Wednesday, November 18, 2015


Blood results

18.1 121.10 5.10 18.09 10.09 3.07 17.06 9.06 Normal
Hb 87 107 95 106 81 104   107 93 130-180
WBC 1.76 1.8 1.95 2.53 2.39 2.85  2.85 2.55 4.5-10.0
N'phils 0.46 0.57 0.87 1.05 1.02 1.16  1.17 1.14 2.0-7
Plt 221 202 225 2.41 2.41 249  232 296 150-450

October 21 Neutrophils were incorrectly recorded last time, corrected in this post, and they have now fallen below 0.5. Consultant decided I should take a holiday from Hydroxycarbamide for the next three weeks and then review the results again. He thought Hb might also recover a bit, an opinion I don't share. Its at about the level I had the last transfusion, and I will be surprised if I don't need one again after the next test.

I raised the problem of the ulcer on my left ankle, which has continued for 6 months, and the consultant is referring me to the specialist ulcer nurse.

PS Friday 15.00: on returning from the House just now, I found a message on my answerphone asking me to come in next Wednesday for a blood test and possible transfusion. Neutrophil count of less than 0.5 x 10^9/L is classified as severe neutropenia. I've cancelled the meeting I had on statelessness that morning, a second meeting to discuss the UK's policy on Eritrea, and an evening meeting I was scheduled to chair on Gypsies and Travellers.

PPS Letter from consultant to GP (in part):

I note a gradual drop in his white cell count despite the gradual eduction of his Hydroxycarbamide dose. His neutrophil count is 0.46 and he understands that he is neutropenic and he will require prompt medical attention if he should feel unwell or have fevers. We shall withhold Hydroxycarbamide from today.. He is okay with his current level of haemoglobin at 87 but if his symptoms of tiredness worsen he knows to contact us to organise a blood transfusion.

With regard to his chronic leg ulcer I shall write to the tissue viability nurse specialist to organise a clinic review......

We shall review him again in three weeks' time to see if his counts have picked up after stopping the Hydroxycarbamide completely. If there is no further improvement we shall consider doing a bone marrow aspirate/trephine biopsy. I will check his blood film today, to look for sny circulating blasts and report back.

With regard to his chronic leg ulcer I shall write to the tissue viability nurse specialist to organise a clinic review......

Blood film showed macrocytosis [see}, aniso-poikilocytosis [see}, neutropenia and adequate platelets with no evidence of clumping. No circulating blasts seen

The problem with this plan could be that my platelets will go through the roof, the reason why hydroxycarbamide was prescribed in the first place. So far that strategy had worked, juggling the dose after each consultation, but clearly the time has arrived when a Plan B is necessary.

Its good that no circulating blasts (immature cells) were seen, because that would have meant that the disease was getting to a new stage. The blasts release chemicals that cause the bone marrow to fill with scar tissue, further impairing its ability to produce healthy cells.

The median survival of all patients with myelofibrosis is slightly higher than 5 years, so I have been lucky to get to four and a half years without having to give up working. Anyway, watch this space.

Sunday, November 15, 2015

Family graveyard

Today we had lunch with Sue and Lyulph, and visited the family graveyard. Unsurprisingly, as its a small area within land owned by Bromley Council, it hasn't been looked after and is sadly unkempt. The memorial stones to my grandfather and some of his descendants were vandalised at some point in the past, and the ones that could be salvaged were moved into the church graveyard 100 m or so away. Now that I expect to be a new resident in the family patch within nine months or so, we thought it would be good to have it cleared, and for the boundary to be demarcated - by coordinates, I suggest. Lyulph has had some preliminary conversations with Bromley Council and will pursue the matter in the near future.

Thursday, November 12, 2015

Sheikh Ali Salman's trial postponed again

 Statement by the main opposition in Bahrain, Al-Wefaq, about Sheikh Ali Salman's trial
The Bahraini regime courts have adjourned the hearing of Sheikh Ali Salman, opposition leader and Secretary General of Al Wefaq National Islamic Society, to December 14 citing reason that only part of the bench attended.
Sheikh Ali Salman was not brought into the court to attend his hearing. Lawyers said this gave negative signals as to the nature of the trial.
Salman is being tried for political activism and expression of political opinion. He was sentenced to four years in prison last June.
The defense team reiterated its requests before the court to allow Sheikh Salman to see the lawsuit papers after the prison administration violated his right to confidentiality of communication with his lawyers, that is, besides standing on the prosecution side and building the case and accusations against him.  
Al Wefaq stressed that the continuation of the trial which was described by international human rights organizations, observers and states, to be lacking the fundamental standards of a fair trial indicates the malicious motives behind the case. It must also be taken into consideration that the defense team was prevented from doing its job prior to the issuance of the sentence and during the appeal process; these facts make certain that the trial is politically-motivated.   
The adjournment of the hearing is aimed to buy time for developments.
Al Wefaq is demanding the immediate and unconditional release of Sheikh Ali Salman who is a patriotic national figure and should not be in jail. The continuation of his trial and imprisonment clearly demonstrates political reprisal, especially as consecutive international calls condemned the arrest.
The statement of the UN Working Group on Arbitrary Detention in which it said Salman is being arbitrarily imprisoned, and the statements made by the Department of State’s spokesperson who called on Bahrain to drop the charges and respect freedom of expression and assembly, make clear that there is no justification for the continuation of his detention. Further, they highlight the fact that the Bahraini Authorities are insisting to walk in the wrong direction.  
Sheikh Ali Salman enjoys a popular position between his people and wide respect by the international community, thus, the authorities should not take uncalculated and reckless decisions. Such vengeful methods only complicate the crisis and move the nation farther away from an inclusive and genuine political resolution. Bahrain needs a comprehensive national review based on the interests of the country and its citizens.
The release of Sheikh Ali Salman would represent the first step to a suitable environment for a real dialogue to reach a political settlement.
Prominent human rights organizations like Amnesty International, Human Rights Watch and the International Federation for Human Rights have all called for the immediate release of Salman, naming him a prisoner of conscience. Bahrain is yet to respond to Prince Zaid, the High Commissioner of Human Rights at the UN, who also urged for Salman’s release.
I have asked Foreign Office Minister James Duddridge MP to demand Sheikh Ali's unconditional release, as the UN High Commissioner for Human Rights and the US State Department had already done. The UK's policy has always been that Bahrain's constitutional and human rights problems can only be resolved by a meaningful dialogue between government and opposition. This can't happen when the Leader of the Opposition is in custody on trumped-up charges.

London Bach society's 25th anniversary Bachfest, on the Leipzig Inheritance

To St John's Smith Square for a memorable LBS concert, dedicated to the memory of their late and much-loved  cellist Jennifer Ward Clarke, who died in May.

Ach Gott, wie manches Herzeleid (O God, what manifold distress) BWV 58, was followed by Suite No 2 in B minor BWV 1067 with Rachel Beckett on the flute.

After the interval we had Ich habe genug (My cup is full) BWV 82 with Peter Harvey (bass). Listen to him singing the aria Schlummert ein, ihr matten Augen (Fall asleep, weary eyes), one of my all-time favourites:

And finally, Ich geh' und suche mit Verlangen (I go in search with longing) BWV 49 with Peter Harvey again and Ruby Hughes, soprano.


Wednesday, November 04, 2015

Incorrect advice by the Government on citizenship

A correspondent has drawn my attention to the failure of the Government to post amendments that were made to the British Nationality Act 1981 by Parliament in the Immigration Act 2014 on the official Government website. The amendments were to add Sections 4E to 4J, enabling certain children whose parents weren't married at the time of their birth to acquire British citizenship.

I am tabling a question asking the Government to update the advice on their website, and to amend the site

It is unacceptable that false information is allowed to remain on the web on such an important matter as entitlement to citizenship.

Investigatory Powers Bill

In 2012 Theresa May and the Tories tabled plans to force internet service providers to keep a record of all your texts, emails and every website you visit.

That was a huge invasion of our privacy, an unprecedented a precursor attempt to get hold of everybody's personal data.

The Liberal Democrats were clear then, and are clear now, a snooper’s charter has no place in Britain, so we blocked it.

Theresa May’s revised plans that are published today are another attempt to sneak these provisions back in again.

The Liberal Democrats will fight any attempt to bring back the so-called Snooper’s Charter under a different name.

Sunday, November 01, 2015

In March 2013 Parliament decided to make caste a protected characteristic in the Equality Act, after the Government were defeated twice on the issue in the House of Lords, and there was no time for them to reverse that decision in the Commons before the Dissolution. But they made no secret of their antipathy to the proposal in their dealings with the Hindu Forum, a powerful lobby group which defends the caste system by pretending that discrimination is non-existent in the UK. It would be remarkable if the large diaspora from south Asia had indeed abandoned such a deeply persistent cultural norm in their travels, and in spite of the formidable obstacles to  litigation against caste discrimination under existing equality law, the recent case of Chandhok & Anor v Tirkey demonstrated that in certain limited circumstances, the courts would find in favour of the victims. The Government then said they were studying the implications of the Tirkey judgement and had to 

"consider carefully whether putting the word “caste” into the Act would actually change or clarify the legal position". []

The fact is that it would remove the barrier to litigation arising from the wording of the Tirkey judgement, which applied only in the particular circumstances of that case. Victims of caste discrimination would have to satisfy the court that they were covered by that judgement, adding to the burden of proof and to their costs. Legal certainty can only be achieved through the implementation of Parliament's two and a half year old decision, which the Government's 'careful consideration' is a preliminary to repealing. 

The Tories have decided, I fear, that the higher castes represented by the Hindu Council need to be placated at the expense of the Dalits, who are generally the victims of caste discrimination here in the UK, as they are still in south Asia. The Government should tell the Hindu lobby that the Equality Act as amended will protect victims of discrimination no matter what their caste in the situations it covers []. High caste Hindus have nothing to fear if they refrain from discrimination, and the amendment is no more a criticism of them as a community than the equivalent sections dealing with racial discrimination are aimed at groups of a particular ethnicity.

Useful article in The Economist

Friday, October 30, 2015

Saudi Arabia in Yemen: humanitarian disaster and possible war crime



11.18 am
Asked by Lord Avebury
To ask Her Majesty’s Government what discussions they have had with the Saudi-led coalition in Yemen on restoring peace in that country.
The Earl of Courtown (Con): My Lords, the United Kingdom Government are in regular contact with the Saudi authorities, including through our embassy in Riyadh and our Yemen office based in Jeddah. The Secretary of State for Foreign and Commonwealth Affairs visited Saudi Arabia earlier this week and underlined the importance that the United Kingdom attaches to finding a political solution to the current crisis as soon as possible. He also reinforced the necessity of full compliance with international humanitarian law and of facilitating access for humanitarian and commercial shipping.
Lord Avebury (LD): My Lords, the Yemen operation has left 5,000 dead, 26,000 injured, 2.3 million internally displaced and 21 million in need of humanitarian assistance. If we agree with the Brookings Institution that al-Qaeda is the principal local winner of this war and with Human Rights Watch that Saudi attacks on IDPs and humanitarian aid are violations of the laws of war, will the Government use our presidency of the Security Council in November to promote a truce and to call for the withdrawal of all foreign forces in Yemen?
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The Earl of Courtown: My Lords, the noble Lord is right: the situation there at the moment is dreadful. In July it was declared a level 3 emergency, which is reserved for the worst humanitarian crises—shared only, I am afraid, by Syria, Iraq and South Sudan. As the noble Lord said, the intensified conflict has now displaced nearly 2.3 million people. He asked whether there is anything that we can do during our presidency of the Security Council. I will pass on his question to my colleagues in the department, but I can say that UN special envoy Ismail Ould Cheikh Ahmed briefed the Security Council in open session on Friday on his plans for further political negotiation. That is something that we are very pleased about.
Lord Anderson of Swansea (Lab): My Lords, does the noble Lord agree that there is a real danger of misreading the situation in Yemen by focusing on the Shia-Sunni divide or on the Saudi-Emirati opposition to Iran and failing to appreciate the fundamental importance of clan and tribal loyalties? Does he also agree that we have a major interest in preventing yet another failed state in the region sending waves of migrants to Europe, adding to the 1 million who have come to our shores over the past year?
The Earl of Courtown: The noble Lord makes a very good point relating to the tribal issues in Yemen that make it increasingly difficult, and always have made it very difficult, to manage. As far as migration is concerned, it is very difficult to compare different areas, and of course this is very different from, for example, Syria. However, we will keep a very close watch on what is happening there.
Baroness Warsi (Con): My Lords, what is the Government’s assessment of the comments made yesterday by the Saudi Foreign Minister, Adel al-Jubeir, who said that the military campaign is now nearing its end?
The Earl of Courtown: My Lords, at last night’s press conference in Riyadh, held jointly with my right honourable friend the Foreign Secretary, the continuing situation in Yemen was discussed. As my noble friend says, it is the case that the military campaign is coming to a close as the coalition forces have established a dominant military position in the country. We now focus on the agreed shared analysis of the need for accelerating the political process.
Baroness Kinnock of Holyhead (Lab): My Lords, will the Minister tell the House exactly why the UK Government continue to license arms to the Saudi-led coalition that is bombing Yemen? As we have heard, more than 5,000 civilians have been killed. Can the Minister give us proof that no British exported weapons, including British-made military planes, are being used to commit violations of humanitarian law?
The Earl of Courtown: My Lords, the noble Baroness, with her great knowledge of this area, asks some questions to which I am afraid I do not know the answer. Munitions are supplied to the Saudi air force, and the UK operates one of the most rigorous and transparent export control regimes in the world.
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Lord Green of Deddington (CB): My Lords, I welcome the Question from the noble Lord, Lord Avebury. As it happens, Yemen was my first post and Saudi Arabia was my last. I suggest to the Minister that we should focus our efforts on the humanitarian aspects here, partly for the reasons given by the noble Lord, Lord Anderson. It is a hugely complex situation, internally in Yemen and externally in the regional powers. The best thing that we can do is to increase our aid to those many millions who are suffering dreadfully.
The Earl of Courtown: The noble Lord, Lord Green, is quite right, in so far as we have to focus the aid so that it gets to the people who need it. However, as the noble Lord is also aware, the logistics of getting it there are proving very difficult.
Lord Ahmed (Non-Afl): My Lords, is the Minister aware that, according to the BBC, war crimes have been committed, probably by both sides, by targeting civilians and world heritage sites, and that on Tuesday, a hospital was bombed as well? Will Her Majesty’s Government support an international investigation into these deliberate attacks on civilians?
The Earl of Courtown: My Lords, as the noble Lord said, issues relating to activities on both sides are causing great concern—whether it is the bombing of a hospital, the use of child soldiers or the use of schools and hospitals for military purposes. But the noble Lord will also be aware that any judgment on whether specific international crimes have occurred is a matter for international judicial decision rather than for Governments and non-judicial bodies.
As far as the Médecins Sans Frontières hospital is concerned, which I think is what the noble Lord was referring to, we are aware of the alleged air strike by the Saudi-led coalition and we await further news on that.
Lord Wallace of Saltaire (LD): My Lords, we must admit that the British record in controlling Aden was not particularly wonderful and that Yemen has never been an entirely coherent state. Britain now prides itself on the closeness of its links with Saudi Arabia and the GCC coalition that is intervening. Can we be assured that conversations with the Saudis on what is happening in Yemen are close and confidential and have not been adversely affected by the recent letter from the Saudi ambassador in London?
The Earl of Courtown: My Lords, we continue at all times, as the noble Lord is aware, to have talks at the highest level on all these issues.
Lord Collins of Highbury (Lab): My Lords, in view of the reports of violations of serious international human rights law committed by parties in Yemen, does the Minister support the establishment of an international commission of inquiry to investigate these allegations?
The Earl of Courtown: My Lords, the UN Human Rights Council, which I think the noble Lord was referring to, has no mandate to call for IHL investigations. Resolutions contain mechanisms for monitoring the
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human rights situation in Yemen. There was recently an agreement on a single text in the Human Rights Council to call for consensual resolution of the position in Yemen.

Monday, October 26, 2015

Cardiology October 14

Dept of Cardiology, King’s College Hospital, 14 October 2015

This 87-year-old gentleman was reviewed today in Professor McCarthy’s clinic with a remote history of bypass grafting in 1995 (LIMA to LAD, RIMA to OM, SVG to diagonal and RCA).  There was an angiogram in 2014 prior to undergoing vascular intervention which showed that all of his grafts are patent.  He underwent left leg angioplasty a few months ago for critical ischaemia of the limb and has previously had an EVAR in 2010.  His main ongoing problem at the moment seems to be related to myeloproliferative disease with anaemia and increasing need for transfusion.

This gentleman attended today along with his wife and from a cardiology point of view he is actually asymptomatic with respect to any undue shortness of breath and he does not experience any angina whatsoever.

His exercise tolerance is very much limited by general fatigue secondary to the myeloproliferative disease and he does not describe any features of incipient heart failure,