Lessons and a legacy

On the 7th November 2007, my life changed forever.

In a very small ceremony in Toronto's Civic Hall, I married the man who completed me. Together, we embarked on a three year journey characterized by security, comfort and love. We had our moments and arguments, but we enjoyed a really good marriage. The overwhelming feeling I remember experiencing in those days is safety.

People are often surprised when I tell them I'm divorced. In my head, I desperately tell myself this is because I look far too young to have been through this particular mill, or because I'm simply so amazingly wonderful that no-one could possibly imagine anyone wanting to divorce moi. I tell myself these things to stave off the fear that they're astounded that anyone would be daft enough to marry me in the first place. And of course, the next natural question for them to ask is "What happened?!"

I find it hard to know how to pitch my answer. Its pretty much impossible to hit the right tone in an everyday conversation. I have no idea if its even possible to convey-within a few sentences of a polite conversation- what it feels like to have your entire world shattered, being forced to give up all your hopes and dreams and worldview in the process, and yet also how you are utterly amazed at yourself for getting through it all relatively unscathed. At least I can now just give them this link and tell them to get back to me in twenty minutes

I usually find myself sounding far too dismissive of it, as if it was all a bit of a breeze and I barely even noticed it happening. But the other alternative is to sound like I'm still a gibbering wreck because of it, which I'm really not.

It was all very sudden. There was an inclination that something wasn't quite right for a week or so before, but nothing too terrible. On Christmas Eve I was feeling a bit wistful. I told him I was worried, to which he said "Don't be so daft. We'll be together for ever." That's an exact quote, by the way. I feel like its burned into the inside of my skull, and can actually see the words scrawledin sooty black. Two days later, on boxing day, he told me he wanted to divorce. He had decided he wanted children, and there was no longer any place for me, and my lack of desire for children, in his life. This was not negotiable. There was no room for trying, marriage counsellors, pleading, nothing. He'd decided that I just wasn't worth fighting for, and that was that. This may have been the best and worst part of the whole thing. Its utterly crushing to know that you're not worth any effort, but his absolute certainty that this was It meant that I was saved from having to hang on for months on end, telling myself that he might just change his mind. I was saved from limbo, but tipped into hell.

The embarrassment is possibly the worst bit. Having to acknowledge that you've failed at what you consider to be the most important and central bit of your life- if not your entire life itself- is truly awful. To this day, I'm terrified of meeting anyone who i haven't seen since it happened. I'm going to a wedding soon in which there will be people there who I haven't seen from school, and I'm already preoccupied with how much of an utter failure they will think i am. I don't think I'll ever quite shake this feeling.

I used to honestly believe that he was my world. I used to worry about him getting ill and dying and whether or not I'd survive without him. I always concluded I wouldn't. I used to think that love was the single most important thing that could ever happen to me, and that if I didn't have it with this man then my life meant nothing at all. I thought I was quite pathetic, emotionally, and that I would never be able to cope with half of the things that most people go through as part of their daily lives. Other people could cope with divorces, but not me, I thought. I'm left both terrified that I won't ever feel like that over someone again and terrified that I will. I thought he made up for all my faults and that as part of a couple they would be forgiven, whereas on my own I wasn't worthy of anyone's consideration.

However, approximately two weeks after that fateful Boxing Day, I had my own flat and I was absolutely loving living on my own. My friends- who I had mildly neglected during my marriage- rallied round and were and still are properly, properly amazing. All of that love that used to be directed at one man is now spread liberally over all of them. I've discovered a fierce loyalty that I didn't know I had. I've gotten myself involved in many things that I would never have dreamed about being brave enough to do during my marriage. these things would seem tiny and inconsequential to anyone else, but to me they are a lifeline.

I totally surprised myself. I didn't sail through it all, by any means, but I surpassed my own expectations of how I would cope with flying colours.  I know now that I have a capacity to cope with things that I would never have discovered if this hadn't happened to me. I have a renewed confidence that, when terrible things happen, I'll survive in my own right. I have faith in my own personality, and know that I don't need another person as a prop. A relationship is an optional extra, not a baseline requirement. My friends come first, above all things. I've learned that support comes from the most unexpected places (@eyeswideshut75, I'm looking at you, amongst others), and that asking for help is not in any way shameful. These are lessons that I'm bloody glad I now know.

I'd love to end on that positive note, I really would. But alas, its not that simple. I'm left with an inherent distrust of anything nice that's said to me. All of my beautiful ideas of love are shattered and I now know that its most definitely not All You Need. I've been unable to say and feel the word ever since in relationships, and have purposefully shied away from a few opportunities because of the terror of letting myself go. I have to fight with the cynicism that raises its ugly head every time a friend announces an engagement, or I go to a wedding. It's not the done thing to laugh bitterly out loud at the vows, I hear. This doesn't mean I'm not genuinely happy for them, I really am. I just hate the fact that my right to feel the excitement and happiness that blissful ignorance brings has been taken away from me.

If you ever visit Toronto Zoo, you'll find a little brick in the pavement just outside the gift shop which commemorates my wedding. It'll be there forever (or at least whilst the Zoo is still there), but the concept of forever has been ruined for me, and I don't think I'll ever get it back. Sometimes I think about how we have let that little brick down.

Anyway, there you have it. I'm not one for mystery, and prefer to have things out in the open. It's cathartic to tell you all, dear readers, this sort of thing, and I'm pretty sure that if this really was just a blog about skepticism in healthcare you'd be bored shitless by now. So forgive my oversharing, and this muddy little puddle of melancholy in an otherwise bright and beautiful day.

Hxxx

Harry, who had seven hairs on his head.

I've been thinking a lot about my Grandad Harry recently. I'm not entirely sure why- it's not his birthday, or the anniversary of his death or anything in particular. I'm not going to bother trying to shoehorn this post into any recent news events or make any great points about skepticism or science in it. My intentions are purely to tell you about him, because he is a worthy subject.

Harry.

At school we had to do an English project on someone who had inspired us.   Of course, it being the early nineties, my English teacher found himself wading through twenty or so biographies of Michael Jackson. But I did mine on my good old Grandad. I wish I still had a copy of that project now.

He was brought up in a Catholic orphanage. I believe his mother died and his father couldn't take care of him and his siblings. I know he had a horrible time there, but the details are sketchy. I know the orphans there were very starved of love and attention. I remember him telling me how, one Christmas, the nuns had told them all how they were getting a very special treat. The boys were each presented with a bit of spice cake, which in their eyes might as well have been manna from heaven. It gave them all a tiny ray of hope, of excitement. When they bit into it, it was full of cobwebs. Those nuns must have been having a right old laugh at that. 

Despite- or perhaps because of- all of this, he vowed that his life-and the life of his family- would be filled with nothing but love and warmth and joy. Where he could so easily have been consumed with anger, he instead became what I consider to be the very pinnacle of what everyone should strive to be. He was a true gentleman. 

He met my Grandma briefly, then again through some mix-up with ration books, and so it began. (i need to check that story actually, i remember it being desperately romantic, but I can't recall the details.) Those two have taught me everything I know about love. Through some hard, poor, and difficult times they were the most loving and romantic couple I have ever encountered. You know when you're in the first flush of a relationship, and you do everything you can think of for someone before the fatigue of familiarity sets in? They seemed to be like that despite being together for many, many years. Their flat was full to the brim of knick-knacks, those little impulse purchases they had bought each other over the years just because they were thinking of each other all the time. 

He was gregarious, and would welcome anyone to his home with a massive smile and a huge hug. Whenever I took boyfriends round to meet him for the first time, he'd welcome them with "hello, bonny lad!" along with a (often to their embarrassment and my amusement) big sloppy kiss. Within about 5 minutes of arriving, he'd be offering you food, tea and whisky, and you'd be totally charmed by him.

He loved whisky, so much so that on his 80th birthday he got 18 full size bottles of it as presents from his friends. I used to go round to see him for a few hours and emerge into the afternoon staggering somewhat from all of the "wee drams" we'd share. Highland Park was his favourite: for his birthday I bought him a bottle of the expensive stuff. The next time I went round he said he had drank it all already, but later on, when he was more sick and I had to retrieve some from the cupboard for him I could see the only-half-empty bottle there, the cheeky devil. 

He had an amazing sense of humour. When he and my Grandma came to stay with me once to look after me when my parents were on holiday they told all their friends they were going to Kingston for the week, neglecting to mention the Park bit which would denote a sleepy suburb of Newcastle rather than Jamaica. He tried his best to be modern: he loved playing on the wii, pottering about on a computer, and listening to his iPod. He had a better mobile phone than me at one point. And he-and my grandma, still- also had modern attitudes. They knew the world was changing around them and they did their best to understand it, not be set in their ways and disapproving if us unruly youngsters. They didn't bat an eyelid when I would traipse in looking all sullen in my goth days, they just gave me a massive hug and told me I looked lovely all the same. 

When he became very ill, there were about four or five occasions when we seriously thought he was going to die. Each time he fought back, but became more and more frail each time. I remember his consultant pretty much saying after the first time that he shouldn't have still been with us, and that he wish he knew his secret. My auntie probably put it best: "he'll do anything he can to stay with her (my grandma)". Perversely, I actually remember the first time this happened as one of the best times I have spent with my family. Waiting in the relatives room, us assembled cousins, aunties, uncles and parents roared with raucous laughter at everything going. We made our own hilarious entertainment using nothing but an old copy of the Evening Chronicle and  some plastic packaging. Some would think that's weird, but I know Grandad would have wanted nothing less. At his wake we holed ourselves up in a room with copious amounts of port and wine, and screamed with laughter as more distant friends and relatives turned their noses in the air and probably thought we were disrespectful.

But he would want us crying tears of laughter rather than sadness.

Now, as you'll probably know by now, I don't believe in an afterlife. But I do believe in a legacy, and if I manage to have a legacy that's even a quarter as powerfully loving as Harry's, I'll know I will have led a good life. 

Hxxx

P.S. The seven hairs thing was a long standing joke. He used to count them and declare that he had seven hairs on the top of his head. No more, no less, always seven.

P.P.S. Its been requested that I mention something else also, something that I actually can't believe I forgot about: The Toilet Of Joy. I have no idea why The Toilet Of Joy came about, but it stems from a family trip to Ilkley for one of Grandad's birthdays. We had a meal in one particular area of a pub which had been roped off for us, and for reasons best known only to the god of wine, the entire family ended up spending much of the night in a toilet cubicle, in hysterics over a hand-dryer. This became known as The Toilet Of Joy. Something very odd, very noisy, and very wonderful happens when my family get together. 

Nose Gunk strikes again: AllergieBLOCK

What is it with people trying to produce "Revolutionary" new versions of rubbing vaseline on your nose whilst charging vastly over the odds for the privilege? Someone, somewhere has obviously decided that our noses just aren't greasy enough. Thanks to my friend Paul for bringing this to my attention.

Enter the new kid on the over-the-counter hayfever market block (see what I did there?): Nasalguard AllergieBLOCK. Firstly, how am I supposed to trust a product that can't even manage to spell allergy properly? Secondly, is that Comic Sans font that I spy on the packaging?! Okay, so it seems like the UK packaging is different, but that doesn't matter. The damage is done, and the use of Comic Sans is an unforgivable crime.

A Crime Against Humanity

Thirdly, on trying to find the UK site, it seems that this is yet another company who has taken to giving free stuff to people so that they will say on their personal blogs how very marvellous it is. This sort of publicity just doesn't wash with me. It feels grimy and seedy and smells faintly of desperation. I therefore imagine this is also what Allergieblock gel smells of.

Let's have a look at what the manufacturer's say:

"NasalGuard AllergieBLOCK® Regular is a revolutionary topical gel based upon patented technology containing cosmetic grade ingredients. The FDA-approved gel creates a positive charge which blocks negatively charged allergens on contact before they enter the nasal passages."

Right, it's really not revolutionary, is it? It's hardly going to free the downtrodden masses from the grips of the evil dictatorship of pollen. It's exactly the same principle as Prevalin and Haymax, and of course good old Vaseline. I've said it before in the Prevalin post, but the idea of putting vaseline on your nostrils to reduce hayfever symptoms is as old as the hills. There's nothing revolutionary about this. This positive charge thing is new, however. It sounds like something that a bunch of marketers sat in an office having a "thinkstorm" session would come up with as being suitably science-y to wow the masses.

But surely this can't possibly be the case, not when there is a heart-warming "Inventor's Story" on the website:

"About 20 years ago, New Jersey Professional Engineer Ashok Wahi's daughter Aikta frequently suffered from allergies after exposure to her friend's cat. He wanted her to be relieved from the constant sneezing, runny nose and congestion without taking drugs.  The conventional over-the-counter remedies made her sleepy at school, he got motivated to create a drug-free solution for his daughter that wouldn’t cause drowsiness, dry mouth and similar side effects.

The project's goal was to prevent the inhalation of allergens rather than treating the allergy symptoms after the fact.

With this in mind, Wahi put his engineering skills to work and developed a unique gel that blocks allergens on contact, therefore alleviating allergy symptoms. Hence the birth of NasalGuard® technology."

So its taken this dude 20 years to reinvent the wheel and come up with a fancy version of Vaseline. Shame really, he could have saved himself the effort if he had only spoken to a decent pharmacist or GP. Whilst I'm sure being a "Professional Engineer" is awesome and all, I'd really rather like it if people who are trying to improve my health have some sort of background or training in healthcare, thank you very much.

Anyway, all of this is by-the-by, because of course there is going to be a wealth of good quality clinical trial evidence to say that it works, right? Dear readers, you probably know the drill by now. There's some testimonial videos on the website, a grand total of 4 of them. With Prevalin, the manufacturers tried to pass off two methodologically poor trials about products that bore no relation to Prevalin at all off as clinical proof that it works. These guys don't even bother going to that amount of effort. There is no mention anywhere on the website about any trials at all. They don't even bother cursorily referencing the Principles and Technology bit:

 "NasalGuard AllergieBLOCK® uses patented technology that works on a simple principle of electrostatic charges: opposite charges attract each other.

AllergieBLOCK gel has a slight positive charge which attracts negatively charged allergens. Allergens like pollen, ragwort/ragweed, hay, dust mites, pet dander and house dust all carry a slightly negative charge. The allergens are blocked on contact. You do not inhale allergens, which means you don’t suffer from allergic reactions"

Now, it does seem to be the case from this PLoS One study that allergens are negatively charged whereas non-allergens are more likely to be postively charged. But until there's some evidence that a mixture of "Dl Water, Polyquats, Propylene Glycol, Octoxynol-9, Glycerin, other cosmetic grade ingredients and preservatives" can definitely produce some sort of nasal forcefield against the nasty pollen, and the manufatcurers can demonstrate an ability to spell properly, I'm not interested.

I'd also rather not apply something to my face which is going to actually attract the very things I am expressly trying to keep away it, thank you very much. Without evidence to the contrary, there is nothing to say that all of those positively-charged allergens which are supposedly now attracted to the gunk on your nose will get stuck on the gunk. A few allergens with probably make it through, given that nostrils are relatively big holes in comparison to how small the allergens are. So if anything, there is a potential that you end up with more allergens than you would have done had you not bothered applying it in the first place. Imagine Justin Bieber in a young girl's school, with only one or two bouncers for protection. a fair proportion of the screaming pre-pubescent youngsters are likely to get through the bouncers to plant a kiss or two on the fresh-faced child-adonis. (If I'm honest, I have only a vague knowledge of who Justin Bieber is, but I understand he's the Jason Donovan of modern time)

How much does it cost? oh, only the princely sum of £11.99 for 3g at Boots. ELEVEN POUNDS AND NINETY NINE PENCE for THREE GRAMS!!! Think of all the other things you could buy for £11.99.

Save your money, people.

e-cigarettes: accidents waiting to happen?

We all know smoking is bad for us, and we all know that giving it up is a good idea. E-cigarettes have been around for a good few years now, and they seem to be the answer to a lot of our prayers to some people: That lovely nicotine hit, without having to traipse outside, and without any of the nasty tar or other chemicals that makes smoking bad for you.

There's currently a bit of a kerfuffle going on about them as the EU look into tighter regulation of them. A quick search on Twitter reveals lots of folk stating that they save thousands of lives, are much safer than other pharmacological smoking cessation methods, and are totally safe, therefore shouldn't be banned by the EU. Others have covered the fact that e-cigarettes are unregulated, that they may actually contain chemicals and ingredients which can be carcinogenic, that they might have adverse safety effects so I'm not going to cover all of those potential issues here. .But there is one aspect of their use which I think is easily forgotten about, but has the potential to be very worrying.

It seems that e-cigarettes come in a variety of forms- none of which are regulated. Some are disposable, some have refillable cartridges, and some require refilling with a liquid. There are even some sites which encourage mixing your own nicotine liquid: a complicated process requiring mixing a nicotine concentrate with a flavouring and a diluent using a dropper.

Now, as a fairly young pharmacist (or so I keep telling myself), it has been a long time since I compounded any medicines myself, but I do remember doing so in university and I have a pretty good idea of how to work out and produce mixtures. I'm a keen baker, so used to following recipes which can be complex at times. And yet a quick glance at some of the mixing guides for nicotine liquids makes me worried. They look complicated enough for a pharmacist like me to follow, never mind anyone else. Milligrams, drops, milliliters, colours, parts etc are all terms used on the same instruction sheet, and the medicines safety part of me is crumpled and crying in a corner, wailing "HIGH RISK COMPOUNDING PROCEDURE!" loudly to anyone who will listen. And yet, because these things aren't considered a medicine, anyone can sell this stuff, and anyone can buy it. There are risks at every step of producing these mixes: not understanding the instructions, not accurately measuring amounts, mixing up the different liquids, storage of the liquids, spillages etc etc. Some sites even suggest using a syringe- complete with needle- to inject the nicotine solution into devices. A little bit of me is dying inside.


Even the ready made liquids are problematic enough. They come in little eye-dropper type bottles, and are often pleasantly flavoured. In short, they're probably rather attractive to children.

In my day job, which partly involves advising on poisoning cases, I have come across quite a few cases where nicotine liquid intended for use in e-cigarettes has been accidentally ingested. A lot of people don't know that nicotine itself can be horribly toxic, particularly for children. It only takes a small amount orally to get some pretty nasty, potentially fatal effects. And yet, freely available to buy without any regulation at all, a variety of attractively flavoured and packaged -and really highly concentrated- nicotine liquids are sitting ready to be bought by eager punters. You can even buy multi-packs of large bottles of highly, highly concentrated nicotine liquid. They don't even have child-resistant tops on them- and why should they, as they're not even considered a medicine? The websites selling these things aren't particularly clear about the dangers of them- again, why should they be, when they're trying to sell them as a safe alternative to smoking?

I've had a quick look around the medical literature and as of yet there is very little information published on this aspect of e-cigarette usage. And that's part of the problem: the technology has been widely adopted without a thorough understanding of all the different aspects of its safety. Even if they were tightly regulated and highly safe, this aspect of accidents with refills will still remain, and in my opinion it is only a matter of time until there are some very serious accidents of this nature.

So, whilst e-cigarettes might be a useful ally in giving up smoking for some people, we really need to put some thought into the safety issues surrounding them, and not just the obvious ones which might affect the person using them.

All of this is without even considering the fact that using them can sometimes make you look a bit daft, especially the ones that light up at the end like a pretend-y cigarette. Others, frankly, look like "discreet" vibrating devices for ladies. You'd be better off with those yummy candy cigarettes from the eighties, if you ask me- they look more like an actual cigarette than most of the e-cigs and they're a whole lot cheaper too.

Hxxx