I've been in London for the last two days. On business, and very fruitful it was too. So yes I am settling into the new job nicely and actually I am very glad I am working in South Wales and not Aztec West. I have travelled my Journey to and from the office on 7 occasions now, and on 4 of them their have been major problems around Aztec West and the M5. I have diverted up the Welsh side of the river before I hit the trouble zone and so have only been delayed by the A40 roadworks in Gloucester that SHOULD HAVE FINISHED BY NOW!!!!!!!! But not delayed by the M5 snarl ups, as I would have been had I taken a position in Aztec West or Bristol. The M5 around Bristol is either a trouble black spot, or has just been incredibly unlucky in the past two weeks. It was a pleasant change sitting on a train and being able to do work on the laptop as I travelled to (and from) work, rather than sitting on the motorway and just having dead time as I travel to and fro.

I shan't say where or why I was where I was, but it was very interesting......

...... but I had awful news whilst I was away, Yvonne ( Who Shall Be Revered At ALL Times ), and Hannah ( her Trainee ) were both left out of work by the collapse of Amethyst Motor Company. The really bad part is that it was the day before payday and so they worked a month for nothing, but for me, what was so bad was the fact that I was over 100 miles away and couldn't be at home on their worst day for years, possibly their worst day since we have been together. A lot has been said about the collapse of Amethyst Motor Company, but I think that the fact that none of the directors seemingly had any motor trade experience probably points towards the root cause.

So. Statins. The wonder drug that magically lowers cholesterol. And because I am diabetic and had a highish cholesterol reading I have been put on statins (simvastatin 40mg). I was on ezitimbe and 80mg of simvastatin, but my diabetic nurse took the ezitimbe off me at my six monthly review in July due to the apparent side effects, and my GP recently reduced my statins to 40Mg. 1 month later and I had a new starvation blood test to check my cholesterol. Total value is 3.7. Whoo who you might saw, but the truth is a little different, the truth is in the values underlying that total value.

The fasting blood cholesterol tests return a number of values measured in millimoles per litre of blood, or mmol/l for short. Cholesterol levels for the average person in the UK are relatively high. The average total cholesterol for men is about 5.5 mmol/l. For women it is about 5.6 mmol/l. The recommended target value is below 5.
These numbers are levels of:

1. Total cholesterol (the amount of bad LDL cholesterol plus the good HDL cholesterol circulating in your blood) (ideally <5.0)
2. LDL cholesterol (the bad cholesterol that clogs up blood vessels) (ideally <2.6)
3. HDL cholesterol (the good cholesterol that picks up any extra cholesterol in your blood vessels) (ideally >1)
4. Triglycerides (bad lipids) (ideally <2.3)
5. Total cholesterol to HDL ratio (the proportion of your total cholesterol that is good HDL cholesterol). (ideally <6)

So the big question is what do these things actually mean? What does LDL mean?

The first thing to say is that cholesterol in itself is actually essential to healthy living, it is the type that is important. LDL means low density lipoprotein and HDL is unsurprisingly high density lipoprotein. LDL is bad because it acts just like the plaque that builds up on your teeth, in that it builds up inside your arteries. In that arteries are actually tubes (or pipes), and build up is bad, it eventually leads to a potential blockage. This is why LDL is bad for you.

HDL, however, is called “good” cholesterol because it clears excess cholesterol from the arteries. As mentioned HDL cholesterol results should be higher than 1.0mmol/L. A HDL level of 1.5mmol/L or more is considered a negative risk factor, i.e. high HDL levels are so good that they can counteract the negative effects of another risk factor such as excess weight.

Triglycerides are another fatty substance in your blood. and elevated triglyceride levels lead to increased risk of heart attack. Triglyceride levels increase rapidly after you eat, then decrease slowly as your body processes fats from your food, which is why people are asked to fast for at least eight hours before testing their triglyceride. Fasting triglyceride levels lower than, or equal to, 2.3mmol/L are considered normal.

Okay, so now we know a bit more about Cholesterol and what is good and what is bad. We know that high levels of LDL increase the risk of Cardio Vascular and Coronary Heart events. So that is why the government is considering prescribing statins to everyone, or at least making them 'freely' available, and that is why, as a diabetic (diabetes increases your risk of CV and CH problems dramatically),my GP prescribed me statins.

Statins are prescription medicines that interfere with the livers metabolic process and result in lower cholesterol production. This leads to a noticeable drop in harmful LDL levels. But you will them become reliant on drugs for relatively little benefit and, most importantly, your HDL production, (remember, the good stuff) will be affected and lowered also.

SO perhaps statins are not a wonder drug after all, my figures revealed that although my overall figure was a healthy 3.7 (well below the ideal 5), my triglycerides were at 2.5 (above the recommended 2.3) and my HDL at 0.9 is below the recommended 1.0. Conversely the LDL was very good at 1.7. The message is that my cholesterol figures were OK.

Well, not to me they aren't. I want a low LDL but a higher HLD and also lower triglyderides. What can be done? The alternative to statins to lower high cholesterol may be with simple lifestyle changes including changing diet, managing weight and increasing exercise.

Diet

Healthy eating can reduce cholesterol. Your diet should be low in saturated fats in particular, and low in fat overall. Biscuits, cakes, pastries, red meat, hard cheese, butter and foods containing coconut or palm oil all tend to be high in saturated fats, so cut down on these foods.

Large amounts of cholesterol are found in a few foods, including eggs, offal such as liver and kidneys, and prawns. However, if you're already eating a balanced diet, you don't need to cut down on these foods unless your GP or dietitian have advised you to.

It's also important to eat plenty of fibre, especially soluble fibre, which is thought to lower cholesterol. It's found in fruits and vegetables, beans and oats. Aim to eat at least five portions of fruit and vegetables each day.

There is some evidence that foods containing substances called plant sterols or plant stanols, such as the brands Benecol or Flora pro.activ, in combination with a low fat diet and physical activity, can help to lower cholesterol

Aim to get your BMI down below 25. There is a BMI calculator HERE.

DO some exercise. A brisk 30 minute walk each day is the minimum target.

Me? I am going to see my GP and see if I can't frop the statins altogether and get my risk factor low and my HDL's Higher.

You might want to also read the following:

1. Triglycerides and the heart. British Heart Foundation.www.bhf.org.uk
2. Heart disease. Food Standards Agencywww.eatwell.gov.ukaccessed
3. Cholesterol. British Heart Foundation Health Statistics.www.heartstats.org
4. Cholesterol and chronic kidney disease. National Kidney Foundation.www.kidney.org
   Law, M.
5. Plant sterol and stanol margarines and health. British Medical Journal 2000: 861-864

I had a couple of comments from 'Paul' on my last post which I printed unmoderated, and I feel that the comments warrant an answer. I will give my responses in blue:

In his comments Paul said
"Do not listen to doctors or take their drugs (such as Metformnin) at least until you have read up on what mercola has to say as regards treating T2D with exercise and changes in diet. I have researched extensively on T2D and yes if you have pre diabetes, exercise and diet can delay the full onset. I don't have pre diabetes, I have full blown T2D. My body does not produce enough insulin, and what it does produce my body is resistant to. I am not a medical person and cannot make sense of all the conflicting and contradictory stuff you can find on the internet. I trust my GP and the advice he gives, and also the diabetes specialist that he refers me to.

You write: "I still eat healthy" ... are you sure about that? Have you always? What do you consider healthy. T2D is like smoking. The damage is acquired over years and can only be undone over months and years. I have eaten fresh fruit and vegetables daily for decades. I avoid salt and added sugars and rarely eat fast food or preprepared foods. I have less than one unit of alcohol daily, and have not drunk to excess for about 30 years. I have avoided additives and preservatives as I knew of the damage they caused as long ago as the seventies. I avoid aspartme with a vengence. The research that I have read tells me that D2D once established is not reversible. It is however manageable. In the UK we have a very good health system and my GP is providing excellent care, checking all associated risks such as CVD and CHD.

"I am still relatively sedentary". This says that until now you have been sedentary in your life. don't expect miracles but decent exercise and diet will undo some of the harm you've done yourself through a sedentary lifestyle." As well as Chronic T2D I also have had lower back pain and knee problems since my teens. I have latterly added hip problems to my list. These are also classed as chronic and have been addressed where possible by surgery to sadly a limited success. I cannot run or jog or swim or lift weights etc. I do what I can, use stairs rather than elevators/lifts etc. I am not a blob glued to the couch, but I am not able to enjoy the benefits of a gym. To compensate this I have had an excellent diet for about 35 years now.


Paul, thank you for your comments and thank you for the reference to the Mercola site, I was aware of it and many similar. I am very sorry to hear that your father passed away from D2D CVD complications, losing a loved one is never easy. My own father passed away at too young an age and I know what a distressing time that is, no day goes by where something doesn't remind me of him.

If you read back through my previous blogs you will see that I comment on diabetes and some of the things that I have discovered. I never moderate comments and welcome every one I receive, you will also see how impressed I am with the medical care I have received. On the framingham scale I am actually a lower risk of CVD and CHD than a non diabetic. (also blogged recently).

Diabetes is a sentence for life but I do not treat it as a life sentence but I do treat it with respect.

Well that was a surprise. I've just appeared on the BBC website (click here). It follows an interview I gave the BBC ages ago and I had almost forgotten about it, and then today I had a very nice comment from Stuart Diamond on my entry from a few days ago. It reminded me that a few times in the past I have a had blood tests done, usually on a precheck prior to going into hospital, and they had suggested diabetes and referred me to my GP for a thorough check up. So I would go and have a check up, and no diabetes found. Not forgetting that I had an annual medical at work that included blood checks, I was supposedly diabetes free for many many years.
But now I wonder.

I wonder if my diabetes was 'waxing and waning' somehow.

I wonder if we need a better way of checking.

Anyway, I still eat healthy, I am still relatively sedentary, but do what I can. I have just built lean to and am now removing a huge old tree and preparing land for growing vegetables. I am not a couch potato, but it just takes me a lot longer to do things than many other people. I refuse to give into my arthritis and I refuse to give into my diabetes.

And people still label me as a glutton because I am diabetic. In response I mentally label them as ignorant. Perhaps I am just as bad as they are.

Well the news is good on the job front. I have been successful and have been offered a position. The future now looks brighter stil. Talking of the future, as the cooler weather is on its way (come on, be honest, if you live north of the Equator it darn well is!), here is a thought. You have heard the phrase cold enough to freeze the balls off a brass monkey? Bet you thought it was a bit smutty? Well read on my friend, read on.


It was necessary to keep a good supply of cannon balls near the cannon on old wooden war ships. But how to prevent them from rolling about the deck was the problem. The best storage method devised was to stack them as a square based pyramid, with one ball on top, resting on four, resting on nine, which rested on sixteen. Thus, a supply of 30 cannon balls could be stacked in a small area right next to the cannon. There was only one problem -- how to prevent the bottom layer from sliding/rolling from under the others. The solution was a metal plate with 16 round indentations, called, for reasons unknown, a Monkey. But if this plate were made of iron, the iron balls would quickly rust to it. The solution to the rusting problem was to make them of brass - hence, Brass Monkeys. Few of us landlubbers realise that brass contracts much more and much faster than iron when chilled. Consequently, when the temperature dropped too far, the brass indentations would shrink so much that the iron cannon balls would come right off the monkey. Thus, it was quite literally, cold enough to freeze the balls off a brass monkey.

And all this time, you thought that was just a vulgar expression, didn't you?

I know I haven't blogged for a while, but I have been preoccupied with job hunting, and also building a leanto on the back of the garage, (about which more later).


It seems that GP care varies greatly according to a report in the gradian. 1 in 4 diabetics aren't given the meds that they need? Well I bet that more than 1 in 4 diabetics don't understand their condition, don't bother researching it, and don't bother following medical advice. No, I don't have any actual stats to back that up, my stement is prely anecdotal. When I tell people that I am diabetic, they nearly always know someone else that is diabetic and that has 'problems'. A bit of digging by me and most times you can see that their diabetic friend isn't eating in a diabetic friendly way. It is so easy, just eat a normal '5 a day' healthy diet cutting out most fats and salt. There is no special diabetic diet, my diet is the same one YOU should be eating to be healthy and prolong your life. I have the VERY occasional MacD etc, but I am lucky, I am a NID (non insulin dependant), and so regulating my blood glucose is a bit easier for me, but by far and away most diabetics are NIDs, so it is easier for them too. Someone close was diagnised recently as 'possibly diabetic' and sent for tests. Their reaction? Binging on cream cakes just in case diabetes was later confirmed. O. M. G !! They won't help themselves, so why should Doctors help 'normal sane' people that won't help them selves?

Because they should, that's why, because we trust them to, and because we expect them to. They dispense drugs, sorry medicines, that we can't buy over the counter, and generally should check that there are no compatibility issues. But every packet of drugs that you get on prescription comes with an information sheet that almost no one seems to read. It tells you about the drug, what side effects it has been known to show in some patients and what to avoid. If you read it, you can you know, it is allowed, and then go on the internet (which is in most homes in the UK and is free at every library so EVERYONE has access to it), and search (google) about your condition and your drugs, you can be informed and can know more, and if you have side effects or questions, you can go back to your GP. But people don't.


Just googling diabetes will tell you that, especially if you are diabetic, that aspirin and statins are almost quintessentialy essential for a diabetics and probably most other people too. You had to have been staying with the Clangers on the Moon not to know, it's been in the news for weeks. Okay so you have to get statins from your GP, (try asking, if for some odd reason they haven't been prescribed to you as a diabetic), but aspirin? You can get it so cheaply at supermarkets these days. People who will spend pounds on vitamin tablets they don't need won't spend pence on aspirin that they do! It's crazy.


And how do I know it's all human nature and how even though I do the right thing about diabetes, that is not the only issue? Because I am human. Whilst working on building the lean to in the rain (yes, exactly!) I slipped fell off the scaffold, not far, only about 6 foot, and landed on my back and left arm. Nothing seems to be broken, but I stunned myself and couldn't breathe or move for a short while (that was scary, I thought I had broken my back for a while).
What normal sane man works on a scaffold in the rain?
Me, that's who, but at least my diabetes is under control, and it's probably my own stupidity that'll kill me, not diabetes, and certainly not my GP not giving me the right tablets, because he s doing his job and he is giving me all the right tablets. Good Man!

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.

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