My attempt to sound nonchalant and care-less about the idea of a strangers finger probing my inner world like a blind man with a stick looking for the kerb was cut short by rather physical reminder than I really wasn’t that nonchalant about it at all! In fact the moment I heard the words several things came to mind. Firstly: Oh God, am I really that old already? Am I now at the age of regular prostate checks?!
My second thought was actually a jumble of anxiety, discomfort at the thought of what was about to happen, and wishing I had known in advance so I could scrub my rear with disinfectant and bleach it porn-star white in preparation for its first public performance.
The final thing that entered my mind, and stayed there for some time after The Event, was

And that isn’t even the worst thing that happened at the urologist (or was promised to happen anyway).

I am losing a lot of faith in GPs at the moment. They failed to take my liver problem seriously for years, have failed to take my partner seriously (specifically refer her to the specialist who might actually be able to help), and apparently didn’t take my weeing blood seriously enough. When I told the urologist that it had happened three or four times in the past five years or so he was stunned that I hadn’t seen a urologist before. Although now I wish I hadn’t because I’m booked in for a less than pleasant experience.

I have had cameras in my body before, run down my throat into my stomach to investigate possible causes of illness, acid, and so on. It is an experience torture I have endured twice, and hope never ever to have to do again. Certainly not helped by my fear of being strangled, which was set off so badly the first time that nurses had to hold me down. This is also when I learned (on a BBC radio show coincidentally on after the procedure) that the “general” anaesthetic they give is pretty much the same as rohypnol, the date rape drug! You are conscious and in control (although compliant) through the procedure, but can’t really remember it afterwards. Luckily I don’t have to go through that again just yet.

Not that my substitute is any better. It’s called a cytoscopy and bluntly it involves a fibre-optic tube being run up into my bladder…from the closest opening.

It should be ok though – I have a feeling that when I see the doctor approaching my penis with this device I will scream like little girl and pass out!

Oh body of mine, why do you hate me so that you put me through this? I know I abused you in the past, filled you with toxins, fats, and all sorts of substances. I know I didn’t exercise you properly or pamper you much. I know I hurt you both accidentally and intentionally at times. But isn’t the liver thing enough? Haven’t you had your revenge already?!

Something that has only been brought to my attention recently – I suffer from a rare sleep disorder (parasomnia) called catathrenia. In my case this manifests as (sometimes loud) moaning in my sleep that sound almost sexual in nature. I actually wish it WAS down to naughty dreams that I could remember because from the way it has been described to me by my poor sleep-deprived partner my moaning is quite…enthusiastic! However I am completely unaware of it when it happens so all the disturbance falls on my partner, and probably the embarrassment too since I have no shame! All this plus loud snoring, and yet we’re the ones complaining about the noise from our neighbours, go figure!

Although this seems to occur comorbidly with obstructive sleep apnoea (periods of not breathing during sleep due to obstruction of the airways) there is by no means a fixed relationship. The groans, which in one study were shown to last between 1/2 and 21 seconds long) can occur at either REM or NREM stages of sleep, although it is thought they are concentrated on the REM stages. There are claims that catathrenia can be treated by CPAP, which Wikipedia usefully explains as:
” Continuous positive airway pressure (CPAP) is the use of continuous positive pressure to maintain a continuous level of positive airway pressure.”
Thanks wiki, very useful! Luckily the NHLBI provide a better explanation:
“CPAP, or continuous positive airway pressure, is a treatment that uses mild air pressure to keep the airways open.”
However, having looked into it, I can’t see myself sleeping at night with a mask on my face attached to a motor device!

In a lecture today we learned that there is is actually no proof that sleep deprivation can cause death, or that it causes psychosis in everyone (although it certainly can in some). I know I function very poorly myself when I start losing sleep, with my attention, concentration, mood, and motivation rapidly deteriorating. I wonder if I could push past that and function on no sleep at all? It would be GREAT to have the extra hours in my day to get everyone everything done! Although I suspect my end of year exam grades might reflect poor learning functions! Maybe I could learn to sleep like ducks, who apparently can sleep with one hemisphere of their brain at a time!

“The record for the longest period without sleep is 18 days, 21 hours, 40 minutes during a rocking chair marathon. The record holder reported hallucinations, paranoia, blurred vision, slurred speech and memory and concentration lapses.”
-ABC National Sleep Project

So why do we sleep? Well one common theory is that we sleep to “recharge” or to restore an internal imbalance. However despite the commonness of this theory, there is no evidence to support it at all – no proof of an imbalance, and no “recouperation” process observed during sleep. Despite this you can find plenty of magazines writing about how sleep is critical to restore your internal balance! (another myth is that all animals sleep – in fact reptiles, amphibians, fish, and insects have cycles of inactivity but do not sleep as we know it).

An alternative hypothesis is that we evolved sleep as an adaptation to the day / night, light / dark cycle around us. This is the Circadian Rhythms hypothesis, and there is a body of evidence supporting this theory, including neurological studies.

There are five stages of sleep, which we cycle through during the night. We start awake, then progress from stage 1 through 4 spending very roughly half an hour at each stage, before moving back up to stage 1 which is now REM sleep. After half an hour here the cycle begins again, but eventually we start going through fewer of the stages, until we finally wake.

Looking at overall brain activity, stage 1 consists of alpha waves which are irregular, low intensity and high frequency waves. Stage 2 consists of theta waves which are slower than the alpha waves. Also at this stage there are the occasional K Complex or sleep spindles – bursts of high intensity activity lasting for a second or two. Stages 3 and 4 are collectively called Slow Wave Sleep (SWS), and it is this that we commonly call “deep sleep”. During these phases the brain – which consumes more energy than any other organ in the body, reduces its energy consumption by 75%. Once we have moved back up to REM sleep in stage 1 the energy consumption is almost back to normal waking levels. It is during REM sleep that most of our dreaming occurs.

If you didn’t need sleep at all, what would you do with the extra hours?

This post is dedicated to my very forgiving partner, in apology for all the sleepless nights my pseudo-eroticism moaning has caused.

For those of you who aren’t familiar with the idea of reading week, it’s basically half term for university students. Only instead of relaxing, it is a time free from lectures to consolidate what you have learned so far, revise, and catch up on anything you’re behind on. In my case, and with many other students, it is a desperately needed time to catch up on lecture notes and reading that I have got behind on.

I annoy myself sometimes. I know all the principles of good study, I know exactly what to do to get good grades, and I can give others plenty of good study advice. But do I follow my own advice? Of course I don’t.

I need to pull my finger out (I still don’t understand that expression – I have to admit that to my corrupt mind it sounds vaguely obscene!). I really need to rediscover my motivation. So today is dedicated solely to two things: typing up lecture notes, and a trip to the gym at 1.

A good friend and I came up with a saying at the start of first year that reflects our goals and reminds us to strive towards them. Unfortunately it makes a terrible acronym, but somehow it still works:

YAFSALO
You’re A First Student, Act Like One.

I like it especially because it reminds me that a First is in the reach of anyone, even me. People on my course often say “But you’re smart, I’m not as smart as you”. The honest truth is I’m really not that smart! I just work hard and put a lot of effort into being organised. Which in itself is a great example of the same thing – people comment on how organised I seem to be but in truth naturally I am terribly disorganised and have comments on school reports right back to primary school to prove it! It is only through huge effort that I have managed to learn how to fake being organised. As they say: fake it till you make it

With that in mind I am off to plan my goals for today. Wish me luck!

“Mr Cameron said he strongly supported the founding principles of the NHS, including “health care for all, free at the point of use, unrelated to the ability to pay”.”

-BBC News

This weekend the realisation hit me just how much of a departure Personalisation is from the values of free and equal health care for all. Personalisation, or whatever it is being called today, is a scheme designed to put individuals more in control on their social care by allocating them a virtual pot of money from which they can “purchase” services like access to day centres, things like custom-built shelving for people with obsessive hording issues, day trips, and so on. Things like day centres have never really been “free”, however the costs have been transparent to the service users because the bill has been footed by the councils and other statutory organisations. The new scheme puts choice, and cost, up front and center.

Aside from the many issues there are with this (for example the fact that many services still are not ready to operate under this kind of a scheme), there is something else happening: The “pot” that you receive is needs-assess (as it should be), but also means-assessed. The upshot of this is that if you have the money, you will have to pay for services yourself. This is where things get contentious. In corner A we have “free for all unrelated to ability to pay”, a core principle of NHS public healthcare. In corner B we have “if you have the money, you should at least contribute if not pay all”, which will translate into massive savings for the government.

So what do you think?

My stance is this: I pay my taxes for public health and social care. I pay, knowingly and willingly, for the care of others who have health and social care needs. We all do. The individual should not be means-tested, WE should. And we are, which is why we pay whatever taxes we do. Bear in mind also that the individual will most likely have been paying takes themself for at least part of their life. If the government wants to continue this scheme then it should stop collecting taxes to cover public and social care and just admit that it is going privatised – but this halfway house where both the individuals AND the public are paying for the care is completely dishonest.

I will leave you with an anecdote. I know of at least one person who has been told that because of his savings he will not be receiving any personalisation budget and if he wishes to continue to use services such as day centres he will have to pay for them himself. The cost of this is not going to be minimal, with estimates varying between £10 and £30 for half a day. As a result this person feels forced out of services, with their only options being to give up on receiving any care or to blast through the savings that he had been hoping to give to his children.

Today’s unit was all about communication and communication styles. It’s an essential topic that really gets visited multiple times throughout the level two and three courses. This time around the slant is to identify “barriers to good communication”, such as internal barriers (insecurity, shyness, fear), interpersonal barriers (power balance, opportunity to speak and be listened to etc.), environmental barriers (noisy environment, environment too public for confidential conversations, interruptions from others) and more. I particularly liked the advice on communicating with someone who is hallucination or delusional – from experience I know how frightening it is when you suddenly find yourself confronted by someone who believes they are Jesus and that everyone can read their mind, and they feel intense guilt because the thoughts going round their mind is wishing that everyone would die. Having even the limited guidance that City and Guilds provides is helpful.

The part about communication styles was fun, I found myself getting (maybe a little over-) excited about the mention of Eric Berne’s Transactional Analysis, a particular love of mine. I also got quite annoyed that the course material equated Rollnick & Miller’s Motivational Interviewing with DiClemente & Prochaska’s Cycle of Change Model. I got a bit animated in my pointing out that they are in fact two quite different things!

I am honestly sad that it has come to this – I prefer to deal with situations myself in an adult manner rather than needing to involved outside services. But sadly she has made it clear that she has no intention of engaging in communication like a mature adult so we have had no option. So much so that tonight we haven’t even bothered attempting to knock, despite the loud TV and shouting.

Tonight we are armed with earplugs so hopefully whatever happens we should be able to get some sleep. I tried these foam earplugs last night and was impressed with how comfy they were and how well I slept – I could swear they even blocked out my tinnitus! I feel worst for my partner tho, with a combination of emetophobia and being ill she really has enough to deal with right now and her stress and anxiety levels are already way high.

The actions of a completely selfish person have significantly impacted our lives, to the point where we are considering moving out. I hate to be “beaten” like this, but if nothing changes then I suspect the situation man escalate into something quite nasty. The stupid thing is her TV may not even be that loud, it might just be because its right above our bedroom and the sound carries through so well. She may not realise this. But she would if she answered the door and actually engaged in conversation. I was thinking about the last complaint we made, and I remember when I knocked again she refused to answer or respond in any kind of useful manner – instead I heard her snap from her living room “fuck off whoever is knocking on my door at this time of night”. Ironic?

I haven’t had a chance to print that letter yet, must get that done tomorrow.

And there are days like today, where I am at a higher education fayre at a college. I am here to talk to students and parents and there are a lot more practical questions to answer (most groups on campus are primary or middle school so much more general interest).

I love this work, I love having the opportunity to encourage people from a more difficult background (like myself) to aim higher, to believe in themselves and aspire to be better than the opportunities given to them. Although today for some reason (probably tiredness) I freaked out at my talk at this morning’s event and stumbled over all my words And as a student I have to admit that, being paid work, the money is certainly welcome!

What I *don’t* like is days like today, when I have committed myself to work at strange times and my partner is ill and having a bad day. I want nothing more right now than to be home with her giving her hugs and comfort

So if anyone is reading this, please send some get-well vibes her way

I am utterly stunned that anyone can be so inconsiderate, selfish, and rude! Sadly this is a case of nightmare neighbours – these are the same ones who flooded their house because they “fell asleep mate” while running a bath, and caused water to come through our ceiling – with no real apology. Even then they refused to answer the door and only eventually did because I came back just as they were stood on the other side of the door (which has frosted glass so they knew I could see them). It is also the same neighbours who have had a number of visits from the RSPCA concerned about the welfare of their cats.

I have to get up in just over five hours now, and will be working or in lectures solidly from 9am-8pm. In the evening I have to be in a state to represent my university at a high school event and talk to parents and potential students. How I’m going to manage it with the lack of sleep I don’t know! It’s times like this that make me wonder if the goal of becoming a therapist is really for me – this makes me hate people

Dear Flat 6,

On Tuesday morning, at around 00:15 we were woken up by loud noise from your flat, apparently coming from your television. You may not realise, but with our bedroom directly underneath the noise carries through quite significantly. At 00:30 I knocked on your door politely to request that you turn the volume down, which you reacted to not by answering the door but by turning the volume up even higher. At 00:35, still having had no response, I knocked loudly and called through your letterbox “can you please turn your music down”. Still with no response I then banged very loudly, which finally prompted you to turn the volume down, albeit still at a level where it kept us awake until 1:54 when the volume finally reached a reasonable level (during which time we also reported the noise to the Hillingdon Noise Complaints Team then at 1:35 to Metropolitan Police).

I regret that such aggressive action was forced and take absolutely no pleasure in it. I deeply dislike conflict and would prefer to treat each other with mutual respect in future. I understand that sometimes it can be easy to lose track of time and have things on loud at late (early) hours, however if someone knocks on your door in the future and you have your volume up high please either turn the volume down or respond to the knock so the issue can be resolved in a pleasant and adult manner.

To all others,

I sincerely apologise for any disturbance my banging may have caused, I certainly did not wish to cause any disturbance to anyone else.

Kind regards,
Psychology Student #-55

“Would you like me to take a look?
Let’s see…would I like a complete stranger, GP or otherwise, to inspect my boy bits? No not really, in fact quite definitely not. But to be honest you’re not going to be much use to me unless you do so I guess we had better get this other with.

Warning: there be talk of medical things ahead, like blood, infections, wee, and in internal civil war. Those of you who find such things repulsive should skip this post!

Auto-immune disorders are like a double-whammy of suck. First you have the damage that your own auto-immune system does to your organs, in my case my liver, but then you are put on immuno-suppressing steroids which have a list of side effects so full of suck that at times you start to wonder if the scales aren’t balancing out in favour of not taking them! Blood sugar problems, weight gain, increased appetite, mania in bipolar sufferers (just what I need), depression, difficulty controlling emotions, osteoporosis, migranes, anxiety, stomach and abdominal pain, mental confusion and difficulty concentrating, fatigue and insomnia, and even bone death. Don’t forget: these are the medications that are supposed to be HELPING me! And then there’s the real fun one: because they are immuno-suppressant (and because they are not especially targeted) I am highly susceptible to infections and viral attacks.

Which leads to situations like today, when I am presenting at the GP with my third urinary infection in as many years (for those of you who just screamed “TMI!!” you should know I write honestly and openly…about everything!). The real kicker is that all previous times the tests have come back as “microbacteria”, which basically means the lab couldn’t figure out what caused the infection but most likely it was the kind of bacteria that passes harmlessly through the body of anyone with a functioning immune system.

I did enjoy the question “are you sure there was blood in your urine” to which I replied “absolutely. Although I am less sure that there was urine in my blood in the sample I provided!”

I was pretty naughty with my meds over summer. While on placement I kept forgetting to take them, and not seeing any overt difference I thought I would try coming off them with the strange thought in my head “maybe it was all a mistake, or maybe I’ve got better!” I know it seems ridiculous to someone who doesn’t take medication regularly, but it is in easy for these thoughts to appear when you have to take tablets every single day – especially if they’re for something that even if you stop taking them for a bit you don’t really notice any difference. I was expecting to see signs of early jaundice if things weren’t going well – I make a great Simpsons character – by my body was keeping secrets from of it seems. The results of my first liver screen and ultrasound in a year came in and told the story that my body had kept quiet. The result is my medication dose has been tripled. So if you see me looking confused, tired, and hungry then you know why. Either that or its another 9am lecture!

As defined in the Department of Health literature Making the Care Programme Approach Work For You, the CPA is supposed to be a collaborative effort with the service user. In fact a large driving force behind the adoption of this model was the complaints of the service users that they felt they were being treated like objects, that they had no say in the care they were receiving and their opinions were completely unvalued. In the Central and North West area there is a target that 30% of care plans should be written in the first person – that is, by the service user.

“It is also expected that all people providing services do so within a set of personal / professional values that:

-Shows respect for you as a person including recognition of your personal strengths and qualities
-Respect your dignity at all times
-Offer you information about reasonable choices you can make regarding your care and support.
-Demonstrate respect for equality of opportunities for all, regardless of ethnic origin, gender, sexual orientation, culture, or spiritual beliefs.
-Help you feel as in control of the whole process as possible
-Respect the views of people who are important to you”

As the importance of carers and families has been more recognised, it has also become a recognised practice to involve the support network around the service user in the care plan, and to invite them to the care plan review meetings.

As well as recognising the problems and needs of the individual, Department of Health guidelines state that the care plans should also look at the strengths of the service user and how these can be developed / leveraged to promote recovery and wellbeing. Finally, the service user should always be provided with a copy of their care plan as soon as possible after it has been completed.

It drives me potty to hear about badly produced care plans. I have heard of care co-ordinators copy/pasting care plans across different clients (!), leaving entire sections of the plan blank, writing no risk factors, or (and this is REALLY common) writing only the barest of plans. By this I mean one sentence responses in sections, showing that the person filling out the care plan has not really paid any attention to the service user. To say something like “service user fine” in a care plan review is simply not acceptable.

So, psychology students, medical students, and anyone else who might one day find yourselves completing someone’s Care Plan: Remember what it is you are filling out, and what its purpose is.