After reading about a menopausal werewolf (fictional) I decided that it was probably a sensible idea to read up on the reality.

Dr Lundy has an inclusive and relaxed tone of writing. She methodically goes through every aspect of the menopause in great detail. The book is sprinkled with humour to lighten what is otherwise an intimidating topic.

This is almost solely focussed on the medical side of menopause. While honest about the limitations of science (and the shocking lack of knowledge among some practitioners) it never lowers itself into the "woo" of crystals and chakras. It goes from a GCSE biology lesson all the way up to cutting-edge medical research. This isn't a casual pamphlet; you will almost certainly want to take notes.

Although it strives to be accessible, it does get a little bogged down in the science. There's an array of acronyms to remember, a hilarious assortment of product names (I'd love to see the marketing exercise which came up with Kyleena, Mirena, Provera, and all the others), and some rather tedious descriptions of exactly how many mg of X should be used in combination with Y.

At times it is like the book doesn't know if it is for the patient or the doctor. I suspect a few people will be put off by some of the overly formal and detailed descriptions of the exact biological changes occurring. It also is, frankly, not for the squeamish.

The books is divided into logical chapters. If you don't need to know about, for example, how Lupus affects the menopause, you can safely skip it. Each chapter ends with a few bullet points of practical information.

It is trans-inclusive - with a whole chapter about the realities of the experience, while being honest about the lack detailed research available.

One of the things which is missing is the role of friends, family, and wider society. There's nothing about accessing social support networks, or workplace adjustments, or how one's family can be useful. This is very much geared to "here are the medical interventions available."

It is also a little lax about privacy. There's a discussion about period tracking apps, but not about the data protection risks. Similarly, there's mention of a menopause discussion group for doctors which, of all places, is hosted on Telegram! I hope none of the 800 participants are sharing confidential medical data on there.

If you or someone you know is going to experience The Change, this is a good book. You may need to gird your loins for some of the more frank and intimate discussions, but Dr Lundy's warmth and humour do a good job of making a difficult subject accessible.

Last week, my lovely dentist fitted my two custom-made teeth. After all the months of drilling, screwing, photographing, x-raying, and prodding, the last fitting was little more than gluing. I now have two colour-matched gnashers installed in my bonce. And all my brain can do is scream…

ARGH! THERE'S SOMETHING IN MY MOUTH!

The first few weeks of having the teeth removed was weird. My tongue kept prodding the gaps as if it were hoping its friends had magically returned. After getting the healing abutments screwed in, I couldn't stop feeling the metal divots in my mouth. And now I have teeth again, the weirdness has returned.

Logically, I know my lips are constantly being touched by my original teeth. But now they're also being touched by new teeth - and that's all I can fixate on.

When I chew, my teeth grind against each other - as they have done for decades. Only now they're grinding against something which wasn't previously there.

The inside of the new teeth feel unnaturally smooth against my tongue. As though they are artificial constructs unwillingly transplanted to my face.

There are foreign objects in my mouth, protruding horrifically into my lips, attacking my teeth, and ensnaring my tongue. They are pushing against the other teeth in my mouth, crowding them out. I hate hate hate hate it.

I'm not normally someone who complains about sensory issues - and I know I will get used to it in time - but this is intensely uncomfortable.

At a hackathon last week, my friend Sidd brought along a 3D printer. How hard is it to convert a CT scan to a file suitable for printing? Slightly trickier than I expected! Most of the guides I found were outdated, or the software didn't work on Linux, or the instructions assumed a level of expertise that I just didn't possess.

So here's my simple guide to getting it working.

I used InVesalius 3 - specifically, the FlatPak version.

I opened the folder of .dcm files and loaded the record it found. From there, you can adjust the sensitivity of the mask.

That shows the 3D version which you can interact with. Then the surface can be adjusted - for example to select the largest area, or other attributes.

Finally, the data can be exported to STL.

Once exported, I opened it in Meshlab to view it.

You'll notice that there are still a few weird lumps in there. Ideally I'd find a decent 3D editor to smooth them out.

The Print

Sidd handled this for me. Rather than spending several hours printing a full-size model, we opted for a scaled down version which would print in about 45 minutes.

After removing all the support material - it looked pretty cute!

Close up, maybe less so 😂

ToDo

The resolution of a CT Scan isn't massive - 500x500px. So there will always be a limitation to the details it can pick out - and errors will creep in.

I don't have the skills to edit the file - but I suppose I can learn.

But, yeah, it's perfectly possible to convert CT Scans into physical objects.

Last week - following some dental trauma - I had another scan of my head. The dentist took great delight in showing me my bones in 3D. So I asked for a copy.

This was something he'd never done before! So, together, we navigated the software, found the export button, and generated a copy. Even zipped up it was half a gigabyte - a bit too much for email and, not unreasonably, he didn't want me plugging in strange USB devices to his medical equipment. So he sent it over WeTransfer. Possibly not the most secure method for my medical data, but I didn't really have time to set up a personal SFTP site or teach him about installing WSL so he could SCP the content. Ah well, needs must.

Unzipped, the folder was about 700MB. Of that, 400MB was taken up by the included Windows app "Ez3D-i". Unsurprisingly, it didn't run on Linux.

The other 300MB was taken up by 450 .DCM files. These are medical images in the DICOM format. This is a relatively open standard which uses JPG plus lots of metadata. There are dozens of Linux programs which can read this - although many haven't been updated in years.

The easiest GUI for viewing the images is Mango. It presents a view of the CT Scan that you can move around.

It isn't the most intuitive app in the world, but it is good enough for browsing the scan.

If you want a 3D model of your scan, I recommend Aliza. Again, not the simplest interface:

But once you get the hang of it, you can manipulate the 3D scan and view it from all angles. It's possible to peel away the soft tissue and do all sorts of other fancy trickery. Even on my laptop without a fancy graphics card, it was fast. Here's a quick animation showing the (false colour) version.

If you have had a CT scan, please do ask for a copy of the DICOM files. It is great fun to explore around your own body.

Now I just need to find a way to import this into my Meta Quest so I can enjoy these teeth in VR!

As per the meme:

• I've sat in the seat of a space shuttle.
• I still have two of my baby teeth.
• I used to be a voice-over artist.

Well, one of those truths is about to come crashing down.

When I was younger, I had two of my adult teeth removed. They were coming out at such a crazy angle that they couldn't be tackled with braces. So they were surgically yanked out. I was a teenager at the time and was told that, with care, my remaining baby gnashers would probably last another decade or so - if I remembered to floss.

Three decades on, and I thought the chompers were doing relatively well. Sure, they looked a little worn and stubby - but they had certainly exceeded their manufacturer's guarantee. My lovely dentist had been prodding at them for the last few years with increasing worry. But reassured me they were doing better than expected.

And then, one morning, one of the teeth suffered a catastrophic structural integrity failure.

WARNING Image of dental horror follows!

Aiii! Luckily it didn't hurt - although it did rip into my lip a bit. But it was clear this tooth needed something more drastic than extra-strength Colgate.

The dentist has whittled down the remaining fang to be a bit less stabby. Now I have to decide what I want to happen to the remainder of my tusks.

I've previously wondered about high-tech dental implants - but it looks like there's nothing available. No NFC, light up, Internet-of-Teeth for me!

So I guess I'm going under the gas once again. These old ivories are destined for the scrap-heap. Titanium implants with glow in the dark colour-matched crowns, I guess. I'm not sure I want to travel abroad to get the procedure done. It may be cheaper, but there's less recompense if things go wrong.

If you've have dental implants in the UK, and want to hit me up with strategic info, please use the comment box.

"Quite right!" I said, feverishly agreeing with his red-faced ranting, "Nurses should spend less time helping patients and more time ordering bandages!"

He paused, slightly, as the gears in his brain started grinding. "Well, no, not like that. Obviously."

I agreed again, "Too true. Doctors shouldn't be installing computers either. They should be co-ordinating those who install computers."

He spluttered, "You're twisting my words!"

But was I? Really?

I'm sure there is some waste in the NHS. There's waste in all organisations. But most of what people think of as bloated middle-management is the boring work of keeping an organisation running.

Once an organisation gets beyond a certain size, it needs people to help manage the organisation itself. I've worked at a startup where the engineers had to take time out of their day to build desks because the CEO didn't have enough cash to pay for delivery and assembly. I've been at corporates where managers spent about a day a week approving timesheets and running payroll - because a professional payroll department was too much of an overhead. Memorably, one company announced that they were getting rid of the tea-ladies who carted around an urn and selection of cakes - rather than having a cuppa at their desks, people left the building for half an hour on a group beverage run.

In all those cases, relentlessly focussing on the "core" mission had a moderate to severe impact on delivery.

Should we try to reduce the unnecessary administrative burden and overhead of our processes? Yes! That's an undoubted good idea. But what is "unnecessary"?

Here's the part where you tell me that the NHS shouldn't be providing... oh... I don't know... racial sensitivity training or coloured lanyards or pagers. Fine. Whatever. You have your bugbears and I have mine.

But the inescapable facts are that non-frontline services need to be performed to support the frontline. Without a payroll team to ensure people get paid, even the most dedicate nurse won't stick around for long. Without someone to tell the cleaners which toilets need cleaning, and researching the most cost effective way to buy bleach, and dealing with the fallout when there's interpersonal conflict - the dirt piles up and people get sicker. Without someone forecasting bandage use, the optimal number to have in storage, the rotation of stock, monitoring the quality of goods delivered - you end up with insufficient bandages or paying too much to store bandages.

Just because you don't understand how the world works, doesn't mean the world doesn't work properly. And just because the world is broken, doesn't mean it is broken in the way you think it is.

Let's get one thing out of the way first. I am not a doctor. I don't even play one on TV. This blog post is not medical advice.

A few years ago I was suffering from some gastric issues. The doctors had tried several things - including a colonoscopy - but found nothing. At the start of the pandemic, when it was impossible to get a GP appointment, I decided to try cutting out dairy. And that basically solved a lot of issues. Turns out, I may have age-onset Lactose Intolerance⁰.

Adjusting to it hasn't been so hard. I was already vegetarian, so switching to being mostly vegan¹ was pretty simple. But I miss proper cheese.

I occasionally take a Lactayse supplement if I know I can't avoid dairy. But that's a bit of a faff. And scientists haven't figured out how to permanently cure Lactose Intolerance yet² - they're too busy trying to cure cancer. Which is reasonable, I suppose.

And then I discovered Manzo Pharmaceuticals Lacto-Freedom. It's a 1 week course of probiotics which claims to give you several months worth of lactase-producing enzymes. Basically re-colonising your colon to allow you not to shit yourself every time you accidentally look lovingly at a slice of cheese.

Total cost including shipping from the USA was about £40. Pricey for a small bottle of pills. But, crucially, do they work?

The experiment

In order to do a proper test, I decided to experiment on myself. I ate some dairy-cheese, a couple of spoonfuls of yoghurt, and washed it down with half-a-pint of semi-skimmed.

The results were... look, do you want the gory details? There was sound, fury, spasms, bloating and - by the next day - I was literally a kilogram lighter³. So I think it's fairly safe to say that milk doesn't agree with me!

Treatment

The probiotics have to be taken on an empty stomach. Either an hour before eating or two hours after. Three times per day. No alcohol consumption - lest you sterilise the little buggers. And, obviously, no antibiotics.

The pills aren't large:

21 of those over a week. Then leave it another week to settle down. Then you should be able to consume dairy with impunity⁴.

The result

Like any probiotic, they can bubble up inside your guts. The pack came with a warning that they might cause stomach cramps. For the first couple of days of taking them, I was much more flatulent than usual⁵. It took a few days for things to calm down⁶.

I took all 21 over a week. Waited a few days. Then poured cow's milk all over my cereal. And...

…Nothing. My stomach gave a few little rumbles throughout the day. But I never experienced that it's happening feeling which will be common to so many of my LI friends. The little critters in my intestines chomped away on the lactose. I felt a little bloated, but nothing like I usually do.

I didn't go overboard with dairy⁷ over the next few days. A scrap of cheese, milk on my cereal, the occasional snaffle of chocolate. It all seemed to go just fine.

The "protection" is supposed to last for around 3 months. Is £160 per year a good deal in order to feel confident that you're not going to have an embarrassing moment if you accidentally eat an entire Edam? You tell me.

How does it work?

SCIENCE! A per their patent, they genetically engineered L. acidophilus MPH734. They tested its effectiveness on rats and humans.

But, it's important to note the disclaimer on their website:

These statements have not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure, or prevent any disease.

There is a clinical trial record - but no results have been published.

Should I take it?

I am not a doctor. I cannot give medical advice. I am not being paid to promote these. The pills haven't been officially tested in the UK, as far as I know.

But, reporting on this study of one person, these seem to work. I haven't tried stuffing my face with a thousand kilos of cheese - that's probably enough to overwhelm anyone's guts. But for managing the odd pizza, or cheese on crackers, or a packet of crisps inexplicably bulked up with milk powder - it's pretty good!

At every dental check-up my dentist prods them, gives them a wiggle, and sometimes takes an x-ray. "Well," they say, "They're fine for now…"

The "for now" is getting closer with every visit. At my last visit, the dentist started to talk to me about "options". It looks like the best thing is implants. A hole is drilled into my jaw (!) and a titanium screw is implanted (!!) then a crown is screwed into that.

But that's pretty boring! A ceramic crown is inert and - frankly - a little dull. But there doesn't seem to be anything else on the market. Here's what I want to see:

• NFC
  • I want my teeth to light up every time I bring my phone to my face - just like those cool LED fingernails!
  • Or, perhaps, just let my teeth carry a few bytes of data? Wouldn't it be cool to have my implants carry my private encryption key?!?
• Materials
  • It looks like my choices are a colour matched ceramic, or a "bling" gold plate. Perhaps with an embossed logo.
  • What about a "Willow Pattern"? Or something which looks like circuit boards? (Probably because no-one wants blue or green teeth!)
• Piezoelectric materials
  • I'm going to be chewing. That can generate electrical power. Probably not enough to charge my phone - but surely something?
  • Would chewing produce enough electricity to power Ultraviolet LEDs to help kill off bacteria in my mouth?

Isn't this a bit silly?

Yes. It's partly me dealing with the fear of needing someone to drill into my face. It's also the annoyance that I'll be paying several thousand pounds for something without an IP address.

If you're a dentist - or working on novel dental treatments - please reach out to me.

I'll never forget the look of horror on my professor's face when I told him I didn't think his university course was good value for money.

I was in the first cohort of UK students paying tuition fees. A massive £1,000 per year. A group of us had gathered to complain about the poor quality teaching materials on a specific course, the lack of contact hours, and decrepit facilities.

Value for money and - by extension - user choice, was an alien concept in undergraduate education. We weren't humbled by wise old men - we were paying a significant sum of money for a resource.

I went back to my old university a few years ago. The crappy computer labs have been upgraded, lecturers seem more engaged with students - rather than treating them as a distraction from research, and the students are more confident in demanding what they need.

A large part of this is because prospective students aren't choosing a course based on which campus has the cheapest beer any more. They're on social media talking to existing students, they're looking up the salaries of graduates, they're investigating the ratings of professors. If you were paying £9k, wouldn't you do the same?

That conversation was 20 years ago. Fuck. I'm old.

But the same conversation has been and gone with swapping energy providers. I was bemused when we moved into our new house to discover that the previous owners were stuck on the most expensive tariff from a company which took 30 minutes to answer the phone. Sure, not everyone cares about switching to the best deal, but within 15 minutes I saved £100s and swapped to somewhere with better customer service.

Like millions of people in the last few years, I've fired my phone provider. I recently told my bank to improve their services or I'd switch to one of those fancy app-only banks.

Nearly every service in the UK has undergone a radical transformation due to digital disruption. Users' expectations have been raised for quality and value for money.

Now the same transformation is coming for healthcare.

My local village pharmacy was crap. They were slow, inefficient, never answered the phone, and were downright rude. OK, their prices for an NHS prescription were identical to every other pharmacy - but I didn't feel like their service represented value for money.

I could have taken a bus to the nearest town and got my drugs from there - I'm lucky to have the mobility and money to do so. Instead, I swapped to an app-only pharmacy.

Echo post out my meds with no delivery charge. They send me reminders when they reckon I'm running low. If I'm away from home, they'll deliver to me. They don't shout out in a crowded shop "MR EDEN? YOUR EMBARRASSING OINTMENT IS READY!"

All I needed was a smartphone and an Internet connection.

I appreciate not everyone has these things. And not everyone trusts online services. That's fine. But most adults do. And there will suddenly be a tectonic shift when people realise that there is a better way of doing things.

The same is true of a regular GP visit. Do I want to sit on an uncomfortable chair, surrounded by ill people, waiting for hours because the previous appointments have been delayed? I might not be able to physically reach a different practice - even if their chairs are comfier - but I can swap to an online GP.

OK, a video chat isn't going to take my blood-pressure or hear my heartbeat - but it is great for a whole range of appointments. And if I don't want to look a doctor in the eye - due to anxiety, embarrassment, or even just time constraints - I can text chat.

I think every GP should have the best equipment, the fanciest chairs, the politest and least-stressed staff, super-fast computers, and plentiful appointments. They should all have amazing pharmacists who are discreet and caring.

But I'd still switch to something which was more convenient to me, better met my needs, and gave me an experience which I thought was higher quality. I suspect many people would.

This is the change that's coming. And it reveals some interesting questions:

• What happens to a GP surgery when the built-in pharmacy doesn't have enough customers to stay profitable?
• If "simple" consultations are replaced with video-chat / triage, does that leave more resources for others?
• Do certain GPs want to work in an area with low / no digital take-up?
• How many patients care about seeing the same doctor each time? Is that easier or harder via digital technologies?
• We used to have doctors which made house-calls. Now they can do so virtually, what new skills do they need?

And, the big one:

What user needs are unfulfilled?

Ten years ago, no one wanted an app-only bank. The world has changed. And that change is coming for you!

I spent some time with one group discussing the privacy implications of what they had built.

Thesis

By monitoring nearby Bluetooth devices, we can tell who has come in to contact with an infectious person.

We can warn people that they may have been exposed, and request that they seek treatment.

Terence Eden is on Mastodon

@edent

Replying to @edentTheory time! These students think they can passively collect Bluetooth MAC addresses.
If a person is infected with a communicable disease, they send their own address to the cloud.
If you've been within X distance for Y minutes, you'll get an alert. But won't know who from. pic.x.com/GD4ZJiKY4B

---

Background

Every Bluetooth device has a unique identifier called a MAC address. This ID is a 48 bit serial number in EUI-48 format.

For example: AB:CD:EF:12:34:56

The first 6 bytes of the MAC tell you the manufacturer of the device. These are public records, so you can easily see that a device near to you is, for example, an iPhone or if it is made by Cisco.

Searching

There are loads of apps which will show you every Bluetooth device your phone can see. You can see the signal strength of that device which roughly correlates to distance.

You can also see the name of the device. It might be generic - "Bose Headphones" or it may be specific "Jo Smith's iPhone 7".

Use

Imagine you had a similar app running continuously on your phone. It would record the Bluetooth MAC of any device which was close to you for more than, say, 15 minutes.

If, later, it was revealed that the owner of a device was infectious - you could be alerted. The hospital could upload the patient's phone's MAC onto a server. Then the server would alert people who had been close to that person while they were infectious.

Privacy

There are a few ways this sort of system could work. Let's ignore (!) privacy for now.

1. Upload a list of everyone you've seen to a central database. Or...
2. Send everyone the MAC of an infectious person.

Neither of these are great, are they? I don't feel comfortable sharing a list of my contacts to a central agency. That feels like a gross invasion of privacy.

Similarly, we don't want to send everyone in the world an easily-identifiable MAC which could expose the identity of a patient.

K-Anonymity

Enter the magical mathematics of K-Anonymity. Here's a brief and incomplete explanation:

1. We identify an infected person and request their MAC address.
2. The server splits the MAC into two pieces.
3. The server send everyone the first piece.
4. If your phone has seen the first piece, send the second piece to the server.
   • You may have seen multiple devices with the first piece, so send all of the relevant 2nd pieces.
5. If your 2nd piece matches the one on the server, you may be infected and will be alerted.

There are all sorts of other privacy-protecting things we could do...

• Your phone could send random / misleading data back to the server in response to any query. That would prevent a central agency tracking individuals.
• Rather than two equal halves, the server could send the first quarter, and your device could respond with the last quarter.
• The data could be one-way hashed before sending in either direction.

Is this sufficiently private?

The whole range of 48 bits can be stored in 256TB. More storage than you have at home - but easily within the range of a well-financed organisation.

In reality, the address space is much less because not all addresses have been issued.

Using this system, how easy would it be to build up a database of everyone you have spent time with?

An open-source app could be audited to make sure that it wasn't recording and transmitting anything it shouldn't. But what's to stop the server going on a fishing expedition and continually pinging your phone with pieces of a MAC?

How do you ensure that people only install the official app and not something which steals personal information?

Is the central database of infected people's MACs a target for hackers? How could it be secured?

Are some MAC addresses so unique that even the first few bits are enough to reliably de-anonymise someone?

Is this politically acceptable?

And here's the kicker. Would you install tracking software on your phone? What if Facebook quietly switched on this feature? What about GDPR? What about...

I politely remind you that this was an idea born out of a 24 hour hackathon, by a small group of students. To my knowledge - this isn't something being developed for use.

But this sort of app could be built easily. And - if not designed correctly - it could be a privacy disaster.

My usual kit is the MS 4000 ergonomic keyboard and an Evoluent Vertical Mouse. But recently I've been travelling a lot, and cramping over a MacBook's tiny keyboard.

And that's taken a toll on me. The pain in my wrists was so bad, I took two weeks off work to heal. Spending a fortnight not engaging with any tech was frustrating and necessary. Alexa barely works if you can't interact with its app. Google's voice commands can be similarly frustrating. Most websites are crap if you're relying on tabbing around with a keyboard.

It was miserable. But sitting in the sun, reading an ebook helped. Of more use was wrist braces. I'm using them now - forcing me to keep a decent posture.

I also couldn't have coped without my incredibly patient wife - who helped me type up blog posts, and swatted my phone away when I was mindlessly fiddling with it.

Look after your health, people.

Afterwards, I asked the dentist if I could have a copy of the scan. She wasn't terribly sure. She thought that she had to charge me for it. Then wondered if there was a data protection problem. Then started talking about copyright and the licence that they had signed with the machine's manufacturer.

As I'm disinclined to argue with anyone wielding a syringe and bone-saw, I asked if I could take a photo of the screen. That was acceptable to her. (I have a higher resolution image, but feel weird about posting it online.)

So - who owns the copyright on medical images? Some points to consider:

• The NHS is free at the point of use - but I pay a small fee for dentistry. So am I the customer?
• The dentist and assistant posed me correctly, but left the room and let the machine take my photo. Who created the image?
• I didn't sign anything about copyright.
• Could a manufacturer claim copyright of images created with their tool? What about the data they derive from analysing the image?
• Can a patient be trusted not to do anything stupid with their medical data - like post it on their blog?

As medical technology gets more sophisticated - and more Internet connected - this will become an increasing problem.

Comments from Tweeps:

ianhf

@ianhf

Replying to @edent@edent Had 2 examples in last months - NHS xray of fractured finger told couldn't have image and couldn't take picture (due to social media abuse & cloning). Private MRI of knee - was told could buy the master raw images on DVD or take a masked pic on my phone of portion of the image

---

Nicky

@knotnicky

Replying to @edent@edent Completely different, but I have the originals of one of my cats x-rays. The vet said I own them, but they keep them for me because they can store them safely if I need them again. I had to sign a waiver to say I’d give them back if needed. Weird!

---

Tony Hirst

@psychemedia

Replying to @psychemedia@edent and when I saw the image pop up as a result of my sharing the link to your dental x-ray, I felt uncomfortable at sharing it... (I don't think I'd share that sort of thing again. Personal comfort line crossed...)

---

Owen Boswarva

@owenboswarva

Replying to @edent@edent My take: the radiographer acquires copyright (or their employer; not a lot of freelance radiographers around). The manufacturer does not unless assigned by contract in their T&Cs, which would be weird. You as the subject have no IP rights unless the IP owner licenses them to you.

---

Owen Boswarva

@owenboswarva

Replying to @owenboswarva@edent But that's just the IP aspects of course. The x-ray contains special category personal data about you, and DP law restricts how that data can be shared and used. (Possibly fewer restrictions now you're published it, as that may affect the "special category" status of the data.)

---

⚫Howard Davies

@howdavies

Replying to @edent@edent Is there any copyright in it at all? There wouldn't be in a straight photocopy - that's different to a photograph because of the skill of the photographer in framing etc. Is an x-ray more like a photo or a photocopy? I bet the latter.

---

I tried to collapse the probabilities by uttering a most unusual secular prayer for a man...

Don't be pretty.... don't be pretty... don't be...

"Mr Eden?"

Maybe that's the nurse. She's barely out of her twenties. Yes. Obviously the nurse. They don't make doctors that pretty, surely.

"Come this way. I'm Dr Lena."

Arse. She was very pretty.

"What seems to be the problem?"

Despite acres of research with doctors Google and Wikipedia, I'm still not entirely sure what it is I am suffering from. So I take a deep breath and out pour the words that no man ever wants to hear himself say:

"I've had an ache in my right testicle for about a week. Last night... I think I found a lump."

DAH-DAH DAAAAAAH!!!!!

An actual diegetic fanfare... I am momentarily confused. Am I living in a film? That would make so much sense...

Dr Lena blushes beautifully and flips her iPhone on to silent. "Sorry about that," she says.

In a sense, it's an excellent way to break the tension of what is about to happen. With very little fanfare she says, "Ok, hop on to the bed, pull your trousers down, and let's examine you."

My stupid animal brain is now faced with a quandary. When a young lady (did I mention how crushingly gorgeous she was?) asks you to pull down your trousers so she can have a rummage, it seems... well... rude not to be...

But, luckily, the more mature part of my brain kicks in. Relax, stand down, think of Margaret Thatcher stealing your milk. Deep breaths. Calm.

But, of course, the insecure part of my psyche is going "Oh gods! Your penis is minuscule! If you don't at least get a semi, she'll laugh you right out of the surgery!"

But, of course, she's seen it all before. Some, no doubt, in a far worse state. Whatever level of flaccidity nothing bad is going to happen.

But simply as a matter of professional pride...?

Keep it together... keep it together... Relax.

Dr Lena locks the door. She walks over to me as I lie prostrate on her bed the bed.

She leans over.

"Oh!" she giggles nervously.

I swear - I am not making any of this up. Honestly.

"Would you like me to fetch my colleague?"

I smile confidently, "Am I too much for you to handle by yourself?"

She licks her lips and calls for a buxom nurse to assist.

Ok! Ok! That last bit I made up. My mind wanders very quickly when I'm under stress!

"Would you like me to fetch my colleague?"

I look confused.

"You're allowed a chaperone if you want," Dr Lena explains helpfully. I decline.

"So, show me where exactly this lump is."

I look down. My penis has decided to misbehave.

In terms of penile span, I appear to have achieved my objective of exactly average length without any hint that I find this ridiculously good looking, intelligent, well spoken, highly educated, dream of a woman in any way attractive.

Except the damned thing is now laying squarely over the offending testicle.

With one hand I gently move my pizzle out of the way. With the other hand I indicate where on the testicle the lump is. Dr Lena takes over.

As she proceeds with her examination, I'm struck by an awful thought. My right hand is laying limply by my side. My left hand, however, is still tenderly gripping my cock. While the wholesome doctor is groping my balls, I'm casually hanging on to my willy like a dirty old man. If I remove my hand now, I'm only going to draw attention to it. If I leave it there, am I going to look like a lonely old man who gets his jollies by self-pleasuring while female doctors fumble around on his goolies?

I feign to scratch my ear. I have a really itchy ear. Yes. Nothing suspicious about that.

"Hmmmm," the good doctor says. Not the sort of sound you want to hear. "Is that it there?"

She squeezes and there is pain. The pain is tempered by the realisation that I have no interest in dominatrices. Pain, it turns out, ain't my bag.

"Yes! That's it!"

"Well, the good news is --"

My heart sings! My penis remains silent.

"-- The good news is that it isn't attached to the testicle. It's on the epididimus, that's the tube which runs from the testicle.."

She doesn't say to where it runs - but we both know it's not down to the shops for a packet of crisps.

"It's probably epididymitis."

All of a sudden I relax. My research indicated that epididymitis was the best prognosis. I'm no longer hanging over the prospect of bollock cancer! Galloping knob-rot is off the cards! My balls shall remain incision free! A weight lifts from my shoulders.

As it does, I realise that I'm still half naked. Only now, I'm half naked and smiling. This somehow makes me feel even more naked than I did before. I literally feel like I am only wearing a smile.

Dr Lena is a kind and noble doctor - and graciously turns her back while I perform the rather ungainly exercise of sliding off a bed, with my trousers round my ankles, while pulling my pants up.

Epididymitis is usually caused by a bacterial infection. It's just one-of-those-things. Usually.

"The other cause," says Dr Lena, "is sexually transmitted diseases." She looks me straight in the eye. I melt a little. "Is that something you would like to discuss?" She asks.

In a way, I'm happy that she thinks I'm the sort of bloke who sleeps around, has his way with all the girls, and gets an exotic array of STDs. She's seen the goods and thinks the ladies about town can't resist me.

I break the news to her that I am happily married and that neither of us really has time for an affair.

She gives me a sample jar to piss in - just in case.

The cure for epididymitis is nothing more than a strong course of antibiotics. Dr Lena writes out a prescription with penmanship that would make a poet blush, then sends me on my way.

And I am cured. The antibiotics do the trick, my STD test comes back negative. I am a free man!

Your Balls

If you are in possession of a set of testicles, do me a favour and check them for lumps and bumps. If you find anything unusual, pop to your GP straight away. It won't be too embarrassing, nor too frightening, nor too stressful.

Women, if you want to make yourselves useful, find a gentleman friend and offer to examine his balls. He will almost certainly be very grateful and - if you're lucky - will reciprocate by checking your breasts.

Everyone's a winner!

Six Months Later

It's back. It came back a few weeks ago. Another course of drugs - which worked for a while - and another test for chlamydia and gonorrhea - which showed I still wasn't sleeping around.

But it's still there. A dull and nagging ache. A tiny, but annoying lump that twinges every now and again.

So, today I am spending at a urologist. Where I will be prodded, poked, made to give specimens, ultra-sounded, analysed, and exposed.

I've looked up the urologist on the Internet. He's not as pretty as my Dr Lena. Which is probably for the best.

QR codes on packets of coffin nails have appeared before as concept advertising. I thought it would be interesting to see if QR codes could be used for good.

Here's my attempt (I'm not a graphics designer!)

Original image via WeMadeThis.

The first QR code goes to Direct.gov.uk's mobile friendly Smoking Calculator.

The second goes to a site which lets your enter your postcode to find help near you. The resultant page has maps and click-to-call links.

The NHS has several great mobile pages for smokers who wish to quit - but these were the only ones I could find with a simple URL.

So, whaddaya-think? Will QR codes save people from the evil grasp of Nick O'Teen?

Of course, some people have other ideas...

Rob Manuel 🍳

@robmanuel

Screw health warnings on fag packets. They should just print them with embarrassing messages. "I have VD" "I touch kids" "I voted Tory"

---