Hospital

Tomorrow I'm going in to King's College Hospital for an operation on my leg to deal with an occlusion extending most of the way from groin to knee. First an angioplasty will be tried (http://bit.ly/1R1OSj5) and if this can't be done the artery will have to be replaced by a graft from the vein in the same leg. Angioplasty is relatively simple, involving one night in hospital, but if it needs a graft that would be a week or more.

While I'm in hospital, Lindsay or JW will post bulletins on this blog to save having to write to everyone individually. Hope to be in touch personally before long.

The House magazine, a weekly journal of Parliament, asked me to write a Diary piece on a week in the Lords, and I reproduce below the copy I sent them. They made an editorial decision to delete the first paragraph when it was too late for me to object, but some readers would have been amused by the anecdote about Patrick Cormack, so here is the unexpurgated text.

They said they had checked with Lord Cormack and he couldn't remember the incident. However, I dare say the records would confirm that my final article as opera critic, appeared some 30 years ago.

It was so exciting to be asked to write a diary for the House Magazine, some 30 years after I last appeared in their pages. My daughter was acting editor of the magazine at the time, and I was just settling into a new career as the opera critic when Patrick Cormack, then Chair of the Editorial Board, discovered this innocent piece of nepotism and I was summarily dismissed!

The Lords is meant to be a self-regulating House, but it does a bad job of controlling the length of questions.  David Alton asked about people trafficking recently. He took 142 words to put his supplementary, but the Minister Joyce Anelay,  Leader of the House, averaged 158 words in her first two replies.  

This week again Joyce Anelay took 152 words to answer a question, but two new Ministers beat her record with 155 and 181 words respectively.

When Ministers so flagrantly abuse the Companion to Standing Orders’ limit of 75 words, its not surprising that backbenchers ignore it widely too.

I was delighted that Rob Marris MP, who drew No 1 in the Commons ballot for Private Members’ Bills, is bringing forward the Assisted Dying Bill, which had a thorough discussion when Charlie Falconer introduced it in the Lords in the last Parliament. 

That Bill ran out of time, but the largest ever poll on assisted dying conducted  in its wake showed that 82% of public support law change. There’s a very good chance it will get through unscathed this time, and I look forward to serving on Dignity in Dying’s Parliamentary Advisory Group, which meets for the first time on Thursday.  

I’m expecting to die of myelofibrosis, a form of blood cancer, around July 2016, so it will be good to be one of the first to have the right to an assisted death.

In the debate on the Queen’s Speech I spoke about the growing menace of the IS – or as I prefer to call it, the Daesh, since it isn’t a state. These terrorists now occupy huge swathes of Iraq and Syria, and are metastasising into the rest of the Arabian peninsula, South Asia, North and West Africa.  I pointed out that the Wahhabism of Saudi Arabia is similar to the theology of the Daesh, which in fact uses Saudi textbooks on Islam in its schools.

The difference between them is political rather than theological, because of the Daesh claim that its caliph has jurisdiction over the whole of the ummah – the worldwide Muslim communities - and its practice of killing infidels in territory under its jurisdiction who refuse to convert to its particular version of Islam.

In their use of cruel and inhuman punishments for expressions regarded as blasphemous, the Saudis are no different from the Daesh.

On Thursday last week when I asked a Question about the barbarous and inhuman punishment of 1,000 lashes on Raif Badawi, the Saudi blogger and founder of the Liberal Saudi Network, concern was expressed on all sides of the House.

Joyce Anelay, who replied, didn't say whether she agreed that it was inappropriate for a country with such laws to be a member of the UN Human Rights Council and whether the UK would try to get Saudi Arabia removed from the Council.

The second round of 50 lashes was postponed on Friday without explanation, and perhaps the weight of international opinion calling for an amnesty may prevail on this occasion. But it's the ideology that lies behind the sentence, a cancerous growth on Sunni Islam, that is the real problem.

Update on Lindsay's and my operations

Lindsay goes into King's tomorrow at 06.00 to have a kidney removed by keyhole surgery, and Victoria comes to stay for the next four days to mind the shop and make sure I don't fall getting into or out of the bath. The hospital reckons she will be in until the following Monday, but she will have to kahe it easy for a couple of weeks after being discharged

Unfortunately L had to spend much of the day wheeling me to a series of appointments in King's starting with a scan of both legs at 11.15. An ultrasound scan of the bad leg later, to see exactssly how far down the occlusion extends, and ending with a consultation with Professor R at 15.15. Much to our surprise, he said they were going to attempt an angioplasty as Plan A, and if that doesn't work they would do the full replacement of the occluded section with a graft from the vein in the same leg immediately. Its good that the surgeon thinks there is a good chance of success with the angioplasty, though it might have been a better bet four years ago when the occlusion was first scanned.

The bad news is that the operating list is full up for the next two weeks unless a patient cancels, and its no fun having to live with a painful leg for the next two weeks minimum. I take Tramadol and Panacetamol but they don't seem to work too well at night and I never get a good night's sleep.

Speech by Shaan Taseer, son of assassinated Governor Salman Taseer, June 18

Below is the text of the speech by Shaan Taseer at a Press Conference in Committe Room G, House of Lords, chaired by Baroness Berridge, on June 28. Shaan Taseer is the son of the Governor of Punjab, Salman Taseer, who was assassinated b his police bodygaurd Mumtaz Qadri on January 4, 2015, as the Governor was about the get into his car in Islamabad, capital of Pakistan.

Qadri was  sentenced to death at a court held in the high-security Adiyala prison in Rawalpindi.

The murderer's family said they were very happy that he had committed this crime, and dozens of people gathered outside the prison chanting pro-Qadri slogans after the verdict was announced.  

The demonstrators were angry that the Governor had criticised Pakistan’s law against blasphemy. He had supported Ms Sherry Rehman MP, who introduced a Bill to amend the law to make miscarriages of justice less likely and remove its death penalty.

"Ladies and Gentlemen, distinguished guests. Thank you for this opportunity.

In the last thirty years, ever since the Soviet invasion of Afghanistan, as a result of which, many seminaries were established and promoted for the purposes of recruitment and indoctrination to fight the Afghan war, there has been a systematic and premeditated genocide of Shias in Pakistan by well armed and well trained groups such as the Sipah Sahaba and the Lashkar-e-Jhangvi. This genocide has been witnessed and documented by the UN, Amnesty International, Human rights Watch, The Human Rights Commission of Pakistan and various Shia groups in Pakistan and abroad.

They are no accurate numbers, but some online Shia groups have documented 1,200 reported attacks on the Shia community since 2002. More worryingly, whereas thirty to forty attacks took place a year until 2011, in the last three years we have witnessed an average of over three hundred attacks a year. So the rate of killing has gone up exponentially, possibly coinciding with the Taliban gaining a foothold in Pakistans Northern Tribal areas, as well as the groups mentioned above, consolidating their positions after a ban on them in 2002.

Whereas the mainstream print and electronic media has described this as “terrorism”, this is not an entirely accurate or complete depiction of the picture on the ground. The groups who are exterminating Shias are not doing so to pressure the government or the public into accepting any political demands. The aim, for which they were formed, is to fulfill their religious duty to exterminate Shias and to establish a Sunni state in Pakistan.

These aims have been well documented over the years in many places. Firstly we have multiple Fatwas (religious decrees that are binding on their followers) to this effect. We also have pamphlets and other literature calling for the blood of Shias. The leaders of the organizations I have mentioned above, as well as the clerics of many allied seminaries have spoken publicly apostatizing Shias, which is all commonly available on social media, as well as having played on mainstream television. Furthermore, and most insidiously, the methods employed by the Lashkar-e-Jhangvi are systematic and methodical; to ensure the cleansing of a community. First of all they strike at places of worship. Secondly they target Shia neighbourhoods. Here the Shia Hazara community in the North of Pakistan is most vulnerable, as they live in ghettoised neighborhoods and valleys, and as such have seen the worst of this holocaust. Shias are particularly targeted when travelling together by bus, as that makes for an easy target. And thirdly, and most sinister, prominent members of the Shia community are identified and murdered. In the last year alone seventy Shia doctors were assassinated. Many more have left the country and sought asylum. So there is no ambiguity as to who is behind the genocide of Shias and what their motivations are. What’s more, these groups have proudly taken responsibility for many attacks and promised more.

Once it is established that someone deserves to die on the basis of religious differences, it doesn’t take long before a religiously mandated cleansing of Shias transmogrifies into genocide of all minority communities. And that is what is happening in Pakistan, at an increasing rate. Ahmedis and their places of worship have been attacked; Christian communities such as Gojra and Joseph Colony have been burned to the ground. Churches have been bombed all over the country, Hindu temples burned. My father was not killed by the Blasphemy law. He was killed for standing to prevent the genocide of minorities. The Blasphemy law is just one instrument in this bloodletting. If Aasia Bibi had been a Muslim woman there would not have been such a fracas over the issue, as there hasn’t been in the case of Junaid Jamshed, a pop star turned Deobandi television evangelist who made some offensive remarks on television, or Khalid Chishti, a cleric who desecrated the Holy Book himself, and placed the evidence to falsely accuse a twelve year old Christian girl. The blood lust we see in Pakistan today is for the minorities.

I have many Christian friends and it is sad to see that the current generation, more often than not, give their children Muslim names so as to prevent a life of discrimination. Right here we see the erosion of a cultural identity.

As I mentioned earlier, there is a complete denial of this genocide in all mainstream media. No newspaper or public figure has yet mentioned the word “genocide” in the context of Pakistan. This is despite the fact that the Genocide Convention of 1948, to which Pakistan is a signatory, describes even the intention, the incitement, the attempt or complicitness in genocide as part of the crime. We do, however, know there is nothing new about this denial. Experience from most theatres of genocide, including Rwanda, Bosnia and Darfur, shows that there is always reluctance on the part of society to acknowledge this crime. The reason for bringing in these comparisons is to show that Pakistan fits a pattern of behavior that is quite typical of theatres of genocide, such as the classification of communities, dehumanisation, ostracisation, organising and arming against them, the preponderance of hate material, and an apparent immunity to law. In the case of Pakistan, in addition to these warning signs, we also have the death of thirty thousand Shias.

Unlike the people of Pakistan, my audience lives in a country where the state protects their rights, and upholds the rule of law. You all therefore have the ability to express yourself freely without any risk to yourselves. Can I therefore please take this opportunity to ask you all in the name of humanity, to raise your voices against this genocide, with the British government, your MP’s, the Foreign Service, the Pakistan High Commission, the International media, and the British public. Change can only begin with awareness.

This is after all a human issue not a Pakistani issue, and genocide is perhaps the worst thing that mankind can do to itself."

Thank You

 

Leg artery bypass

Spent 13.00 to 17.00 in haematology outpatients to review status following Tuesday and Wednesday totally zonked. They couldn't see a direct cause, but it became clear later.

After that, a discussion with vascular consultant, who said the scan I had on June 10 showed left femoral artery is blocked down as far as the knee, and he recommends replacement by a venous graft. The only alternative would be to do nothing, which would mean that the artery blockage would extend still further, so that the leg would have to be amputated. He wants three further scans, which can probably be fitted in next week,so that my operation might even overlap with Lindsay's, next Thursday. I could be in hospital for up to a week, followed by several weeks' recuperation.

Mr M says that King's perform dozens of these operations, many of them on patients in a worse condition than mine. Although there are obviously some risks, the quality of life improvements make it a no-brainer, and Lindsay agrees.

Blood results last 8 months below. Platelets continuing to fall, so hydroxy- carbamide reduced to three days a week pending further consultation next Wednesday. White blood cell count also continues to fall. Hb has gone up a bit, as a result of the transfusions I had last Thursday and Friday.    17.06 9.06 27.05 25.03 2.03 21.02 24.12 26.11 Normal Hb 107 93 96 98 98    101 104 109 130-180 WBC 2.25 2.55 2.91 3.15 3.36 3.52 4.00 3.02  4.5-10.0 Neutrophils 1.17 1.14 1.3 1.57 1.78    1.6 1.8 1.16 2.0-7.5 Plt 232 296 342 369 449    494 551 391 150-450

Letter from consultant to GP of June 17:

I reviewed Lord Avebury in clinic today. His left leg perivascular disease symptms hae progessed further. For he last few weeks he has bee having constant pain in his foot for which he is required to take Tramadol. Even then he is still waking up from the pain. His claudication symptom.. is now at very short distance.......More worryingly over the last few days he stated developing skin lesions which I examined today and they looked a ischaemic part of the skin.

He saw today the haematology team ... to see whether it has anything in relation with his haematology disorder and I will.... contact Professor M to have further feedback directly from him. However his left foot does look quite ischaemic today..... On the left hand side, he had progression of his short SFA occlusion which was picked up on the scan two years ago [it was October 2011 to be precise] now he has full SFA occlusion shortly after its origin and extends all the way to the poplitea. Beyond that the popliteal artery is damped with  very low flow of only 0.2 m's  and the ATA occludes at the origin, however his PTA and peroneal are patent all the way down to the foot with severe damped flow.

I explained the finding and I am concerned that now he has got critical ischaemic symptoms, this would need revascularisation based on his scan, therefore we will put his scan on our next MDM meeting to discuss this further. However, I have warned him that this might require also a bypass surgery rather than endovascular treatment, with complication of surgery including risk of bleeding, infection, pain, failure of bpass which might lead to limb loss or even death as a result of surgery.

To start with we can book a CT angiogram to look at the arterial tree fr target vessels as well as echocardiogram to assess his fitness and vein mapping. We will see him next week in the clinic to discuss the results and we will take it from there,

ATA = anterior tibial artery
SFA = superficial femoral artery

It seems to me that the vascular team are not keen on leg angioplasty, possibly because the occlusion tends to return. For patients with a short expectation of remaining life this may not be an important consideration

Saudi Arabia

Following my Parliamentary Question yesterday (bit.ly/1Gjv16R)about the barbarous and inhuman punishment of 1,000 lashes on Raif Badawi, the Saudi blogger and founder of the Liberal Saudi Network, concern was expressed on all sides of the House. The Minister who replied, Joyce Aneley. didn't say whether she agreed that it was inappropriate for a country with such laws to be a member of the UN Human Rights Council, and whether the UK would try to get Saudi Arabia removed from the Council

Transfusions

In the end I had two transfusions, one unit each, the first yesterday evening and the second this morning, each taking some four hours counting journey times etc.  They certainly made me feel better.

Lindsay's operation

Lindsay had an ultra sound scan followed by a CT scan which revealed a small lump on her right kidney.  The consultant at King's College Hospital advised thst because there was an 80% possibility that the tumour was cancerous,   the kidney should be removed.  This is a routine operation involving keyhole surgery  and a 4 day stay in hospital, then taking it easy for a week or two afterwards.  The consultant and others assure her that one can live perfectly well with one kidney (though he warned that contact sports, such as rugby football, should be avoided!)

She is having the pre-assessment next Monday, and the operation on Thursday June 25. Needless to say, she is taking it very calmly.

Not surprisingly, I've been feeling more tired than usual the last few days, but have also had much joint pain, an expected symptom of myelofibrosis. On an extra visit to haematology out patients paracetamol four times a day, and codeine twice a day was prescribed.

In view of the drop in Hb in spite of the reduction in the dose of hydroxycarbamide I will get a transfusion on Friday morning.

Blood results last 7 months 9.06 27.05 25.03 2.03  21.01  24.12  26.11 29.01 Normal Hb 93 96 98 98    101 104 109 100 130-180 WBC 2.55 2.91 3.15 3.36 3.52 4.00 3.02 3.10  4.5-10.0 Neutrophils 1.14 1.3 1.57 1.78    1.6 1.8 1.16 1.43 2.0-7.5 Plt 296 342 369 449    494 551 391 427 150-450

Tuesday at the House of Lords, with Hannah Couchlin, a law student at Dundee University studying Scottish and English law with a specific interest in human rights law, now assisting the All-Party Group on Child Health & Vaccine Preventable Diseases 

Jeremy Corbyn MP speaking at seminar on mercenaries in Bahrain June 2, 2015

Jeremy Corbyn MP, speaking a the seminar on Bahrain's mercenaries, the main tool of oppression.

Because the regime doesn't allow journalists into the country there is very little reporting about mercenaries in the mainstream international media. but evidence was given at the seminar by an independent journalist who went there as a tourist, and by the Islamic Human Rights Commission; Complaints are being made to the UN Working Group on the use of mercenaries as a means of violating human rights and impeding the exercise of the right of peoples to self-determination’