even avoiding lactose. There is a cycle of several days, or even a week or two, of being OK, followed by a windiness, then explosions over several days, gradually calming down. This has been harder to track down. We have had to explore FODMAP sensitivity in a detailed way (and you can find lots of detail on the Internet (of course). FODMAPS are Fermentable Oligosaccharides, Disaccharides, Monosaccharides and Polyols (so there!). Effectively, they are types of sugars broken down (fermented) by bacteria, mainly in the large bowel.  ‘Fermentable Oligosaccharides’ include Cereals like Wheat, rye, and barley as well as vegetables like onions, leek, shallots, garlic, legumes, lentils and artichokes. Disaccharides are basically Lactose. Monosaccharides include honey and fruits like mango, watermelon, apples, pears (you know, all your favourites). Polyols include more favourites like apples, pears, apricots, nectarines, plums, and (rather quaintly) cauliflower.
So what we had to do was become diet detectives, and reduce my diet to very plain food like rice and green vegetables with small servings of meats, and then gradually add things from the list above. One of the first things we added was a daily Probiotic capsule, in an effort to help my gut flora recover.
The upshot of our detective process was that Lactose remained the prime suspect, and I seem to be sensitive to even very small amounts (even if it is hidden in the fine print on food labels). Of course when I am in a sensitive phase, a good curry can lead to my spending large tracts of the day on the toilet (very unproductive!).
Personally, I have concluded that I may also be sensitive to nuts including Cashews and Macadamias, but that may relate to the age of the nuts, and whether they have begun to deteriorate.
I am currently in a phase of being reasonable comfortable. I am back into attempting to recover my exercise program, which has been a shambles in the last three months. But I do find myself continuing to be anxious about what I eat, and the possibility I may be stranded somewhere with limited or no access to a toilet. From my point of view as a retired psychiatrist, it is clear I have developed a form of Agoraphobia. Technically I do know how to fix the problem; but it is always hard in practice. It is a strange world.

So, does TM make you more likely to get a gut that has food sensitivities? Or is it just the fact that being handicapped makes life almost impossible when you have food sensitivity induced diarrhoea? I would be interested in your feedback.

Tuesday, July 26, 2016

Making of a Child Psychiatrist: (44) Work, if you want to call it that(3)

The reception area was a cosy hangout when there were few patients, although we got turfed out quickly enough when things got busy. There was a piece of machinery tucked into a corner of a high level desk that intrigued me (as electronic bits and pieces often have). It was a primitive facsimile machine attached to a telephone line that used a wire to apply heat to sensitized paper in a roll. I had never seen such a thing, and we were not allowed near it (of course), until we had been trained in changing the roll (often necessary late at night). It was a bit limited given you needed some sort of similar device the other end to be able to send notes or letters. It was also frustrating given the quality of the information which came was often blurred, or the paper had found a way to ruckle up. But it was intriguing, and once in a while proved its value.
I was attempting to change a roll of paper one night when there was a screech of tyres outside down the ramp, a thump followed by slamming car doors, and then the squeal of tyres as a car sped off. As we went to investigate, a man crawled towards us announcing he had ben shot in the head. He had indeed. When we lifted him onto a trolley, we could see the entry wounds; it was remarkable that he was still conscious in terms of the head injury, and the loss of blood. An emergency call went out for the Neurosurgeons, and in the meantime, blood was drawn for cross-matching, a drip line was set up, and head Xrays were organised. Within about 20 minutes he was wheeled away, and we were left looking at each other and shaking our heads at how violent South London seemed to have become.
There were interviews with police when they arrived, but none of us could identify the car. I understand our patient went straight into surgery to remove the two bullets. The report ultimately was that he had lost part of his eyesight in one eye, but remarkably little else. I guess he was able eventually to provide reasonable information to the police on the sequence of events. But as I noted earlier, you never hear much in terms of outcomes. Casualty is simply a passing show of a wide array of problems and trauma; as medical staff, we have a very temporary set of responsibilities.
My stories make it sound as if it may have been a violent place in itself. And when you hear a story like the one I have just recounted, you wonder whether staff themselves may ever be in danger. Certainly Friday and Saturday nights were often rowdy, and occasionally a staff member would be injured in a minor way by accident. There were some hefty male security staff who provided protection to the whole hospital and were available within minutes to subdue a stroppy customer. I don’t remember them being called in often, though I do have a memory of one particular night.
It was late, and Casualty customers were beginning to thin out, when some young male drunks came to the desk with a friend who had taken a solid blow to the jaw. We were busy; so they had to wait. They were rowdy, and began to be really belligerent. At first it was a polite enquiry to nursing staff as to how long they might have to wait; they were not happy with the answer, but everyone was tied up. I finished with a case and went to reception to get the notes for my next patient. As I emerged, I was confronted by one of the young men, about my height and build but a few years younger. He demanded I see his friend immediately. When I said I already had a case to see, he got really stroppy, grabbed the front of my white coat with two hands bringing my face close to his he began to abuse me and the department, spraying bits of beer-loaded spittle. When I repeated, very calmly, that I already had a case to see who was just as urgent as his friend, he almost exploded and lifted a fist to hit me. I am afraid my right knee rose rather swiftly into his groin. It was a reflex action; I did not learn it from anyone nor had I had time to plan it or even think it through. It just happened. He doubled over, letting go of my white coat. Groaning, he was led away by one of the other abusive young men. From the waiting benches, having recovered his poise a bit, he abused me, telling me he would make it his business to get me. If not tonight, then one night he would get me!
My heart was pounding, and I was both recovering from my violent act, but also very embarrassed. I had probably made the whole situation worse. As it happened, the group became much quieter, restless but with no verbal abuse. A couple of them looked daggers at me as I collected my young patient and his mother and took them to a cubicle. Once behind the curtain, the mother sympathised with the department having to cope with angry young men; I shrugged my shoulders and began to clean up a very nasty cut on a knee that required several sutures.
Several hours later, at the end of the shift I found myself quite anxious as I left Casualty and walked down Denmark Hill to our flat. I am not sure what I expected, but found myself with my right hand in the pocket of my Mackintosh, with my keys slotted uncomfortably between my fingers. I have no idea which B grade movie such an idea came from. I have no idea what I thought I might have to deal with, or what I was going to do if I had to. In fact, I reasoned I was likely to severely damage my hand from the keys as much as damaging someone else. It made no difference. For the next two weeks I found my keys creeping into my loose fist on my short walks home.
With a regular salary finding its way into the bank account from both Jan and I, we began to have ideas above our station. Perhaps we should begin to think about buying a house or a flat. No, it was much too early for that. It was still summer, and a whole year since our last holiday. Given we were both quite exhausted from our work days, and finding it difficult to get sufficient quality time together, perhaps we should have another holiday. A decision was made. We would not be having a holiday that demanded hours and hours on a Vespa scooter. We had loved our time in France and Spain, but during the past winter had found the icy cold of riding down to Thanet almost too much. In addition, Jan had never really come to terms with driving the bike even though she had made several attempts the previous year. We decided that if we were to have a holiday, perhaps we should look out for a cheap car. Jan would be much more comfortable in a car (and they usually had heaters), and she might want to complete her driving licence.
I began to look on notice boards in the hospital and medical school, bought some newspapers looking through the ‘For Sale’ lists, and talked with my friend on Coldharbour Lane who had contacts in the car trade. Eventually we found a 1962 bright red Mini for £120; it had done close to 50,000 miles, but looked in good shape. I asked a garage I had worked for to have a look at it; they said it was a good buy, the engine appeared to be running well, the tyres and brakes were good. It only had two doors, but then there were only two of us. So we decided. Despite the fact I had to sell the Vespa that had served us so well, we were excited.
My first job in Casualty did allow a one week holiday, and mine had been rostered about two-thirds the way through; I was ready for it. Jan had made some tentative enquiries in her Biochemistry Department and they were prepared to let her go. She, too, was ready for a break. So instead of just sitting around, or perhaps going to our old haunts in Thanet and staying with family, we planned a proper week off and went down to Cornwall, staying in Bed and Breakfast hotels, and getting lunches and dinners as and when we could. We dug out our old movie camera and bought a couple of reels of 8mm film intending to take silly movies like we had done with our old friends Bob and Chris.
We headed due west, staying overnight in Bath. The next morning we did the tourist thing and had a look at Cheddar Gorge. Then, being a couple of romantics, we headed for Tintagel on the West Coast; reputed to be the site of Camelot. The next day we headed further down the coast to St Ives and Penzance. The following day we came back via the New Forest, staying overnight and then heading home.
The most spectacular memory is being deep in the woods, and finding a quiet spot to make a small film on one reel of 8mm. The fantasy was of a wolf dreaming of and being seduced by red riding hood, chasing her through the woods and eventually catching her. Jan did the bits of filming of the wolf, and I filmed the bits of red riding hood – part reality and part in a fantasy world. The whole idea was to have a brief silent movie which could be played with Sam the Sham and the Pharaohs’ version of “Little Red Riding Hood” (which had been released on a 45rpm black vinyl record in 1966). We still have these romantic little treasures, and a projector that still seems to work every four or five years when we drag both out of a box.

More tomorrow….

Haiku on Pull/ Deep/ Tardy/ Question


You can pull a stunt
Which may seem to be clever
But not authentic

Pull this lever down
Simple instruction program
Male toilet training

I am perceptive
Pull the wool over my eyes
It makes me itchy


Deep under cover
Enemy territory
Now in shallow grave

She buried feelings
So deep down inside herself
Never felt again

So deep in his thoughts
He did not notice Rodin
Cover him in stone


Late for funeral
Tardy is as tardy does
Now late forever

Forest was burning
Somewhat tardy, rain arrived
Now just some embers

Thank you for calling
Know I am a bit tardy
But I am here now


Who set the question
Have you been a good girl, Jane?
Maybe A A Milne... 

Answers to questions
The complete set is online
Open book exams

A set of questions
For each and every stage
The story of life