Daily Physio for Cystic Fibrosis

This article is a repost promoting content originally published elsewhere. See more things Dan's reposted.

My friend Jen‘s been blogging and vlogging about cystic fibrosis – which her young son Lorcán has – in order to raise awareness of it and of a promising new treatment, Orkambi, which would very likely dramatically improve the lifespan and health of chidren like Lorcán… were it available on the NHS. For more information, including petitions you can sign, see their blog Little Fierce One.

Into the Lair of the Bladder Monster

Warning: this blog post contains pictures of urine, invasive equipment, and the inside of a bladder. It’s probably safe for all audiences, but you might like to put your glass of apple juice down for a minute or two. The short of it all is that I’m probably healthy.

Since my hospitalisation the other month with a renal system infection, I’ve undergone a series of investigations to try to determine if there’s an underlying reason that I fell ill. As my doctor explained to me, it’s quite possible that what I’d experienced was a random opportunistic infection (perhaps aided by a course of unrelated antibiotics I’d been on earlier this year or by certain lifestyle habits), but if that wasn’t the case – if there were some deeper explanation for my health problems – it was important to find out sooner, rather than later.

A sterile pot full of Dan Q's urine.
I’ve peed in so many little pots over the last few months! If you laid them end-to-end across your kitchen counter, then people would think that you were some kind of weirdo.

Early on I had several ultrasound scans of my bladder (at a number of different times and at a variety of levels of fullness) and one of my kidneys, the latter of which revealed some “minor scarring” of one of them which apparently isn’t something I should be worried about… although I wish they’d started the two-page letter I got with that rather than opening with, effectively, “Contrary to what we told you at the hospital, we did later see something wrong with you…” But still, good to be reassured that this is probably not an issue.

Ultrasound scan of one of Dan Q's kidneys.
An ultrasound scan of one of my kidneys. Can you tell the sex yet?

More recently, I went to the hospital to have a “flow rate test” and a cystoscopy. The flow rate test involved the most-ghetto looking piece of NHS equipment I’ve ever seen: functionally, it seemed to be little more than a funnel on top of a large measuring beaker, in turn on top of a pressure-sensitive digital scale. The scale was connected up to the only fancy-looking bit of equipment in the room, a graphing printer that output the calculated volume (based on their weight) of the same and, more-importantly, the rate of change: the “flow rate” of the stream of urine.

A stream of urine pours down into a funnel.
I’m right, aren’t I? That’s basically a kitchen funnel, isn’t it?

I suppose one advantage of using equipment like this is that it basically operates itself. Which meant that the nurse was able to give me five seconds worth of instruction and then leave the room, which saved us from our own Britishness forcing us to make small-talk while I urinated in front of her or something. Ultimately, I turned out to be within the range of normalcy here, too, although I was a little disappointed to find that the ward didn’t maintain a daily “score board” of flow rates, as sort-of a science-backed literal pissing contest.

A graphing printer describes Dan Q's urine flow. The 'flow rate' graph shows an initial peak, then a trough, then continues to a higher sustained peak.
Apparently not all men experience that ‘spurt-and-then-full-pressure’ thing you’ll see on the upper graph, when they start to pee, but some of us do, and I’m told it’s perfectly normal. I’m learning so much!

Finally came the cystoscopy, and this was the bit that I’d been most-nervous about. This procedure involves the insertion of a long flexible tube into the urethra at the tip of the penis, under local anasthetic, and pushing it all the way down, through the sphincter, down through the prostate and then back up into the bladder. It’s then used as a channel to pump water into the bladder, filling it to capacity and stretching out the sides, after which the fibreoptic cord (and light) that runs along its length is used to look around inside the bladder to inspect for any of a plethora of different problems.

Cystoscopy equipment, ready for insertion.
You’re going to put that WHERE?

The doctor invited me to watch with him on the monitor, which I initially assumed was because I was clearly interested in everything and kept asking questions, but in hindsight I wonder if it’s just that he – quite rightly – assumed that I might have panicked if I’d have been looking in the direction of the piece of equipment he brought in and jabbed at my penis with. I only looked at it while it was on its way out, and my god its a scary-looking thing: sort of like a cross between a tyre pressure gauge and a blowtorch. The first few inches were painless – the local anasthetic had made me completely numb right up to and including the external sphincter, which is at the base of the penis. However, what I can only assume was the second sphincter complained of the discomfort, and it stung pretty sharply any time the doctor would twist the cystoscope to change the angle of the picture.

View up a urethra, from a cystoscope.
The view as you ‘travel’ up the urethra looks pretty much like I expected. With a motion simulator, it would make a pretty cool ride!

Seeing the inside of your own body is an amazing experience. I mean: it’s not amazing enough to even be worth the experience of a cystoscopy, never mind the illness that in my case preceeded it… but it’s still pretty cool. The ultrasounds were interesting, but there’s nothing quite so immersive as seeing a picture of the inside of your own bladder, gritting your teeth while the doctor points to an indentation and explains that it’s the opening to the ureter that connects to your own left kidney!

Unfortunately I neglected to take my phone into the operating room, having put it into a locker when I changed into a gown, and so I wasn’t able to (as I’d hoped) take photos of the inside of my own bladder. So you’ll have to make do with this video I found, which approximates the experience pretty well. The good news is that there’s probably nothing wrong with me, now that the infection from earlier this year has passed: nothing to suggest that there’s any deeper underlying issue that caused me to get sick, anyway!

The bad news is that while the procedure itself was shorter and more-bearable than I’d expected, the recovery’s been a real drag. A week later, it still hurts a lot to urinate (although I’ve stopped yelping out loud when I do so) and my crotch is still too sore for me to be able to cycle. I’ve also discovered that an errection can be painful enough to wake me up, which is definitely not the most-pleasant way I’ve been roused by a penis. But it’s getting better, day by day, and at least I know for sure that I’m more-or-less “right” in the renal system, now.

The Bladder Monster

As I mentioned last week, I’ve been ill. For those who wanted the grisly details, well: here you go.

Warning: this blog post contains frank subjective descriptions of the symptoms of slightly-icky medical conditions including photographs. It’s probably safe for all audiences, but you might not want to be drinking anything while you read it.

The trouble began, I suppose, about a month and a half ago, when a contracted what seemed to be a minor urinary tract infection. If you’re a woman then, statistically-speaking, I probably don’t need to tell you what that is, but for the benefit of the men: it’s what happens when bacteria (or, sometimes, a fungus or virus) infects the renal system: the kidneys, bladder, ureters, and especially the urethra. It’s not pleasant: it gives you the feeling of needing to pee the whole time, makes it harder to pee, and – when you do – it feels a little bit like you’re piss is made of lava.

Microscope view of infected urine.
This urine contains white blood cells (the big circles) and bacteria (the tiny ‘wormlike’ things). Healthy urine contains little to none of these. Anybody else feel like they’re playing Spore?

Despite it not being common for men (more on that later), I’ve had mild UTIs on a couple of ocassions in my life, and I’d always found that ensuring that I got plenty of water and a full RDA of vitamin C was more than enough to make it clear up all by itself within a couple of days. So that’s what I started doing. But then things took a turn for the worse: I started getting a stabbing pain in my left kidney. Recognising this as being pyelonephritis, I went to the doctor who prescribed me a course of the antibiotic ciprofloxacin. Within a couple of days I was feeling right as rain (of course I continued to finish the course of drugs, although I was interested to see that that advice is starting to become controversial).

Dan and Annabel have a picnic in the park.
Happy, healthy, and out for a picnic. I guess everything turned out okay, right?

Naturally I was a little disappointed when, the week before last, I started getting UTI-like pain again, followed very swiftly this time by pain in my bladder that constantly felt a little like I was recovering from being punched. Back to the doctor I went, where (after the usual tests to work out what the most-likely best-antibiotic to use was) I was prescribed a course of nitrofurantoin. I’d never had this particular drug before, and it wasn’t initially clear which of the escalating ill-effects I was experiencing were symptoms of the infection and which were side-effects of the medication: it started with joint pain, then nausea, then diarrhoea, then a full-on fever. It was at the point that I was fully-clothed in bed, running a temperature and soaked in sweat but still feeling cold and shivering that Ruth called 111, who told her to take me to A&E.

(Which, like her care for me in general, she did fabulously well, except for a little bit where she sort-of ran me over in the car park of the hospital: thankfully some friendly paramedics were standing around and were able to drag me into the building. Anyway, I don’t have much memory of that bit and I certainly don’t have any amusing photos, so I’ll skip over it.)

Dan, shortly before inpatient admission but already recovering from the worst parts of his hospital visit, last week.
Feverish to the point of delirium, I don’t have much recollection of the first few hours(?) in the hospital. But I was alert enough to request that a photo was taken for the inevitable blog post. Ruth, however, insisted upon waiting until I apparently looked a lot less like I was about to die: so here it is!

A few tests later, the medical staff seemed confident that what I was experiencing was not an allergic reaction to the antibiotic (however, I see that they still made a note of it as a risk on my notes!) but was a progression of the infection, which seemed to have crossed over from the tissues of my renal system and into my bloodstream and was now generally causing havoc by attacking the rest of my body. They hooked me up to a drip of an intravenous antibiotic and kept me stocked with painkillers, then sent me up to the urology ward and set me up with a “bed” (urology mostly deals with outpatients, and so my ‘bed’ was actually a trolley, but they wanted to keep me close to the urologists in case of any complications).

The view from my hospital ward window: Oxford city is visible in the distance.
It was only the following morning, with the delirium passed, that I realised that I was on the sixth floor. Looking out of my window, I could just make out the spires of the Bodleian Library in the distance, so I dropped my coworkers an email to apologise for not being on my way there.

A consultant switched me to a week’s course of yet-another different antibiotic – co-amoxiclav – and recommended keeping me in for another night. Now, I think that co-amoxiclav is a really interesting drug, so I’m going to be a bit of a nerd and tell you about that for a bit (I promise we’ll get back to my health in a moment: if you don’t want the science bit, just scroll past the diagrams to the next photo).

Amoxicillin, with lactam ring highlighted.
This is amoxicillin. I’ve highlighted in blue the lactam ring, which is the important bit.

Co-amoxiclav is a mixture of two drugs. The first is the antibiotic amoxicillin. Amoxicillin belongs to a class of antibiotics (which includes penicllin) called β-lactams, which is the most-commonly used family of antibiotics. These antibiotics contain a four-point lactam ‘ring’ (highlighted in blue above), and the way that they work is that this part of the molecule bonds with a particular protein common to all gram-positive bacteria. Normally this protein is responsible for producing peptidoglycan, which is an essential ingredient in the cell walls of these kinds of bacteria, but when it gets locked to a β-lactam ring it stops working. As a result, when the bacterium reproduces the new child doesn’t have a proper cell wall, and can’t survive long in even the least-hostile environments.

Of course, we’re in a medical arms race right now because some of the bacteria which we’re targetting with antibiotics are becoming resistant. And here’s one what that they’re doing so: some of these bacteria have evolved to produce beta-lactamase, also bonds with beta-lactam rings, adding an OH to them and making them useless. Bummer, eh?

Clavulanic acid, with beta-lactam ring highlighted in blue.
And this is clavulanic acid. Recognise that shape on the left-hand side of the molecule (highlighted in blue)? Yup: it’s another lactam ring.

The second drug in co-amoxiclav, then, is clavulanic acid, which was discovered in the 1970s and started being added to drugs in the 1980s. Despite having a β-lactam ring (as you’ll see in blue above), clavulanic acid by itself it isn’t an effective antibiotic (for reasons I can’t quite get my head around – anyone want to help me?). But what it’s great at is bonding that lactam ring to beta-lactamase, thereby deactivating the bacterial counter-offensive and allowing the amoxicillin to carry on working, combating resistance.

So what you’ve got in co-amoxiclav is a an antibiotic and a chemical that counteracts the effects of a chemical that deactivates that antibiotic. Wow! It’s things like this that really make me wish I had a brain for biology!

A cannula in the back of Dan's hand.
These things aren’t terribly comfortable when you’re trying to sleep.

I was eventually discharged from hospital and released to go home for lots of bed rest and water, along with a further week’s course of co-amoxiclav. Unfortunately it turns out that I’m one of the unlucky folks for whom amoxicillin makes me dizzy, so I spent most of that week lying down in-between wobbly vertigo-filled trips to and from the bathroom. But it worked! Within a few days I was feeling much better and by the end of last week I was able to work from home (and actually feel like I was useful again!).

Free of symptoms and off the drugs, I returned to work properly on Monday morning and everything seemed fine. Until, late in the morning, I went to the bathroom and started pissing blood.

A kitten lying on its side.
I took a picture, but it’s too grim even for this blog post. Here, have a kitten instead. Do an image search for ‘gross hematuria’ if you want a clue: the kitten will still be waiting here when you need it.

Now apparently blood in your urine, while horrifying when it happens to you unexpectedly, isn’t actually a sign of a medical emergency. I was starting to get bladder pain again, quite intensely, so I excused myself from work and called the urology ward, who decided that I wasn’t in bad enough a condition to go and see them but sent me straight to my GP, who gave me another fortnight’s worth of co-amoxiclav. They’re monitoring my progress with urine and blood samples and if by Friday it’s not having an impact, they’re going to want to send me back to hospital (hopefully only as an outpatient) and pump me full of the intraveneous stuff again. So… fingers crossed for a good result out of these drugs.

Co-amoxiclav tablet in packaging.
My co-amoxiclav tablets each come individually wrapped in a nitrogen-filled foil bag. I’ve no idea what it is that they’re concerned that they’ll react with, but I’m eating three of them a day anyway.

I was hoping that by this point I’d be writing this blog post and telling you all about how I’d fought the bladder monster and won. But it looks like I won’t be able to claim that victory for another week or two, yet. All I know is that I searched for “bladder monster” and found this. Yeah: that feels about right.

“Uncle Dan”

A week ago, Ruth pushed a baby out of her body, completely upstaging my birthday and, incidentally, throwing all of our lives pretty much into chaos. Having gotten to the point at which she’d resigned herself to “being pregnant forever“, Ruth would have certainly been glad to have that stage over and done with, were it not for a long and painful labour followed by a torturous and exhausting birth.

JTA, Ruth, Dan and 'Tiny' in the delivery suite.
If Ruth looks like she’s about to die of exhaustion in this photo, that’s because that’s how she’s feeling.

There’s a lot that can be said about the labour: a 38-hour crescendo of Ruth gradually and repeatedly finding levels of pain and tiredness that each seemed impossible, until she reached them. But Ruth has suggested that she might like to write a little about it herself, so I shan’t steal her limelight. What I can say is that I didn’t – and I don’t think that JTA, either – appreciate quite how emotionally draining the experience would be for the two of us, as well. There was a strange sensation for me about twelve hours in: a sensation perhaps most-comprehensible by our friends who’ve done emotional support work. That was: after watching somebody I love so much suffer so greatly for so long, I felt as if I’d somehow begun to exhaust whatever part of my brain feels empathy. As if the experience of supporting Ruth had served to drain me in a way I’d never fully experienced before, like when you discover a muscle you didn’t know you had when it aches after an unusual new exercise.

Forcep-marks still visible, the newborn takes an extended nap in a crib alongside Ruth's recovery-bed.
Forcep-marks still visible, the newborn takes an extended nap in a crib alongside Ruth’s recovery-bed.

Of course, after the ordeal we got to take home a little bundle of joy, who continues – despite now having a perfectly fabulous name of her own – to be referred to as “tiny”, even though her birth weight of 8lbs 12oz (that’s about 4kg, for those who – like me – prefer to think in metric) doesn’t really make that a very fitting nickname! Nor the amount of damage she did to Ruth on the way out, which also might be ill-described as “tiny”! She’s also often referred to as “the poopmachine”, for reasons that ought not need spelling out.

Dan rocking the baby, in the sunlight.
I’m smiling, because I don’t yet know that, within seconds of this photo being taken, she’s about to fill her nappy.

My employer was kind enough to give me paternity leave, even though I’m not the biological father (JTA is; and he’s very-much still in the picture!). I’d looked at my contract and discovered that the wording seemed to imply that I was eligible, stating that I’d be permitted to take paternity leave if I was about to become a father, or if my partner was about to give birth, the latter of which seemed perfectly clear. To be certain, I’d wandered along to Personnel and explained our living arrangement, and they just had looks on their faces that said “we’re not touching that with a barge pole; let’s just err on the side of giving him leave!” As a result, we’ve had all hands on deck to help out with the multitudinous tasks that have suddenly been added to our lives, which has been incredibly useful, especially given that Ruth has been spending several days mostly lying-down, as she’s been recovering from injuries sustained during the delivery.

Tiny in front of the new beta version of Three Rings.
If only we had some kind of way to set up a web-based rota of feeding, changing and comforting the little one…

Despite everything, we and the rest of the Three Rings team still managed to push the latest version into testing on schedule, though fitting in time for bug-fixing is even harder than it would be were we at our “day jobs” during the daytimes! It’s not that our little poopmachine takes up all of our time, though she does seem to take a lot of it, it’s simply that we’re all so tired! For the last few nights she’s been fussy about sleeping, and we’ve all lost a lot of rest time over keeping her fed, clean, and feeling loved.

Ruth snuggles with her baby.
Who loves boob? Baby does! Also, everybody else in the house.

For all my complaining, though, what we’ve got here is an adorable and mostly well-behaved little bundle of joy. And when she’s not covered in poop, shouting for attention, or spitting milk all over you, she’s a little angel. And I’m sure you’ll all be sick of hearing about her very soon.

Hello 2013: Goodbye 2012

This post has been censored at the request of Sundeep. See: all censored posts, all posts censored by request of Sundeep.

This is the first in a series of four blog posts which ought to have been published during January 2013, but ran late because I didn’t want to publish any of them before the first one.

2012 was one of the hardest years of my life.

RT @misterjta Dear 2012, Fuck off. Sincerely, JTA.
My retweet of JTA’s sentiments, shortly after midnight on New Year’s Eve, pretty much covers my feeling of the year, too.

It was a year of unceasing disasters and difficulties: every time some tragedy had befallen me, my friends, or family, some additional calamity was lined-up to follow in its wake. In an environment like this, even the not-quite-so-sad things – like the death of Puddles, our family dog, in May – were magnified, and the ongoing challenges of the year – like the neverending difficulties with my dad’s estate – became overwhelming.

My sister Becky with Puddles, on a train.
My sister Becky with Puddles, both younger and more-foolish than they eventually became. I don’t know why Puddles is wearing a t-shirt.

The sudden and unexpected death of my dad while training for his Arctic trek, was clearly the event which had the most-significant impact on me. I’ve written about the experience at length, both here on my blog and elsewhere (for example, I made a self-post to Reddit on the day after the accident, urging readers to “call somebody you love today”).

My dad, climbing Aladdin's Mirror in the Cairngorms.
My dad, climbing Aladdin’s Mirror in the Cairngorms.

In the week of his death, my sister Becky was suffering from an awful toothache which was stopping her from eating, sleeping, or generally functioning at all (I tried to help her out by offering some oil of cloves (which functions as a dental contact anesthetic), but she must have misunderstood my instruction about applying it to the tooth without swallowing it, because she spent most of that evening throwing up (seriously: don’t ever swallow clove oil).

Sandals (with socks), shorts, checked shirt.
My dad’s clothes for his funeral. My sisters and I decided that he ought to be dressed as he would be for a one of his summer hikes, right down to the combination of sandals and socks (the funeral director needed reassurance that yes, he really did routinely wear both at the same time).

Little did she know, worse was yet to come: when she finally went to the dentist, he botched her operation, leaving her with a jaw infection. The infection spread, causing septicæmia of her face and neck and requiring that she was hospitalised. On the day of our dad’s funeral, she needed to insist that the “stop gap” surgery that she was given was done under local, rather than general, anasthetic, so that she could make it – albeit in a wheelchair and unable to talk – to the funeral.

Five weeks later, my dad finally reached the North Pole, his ashes carried by another member of his team. At about the same time, Ruth‘s grandmother passed away, swamping the already-emotional Earthlings with yet another sad period. That same month, my friend S****** suffered a serious injury, a traumatic and distressing experience in the middle of a long and difficult period of her life, and an event which caused significant ripples in the lives of her circle of friends.

VARLEY Margret Of Doddington Lodge, Hopton Wafers, formerly of Newcastle-on-Clun, on April 28, 2012. Funeral Service, at Telford Crematorium, on Tuesday, May 22, at 2pm. Inquiries to LINDA DAWSON Funeral Director Corvedale Road Craven Arms Telephone 01588 673250. Originally printed on May 17, 2012.
The notice of Ruth’s grandmother’s death, as it appeared in the online version of her local newspaper.

Shortly afterwards, Paul moved out from Earth, in a situation that was anticipated (we’d said when we first moved in together that it would be only for a couple of years, while we all found our feet in Oxford and decided on what we’d be doing next, as far as our living situations were concerned), but still felt occasionally hostile: when Paul left town six months later, his last blog post stated that Oxford could “get lost”, and that he’d “hated hated 90% of the time” he’d lived here. Despite reassurances to the contrary, it was sometimes hard – especially in such a difficult year – to think that this message wasn’t directed at Oxford so much as at his friends there.

As the summer came to an end, my workload on my various courses increased dramatically, stretching into my so-called “free time”: this, coupled with delays resulting from all of the illness, injury, and death that had happened already, threw back the release date of Milestone: Jethrik, the latest update to Three Rings. Coupled with the stress of the 10th Birthday Party Conference – which thankfully JTA handled most of – even the rare periods during which nobody was ill or dying were filled with sleepless nights and anxiety. And of course as soon as all of the preparation was out of the way and the conference was done, there were still plenty of long days ahead, catching up on everything that had been temporarily put on the back burner.

My sister Sarah and I at the christening of a bus named after my dad. Click the picture for the full story.
My sister Sarah and I at the christening of a bus named after my dad. Click the picture for the full story.

When I was first appointed executor of my dad’s estate, I said to myself that I could have the whole thing wrapped-up and resolved within six months… eight on the outside. But as things dragged on – it took almost six months until the investigation was finished and the coroner’s report filed, so we could get a death certificate, for example – they just got more and more bogged-down. Problems with my dad’s will made it harder than expected to get started (for example, I’m the executor and a beneficiary of the will, yet nowhere on it am I directly mentioned by name, address, or relationship… which means that I’ve had to prove that I am the person mentioned in the will every single time I present it, and that’s not always easy!), and further administrative hiccups have slowed down the process every step of the way.

A hillside. A sunset. A fast, hard cycle ride. A beer and a Mars bar, just like old times. Wish you were here. Still miss you, Dad.
On the first anniversary of my dad’s death, I cycled up a hill to watch the sunset with a bottle of Guinness and a Mars bar. And sent this Tweet.

You know what would have made the whole thing easier? A bacon sandwich. And black pudding for breakfast. And a nice big bit of freshly-battered cod. And some roast chicken. I found that 2012 was a harder year than 2011 in which to be a vegetarian. I guess that a nice steak would have taken the edge off: a little bit of a luxury, and some escapism. Instead, I probably drank a lot more than I ought to have. Perhaps we should encourage recovering alcoholic, when things are tough, to hit the sausage instead of the bottle.

A delicious-looking BLT.
It’s been a while, old friend. A while since I used this delicious-looking photograph in my blog, I mean! This is the sixth time… can you find them all?

Becky’s health problems weren’t done for the year, after she started getting incredibly intense and painful headaches. At first, I was worried that she was lined-up for a similar diagnosis to mine, of the other year (luckily, I’ve been symptom-free for a year and a quarter now, although medical science is at a loss to explain why), but as I heard more about her symptoms, I became convinced that this wasn’t the case. In any case, she found herself back in the operating room, for the second serious bit of surgery of the year (the operation was a success, thankfully).

The "F" is for "Fuck me you're going to put a scalpel WHERE?"
The “F” is for “Fuck me you’re going to put a scalpel WHERE?”

I had my own surgery, of course, when I had a vasectomy; something I’d been planning for some time. That actually went quite well, at least as far as can be ascertained at this point (part three of that series of posts will be coming soon), but it allows me to segue into the topic of reproduction…

Because while I’d been waiting to get snipped, Ruth and JTA had managed to conceive. We found this out right as we were running around sorting out the Three Rings Conference, and Ruth took to calling the fœtus “Jethrik”, after the Three Rings milestone. I was even more delighted still when I heard that the expected birth date would be 24th July: Samaritans‘ Annual Awareness Day (“24/7”).

Ruth's pregnancy test, showing "pregnant".
One of the many pregnancy tests Ruth took, “just to be sure” (in case the last few were false positives). Photo from Ruth’s blog.

As potential prospective parents, they did everything right. Ruth stuck strictly to a perfectly balanced diet for her stage of pregnancy; they told only a minimum of people, because – as everybody knows – the first trimester’s the riskiest period. I remember when Ruth told her grandfather (who had become very unwell towards the end of 2012 and died early this year: another sad family tragedy) about the pregnancy, that it was only after careful consideration – balancing how nice it would be for him to know that the next generation of his family was on the way before his death – that she went ahead and did so. And as the end of the first trimester, and the end of the year, approached, I genuinely believed that the string of bad luck that had been 2012 was over.

A kitten.
In Ruth’s blog post, she’s used kittens to make a sad story a little softer, and so I have too.

But it wasn’t to be. Just as soon as we were looking forward to New Year, and planning to not so much “see in 2013” as to “kick out 2012”, Ruth had a little bleeding. Swiftly followed by abdominal cramps. She spent most of New Year’s Eve at the hospital, where they’d determined that she’d suffered a miscarriage, probably a few weeks earlier.

Ruth’s written about it. JTA’s written about it, too. And I’d recommend they read their account rather than mine: they’ve both written more, and better, about the subject than I could. But I shan’t pretend that it wasn’t hard: in truth, it was heartbreaking. At the times that I could persuade myself that my grief was “acceptable” (and that I shouldn’t be, say, looking after Ruth), I cried a lot. For me, “Jethrik” represented a happy ending to a miserable year: some good news at last for the people I was closest to. Perhaps, then, I attached too much importance to it, but it seemed inconceivable to me – no pun intended – that for all of the effort they’d put in, that things wouldn’t just go perfectly. For me, it was all connected: Ruth wasn’t pregnant by me, but I still found myself wishing that my dad could have lived to have seen it, and when the pregnancy went wrong, it made me realise how much I’d been pinning on it.

I don’t have a positive pick-me-up line to put here. But it feels like I should.

Ruth and her father at High Green.
A few days before the miscarriage became apparent, Ruth and her dad survey the back garden of the house he’s rebuilding.

And so there we were, at the tail of 2012: the year that began awfully, ended awfully, and was pretty awful in the middle. I can’t say there weren’t good bits, but they were somewhat drowned out by all of the shit that happened. Fuck off, 2012.

Here’s to 2013.

Edit, 16th March 2013: By Becky’s request, removed an unflattering photo of her and some of the ickier details of her health problems this year.

Edit, 11th July 2016: At her request, my friend S******‘s personal details have been obfuscated in this post so that they are no longer readily available to search engines.

Edit, 26th September 2016: At her request, my friend S******‘s photo was removed from this post, too.

The Snip, Part 2

[spb_message color=”alert-info” width=”1/1″ el_position=”first last”]This is the second part of a three-part blog post about my vasectomy. Did you read the first part, yet?[/spb_message]

My vasectomy was scheduled for Tuesday afternoon, so I left work early in order to cycle up to the hospital: my plan was to cycle up there, and then have Ruth ride my bike back while JTA drove me home. For a moment, though, I panicked the clinic receptionist when she saw me arrive carrying a cycle helmet and pannier bag: she assumed that I must be intending to cycle home after the operation!

The Elliot-Smith Clinic. Picture copyright Google Street View.
The Elliot-Smith Clinic lives in an old prefab building buried at the back end of the hospital campus. If you think it looks scary in this picture, imagine what it’s like when it’s dark and you’re going there to be stabbed in the genitals.

It took me long enough to find the building, cycling around the hospital in the dark, and a little longer still to reassure myself that this underlit old building could actually be a place where surgery took place.

My tweet: "Arrived at vasectomy clinic. It's the most well-hidden, badly-lit, shady-looking building I've ever seen on a hospital campus."
My tweet upon arriving at the clinic.

Despite my GP’s suggestion to the contrary, the staff didn’t feel the need to take me though their counselling process, despite me ticking some (how many depends primarily upon how you perceive our unusual relationship structure) of the “we would prefer to counsel additionally” boxes on their list of criteria. I’d requested that Ruth arrive at about the beginning of the process specifically so that she could “back me up” if needed (apparently, surgeons will sometimes like to speak to the partner of a man requesting a vasectomy), but nobody even asked. I just had to sign another couple of consent forms to confirm that I really did understand what I was doing, and then I was ready to go!

I’d shaved my balls a few days earlier, at the request of the clinic (and also at Matt‘s suggestion, who pointed out that “if I don’t, they’ll do it for me, and I doubt they’ll be as gentle!” – although it must be pointed out that as they were already planning to take a blade to my junk, I might not have so much to worry about), which had turned out to be a challenge in itself. I’ve since looked online and found lots of great diagrams showing you which parts you need to shave, but the picture I’d been given might as well have been a road map of Florence, because no matter which way up I turned it, it didn’t look anything like my genitals. In the end, I just shaved all over the damn place, just to be sure. Still not an easy feat, though, because the wrinkled skin makes for challenging shaving: the best technique I found was to “stretch” my scrotum out with one hand while I shaved it with the other – a tricky (and scary) maneuver.

Where to shave before your vasectomy: front and side of the scrotum.
If I’d had a diagram like this, rather than an Italian street map, I might have stood a better chance of just shaving what I needed to shave.

After sitting in the waiting room for a while, I was ushered through some forms and a couple more questions of “are you sure?”, and then herded into a curtained cubicle to change into a surgical gown (over the top of which I wore my usual dressing gown). The floor was cold, and I’d forgotten to bring my slippers, so I kept my socks on throughout. I sat in a separate waiting area from the first, and attempted to make small talk with the other gents waiting there. Some had just come out of surgery, and some were still waiting to go in, and the former would gently tease the latter with jokes about the operation. It’s a man thing, I guess: I can’t imagine that women would be so likely to engage in such behaviour (ignoring, for a moment, the nature of the operation).

There are several different approaches to vasectomy, and my surgeon was kind enough to tolerate my persistent questions as I asked about the specifics of each part of the operation. He’d said – after I asked – that one of the things he liked about doing vasectomies was that (unlike most of the other surgeries he performs) his patients are awake and he can have a conversation while he worked, although I guess he hadn’t anticipated that there’d ever be anybody quite so interested as I was.

[spb_message color=”alert-warning” width=”1/1″ el_position=”first last”]Warning: The remainder of this blog post describes a surgical procedure, which some people might find squicky. For the protection of those who are of a weak stomach, some photos have been hidden behind hyperlinks: click at your own risk. (though honestly, I don’t think they’re that bad)[/spb_message]

With my scrotum pulled up through a hole in a paper sheet, the surgeon began by checking that “everything was where it was supposed to be”: he checked that he could find each vas (if you’ve not done this: borrow the genitals of the nearest man or use your own, squeeze moderately tightly between two fingers the skin above a testicle, and move around a bit until you find a hard tube: that’s almost certainly a vas). Apparently surgeons are supposed to take care to ensure that they’ve found two distinct tubes, so they don’t for example sever the same one twice.

Next, he gave the whole thing a generous soaking in iodine. This turned out to be fucking freezing. The room was cold enough already, so I asked him to close the window while my genitals quietly shivered above the sheet.

Next up came the injection. The local anesthetic used for this kind of operation is pretty much identical to the kind you get at the dentist: the only difference is that if your dentist injected you here, that’d be considered a miss. While pinching the left vas between his fingertips, the surgeon squirted a stack of lidocaine into the cavity around it. And fuck me, that hurt like being kicked in the balls. Seriously: that stung quite a bit for a few minutes, until the anasthesia kicked in and instead the whole area felt “tingly”, in that way that your lips do after dental surgery.

Pinching the vas (still beneath the skin at this point) in a specially-shaped clamp, the surgeon made a puncture wound “around” it with a sharp-nosed pair of forceps, and pulled the vas clean through the hole. This was a strange sensation – I couldn’t feel any pain, but I was aware of the movement – a “tugging” against my insides.

A quick snip removed a couple of centimetres from the middle of it (I gather that removing a section, rather than just cutting, helps to reduce the – already slim – risk that the two loose ends will grow back together again) and cauterised the ends. The cauterisation was a curious experience, because while I wasn’t aware of any sensation of heat, I could hear a sizzling sound and smell my own flesh burning. It turns out that my flaming testicles smell a little like bacon. Or, if you’d like to look at it another way (and I can almost guarantee that you don’t): bacon smells a little bit like my testicles, being singed.

Next up came Righty’s turn, but he wasn’t playing ball (pun intended). The same steps got as far as clamping and puncturing before I suddenly felt a sharp pain, getting rapidly worse. “Ow… ow… owowowowowow!” I said, possibly with a little more swearing, as the surgeon blasted another few mils of anesthetic into my bollocks. And then a little more. And damnit: it turns out that no matter how much you’ve had injected into you already, injecting anesthetics into your tackle always feels like a kick in the nuts for a few minutes. Grr.

  • The removed sections of my vas, on a tray (actually mine)
    You can see the “kink” in each, where it was pulled out by the clamp. Also visible is the clamp itself – a cruel-looking piece of equipment, I’m sure you’ll agree! – and the discarded caps from some of the syringes that were used.

The benefit of this approach, the “no-scalpel vasectomy”, is that the puncture wounds are sufficiently small as to not need stitches. At the end of the surgery, the surgeon just stuck a plaster onto the hole and called it done. I felt a bit light-headed and wobbly-legged, so I sat on the operating table for a few minutes to compose myself before returning to the nurses’ desk for my debrief. I only spent about 20 minutes, in total, with the surgeon: I’ve spent longer (and suffered more!) at the dentist.

"Happy Vasectomy" card from Liz and Simon.
Later, I would receive this “Happy Vasectomy” card from Liz and Simon. Thanks, guys!

By the evening, the anesthetic had worn off and I was in quite a bit of pain, again: perhaps worse than that “kick in the balls” moment when the anesthetic was first injected, but without the relief that the anesthetic brought! I took some paracetamol and – later – some codeine, and slept with a folded-over pillow wedged between my knees, after I discovered how easy it was to accidentally squish my sore sack whenever I shifted my position.

The day after was somewhat better. I was walking like John Wayne, but this didn’t matter because – as the nurse had suggested – I spent most of the day lying down “with my feet as high as my bottom”. She’d taken the time to explain that she can’t put a bandage nor a sling on my genitals (and that I probably wouldn’t want her to, if she could), so the correct alternative is to wear tight-fitting underwear (in place of a bandage) and keep my legs elevated (as a sling). Having seen pictures of people with painful-looking bruises and swelling as a result of not following this advice, I did so as best as I could.

Today’s the day after that: I’m still in a little pain – mostly in Righty, again, which shall henceforth be called “the troublesome testicle” – but it’s not so bad except when I forget and do something like bend over or squat or, I discovered, let my balls “hang” under their own weight, at all. But altogether, it’s been not-too-bad at all.

Or, as I put on my feedback form at the clinic: “A+++. Recommended. Would vasectomy again.”

(thanks due to Ruth, JTA, Matt, Liz, Simon, Michelle, and my mum for support, suggestions, and/or fetching things to my bed for me while I’ve been waddling around looking like John Wayne, these past two days)

The Snip, Part 1

I’d like to start with a joke:

Is there a difference between men and women?

Yes! There’s a vas deferens.

What’s no joke, though, is the human population explosion. There’re just too damn many of us, as I explained last year. That’s the primary reason behind my decision, held for pretty-much the entirety of my adult life, to choose not to breed.

World population for the last 12,000 years.

I’m fully aware that the conscious decision to not-breed by a single individual – especially in the developed world – makes virtually no difference to the global fate of humanity. I’m under no illusion that my efforts as a vegetarian are saving the world either. But just like the voter who casts a ballot for their party – even though they know it won’t make a difference to the outcome of the election – I understand that doing the right thing doesn’t necessarily have to have a directly quantifiable benefit.

Somehow, this delicious-looking BLT makes an appearance almost any time I talk about overpopulation or vegetarianism. This is the fifth time.
Somehow, this delicious-looking BLT makes an appearance almost any time I talk about overpopulation or vegetarianism. This is the fifth time.

That’s why I’m finally taking the next obvious step. Next month, after literally years of talking about it, I’m finally going to put my genitals where my mouth is (hmm… maybe that wasn’t the best choice of words)! Next week, I’m getting a vasectomy.

The "F" is for "Fuck me you're going to put a scalpel WHERE?"
The “F” is for “Fuck me you’re going to put a scalpel WHERE?”

I first asked a doctor about the possibility of vasectomy about a decade ago. He remarked upon my age, and said – almost jokingly – “Come back in ten years if you still feel the same way!” I almost wish that I still had the same GP now, so that I could do exactly that. Instead, I spoke about a year ago to my (old) GP here in Oxford, who misled me into thinking that I would not be able to get the surgery on the NHS, and would have to have it done privately. Finally, a second doctor agreed to sign off their part of the consent form, and I was good to go. The secret, it seems, is persistence.

I suppose I'll be eligible for a Golden Snip Award. Click through for more information.
I suppose I’ll be eligible for a Golden Snip Award. Click through for more information.

I’m sure that this is a decision that won’t be without it’s controversies. And believe me: over the course of the most-of-my-life-so-far that I’ve hinted at or talked about doing this, I’m pretty sure I’ve heard all of the arguments. Still: I feel like I ought to pick up on some of the things I’ve heard most-often –

"Breeder Bingo" card. Complete a line, get a free case of contraceptives!
“Breeder Bingo” card. Complete a line, get a free case of contraceptives!

What if you change your mind?

Even despite medical advances in recent decades in vasectomy reversal, vasectomy should still be considered a “one way trip”. Especially when I was younger, people seemed concerned that I would someday change my mind, and then regret my decision not to spawn children.

I suppose that it’s conceivable – unlike my otherwise potential offspring – but it’s quite a stretch, to believe that I might someday regret not having children (at least not biologically: I have no problem with adopting, co-parenting, fostering, or any number of other options for being involved in the upbringing of kids). I honestly can’t see how that’d come about. But even if we do take that far-fetched idea: isn’t it equally possible that somebody might ultimately regret having children. We take risks in our lives with any choice that we make – maybe I’ll someday regret not having taken my degree in Law or Chemistry or Rural Studies. Well then: c’est la vie.

Do you just not like children?

Children are great, and I’d love to get the chance to be involved in raising some. However, I don’t define myself by that wish: if I never have the opportunity to look after any kids, ever, then that wouldn’t be the worst thing in the world: I’d just spend my years writing code in a house full of cats. I have no doubt that raising children is great (for many people), but just like there are plenty of people for whom it’s not great, there are also plenty of people – like me – who could be happy either way. No biggie!

There are those who have said that this laid-back “take it or leave it” approach, especially when coupled with the more-recent act of rendering myself infertile, will make me less attractive to women. Leaving aside the implicit sexism in that claim, wouldn’t a fair retort be to point out that a woman who is looking for monogamous breeding probably isn’t my “type” to begin with!

But if only we could make sure only the RIGHT people breed...
But if only we could make sure only the RIGHT people breed…

But you should be breeding?

This argument’s usually based on the idea that I’m somehow genetically superior and that my children wouldn’t be such a strain on the world as somebody else’s, or that mine would have a significantly better-than-average chance of curing cancer, solving world hunger, or something.

The explosion of planet Earth.
Only sterilisation can prevent the detonation of the planet. Maybe.

And let’s face it, any child of mine would be just as likely to be the one to build a really big bomb. Or create a super-virus. Or just engineer the collapse the world’s economies into a prehistoric barter economy in a technophobic future anarchy. Attaboy.

In any case, I’m pretty sure that my personal contribution to the betterment of the world ought not to be a genetic one. I’d like to make a difference for the people who are around right now, rather than hypothetical people of the future, and I’d far rather leave ideas in my wake than a handful of genes. I’m sure that’s not the case for everybody, but then – it doesn’t have to be.

How about a vasectomy? (comic)
It takes balls to have a vasectomy. Literally.

Or are there some arguments that I’ve missed? If you’re among the folks who feel really strongly about this, then you’ve got about seven days to make them, and then it’s off to the clinic for me! Just remember: what’s right for me isn’t necessarily what’s right for you, and vice-versa. Just because I use Emacs doesn’t mean that some other, inferior text editor might not be the right choice for you.

I wonder what my surgeon might say to the possibility of me live-tweeting the process? Would anybody be interested? (I promise not to include any photos.)

(with thanks to Nina Paley for permission to use the comics)

The Tampon Gun

This picture’s been floating around the Internet lately. I’m sure that the guy in the picture thinks he’s original, but we totally beat him to it. Back in about 2003.

The Tampon Gun

The difference is, though, that when some friends and I were messing around with about a thousand applicator tampons that had reached their use-by date, we went one step further. We sellotaped laser pointers to the barrels of our guns, and had a laser-guided tampon battle in the car park.

It turns out that laser sights don’t actually improve the accuracy of tampon blowguns. As a weapon, they’re worse than useless,  of course – tampons have actually been used to save people from blood loss after a bullet wound. But still, it made for a more fun – if sillier – afternoon than would have been had by just throwing the damn things away, even if we did then have to spend quite a lot of time picking them all up and binning them anyway.

Ouch

Recently, I’ve been diagnosed with cluster headaches. I could tell you more about them, but I’d rather just point you at the Wikipedia article and say “that’s pretty much spot on.”

This picture, from Wikipedia, covers it pretty nicely, actually.

So that’s pretty shit.

It’s been several months now – long enough that, to begin with, I suspected that these new, severe headaches were something to do with the concussion I suffered while moving house. I’m still not convinced that they’re not: it just seems a little too much like a coincidence that that’d happen just weeks before they started.

Since then, they’ve come and gone. Attacks will come on every couple of days – usually at about 3am, but sometimes in the afternoon – for about two weeks, and then will be gone for several weeks. And then they come back again.

The pain is… incredible. I can’t even begin to describe it nor compare it to anything else. Painkillers don’t seem to touch it at all. The only success I’ve had with painkillers has been when I’ve taken so much codeine that I’ve had an “opium high”. The pain doesn’t go away, but at least then I don’t care so much. Then within a couple of (long, long) hours, it’s gone, leaving me drained and exhausted. Sometimes it leaves me with a headache – just a “normal” one, the kind that you can wince and ignore, or treat with asprin – for about a day afterwards, but usually it just disappears as quickly as it came on.

Those things on the left that are shaped like space rockets? They go up my fucking nose, would you believe it. They're supposed to be for migraines, and they seem to work for me - at best - about one time in three.

I’ve been working my way through a variety of medications, with limited success. Basically, the doctors are guessing. In sheer desperation, I’ve even been caught using mild-to-moderately ridiculous alternative treatment, like chiropractic. It didn’t work – it just left me with a new variety of back pain: temporary, I hope – but I think  it goes some way to expressing how crippling it is when I of all people will go to a “spine wizard”. Needless to say, I’m still a long way from desparate enough to try the really stupid alternative medicines: it’s still got to at least sound like it might work before you’ll get me to try it – after all, it’s not like any of these therapies are without risks.

There’s next to no build-up, and no warning, and no relief: they just start and go away their own accord. That’s a terrifying feeling of powerlessness. It’s genuinely scary, going to bed during one of their episodic periods, and not knowing if you’re going to wake up in agony a few hours later.

We’re getting somewhere, though, hopefully. I’ve been assigned to a specialist (to whom I’m sure I’ll be as much a research subject as a patient: I suppose it’s pretty ideal – if you have a rare, barely-understood disease and you’re at the point of being willing to try anything, you probably make a great research subject), and in the meantime there are plenty more medications left to “try”. And I’ve been reading some of the thoughts of other sufferers via an online support group, some of whom have shared some of their relief/coping strategies (some of which I’ve tried already; others of which I’ll try in the future). So there’s still plenty of opportunity for a “fix”.

I didn’t blog about this before now because I was hoping to get to a point where I’d be looking back on it and laughing, first. I quite liked the idea of putting up a blog post – perhaps with some photos of my MRI scans, or something – and saying “Hey; look what happened to me! It’s medication-controlled, now, and the only side-effect is that I can shoot frickin’ laser beams out of my eyes! Muhahahaha!” But I guess that point might still be a way away, and I didn’t want to keep you all in the dark.

Anyway: there’s that, then. If you were hoping for a clean, concise blog post with some closure at the end, you’ll be left hanging. But hey: if I have to suffer, I might as well spread a little bit of suffering to you, too.

Content Freeze

Isn’t memory strange?

Last week, we updated to the latest version of the CMS that powers the Bodleian‘s web site. During the process of installing and testing the new version, we initiated a “content freeze”, disallowing the 100+ regular content editors access to the administration sections: any changes they’d have made wouldn’t have been replicated in the new version, and we didn’t want a discrepancy in content while we were testing that the change had taken! We still had back-end access, of course, and a few minor “emergency” changes were made (on both the old and the new version), but in general, the site was in a read-only mode for several days.

A similar thing happened to my head during this weekend’s house move.

While running  a van-load of stuff from Old Earth to New Earth, Ruth, JTA and I stopped off at Argos to buy a few bits and pieces for our new home. We parked in one of the few remaining parking spaces capable of accommodating our extended wheel-base van. Unfortunately this brushed us up very close to an unfortunately-placed tree, whose branches reached in through the door as I clambered out. I spent a while trying to reposition them so as not to slam them in the door while Ruth and JTA walked ahead, towards Argos, and so when I was done they were quite a way ahead. I turned and ran to catch up with them…

BAM! Something struck me on the top of my head. We’re still not all in agreement as to whether it was a branch or the wing mirror of the van, but it hurt like hell. My knees buckled up and I collapsed into a heap.

Before long I was on my feet, but as I began to feel dizzy and nauseous, we started to worry that I might be concussed, and Ruth took me to the hospital. By then, I was unable to keep my eyes open without feeling like the world was spinning and I was going to throw up, and I kept feeling like I was moments away from falling asleep.

By the time I’d seen a doctor, about three hours later, I was starting to feel a little better. We took a leaflet of “things to watch out for after a concussion”, which advised that I shouldn’t lift any heavy things (“But I’m moving house today!”) nor use a computer or drink alcohol (“This is my life you’re talking about!”), all of which I ignored to some degree or another.

I napped on and off for a lot of Sunday and some of Monday, but it was on Monday that the amount of damage I’d done became most apparent. I got out of bed and staggered downstairs to find that Ruth and JTA had at some point bought a shoe rack. They weren’t around, but neither was the van, and I reasoned that they must have been out collecting more boxes, but I thought I might as well make myself useful by assembling this shoe rack they’d gotten. It was of the variety that hangs on the back of a door, so I spent some time deciphering the instructions and putting it together… only to find that it wouldn’t actually fit onto any of the (quite thick) doors in our new house.

That’s when Ruth & JTA arrived. “I saw you’d bought a shoe rack,” I said.

“Yes,” they replied, “We bought it yesterday. We told you about it.”

“Oh. I don’t remember that. Anyway, I built it, but it turns out that it won’t fit any of our doors.”

“Yes, we know: we told you that too. We were about to take it back to the shop.”

I have no recollection whatsoever of that conversation. Or several other conversations, it seems. In the hospital, I remember that Ruth talked to me for an hour or more (I wasn’t capable of conversation myself, some of the time, but it was nice to hear a familiar voice), and I still can’t remember any of it except for snippets (something about her father’s new house?).

For much of Sunday, my brain went into “content freeze”, too. A read-only mode where my memories worked fine, except that I couldn’t construct any new ones: everything just went in one ear and out the other. Maybe this is to be expected: a quick look at some maps of brains and an examination of the bump on my head indicates that the blow came to a point squarely in the centre of the middle frontal gyrus (the dorsolateral prefrontal cortex)  of the right hemisphere of my brain: an area associated with emotional self-control, social judgement, lateral thinking, and the transfer of working memory.

Still: it was certainly a strange experience to be told about events from only a day earlier that I simply can’t remember. It also made Tuesday interesting: long weekends are confusing at the best of times, but parts of my memory made it feel like I’d had only a two-day weekend (as parts of Sunday are simply missing from my memory), and so it was even harder than usual to shake the feeling that it was Monday when I arrived at work on Tuesday. That’ll be a pleasant surprise on Friday, anyway, when the weekend “comes early”: maybe I should bang my head every time there’s a long weekend.

The Doctor That DOESN’T Just Tell You What You Want To Hear

[this post has been partially damaged during a server failure on Sunday 11th July 2004, and it has been possible to recover only a part of it]

[this post was recovered on Friday 24 November 2017]

I went to the doctor this morning to discuss the side-effects of the lariam tablets. I’d made the appointment just a week ago, when I was still having wierd mood swings and not being able to sleep, like, at all. Since my last tablet, though, last Tuesday, I’ve been pretty much fine: nothing worse than the wierd dreams, which I can cope with. I kept the appointment anyway.

“What I really want to know is,” I told the doctor, “Are the bad side effects – the ones I had in the first week – likely to come back? Is lariam one of those things that, if you get your body attuned to it, it’ll be fine from then on… or is it somewhat more random and unpredictable?”

“All I can say,” replied the doctor, and here’s the best line in the entire dialogue, “Is that if it were me, I wouldn’t be taking lariam.”

Lovely. Thanks, doc.

In any case, he’s agreed to write a prescription for a more expensive but less-contraversial drug, which I can collect later in the week if my third pill (tomorrow) makes me go wierd again. He seemed quite keen to switch me to it immediately, but I’ve opted to give lariam a go for a little longer yet.