Adulteration of food for profit

Horse burger anyone?  I for one am not surprised that some pre-prepared foods don’t contain what they purport to.  Any industry (and food is a multi-billion £/$ industry) that is susceptible to fraud will suffer fraud, the ‘crims’ will try anything.   I wonder how far this might go: any foodstuff which contains a high value component is at risk of having part, or all, of that component substituted by a similar, lower value, component.  How sure are you that your tuna mayo sandwich is really all tuna, and not part mackerel, or that the mayo really is mayonnaise?

What is more disturbing is that we seem to have learned little from the BSE crisis.The  answer must be buying, or growing, your own ingredients and cooking your own food.

GRR

PS I wrote to the Food Standards Agency about the testing of other foods; they said, in effect, that they don’t have the resources to test anything but the high risk items and were concentration on the beef issue for now.

Mis-selling insurance and one-way car hire charges

We’ve, presumably, all heard about the PPI (Payment Protection Insurance) mis-selling scandal.  Here’s another dodge to get you hot under the dashboard – Car Hire Collision Damage Waiver (CDW).  When you hire a car all the companies (Hertz, Europcar, Avis etc.) tell you that if you damage the car at all you will be liable for the first guzzilion pounds of repair costs.  Then they offer to mitigate your risk by selling additional insurance – often adding 50% to the apparently competitive headline daily rate for hire alone.

I recently hired a car from renatalcars.com, a broker, who subcontracted me to Avis at Exeter Airport for a one-way trip to Bristol Airport.  In round numbers that’s £80 for a one-way, one day, hire plus £20 for CDW.  When I picked up the car Avis told me that the CDW I had prepaid to rentalcars.com did not mitigate my risk to Avis and that, in any case, it didn’t cover everything that Avis insurance would do (windscreen, tyres etc.).  Given they had upgraded me, for reasons unexplained, from a cheapo Peugeot 107 to an Audi A3 I was obliged to buy another load of insurance: scratch an Audi and it’s going to cost a lot more to fix than a Peugeot roller skate.  We (the Avis receptionist and I) spoke to rentalcars.com who confirmed that their CDW was limited in scope (though this is not confirmed on their website).  So, my 75 mile trip cost £120 + fuel.  Despite the fact that my contract was with rentalcars.com, I was railroaded by their subcontractor.

As for one-way premium charges, what’s that all about?  Lots of people want to go from A to B rather than A to A.  I don’t believe the individual hire locations have a fixed inventory – they hire out what they have ‘in stock’ (hence unexplained upgrades) and only rarely have to transport a car back to base.  If it were that common an occurence they could offer one-way hirers to take the car back: “I’m going from A to B, have you got any cars to return there?”

GRR

P.S.

I e-mailed rentalcars.com, via their customer services contact, and they very promptly considered my complaint.  They stated that the ‘small print’ gave them the high ground but, as a gesture, refunded the charge for CDW insurance that I couldn’t use.  My advice would be that, if you regularly hire cars, you take out a comprehensive stand-alone CDW policy (e.g. from protectmybubble.com) which will cover you for unlimited hires over a year for substantially less than the hire companies will charge.

QUEEN WEI’ME AND THE WELL OF HAPPINESS

Somewhere in the middle of a blue, blue, sea was a group of eight islands: the Wei archipelago.  Western Wei had six islands and Eastern Wei had two.  The islands were always ruled by Queens, not Kings, but the Queens took consorts whom they called ‘King’.  Queen Wei’me XXV, who lived in a palace on the main island, Wen, had married King Wei’nat.  The King was joyful, strong and handsome, and the Queen, who was rather plain and sickly, always felt beholden to him for marrying her.  However the King loved his Queen very much and, over the years, she bore him several children:  the princesses Wei’wei, Wei’nau and Wei’dem; the princes Wei’wauri, Wei’bodda, Wei’wok.  The seventh, and youngest, child had been sent away, for reasons that will become clear, to a different group of islands to be brought up.  She was called Wei’natme (after both her father and mother).

Sadly, after many battles, the King died and Queen Wei’me had continued controlling the islands alone and, without the loving hand of her dear husband to moderate her, bringing up her children with fierce authority.  She became an increasingly sad and fearsome ruler.

Like their father, King Wei’nat, the princes had a carefree attitude to life, preferring to enjoy whatever the new day would bring and go to bed each night thankful for life and eager for tomorrow.  The princesses, on the other hand, were like their mother:  always looking back at the hour before, jealous of each other and generally discontented.  Over time, as they each came of age, Queen Wei’me’s children went away to live in their own islands, in other archipelagos, where they married and had children; some were so afraid of the Queen’s fierceness that they went far away, almost to other seas entirely.

After many years the old Queen became frail and, as she expected to be soon reunited with her beloved King, she called for a council of her children to see who would become the next ruler of the whole Wei archipelago.  However none of the princes and princesses would come; Princess Wei’nau thought that there were more pressing things at home, and could come to see her mother ‘nearer the time’; Princess Wei’dem was sure that it wouldn’t be her that was made ruler, as it (whatever ‘it’ was) always happened to benefit somebody else; poor Wei’wei could never get beyond the nagging doubt that she had forgotten something more important than the thing right under her nose and, consequently, never left her palace.  The Princes would never rule anyway, so Wei’wauri and Wei’bodda were on permanent holiday and could not be contacted.  The other prince, Wei’wok, had formed a successful little federation of his own with some other islands and was too busy.  But, most of all, they were all still afraid of the Queen, and agreed it would be best to send an emissary to represent them at the dowager’s bedside: so they sent for Princess Wei’natme.

Wei’natme was also still afraid of the Queen but wanted to please her brothers and sisters, and perhaps return to the body of her family, so she agreed.  Having been brought up without the influence of either King Wei’nat or Queen Wei’me, Wei’natme was, in many ways, quite unlike either of them.  She was gentle and pretty but, unlike her mother, unconcerned about her looks.  She was quite brave and carefree but, unlike her father, diligent.  She had married a commoner and had only one child, a daughter, but lived an independent and fulfilling life as a teacher.

The old Queen Wei’me was both happy and sad, and perhaps a little guilty, on seeing Princess Wei’natme.  The years of separation, and her memories, had led her to assume all kinds of things about her daughter, things about her beliefs, her attitudes, her likes and abilities.  For her part, Wei’natme assumed only one thing: that her mother did not love her because she had sent her away.   The Queen hid her happiness on seeing her daughter, even though she reminded her of her beloved husband.  Instead of saying “Hello, how are you?”, she said “Why have you come, I called for the others?” and, instead of saying how nicely she had turned out, she said “I preferred you when your hair was shorter”.   Wei’natme was hurt at first, and then angry, for it seemed as if the Queen had, indeed, not loved her – and still did not love her.  But she had learned from teaching that not everyone knows how to say what they really want to say.  She supposed that the Queen could not acknowledge her daughter’s beauty because it was a painful reminder of her handsome lost husband, and she could not say “I love you” because it was too painful to face up to having exiled her.

The Queen, in her anger and loneliness, found it easier to fulfil her fear that her child hated her by antagonising her.  And she preferred to be proved unhappily right than happily wrong because, in sole control of her children and her islands, being right had always been the one thing she could be sure of.  She brooked neither disobedience nor contrary opinion.  They stood in silence for a while as they wondered how to bridge the gulf between them.  Wei’natme spoke first.

“I have come because my brothers and sisters would not, or could not – perhaps you should ask them, rather than me, why they are not here.  I am as I am, and I please myself, and my husband, with how I look and what I wear.  Since you seem to dislike me so, perhaps I should go away again?”   Queen Wei’me was shocked by her daughter’s directness, for it had been years since anyone had dared speak their mind to her.  “Disobedient child!  How dare you speak to me like that – I am your Queen and your M….”  She stopped, as the word ‘mother’ was stayed by Wei’natme’s gentle hand on hers.  “Yes,” said Wei’natme, “you are my mother, but not my Queen any longer – remember I live far away from Wei, where you sent me.  And as for ‘disobedient child’, I am grown and married with a child of my own.  Perhaps we can agree on ‘respect’ as a place to start?”  The old Queen rose from her throne, with such pain and difficulty that Wei’natme moved to steady her but was brushed away.  “I am tired”, said the Queen, “come again tomorrow and we’ll talk about your respect then.”  And with that, she went to her chambers.

The next day Wei’natme was by the harbour, arranging for a boat to take a message to her husband, and buying some cloth for a child’s dress, when the Queen’s secretary found her.  He stayed only long enough to announce “Her Royal Highness, the Queen Wei’me, commands that you attend her at once – come with me”, before turning on his heel and marching stiffly away.  Wei’natme finished her purchase and sent her message before following, through the cool palms, to the summer palace where the Queen sat in the sun, by a well, reading.  She was grandly announced by the secretary, “Her Most Royal Highness The Princess Wei’natme”, before he withdrew, bowing so low that his billowing sleeves trailed in the dust. For a long time the Queen did not acknowledge her daughter’s presence, instead she continued to read several more chapters before finally closing her book and looking up.  “You wanted to talk about respect” and, roughly dismissing the servant who was fanning her, “then why did you keep me waiting – is that the kind of respect you mean?”

Wei’natme, trying to not embarrass the Queen, waited until the servant was out of earshot before replying.  “No, Your Majesty, I meant mutual respect.  I might ask why you kept me waiting?  After all it was you who had me commanded to appear ‘at once’, when I was occupied doing something for my husband and my daughter, but you continue to read while I stand before you in the hot sun.  And why were you so rude to your servant, she was only trying to help keep you cool?”   The Queen hurled the book at Wei’natme, but her arm was weak and her aim poor, so it fell into the well instead.  The well was all but dry, and Wei’natme retrieved the book and handed the muddy parcel back to the Queen, the ink running black onto her hands. “There, see what your anger achieves – you’ve destroyed something important to you”.  The Queen tossed the book onto the ground saying, “I don’t care, it wasn’t very good anyway and I’ve plenty of other books…..and servants.” before tottering off into the shade and slumping, gratefully, into one of two elaborate cane chairs by a hibiscus bush.  Wei’natme followed and, without being invited, took the other chair.

Wei’natme broke the awkward silence.  “I like hibiscus, don’t you?  The blooms are so vivid, and yet so temporary: here one moment and then gone.”  “Rather like children,” said the Queen, with a contemplative voice that surprised Wei’natme with its sad and unexpected insight.  But she took her chance and said “Then, why did you send me away?”  Without showing any regret, the Queen said “I suppose I feared that your father favoured you over the other children and, if truth be told, over me.  You were different: pretty and wilful.  I worried that my place, as matriarch, would be threatened if you came to be Queen one day.  And yet, of all of my children, here you are.”   “Yes.  Here I am. But if you were jealous of father’s affection, why were you so fierce with us after he died?  I was so afraid of you that, had I not been sent away, I would have left as soon as I could anyway, just like the others.”

“I only treated you as I had been treated by my own mother and father.”  Wei’natme was puzzled by this.  “And did you enjoy being treated like that?”  The Queen’s eyes were misted by tears, the first Wei’natme had ever seen from her mother, as she said “No, I hated it.  But I was afraid, of my mother especially.  She could be cruel and spiteful if you disobeyed her.  But it was necessary, I realised that.  The world is a bad place, fighting and danger everywhere.  She taught me that no child has a right to an opinion about its upbringing.  You are still headstrong – had you remained at court you would have learned that obedience is everything, whether it be your subjects or your children, otherwise there is only chaos and disintegration.  Perhaps I should have kept you here.  Obedience has held the islands together all these years.”   Wei’natme, though filled with compassion for the pain of her mother, could not allow her to escape.  “Compliance without respect, or reason, is not obedience – it is fear.  Since father died your islands, your people, and your children, have been bound together only by fear, not obedience.   They had respect for father because he showed them that life was for living, not controlling.  You taught them only fear.  And as for your servants, they may make your life tolerable, but you abuse them so that I am surprised any of them stay with you.  If they had any choice I imagine you would be quite alone here.”

The old Queen stood up, as if to make an escape from the awful answers to the awful questions that confronted her, but she was frozen.  The only parts to move were her eyes as they searched in vain around the courtyard, the sky, and the ground before her feet, for a way out.  Wei’natme continued.  “And what of love?  Did you respect, obey and love father, or only fear him?”  The Queen, her face no longer frozen, spoke through her sobs.  “I do not know.  I was not taught to love by my parents, so how could I know?  When he asked me to marry him, I supposed my mother and father would be pleased that somebody would take me.  I was still afraid: afraid to say no, afraid to disobey.  Perhaps it was love, perhaps dependence, perhaps companionship, perhaps escape; and then there were so many children there was no time to find out.”

Wei’natme also stood, and held her mother warmly, but feeling only her stiffness and emptiness through the fine clothes, she stepped away.  “I feel sorrow for you, mother, but not love.  You cannot disguise your fierceness and brutality as a necessary lesson in obedience.  It was only anger.  You visited your anger with your parents, for treating you so badly, on us your own children.  You were angry with us for preventing you from discovering yourself.  You still are angry with us – perhaps now because we are there, while father is not.  I believe that, if you had the power to turn the tides, you would prefer it if we had not existed.  We’ll, I can cease to exist for you.  I can return to my island and my husband and child.  I can leave you here with your poor servants, your ‘obedience’ and your other books.”  And, with that, she turned and strode toward the gate but, as her hand reached for the latch she heard the sound of her mother in her own flailing, angry, voice and stopped.   Across the courtyard she saw, not a figure of hate but only a joyless old woman.  Unlike her, she did not know love; unlike her, she feared the power of her own emotion and, unlike her, she stared down an empty well of happiness.  For Wai’natme had learned love from her father, had recognised it in her husband and given it to her child.  Her well of happiness was full, and always replenished.  She had learned that the more love she gave, the more she received.  Wei’natme returned to the Queen’s side.  “I cannot pretend that I love you as a daughter ought to love her mother, but neither can I ignore my compassion.  I will return to my brothers and sisters and tell them what has happened here, and then come again.  Perhaps, by then, you will have thought more about respect.  But know now that, when I return, I will not submit to any more of your anger or spite.”  Queen Wei’me watched her go, still with a little anger, some pride at her daughter’s assurance but, mostly, sadness at being reminded of her lost husband by, despite her banishment, how very much like her father she was.

Wei’natme travelled around the other islands, visiting her brothers and sisters, bringing the news of the Queen’s health and trying to explain why her mother had been so harsh with them all.  It was very hard for Wei’natme to be even-handed, for she too was still angry, and also sad at being reminded of her lost father.  Yet she was proud of what the Queen had achieved as ruler.  The princes and princesses were all still angry too, but more concerned for themselves and Wei’natme.  They told her that she should return to her husband and daughter and forget her mother entirely.  The Princes Wei’wokwok and Wei’bodda, and the husband of Princess Wei’wei were the most outspoken.  “Why should we go to her now; it was her beatings, that drove me away as soon as I was old enough to leave?  Let her face the consequences alone!”  “She made Wei’wei’s life a misery and tried to stop our marriage, let her rot!”  “Let her physicians and courtiers tend her, I still feel the scars of tongue whippings as if they were from a real lash.  I’m not going anywhere near her.”  The princesses, made meek and uncertain by years of being ordered what to think, did not know what to say.  Wei’natme, however, had seen the terror in her mother’s eyes and could not forget it:  she returned to Wen island, the capital, and her mother.

Queen Wei’me was happy to see her daughter again, but could not help herself and, instead of greeting her with affection, scowled and scolded her.  “What a poor dress!  You may live as a commoner but you don’t have to come here dressed like one”, and commanded “ go and see the court dressmaker before you come next time!”  Wei’natme felt the pain of years, as if her ear was still being twisted or her mother’s knuckles were still being rubbed into the top of her head.  She backed away, and blazed through her tears:  “Next time?  NEXT TIME?  Why should there have even been a this time?  I wish you could hear yourself, mother.” and she ran away.  The Queen’s secretary found her, weeping, by the harbour.  “Madam, the Queen is feeling unwell.  She has asked me to find you and plead with you to come back to the palace.  She sends this dress as a gift.”  Wei’natme accepted the dress (for, in truth, her own dress was a little shabby) but refused to return, saying that, though she thanked the Queen for her present, if she was really unwell she should send for her physician.  She would come again in a month, but only provided the Queen promised to be more civil, and with that she boarded the boat for home.

A month later the inter-island ferry was delayed by bad weather and Wei’natme had been terribly sea-sick, staining her new dress.  The Secretary had been too afraid to relay all of Wei’natme’s message, especially the part about promising to be more civil, so the Queen, who knew nothing of weather and it’s effects on the lives of commoners, scolded Wei’natme again.  “You’re late.  And what a state you are in.  I would never have dared let my mother see me like that.”  But then, with a little more softness in her voice, she added “But, tell me, how is my grand-daughter?”  Controlling her urge to respond to her mother’s criticism, or to run away again, Wei’natme replied “She is well, thank you,” and after a pause which she hoped the Queen would fill, but did not, “ as am I and my husband.”  She took a cloth and cleaned her dress by the fountain, before siting down by the Queen’s chaise longue and asking, in return, “And, how are you today?

The old Queen, unused to the niceties of conversation between equals, or genuine enquiries for her health, could not measure her reply; she unleashed a torrent of complaint and, for good measure, some unconcealed jealousy:  “How do you think I am… I am old and sick….and nobody comes to talk to me…..you’re young and pretty….and you still have a husband.  How do you think I feel – how would you feel?”   “Mother!” Wei’natme recoiled, ducking mentally under the distant memory of a slap to the head.  “STOP!  I only enquired about your well-being!  If it is true that nobody comes to talk to you, why do you imagine that is?  If you behave like this with everyone, you must frighten away all those who might come to see you – it is hardly a pleasant experience.  As for me being young and pretty, and not old and sick: I expect my turn will come.  Yes, I have a husband and a lovely child: it is the natural order of living things that mothers and fathers pass on to the other world before their children.  Until that happens I mean to show my love for them every day, as they love me, not thrash around like a wounded animal at bay, spitting anger and frustration like you.  Now, tell me again, how are you?”           

The Queen subsided, her angry turmoil giving way to sadness, but did not know how to apologise.  “You are right of course.  I am tired and in pain.  I eat little and my eyes are failing.  It will soon be my time.  You might think that I would be impatient to be free of pain and to see your father again – but I am frightened.  I know, in my heart, that I treated him as I have treated all of you.  He may not want to receive me in the next life.  I cannot bear the thought of eternal loneliness.”  Wei’natme comforted her mother but her kindly reply was firmly given.  “Father loved you, even though you treated him badly.  I am sure he will be pleased to see you, have no fear.  Now, ask me how I am – and listen to my answer.”  The Queen did as she was asked, and Wei’natme went on.  “I had a terrible journey, and was very sick.  My husband has no work and we struggle to buy bread and clothes on my teacher’s salary.  My beautiful daughter has to work in the fields to pay for her own schooling and it costs a great deal to travel here: my brothers and sisters have paid my fare.  You see, others have problems too.”  The old Queen seemed, at last, to understand a little and together they walked slowly around the courtyard garden talking of ordinary things like flowers and the weather, until it was time for Wei’natme to return to the ferry boat and home.  “Please come again – I enjoyed our talk” called out the Queen as Wei’natme left “and, perhaps bring my grand-daughter?”

Wei’natme conferred with her brothers and sisters, telling them of the Queen’s changing attitude.  In spite of her own fear and difficulties, Wei’natme knew the power of love and tried to tell them that they, too, might benefit from seeing the Queen again.  A month later, on her next visit to Wen Island, Wei’natme was accompanied by her own daughter, Poppy.  The Queen looked sternly over her pince-nez (which she found more ‘regal’ than spectacles, even though it was difficult to see clearly with them):  “Come closer child, let me see your face.”  Poppy, who knew no fear, advanced right to the Queen’s feet and jumped up on her lap.  “There granny” she said cheekily, “Is that close enough?  What are those funny things on your face, they make you look like a … frog”  “Silence!” ordered the Queen.  “How dare you speak to me like that?”  Poppy did not know that rhetorical questions required no answer.  “But you’re my granny, how should I speak to you – you’re funny!” and she slipped from the royal knees and skipped away to investigate the garden.  Once the Queen had recovered her composure, she was secretly amused by the bright little girl who inquisitively flitted around her courtyard with the butterflies, like them never settling for long in any one place.  “You see how a childhood without fear can be, mother?” said Wei’natme before Poppy returned with a Hibiscus bloom which she thrust under the Queen’s nose.  “What’s this called?  It’s very pretty isn’t it – but this is the only kind of flower in the garden, why is that?”   The Queen looked at the brilliant bloom and smiled at Poppy.  “Not enough water in the well.  But it does not look beautiful for long, child, – they quickly fade.  And it has no smell, well, not a flowery one anyway.  It should have a nice smell, shouldn’t it?”

“Well, I think it is lovely enough without a perfume, Granny”, said Poppy.  “not everything in a garden has a perfume that we can smell you know, but everything has its place:  the butterflies and the birds seem to like different things, don’t they?”  The rest of their visit passed in rare gentleness and good humour but, after Wei’natme and Poppy had gone, the Queen sat alone watching the butterflies and the hummingbirds that had joined them.  She thought to herself.  “The child is right.  Even though I cannot smell the Hibiscus bloom, the hummingbirds and butterflies are drawn to it.  Everything does have its place and a purpose.”

And so it was that, over succeeding months, Wei’natme brought her brothers and sisters, one by one.  With each visit, and especially those from Poppy, the Queen’s temper grew more even.  The other princes and princesses shed some, though not all, of their fear and, with it, their envy of each other.  In time, although she never quite got over being most important, and still barked at her servants sometimes, the Queen was more accepting.  The well in the courtyard was less empty, the garden had more flowers and the matter of succession seemed, somehow, less important.  And she thought that, one day, Poppy would be Queen – but only if she wanted.

© Andrew Gold

August 2002, revised January 2012

My first Herx!

Howdy Doody

Well, glory be, I’ve had my first Herx.  To those not in the ‘Lyme Club’, that’s short for Jarisch-Herxheimer reaction.  In the early 1900s these two described a severe worsening of symptoms in Syphillis sufferers, when under treatment, caused by the toxic product of the ‘die off’ off bacteria.  With all the drugs I have had in the last 18 months it’s a surprise to me that I’d never ‘herxed’ before, but I guess it says something about the effectiveness of the treatment I’m on now compared with all that went before.  I’m in week 11 now and will revisit my GP in week 13 when I will just have run out of pills.  Onwards and upwards (and, occasionally, sideways)!

Happy New Year – Keep the faith

Hi all

Happy New Year to you, my reader.

Sorry I’ve been off line for a while – staying away from home in a place without internet access.  I just wanted to post a progress report on my treatment, which has now been going for 6 full weeks (week 7 starts tomorrow).  I’m on the ‘triple ABx’ protocol: Azithromycin and Amoxycillin 4 days a week and Tinidazole on the other three.  My doctor consulted with a doctor in England and the suggestion was that I stick with this for 8 weeks and, if without symptoms by then, to end after 12.  The side effects have been (so far, touch wood) very mild: I’ve not had much ‘herxing’ nor upset tummy.  The most persistent has been occasional bouts of oral candidiasis, but even that hasn’t been unmanageable.  I’m much improved and feel like I’m getting my life back at last.  Many symptoms have reduced to ‘not bothersome’, while others have stopped.  With only 2 weeks to go (to the 8 week threshold) I suspect I’ll be going beyond 12, but maybe not as long as the 24 weeks endured by the doctor in England.

I found my GP open to reading papers, including another doctor’s piece in the BMJ last year, so keep the faith if you are having trouble with your GP.

Andrew

Reasearch suggests….

Research is a great job opportunity for someone.  Where / who are these spivs thinking up research projects to pitch to funders – for a FEE of course?  It seems like every week we have at least one headlined announcement about the results of some new piece of work.  Have you noticed that they often have the following features: the answer was predictable and it will soon be contradicted by another piece of so-called research?  Sometimes I sit here thinking “I could have told them that”, I bet that you do the same.  This morning it was Statins:  a few weeks ago we were told that we should all be, more-or-less, compulsorily medicated with statins, and now “research suggests” those on statins should have their dosage cut to avoid side effects.  Doh!  I could have told them that.  Not long ago we were hearing that research suggested a glass of wine a day (for those that can afford to drink wine) is good for you:  now it isn’t.  Let’s all take an Aspirin a day.  No, on second thoughts, let’s not.  Give up smoking, it will kill you.  Well, hang on, it’s apparently relatively ok to smoke until you are thirty (who thought that one up, Imperial Tobacco?).  “People with more money are generally happier and healthier than poor people”  Well, blow me down, who’d have thought it?  At least purveyors of anti-wrinkle cream are transparent: we know what they want.  “82% of 129 women (or men) agree…”, it’s only the maths that’s suspect: presumably 105 agreed but one person wasn’t sure.  What lunatic bases a marketing campaign on such a thin sample, and why would anyone base a purchase on that sort of evidence.  I suppose it’s the transparent contempt for our intelligence and common sense that is so offensive.

I wonder how much of our shrunken GDP is dependent on the research industry?  Maybe SAGA could set up a research consultancy?  I’m sure that a panel of “economically underactive” older people could answer some of these pressing questions over a cup of tea and a Hob Nob.  A nice little earner in a recession too, and more entertaining than a trip to the local day-care centre.  Oh, sorry, that’s probably closed isn’t it.

GRR.

 

 

 

 

BBC ‘Autmn Watch’ and Chopping Down Trees

I was watching the BEEB the other night: ‘Autumn Watch’ broadcast all this week from the Aigas Field Centre, which is not a million miles from here.  The presenters enthused about the rare and secretive otters and pine martens, and the even rarer red squirrel, all of which we see here too.  It occurred to me, though, that large scale  ‘harvesting’ of commercial forest, also going on round us, must have a drastic effect on the habitat of these creatures.  Does anyone else join the dots, or is it just me?

 

What was your name?

We’ve all been there: the receptionist at an hotel, the telephone enquiry, the customer services representative who barely looks up and says “and what was your name?”  Why should my name have a past?  I haven’t changed it: I’m not a part of a police witness programme or a pop musician travelling incognito.  I know they mean “What name is the booking / purchase under” or similar but why can’t they say “What is your name?”  “Please” would be a nice addition, but I suppose that is too many syllables.   It grates like the announcements in the local airport, which invite us to “await in the departure lounge”; await what, exactly?  Don’t they know the difference between wait and await?  Silly question.  I wonder if these truncations are borne from tweeting and texting, assuming the random casting off of words isn’t important, that we’ll all understand.

The last time I was asked “What was your name” I said “it was, and still is, Andrew Gold”.  There was only the slightest twitch of a mascara’d  eyebrow to show that she was thinking “pedantic old twat” but she said, “Room 401.  Take the lift to the fourth floor and turn right.  Have a nice stay with us”.  What she meant was “and I hope the lift gets stuck.” Maybe she had a point.

Lyme Disease – a personal overview

NB This blog is not finished and represents my personal view.  If it interests you, keep any eye out for additions.

I want to say, right at the start, that any negative comments I make about diagnosis and treatment do not, in the main, apply to me:  I owe my relatively improved health to my excellent GP and his Infectious Disease specialist colleague at my local hospital – when I was living in the Highlands of Scotland.

The second thing I want to say is that there is a lot of bad science, even misinformation, out there.  There are charlatans too.  I am not an expert, I am a victim.  If you have an interest in Lyme Disease, I recommend you look at one of the well-known specialist charities, like Lyme Disease Action.  If you are in the UK, or Europe, the Deutsche Borreliose-Gesellschaft guidelines are worth reading.  See them here

INTRODUCTION

I was diagnosed with Lyme Borreliosis (a.k.a. Lyme Disease, LB or LD) in July 2011.  When I started this, in April 2013, I was not fully recovered and still under treatment. At the time of this update (May 2016) I am no longer under treatment and substantially recovered, but I do not know if I am cured.

LD is a bacterial infection transmitted (mostly) by the bite of an infected tick.  I say ‘mostly’ because, like many features of LD, there is uncertainty (if not full blown disagreement) about whether the Borrelia pathogen can be transmitted in other ways (more on this later).  About the only thing on which there is consensus around the world is that, if diagnosed early enough, LD is curable by a course of antibiotics and that, if not diagnosed early, it can invade the brain and central nervous system leading to permanent disability and, possibly, premature death.  There is disagreement about how early is early enough: it can develop very quickly into a multi-systemic illness that can be hard to treat, never mind cure.  It can mimic many other recognized diseases, like Parkinson’s, Alzheimer’s and Multiple Sclerosis to name only 3.  If you are familiar with the effects of these diseases you will have some inkling of how devastatingly life-changing LD can be.

DIAGNOSIS – First Room in the Hall of Mirrors

Clearly then the really critical thing, for a good outcome, is getting an early diagnosis.  Welcome to the first room in the Hall of Mirrors: for many LD victims, getting a diagnosis of any kind is a challenge.  First of all, assuming the mode of transmission WAS an infected tick, you may not know you were bitten. I had a ‘fastened on’ tick in March 2011 (too early in the year according to ‘the rules’). I became noticeably unwell, with very odd symptoms, in early May 2011.  The symptoms were so bizarre that I began a daily diary.  As a direct result of this evidence, and my general awareness of the potential for Lyme Disease where I lived, I was able to persuade my GP to carry out tests and I was diagnosed in July 2011.  Without that diary I may never have been tested at all, even in Scotland, but recording such detail is a double-edged sword: one doctor thought I was neurotic to be keeping a diary.  In hindsight (while my memory still worked!) I recalled a ‘flu-like’ spring cold – another symptom of early Lyme but, being a “mucus trooper”, had shrugged it off at the time.

Even the nymphal stage of the most common tick Ixodes Ricinus (there are several others) can carry infection; the nymphs can be the size of this fullstop (.) but nearly translucent.  You may only see it if it bites you in a visible place, or when it has started to swell with your blood, or after the bite site has begun to get inflamed. Incorrect removal of the tick may result in giving yourself an infection that you might otherwise have avoided (more on this later).  Similar to the organism that causes Syphilis, the effective agent of the Borrelia pathogen is a spirochete, spiral-shaped: it travels in your blood to any part of the body where it, almost literally, ‘drills’ into your tissues.

The annual number of new cases of LD, in the UK, is disputed.  The official statistics exclude anything directly diagnosed by a doctor, that is to say clinically, without a laboratory test.  Of course what is also excluded from the statistics is the unknowable number of cases that go undiagnosed or misdiagnosed.  Even if the informed, but unofficial, estimates of 3000+ UK cases are correct, many doctors will never have seen a case, ever.  What is not disputed is that the rise in cases, year-on-year, is faster than those of HIV/AIDS which has a much higher public profile.  Recently (since 2015) there has been a change in the official perception of LD as an emerging disease, and the challenges to diagnosis and reatment it presents, but opening the minds of, and offering training to, GPs is slow.

It is, therefore, still highly unlikely that any UK doctor will treat for LD following a tick bite without symptoms present.  If you are infected you have 30%+ chance of NOT developing a signature rash, the so-called ‘bullseye’ Erythema Migrans.  Note the word  ‘migrans‘ – spreading.  If it appears, it may not be at the site of the bite, or it can disappear to reappear somewhere else.  If it appears it might be a few days to several weeks after the infecting bite: you may have forgotten about being bitten, or even having been in a location where you might have been exposed to being bitten.  A rash might be large or small, might not be distinct, there may be several.  However, and this is important, the appearance of an EM rash is, by itself, accepted as clinical evidence of LD and your doctor should prescribe antibiotics right away.  Should.  Unfortunately the experience of many LD sufferers is that GPs, even in areas where LD is recognised as endemic, ignorantly misdiagnose even a classic ‘bullseye’ rash as a skin condition or something else.  “Try this cream and come back in 10 days”.  “Let’s try some steroids (the worst thing you can do for Lyme because it interferes with your immune system)”.  If this doesn’t resolve doctors have been known to treat for psychosomatic disorders (stress).  On the other hand, the rash may resolve, leading to the presumption that the diagnosis of psoriasis, ringworm or eczema, was right and you go on your merry way – as do the borrelia organisms.  As it happens I was one of those who didn’t get a rash. So your next chance to get a diagnosis is when you start to exhibit other symptoms: kiss goodbye to early diagnosis and welcome to the second room.

SymptomsSecond Room in the Hall of Mirrors

The list of possible symptoms is enormous, and I’m not going to reproduce it all here, but many of them can be associated with other illnesses or diseases.   Muscle weakness, pain and cramp, twitching, Bells Palsy, joint pain/arthritis, severe headaches, vision and hearing disturbance, loss of co-ordination or the ability to walk, extreme fatigue, inability to think (so-called “brain fog”) are just a few.  The many effects on the central nervous system may be fleeting and move about the body, vague and difficult to describe.  You may have one major symptom, or many.  Your doctor may again think you are over anxious or neurotic.  He/she may diligently set off on a number of tests – all of which take precious time and, confusingly, may unearth another, previously unsuspected, condition which complicates diagnosis and redirects treatment.  Moreover LD is, by nature, a remitting/relapsing disease: you may spontaneously get better, again pre-empting correct treatment.  As a result some victims of LD fight for a diagnosis for YEARS while the disease slowly infiltrates their bodies and becomes ever more difficult to eradicate.

If you are, somehow, tested for LD the blood test(s) may come up negative: the tests are fallible and there is NO test to prove active infection, only a test to show, by presence of antibodies, that you have at some time, been exposed to the infection.  With an equivocal blood test your doctor may adopt a ‘wait and see’ approach.  I have been confirmed twice, by Western Blot blood test, as “weak positive” for LD.  My Lyme-aware GP started treatment immediately we found out but, as bad luck would have it, he was on extended leave when I first got ill, so I was initially seen by 2 locums, one of whom clearly thought I was neurotic (but later apologised).  By the time I started antibiotic treatment crucial months had passed, however this might have been to my advantage as it can take several weeks for the antibodies to appear and a false negative test would have been disastrous.

TreatmentThird room in the Hall of Mirrors

With a firm diagnosis of LD you would think your troubles are over.  Indeed many sufferers (some of whom will have begun to doubt their own sanity) express profound relief that they at least know what is wrong.  This relief is likely to be very short-lived, as the next battle will be over getting a treatment that works.  The fact is that the science on Lyme Borreliosis is both developing and mired in controversy.  Until 2016 Public Health England (PHE), and Health Protection Scotland (HPS) based UK treatment guidelines on the American model promoted by their Centre for Disease Control (CDC), and the Infectious Disease Society of America (IDSA).  Although the PHE clearly stated that adherence to the guidance is not mandatory for clinicians they, the General Medical Council (GMC) and the British Medical Association (BMA), behaved as if it were.  This left clinicians who diverged from the guidelines open to disciplinary action, which they naturally avoided.  Unfortunately the CDC/IDSA guidance is founded on the species of ticks, infective pathogens, and potential co-infections, found in America.  The most common of these is Borrelia burgdorferi whereas in the UK and Europe generally you are more likely to be infected by Borrelia afzelii or Borrelia garinii. These agents affect, and may need to be treated and tested for, differently: the American experience is not necessarily relevant but the HPA/HPS continued to base treatment guidelines on those of the CDC/IDSA.  At last PHE is reviewing and revising its guidance, acknowledging the uncertainties of diagnosis and treatment, but it may be a long time before hard-pressed GPs approach LD with a more open mind than hitherto.

To date, then, the first-line response to an early diagnosis, say by erythema migrans rash, is a single course of a tetracycline antibiotic (usually Doxycycline) at 200mg per day for 14 days.  Once this course is completed, some clinicians will not prescribe further courses.  Some will prescribe the same dose for 28 days, as a first course, or as a further course if the first course fails.  Some doctors say that all of this is ineffective for disseminated disease because the blood concentration resulting from these dosages is too low to be bactericidal for LD, and of too short a duration.  Very few doctors will follow the European guidelines, e.g. Deutsche Borrelia Gesselschaft, or those of the International Lyme and Associated Disease Society of America (ILADS) which suggest a more appropriate dose is at least 3 or 400mg/day for one, two, three, or even many more, months.

For so-called “late stage” and strongly neurological LD, the “silver bullet” is suggested to be several weeks of intravenous antibiotics, commonly Ceftriaxone.  As I said before, everything from the particular strain of your infection to your age, general health, and physiology may make one treatment succeed where another fails, and vice-versa, but the authorities persist in following a “one size fits all” approach.

Persistence of Infection – Fourth Room in the Hall of Mirrors

The official position is that once “appropriately” treated (i.e. according to the guidelines) LD will have been cured, and that any persistent symptoms or relapses are either due to something else or re-infection.  For those people who live in tick ‘hotspots’ re-infection is always a possibility and cannot be discounted.  However there is no blood test to show that your symptoms are caused by a new infection only, as before, that you have been infected sometime.  So this is unhelpful in determining persistence.  The “something else” list is long. The main theory is that, though the disease is eliminated by the “appropriate” treatment, there is long-lived, even permanent, damage to the central nervous system or an over sensitive auto-immune response.  If you want to see the experience of one UK individual who has persistent Lyme, you could do a lot worse than follow this link.

If you want to read a brief, learned, exposition of the two sides of the persistence debate, try this link.

The main ways currently used to determine whether you have viable spirochetes in your system is by biopsy, or spinal fluid examination; sequential brain scanning might show continuing scarring implying ongoing disease.  These tests are invasive, expensive and, consequently, rarely done in the UK.  Some promote the use of various microscopy techniques on live blood smears but the UK health system does not support these. Amongst other candidate reasons for persistent symptoms are residual inflammation of nerves and (surprise, surprise), neurotic focus on otherwise ‘normal’ symptoms; etc., etc.  As previously noted, it is also unfortunately true that the presence of other disease in the victim can cloud the issue:  I had confirmed diagnoses of a virus, and a D.V.T, simultaneously with my Lyme diagnosis.

Of all the areas of medical dispute, perhaps the most contentious is what drugs to use, how often and, especially, for how long.  LD was first named in 1970’s America; after Old Lyme, a town in Connecticut, where a large number of cases of childhood arthritis had appeared.  Although there is evidence that the disease has been around for thousands of years, the infective organism there was isolated by Willy Burgdorfer – hence the most commonly quoted strain is Borrelia burgdorferi.  The American healthcare model is one of private medicine funded, mainly, through insurance: the expensive testing, treatment, and subsequent care of LD is accessible mostly to those with insurance.  Self-evidently the insurance companies have a vested interest in limiting their exposure to, potentially, open-ended care.  Many of the doctors who compose the board of IDSA have direct, or indirect, financial relationships with insurance and drugs companies.  Is it any wonder that the IDSA promotes guidance that has the effect ot supporting the commercial interest?  With a publicly funded healthcare system in the UK, and with very few cases of LD caused by Borrelia burdorferi (which are mostly, if not all, acquired outside the UK) it is hard to understand why the PHE/HPS rigidly promoted adherence to guidelines based almost entirely on the American experience.

Those that maintain the persistence of LD say that the low dose, relatively short, courses of antibiotics actually cause the spirochetes to ‘hide’ under a so-called biofilm, or transform into a cyst in tissue out of the bloodstream, or other location with a poor blood supply and inaccessible to drugs.  Then they re-appear when conditions are favourable to their continued reproduction.  There are physicians who recommend high dose, intravenous, antibiotics for months – perhaps years.  Over-prescription of antibiotics is widely held to be a cause of drug resistant infection in hospital, some of them potentially deadly like C-Difficile, so their caution is understandable.  Given that Doxycycline is prescribed by doctors for skin conditions (as an anti-inflammatory not as an antibiotic), sometimes for years, it is odd that the same doctors will not give long-term courses for a potentially life-threatening illness like LD – as indeed they would for Tuberculosis (TB).  Of course long-term antibiotic therapies may have unpleasant, even dangerous, side effects that need to be monitored and managed.

Other uncertainties

Vectors and Distribution

World-wide there is an assumption that Lyme Disease is predominantly, if not entirely, limited to a band of the northern hemisphere.  Amongst other things this has led to official denial of its existence (and therefore treatment) in Australia where, nevertheless, cases appear!  In the UK there is a presumption that you would have to visit a ‘hot spot’, and then in spring or summer, to be exposed to Lyme Disease.  The key areas are thought to be heathland, where wild deer, ponies, and sheep roam.  Therefore parts of Wales, the New Forest, the hills and dales of Yorkshire and Derbyshire, the Dartmoor and Exmoor national parks and the Highlands of Scotland, are often quoted as the hotspots.  This is a mistake, based on the common perception that deer, and infected deer ticks, are the only vectors of LD.  In fact deer are not vectors for Lyme Disease at all, they are so-called “dead end hosts”.  They support tick populations by providing a blood meal, and therefore spread ticks, but ticks acquire the disease pathogens from other hosts like mice.

There are several types of tick in the UK and they are all opportunistic feeders: all they need to survive and reproduce is a warm-blooded host to feed from.  They are able to survive temperatures in excess of 40C and, clearly in Scotland, long periods of sub-zero conditions.  Birds (migratory or otherwise), small mammals like mice, rats, rabbits, hedgehogs etc., all can carry ticks and host the pathogens.  All larger mammals like foxes, badgers, cats, dogs, horses, cattle (of course, deer) can also carry ticks.  It is not much of a leap of imagination to say that foxes, birds, hedgehogs and the like, transiting rural corridors, can bring ticks right into your city garden, your urban farm or allotment, or to a park near you.  There is no research to find out the extent of infection being carried in this way, but LD is widespread in continental Europe so is perfectly feasible for a strain of Borrelia, totally unknown in the UK, to be brought right into your house via a migrating bird and then your pet cat or dog.  Recently a tick borne pathogen previously known only in Japan, Borrelia myamotoi, was isolated in Sweden (Gothenburg University).  There is, at time of writing, a furious dispute in Australia where the state government of New South Wales is denying the existence of Lyme Disease in Australia despite growing evidence to the contrary.  The truth is that you may get a tick borne illness anywhere.

Co-Infection

Ticks can carry more than one pathogen, potentially infecting you with more than one disease.  The official position in UK is that so-called co-infection is not a problem.  Some LD specialists and patient support groups disagree on this vehemently, saying that one or more of Anaplasma, Babesia, Bartonella or Erlichia may be transmitted along with the Borrelia.  They say that the overlaying of these diseases means symptoms of LD may manifest differently and will need to be treated differently.  Quite how this affects the treatment of the number of UK residents who acquire Lyme while overseas, where co-infections are accepted to be common, I don’t know.

Inter-Human Transmission

There is no research to find out if a tick bite is the only way to catch LD. There are alleged cases of trans-placental infection from mother to unborn child; there are suggestions that other body fluids like breast milk, tears and sexual fluids are capable of transmitting infection.  There is a question mark over other, blood-feeding, biting insects.  There is, as yet, no evidence for any of these. Though definitely blood-borne, the UK Blood Transfusion service does not screen donations for Lyme Disease.

Incidence

Since 2010 it has not been a requirement to notify PHE or HPS about a case of Lyme Disease in the UK.  It’s not even reportable unless it has been diagnosed by a laboratory, or occurs in the armed forces, or is acquired “occupationally”, in which latter case it is a matter for the Health & Safety Executive under RIDDOR.  That means all cases which are diagnosed only on the basis of clinical suspicion, perhaps because of an Erythema migrans rash, simply do not figure in the official statistics.  Other European countries, with smaller populations than the UK, report many times the number of cases: they may have different recording systems.  Obviously our governments do not think it worth prioritising scarce resources, or research, on the basis of a few hundreds of cases but if it were many thousands (as suspected by the leading testing laboratory in the UK), then what?

Tick Removal

Unattached

Ticks, especially the adults, are tough and incredibly hard to get off your skin, even if not attached. Unattached they can be hard even to crush between your fingernails.  This is not recommended as you could infect yourself through your skin, especially if broken, but if you get one off you before it attaches, make sure you kill it DEAD.  If you flush it down the toilet, make sure it has really gone.  Wash your hands.

Attached

Once attached you should proceed with great caution.  It is said that a tick is unlikely to pass an infection to you if it has been attached for less than 24 hours, though there are those who say even 12 hours or less is possible.  Even if <24 hours is true, the key word here is “unlikely”: don’t wait, get it off as soon as possible.

Bizarrely, NHS Highland recently pubished advice which encouraged the application of methylated spirits or alcohol to remove a tick!  This is completely wrong.  Do not, under any circumstances, apply creams, fluids, cigarette ends or anything else to an attached tick.  Anything which stresses or crushes the tick may cause it to regurgitate the contents of its mouth or stomach into you, along with any infection it is carrying.

The easiest way is to use a proprietary tick removal tool – there are several on the market.  A problem here is that the proprietary tools are less good at grasping nymph ticks: they are so small.  Better than nothing, but trickier, use a pair of needle nosed (precision) tweezers, NOT the blade ended type you might use for eyebrow plucking.  You must grasp the tick close to the head NOT by the body and pull gently upwards.  Try not to leave the head attached in your skin as this can also result in infection and, in the worst case, septicaemia.  At all costs avoid crushing the tick.  It may seem ridiculous at the time but, if you get an attached tick off, save it in a secure container (an old film canister would do) and mark the date and geographical location where you were bitten.  You can send the tick to be identified and it may even be tested for infection (though this is unusual).  Even if a tick that bites you is found to be carrying the LD pathogen it does not mean you will have been infected but it should encourage your GP to treat you anyway, even without symptoms and even if you haven’t had a positive blood test,.  If nothing else it will add to the knowledge about spread of infected ticks in the UK.  The PHE website has information on how to do this at

http://www.hpa.org.uk/Topics/InfectiousDiseases/InfectionsAZ/Ticks/TickRecordingScheme/

If bitten you should note the date in a calendar or diary, and then watch for early signs of illness.  If it is going to appear, the Erythema migrans rash should be seen within 4 weeks as the infection has a (roughly) 4 week cycle.  If you don’t get a rash but feel like you’ve unaccountably got a mild dose of ‘flu (especially out of season), get odd cramps or twitches, feel excessively fatigued or have trouble concentrating, start a diary and consult a doctor.  Mention the tick bite and ask about Lyme Disease but be prepared to be dismissed – keep your diary going for as long as you are symptomatic.  When I presented my Infectious Diseases consultant with a chart covering 9 months of symptoms and treatment he laughed at my self-description of “mildly obsessive”, but he did agree it was helpful data and added it to my burgeoning file.  Not all doctors would be so open-minded: you need to be cautious about the impression you give to your doctor.

Finally, the web site Wikipedia has a good overview of Lyme Disease and it can be found at http://en.wikipedia.org/wiki/Lyme_disease

Where’s my magazine?

In March of this year I gave a magazine subscription as a birthday present.  I did it online with the publisher, Archant Life Magazines, who print and circulate a range of glossy ‘lifestyle’ magazines across the UK.  This one is a monthly about Devon and is called ‘Devon Life’.  The issues have repeatedly arrived late, or not at all, the latter event prompting an extension of the subscription.  There have been several ‘phone conversations with subscription staff and, earlier in the year they applied a “Track and Trace” label to our copies which briefly seemed to correct the situation.  Needless to say the October issue, which was released on 26th September, hasn’t arrived.  My wife ‘phoned Archant and was given the clear impression that they thought she was making a fuss about nothing: “We allow 10 days for delivery, but if it isn’t there by 4 October, call back”.  It wasn’t, so I did.  Finally I got to the truth: it is because we are not in Devon.  Apparently the magazines are shipped by a carrier, TNT, who will not ship until they have at least 25 items for the same distribution hub.  However long it takes.  I railed against this, particularly since there is nothing in the subscription process that warns you of these facts.  Although the subscriptions are quoted as including P&P (postage and packing) there isn’t a way of “out of area” subscribers to pay extra for postal delivery.  So we are left with two options: cancel and get a refund or wait indefinitely for a magazine that is out of date if and when it arrives.  “We don’t want to lose a valued customer” seems pretty hollow to us, so I wrote to the MD and got a reasonably quick and positive (if badly written) reply.  Our subscription is being extended for 12 months in compensation.

Update 26 October

Archant promised a direct mailing of the missing issue by first class post.  It arrived 5 days later, having been posted second class.  The original traceable copy, supposedly with TNT, has still not arrived.  The MD of Archant admitted they were having a meeting with TNT as we weren’t the only people to complain.  My wife wrote to him on the 17th to ask about progress, and express her worry that this would happen all over again with the November issue, but he hasn’t bothered to reply.  Great Service, Archant.