Loss of Innocence (The Complaint).

I left the story last at the juncture where I was trying to fathom what had happened to J' whilst she was in Hospital, and why so many things had gone wrong. I had been trying to convince her, that we needed to both find out exactly what her prosthetic hip, was and to ascertain why she had been so ill postoperatively, at least.

It took some convincing, on my behalf as J' wanted to put it all behind her; to forget all about it completely, whereas I did not. I did quite a lot of soul searching, as I knew that J' continued to display stress when talking about events that had occurred and I did not want to coerce her into anything. It was painful for me too, but I felt it imperative at least to garner some information, so as to guide any action in the future. So the first step was taken; that of requesting all the notes about her Hospital treatment.

What may seem a simple request, turned out to be more difficult than anticipated and I sought the help of the Patient Advocacy Service to assist me in this. I was not confident that they would be of any use but was pleasantly surprised by the case officer appointed, Andrew (not his real name, which I never knew) whose knowledge and understanding was of great help. So we submitted a request for the medical notes and sat back and waited, and waited. Well it took an age, cost some £50 and came in instalments. And of course you have no proof that what you receive is comprehensive, because you do not know what may have been omitted. Some two months later we actually had them all and I commenced the task of review.

Despite my knowledge of Human Biology and Biochemistry, I admit to floundering somewhat; well quite a lot actually. I had not looked into science in this area for more than thirty years (my how time flies) and I found that I not only had to hit the books, but had to buy some more contemporary ones. But of course we now had the Internet, except I had not used it much before, being a bit of a 'luddite' in a way although I had embraced microprocessor logic quite extensively. So now I had to embrace that as well. But after a few hiccups I was soon getting up to speed.

My review of the various tests conducted proved to be the most illuminating element of J' treatment and the memory I had of the Paramedics question, about controlling her Diabetes soon became understood. Her preop' blood glucose was 19.50 mmol/L ! That is severe, uncontrolled hyperglycemia, a situation that could only indicate Type 11 Diabetes. In addition she had been given a 'bolus' of several antibiotics including several penicillin's. She has a well documented adverse reaction to this type of antibiotic, which was advised to the Hospital on admission and it was clearly stated on the notes. There was also strangely, a copy of an ECG trace together with a chest X-ray copy (on disc). These were 'ghosts', because no such procedures were undertaken, and let's face it it would be extremely difficult to 'sneak' an ECG onto a patient, with ten electrodes having to be placed onto various parts of the body and the machine, being wheeled into the cubicle, especially as I was there too. Bizarre is the only word I can use for this.

So the first thing I had to do was to address the distinct possibility of Diabetes. I knew that high blood sugar is symptomatic in trauma patients, it's part of the human stress reaction, but not anything like the levels reported (and ignored!). So I purchased a blood glucose monitor and some test strips and tested J' for both fasting and post prandial (after a meal) levels. I did this on three days to be absolutely certain and the figures were indeed well above normoglycemic levels, in the region of 10mmol/L (fasting). So whilst I was by then sure she was a Type 11 Diabetic, it has to verified by a Doctor for this to be 'official' so we had to make an appointment to see the GP which we did. When we talked to her (the GP) she was also convinced of the same and immediately wrote out a 'scrip' for Metformin. And she gave us a blood test instruction to be fulfilled at either of the two local Hospitals. I viewed this as somewhat premature, but she dismissed totally the concept of diet and exercise as a protocol for containment of the Diabetes. A rush to judgement? Well pretty much I felt, so we did not fill the prescription and never did.

I had already completed some research into Diabetes prior to the GP visit as the only thing that I could recall from College was that the 'Islets of Langerhans' become non-functional and thus produce little to no insulin. J' also had more practical experience than I, as her father had Non Insulin Dependent Diabetes Mellitus (NIDDM) for a large part of his life. But his condition was treated with diet and exercise. That frankly was my take as well because that had been the protocol for most, thirty or more years ago. What had changed it seemed, was the fear of fat and meats, as the diet route dictated that little to no carbohydrate be consumed. As all carbohydrates convert to glucose in the digestive system somewhat rapidly, it also made biological sense to shun them. What had changed then since my studies in the 1960's? Well quite a lot it seemed.

'Big Pharma' in it's ceaseless pursuit of money had become all powerful along with Diabetes UK, an alleged patient advocacy organisation, and their dominance of  the treatment paradigm now in place dictated that Diabetics take a cocktail of drugs including it seems Insulin. Insulin Dependent, Non Insulin Dependent Diabetics? Well that seemed somewhat nonsensical. More research was obviously needed and urgently, but we did concentrate our efforts, (for by this time J' was 'onside' about this, if little else), on reducing carbohydrates with a view to elimination.

After more heart searching J' finally agreed that we should also register a formal complaint with the Trust about her treatment and now, because of the notes, we also had (at last) found out what 'they' had put inside her (hip). It was a bi-polar hemiarthroplasty, which is a 'hemi' with a plastic cup added to the top of the head (ball), that was 'stuffed' (no other word describes it better) into her acetabulum. Research sadly does not attribute this with any better outcomes than a simple 'hemi' and the recipient also has more plastic debris to cope with together with little in the way of less acetabular erosion or protrusion. So it is little better than a simple 'hemi', just a bit more expensive. It had taken more than four months to determine the presence of this prosthesis, which somewhat flies in the face of so-called 'informed consent' we were alleged to have given.

And so the Complaint System rumbled forward, until we at last had a meeting. I have written about this in detail a while ago and do not propose to go over it again. Suffice to say we were both devastated by the outcome and resolved to pursue things further, but frankly the ground rules kept moving throughout the procedure making it difficult to find our way. The Brown Government, overseen by that most useless of all Health Secretaries, Andy Burnham decided that a change was needed halfway through our complaint, and we were now left with no choice than to complain that we thought we had been dealt with unfairly, and that the 'Local Resolution' system should review the case once more. The response to this was a refusal, leaving the 'last hope', a referral to Parliamentary and Health Service Ombudsman as our final port of call. But at this stage we decided to concentrate on J's various problems and look for as many solutions as we could.

These were; the need to restore her mobility as much as reasonably practicable with the poor prosthesis she had been given.
To control her Diabetes and achieve normoglycemia as much as possible with the minimum of side effects.
And to investigate the pronouncement about her having osteoporosis we found in the notes.

She had a pronounced limp, termed Trendelenburg's Sign, which was placing some strain on her left leg. We needed some physiotherapy intervention for this and, luckily the PCT in the area had a a policy of self-referral, so we did not have to see the GP for this. Using a bit of 'leverage' in my circle of  friends, I was able to get her an appointment quickly and we got one of the best in the area. He agreed that J' needed help and devised a work plan that involved resistance exercises that I had to help with, that rebuilt the muscles damaged by the operation. It was hard for her and sometimes painful to see, and often I felt terrible for driving her efforts. But after three long months, it bore fruit and the limp was gone. It also helped with her Diabetes by gist of the exercise needed which reduces insulin resistance in the muscles that helps to lower blood glucose.

Her Diabetes gradually came under control with a low carbohydrate diet, regular exercise with walking and an exercise bicycle, together with a few carefully targeted supplements. Her Hba1c reduced from 8.5 to 6.5 in three months, she lost some weight and the youthfulness she formerly displayed, gradually returned. There was a lot more to achieve as yet, but the walks along the canals helped to keep us both reasonably fit and sane. J' had gone from a vibrant, youthful woman, holding down a well paid job to a partially disabled Diabetic with alleged 'brittle' bones, needing help with at least some aspects of life. She had to have an automatic car, help with getting in and out of bath and could only work part-time.

No one person or organisation was responsible for the accident or the Diabetes, but what the Trust did was to ignore many obvious and relatively simple measures that prejudiced her recovery, her future, her very life even at one point, without any sense of responsibility for their actions and lack of them. No sense of danger in their lax and supine protocols; no remorse, no empathy, but above all no candour and no justice.  I had lost my innocence about 'our' NHS, an organisation I had championed in the past, even been grateful to for saving the lives of two of my children. Yet now, after the injection of extra billions in funding, it was actually worse than when it was a service for the poor 'proles' back in 1948. It was devoid of humanity, and the primary tenet governing all that medicine stands for, 'do no harm', because it was doing great harm and 'selling' it as care. It had made an enemy of me and I was to learn in the coming months, many others too. I was no longer 'Winston Smith' and I no longer loved Big Brother.

This saga continues shortly, after I catch my literary breath.

21st Century Health Care?

Upon arrival back at the hovel, a few days ago I perceived that the answer 'phone was flashing a message. Pulse racing with anticipation, I scrolled through the interminable menu at BT to retrieve it and lo' it was my friendly neighbourhood Health Centre, inviting me to call them to arrange a 'health check'. How sweet, how kind, that they should be so concerned about my health and well being (sic).

This same provider of Primary Care, that fails to provide any help or support for she whom I care for, in the lack of any provision of testing strips to monitor her blood glucose, will not prescribe any Colpermin for my IBS, failed to help with my severe PTSD beyond a referral to a community mental nurse for an assessment, eight weeks down the line, when I was already in such anguish that I could barely function. Never reminds us of the need to get an HBa1c test for my loves NIDDM (Type 11 Diabetes). Looks askance when I suggest a (25)OHD test for her, to ensure her levels (Vitamin D3) are improving from the appalling low level of last year. In fact unable (or unwilling) to support any of the interventions that are useful or sustaining of health, but can find time and funds to fulfill the the needs of the prospective rewards available under the Quality and Outcomes Framework, if they can undertake a number of tests (on me) that will assist in achieving the practise goals.

I gave the matter some thought, for about ten seconds and thought 'f**k 'em, why should I help them earn some extra cash when they provide no real support, for mine and my partners problems. She will not take Diabetes drugs, and prefers to control NIDDM, with diet, exercise and supplements. Yet, to ensure that this is containing the disease, which it is, we need to undertake at least two or three tests per day. The cost of the test strips is £28.00 per 50. By buying on-line I can reduce this to £21.00 per pack, but that is still £31.50 per month. Vit D3 and Omega 3 supplements plus Vit C and ALA adds at least another £20 a month. Add to that my Colpermin at £21.00 per month and before we know where we are a £100 is gone. I do get a free prescription for the rather dubious pleasure of dosing my self for Glaucoma, which I've had for 25 years, with a prostaglandin analogue. But hey, I've been paying the State for over 40years, with taxes that make my eyes water, is it not about time I got a little back? But no, if you don't take hypoglycemic agents, you don't get free strips; it's a sort of punishment perceived somewhere in the DH, that is basically saying to those who won't tread a certain path, to the wheelchair into the dialysis suite, that we won't play ball with you. This is despite the fact that all the indicators are that a 'low carb diet' is just as effective but less dangerous than the DH recommended protocols.

No, the simple truth is that the NHS and all pretty much who sail in her, have their heads stuck so far up their own backsides and that of 'Big Pharma' that not only can they not see the wood for the trees, they lost sight of the wood itself. They are not interested in outcomes, only dubious 'surrogate' markers of alleged, sometimes invented diseases. When some 'wet behind the ears' locum GP tells me that fat (not even cholesterol), could be clogging up my arteries, and cause heart disease, and that 130/60 is a high BP, I feel like strangling her with her own stethoscope. So if they want to monitor my BP and do a lipids test, and ascertain my alcohol intake, more to make the what, £136 a point for QOF (average would be about £250,000 a practise all told) than for any regard for my health. Then I could be lectured about my lifestyle, at a level about that of a 12 year old, so I could then retort that 'I wear shoes older than you and was studying biology and biochemistry before you were born' and 'you can't change the rules of human metabolism just because of the rubbish you learned by rote a med' school'. Life is too short and I need to keep my BP down (allegedly).

New Idiots Guide For NIDDM Published!

NICE has published it's latest guideline for the prevention of Type II Diabetes or as I call it, 'the NICE guide to the manufacture of new patients'. And yes, it's the same old drivel, regurgitating all the tired old protocols, most of which have proven pointless, counterproductive, and more based on dogma than any scientific proof.

I state that with considerable conviction, because these guidelines are unlikely to have any effect on the cohort they are aimed at; those with Metabolic Syndrome. There is still some conjecture as to how this comes about, with often touted views regarding Genetics (the medical excuse for pretty much everything 'they' can't explain) being responsible. And, it is often true that Diabetes does run in families, but whether by 'nature or nurture', there is plenty that we can do to thwart its arrival. The problem is that virtually nothing that is in these guideline's is likely to help.

Looking at the main advice, we have;-
Basing meals on starchy foods, such as potatoes, bread, rice and pasta (wholegrain of course)
(That will be the carb's then)
Fibre rich foods, oats, beans, peas, lentils, grains, seeds, fruit, vegetable etc,etc.
(Some more carbs' then)
Five portions of fruit and veg.
(Even more carb's)
Low fat. (Makes you fat, does fat, you know)
Don't increase your fat or calories. (Just starve then)
Don't have fried food, sugar containing foods or drinks, confectionery etc. (Some sense there)
Cut down alcohol (OMG!)
Watch your portion size. (As you eat it)
Eat breakfast. (?)
Be active as part of your routine. (That'll make you slim you know).
Stop lounging around you lazy buggers. (Sell the TV?).
Walk or cycle instead of driving. (And die under the wheels of the No7 Bus).

Well, that's the gist of it, but will any of that make any inroad into most people's risk of becoming overweight or Diabetic. Frankly no!

Eating excessive carbohydrates is more than likely the reason why some of us become Diabetic in the first place. Numerous studies have shown that carbohydrates are the food group most likely to add weight and increase resistance to insulin, especially refined carbohydrates and this includes 'so-called' wholegrains which are pretty much like all grains, err, only 'browner'. Carb's are converted to glucose, just like sucrose (sugar) at almost the same speed, and if large amounts of glucose flood the bloodstream then it cannot be utilised immediately. The liver will keep some as an 'emergency' supply, to smooth out metabolic need (fight or flight requirements while the body accesses glycogen). The rest will go to storage in adipose cells. If you need a more scientific explanation of the process, there's a really complicated diagram here.


Losing weight, especially if you are moving toward Diabetes is best achieved by diet. A large number of studies support this.Such as this one and yes I know the cohort was small! Well what about this one then? Or perhaps this one, and this one too. Or even this one. Increasing saturated fat intake and protein has more benefit than does lowering them and the review of the Atkins Diet came out strongly in its favour for the treatment of Diabetics and those with Metabolic Syndrome, yet mainstream views continue down the road of banning fat, extolling exercise and generally removing pleasure, all founded on virtually nothing more than dogma.

Looking at exercise, do we find that it has virtue? Well a little. It will not make you slim, but it will help to make you more healthy. But to sell intensive exercise or indeed any exercise as a means of losing weight is to raise false hope. This trial was designed to look at dose dependent exercise to see the results on a number of outcome. It will be seen (toward the end) that little to no weight loss occurred even in the upper levels of exercise, on quite fat people. In fact, intensive, long term exercise, such a marathon running, exacts a toll on the human body that costs the NHS considerably more in net cost than does smoking. Knee and ankle injuries cause the joints to wear out long before their usual time, costing vast amounts in new joints and orthopaedic repairs, without of course the financial input to the system exacted from smokers in the form of taxation. From 'runners world forum' you will see that most who exercise at the extreme, even tend to gain and not lose weight when in training. As a 'rough' rule of thumb guide, 1 mile of intensive running will burn 100 calories, so you can imagine how little is burnt in the sort of regime suggested in the guideline
.
As for 'low fat', well there is no evidence that links fat consumption to any consequence that is damaging to health. It is in fact quite helpful because it is satiating of appetite, as is protein. So those who mainly take their energy from these food groups, become 'fuller' for longer and tend to consume less calories. Anyway, calories in/calories out is a construct that ignores the second law of thermo-dynamics and is little to do with human metabolism. The human body is not a bomb calorimeter, it's a complex and often wasteful organism that utilises energy in many different ways both for immediate needs and storage for the future. There is in fact considerable evidence that Saturated Fats do not cause heart disease or indeed any other illness, in fact those society's that utilise large volumes of saturated animal fats are in fact extremely healthy (The Inuit). We can in fact live devoid of carbohydrates, but not protein. Death would result, because humanoids cannot live without it as it is the 'building blocks' of most cells.

Cutting Alcohol! Well it won't hurt if you are a bit of a lush, but if you drink moderately of high alcohol drinks it will have little effect on your progress to diabetes. If anything, alcohol tends to lower plasma glucose marginally, but if it has a high carb content like ales and beers, it will raise it. That's where the term 'beer belly' really comes from, it should be termed 'carb belly', it's probably more accurate. So the cola, mixers, fruit juice etc, should be avoided, if you want to drink. Go for spirits with water, or soda, or high alcohol wines, that are not fortified. Anything above 11-12% has had virtually all the carbohydrate turned to alcohol. But don't forget that alcohol has calories and we tend to take drink, on top of an adequate diet, so it can add weight in high volumes. It is also an anticoagulant and as such thins the blood. That daily glass of strong red wine is really medicinal, honest!

Being active is not a bad idea, but surely they don't have to patronise quite so much! Exercise, especially if you sit behind a computer every day is quite a good idea. But don't go mad, and exercise before eating, when you have fasted. What little weight loss that can be gained from exercise, works best whilst in a fasting state. However, specifically to lower plasma glucose, a walk about 1 hour after eating will help your insulin resistance and lower the level in the blood, at about the time it is peaking.

Breakfast. Well a number of experts actually recommend no breakfast at all, or at least not every day. If you wish to, then have a high fat/protein type. Yes, the old-fashioned breakfast, eggs, bacon, sausage (high meat content 90% or better), but forget the bread, toast and cereal. They will make you fat! And a cooked breakfast of this type will keep you going well into the afternoon, even until dinner. I personally fast several days until lunch, and I do eat a hearty breakfast occasionally and then eat dinner, missing lunch, because I'm not hungry. There is in fact a YouTube movie that explains some of the myths that have built up around fat and diet and the inevitable cholesterol. It's quite amusing and true. It can be viewed here.

The problem is that this type of government sponsored propaganda is 'dressed up' as being science. The references given are not studies, but other guidance, most from NICE. Worst, it simply restates that which has been refuted by forty years of trying to reduce the number of diabetics and failing! An inexorable rise that seems to confound all efforts at it's reduction. And obesity, sloth, gluttony and worse, is given as the reasons when in fact many people go to great lengths to lose weight, using such protocols and either fail or obtain a brief respite, only to regain all the weight or worse, gain a bit more!

To put things into perspective, we have evidence that the key markers utilised to indicate risk for all cause mortality, BMI (body mass index) and/or waist measurement, are in fact quite a poor guide. In this study, it was found that those with a lower BMI, were in fact at greater risk, than those with high index. So please NICE. base your guidance on real science, not junk science!