Saturday, 28 September 2019

Fiona wounded, but a fine sunset on arrival in Pembrokeshire

A couple of weeks ago I arrived in Pembrokeshire after a two-night stop at Newport on the way, to break up the long journey from Sussex. I hadn't been to Pembrokeshire for ten years, and longed to see it again, and this time by myself. In 2009 I'd been with M---. There were some ghosts to lay. I didn't take the caravan to the same farm site we'd used. I booked a week at the Caravan and Motorhome Club's site near Whitesands Bay, a couple of miles from St David's, the local cathedral city (it's not so grand, really - just an attractive, upmarket village with the senior cathedral in Wales at its heart, which makes it a 'city')

After getting set up, I decided to have a look at the Cathedral and Bishop's Palace at St David's, and then adjourn to nearby Whitesands Bay for what ought to be a fine sunset. I saw there was a fairly direct route to the Palace and Cathedral, using a narrow lane. Turning Fiona into this, I was doing well until a small herd of cows came into view. They were being driven my way by a farmer and his boy.

Well, cows are big lumbering animals who think nothing of taking off door mirrors and denting the bodywork of any car in the way. They can't help it. I needed to get Fiona off to one side. I'd just passed a gateway into a field. I reversed Fiona into it, as snugly as I could, so that the cows had plenty of space to pass by. I'd put my car pretty close to a low stone wall, but congratulated myself on having the skill to do so. The cows slowly went by. The farmer told me that they were being moved from their summer field to another closer to the farm. They had the air of cows who didn't really want to leave their favourite pasture, and they weren't in any hurry. They shuffled along, grazing as they went. But eventually they all passed. I got a fine shot of the brutes' backsides:

I fired up Fiona, and went on my way. Clearly I was approaching Cow City, and had better be wary! There were in fact no further encounters with farm creatures, but I resolved not to use that lane again. 

The sunset was coming along nicely. It warmly lit up the Cathedral exterior.

This is a nice, friendly cathedral, and although not as big as some, it has character and presence. It's easy to get great photos of it from various angles, as it's set in a valley below the main part of the city, and you can view it from above too.  

Inside it was much as I remembered it from 2010. I'd wanted to explore the interior just as before, but something was clearly going on, and only the nave was accessible. There were in fact many more people about than I expected, and more were arriving all the time. Feeling something of an intruder, I could only have a rapid (and discreet) look around. I grabbed some shots, and made for the door. The entrance was suddenly packed with visitors. I had to worm my way to the outside, with many an 'excuse me'. Ah! There was to be a choral programme that evening. That explained the crush - these things are surprisingly popular.

It wasn't my thing, though, and so I made my way back to Fiona and drove on to Whitesands Bay. And it was here that I discovered that I'd scraped Fiona's nearside bodywork when reversing in to avoid those cows. It wasn't dire. But it wasn't a pretty sight.

My poor car! This would have to be dealt with. But it would have to wait until I returned home. Fortunately I knew a local man who would do a great job. 

And it's now all fixed up for two days ahead. It'll cost me £150, but Fiona will be restored to her pristine glory. Which is what she deserves, considering how well she has served me for nine years already. And she will most certainly be my faithful set of wheels for another six years ahead. There is no way I can let her carry scars like this for the rest of our acquaintance. 

It has of course struck me that the £150 spent (and wasted) on those earbuds would be very handy now. Something or somebody is teaching me a lesson!

I wasn't upset for long. A glorious sunset was happening. Lots of other people - many more than show in the following photos - had come to enjoy the scene, and take their own shots. 

Surfers coming out of the water couldn't help looking back to admire the view.

When the show was over, I headed back to the Club site to eat. Fiona was being very brave. I felt very contrite. But if those cows hadn't come along, she would still be unblemished. Well, it was an encouragement to take extra care in the days ahead. (And indeed, there were plenty of narrow lanes yet to come, though no more cow moments)

Friday, 27 September 2019

The audio problem continues

I'm still having a problem deciding which I prefer: the free-standing JBL speaker, or the RHA earbuds. Here they are:

They are both wireless, relying on a Bluetooth connection with my phone, where my 1700-odd mp3 tracks reside. Both connect easily, although the JBL speaker makes a lively noise when doing so, making the process fun. The RHA buds just bleep, which is dull. Both are well-made. Both put out a lot of nicely-balanced sound, and it's hard to say which is the better to listen to. The JBL speaker rests some feet away, and the volume control can be safely turned up a fair bit. The RHA buds are right inside the ears, and can't safely be turned up to sound loud - I'm now acutely aware of how easily intense (and, particularly, nearby) noises can inflict hearing damage. 

There are other differences between the two. One is an object with some heft, that you can get a good grip on and won't drop. One is a pair of lightweight fiddly, easily-dropped earpieces. The speaker can easily be carried from room to room in the home, or moved about the caravan, but you wouldn't take it outside. The earbuds are eminently portable in any situation, and let you listen privately and silently in public places, so that you bother nobody. On the other hand, the earbuds insulate you almost completely from external noises, which can be dangerous: the chances of not hearing warning shouts, or being run over by bikes, or not being aware of someone following you with ill-intent, are significant.

The speaker isn't attached to your body in any way. The earbuds are of course touching (and penetrating) your ears, and you are very aware of them. I don't personally find them uncomfortable, although I might not want to wear them on a hot or humid day. (Mind you, I'm not sure I'd want to be listening to music anyway on a sweltering day)  

In some situations there is no problem in deciding which of these audio devices to use. Out of doors, or in any public area, it has to be the earbuds, and personal preference is irrelevant. 

But in my own home, or in my caravan? Well, what actually happens is that I use the JBL speaker almost exclusively, even for my ironing sessions now. It's just simpler to switch on and get connected with. I just press one button. I don't have to take anything out of a little case, as I must with the buds. I don't have to check that the correct bud is going in each ear. I don't have to remember the right number of button-presses for volume or skipping tracks or whatever. Convenience matters. 

And here's a thing that niggles me. The speaker cost me nothing - it was a free gift from BT. The earbuds, bought rather impulsively, cost me £150. I'm using the free gift 95% of the time. I am definitely regretful that I spent that £150 on the earbuds. I have wasted money. Although they are potentially very useful, in practice the earbuds are almost redundant. I should have waited until I really did need them - if I ever do.  

Should I have another stab at putting them on eBay? I'll think about it. I'd rather they go to somebody who will use them - a commuter or jogger, say.

A change of HRT?

I was driving towards Hereford a few days ago when my mobile phone rang. Luckily there was a lay-by coming up, and I was able to turn into it, stop, and answer the call. It was Boots in Burgess Hill. They still couldn't get hold of my usual 100mcg Estradot patches - I was presently owed eight weeks worth of those, and there was no word as to when they might be available again - but they had sourced a supply of 100mcg FemSeven patches. FemSeven? Hmm. OK, I said, let's give them a go.

So the day after I got home from holiday - yesterday, in fact - I picked up a four-week pack of FemSeven. It's on the basis that I will trial them. If I like them, and if my doctor approves of them when I see her next week, then we can continue with them until the Estradot patches are available again.

I opened the pack and read the instruction leaflet carefully. I couldn't see anything that warned me that they might not be suitable. I can take oestrogen-only medication, because I haven't got a uterus and there is therefore no risk of the womb lining becoming cancerous. I imagine the majority of women on HRT do still have a uterus, and need to have oestrogen-plus-progestogen medication, which seems to be in particularly short supply just now. So I may lack a womb, but at least I can get my HRT.

There are important differences between FemSeven and Estradot: the FemSeven patch is larger, and stays in position for a full seven days, whereas the Estradot patch is smaller and is changed twice a week. Which raises questions on effectiveness - how efficiently and evenly does FemSeven 'leak' its oestrogen into the skin, and onward into my blood system? How does it compare to the way Estradot does it? I can only find out over time.

I've heard, too, that the adhesive used in the FemSeven patches isn't that great. Well, we'll see.

There may also be an issue cosmetically. After three or four days, the rectangular Estradot patches acquire a narrow fringe of black fluff from my knickers, which has to be rubbed off with cotton wool and baby oil. It's possible that a patch that's been in place for seven days will look tattier, and need a longer clean-up job. Fortunately it won't be on sight.

The bottom line for me is that if the FemSeven patches give me no trouble and perform as well as the Estradot patches do, then I might well stick with them. Especially if Boots can get them without difficulty. And if the FemSeven patch doesn't actually look tired and tatty after a week, it's obviously more convenient to use than the twice-weekly Estradot patch. So it's worth a fair trial. 

Tuesday, 3 September 2019

HRT supply worries

HRT is mostly prescribed for menopausal women who are suffering bad side-effects from the body's natural switch from child-bearing status to a quieter existence in later life. That process often goes smoothly, but frequently not. I've observed some horrendous hot flushes and dire mood depressions in my time, and I've been grateful for never having suffered in that way. HRT can work wonders, keeping sufferers comfortable, upbeat, able to think, and generally geeing up the will to live. And in many ways, counteracting the effects of ageing.

I've been on HRT for a long time, and I've marvelled at the wonderful physical enhancements it has brought. Nice skin, better hair, a younger look all over. HRT isn't so good if you are struggling with your weight, but it undeniably gives you a proper shape, and helps to keep you feeling feminine at a time of life when a lot of women have thrown in the towel where attractiveness is concerned. Not that I make any claims in the looks department, but I'd readily agree that were it not for HRT I would be, at age sixty-seven, a raddled, shapeless, odd-looking old hag. Or going that way.

My personal need for HRT is however deeper and more urgent. I take it not only to feel comfortable, but to stay in basic good health - in particular to ward off galloping osteoporosis and other serious medical issues. There's no choice about this. I can never come off HRT. I have to take it for the rest of my life.

I'm not of course the only one in this position, but I do wonder who at my local surgery - besides my usual doctor - really understands why I can't do without my twice-weekly hormone fix. I suspect I'm one of only a small handful of patients handled by the practice who need HRT for special and urgent reasons. Say a maximum of five out of several thousand. We might easily get overlooked. It's concerning.

And now there's a general shortage of HRT supplies, which I rather believe is down to the pharmaceutical companies being reluctant to maintain a sufficient level of manufacture when they can't make much money from it.

This is my regular HRT treatment: a 100mcg patch of estradiol on Tuesdays and Saturdays. It's Estradot, made by Novartis.

In February 2013 I asked my doctor what these eight-patch packs (each a four-week supply) cost the practice. She said it was about £5. Say £65 a year. That was reassuringly cheap - I didn't feel that in any way I was sucking the NHS dry by expecting free hormone therapy!

I dare say that by now, in 2019, the cost might have doubled. But even so, £10 every four weeks (or £130 a year) will scarcely be a drain on the NHS's resources. But the low cost to the practice must mean that the NHS are not paying anything like the full commercial price to the manufacturer. I rather think the commercial price - the wholesale price, anyway - is twice what the NHS pays. And the price to me, if I turned to the Internet for my own privately-funded supply, would be £36 for a four-week pack:

£36 every four weeks, if I could get it at all.

And the loss of profit to Novartis (and companies like them) - if they have a contract with the NHS to supply HRT for a lot less than £36 per pack - could well explain why they are not keen to over-produce HRT patches. The consequent lack of any big reserve leads to an easily-upset supply situation. In a nutshell: they can get a steady, large-scale order from the NHS, but can't make enough profit to make it really worthwhile.

Currently I am owed one four-week supply by Boots (the chemist I use). I've just asked my doctor to authorise another eight-week supply - the routine is to prescribe my regular medication in eight-week batches - but I expect that Boots will be unable to get hold of further patches for some time. So very soon they'll owe me three four-week supplies - twelve weeks' worth.

Well, I've got an appointment with my doctor on 30th September (soon after I return from my holiday in Wales), and we'll discuss alternative HRT medication to take until the Estradot supply problem eases.

I used Evorel patches for a short time once. I wasn't impressed with them, but they would do.

I don't mind trying gel.

I don't much want to go onto pills: when I first began HRT, the consultant told me that pills would hammer my liver, which was already having a hard time with my statin tablets. If it has to be pills, it might mean a spell of coming off statins, or not drinking alcohol. Hmm...

At the back of all this, the ongoing worry that the supply of HRT, so necessary to my continued good health, will never get back to normal. And what might happen if I can't get the HRT I need.