You are currently browsing the tag archive for the ‘growth hormones’ tag.

The absolutely LAST thing I have time for tonight is a post…but I feel determined not to let work get on top of me yet again. Especially after meeting Clare H (hello Clare!), a regular reader, in the gym yesterday. I’m thinking: do a post, do a post… And all the best for her daughter C’s move this week to a pump!

ANYWAY. All well here. Some weirdo numbers. Mostly too high. But not thousands. Just a few irritating ones. Pizza dual wave needs changing. Breaded chicken continues to be problematic. And spag bolognese is a pain in the bottom: the normal pasta dual wave is consistently a disaster with this; evidently the fat in the meat slowing things down. So E crashes. Treats hypo. Then hours later goes high.

Argh.

ANYWAY. Another fun one is that using the pump is SO automatic that last night it backfired the opposite way from usual: instead of forgetting to bolus for a meal, E accidentally bolused when he meant to have some free carb (eg without taking insulin to cover the carb content)! Ack. He hadn’t eaten all his meal, so needed to have some free carb to soak up the leftover insulin… Had a cereal bar, and automatically bolused for it. I realised too late, with a kind of weird retrospect, suddenly recalling the buzz from the pump of the dose delivering… an hour after. So in goes TWO boxes of juice (because the extra insulin in the meal still hadn’t been accounted for), and we’re in bed over an hour later than we wanted to be in order to see through this errant dose…

Sigh.

AND — as if life weren’t complicated enough (as ever), Cleo is beginning to pound the floorboards. Which can only mean one thing: the vet was wrong, and the breeder was right — she’s coming into season way before spring.

And Archie is obviously an adolescent. And you know they only want one thing…

Ack.

We’re thinking we’ll put her on the pill for a year or so — what do you think? A bit like when you have babies, it’s hard to stop having kittens…

With that: back to the coal face for me…

 

Hello everyone. And hello again. So many hellos indeed that it’s hard to know how I will start this post… Apologies? Reassurances? Thank you firstly to those who sent messages via email or facebook about whether we were okay.

Yes, we are really fine. Truly fine. I just had to let things slide in the middle of what was the busiest teaching and admin term for me in several years. It became a case of only the absolutely essential bits of life survive! And the blog just went — poof! — like dust. Before I knew it so much time had passed. It is only with the New Year now upon us that I can sit back a little and think now I can get back to this. Thank goodness.

Because I’ve missed it. Lots.

***

Catching up info: E is now at least three inches taller than me! Yes, choke in surprise. It has happened so fast that I keep thinking he’s either wearing heels (not likely!) or standing on his toes (also not likely since he gave up dance about a billion years ago). He is now creeping toward his father’s height of 6 foot, which his father categorically refuses to acknowledge. M too has shot up: fits my shoes and also wears the smallest women’s size 6 (uk, that is. American it’s 2 I think?).

What the heck?

But it’s the sheer food consumption that is doing our heads in. Forget monitoring carb intake. Just forget it. The best we can do is try to get him not to eat too late in the night, so that we don’t have to get up and test. He’ll sit down and have 400 g of mashed potato, eight small sausages, and a pile of vegetables. Faster than any of us can finish our meals, he’s done and standing up for ‘more food’. He returns to the table with a cereal bar, a pot of yoghurt, more sausages… Our food bill has gone up by 50% in the last six months. SO alarming. He eats all the time. We go through boxes of cereal bars, probably one per day. He also doesn’t seem to want non-carb, like meat and cheese. He really, really wants carb, big time. His body must just be building itself, putting together the infrastructure, like constructing a building… It’s incredible to watch.

I realise I’m not telling you anything many of you won’t know. But I am really reveling in it: his growth means his diabetes is controlled. Which is a source of intense relief.

And controlled it is. The last HbA1c was again very good. This is not to say that we don’t have days of weird swings and runs of highs and lows — but we are blessed with a young man who is admirably keen to stay in some control. He never does not act on the information his testing kit gives him, and he never (unless out with friends in town) doesn’t test. This is hugely to his credit, and how very lucky we feel in this.

Case in point: yesterday he was inexplicably 16mmols before lunch. It scarcely matters how that happened, and although it was less than two hours since he’d eaten his snack, he still felt the number was too high. So he overrode the pump and gave himself a partial correction. By PE two hours later he was down to 6mmols — he didn’t eat to bolster up for exercise because he was worried about having been high (is this a run of highs? for instance), but within an hour he’d hypo-ed and had to stop. He treated, and by the time he was home he was a nice even 7mmols.

I told his father the story. He’s a good lad, he said. Indeed. Much better to have tried to get things lower than leave a high and allow himself to get insulin resistant. We know by now that if we don’t act quite harshly, he can stay high for hours sometimes, depending on why it’s happened. In this case, it was inexplicable. He rightly thought the mostly likely reason was not because of a previous bolus, but because of feeling slightly ill, or from a cortisol high. It was unusually high even for the middle of a bolus.

As it turns out he probably didn’t need to do this, as evidenced by his quick fall in blood sugar. But better to do what he did. 

***

Enough extolling! Suffice it to say that we press on. Funny night highs continue, and we just tweak the pump when we think the high might have set in…whereupon it goes away and of course he’s too low. Sigh. We’ve had a good enough few weeks at the moment such that we are hardly ever getting up to test. Thank goodness, because we have been on the floor with exhaustion, both of us. E understands this, and is careful not to eat late if he can help it. We also almost always aim to have any pasta or rice earlier in the evening — before 7.30 pm — so that we can test him right at the end of the dual wave, at 12.30am. I confess that staying up even that late is fairly dire. And once last week OH spilled hot tea over himself in bed after falling asleep waiting for the right time to test… But it’s better than a 3am alarm, for sure.

***

While I’ve been away, some folks have carried on an intermittent reflection over on A Place to Talk. And one question that’s come up from Angela is what people think ‘triggered’ or ’caused’ their own or their children’s diabetes?

Medicine knows quite a lot about genetic predisposition and about viral triggering… I can trace I think E’s trigger through to a stomach bug he had in Italy in 2008. Everyone else had it too, though we only had cramps. He had cramps AND a fever, was really quite poorly. Three months later he was diagnosed.

What are others’ theories, and experiences? As Angela points out, it can feel so random, especially, as in her case and many others’, there is more than one child in a family affected?

And of course it can feel unfair. Does feel unfair. Is unfair. And arbitrary. And stupid, stupid, bad luck.

So there.

Any thoughts welcome.

For now: great to be back.

Is it very bad if I take this one chance in two weeks to post – seeing as I’m sequestered in a Starbuck’s waiting for straggling students. Straggling and bedraggled as it turns out, in the light rain.

We are in town ‘doing’ some psychogeography – a walk following an algorithm. But it’s wet, alas.

So. News in brief:

1) E again running high in the mornings. Growth. Herewith ends our 2 week stretch of unbroken nights. We must get up and test to try to ascertain at what point he is rising…

2) but not react too aggressively because from Sunday he is away in Wales for a week, no running water, no electricity. Snowdon to climb. Heart attacks to give his parents. He will set running a little high (but not too or he will feel rough and be low energy) the whole time. Hence we go easy on the night levels. For now.

3) this trip should be fine. Should be great. Everyone is prepared. My motherly concern is that he not feel too alone in having to deal and make so many hour by hour by minute judgements in the no doubt changing and out of routine environment. We shall see. Gulp.

4) term has started for me. Hence the headless chicken thing. I think I will come up for air around early November. Alas again.

5) it’s raining. I said that, didn’t I?

6) the KITTENS are spectacular. Like popcorn. Heads held quizzically. Napping in the most awkward positions (sliding down sofa arm, in someone’s crossed ankles). Photos. Will add vid when I get home.


They are now of course escape artists so are underfoot all over the house. And unbelievably lovely. What an experience. And mama Cleo has just been so happy, calling them, checking on them, grooming them. Even though they are weaning. So salutary really….

7) we went to Cornwall for a flying visit – very gorgeous. St Ives Tate, surf beach, and the Eden Project. (sorry, will imbed links at home!) Glorious weather and a special gift of a time, just before we go blinkered for three months…


— Posting on the move, tiny screen!

It’s felt a very full few days. Sometimes in families there is a time when it seems things are changing quickly. The children outstrip themselves. The adults make plans. Some kind of change is in the air.

We had another clinic appointment yesterday, and despite the week of highs after our holiday, E’s HbA1c is again very good, the lowest yet, well under 7%. Just how lucky we are in this achievement was brought home to us when we both heard another teen’s HbA1c, same day, same clinic: 12%.

Living with diabetes requires an incredible vigilance, and, as the consultant pointed out yesterday, gaining control requires a kind of obsessive nature, a perfectionist bent. How true for E.

Growing with diabetes, growing up with it, requires quite a different set of coping mechanisms. And some are winners in it, and some have Herculean sized struggles with it. This is the hormone story: insulin (a hormone), brings blood sugar down. Cortisol and adrenaline — both typically sky high in adolescents, and especially in driven adolescents (check) — raise blood sugar. Unpredictably. Of course.

Growth hormone, as I’ve mentioned before, also raises blood sugar. And is only secreted at night. What I did not know is that it is secreted at all different times of night, in response to the body using up the glucose present in the blood. As the blood sugar drops, growth hormone has the chance to kick in. So it is secreted in a pulsating type pattern. Unpredictably. Which is why over the last six months we have had these astonishing runs of highs in the night, and then just when we want to do something about it, boom, they stop. We have been completely unable to predict or grab them.

The consultant’s advice for these adolescent highs was very good: correct the random highs (perhaps caused by cortisol and adrenaline) as you find them. Don’t worry overly about the growth hormone highs in the middle of the night, because some of the effect may well settle and drift off by morning. So try to get the morning reading okay, but stress less about the night time one.

He also confirmed that E had grown over an inch since June, and another inch in the preceding three months. So we all had a bit of a celebration and a sigh: we are in the middle of his main growth spurt, which may  last another year. Hold on for the ride.

It is clear that E and we seem to have the mentality to constantly ‘be after’ diabetes and control without it wrecking our lives. He tests as a matter of course, without protest, and is keen to keep in range if at all possible. His most upset times come when he runs high — not just because he feels bad, but because he is hugely, hugely aware of how bad this is for him.

In that way and so many others, we are lucky. We are able to carry all this, to hold it, without it taking an incapacitating toll on us.

But how easy it is to imagine a family, many families, where people just aren’t put together like us. Their lives are not as settled, not as happy in other ways. They’ve not had the support of a good diabetes team in the early years. The child or teen just wants to pretend it’s not happening. And the numbers spiral up, kept just within the need the hospitalisation.

I’m not saying anything that almost all of you know, and may even be experiencing. It does make me desperate though, desperate for help with this: how can all families be expected to essentially cope on their own? How can every person be expected to understand and be motivated to look after themselves? They can’t and UNDERSTANDABLY SO. It’s dire. But the price is so high.

E was speechless when he realised that the teen across from him had an HbA1c which was almost twice as high as his. I could see a helplessness mounting in him. How does this happen? We both felt chastened, and left feeling quite humbled. And for me, a little heartbroken too.

***

A little kitten vid. Cleo calling and playing with them. After a while she realises one is still in the box. Hmm… goes to check it out, and they all (eventually) follow… Our bundles of good and silly stuff amongst all the sobering thoughts…

As is the way with life, business as usual has now taken hold: school and stationery preparations have occupied some considerable time, as has the trying on of shoes and uniform etc… The good news is that for daughter M’s final year at her school we won’t have to buy any more uniform! Yay. Everything more or less fits. Never mind that everything was a little baggy to begin with, and that her skirt — bought three inches above her ankle — now rides slightly above her knee. Never mind that the SAME P.E. kit has lasted E and M both in this school — that’s eight years, altogether. Good quality stuff, eh? Though by now quite, ahem, faded. And it was second hand when I got it! The truth is out.

The bad news is that E does not fit in one single item of his school clothes. In six weeks he has outgrown his shirts, his jumper, his blazer, his trousers and his shoes. Granted, he was looking a little ‘wristy’ as we say, in his shirts and blazer by the end of the school year in July, but now they are unwearable. Sigh. AND he only has two more years in his blazer before going into the top of the school where they all wear ‘home clothes’. Sigh again. And blazers are eye-wateringly expensive. Second hand shop, here we come!

Life with the kittens has settled into a very sweet pattern: Cleo scratches to get out between 6-7 am, eats and drinks, goes outside. Kittens snooze. Cleo returns in an hour expecting some fanfare, which she receives, then goes back upstairs, checks them, eats a bit more in the room, stretches out asking us to tell her how very clever she is and how much she is loved, then climbs in with them. We check on her over the day but although she sometimes climbs out and stretches (and oh yes, eats two more meals), she doesn’t want to leave the room. At about 5.30pm, she fancies a stroll and goes out, eats again, visits with everyone and goes back into her room. Last night for the first time she wanted out at 11pm, so muggins here had to stay awake long enough to let her into the room when she was ready. She also wanted ANOTHER meal, and was interested in traversing the top of the piano, which she miscalculated somewhat and tumbled down, waking the house with her dischord. Oops.

Schubert her brother has stopped being quite so cross with her, which is a relief. He now greets her at least. He has yet to meet the kittens; we’ll wait for 3-4 weeks for that. Meanwhile two out of four babies have opened their eyes completely and one in particular is very pleased with her ability to hold up her wobbly head and look out. The eyes of the other two, the darker ones, are half open. All can do a very endearing hiss when they smell or see something they don’t recognise. Completely soundless and expressionless, they pull back their mouths repeatedly. Then snuggle down with the others, job done. It’s pretty hilarious.

Eight days old!

We think we have two seal point Birmans, one of them the boy, and two chocolate point Birmans, though one of these looks a bit lighter in the ears… could be developmental, or we could have a blue point? Not expected, but hey. (Classic examples of Birman types here. Cleo is a lilac point and the kittens’ father is a seal point…)

***

Re E’s numbers, well. Generally pretty good, but some inexplicable highs. Since I last posted we’ve had two unbroken nights’ sleep: one was fine; another he woke up on 2.7mmols. Right. Then the last two nights at 3am he’s been high again, 13mmols. So we can’t yet find a way to get full nights’ sleep with any consistency. We do look for opportunities, but there have been reasons to get up every single night: he’s running high, he’s running low, he’s at the end of a pasta or rice dual wave, it’s the first night of a changed basal dose, we’ve had three different numbers the last three nights so we can’t risk it! Etc.

People weren’t kidding when they said adolescence plays havoc with blood sugar levels. There are many, many times when it’s just random, random, random.

And today he’s eaten like a horse. He’s always hungry again. For us, this usually corresponds to growth and fighting to control high numbers. Sigh for the third time. (Really, we are okay. It’s just when I look at it baldly I admit we’re tail chasing again…)

It’ll be fine. Some day. Just please lord let his new clothes fit him for a little while.

1) no kittens yet, though prowling mama won’t settle and then sleeps for hours. I’m off out this morning to get rubber gloves (eek) and antiseptic. Just in case.

2) E’s nighttime numbers have been CRAZY. First we up the basal, then we lower it, then god knows…. Not meeting with much settled success at the moment. Messed up my alarm last night and didn’t wake til 4am. Tested and he was 2mmols. Mega ugh. CHILDREN DO NOT WAKE WHEN HYPO.  All this when having been 7mmols the night before, and 14mmols the night before that. Sigh.

3) we have not had an unbroken night’s sleep since about 20 July. Feeling quite used to it, but if we can’t get on top of this in some form before school starts, we will be dishcloths. I cannot help but feel that being in our late forties has something to do with this…Not built for it anymore. (Sorry, OH!)

4) AND Schubert disappeared for 12 hours yesterday. Scared us silly. Last thing we need is a runaway cat. Would rather trade in the kittens than that! He is now zonked out, not even rising for breakfast…

Over and out… And around and around…

Upon arriving home, we knew for sure that Cleo was expecting. She is round. Eating like a horse. And there are kittens in there! Moving around like crazy.

She is due sometime after 21 August (three days). We are in a bit of a lather.

First time grandmother, I have taken to it with typical obsession. She has not one, but three firm ‘nest’ alternatives now. Which have been alternately lined with towels, fleece and now finally newspaper in the last week. She has not so far chosen any of them. I pray her eventual stopping place will not be a) under a double bed or b) on a window sill, which to be honest has been her favoured place these last ten days. A windowsill! Imagine this. Or not.

Establishing nests for her also seems to have led me into my own nest building: I have been (again rather obsessively) clearing out cupboards and wardrobes. It’s a case of serious overdrive. You could be forgiven for thinking we were getting ready to either move or adopt a child. We have so far filled about ten black bags with STUFF. Only two more sets of clothes and two more chests of drawers to go, and then we will have been through all storage items in the house. Preparing for babies, moi?!

OH says that daughter M would do best to be at some distance when she falls pregnant (one hopes, years from now!). I think he may be right. Meanwhile, I am trying to catch languishing Cleo long enough to trim around her teats (yes, she says defensively, this is actually done, we are informed by the breeder!) so that the kittens (kittens! kittens!) can find their milk…

Sigh.

Cleo looking altogether more relaxed than I feel!

***

On other fronts, we did have an absolutely wonderful time: we read and swam, read and swam. But also saw a number of deep South of France cities we hadn’t before: Avignon, Orange, Arles. Of these, Arles was stupendous. The kind of working, ancient town — with a few Roman remains thrown in — that you’d just like to get inside of. This is what I love about imbedded history: yes, there are tickets to buy and audio books to listen to. Yes there are tourists. Of a sort. But the life of the city just carries on around it. People drive around the Roman amphitheatre, walk through it on the way to work. It’s incredible. And heartening. We also went back to Uzes and the Pont du Gard, two favourite spots which lived up to our memories of them. Stunning, Provencal, and somehow liberating.

ANYWAY.

Number wise things were just fabulous: after the first couple of days of temp basals, E’s insulin levels seemed to settle rather miraculously. We began not to put him on any temps, he hardly had any lows, played in the pool a great deal, walked a great deal… And, you guessed it, GREW like a beanpole. By the end of the holiday we realised his needs had gone up overall, which is why all the exercise etc had not sent him crashing over and over.

And you guessed it: on the way back in the car, his numbers began to soar. Where they stayed, enduring the battle of the 200% temp plus corrections, for about 4 days. Like a plant, with a little sun and water, he had shot up. Had he been less active, we would have had to increase his insulin by about 30%. As it was, we had to do it when we got back.

We figure he grew about an inch in that two weeks. No kidding. He came downstairs the morning after our return saying his eyes were at a different level in the mirror! My lord!

No wonder we have been running to keep up.

So OH and I have not had an unbroken night in four weeks now. We are still trying to get night basals right — he keeps being 12-14 mmols at 2 or 3 am, which is sort of incredible. We then correct him and he’s usually (but not always) okay in the morning. Clearly he’s doing all his growing at night! This morning he was 2.9mmols however, too low, so it’s just that middle of the night window that needs looking at again. We’ve already raised it by two increments since our return.

Oh well. We will get there. Until something else changes.

We’ve also had to change his insulin sensitivity on the pump, or his correction ratio (eg how many mmols can one unit of insulin be expected to lower him?). It used to be 1 unit insulin to 4 mmols in the daytime (high, but he’s quite sensitive), and 1 unit to 5 mmols in the nighttime. For the first four days back at home, we kept finding corrections less effective, lowering him only a little. After setting the basals on 110-120% temp all day and night, and still corrections were not doing it, we figured it wasn’t just a question of basal adjustment. We therefore changed his correction ratio to 1:3mmols for the day, and 1:4mmols for the night. The nighttime one still seems hit and miss (eg didn’t bring him down from bedtime to 2am, and brought him down too much this morning) — but we’ll have to tackle this again through basal rates, as I say…

Endless.

But he’s  three inches taller than me now. Since Christmas. He looks like a tall person in a queue of people. He is beginning to measure up to his father. Which is some good growing, type 1 diabetes aside. Yay!

***

And I haven’t even mentioned daughter M. Who grew like a plant as well, and was the only one in the family who turned the colour of a nut effortlessly and has French style, with scarves and tank tops and gladiator sandals and sunglasses, like nothing I’ve ever seen. Who is only now four inches shorter than me. Who will pass me in height in oh, two years or less. And I will be the short, comparatively squat one in the family. It’s alarming. Really wild. I always thought I was tall. 5’7″ is pretty tall for a woman. Isn’t it? Isn’t it?!

But I’m surrounded by lean, soaring, willowy folks. Of whom I’m so proud. Sniff.

Cleo, E and M. Must be something in the water.

Things were so fraught last week that although I had a lot to say, it all slipped out of my grasp…. We boarded the internet-less boat called ‘Holiday in a Hot Place’, and I left everything dangling.

And here we remain for another week and a bit. Several days in, we are unwinding, reading a book every two days, eating lots of tomatoes and soft cheeses. Not to speak of wine tasting!

E’s numbers are so far so okay, though early on an approaching cold combined with pizza weirdness sent him into a nasty, throwing up hyper (>15 mmols) that took us hours to conquer through 200% temp basals and overriding pump corrections…. The cold itself was hardly anything by comparison. Grrr.

Other than that, all the pool play and walking has meant hours off the pump, 50% temps and still having good numbers for the most part. Mornings tend to be a little high, but this is a holiday pattern: he seems to particularly GROW over breaks! We are also having more slow-digesting food than usual – pasta, rice, lentils – so OH and I are up once again every night testing dual waves – but with life this laid back it’s hardly noticeable.

Which shows how not laid back life normally is, sigh.

I’ll sign off now until after 9th August. A bientot.

— Posting on the move, tiny screen!

But we don’t. After thinking the high numbers of the last post were set probs etc, here we are on the third day since the last change and ALL IS WELL. A relief. Stable ish numbers. A night’s sleep….

And lovely Cleo has passed the worst of being on heat. After two nights locked in the bathroom she’s to all of our great reliefs a bit more settled. Phew! No more earplugs, and a bit happier a cat….

Finally, exams: I phoned the school and they suggested 10% extra time to account for E’s lack of concentration. Which he has done.

It’s good to get in the habit of being obvious and up front about all this: hypo or hyper, he can lose at least 15 mins of a test to treating it. Now, he’s a VERY bright boy. He would do ok no matter what. We know this. The school know this.

But he never complains. He gets on with things. He thrives and excels. So when he says he thinks his performance is affected by his diabetes, the school listens. They want to set up similar formal provisions for him for GCSEs. Just to give him the best of all possible worlds.

They believe in him and trust him. I was quite choked up on the phone, hearing how much they thought of him. In his RS public exam the next day (part of a GCSE) his numbers were fine. But arrangements had been made for him to sit close to the door. All of the invigilators knew the situation. He came home saying he felt so much better now that nothing was unknown. Before he had gone into every exam explaining…. Uncomplaining and necessary, but hard work I’m guessing before an exam.

Anyway. For the first time I feel, tentatively, that the school is beginning to understand….

***

Morning at the hut.

– Posted using BlogPress from my iPhone

As a correlate to yesterday’s bizarre morning reading: it happened again this morning!

Only thing is, we sent him to bed on 9.4mmols — considerably higher, just in case.

And the just in case came true: woke on 4.4mmols. A good number in itself, but…

A drop of 5mmols, two nights in row. All of a sudden.

Seems to be fighting illness? Very tired?

We can’t figure out whether to change the insulin dose (which will guarantee, as is the way with diabetes, a sky high shoot for no apparent reason!), or to just wait this out…

Objectively, it’s kind of interesting to think that maybe E being busy and a bit stressed interrupts the growth hormones or something…? That’s all we can think of. It seems to be these pesky growth hormones anyway which cause so many irregular highs — why not irregular drops, as well? And is this what happens in our bodies all the time, only we don’t know it…?

***

Today E has a GCSE (big exam) component to take — in Physics. We under-carbed breakfast a little, so he wouldn’t risk going low. The exam is mid-morning, traditionally an okay time of day for him — but he’s been known to drop like a stone after 10am…so we wait! Sent him with fruit pastille sweets and a box of apple juice.

Just in case!

***

After a dull morning, the sun is out again, although the wind is biting biting cold.

Setting sail

In November 2008 my 12 year old son was diagnosed with type 1 diabetes. The effect of this event on me -- and on our nuclear family -- was like being thrown overboard and watching the ship leave.

'Dealing with type 1' in the family has morphed into another sort of 'dealing' -- a wholesale resituating of parenting, of family dynamics...of life.

At my son's diagnosis I could not to locate a record of what living with a type 1 child in the family is like. I could not see myself or our family anywhere. I longed for a starting point, a resource and a sense of the future. Being a writer, my instinct is to write it. This space, I hope, is a start.

Blood Sugar Ranges (UK)

<4 mmols = low or hypo, life-threatening if untreated
4-8 mmols = within target range
8-13 mmols = high but not usually dangerous
14+ mmols = very high, or hyper, life-threatening if untreated

Bubbles

Enter your email address to subscribe to this blog and receive notifications of new posts by email.

Join 28 other followers

Distance Travelled

Disclaimer

I am not a medical professional. Any view expressed here is my opinion, gleaned from experience, anecdote or available research.