My Brain

I woke up on the 17th, a month after my stroke, with new pain in my wrist and knee. Previously the evil had withdrawn from those regions. I was worried that this reversal of progress might indicate a new stroke. My wife drove me to A&E, where I had a new battery of tests. They called my consultant, who ordered another MRI scan, and asked to see me after that. I swear that scanner is getting noisier - still, just the one scan this time.

I went straight up to see the consultant and she had the scan on her system straight away, which was pretty impressive. I know, that shouldn't be impressive these days, but…

A slice of my brain.

Anyway, I took this snap with my phone. It shows a slice through my head, viewed as if from below. It doesn't show the stroke damage - that's lower down than this slice - but I liked this slice because it shows my eyes and optic nerve, so it's quite easy to read. You can also see one ear (I've played with the contrast a bit, and you can't see the other one), and my "wonky nose" as the consultant put it. The black 'holes' near the front of my eyes are actually the lenses, not the pupils.

The good news is that this particular scan can show new stroke damage - that is damage that's occurred in the last ten days. And we didn't see any. So, I'm somewhat reassured that my brain isn't just gradually melting away. And, I've been prescribed some new drugs to help with the pain. They're gabapentin, which is also used to treat epilepsy.

Stroke update

I want to describe the symptoms that I'm feeling, and how they've changed since I had my stroke on 17th October - almost three weeks ago. I've definitely improved in some ways, having recovered much touch sensation, but I'm also feeling more pain and cold.

My stroke (for which I'm still awaiting a definite diagnosis, by the way) was a pure sensory stroke. It hasn't affected my mobility or cognition in any way. That is, apart from a slight lack of confidence when using my left hand. Fortunately, I'm right handed.

Half Michelin man

Currently, I'm feeling the following symptoms pretty much all the time, but all only on the left side. In short, I feel like my left side has been blown up like a balloon, but the sensation is different in different parts.

In my face, I feel like I have a black eye and cauliflower ear, and am a bit numb on the chin. The ear is constantly slightly painful, as if someone had punched me there quite hard a few hours ago. The eye sometimes feels a bit dry, and I use optrex eye drops a few times a week. I don't know if it really is dry, but the eye drops do seem to help.

My neck feels stiff, which is a symptom that has come on in the past few days. Lifting heavy shopping bags hurts my shoulder more than it should. The upper arm feels constantly as if I have a blood pressure monitor inflated on it, but isn't painful. The lower arm including part of my hand (but only the little finger) feels like it's slightly sunburned. When I'm tired, or cold, the pain extends right up my arm, and becomes quite serious. I haven't resorted to pain killers yet, and have no idea if they would work, but this does keep me awake at night somewhat.

My side, over my ribs, feels like it's ballooned up. When I wear a heavy coat, it feels like I'm carrying a few phone directories under my arm. That's the most peculiar of all the sensations, since it feels like my arm should be sticking out almost horizontally. And yet, there's no apparent motion impairment. Between my rib cage and my waist is numb, but I'm please that the chafing sensation at the waist has subsided now.

When I sit down, it feels slightly uncomfortable. It always feels as if someone has left a wooden ruler on my chair, so I always have to check that there's not actually anything there. My thigh also feels constricted, just like the upper arm. Also like the upper arm, it can become painful when cold, but not to the same extent. From the knee down, I feel relatively normal!

Signs of improvement

There have been changes, particularly over the first few days, and I'll try to describe them. On the day of my stroke, I was sitting in an armchair and tried but failed to lift my arm. Looking down, I realised my arm had slipped off the arm of the chair, and was trapped between my side and the chair arm. Within a day or so, I'd recovered enough sensation in my arm that that wasn't possible.

Also, on that first day, I was walking very tentatively because I could not feel the weight on my foot, so I wasn't sure of my balance. In fact, I was walking independently and quite well, but I had to look down to be sure of myself. The next day, though, I was walking normally, and my wife still complains that I walk too fast!

The strangest sensation on that first day came when I need to remove ear-plugs after an MRI scan. MRI scans are very noisy, and the radiographer had inserted ear-plugs for me. After the scan, though, I was left to remove them myself.

I took the right one out first. Then, I raised my left hand, and touched something, but what? It had to be my ear, but neither my hand nor my ear was giving me any clues. It was simply impossible to remove the plug with my left hand. So, I reached around with the right. It was still tricky. Of course, I couldn't see, so I had to grope around to find the plug in what felt like someone else's ear. A week later, when I went for a repeat scan, I had no problem inserting and removing an ear plug with my left hand.

Pain management

I mentioned that I've not been using pain killers. That's partly because the pain isn't severe, and partly because I'm concerned about how pain killers might interact with my other medication - which included aspirin for the first two weeks. The best way to deal with the pain is just to get on with life, and take my mind off it. Staying warm helps, too.

From what I've read, there's a good chance that things will improve, but it could take a few months and may not be a complete recovery. Exercising the affected areas might help - apparently recovery in the arm is more common than in the leg, and that may be because the arm gets more exercise just in daily activity.

Finally, on the Thursday after the stroke, my wife printed out some diagrams of a body, and we compared how a simultaneous light touch on both sides (for example, on both elbows) felt. At each point, I rated the sensation on the left compared with the sensation on the right. At many points, I could only just sense something on the left, and at some points not at all. At other points, I was super-sensitive. We repeated this exercise a week later, and there was a dramatic improvement almost everywhere. However, there are many other types of sensitivity - to heat, to sharp pricks, to cold and so on, and we've not measured any of those.

My stroke.

Last Monday 17th October, at about 8:30am, I was sitting at home when I felt dizzy, and suddenly numb on the left side of my body. The dizziness, and the numbness came in waves and I hoped it would subside. After a few minutes of this, though, I started to worry. Although the symptoms were particularly strong in my arm and chest, I didn't think I was having a heart attack, because there was no pain. In fact, it felt quite pleasant. My father had had a stroke in his early sixties, and I knew that a generalised hemilateral effect was likely to to be something neurological. So, I called my wife and we decided to call NHS direct.

They took me through some questions, again ruling out heart attack, and sent an ambulance. By the time the ambulance arrived (only a few minutes later), my symptoms had subsided. As the paramedics went through similar questions, I began to feel a little fraudulent. They took me to the ambulance to check my blood pressure, and temperature, and wired me up to an ECG machine. The ECG and temperature were normal, but my blood pressure a bit high. The paramedics offered to take me in to the Royal Sussex County Hospital, for a check over.

On the way, my symptoms returned, and were much more intense. I felt dizzier, and the numbness was more widespread, and more intense. It seems likely now that this was a stroke, and that the earlier attack (about an hour had passed) was a TIA or "mini stroke". So, somewhat amazingly, I was already on the way to hospital when I had my stroke - if that's what it was.

On arrival at the hospital, I was assessed pretty quickly, and a stroke team assembled around me within about 15 minutes. I scored one out of twenty-five on some scale or other, according to all the prodding, poking and various other tests. Not high enough to justify administration of thrombolytic drugs, but had I required them we were still well within the three hour schedule. While being prodded and poked, blood samples were taken, and afterwards I was sent for a CT scan, and then taken to the stroke ward.

There, I was assessed again. I was told that I'd be in overnight, and then taken away for an MRI scan, and ultrasound scans. The ultrasound scans showed that my carotid arteries were nice and clean. I got to see them live, and that was quite cheering. I think they were particularly looking for build up of fats at the point where the common carotid artery branches into the internal and external carotid arteries.

Back on the ward, I was further cheered by being offered a choice of six different vegan meals! When the meals came, they were piping hot, and reasonably tasty. Not haute cuisine, but certainly way above my expectation. And, they had soya milk for my breakfast Weetabix. My bed had a sea view, and I was set to stop for the week. That is, until the night shift started!

I don't think anybody got much sleep that night. One patient seemed to think we were all police officers being subjected to some horrendous illegal experiments. He was threatening to throw furniture around, and ordering nurses to -variously- attend to his every whim, or leave him alone. Fortunately, he never made good on any of his threats. The nurses were amazingly patient throughout. The shouty man calmed down when the ward got busier in the morning; perhaps because he had more to think about than his own fantasies. Unfortunately for the nurses, another patient took great exception to being dressed, and whacked one of them pretty hard. She had to go to A&E with a suspected broken nose.

I had a load more bloods taken in the morning - about six vials. I learned that these vials come vacuum filled, so they literally suck the blood out of you. I was seen by a consultant, who was satisfied that I was fit to discharge. Still numb all down the left side, but with some sensation returning to my hand, foot and lower leg.

Yesterday, I returned to work. But, today I had more MRI scans - two head scans and two neck scans. They included MRAs, looking at blood vessels, and one used Gadolinium contrast agent. That was a total of an hour, inside a machine so noisy that it was a bit like being stuck inside a giant dial-up modem.

Now, I'm getting used to life, still trying to work out what this means. I feel like I'm carrying a stack of phone directories under my arm, and it's uncomfortable to lie on my previously preferred left side. I think I'm tiring more easily, and my arm seems to get painful when I am tired. I think I have a full range of movement, and haven't lost any strength. I may be a bit more grumpy than I was, but my speech seems normal, and Tories and John Humphrys still make me cross.

And, I love the NHS! The nurses, nursing assistants, porters, doctors, caterers and technicians, -and my wife- were all really professional, kind and attentive. One of the paramedics waved at me from his ambulance as I walked through Lewes at the weekend!

30 Oct - edited to correct spelling of John Humphrys' name.

Lewes District Tories paid to do nothing.

Lewes District Tories run the only council in Sussex to pay their own members for a cabinet role without portfolio. Actually, there are three of them.

Until May 2011, Lewes District Council had a cabinet with nine members, six from the majority group (Liberal Democrats) and three from the minority group (Conservatives). Apart from Hastings, Lewes was the only local authority in Sussex to have a mixed cabinet. When the Tories won control, they decided that the cabinet would be all Tory.

It's a bit hard to keep up with their reshuffles since then, but now they have a cabinet with nine members. Three of those members have no portfolio, but receive (or are entitled to receive) a full "special responsibility allowance" despite having no special responsibility. They do, of course, attend cabinet meetings, but there's already a much lower special responsibility allowance for members of committees that meet frequently.

I decided to take a look at what the other local authorities (District, Borough, City and Council) in Sussex do. I didn't include town and parish councils, since their members receive far lower allowances.

Hastings is the only one with a cabinet that includes opposition members. They have six Labour members, and four Tories. Five of the Labour members have a portfolio, and the sixth does not receive a special responsibility allowance. The four Tories have no portfolio, and receive an allowance of about half that of the other members.

All of the rest have cabinets of a leader, and five, six, or seven, other members members (nine in the case of Brighton and Hove), and every one of those members has a portfolio of responsibilities.

So, it seems that only the Lewes District Tories think it necessary to award a "Special Responsibility Allowance" to one (well, three actually) of their own members without a special responsibility.

Brighton and Hove - all ten cabinet members are Green party members, and have a portfolio.

East Sussex County Council - all eight cabinet members are Conservatives, and each has a portfolio.
Eastbourne - all six cabinet members are Liberal Democrats, and each has a portfolio.
Wealden  - all six cabinet members are Conservatives, and each has a portfolio.
Rother - all eight cabinet members are Conservatives, and each has a portfolio.
Hastings - ten cabinet members. Six Labour, four Conservatives. Five portfolios are held by Labour members, the sixth does not receive a special responsibility allowance.

West Sussex County Council - all eight cabinet members are Conservatives, and each has a portfolio
Adur - all six cabinet members are Conservatives, and each has a portfolio.
Arun - all seven cabinet members are Conservatives, and each has a portfolio.
Chichester - all seven cabinet members are Conservatives, and each has a portfolio.

Worthing - all six cabinet members are Conservatives, and each has a portfolio.

Mid Sussex - all six cabinet members are Conservatives, and each has a portfolio.

Horsham - all seven cabinet members are Conservatives, and each has a portfolio.

Crawley - all eight cabinet members are Conservatives, and each has a portfolio.

Blood, Drugs and Violence - at Lib Dem conference.

The Lib Dem conference agenda for Autumn 2011 includes policy motions on Science Not Stigma: Ending the Blood Ban (p39), Protecting Individuals and Communities from Drug Harms (p24), and Tackling Violence against Women (p30). Full texts of these motions and others, are found in the agenda (pdf).

If you're going, and you have an electronic diary, then you may find this iCalendar file useful: LDconf-09-2011.ics The information here is taken from the very nice new pocket diary, but please let me know in the comments below if you see any errors.

You won't see Labour or the Tories debating these issues. Neither party makes policy at conference. Labour don't even publish their conference agenda!

Edited to add: I've also posted copies of the conference agenda and the conference directory, to which I've added electronic Tables of Contents. Note that they'll only be available here for 30 days. The Tables of Contents make it much easier to use the electronic versions of the papers. Don't forget to also consult the "Conference Extra" papers, with late amendments and editions, available from http://www.libdems.org.uk/autumn_conference_papers.aspx You'll also find full policy documents and consultation papers there.

Silver Address Book

Like me, Giles of Simple and Usable doesn't like the fussy new faux leather appearance for Apple's iCal and Address Book. He's created a new skin for iCal, and inspired by that, I've done the same for Address Book. To use it:

1. Make a copy of Address Book, in case something goes wrong.
2. Download this file (simply a compressed folder of .png files).
3. Quit Address Book.
3. Copy the contents of my file (all the .png files) into "/Applications/Address Book.app/Contents/Resources/"

If you need more detailed instructions, the process is very similar to that described at Simple and Usable

This is what it looks like.

If you wish, you can colour the interface by modifying the files  inwardPointingCards.png inwardPointingGroups.png (the two tabs) and leatherTile.png. Doubtless a variety of alternative hideous skins can be created by modifying just these three files.

Macnix has an easy to install silver skin for each of iCal and the Address Book. I've not tried them, but it looks like the Address Book skin leaves in place quite a lot of unnecessary shadows, faux "stitching" and so on. I've tried to remove as much of that as possible.

Edited to add: I've fixed the link above. Apple killed me.com, so I moved the file to my dropbox.com account. If you like this fix, please open a dropbox account with that link and I'll get a bit more free storage!

That Lib Dem letter in full

Liberal Democrat council leaders wrote a letter to the Times today. I'm pissed off that that meant I had to give a quid to the Murdoch Empire today, but I agree with the content. The letter is also behind the Times Paywall, and printed in today's Times. Only the first few signatories are listed in the print version.

Italics below are mine. I've highlighted those parts because while you can read the misleading headline for free at the Times, you have to pay to read the truth - that this letter is all about Eric Pickles.

In contrast to central government’s runaway spending, local governments have been making savings for years

Sir,

Local government is playing its part in tackling the country’s deficit and advancing the Coalition’s aims of localism and the Big Society. But local, and central, government are being let down by the Communities and Local Government Secretary who appears unwilling to lead the change that’s so desperately needed. Local government has made efficiency savings of 3 per cent in each of the past eight years — in stark contrast to the runaway spending of central government under the previous administration. We’ve also been planning for further saving since the true state of the economy became apparent six months ago.

What has been delivered is a difficult cuts package across all government departments but clearly the most severe is to local government. These cuts will have an undoubted impact on all frontline council services, including care services to the vulnerable.

Rather than assist the country’s recovery by making public-sector savings in a way that can protect local economies and the frontline, the cuts are so structured that they will do the opposite. The local government settlement will take a major hit in this coming financial year and further, smaller, cuts in subsequent years. This front-loading means councils do not have the lead-in time necessary to re-engineer services on a lower-cost base and ease staff cuts without forced, expensive redundancies. Inexplicably, local government is also being denied the opportunity to spread the cost of reorganisation and downsizing over several years — at no cost to central government — which just makes even bigger in-year cuts inevitable The Secretary of State’s role should be to facilitate necessary savings while promoting the advance of localism and the Big Society. Unfortunately, Eric Pickles has felt it better to shake a stick at councillors than work with us.

Local and central government should be united in a shared purpose. Instead of chastising and denigrating local authorities through the media, the Government should deploy all its efforts to help councils minimise the impact on vulnerable communities and frontline services.

We would be delighted to discuss with the Secretary of State how we could take on the difficult challenges shared by all levels of government and would prefer to do this than continue with the gunboat diplomacy which is the current order of the day.

Cllr Richard Kemp

Leader, Liberal Democrat Group, Local Government Association

Cllr Carl Minns

Lib Dem Leader Hull City Council

Cllr Cec Tallack

Lib Dem Leader Milton Keynes

Cllr Paul Tilsley

Lib Dem, Deputy Leader, Birmingham City Council

Cllr David Faulkner

Lib Dem Leader, Newcastle City Council

Cllr Ian Marks

Lib Dem Leader, Warrington Borough Council

Leaders

Cllr Virginia Gay, North Norfolk; Cllr Andrew De Freitas, North East Lincolnshire Council; Cllr Tim Carroll, South Somerset; Cllr Stuart Langhorn, Lancaster City Council; Cllr David Watts, Broxtowe BC; Cllr Tony de Vere, Vale of White Horse; Cllr Keith House, Eastleigh BC; Cllr Anne Turrell, Colchester (NOC); Cllr Sian Reid, Cambridge City; Cllr Alan Connett, Teignbridge DC; Cllr David Budd, Purbeck DC; Cllr Ann De Vecchi, Lewes DC; Cllr Dorothy Thornhill, Watford Mayor; Cllr Gerald Vernon-Jackson, Leader, Portsmouth City Council

Group Leaders

Cllr Alan Boad, Warwick DC; Cllr Gavin James, Basingstoke & Deane BC; Cllr Tom Smith-Hughes, Essex CC; Cllr Joe Abbott, South Tyneside; Cllr Roger Hayes, Bolton MBC; Cllr Peter Wilcock, Uttlesford BC; Cllr Simon McDougall, Arun DC; Cllr Brendan Haigh, Newark & Sherwood DC; Cllr Nigel Martin, Durham; Cllr Hilary Jones, Derby City Council; Cllr Linda Redhead, Halton; Cllr Sue Carpendale, Babergh DC; Cllr Iain Sharpe, Watford BC; Cllr Kathy Pollard, Suffolk CC; Cllr Maureen Rigg, Stockton; Cllr John Boyce, Oadby & Wigston BC; Cllr Andrew Smith, Chicester DC; Cllr Phil Taylor, Tewkesbury BC; Cllr Len Gates, Test Valley BC; Cllr Ruth Davis, South Gloucestershire; Cllr Tony Gillam, Gedling BC; Cllr Chris Maines, Lewisham BC; Cllr David Milsted, North Dorset DC; Cllr Roger Price, Fareham BC; Cllr Brian Greenslade, Devon CC; Cllr Ian Stewart, Cumbria CC; Cllr Richard Andrews, West Oxfordshire DC; Cllr Margaret Rowley, Wychavon DC; Cllr Ann Buckley, Havant BC; Cllr Jane Parlour, Richmondshire DC; Cllr Alan Sherwell, Aylesbury Vale DC; Cllr Graham Longley, Southend BC; Cllr Zoe Patrick, Oxfordshire CC; Cllr Brian Jeffries, East Riding of Yorkshire; Cllr Bob Sullivan, Waltham Forest BC; Cllr David Lomax, High Peak BC; Cllr Paul Coddington, Doncaster MBC; Cllr Liz Tucker, Worcestershire CC; Cllr Simon Ashley, Manchester City Council; Cllr Roger Walshe, Sevenoaks DC; Cllr John Fisher, Staffs Moorlands; Cllr Paul Morse, Norfolk CC; Cllr Jane Clark, Wealden DC; Cllr Christina Jebb, Staffordshire CC; Cllr David Walker, Charnwood BC; Cllr Noel Rippeth, Gateshead; Cllr Penny Otton, Mid Suffolk DC; Cllr Nan Farmer, Carlisle; Cllr David Foster, Blackburn with Darwen; Cllr Dr Robin Studd, Newcastle under Lyme; Cllr Peter Chegwyn, Gosport BC; Cllr Richard Sharp, Woking BC; Cllr Mary Baldwin, Bucks CC; Cllr Jerry Roodhouse, Warwickshire CC; Cllr David Neighbour, Hart DC; Cllr Arthur Preece, Hartlepool BC; Cllr Nigel Hartin, Shropshire CC; Cllr David Neve, Tunbridge Wells BC; Cllr Geoff Welsh, Blaby DC; Cllr Roger Kutchinsky, Hertsmere BC; Cllr Ross Henley, Taunton Deane BC; Cllr Jack Cohen, Barnet BC; Cllr Julie Morris, Epsom & Ewell; Cllr Terry Stacy, Islington BC; Cllr Alex Perkins, Canterbury City; Cllr Geoff Chamberlain, East Devon DC; Cllr David Fearn, Derbyshire Dales DC; Cllr Helen Dyke, Wyre Forest DC; Cllr Paul English, Craven DC; Cllr Paul Elgood, Brighton & Hove; Cllr Paul Hodgkinson, Cotswold DC