Happy Christmas

... to our Leukaemia friends.

Rosie and Leonie in Ireland,

Rob, Lauren Fergus and Norah in Vermont,

Lea, Terence, Bianca and Caitlyn in New Zealand.

Clare in France,

Lucia in Blackpool,

Ann and Hayley in Preston.

And everyone at the Royal Manchester Children's Hospital.

What's the difference?

The U.S. heath system is run by the insurance companies (see this), the U.K. systemis run by the politicians - in neither one nor the other do the health professionals ... sigh.

Sicko!

Data Protection

On top of all the UK government scandals re the loss of data protection I find this story regarding Sefton PCT which has not hit the headlines or Parliament.

On the Plane

This time tomorrow I'll be on the plane. Not sure how much I'll post before next year - so happy festive season to all our readers.

Fish and Chips

As you might appreciate, if you are a regular reader of this blog, I like my food. Food, culinary art, cuisine etc themselves fascinate me. I am not a glutton, rather I like small quantities with exquisite taste. Having travelled a fair bit, I have learned to enjoy the cuisines of different cultures. Every culture has something to enjoy.

My first exposure to the cuisines of other cultures was through takeaways and restaurants opened by ethnic minority populations in the UK - when I grew up, principally Chinese, Indian and Pakistani. Increasingly, the range and size of ethnicities in the UK increases.

One of my first stops when I get back, quite probably on my first day, will be the local Pakistani takeaway just 30 seconds from the house, which along with its sister restaurant down the road have the reputation as being the best Pakistani eating-places in town. The owner of both, Mr Raj, is a grand character with a totally shaved head who prefers working in the small takeaway than the larger, more opulent restaurant. He very soon got to remember me and, in spite of my very intermittent visits, I can phone on my first night and say,

"Good evening Mr Raj, Mr Gascoigne here ..."

"Good evening Mr Gascoigne. What can I do you for?"

"Two Lamb Baltis with a nan".

... and sometimes some sundries (bhaji, poppadoms, mango chutney etc).

"How long will that be ?"

"Give me 15 minutes".

"Cheers"

Addressing each other as Mister, amuses me somewhat as we are more or less contemporaries and he is otherwise blunt, straightforward, efficient. The only person I seem to address by other than first name is Jaime's headteacher.

Over my many years of absence from the UK, I have become more appreciative of what are viewed as traditional UK dishes - Black Pudding, Meat Pie and Mushy Peas (with gravy), Steak and Kidney Pudding, Fish and Chips, UK cheeses (Cheshire, Lancashire, Stilton, Cheddar etc etc ... aaahh swoon!) and in this festive season Chritsmas Pudding ! (Generally, I do not have a sweetooth). Additionally, world foodstuffs unavailable here ... European cheeses, wines from Australia, New Zealand, Spain, Chile ...

Nanda isn't particularly appreciative of British or Pakistani food - but has developed a like to a Balti and loves this traditional British dish (from a Chinese takeaway up the road !).

To make a Black Pudding

First, kill your pig.

I wasn't present for that part so cannot regale you with a photo - you probably wouldn't want to see it anyway. I've witnessed killing a pig in your backyard before - Halal or Kosher killing of an animal seems humane in comparison - here it's a sharp implement into the heart. I wouldn't know which is more effective at collecting the resulting blood outflow (hmmm ... and it makes me wonder how they collect the blood for Black Pudding - do Black Pudding abbatoirs have similar dispensations as Halal and Kosher abbatoirs ?).

I once witnessed a Halal killing for our landlady's wedding in Darfur. Two sheep were purchased and tied up in our yard. "Baa, baa, baa ..." one would state, and the other would reply "Baa, baa, baa ...". And then they seemed to get into a shouting match and "Baa, baa, baa ..." together. It was beginning to get on my nerves just a little bit.

The moment arrived - the first sheep was strung up by its hind legs (a bit undignified I admit, justified "baaing" and a bit more shrill) and quickly had its throat cut. Sheep no. 2, having witnessed all this went suddenly silent. Phew! What a relief!

Back on subject ...

Then collect the pig's blood and butcher it, making sure you save the intestines for the pudding skin. Wash out the intestines.

Next chop up the intestine "skins" into the required length.

Tie a piece of palm frond round the end of your skin and fill it with blood.


Close your pudding with another piece of palm frond.


Repeat until you finish up all the blood.

Tie the two ends of the pudding together.

Meanwhile you have got your fire going and put a big saucepan of boiling water on the go.

Put your puddings with some choice herbs in the boiling water and boil for approximately 15 minutes ...






... and remove.



And the last step (after my camera battery had ran out) is barbecue them on the fire.

Microsoft

... is the name of mobile discotheque here ! (I wonder if Bill will sue for trademark abuse). There are various mobile discotheques playing on the weekends and holidays, usually in the open-air. I await (and probably will for a long time) one called Linux!

Blood, Sweat, and Tear-wrung millions

Tom Reynold's, of the London Ambulance Service and the blog Random Reality, has just opened a competition to entitle his second book on which he is working, the first being the exquisite "Blood, Sweat and Tea".

Obviously, Blood, Sweat and Tea is a pun on "Blood, Sweat and Tears".

So I thought I would look this expression up in Brewer's Dictionary of Phrase and Fable (1981 edition), and found the following ...

"The words used by Sir Winston Churchill in his speech to the House of Commons, on becoming Prime Minister, 13 May 1940,

"I would say to the House, as I have said to those who have joined this Government, I have nothing to offer but blood, toil, tears and sweat." In his Anatomie of the World, John Donne, says "Mollifie it with thy tears, or sweat, or blood", and Byron has,

"Year after year they voted cent per cent,
Blood, sweat and tear-wrung millions - why? for me?"

The Age of Bronze, xiv, 621.

Gladstone's speech in Westminster Abbey (22 Feb. q866) commemorating Lord Palmerston includes reference to "the unhappy African race, whose history is written for the most part in blood and tears".

An element of truth in all perhaps ...

Tom's competition is only open until Sunday - so get an entry in quick. I, myself, can't think of anything ...

...except, given the state of the NHS, perhaps Byron's phrase ...

"Blood, sweat, and tear-wrung millions".

Medical Ignorance - T-cells and the Thymus

I have not posted on ALL science for a long time as I thought I had investigated and written about as much as I needed to, that I could understand and that I could try to communicate to others.

I subscribe to the email notification service of BioMed Central for oncology papers. Most are nothing to do with leukaemia but I came across this open-access paper, Gene expression profiling of leukaemic cells and primary thymocytes predicts a signature for apoptotic sensitivity to glucocorticoids, published in November this year.

And I was stunned by a major gap in my ignorance. However, I am also stunned at how recent the science I describe below is.

In the foetus and up to puberty white blood cell T-cell lymphocytes are produced in an organ called the thymus located in the upper chest, not in the bone marrow. In a normally functioning thymus the T-cells are filtered - good from defective, and the defective ones are killed off (apoptosis). Not until 1961 was the importance of the thymus realised - previously a thymus would be surgically removed with a resulting loss of lymphocytes and immunity!

When the T-cell precursors are in the thymus, forming an integral part of its structure, they are known as thymocytes.

The T-cells migrate to other organs (principally the spleen, lymph nodes and bone marrow) and the blood. Gradually, T-cell reproduction is, at puberty, transferred from the thymus to the bone marrow, lymph nodes and spleen and the thymus gradually becomes a redundant mass of fatty tissue.

In childhood T-cell Acute Lymphoblastic Leukaemia the thymus is pushing out loads of T-cell lymphocyte precursors (or as they are referred to in science, progenitors) known as lymphoblasts, not mature T-cell lymphocytes. This is the key to diagnosis - levels of lymphoblasts in the blood and bone marrow.

However, it is seemingly not the fault of the thymus.

The progenitors of the lymphoblasts and lymphocytes are stem cells produced in the bone marrow. Stem cells come in a variety of flavours. Our famous embryonic stem cells can differentiate into whatever part of the body they like - heart, liver, kidney, skin etc. Then they become body-part specific stem cells but some are seemingly multifuctional (interesting research was announced on Friday into using skin stem cells to cure the blood disorder Sickle Cell Anaemia).

Some become blood (hematopoietic) stem cells - those destined to become B-cell lymphocytes stay in the bone marrow, and those to be metamorphosised into T-cell lymphocytes find their way by blood to the Thymus.

Recent research into the roll of leukaemic stem cells (and when I say recent I mean this decade) has been focussed on Acute Myeloblastic Leukaemia rather than B or T-cell Lymphoblastic Leukaemia but malformed stem cells do seem to be the "culprit" in all leukaemias.

Genetically-malformed hematopoetic stem cells cannot be processed into full-blown T-cell lymphocytes but remain as T-cell lymphoblasts. It would seem that the thymus is unable to distinguish between good and bad stem cells, the progenitors, but can distinguish between good and bad product derived from good raw material. If it receives bad raw material and produces excess lymphoblasts, it won't kill off the bad cells.

At the end of the day the thymus (a factory) is pretty dumb!

The leukaemic stem cells are apparently not very receptive to chemotherapy drugs.

So I will worry.

P.S. Obviously, and as always, this is a lay-person's explanation in both its writing and its reading - if any of my science is erroneous or just slightly "fucked up", then please correct me either through the Comments or by email.

I'll try and get on to Dexamethasone and thymocytes in our next scientific post - hopefully, before I go back to the UK for Christmas.

Gumpagraph

I much admire Past Peak's very artistic daily photo which Jonathan posts under the title "Gumpagraph". They are exquisite and beautiful, and followed by very very funny George Bush jokes - a great juxtaposition to his serious, and more often than not, depressing commentaries on current affairs.

I do not know how he keeps up the energy to do this day after day - and, having experienced some "writer's block" recently, I note how many of my blog links on the right have seemingly died (NHS Blog Doctor, the Head Heeb, Cancergiggles etc). I particularly note the seeming demise of the weekly BritMeds (a round-up of medical blogs - particularly as it was giving my own jottings occasional exposure!).

So dedicated to Past Peak here is our own Gumpagraph (I think Jaime took it as I cannot for the life of me imagine why I would take such a silly but beautiful photo!).

Tantrum

Dexamethasone

Gastric Flu

Shit (excuse the pun) I came down with gastric flu on Monday. Diarrhoea in the morning and vomiting and nausea in the afternoon.

So I went to see Doc and, in what seems like medieval medical logic, he gave me suppositories for the nausea and pills for the diarrhoea!

Left work at 14:30.

Voluntary Ambulance Drivers

I recently wrote about Tom, our ambulance driver, who picks up Kezia and Nanda to ferry them the 14 miles from home to the Royal Manchester Children's Hospital and back again. He is a volunteer, he uses his own car. He doesn't get paid. He gets mileage rates to cover his fuel and the inevitable maintenance costs on his car.

Last week his colleagues in Wales went on strike for two days - they are not being compensated for ever-increasing fuel costs and are seriously out-of-pocket. I don't blame them.

The notoriusly ever over-stretched Welsh ambulance service could hardly do with this strike. I bet the regular full-time struggling-to-cope ambulance service was over-stretched last week, although the NHS managers claimed it had put all contingency plans in place - a voluntary ambulance substitition contingency plan basically means that the NHS pays for a private taxi.

Patients and carers at the RMCH would suffer immensely but for the likes of Tom

Strong Woman

All Done!

Aphorisms IV

I like my current header aphorism so I am not going to change it yet.

However, I almost did with this one from Havellock Ellis. It is poignant. It has no wit. It verges on the Rumfeldesque. But it merits quotation.

"we seldom learn to go right except by going wrong, and we are often most wrong when we think we are most right".

... particularly given my recent comments on "youthful follies".

Of Polyclinics and Hospital Closures

For once the BBC isn't knocking the doctors!

Cancer in Africa

Our regular reader, Rosie, whose daughter Leonie has ALL, posted this comment regarding a paediatric oncologist friend of hers currently work in Tanzania. It speaks for itself …

“… I’m trying to get more drugs out to her after Christmas, I bought a case load from the hospital here and sent them out with a doctor friend of the pharmicist ( Ireland is just the right size to bypass all the necessary paperwork to do things like this). She lost a little patient recently as there was no money to pay the taxi to take the blood from the blood bank to the hospital. However she had a little girl like Leonie and Kezia with ALL who had gome blind and for weeks was having seizures in a semi coma. After consulation with the docs here she kept plugging away with the treatment until one day she woke up looking for her breakfast ! Hardened oncologist she wept with the other staff- this is what keeps her going. She is a marvelous young woman called Trish and Tansania is lucky to have her.”

Imprisonment

A constant source of blogging inspiration has been Jon's Jail Journal in which Jon has recounted to us his many months of incarceration in US penitentairies (i.e. jails). He is (you are if you read this Jon) now out and "free" and back in he UK with his (your) family.

In November I wrote about my friend A. who is serving a perpetual Kafkaesque sentence of imprisonment in a civil society and far from his home to which he is not allowed to return.

Both Shaun and A. were imprisoned through offences committed by, what I will term, "youthfull folly". And I was rather lucky not to go there myself i.e. the "youthfull folly" occurred - just I didn't get caught and imprisoned.

My own last (?) act of "youthfull folly" was having Kezia. Me!? who swore never to have children! At the age of 42 has a child who gets sick with leukaemia. Our imprisonment.

Have a Happy Christmas Shaun and Family!

Urban Landscapes

When I was last at home (and I have to admit now that my home is where my family is), I took these two pictures on a walk with just me and Kezia. I am proud of these two photos because I'm not a good photographer.

This seemingly rural area is in the middle of a decaying ex-industrial northern town. The woods are, in many places, taped-off as the enormous ex-textile mill next door, now owned by the multinational Federal Mogul, was converted into an asbestos brake-pad factory and dumped waste into holes in the woods. And then had to stop and close its activities.

The photo of Kezia does not show her particularly happy, but serious. It was taken at the top of the mill's canal race (diverted water from the river to the mill's water-wheel, when long ago it had one)) she was beginning to get worried when this photo was taken, although she knew she was on the way home. The juxaposition of the vertical of the the tree-trunk on the right, the vertical sapling in the backgound on the left, the ferns at her feet and the stream flowing from background to forground and disappearing behind the tree all combine to make this a magical photo.

On our return she wouldn't pose in front of this graffiti commemorating Pink Floyd's Syd Barrett, although she grumpily had a Coca-Cola in our local pub.

When we got home, she slept - probably we went a little too far.

I am not there to show her and Jaime rural landscapes.

Medical Update

Kezia went to the hospital yesterday for Intrathecal Methotrexate. Seemingly no problems.

I've been at a bit of a loss the last couple of weeks about what to post. Writers' block? Cancer Routine?

I will attempt another post on Dexamethasone from a recent paper but it might take me a few days as I get my head around the science. I should react to the UK government's new Cancer Strategy ... but I wonder if 144 pages of printing is worth the theft of paper and toner from my employer ...

Ful Medames

For Rosie

Along with Aseeda, Ful Medames is the national dish of Sudan and, according to Alan Davidson's monumental Oxford Companion to Food, Egypt.

During our two year stay in Nyala, the capital of South Darfur, Rosie and I would eat Ful five or more times a week. It is delicious and, surely, it must be addictive.

What is Ful Medames?

Alan Davidson explains that ful a variety of the Fava bean, or, as it is known in Europe/America, the Broad bean, Vicia faba. t is strange that I hate British Broad Beans (the alliteration begs capitals!).

Ful is brown, British Broad Beans are green. Sudanese/Egyptian beans have been dried, whilst in the UK they are eaten fresh. It is strange that I hate British Broad Beans (the alliteration begs capitals!). I assume the cans of ful I am now able to buy here (of which more anon) must be rehydrated before canning.

We would stroll down with a Scots couple working alongside us in local secondary schools, and who lived around the corner to the major crossroads where there were a conglomeration of local outside eating-joints. We had a favourite as it made us feel welcome. On the short walk home we would stop at a small Eritrean famine/war refugee-run shop that sold baclava, pistachio nuts and all. Yum! They doubled-up as a tailor shop in the day.

To bring our "wives" into an all-male street cafe, eating outside etc in a Muslim society at 6 o'clock at night might beggar your belief ... but Darfur, believe it or not given the current situation (I cannot speak for the rest of Sudan), is culturally a very tolerant society. Yes - if Rosie and her Scots colleague finished work earlier than their spouses, they wouldn't eat lunch at our busy crossroads joint, but they did find a quite backstreet cafe where they would not be hassled by rough misognyist types.

Back to ful ...

I cannot do more justice to the subject than Alan Davidson's entry in the Oxford Companion to Food, too long to quote here. But the Wikipedia entry is also well-written and provides a couple of links on how to prepare it.

In Darfur it could be ordered "plain" or garnished with grated local cheese - a hard, pungent and spiced (carroway, cumin, poppy seed? Ican't remember) cheese that came in thick twisted "plaits". Oil poured over and eaten with flat unleavened bread. You could add a hard-boiled egg and accompany it with a tomato side-salad.

The enormous ful saucepan must never stop from one day to the next - more ful was just added to last night's left-overs.

Once a week I would choose what one might call Dal for a change.

About two years ago a young Lebanese businessman (and now not the only one) opened a supermarket here. I didn't visit for over a year but was eventually persuaded to ... only to find cans of ful and hummous. Flabbergasted, I have become a regular customer!

Unfortunately, he does not import tahini, so I cannot make my own hummous (chickpeas are widely available here - and I did bring back two jars of tahini - one dose left !).

Our cans of ful come from China!