Trunkles at Large

Cats are remarkably photogenic. Add a few words and they can be hilarious.

The “lol catz” are a perfect example of this. 58 pages of them so far and I had to look at them all.

On a similar note to the last post…

A common drug prescribed for ADD sufferers is Methylphenidate Hydrochloride, commonly known as Ritalin. There are a number of different manufacturers of this and it comes in several forms; standard, slow release and extended release. In New Zealand the government subsidised slow release formulation was “Ritalin SR”. However, “Rubifen SR” is cheaper, so the Ministry of Health have decided that you can no longer get Ritalin SR on subsidy, only Rubifen SR. I can understand their reasoning, why waste money. What they didn’t consider is the subtle differences between the two formulations. I had been taking Ritalin but had to change to Rubifen and Rubifen does NOT agree with me. Conversations with others (including a practitioner who specialises in ADD) suggests that the same applies with a large number of patients.

Whilst it makes sense for there to be a restriction on the subsidy provided, why is it removed completely? Subsidy on Rubifen SR is NZ$10-95 for 30 tablets, leaving the patient just NZ$3 to pay. Subsidy on Ritalin is ZERO. The patient has to pay the lot and that is beyond the reach of most people.

Hey, Ministry of Health, don’t cut all the subsidy, just reduce it to the same level as you would be paying anyway. Give us a chance to make a choice that we are more likely to find affordable.

Not just for “Ritalin” but for other drugs too. The Lantus in my last post for example. If you aren’t on Lantus then you are probably taking, Protaphane or something similar. You might be able to afford Lantus if it had a partial subsidy but no such luck. The government won’t give you a cent towards it.

I think it is time for the government to look again at how the drug subsidies work, with a view to giving the patient partial subsidy where appropriate.

Please read this article that appeared today on NZCity. If you read it you will notice that a similar warning was given in 2001 but the government ignored it. Diabetes (and other chronic disease) groups might as well tilt at windmills; governments have no real interest in the future, their sole interest is for the rest of their tenure in power. If they spend a fortune on prevention then they have been seen to spend money with no result and are, therefore, wasting it. If it ain’t gonna buy you votes, don’t bother to do it.

Moi? Cynical? Yep, very. I’m realistic too. Money is a large part of the problem. There is a form of Insulin called Glargine (trade name Lantus) which provides an excellent basal insulin. An enormous proportion of insulin dependent diabetics would benefit from it in both the long and short term. In the short term it helps prevent hypoglycaemic events, particularly at night (which can be life threatening). In the long term it helps prevent a myriad of diabetic complications, such as blindness, limb amputation and other such nasties.

You would think that anyone who would benefit from Lantus would be able to get it through the normal government subsidised channels. Not so. It is only subsidised if you are a type 1 diabetic and have had hypoglycaemic attacks that have required intervention by another person. If you are a type 2 then tough, it doesn’t matter how much you would benefit from it, you shat out. If You are lucky enough to have caught all your hypos and dealt with them on your own then tough, you shat out. The fact that you might not catch your next hypo and die as a result is irrelevant. Oh yes, you can get unsibsidised Lantus if you don’t fit the criteria, but it is rather expensive to buy and out of the reach of Joe Average.

Any politicians care to answer this…

Which is more important, the nations health both now and in the future or money and you getting voted back into office at the next elections?

Ah, sorry, lets try again. Any politicians care to answer that HONESTLY?

Having mentioned Yorkshire pud, I thought I should put my recipe for it on here, along with Toad-in-the-Hole. Not only is it extremely simple to make, it is delicious. Enjoy!

Yorkshire Pudding

Ingredients

• 3oz (75gm) plain flour
• 3 fl oz (756mls) milk
• 2 fl oz (50 mls) water
• A large egg
• Salt
• A little freshly ground black pepper

Method

Pre-heat the oven to 425°F (220°C)

Put the flour, salt and pepper in a mixing bowl. Use a whisk to get a little air into it and make a well in the centre. Break the egg into a jug, beat it a little and pour it into the well in the flour. Now, using the balloon whisk, beat the egg and then slowly combine some of the flour into the egg until you have a thick goo. Now add a little of the milk/water mixture. Whisk that with the goo until it’s on the runny side. Incorporate more flour until you are back at the thick goo stage. Repeat this until all the flour has been combined. Add the rest of the milk/water, whisking as you go.

Make sure the cooking pan or tray is really hot and then grease it, with beef dripping if you want to be traditional or a little oil. Put the mixture in the tray/pan and put it in the top of the oven until golden brown, which should be 25 to 30 minutes.

There is a school of thought that says that the mixture should be allowed to stand for an hour or so before it goes in the oven. No reason why you shouldn’t but I’ve never noticed any benefit from it.

Do NOT use self-raising flour, you will have a minor disaster.

Toad-in-the-Hole

Pre-heat the oven to 425°F (220°C)

Gently bring to the boil some sausages and simmer them for 7-10 minutes. Well grease a smooth bottom roasting pan and get it nice and hot in the oven. Pour the Yorkshire pudding mixture into the pan and stick it in the oven for about 2 minutes. Arrange the sausages in the batter and put it back in the oven for 20 to 30 minutes - until the batter is golden.

I am astounded at some of the things you can buy in packets. Mixes to make pancakes/Yorkshire Pudding are, perhaps, the must ludicrous of these. Both of these are, essentially, the same mixture.

• Flour
• Eggs
• Milk
• Water
• Seasoning

I’ve been trying to work out what the packet could actually contain, other than the flour and seasoning. Does anyone know what else is in there? I don’t particularly want to be seen picking up a pack in the supermarket, I’d be embarrassed.

The point is that nothing is gained from using the packet mix, except profit for the manufacturer. You may save 5 minutes in the preparation time, but that’s about the limit of it.

The same can be said for Bolognese sauce in a jar/tin. Making it from scratch is easy and, I’m certain, cheaper than buying a pre-prepared mix. I have a suspicion that the home-made would be nicer. It might take a little longer to make but hey, you also know what’s gone into it. Or more importantly, what’s NOT gone into it, i.e. preservatives, colourings, flavourings, additive-this, additive-that, etc.

If you really want to spend money on stuff for the kitchen, then get a set of GOOD kitchen knives, the means to keep them sharp (which you will do, won’t you!) and a recipe book or two.

From where I live I am fortunate enough to see some truly awesome sunsets. Tonight was one of them and my camera was to hand.

and her name is…

All you diabetics will understand this one.

Some time ago I wrote this for use elsewhere. I have decided that I should share it with the outside world. It tells of my diabetes and the struggle I had accepting it and will, I hope, give others who are making a similar downward journey a little support. I know where you are folks. It ain’t fun, it ain’t good, but it ain’t going away either. Please, for your sake and for the ones you love and who love you, accept your diabetes and get as in control as you can. It is worth the effort; I’ve seen the effects it can have if it isn’t kept in check and, believe me on this one, they are very unpleasant.

Here it is…

It was five minutes to three in the afternoon on Friday the first of June, 1979, and I had no cash. I did, however, have £8-50 in the bank and a hot date! So I wandered in to the bank, wrote out a cheque, and waited. Whilst I waited, three other gentlemen came into the bank to withdraw some money. Their cheque book was slightly unusual; it bore more than passing resemblance to a sawn-off shotgun! To cut a long story short, the trigger got pulled and a large part of my right calf got turned into mince. Just between you and me, dear reader, getting shot is NOT fun! One hot date straight out the window! I spent three months in hospital, whilst the doctors did skin grafts and such like.

When I left hospital I was told that I would spend the rest of my life on crutches or sticks. “NOT SO!” says I. I worked on my disability, determined that it would not hamper me and I succeeded. Ultimately, the only thing I had to give up was rock-climbing, which put just a bit too much strain on my leg. Other than that, you’d hardly know it was there.

The point was that I fought it. I fought like hell, and I won! Going through that process changed my life. I found inner strength. I felt empowered. I found I could go into a bank again without a cold sweat and abject terror. I got self-respect, something I’d never had. I got respect from other people too, which was something I wasn’t used to. Just so you know, I had a rotten childhood for the most part.

Seven years later, in 1986, I went for a job interview. Part of that interview was a medical, complete with a dipstick in a urine sample. Brown. The damn thing changed colour and turned brown! (Uristix turn brown in the presence of glucose.) Lo and behold, I’m a diabetic, or pre-diabetic to be precise.

I was devastated. I’d put all that effort into fighting for my health and along came diabetes, sneaking up behind me and whispering “Got you!” I was 30 at the time… less than half way through my life - and stuffed, at least that was how I saw it. I think I pretty much gave up. Like building your dream home and then they decide to build a highway, right through the middle of it and knock the place down. How big a kick in the teeth can you get?

My diabetes slowly developed from there. But I refused to believe that I had diabetes, life couldn’t do that to me. I stuck my head in the sand. I was NOT going to let it be there! It was irrelevant. Forget it, it doesn’t matter, just continue life and die early. I decided I’d rather have a short life with a good quality, than a long and boring one. I didn’t expect to see sixty.

Eventually I ended up on insulin, as is to be expected. STILL I didn’t really want to know. I injected when I could be bothered to. I tested occasionally, getting double figures for most of the time. My A1c was in double figures too. Although I didn’t realise it, I was on a slippery slope to a VERY unpleasant end.

Just over a year ago, my life changed significantly. I realised I was in love, truly in love! I had a reason to live and be well. I borrowed a phrase from the film “As Good as it Gets”; Jack Nicholson had the line “You make we want to be a better man” and I had a reason too. I found my inner strength again. I found my self-respect. I had cause to make an effort and I made that effort!

My A1c in 2000 was in double figures, in October 2005 it was 9.7. It’s now consistently in the sixes. My cholesterol levels are improving and I’m a lot healthier than I was two years ago. Yes, I do have some problems; a little neuropathy in the feet and my eyesight could be better. I have a blockage in my iliac artery that needs an operation to fix, but I’ll survive it. The point is that I’m doing my best to make sure those problems don’t get any worse.

My reason for writing this is for all the diabetics out there who have the same attitude I did – “I don’t have diabetes” or “If I ignore it, it will go away” or “It’s only diabetes, it doesn’t matter”. Well, it doesn’t work that way, not in the end. All you end up doing is making a total mess of your body and you WILL go through hell before you die. You will hurt the people you love and who love you but, most of all, you will hurt yourself! You HAVE got diabetes. It will NOT go away. Deal with it and deal with it now. Learn everything you can about it. (Teach your family and friends about it, the view that “Diabetics mustn’t eat sugar” is all to common. Diabetics know that glucose is the fuel our bodies run on and if, we run out of it, we die! It’d be a good thing if everyone else knew that!) Modify your life to accommodate it, which can be done; I’m living proof of it! Call it a marriage if you will. You are married to your diabetes and there ain’t no divorce! Look after your diabetes and life can be good. But, whatever else you do, don’t deny it, ‘cos it ain’t going away!

The “how” is quite simple. It’s your diabetes and you own it, rather than the diabetes owning you. You have to manage it. Adjust your diet. Keep a close eye on your BG levels (and test regularly!). If they are too high, get them lower, by diet or meds or whatever works for you. Learn about DM. Learn about your meds. Monitor what effect they have. Talk to others with DM and learn from them. Get a GOOD endocrinologist on your side. Your doctors and nurses are part of your team and if they aren’t good, change them, or educate them so that they can not only help you, but be a real help to others. One important point to remember, going from poorly managed diabetes to well managed doesn’t happen overnight. It does take time and you will have times when things go pear-shaped. Don’t despair, work through them and they will come right soon enough.

Oh and, I still love her deeply. The Lady in question (and Lady she most certainly is) has shown me care, respect and warmth and helped me greatly. Thank you, Lady.

I have type 1.5 (LADA) (wikipedia on diabetes) Diabetes.

There are some people who will read that statement and know exactly what I mean by it. However, a lot of people will instantly think that I can’t eat sugar and am (or was) obese and that caused my diabetes. Wrong on both counts! And that is the point of this post.

From what I can see, health education is missing from the usual schooling of children. We need to educate; to give our children a little knowledge about the many diseases that they may have the misfortune to come across in life. I’m thinking of diabetes, Celiac, MS, arthritis, cancer, depression, Alzheimer’s and the like. I’m quite sure that a majority of kids leave school knowing nothing about any of those except, perhaps, the name. And frankly, that stinks! Not only do they need to know about them for their own well-being, they need to know because they will, almost certainly, come into contact with other people who suffer.

I wouldn’t want to see a fearful form of education, just enough knowledge that people are aware of these diseases and what it involves.

For those who had the wrong instant thoughts above. If you don’t have glucose in your blood stream, then you are dead. Glucose is, in effect, gasoline for humans, and if you run out of gas, the engine (in this case YOU) stops running. And there is more than one form of diabetes. The one I suffer from has nothing to do with being obese, it’s an auto-immune thing.

Educationalists the world over, please, add health education to your curricula.

For a good view of how diabetes effects people’s lives, read Six until me.

In the early nineties I saw an x-ray machine that provided real-time x-rays of angiograms. Attached to this machine was a tape drive for archiving the x-rays. It looked familiar to me. I was fortunate enough to be able to examine this tape drive internally and it was indeed familiar! It was a totally standard drive that was available off the shelf for about £2,000.

The only differences I could see were the colour and labelling. I might add that I looked very carefully at the internals.

This branded and painted box cost a princely £15,000!

So, my question to the ethical medical equipment manufacturers is…

Why the extra £13,000?

There are now Continuous Glucose Monitoring Systems for diabetics. The cost of one of these here in New Zealand is ~NZ$9,000. The system consists of a small receiver and a transmitter that attaches to your skin. There is also a sensor that you insert through your skin. The sensors cost ~$75 each and last for 3 or 4 days. The receiver is about the size of a mobile phone. It has a small LCD screen and a few buttons on it. I don’t know what is inside the box, but I can’t imagine it would be more complex than a mobile phone. The transmitter is certainly miniature but again, I doubt if it’s anything more than a Bluetooth device. What I’m having trouble with is why $9,000? At that price, very few diabetics could afford to buy one. At $1,000 each I could see them selling like hot cakes!

One interesting point about that price. In Australia they are AU$10,000 each (~NZ$11,500). Why, you may ask, is the price so much higher in Australia. The answer is very simple. In Australia, supply of these systems is subsidised by the government. Is it just me, or is someone profiteering? (I’d like to thank the NZ importer for that bit of prcing information.)

So, my question to the ethical medical manufacturers

Why the extra £8,000?

Now don’t get me wrong here. I know that a very great deal of ground breaking work went in to creating CGMS and I fully understand the need to recoup that cost and to make a profit. But why price the thing outside the range of the vast majority of potential buyers? Which would be better, to sell one at $9,000 or twenty at $1,000? I doubt if they actually cost more than $500 each to make and whilst there is a marketing cost, etc. that would be amortized over a large number of machines and so be a small proportion of the overhead.

So, please, if you make medical equipment or ethical drugs, have a thought for the poor souls that have to or want to buy your products. Make a profit by all means, but a reasonable one. Or, in other words…

STOP RIPPING US OFF!