Final push to the end

I have discovered a new English proverb: "There is nothing so attractive as housework when the alternative is revision."

On Saturday I was so stiff and bored of revision by the end of the day that I went for a big walk around town and took lots of photos of plants and interesting houses that other people live in. I expect you will see some of them in future posts - the photos on this post were taken last week when it was much sunnier. I took a few pictures of our version of Queen Victoria, and one of these now appears at the top of the last post, so you can imagine her decked out glamorously. I think the Canadian statue was created from a younger model.

I peaked too soon with the Clinical Pharmacology. Eight days is too much time to revise for one exam, so I did no exam work yesterday. The trouble is that most of the things I need to do when I am not revising are either too big for one day (sort out ALL the dead plants around the house and prune and weed every plant in the garden) or are unpleasant (clean the toilet and the inside of the car). So I attempted some of the unpleasant things, because as my new proverb says, the alternative is worse.

The university Ethics Committee has responded to my research proposal about interviewing blind and partially sighted people about what food they buy, cook and eat. They quite rightly want to know that the four organisations I have approached to provide volunteers are happy to work with me, so I need to get them to write me a letter saying so. I spent some time yesterday morning composing and sending this request to each organisation - I do hope that they agree, because otherwise my fourth year project will be well stuffed.

I have rather lost touch with the real world of other people who work during the week and then don't work at weekends. When I speak to someone I have to work out what day it is so I can tell whether they have been at work or somewhere else. Lola II confused me by having a day off last Monday, and today there is a Bank Holiday for other people which has confused me again, because I am back at work in anticipation of the last exam tomorrow.

Clinical Pharmacology is actually quite interesting, but there are an awful lot of drugs to remember. For once I will not be stuffing everything into my head, because it really looks as though I can swot up on respiratory disease, cardiovascular disease, diabetes, dyspepsia and gastric motility and be able to answer three questions out of any six they throw at us - it would have worked for every past paper since 2005. But we'll see when 4.30 p.m. rolls around tomorrow.

It will all be over by 6 p.m., but unfortunately this exam is at the main campus so I won't be home until about 7.30. It will be a fine evening, I know that already.

A make-over for Queen Victoria

We should definitely do this to the statue of Queen Victoria outside the Town Hall in Leamington Spa. Non-Working Monkey took the photo. She writes a very funny blog that has most amusing home-made films in it as well as other very astute observations.

Pip pip!

Day off

Fourth exam done now, only one more to go, and I have a whole week to prepare. I had my planned day off yesterday. As predicted, the sunshine was sadly lacking. I did manage to spend most of last weekend revising outside under the wisteria, so I did catch some of the glorious weather.

The exam on Monday went quite well on the whole. I have a policy of trying to avoid talking about exams just finished with any other students - it NEVER helps. All that happens is that someone else mentions something that you realise you should have included but didn't, and it's too late to change anything so what's the point? This time I just happened to overhear someone else talking, and realised that in the question about Social Services I had completely forgotten to write about Social Workers.

Anyway, with just Pharmacology to revise for I was looking forward to a wonderful lazy day off in the sunshine (even though my plans included cleaning the toilet and the inside of the car). My enormous lie-in yesterday morning (after sauna-style badminton on Monday night) was interrupted by a removals lorry roaring and beeping to and fro directly outside the bedroom window - it was 9 o'clock, so I can't really complain.

I had a good day wandering about doing various odd jobs, making salads, filing away all the university paperwork in relation to the completed university modules, and not cleaning the toilet or the car. We watched a foodie DVD in the evening - Julie and Julia - and it was unexpectedly wonderful. So a good day overall, not a great deal achieved except tidiness and good food, and back to work today.

And another two out of the way

Once they've started, the exams seem to pass quite quickly. It's the build up that is so agonisingly slow, and revision truly is one of the most boring activities I can think of, even when the subject is interesting.

Molecular Nutrition on Thursday was the last of the three-hour marathons, and the questions were pretty much as expected so I probably did OK. On the previous evening I thought I'd tot up the marks I'd already achieved in the coursework, and realised that I didn't need to get a whole lot of marks from the exam, so that took the pressure off.

Friday's wasn't going to be quite that easy, but I was very pleased with my time management. Only two hours for three questions meant very tight timing of the subsections - elements that were worth 10 marks only got three minutes, and I stuck to it. One thing that seemed a little unfair was that one of the questions was about Coeliac Disease, which I'd obviously done a lot of research about for my 'lesson' in a different module. People who had chosen other subjects for their lesson didn't feel the benefit so much. I'm not about to complain, though.

This weekend is all about 'Nutrition in the Community', which is an awfully vague subject for the exam on Monday. There seems to be a lot about interprofessional working with social services and primary care teams, together with home tube feeding and infant feeding. We went through a past paper in one of our last teaching sessions and it all seemed pretty much to be common sense, but I still don't like essay questions along the lines of "What is the role of the Dietitian in the multi-disciplinary team?"

The weather has been astonishingly hot. I'm having a day off after the exam on Monday, and if revision goes well I might have either next Saturday or Sunday off as well. I bet it rains.

First exam done

What can I say? I've sat at my desk from 8 a.m. to 8 p.m. for weeks now doing very little other than reading, making notes, occasionally getting up for breakfast, lunch, supper, cups of tea, a quick bounce on the trampoline, badminton once a week when it isn't a bank holiday. I will attempt to write something about the stuff I've been revising, but it's not easy. There's so much of it, and it's become rather esoteric at this stage of the course. We've almost stopped learning new things that would be of interest to a layman, it's mostly the application of all the stuff that we've learned so far.

The exam on Monday was fine. I was probably most concerned about this one, because not only was it a double module, so twice as much to learn, but we had a pre-exam class where it was made clear that for the best marks we needed to write about a topic in depth. Luckily, we were also given some guidance about which might be the best topics to revise in depth, and my choices turned out to be OK. Just to give an indication of how big this thing was, the separate subjects included nutritional assessment, assessment of physical activity, intervention strategies in public health nutrition, nutritional epidemiology, fertility, periconceptual nutrition, nutrition in pregnancy, lactation, infant feeding, childhood obesity, nutrition in adolescence, nutritional aspects of cancer, cardiovascular disease and osteoporosis, elderly people and ageing, and nutrition in the developing world (concentrating on vitamin A, iron and iodine).

I particularly focused on male and female fertility, and ageing, but it still isn't interesting enough for me to want to share what I discovered here, except to say that restricting energy intake extends lifespan significantly in nematode worms, Drosophila, rodents and probably non-human primates, but isn't really a great strategy for the human population, despite what the CR Society says. The module has mostly been about drawing conclusions based on the research evidence, and I'm starting to think that I'm not that excited by research after all.

Tomorrow's exam is Molecular Nutrition, which is all about the effect that nutrients such as glucose, amino acids, vitamins and minerals have on gene expression, i.e. how our body works at a molecular level. An obvious example is the effect on gene expression within pancreatic beta cells - glucose directly triggers the cells to synthesise insulin. We have looked at the interaction between molecules of a nutrient, proteins in the cell membrane and messengers within the cell that carry the message to the DNA, and what actually happens there on a molecular level. As we can't see this directly, there are a number of techniques used to interpret what is happening, and it's all jolly complicated (as you will discover if you click the link and watch the animation).

This is another double module, but somehow less daunting because the compulsory section is interpretive rather than a feat of memory. Still, it contains very technical subjects and more vague research results, and I've got to practise some exam questions today. Both Monday's exam and this one are three hours long - a long time to be sitting writing, and requiring very careful timing of fluid intake.

And all the while, the spring weather is taunting me, with blossom and flowers blooming gloriously where I can't see them. I've missed the whole of May for the last three years, and it will happen again next year. Our wisteria is just coming into bloom, and the ceanothus will be next, and they'll both be just finished when I'm free to spend time outside. I should catch the rose flowering in June, so that will be nice. Except I'll be working weekdays...

Thoughts from my desk

They say that the human brain has an infinite capacity. A recent podcast from 'This American Life' featured an unfortunate man who was unable to forget anything, and his life was not pleasant. Despite this, I have to report that my brain is full, and there is still more that needs to go in. Lola told me a fact the other day, just an ordinary fact, not about my course or food or nutrition or anything, and I felt something in my head go pop. Some other facts had fallen out of my ears to make space. Mr A is coping well and managing our sustenance (although the house has degenerated into filth again), but when he came to ask me what time I would like supper, I had to ask him for some options.

---

I have been pondering on the nature of time, at odd moments when I haven't been stuffing information into my poor memory. Inexorably, the exams are becoming closer, until they arrive, and then are gone. I dream of a science fiction existence where I can revise and do the exams but in some unconscious state, so that I go to sleep now, say, and wake up after the last exam with that delicious feeling of relief and freedom. And without the torment of day after day at my desk, while other people do whatever they choose in the sunshine. Or in the rain, that would be fine too.

---

I did actually forget about revision for one brief period this week - Mr A and I went to see Alabama 3 again at our local, award-winning music venue. I was very uncertain about whether I should go at all, in case of after-effects, but it didn't really go on very late at all, and we had a bit of a dance about and then home to bed. Smurf had even arranged very kindly to put us on the guest list, so it didn't cost very much, and, as ever, we saw people we knew there. I really like living here.

---

The pub next door is doing OK, but it isn't the place it was with Smurf in charge. There are still plenty of customers, but the atmosphere isn't quite as buzzy, and we suspect that takings are down. The owner had a word with us last time we were in, to say that he was thinking of trying to boost custom for the football World Cup by putting a screen outside in the beer garden. We are not keen, but I suspect he will go ahead anyway. Having bought a house next to a pub we are generally fairly flexible about noise, but we'll probably have a word with some other neighbours, and I've asked our local councillor if there are any relevant regulations.

---

There was another small diversion this week, when I went to give blood. It's an easy and worthwhile thing to do, even though obviously not a huge treat. There were two pleasant things though - firstly I treated myself to a Penguin biscuit after donating, which is the only chocolate I've had for about a month, and secondly a group of three young students were in, two of whom were teasing the third about his reticence and generally uncomfortable demeanour. He gave them a great deal of material for future anecdotes when he felt faint and was made to lie down with his legs raised.

I've been donating blood since I was a teenager, and much has changed - timed appointments, a drink before as well as after donating, machines that monitor the rate of flow and beep when the bag is full, timers to make you sit for a bit before they let you off the bed. But there still are some stupid procedures - for instance, every time I donate I have to say that I twice lived outside the UK for more than six months, and they have to look it up to make sure it's all right. If it was all right the last time, then surely it is all right this time? Those two periods of six months were more than 20 years ago.

The other stupidity is the blanket ban on donating blood if you are a man who has ever had sex with another man, even just once, even if you used a condom. Incidence of HIV in heterosexuals is higher than other groups, and has been for the last decade. It appears that this policy is under review, and the committee's findings will be published this year.

What I've been reading

Longitude
by Dava Sobel

"The thorniest scientific problem of the eighteenth century was how to determine longitude. Many thousands of lives had been lost at sea over the centuries due to the inability to determine an east-west position. This is the engrossing story of the clockmaker, John Harrison, who solved the problem that Newton and Galileo had failed to conquer, yet claimed only half the promised rich reward."

I read this quite a long time ago, and haven't read anything for fun since then. It's a really interesting book about a very dry subject: clockmaking. The politics of the age is brought to life, with the clockmakers ranged against the astronomers in fighting for the £20,000 reward. Poor old John Harrison (and in later years, his son William) really have the odds stacked against them, given that their main rival for the prize (Astronomer Royal Nevil Maskelyne) is actually on the judging panel...



Manual of Dietetic Practice
by Briony Thomas (ed)

"The standard work for all those involved in the field of clinical nutrition and dietetics, The Manual of Dietetic Practice has been equipping health care professionals with the essential foundations on which to build expertise and specialist skill since it was first published in 1988."

The dietitian's Bible. I wouldn't say I've read every word yet, but by the end of next year I will have. It's two inches thick.



Nutrition: A Lifespan Approach
by Simon Langley-Evans

"Taking the reader through how the body’s demand for nutrients continues to change across the many stages of life, such an approach allows full consideration of how diet relates to health, wellbeing and disease and provides an excellent vehicle to illustrate the key concepts in nutrition science."

A textbook. A fairly readable textbook, but a textbook nevertheless. The standard work for my first exam. I wish it were over.

Confidentiality

The university is starting to get us ready to go out into the real world on our second clinical placements. The first placement was two years ago, and you may remember that I was sent to Rotherham. I didn't like it much.

That placement was a taster, for just four weeks (and last year's students only did two weeks). It was mainly intended to weed out those students who decided, having seen what is involved, that they don't really want to be dietitians after all. It gave the rest of us an idea of how a particular dietetic department works, what the workload looks like, what sort of activities are undertaken in hospitals and in the community, and who dietitians work with. At that time, we didn't know much about anything so we were just observing, and it didn't involve patient contact beyond talking to them a bit about what they thought of the hospital food.

The next placement will be twelve weeks rather than four, and I won't be in Rotherham. Now that we have done three out of four years of academic study we know a lot more about actual dietetics than we did then, and will be expected to carry out clinical duties, albeit fully supervised, and only to the extent of our abilities. By the end of the summer we will be conducting consultations with patients and groups who don't have complex needs, we have to compile and present a case study and do at least two presentations to the department. And a whole lot more. It's an assessed exercise: I have to pass the placement, otherwise I can't continue on to the fourth year of the Masters. If I miss a week through illness or whatever, I may have to carry on for an extra week at the end.

We will also have a proper nominated supervisor from the dietetic department, and a placement tutor from the university too. I will be meeting mine as soon as I can make the arrangements, and hand over the copious paperwork that accompanies this exercise. I have to identify what I'm good and bad at, and we'll have a chance to discuss expectations and any anticipated problems. The university has already decided to issue us with a uniform, which means there definitely won't be a repeat of my previous 'dress code' problems.

I have to admit, though, that the Rotherham experience has left me with a few uncertainties, and a little lacking in confidence. There were more issues from my A placement than just the dress, and I have mentioned a few before. It is difficult to know how to deal with the feedback that my communication with that team was too 'challenging'. Do I come over as too 'challenging' when I communicate with other people? Is this important, and if so, how do I address it? I'm hoping that my tutor will give me some objective advice, given that it's someone who knows me a little bit from the last three years.

There is one other issue that I haven't yet come to terms with, and that is blogging. It is obviously extremely important that patient confidentiality is maintained, but I imagine that there will be interesting and educational situations that I would like to blog about. Even if patient names are not used, and I'm not planning to mention the location of my placement, it may not be wise to write about real people. Breaching patient confidentiality is a serious disciplinary offence, and I'd be foolish to jeopardise everything I've worked towards for so long.

Anyway, that's for a future time. I've still got exams to look forward to, and I'd better get on.

Prizes and presents

Thursday turned out to be a lovely day, despite a coursework test in the afternoon - the one that required us to know the energy, protein and carbohydrate content of various foods. That went OK, but it's only a tiny 5% of the module mark. You may find it interesting to know that a medium portion of boiled potatoes (150 g) and a standard bowl of cornflakes (30 g) have the same energy content (115 calories), carbohydrate (30 g) and protein (2 g). Or, more likely, you may not.

Apart from the test, some very nice things happened on Thursday, two of them as a direct result of blogging.

- My essay about whether UK flour should be fortified with folic acid was returned. When I started researching before writing it, I did some preliminary reading around the subject and came to the conclusion that it shouldn't. Then I read the textbook written by the lecturer, who was also the person marking the coursework, and discovered that his view was that it should. I went ahead anyway, and got a First class mark despite our disagreement. So that was very nice, and some of the marker's comments made me smile too.

- My Bento box arrived in the post. This was utter self-indulgence on my part, prompted by a blog that I read regularly about Bento lunches and Japanese food in general. I am very keen on packed lunches, mainly because buying lunch costs so much more and because making my own means I can limit quantity and make it relatively healthy. I have been trying hard to include less food for lunch, as part of the insane effort to make sure I don't have to buy any new, larger clothes for my placement over the summer. This box is beautiful to look at, the right shape (narrow and tall - wide flat lunchboxes end up on their side in my bag) and holds no more food than I should be eating for lunch. It was shipped from Japan and took less than a week to arrive. I absolutely LOVE it already.

- Most delightfully and unexpectedly, I won a cookbook! Another highly food-focused blog that I read regularly is written by English Mum, who is a proper Blogger rather than a rank amateur like me. She is often given promotional goods and is taken on trips simply by being rather a good writer. She had a cookbook to give away, and all I did to win it was to let on that I used to like eating icing sandwiches. If only all of my slightly offbeat food preferences netted me prizes (raw pastry anyone?)

- You may recall that Mr A is doing various computing and maths Open University modules, working towards a degree in Computing. He is mostly doing Level 1 modules, but the marks for the last assignment came back, and he got 98%! He's pretty cross about those 2 marks...

- We went for a short walk to the polling station and exercised our democratic right to vote. There were no queues, although unlike previous elections there were more people than just us in the place. Later we watched the first episode of House, a series recommended by several people that should tide us over until we buy more series of The Wire.

It was a very good day.

What we do and don't know about food

I now have a cold, not too serious, but annoying. Saturday it dripped, yesterday my nose bunged up, today I'm back to dripping with the extra joy of a very deep voice.

Still revising, and thanks to Facebook I'm aware of what some of my peers are up to. Many seem to be completing coursework in time for handing in this week, and haven't started revising. I'm well aware that I'm not a standard sort of student, given that I have been there before and am now quite content to work by day and stay in most nights. Even so, we now have a week of lectures, then a free week, and then our first exam. Fourteen days from now, I will be immersed in the first paper, and then there are four more. Granted, there's a week between the fourth and fifth exams, but just fourteen days left to revise for four exams, two or three of which (depending on optional choices) are double modules with a year's worth of lectures to revise?

Anyway, as Mr A reminds me, that isn't my problem, or 'NMFP' as we have learned from 'The Thick Of It' (series 1), which is one of our current DVD watching pleasures. It's pretty brutal, so after one half-hour episode we have to wait a few days until we're ready to see the next one. If 'Yes, Minister' is like a ride on a miniature railway, then 'The West Wing' is a Japanese bullet train and 'The Thick of It' is the scariest roller-coaster you can imagine. We are also watching the 1981 ITV series of 'Brideshead Revisited', which is relaxing to the level of soporific, but so beautifully written and acted. I can't read for pleasure at the moment - by the end of a day's revising, I can hardly bear to look at words any more.

In academic news, since last time, I have done a day of mind-stretching Molecular Nutrition (perhaps I'll write about that another time), and two days of nutritional issues around infant feeding, childhood obesity, cancer and the Developmental Origins of Health and Disease. This last, known as DOHAD, proposes that conditions in the womb have a permanent 'programming' effect on the genome, predisposing the foetus to develop conditions such as heart disease and diabetes in adulthood. Further, the theory goes that this foetal programming is actually heritable, which goes against all prior assumptions that the DNA code is not influenced by environment.

Traditional theories are based on genetic inheritance - if a naturally thin person is force-fed until fat, we would expect their offspring to inherit thinness, not fatness - their genetic inheritance, rather than environmental conditions. This theory says that a foetus in the womb which is subject to maternal undernutrition somehow 'expects' poor nutritional conditions when it is born. It is 'programmed' in the womb to make best use of nutrients when it is born, thus predisposing it to obesity when all the fat and salt they could desire is actually available. So a thin woman having a baby with a similarly thin partner eats badly when pregnant, and the child grows up to be fat, and what's more, their grandchildren will inherit fatness rather than thinness.

If I'm not convincing in my explanation, it's not surprising, as I'm not entirely convinced myself. Other aspects of this module that I've been revising have been equally frustrating. You'll probably have seen some news item about this nutrient or that food causing or protecting us from cancer. While the experts agree about smoking and sunbathing, nutritional factors are much harder to untangle.

It's perfectly possible to feed mice a specific diet for the course of their natural lives and compare cancer incidence with other genetically identical mice fed a different diet. Perhaps we find that a diet high in saturated fat always causes an increase in cancer rates compared with a diet low in saturated fat. Knowing that mice are not the same as humans, we'd like to see if these results are applicable to us. Well, we can't. The main problems are a) we eat food rather than nutrients, b) researchers cannot control what subjects eat for more than a few days, c) food records are notoriously unreliable and d) researchers and research money rarely last for the length of time needed to run a reliable experiment.

So every two minutes someone reaches some conclusion somewhere about which foods cause cancer, and it's published in all the popular magazines, and the trouble is that on its own, each individual piece of research is unhelpful. It's only when you put together a large number that a balance of probabilities can come up with a reasonable estimate of the real effect. Out of 13 human studies looking at consumption of cereals, 3 studies concluded that they lower the risk of colon cancer, 3 studies suggested a higher risk, and 7 found there was no significant effect at all. Even then we don't know which bit of the cereal to focus on - is it the soluble or insoluble fibre, the folate, or some other component? It's no wonder that people think that we're always changing our minds about what they should eat.

There are, however, two themes consistently running through virtually every subject I've studied over three years. The first is that not fat = good and fat = bad, and the second is that moderate physical activity is good for you. If only it were that easy.