Being grateful

I am grateful today for two things.

Firstly J has his diagnosis. ADHD inattentive subtype so a great big thumbs up to his psychiatrist.

Secondly, that although there has been two more large aftershocks in Christchurch NZ my family and friends there remain unhurt.

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Adult Attention Deficit Disorder…

This has been an interesting year for some people who are important in my life.

Late last year my SO and I were talking about some of his professional struggles and I suggested he look at ADHD. After reading about it, he came back and we talked more about it, and he managed to find a research study looking at ADHD in adults, and got his diagnosis of ADHD (inattentive subtype). Unfortunately due to the stresses bought about by living in an earthquake damaged city, he was not able to follow through on the research trial, but has now started on medication and is making huge strides in overcoming  many of his challenges in life. He admits it has not been a “cure” because he has lots of bad habits to unlearn, but the extra focus the use of methyphenidate in extended release form has given him has allowed him to start addressing some of his difficulties.

At the same time, J my flatmate has been struggling in his workplace. J has a formal diagnosis of dyslexia and his workplace support worker suggested that he might have dyspraxia in addition to the dyslexia. He felt this was not right – because I am dyspraxic and he does not present in a similar way to me. He did his own research and also came up questioning whether he has ADHD.

Anyway, the process for J could not have been much more different than it has been for M my SO. The first attempt was with a psychiatrist who spoke to him for less than 1 hour and then blamed J’s work problems on his personality being wrong for his chosen profession – not the best thing to say to someone who has worked for 22 years to get into his chosen field…and that his depression had never been properly treated.  He was left dismayed and confused. I was furious.

Assessment of adults for any psychiatric or neurological condition is not something that should be done using one methodology. Where possible there should be both objective and subjective measures and some form of triangulation with observers who know the person. This is all clearly laid out in the NICE Guideline on ADHD, which was completely ignored by this psychiatrist.

As you will know from my previous posts, I am all for practice based evidence being used for development of new ideas, but where there is a good robust and evidence based process then it SHOULD be followed.

Fortunately or unfortunately J decided he needed a second opinion when he realised his employers were looking for reasons to fire him, so tomorrow he goes to see a psychiatrist who specialises in adult ADHD. The cost of this consultation is a bit of a brain bender, but already we can see she is following the process, as J has had several tests to complete, he has completed an extensive health and social questionnaire, and he had required both me and his Mum to answer questions on his behaviour as we see it.

I am hoping that he gets a positive diagnosis tomorrow and then he will fight the battles with his employer from a stronger position. I am afraid to say I will probably have a lot to write about in terms of disability and discrimination in the next few months.

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Plain Txting for Quakers

This is a bit of a silly blog entry. It comes from posting on the Association of Bad Friends on Facebook.
I use txt messages a fair bit. I seldom plug commercial companies, but as someone who was horrified at how much international txting was costing me, I was delighted to find fishtext as a solution – with texts to my family and friends in NZ costing less than £0.02 each.

This is some txt abreviations dealing with particular Quaker concerns, phrases and situations

  • CQUMB -”Chuckling Quietly Under My Breath”?
  • PFMWHAMS “Please, Friends, May We Have A Moment of Silence?”
  • CTCTF “Could Thee Clarify That, Friend?”
  • ITGTHOOH! “I’m Trying To Get The H*** Out Of Here!”
  • SER “Surreptitious Eye Roll”
  • TIANTWNHOTM “That Is A Name Which Would NOt Have Occurred To Me”
  • LYLS  “Let your life speak”
  • ITCR  “Is the clock right?”
  • YKSPTSTAW “You know she planned to say this all week.” (Referring to people who take the silence as a moment to deliver a sermonette.)
  • TFSMM “That Friend speaks my mind”
  • WDTVWDTBWDTDLS? texting for congregationalists in a Quaker Meeting — why don’t they vote, why don’t they baptize, why don’t they do Lord’s Supper?
  • IIWNQ — If I was not Quaker!
  • WICH? Who’s in charge here? Said by clergy from neighboring church, walking into Meeting in the midst of a crisis.
  • FHTAALOTS? Friend, has thee any additional light on this subject?

Please feel free to contribute your own ideas!

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Is it ministry?

This is something copied from Ben Pink Dandelion’s book “An Introduction to Quakerism”

I am aware that some Friends will have problems with the God language in it, but if they can look past the language it gives some very clear processes on discerning ministry Is_this_Ministry

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Which comes first, the evidence based practice or the practice based evidence?

As a health professional, I am expected to undertake evidence based practice.

Now this makes sense in many fields.  The Cochrane Collaboration Logo showing the benefit of corticosteroid treatment of women threatening premature labour and its huge benefit towards preventing complications in their unborn babies because it stimulates the development of their lungs is a fine example of why evidence can make a huge difference to lives.

However, it raises the question – who thought about giving these women steroid treatment in the first place. Where there was no evidence, someone thinking about practice and the principles of biochemistry and physiology came up with the idea.

This is where practice based evidence comes in, and it is a hard to deny the benefit that can be derived by a practitioner observing a particular disease state and asking how it be best treated using first principles.

Unfortunately, training in health sciences does not encourage this kind of work at this time. The training for health professionals focuses on the idea that there as an algorithm for the diagnosis of disease, and in many cases this is an efficient and effective process by which health care can be decided and managed.

Where it falls down, is that those people who do not fit the algorithm are either labelled as being non-compliant in treatment or will spend all their lives under the suspicion that the disease they suffer from is psychological in origin.

Obesity (my specialist area) is amongst the areas which suffer from this algorithm approach in the worst way.

For the vast majority of obese individuals, their obesity is a simple mismatch of energy intake versus energy expenditure. In a country where over one-quarter of the population is obese this probably accounts for 70% of the cases of obesity. Approximately another 12% can have their obesity explained by this energy imbalance exacerbated by either comorbid health problems associated with the original obesity (insulin resistance, reduced mobility due to osteoarthritis) or their obesity has been worsened by the medical treatment of conditions such as mental illness or diabetes. This leaves approximately 8%of the population. In these cases there are a multitude of possible causes, which broadly fall into complex psychological or social factors (overreaching in response to childhood trauma), or genetic factors.

Recent work has demonstrated that approximately 1% of the adult population has MC4 receptor defects, which is contributing to their severe obesity. However if you spoke to 100 doctors, you might find one who was aware of this research, and was prepared to consider this as a possible cause of someone’s problematic weight gain.

My own interest in severe and complex obesity is where it interfaces with HLA mediated autoimmune conditions. I have seen in my own practice individuals who are both malnourished and obese, and to respond to the removal of gluten (the protein associated with wheat,  rye, barley)p with a dramatic improvement in their health, and with a calorie deficit achieve substantial weight loss.

Getting acceptance, and/or funding for this kind of research to be shifted from practice-based evidence to evidence-based practice has proved to be something of a nightmare.

If anyone knows someone who might be willing to spend a spare hundred thousand pounds or so on this, please send them in my direction!

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Social Class – a measure of the person?

I found this after a discussion with a Friend, where we realised his dis-ease about something that had happened at Summer Gathering reflected his working class origins compared with the more middle class origins of the vast majority of Friends.

Anyhow, I went blog surfing and found this blog that really impressed me, Social Class and Quakers.

This quiz came from there, and I thought it would be good to measure this and comment from my POV.

  • Father went to college
  • Father finished college
  • Mother went to college
  • Mother finished college
  • Have any relative who is an attorney, physician, or professor.

Yes to all of these. I come from an enormously privileged background with 8+ generations of education which counts as “tertiary”. 4+ generations of female family who had tertiary qualifications. The family is littered with doctors.

  • Were the same or higher class than your high school teachers

Kind of goes with the territory with our family, but particularly in my family of origin care was taken to never highlight class differences in our social dealings.

  • Had more than 50 books in your childhood home
  • Had more than 500 books in your childhood home
  • Were read children’s books by a parent

Loads and loads of books, and loads and loads of reading to the children in the family. We all take turns at reading to the younger children in our family. Books accumulate in our family. However, we are also keen users of public library services, so the books that accumulate are often of the “rarer breed”.

  • Had lessons of any kind before you turned 18
    Had more than two kinds of lessons before you turned 18

Ballet at 5, but was too short, plump and dyspraxic to continue. Art from 6 – 9. Piano between ages of 8 and 10.  Teacher wanted me to do grades, Mum felt that I had the right to chose to play for fun. Learned trombone at secondary school, and I have recently started playing again after 25 years in retirement. Amazing how much I remember, and how much more joy there is now in playing the harmony, rather than melody.

  • The people in the media who dress and talk like me are portrayed positively

This is a tricky one, I am fortunate that through the accidents of my parent’s both being born in UK territories to NZ parents I have a UK passport. However, I identify as an economic migrant and the government here wants people to believe as a non-EU migrant I am a wastrel. Also, I am a clinical dietitian, and most people who do nutrition on TV scare the begebers out of me!

  • Had a credit card with your name on it before you turned 18

No, and would prefer to be without one now, if that was possible in this modern time.

  • Your parents (or a trust) paid for the majority of your college costs*
  • Your parents (or a trust) paid for all of your college costs*

No and no. I was lucky to come through University at a point where fees were increasing but not extortionate.  I was also fortunate that I had highly useful skills for obtaining summer jobs, so I worked every summer from the age of 13. I also worked a “gap year” between each of my three qualifications, and saved money to allow me to study each time.

At the moment, I am making a hard choice about giving up my part-time PhD studies to go up to full-time employment again. If anyone knows someone who will fund a fairly radical departure from usual clinical thinking on obesity for a PhD topic, please send them this way (will blog more on this later)

  • Went to a private high school

Hell no. Local state school. And proud of it.

  • Went to summer camp

No. Family holidays at family holiday home (yes, a sign of privilege), in the country.

  • Had a private tutor before you turned 18

If tutoring for dyslexia counts, then yes. It was done out of frustration by my mother because the teachers assumed that because I came from an “educated” household, I should get As, whereas I was a B or C student. Mum knew there was a problem. Argued 7 years with the schools then paid to have me assessed privately.  Blessings to the man who did the 10 lessons after the assessment with me – it is nice to know its OK to use my fingers to keep place in mental math, and that there are rules for spelling, and ways of estimating your calculations so you know if you are out by a factor of 10.

At University I was once asked why with my A+ brain I got B+ results, and my response was “I have more things on my mind than just my studies”…

  • Family vacations involved staying at hotels

See above re holidays. Yes, there was the odd night in a motel, but mostly it was with family every time.

  • Your clothing was all bought new before you turned 18

Most definitely not. Lots of hand-me-downs and hand-made stuff. I was glad at 13 to get to be taller and have bigger feet than my Mum and sisters, so I had to have new stuff.  Even today we recycle kids clothes – my nephew recently was heard to exclaim “That’s my dinosaur jersey”, when his son came out wearing the tyrannosaurus rex with blood dripping off his fangs, which his gran had lovingly knitted for him age 3.

  • Your parents bought you a car that was not a hand-me-down from them

Absolutely not, and we had 1 car and had to pre-book it if we wanted to use it, and there had to be a purpose for the journey, not just hanging around with friends. I was an expert at bus time tables in my home city!

  • There was original art in your house when you were a child

Yes, families like mine acquire these things

  • Had a phone in your room before you turned 18

No. Also, we had a 5 minute call limit when my father was on-call and a 15 minute time limit when he wasn’t. There was an egg-timer.

  • You and your family lived in a single family house

Almost all houses in NZ are detached. The sign of privilege for us was we had a second family home. Admittedly it had no sewerage (long drops or dunnies till I was 12), and was on tank water, plus it had no phone (funny episode when I was 10, when the police arrived to speak to Dad because he had been asked to head up a government enquiry and this was the only way to get hold of him).

  • Your parent(s) owned their own house or apartment before you left home

Yes, and I struggle with the inner demon I am not a proper grown-up because at 40 I still rent.

  • You had your own room as a child

Yes, but that was as a youngest child after my sisters had left home

  • Participated in an SAT/ACT prep course

Hehehe…not likely. By the time it came to exams in secondary school, I relied on my memory and didn’t study if I could help it.

  • Had your own TV in your room in High School

No, and I still object to this as an idea on principle.

  • Owned a mutual fund or IRA in High School or College

Had investments? No. Was shocked to realise a private pension I had when I worked in the private sector was worth as much as it said on the last statement.  Yes, and it is an ethical one.

  • Flew anywhere on a commercial airline before you turned 16

Flying was one of the few options for seeing Dad’s family

  • Went on a cruise with your family
  • Went on more than one cruise with your family

No.

  • Your parents took you to museums and art galleries as you grew up

Yes. I guess this is a sign of privilege isn’t it? Also, our family has given items and artefacts to said museums….

  • You were unaware of how much heating bills were for your family

I think this is one of the big differences in my family of origin. Us kids were very much a part of the family economy from an early age and were expected to do things around the house, without receiving pocket-money for doing so – because it was our expected contribution. So we knew early, the value of things. The downside is I suspect I am much more anxious about money than I should be.  The upside, I find the testimony of simplicity relatively easy, because mostly, if I can’t afford it, I don’t buy it.

I’ve spent the majority of my working life working within relatively poor communities. It is a buzz when I am owned as “one of us” by these communities, which has happened on a number of occasions, despite being of different race or ethnicity in the majority of my work settings.

It says to me that despite my privilege I am managing to see people for who they are, rather than what they are.

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Christenings and other celebrations

I was at a christening today for a very handsome wee man (the son of a colleague).  It was in a wonderful old church and was a christening outside the usual church service.

I cried through it…in the way most people would with weddings.

Christenings are seen as celebrations, but as I listen to the words and understand the promises in faith that are made, I weep at the commitment made by his parents and godparents to raise him in a faith community.

Quakers don’t do sacraments such as christenings, those we see as outward signs rather than an inward movement of the Spirit. However, I can admire and understand the desire to welcome a child (or adult) into a faith community.

Welcome wee man to a community of Faith

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