Booking a holiday

My back is playing up and I feel giddy. I suspect that it is because I am trying to wean myself off the Gabapentin and Venlafaxine - the combination of drugs that I use to manage my daily chronic pain. Not the flare ups - I use OxyContin and Diazapam for them, no just the daily pain. I take so many tablets these days for the diabetes and associated, that I am determined to stop rattling like a bag of M&Ms.

Anyway I digress. We are in the process of trying to book next years holiday. You would think it would be simple, but no. Because of my height and my back pain, I cannot fit into a standard economy airplane seat, and I guess I will never be able to fly budget - their seat pitch is about 2" (50mm) less then my back to knee length! So it has to be business class if I am to be able to actually move when we land. Virgin Upper Class Suite is about the best value we have found, and so that is basic requirement number 1. Virgin Upper Class.

We do not want to try and suffer the transfers stuffed like sardines into crammed coaches, same reason as for requirement number 1, so we want private transfers by car. Requirement number 2.

Then we really do not want a hotel overrun with children. We have had our children and really do not want to 'enjoy' other peoples. So requirement number 3, No children and no couples only rule, there will be three of us holidaying..

We want uninterrupted sun. No rain or hurricanes or tornados or typhoons or tropical thunderstorms. Well that rules out the carribean, most of the indian ocean and a lot of asia. Iraq is nice this time of year. So, requirement number 4. No rain.

Yvonne is not particularly fond of anything other than plain food, mostly because anything other than plain food disagrees with her food transit system. So we often go for plain buffet type food plans. Requirement number 5. No spicy food.

With me so far? I mean, these are not unreasonable requests, and we are British after all, and so we helped to shape the world into what it is today (yes, quite), and so it should be a straight forward thing, booking a holiday that meets our needs. Getting back to our needs:

We don't want to stay in the same hotel all the time. In this years holiday we stayed in three, The Burj al Arab, the One and Only Residence & Spa and the Al Maha. All in Dubai, but a multi centre holiday non the less. Shouldn't be difficult next year, we only want to stay in two hotels, the Al Maha in the desert and one other on the coast. The Palm Court & Spa at Jebel Ali looks ok apart from Requirement number 3 which is almost impossible to meet anyway. So requirement number 6  - multi centre holiday but in one resort.

No special medical requirements for travel. I mean, have you ever taken anti malarial tablets? My go, they play absolute havoc with your system, and I've already got diabetes doing that for me, so requirement number 7 - No Mozzies or other nasty lurgy carrying insects.

So, we have seven criteria for our holiday next year and they are easy to meet, because we have already done most of the research.

1. Travel - Virgin Upper Class please.

2. Private Car Transfers please.

3. Al Maha Desert Resort and Spa meets this, Palm Court doesn't, but we can live with that. 10 nights at Palm in Junior Suite HB, 4 nights at Al Maha in Royal Suite FB please.

4. Dubai. June/July . No rain of any type. thank you.

5. Food, the hotels we chose meet this requirement. Thank you.

6. Multi centre / one resort. Can be done, just not on the internet. Need to speak to real people.

7. Dubai meets this need.

So all we want is a tour operator to put the package together and so we googled dubai toour operators and contacted them, clearly explaining our needs. The results back were staggering.

1 in 3 got the basic requirements wrong, even though they were clearly identified. 2 people not 3, wrong room types, wrong Board type, wrong airline etc.

Prices. Lordy what a difference. Let me just tell you that one company wanted a 33% per person deposit (!!!!), and that the most expensive company was twice the price of the cheapest.

Detail. So many got basic things wrong with the holiday details, such as flight numbers and times. (We know that it is VS400 out and VS401 back, and we know the flight times. Pity the tour operators don't!)

 

So, no, we have not yet booked our holiday, it is almost impossible to make sense of the quotes, so few got it right, how can we trust them? It is no wonder so many people complain about their holidays if the tour operators cannot get it right before their clients go.

Technorati Tags: duba,al maha,holiday,tour operators

I think I am in heaven. We are at a place called the Al Maha Desert Resort and Spa. When we told people that we were going to stay in the desert in Dubai in July, they told us that we were mad. We almost kind of believed them too. But then we got here and wow. Look at the view from our bed. We have Arabian Oryx wandering past and a huge array of birds, many of which come and drink from our own personal not overlooked ( except by occasional oryx) pool. We even have room valets who put towels on the sun beds for us! The temerature in the shade at midday is 48C or thereabouts, but after the humididty in Dubai city, it is absolutely great. It is a much drier heat and we have no problem spending all morning on the sun deck and in and out of the pool. Me? I stay in the shade and write on the laptop, Yvonne lies in the full sun, fully factored up and then we get together in the pool for a cool.

The food here is superb, fully the equal of michelin starred restaurants that I have eaten in. Let me give you a for example, tonights dinner menu was:

Amuse Bouche: Marinated Lobster with a rouille sauce
Starter : Asian Crab cake with Mustard aoilli, fennel salad and caramelized kumquats
Salad: Baby beetroot salad with karkadeh
Sorbet: Summer raspberry
Main: Fillet of Hammour with a spiced crab crust on a saffron potatoe puree with steamed baby asparagus and a light apricot and ginger sauce
Desert: Lavendar & Rhubard panna cotta with pistachio syrup & candied almonds.

Six courses of absolutely stunning prepared food, that tasted divine, and if you don't want what is on the menu, then, they will do you something that you like, you just work it out with the chef (madame chef!) in advance, no hassle, no fuss. My blood sugar is around 6.2 two hours after eating, and so no problems at all with my diabetes, and even if there were, then chef would work with me to sort it out. Not many places where you can say that and get haute cuisine.

Lunch today for me was sushi and a selection of fruit, breakfast was a full English (yes with pork sausage and pork bacon) with toast and marmalade. I have truly never eaten so well on holiday, and that does include staying at the Burj Al Arab.

We have stayed at the Burj three times now, and to be honest, I don't think that we will go back again. We will probably do two nights in a city centre hotel such as the Le Meridien so that we can get a full day of city shopping - Al Karama Souk is the best place for designer bargains on the Ralph Lauren etc style, and then we will head out to the desert for our main chilled out holiday in the summer desert. Yvonne will no doubt use the Timeless Spa again, and me, I will just write and swim and eat. Heaven - oh yes!

Do you know how much risk you are at from Coronary Heart Disease over the next ten years? You can bet that your GP does, and he will be using that value to help him decide what treatment regime to give you.

Interestingly, you can use the same tool that your GP uses to work out your risk yourself and monitor your progress in terms of risk factor. You will need to know just a few values, and you should have these and they will be checked in your annual review, just make a note of them. You want:
HbA1c
Systolic BP Value
HDL Cholesterol
Total Cholesterol

and then a few things that you will know,
are you a smoker (yes if you have smoked within last 5 years)
age
length of time diabetic in years.

Then go to the Oxford Centre for Diabetes, Endocrinology & Metabolism website and download the analysis tool. When you have run it (it was version 2.0 when I used it), you can enter your values and get your risk factor. I put in the values when I was first diagnosed, and again now after two years of treatment. I have gone down in risk of CHD.

When I was first diagnosed diabetic, the values of the key indicators gave me a CHD risk factor of 16% with a 13% chance that it would be fatal, and a 2.3% chance of a stroke, 0.5% chance it would be fatal.


Now two years on, and after two years of treatment by by GP, my risk factor has changed quite significantly. My CHD risk is down to 1.9% with a 0.7% chance it'll be fatal, and a 1.7% chance of a stroke with a 0.2% chance it'll be fatal.

This is of course absolutely fantastic news for me and a great testament to following my GPs advice. I only hope that you are not reading this post mortem !

You can read up much more on this and the Framingham study here.

HERE is another teaser / taster for episode 12 of Dr Who.

and here is an interesting group photo that may count as a spoiler......

Okay so I admit that I am a Doctor Who fan. I have seen every episode ever made first time round, i.e. not on video's and tape, live as and when broadcast. And I remember that series 1 episode 1 was repeated before series 1 episode 2 was shown, something to do with power cuts in some parts of the country I think, I am not sure, well I was only about 8!

And now, the really big finale, probably the biggest of all the series ever. There is a trailer here (and a slightly different one on you tube see the end of tis post) for the part 1 of the series finale and there are plenty of clues - Torchwood in the guise of Jack, Ianto and Gwen (God how I would love to see Gwen in Dr Who), a red dalek, someone who looked like Brigadier Sir Alastair Gordon Lethbridge-Stewart and so much more. Questions from this week float round in my mind - why is Donna so important? Is her name (NOBLE) relevant, Is Donna another name for Lady, and Noble = Lord, so is she actually a Time Lord, or indeed perhaps the sum total of all the time lord? Is the fact that temp relates to latin for time and she keeps going on about how she is a temp a coincidence? Why does Wilf keep looking through a telecope and going on about Aliens? If he daleks and the timelords were all supposedly destroyed in the Timewar, and the daleks somehow keep managing to reappear, then why can't the timelords?

Hopefully the next two weeks of extended Doctor Who episodes will explain all.

Can't wait.

Blood Sugar Testing - If, like me, you are Type 2 Diabetic, you will probably have had your testing strips stopped by your local Medical practice - it may well be a simple cost cutting exercise, but in the long term it is an action that may well cost the NHS even more.

Accord undertook a study into type 2 diabetics in USA and Canada and found that intensively targeting blood sugar to near-normal levels in adults with type 2 diabetes ... does not significantly reduce the risk of major cardiovascular events, ... , but increases risk of death, compared to standard treatment.

The study set two strategies for diabetic control, one aggressively targeting A1C to less than 6 percent – similar to that found in adults without diabetes, and one aimed at lowering blood sugar levels to an A1C of 7 to 7.9 percent – a target similar to what is achieved, on average, by individuals treated for type 2 diabetes in the United States.

Other earlier medical trials have shown that lowering A1C to around 6 or better reduces the risk of retinopathy or neuropathy and thus reduces the risk of blindness or amputation. However, and this is a BIG however, the ACCORD trial suggests, (at least to me) that this is at the expense of increased risk of death, compared with and A1C of around 7. In the detail of the study, I believe that the increased risk is linked to Hypo's.

I believe that this means that improved understanding of blood glucose levels is absolutely essential for diabetics, and as such testing needs to come high up the agenda list, not removed completely. SO come on NHS, get us diabetics testing again!! Then we can know for sure if we are dipping towards Hypo's - sometimes I don't get the symptoms even though my glucose levels are very low. I think that means that I am one of those people that will go into hypo shock without realising it is coming. Now I am beginning to think to myself that I am probably going to worry myself into a heart attack and thus 'prove' the study results.



ACCORD - Action to Control Cardiovascular Risk in Diabetes is a study into why patients with type 2 diabetes mellitus die of cardiovascular disease (CVD) at rates two to four times higher than non-diabetic populations of similar demographic characteristics.

ACCORD

Sponsor: National Heart, Lung, and Blood Institute of the National Institutes of Health Studied: 10,251 patients in the USA, Canada

The following is taken from a press release on June 6th 2008.
ACCORD Clinical Trial Publishes Results --

A Therapeutic Strategy Targeting Blood Sugar to Near-Normal Levels Does Not Reduce Cardiovascular Events But Increases Mortality in Persons with Diabetes at High Risk

Intensively targeting blood sugar to near-normal levels in adults with type 2 diabetes at especially high risk for heart attack and stroke does not significantly reduce the risk of major cardiovascular events, such as fatal or nonfatal heart attacks or stroke, but increases risk of death, compared to standard treatment. Researchers from the ACCORD (Action to Control Cardiovascular Risk in Diabetes) clinical trial compared a medical strategy aimed at near-normal blood sugar levels – below current recommendations -- to a strategy to reach more standard blood sugar levels. Supported by the National Institutes of Health, the study evaluated the effects of intensively targeting blood sugar control among adults with established diabetes, high blood sugar levels, and pre-existing heart disease or at least two cardiovascular disease risk factors in addition to diabetes.

The first published results of the ACCORD trial of over 10,000 participants appear online in the New England Journal of Medicine (NEJM) today and will be in the June 12 NEJM print edition. The results are being presented at the American Diabetes Association's 68th Annual Scientific Sessions in San Francisco on June 10.

In February, the NIH's National Heart, Lung, and Blood Institute (NHLBI) stopped the intensive blood sugar strategy after an average of 3.5 years of treatment, instead of the planned 5.6 years, due to safety concerns. The intensive strategy group had a 22 percent higher risk of death – or 54 more deaths -- compared to the standard group. The increased risk began emerging within 1 to 2 years after the strategy began to aggressively lower the participants’ blood sugar levels. All participants now follow a medical strategy to reach the standard blood sugar levels while other components of the study continue.

"ACCORD is providing important evidence to help guide treatment recommendations for adults with established type 2 diabetes who have had a heart attack or stroke or who have two or more risk factors for cardiovascular disease in addition to diabetes," said NHLBI Director Elizabeth G. Nabel, M.D. "For these individuals, intensively lowering blood sugar to near-normal levels appears to be too risky."

The researchers caution that the results might not apply to patients who are at lower risk of cardiovascular disease than the ACCORD participants or to patients with more recently diagnosed type 2 diabetes. On average, ACCORD participants had been diagnosed with diabetes for 10 years at enrollment.

ACCORD's ongoing studies of the effects of aggressively lowering blood pressure and treating multiple blood lipids (cholesterol and triglycerides) in high-risk diabetic patients are expected to continue through June 2009.

"Adults with type 2 diabetes are two to four times more likely than adults without diabetes to die from heart disease, so identifying the safest and most effective ways to help them lower their risk of heart disease, stroke, and death is critical," Nabel noted. An estimated 21 million Americans have diabetes and 284,000 die from it each year. Sixty-five percent of deaths in persons with diabetes are from cardiovascular causes.

Conducted at 77 sites nationwide and in Canada, ACCORD randomly assigned 10,251 participants between the ages 40 and 79 (average age 62) to standard or intensive blood sugar treatment goals. Therapy in both groups included patient education and counseling, and treatment with any of the major classes of Food and Drug Administration-approved diabetes medications, as prescribed by their study clinician: metformin, thiazolidinediones (TZDs, primarily rosiglitazone), insulins, sulfonylureas, exanatide, and acarbose. Combinations of medications could be used as needed to reach the treatment goals.

Hemoglobin A1C levels, a standard measure of average blood sugar levels over the preceding two to three months, were used to monitor participants' blood sugar. The standard strategy group (5,123 participants) aimed to lower blood sugar levels to an A1C of 7 to 7.9 percent – a target similar to what is achieved, on average, by individuals treated for type 2 diabetes in the United States. The intensive strategy group (5,128 participants) had an A1C blood sugar target of less than 6 percent – similar to that found in adults without diabetes. To join the study, participants needed to have an A1C level of 7.5 percent or higher; at study enrollment, one-half of the participants had an A1C level over 8.1 percent.

Half of the participants in the standard strategy group achieved an A1C less than 7.5 percent, and half of the intensive strategy group achieved an A1C less than 6.4 percent. On average, participants in both groups achieved these levels within the first year of the study and maintained them throughout the study.

After an average of 3.5 years, 257 people in the intensive strategy group died, compared to 203 participants in the standard strategy group. This difference of 54 deaths resulted in a 22 percent increased death rate in the intensive group. Causes of death were similar in each group, with about half from cardiovascular conditions, such as heart attack, sudden cardiac death, stroke, or heart failure. However, the intensive group had 41 more cardiovascular deaths than the standard group, resulting in a 35 percent higher cardiovascular death rate.

"Despite detailed analyses, we have been unable to identify the precise cause of the increased risk of death in the intensive blood sugar strategy group," noted lead author Hertzel C. Gerstein, M.D., M.Sc. "Our analyses to date suggest that no specific medication or combination of medications is responsible. We believe that some unidentified combination of factors tied to the overall medical strategy is likely at play." Gerstein holds the Population Health Research Institute Chair in Diabetes and is director of the Division of Endocrinology & Metabolism and Diabetes Care and Research Program at McMaster University and Hamilton Health Sciences, Hamilton, Canada.

To meet their more aggressive targets, participants in the intensive group used more medications, were more likely to use combinations of medications, and changed medications and/or doses of medications more frequently than those in the standard group. For example, 52 percent of participants in the intensive strategy group were on three oral medications plus insulin compared with 16 percent of participants in the standard strategy group. The intensive strategy was associated with more adverse side effects from medications, hypoglycemia (low blood sugar) events, weight gain, and fluid retention.

The researchers also studied whether participants' characteristics at enrollment had an impact on their outcomes. They compared persons with and without existing cardiovascular disease, women and men, those older and younger than age 65, those with A1C levels lower and higher than 8 percent, and white and non-white participants. Death rates were consistently higher in the intensive strategy group regardless of baseline characteristics. However, compared to participants in the standard group, those in the intensive group who began the study with no history of heart attack or stroke, or with lower blood sugar levels (A1C level 8 percent or less) had fewer combined cardiovascular events – fatal and nonfatal heart attacks or strokes – during the study.

The increased risk of death from the intensive strategy surprised researchers and other experts because earlier studies had shown that blood sugar at near-normal levels was associated with lower cardiovascular disease risk in people with type 2 diabetes. However, these were observational studies, rather than randomized clinical trials, as they did not test treatments to reduce blood sugar. In addition, intensive blood sugar control has been shown in clinical trials to reduce microvascular complications from diabetes – including eye, kidney, and nervous system diseases – in people with type 1 or type 2 diabetes, and to lower cardiovascular disease risk in people with type 1 diabetes. However, the levels tested in other studies were not at as low as the level targeted in the ACCORD intensive treatment group.

The American Diabetes Association's clinical guidelines recommend that most people with type 2 diabetes reach and maintain an A1C of less than 7 percent. The guidelines also state that treatment should be individualized. For example, a less stringent A1C goal should be considered for people with severe or frequent low blood sugar or with other medical conditions.

I promise to tell the truth, the whole truth, and nothing but the truth so help me God.

Gabapentin, so they tell me, has a side effect that affects memory. There are, genuinly, things that my familiy have said to me recently that I have absolutely no recollection of them saying.
But is it the gabapentin? I remember doing a training course on Human Performance a few years ago. We were all shown a short film and then asked a number of questions on it. There were twenty of us doing the course, and twenty of us all saw a different film. MOST of us did not see a man with a banana, some did but thought it a knife, and so on. I performed no better or worse than anyone else, but i have a long lasting memory of a question, What is the truth?
Is it what I remember?
Is it what someone else remembers?
Is it what mattered what happened?

Do you remember driving to work yesterday? What colour was the second bus you saw? What car was behind you at the third set of lights? Did a car cut you up? Was the driver young or old, male or female. What car did you park next to in the car park. What dress/tie was a c0-worker wearing? And so on. You can't remember some key issues can you?
'But they are not key' you might rebuff, but what if you read the local paper tomorrow and discover that the car that cut you up was fleeing from a crime, perhaps a murder? I grew up with the Birmingham bombings, and I know what I remember seeing on TV, but what do I remember of the actual events as they unfolded. How reliable would I be if I were called as a witness 40 years on? How reliable would you be, I day, 1 month, 1 year on from an event.
How reliable a witness could you be? And you probably are not taking gabapentin. Just think about it next time there is a report of a big trial on TV, perhaps a terrorist bombing.

Perhaps it ought to be

I promise to tell the truth, the whole truth, and nothing but the truth, as my memory remembers it, so help me God.