mmmmmm ice cold Australian beer

actually… it’s a syndrome

My folks live in Ramo and i was brought up there many moons ago… i don’t think its as rough as it used to be when i was a kid. Have been out and about there a lot at all times of night and day and never have any trouble. Admittedly there are a couple of places i’d avoid but they don’t look too welcoming anyway so you wouldn’t be tempted to go in (unless you like sunburnt skinheads with football club tattoos).

You can get a boat ride out to sea the seals in pegwell bay (some are on powerboats so i suppose they hoon about a bit on the way there), or if you are lucky there are sea kayak tours that go out that way too. You can also SUP / kayak / paddle on the stour about further inland.

Other stuff to do would be explore the local coastline if the weather is nice, some pretty varied coastal ecology from mudflat (if you are a twitcher pegwell bay is an SSSI and great for supporting waterfowl) to chalky rockpools / mussel beds and beaches.

Half decent pubs in the area are the belle vue in pegwell, and maybe the wetherspoons just as its the old pavillion on the beach. There are a few smaller cafes and bars fronting onto the harbour in the old arches.

There is a pretty good restaurant that i would recommend in Ramsgate, called the empire room. We went there a few months back and it was delicious, plus the portion sizes were crazily big (which gives it an even bigger tick in my book).

I’d head to margate and broadstairs for a look round. In Margate you have the The turner museum which is free and fairly decent. There are also a few decent independant coffee shops / cafes too e.g. curve roasters.

In broadstairs there are a few niceish beaches (viking bay, minnis bay, joss bay) and a few pubs. Always worth a pint at the tartar frigate as its right on the beach on viking bay.

I’d also hit canterbury if you have time…

San Miniato Alto (just south of Lucca) is a beautiful little village with a great gelatoria and cute little shops. The tower there is apparently meant to be from Dante’s inferno, and has amazing views over the tuscan countryside (i got married in San Miniato so am biased).

There is also a really nice organic vineyard in San Miniato (agrisole SSA) who do great tastings – just make sure you aren’t the desigated driver as we got really sloshed there.. they do charge (10 euros pp) but each wine was paired with food.

San Gimignano just down the way is also really nice…..

was a Sydneysider for 3.5 years until a month ago till i moved back to the UK, and have to say if you are looking at Sydney then Batfink has pretty much nailed all the good stuff in Syders…

Depending on how organised you are and how much you want to spend (xmas / NY is prime holiday season for everyone) you might want to head south –

Jervis bay (Huskisson, Vincentia) has amazing crystal clear water, calm seas and amazing white sounds (apparently some of the whitest sand in the world). It is awesome for snorkelling / scuba

On the way down you can stop at Gerringong / Gerroa where the southern highlands come down to the sea, it is probably my favourite place in the area – some fairly decent surf beaches and way less busy (and less gnarky) than Sydney beaches. There are also some great vineyards round there to stop in at on the way past (the best by far is Two figs winery at Shoulhaven heads – one of the more spectacular views you will get from a vineyard).

I would also stop in at Berry (a twee town) and take a detour into Minnamurra rainforest / Kangaroo valley if you can be bothered.

The Illawarra is also amazing and a great chilled out place to spend Christmas (we stayed there 2 years running), Bulli and Thirroul are cute little towns with great surf beaches and with the escarpment behind them for bush walks.

As mentioned before, palm beach is well worth going to (so, so beautiful) and staying for a while, and heading up into Kuringai national park for a spot of camping / bush walking. You could also look at getting a boat on the hawkesbury river…

The mountains are really nice but get a bit hot (and prone to the odd bushfire) in the summer – so probably a short trip is best – i’d rather be at the beach in the summer.

Outside of NSW – Melbourne is a great city, but probably isn’t the most fun place for kids – the inner city beaches are rubbish but head out along the GOR and you’ll get great beaches, but will have to fight for a park… Noosa is nice for a short break, the Queensland will be hot and humid (and best avoided at that time of year unless you love it that way), the top end will be even hotter and the interior will be so hot it will melt your eyeballs.

Tassie is just amazing. I love it there! If you can go, do it.

Most of all, sit back, relax and do what aussies do at christmas. Enjoy time with family, grill meat and fish and drink beer!

Ayup ben, this used to be my old stomping ground… So have a few suggestions (moved to Oz 4 years ago so worth checking them online to see if they are still good…)

The goldsmith on southward bridge rd (between southwark and borough tube stations)- we hired the whole pub for our leaving do (i think it was just a minimum spend at the bar), we had free reign of music (plugged our ipod in) and they catered also. Was a great time and they used to have cracking beer too..

The roebuck on great dover street (near borough tube station) has a few seats outside (although you can’t book them), a private function room upstairs and fairly decent food. Beer used to be pretty good there – mostly craft beer and lagers… This used to be our local and is a really nice, friendly pub and is pretty big.

The old red lion on kennington lane (near kennington tube) – bit of a walk but a great pub and you used to be able to book out the conservatory bit out the back for a minimum spend (we had our engagement party). They sometimes have a weird beer selection to compliment their standard taps…

The laughing gravy on southward bridge rd (Southwark Tube Station) – great food but a bit pricey, more gastropub than boozer.

The royal oak on tabard street – routinely wins best pub ever from CAMRA (London bridge or Borough). Properly great old school boozer, traditional pub grub, not the biggest and used to have stinky toilets. Byut they do harveys beer and they do it really, really well.

We are moving back in a few weeks so will give you an update on whether they are still as good!

Hey Mudmonster,

Sorry to hear your back is playing up (again). I know it is massively debilitating, i had it years ago (for over a year) and was offered surgery which i declined. I took up pilates, changed bike position and riding style etc, and just tried to keep active without winding up my back too much. I am now pain free…

I also come at this from a different perspective to many others as i trained as physio, and am now a researcher in back pain (and pain in general). I have been out of the UK so am not fully up to date with the recommendations but am pretty sure the Aus and UK advice is similar.

You only need an MRI if it is medically indicated (e.g. suspicion of cauda equina, other insidious symptoms) where the exposure to radiation is outweighed by the benefit the diagnostic test can give. Your front line clinician should be well versed in when to (and when not) to send someone for imaging. I know it seems as though having the scan would give you the all clear for your back. However, the majority of backs will show some changes to discs, joint spaces etc. The great majority of these people with altered structure don’t (and haven’t had) significant back pain – so changes in structural composition do not allow us to predict whether anyone actually has (or will develop) pain.

Also, there is fairly strong evidence that MRI should not be used as a first line assessment as it can actually increase your likelihood of developing long term pain. This is thought to be in part due to the influence it has on your emotional / affective systems (essentially increasing fear and anxiety related to your current pain) which can increase the likelihood of pain persisting – via, in part an increased sensitivity in the nervous system.

The best advice at the moment, is talk to your GP (and keep in regular contact – every coupe of weeks for monitoring) and seek access to a healthcare provider that can support your rehab – both things that i believe you have done. Try to keep moving as much as you can (without flaring up your back), we always say motion is lotion! The other thing is to try to be comfortable with the time course of recovery, backs can take a while to recover (up to 3 months), and not get too frustrated or worried because it hasn’t got better as quickly as you’d like.

Keep in mind that the spine is very strong, and is very well engineered for its job. Sometimes things do go amiss with it (what your GP should be screening for) but in general it will sort itself out in time, if there are no confounding issues.

For all of those who have low back pain, a great read is Explain Pain by Lorimer Mosely and David Butler. I would look up his videos on youtube – he is a great speaker, a great physio and one of the top pain scientists around.

Also check out the advice from the CSP

http://www.csp.org.uk/your-health/healthy-living/public-information-leaflets/back-pain-myth-busters

or if you like the australian viewpoint – info from the ACI

https://www.aci.health.nsw.gov.au/__data/assets/pdf_file/0003/363450/ALBP-ConsumerInfo.pdf

Cheers, and hope it sorts itself out soon.
Marp

Luckily i live in Syders so we don’t get crocs around these parts, but sharky enough (and we do get some bluebottles)….. I will take heed of the skinny dipping tips, don’t want to be enticing the local wildlife with my pasty english skin and dangly lure….

Hi Colin, you aren’t alone! I learnt to swim properly about 4 years ago, having been previously scared of open water or being out of my depth… I went to beginner and improver classes to iron out my technique (as a wedding present for my wife!).

I then moved to Oz 3 years ago and have been lucky to have a pool so swim most days and am now a confident swimmer with a pretty solid stroke for indoor and open water swimming (although open water swimming still gives me the willys a bit due to the whole shark thing).

My tips would be look at swim smooth, has some great drills and tips for stroke length, feel and breathing. I found once I slowed my stroke a little and learned to glide through the water you have a little more time to breathe, and i wasn’t so tired so wasn’t gasping for air. I also changed from breathing every 3 strokes to 5 gave me more time to exhale and made the in breath easier. Also as mentioned above, do less kicking, i work with a pull buoy to get upper body technique right and don’t do any kicking, I focus on getting a good roll motion (preventing you popping up to breathe and stalling in the water).

The greatest thing for me was having my wife watching and giving feedback, i’d tell her what i was trying to do and then she would tell me i was rubbish and should do it better…

Just keep plodding away at it and it’ll come…

i went to TK maxx and tried on all they had. I got a pair of brasher hillmaster GTX for about 65 quid, they are still going strong after a fair few years.

Not an entirely practical tip, but will save everyones blushes.

Do not walk back into a restaurant wearing the toilet slippers!

I definitely second the Royal oak in borough, it’s one of my favourite pubs… a proper no nonsense boozer that serves Harvey’s best bitter. Much less busy than the pubs nearer waterloo too

i heartily support the use of durian, tastes horrid but my god the stench of the burps that will follow for the next 6 hours makes it worthwhile…

For me, nothing makes a bad ass smell like the combination of real ale and eating an entire pack of asda sage and onion cocktail sausages… i once made a stranger retch with the toxic fumes after that night

I wholeheartedly agree with mankylung… You most likely do not need an MRI or X-ray (certainly within the first 6 weeks of pain) but the need should be identified (if there is one) according to previous medical history, neurological signs etc by your doc. They shouldn’t be doled out willy nilly as somewhere around 90% of back pain will end up with a diagnosis of non specific low back pain and your scans will be similar to someone else’s your age, irrespective of whether they have pain or not.

Try not to worry too much about it, keep dosed up and keep moving as much as you can, it should ease up with time and return to normal. If you want to go and see an AHP (Physio/Chiro etc) they should be able to help and provide some advice and treatment tailored to you and your problems. That is the best advice (basically i second everything mankylung has said) If you were in Oz you could come and enrol on our research study!

dosa n chutny by tooting broadway station used to be pretty good when i worked round there and was cheap as chips. Haven’t been for a while but if you live nearby might be worth a look

i’ll just check down the back of the sofa to see what change i’ve got hanging around back there 🙂

if you lived in Sydney you could join our research study… we are in desperate need of people with low back pain!

if you do go through hyde park, the Victoria at Lancaster gate is a great little pub. If it’s open see if you can sit in the library upstairs.

South of the river there is west square gardens near the imperial war museum, near there you have the old red lion in kennington, the laughing gravy on blackfriars road, the kings arms on roupell street, or the royal oak on tabard street. There’s also the George on borough high st but i’m not that fond of it…

by the way, where are all the other sydneysiders residing? We are in newington (Olympic Park)

i moved out to sydney for work in october with the Mrs. Brought 2 bikes on the plane for free which were cleaned within an inch of their life, customs didn’t even bother to open the cases to look at them. Haven’t had our stuff arrive as yet so can’t comment on shippers.

As for not living west of inner west, i would agree whole heartedly. i live west of the inner west and it sucks – just endless suburbia with little to do and it takes forever to get anywhere. We will be moving inwards or to the Illawarra coast as soon as we can afford it.

My wife is currently jumping through a lot of expensive hoops to be able to work as a physio, hopefully both of you will have it easier than she has…

I cycle commuted through London for 9 years luckily with only 1 minor accident, i think as long as you ride assertively, take up the lane when necessary and move into position for turning nice and early then generally you will get by ok. I also tried to avoid being on the inside of any high sided vehicle like the plague… 20 seconds off my day is way better than a ride in an ambulance. That’s not to say i didn’t have my fair share of near misses when either a) i was being a nob ( i learned to ride a little slower and improve my positioning to be safer) or b) buses / addison lee were being complete to$$ers.

If you think london is bad, you should try Sydney. I have been here 3 months and have been sideswiped, sworn at and nearly taken out at roundabouts (whilst on them and other cars flying onto them). Also half of sydney roads seem to be at least 3 lanes wide and full of double length articulated lorries. Proper scary…

what a great thing for your daughter to do. If i were lucky enough to win the t-shirt, please sell it and use the money to buy your daughter something nice.

Cheers

Matt liston

bit of a curve ball here…. but there is the Shangri La in the shard which is due to open in May (if the rumours are correct). I imagine it might cost a few bob though…

The lanesborough is really nice if you want something a bit more classic, (although it never actually used to be a hotel, used to be a hospital!)

I would go for suit. For me it makes me out on my game face anyway..

Where’s the interview?

if you were thinking of hitting the southbank then cocktails up the Shard? Great views and not too expensive (£10-15 each)… also no booking required. Then you could mooch down to Bermondsey street to Casse Croute (v good french Bistro, or Jose’s or Pizarro’s for spanish fare. Also a few decent pubs around there

Good luck! It sounds as though you are well prepped and feeling happy about it all.

Enjoy your conversations with your examiners, then enjoy the post viva meal (and subsequent skin full of well deserved beers / champagne / shots etc). Please let us know how you get on…

My examiners brought tea and cakes to my viva. Helped calm me down a little…

I’d reiterate what a few people have said. Unless your examiner is a total arse, it should all be about you demonstrating your understanding of the research process, the methodologies used, the analysis and presentation of results. The examiners are there to facilitate that process, make sure you did the work, and check you know what you’re talking about.

A few tips i can think of… You should be aware of the flaws in your work (don’t try to bullshit them as they may well smack you down)and be able to reason why you did it that way, and how you would change things if you had the opportunity to do it again.

I’d also recommend being honest if you don’t know the answer, but feel free to have a stab “i’m not 100% / i don’t know the exact evidence, but if i were to speculate then i would think it was this..”

Also, remind yourself that you know the thesis better than anyone, and the reason you have the examiners there is because they most likely are interested in the topic, have enjoyed reading and would like to know more.

Good luck with it, and enjoy it. Remember, this is probably the only time you have a few hours to talk with experts about your work.

Fontmoss, that was the ne piece of advice my uncle and cousin gave me (cabbie and met police officer respectively) when i moved to London. Have a few friends doing their pre-reg at KCH and still struggling to get opportunities (very dog eat dog), so i reckon going for a DGH is a good bet at least till you get a few more hours under your belt.

If you wanted clapham junction way then parts of wandsworth and balham are quite nice and easy to get to clapham junction from. The northcote rd area of clapham is nice but pretty expensive. Depending on the region you went for i would be tempted to go further out where the access to riding is better and you can hop on trains to get everywhere. Sutton / merton would be good as mentioned earlier for access but not exactly the bright lights of London…(if you were after that)

Have you just got your F1 post?

There are plenty of fine places in south london to live, indeed i live here now and still love it after 7 years. If you are working at King’s / Thommies or Guys then i would say being close by is fantastic. Elephant and castle has the best links – on every bus route, 2 tube lines and an overground and is fine. It has a bad rep but i’ve lived here 7 yrs problem free. It’s about 5-10 minutes from any of the above hospitals on bike and is dead cheap for Zone 1. It’s also a 20 min walk to all of the southbank (waterloo / westminster / tower bridge etc)

Failing that Brixton, has ok links (1 tube line and an overground)and has a fairly decent vibe – nice restaurants in the old indoor market.
Vauxhall and Kennington are a bit dearer and slightly further away than E&C. Camberwell green / peckham rd is getting trendy but has crappy access (only buses). Streatham is a bit of a hole and i wouldn’t bother (although some bits edging onto the common are nice). Herne hill / Tulse hill have overland trains and buses which are ok in the wk but infrequent at times at the wk end, have some friends live out there and they like it. If you want to go further out east Brockley and Greenwich are quite nice, New cross has a slightly bohemian trendy vibe and quite nice ladies (Goldsmiths art college is there). If you are inclined to go west it’s more expensive than east..If i were you i’d avoid clapham like the plague, it’s way overpriced and quite a good place for muggings as all new londoners move there. Your best bet is go visit lots of areas, get a feel for it and decide what you want (location vs amenities vs cost vs overall vibe) and make a decision from that. All areas have good and bad bits so go with an open mind… But most of all good luck!

Nolias 11 at blackfriars bridge (Stamford St) has a really nice and friendly cocktail bar and a small jazz club underneath. it’s run by the ex manager of Ronnie Scott’s (so music is pretty good).

If you get bored you can easily just wander to the laughing gravy on blackfriars rd for some lovely food.

good luck

Hey Alex,

It seems as though there could be issues around sensory integration – you describe getting dizzy after a long drive, there are a couple of aspects here, repetitive head turning may have been a factor but also the constant visual flow from the white lines in the road can also play a part. When on the tube there are a few things that can upset the sensory processing systems if they’re not quite up to scratch – which will tend to be what makes you feel really dizzy and cloth headed. If yu’re standing you’ve constant accelerations and decelerations combined with a relatively static visual surround which confuses things a little. But also you may be sat looking out of the window, so the world looks like it’s moving but you’re sat still – most types of full field moving visual stimui will bring on feelings of dizziness and / or disorientation. On the boat / plane you are being provided with mismatching sensory information if you’re sat inside looking ahead. You will have subtle accelerations and decelerations and changes in vertical positioning (detected by the inner ear) but your visual system will be telling you nothing has moved, again causing sensory conflict.

these are just me thinking out loud and as such is an internet diagnosis and should not be mistaken for real life information. I would follow the normal route of checking with medic etc but may want to sound him out on sensory integration…. Although i wouldn’t discount any other medical prob unless it has been thoroughly checked out and excluded.

By the way that graunchy sound is entirely normal, we all have that although it still doesn’t sound very nice.

You can have a crack at this and see if you’re more unsteady in any situation. I wouldn’t bother with the sensory conflict dome (that is unless you have a spare one laying around!)

http://web.missouri.edu/~proste/tool/vest/CTSIB.pdf

Marp

Hey Alex,

It depends on what sort of problem you have and how good your sensory integration is. Typically cycling or skiing aren’t too provocative as the head is relatively stationary and you are mostly using visual info for orientation. Therefore you aren’t getting much sensory conflict and therefore you’ll feel ok. The times you’ll really notice it are when you are using lots of head movements (looking around environment) or when visual cues are disturbed or absent. These provide some sensory conflict and will tend to aggravate symptoms more.

How do you feel when in really busy visual environments such as supermarkets, watching large rivers flow past or in really crowded places? Also how are you when walking when turning your head side to side quite quickly? Does it make you feel pretty gross? If you’re walking at night in the dark do you feel more unsteady? is it worse if you’re on fresh snow?

Hey alex,

First and foremost I am not a medic, so I would always say make sure you have been fully checked out by your medic. I am however a physio specialising in balance disorders.

It seems as though your GP has tested a number of things and is happy it isn’t anything too suspicious. I am wondering whether in your medical assessment at the hospital they sent you to a vestibular clinic to checkout your vestibular (inner ear balance system) function? You can always discuss with your GP whether they think the cause of your dizziness is vestibular in origin.

I can’t diagnose over the internet and wouldn’t attempt to, but it might be worth mentioning if this is something that hasn’t been investigated as yet. Vestibular rehab is pretty good at sorting balance problems out (if it turned out to be that), but takes time and effort.

Hope you feel better soon,

Marp

Hi Glupton,

Interesting question… I think it depends on the clinicians clinical training and understanding of pain (especially chronic pain), their communication skills to describe the underlying mechanisms behind chronic pain and their ability to listen, empathise with their patient and understand the greater context of their pain. The approach they use should then be centred around the patient and should try to provide insight into their problem and provide solutions to that, which may or may not be analgesic based.

I think that CBT very much has a place, however it is tricky to say to your patient i’m referring you for behavioural therapy for your back pain. FRP programmes in physio (and physios in general) tend t use quite a lot of CBT in their interventions. they also benefit from having slightly longer assessment times / slots than medics do.

I’m not sure if you know Mick Thacker’s work looking at immunology and pain or Lorimer Mosely’s stuff looking at perception and pain amongst other things. Really interesting and very thought provoking. I was lucky enough to train under Mick and feel my approach to pain is very different to the average clinician, as i would hope anyone who has seen him or Lorimer talk would be.

so in conclusion, i’d want to be seen by someone who had the time to listen to me, the personal skills to listen to me and understand my problem and some idea about how to promote healthy activity to promote resoration of function. Personally i would lke an MDT approach including medic, physio and CBT with all singing from the same hymn sheet.

Marp

Mattbee, depending on the severity of your occasional problems and the provoking situations you may want to ask your GP to send you for vestibular rehab.

There are some pretty simple exercises to do to help you finish the recovery that your body has mostly done by itself. You will most likely get there yourself but VRT can speed things up for you.

I trained as a physio at 27 and there were quite a lot of older students than me on the course (king’s college) and it was amazing! I think a bit of life experience actually makes people a better physio, and i think a lot of HE institutions have noticed this and are taking on older students. I teach at King’s and St George’s and have noticed the ages creeping up of the mature students.

So in terms of life exerience, suitability to the job and having a much better understanding of the clinical environment would put you in great stead for clinical placements and on those points i’d say go for it.

However, on the pessimistic side, do you want to start at band 5 again? There are a lot cuts (as you will well know) in the healthcare system and physio depts are being squeezed left right and centre. Because of this there isn’t a huge amount of movement and progression isn’t as quick as it once was, most people are band 5’s for 2-3 years now (well certainly in london anyway).

I’m not sure if thats helpful or not…..

marp

TJ.

I would say there are appropriate western ways to treat acute NSLBP that appear to work reasonably well (there is still room for improvement). There isn’t really an appreciable difference in outcome if you use manips or exercise, however the evidence base is pretty ropey on both sides. Combining the two appears the most sensible approach and is common in osteo / physio.

The problems (in my opinion) behind using manips is that they provide a quick fix, and a lot of the time folk don’t bother with their ex’s as they feel better. However over the coming week (s) they stiffen up and want another bash of manips. This can foster dependence on the practitioner which is a seriously bad thing (for the person not the practitioner £££) and can have an effect on the likely long term outcome for getting long term reductions in pain.

Pain is an incredibly complex phenomenon that is way beyond simple stimulus level nociception, and is something that we still don’t understand at the moment. The reasons for why some people develop chronic pain are still largely unknown, and until we know that then treating it is not an easy thing, and i feel doesn’t solely involve traditional medication / manip / ex interventions.

The laughing gravy by southwark tube is fantastic, as is el vergel on great suffolk street (nearest tube is borough). Coopers on lower marsh (by waterloo) does massive and really tasty salads if you like that sort of thing.

They are all pretty easy to get to for both E and W london

Also the use of X rays can be a smidge misleading…. If we x rayed a large amount of the population over 40 a larger proportion than those experiencing back pain have degeneration. So why do only some of them report pain?

There is a lot more to back pain than simple mechanics. True in the short term muscle imbalance, acute nerve compressions etc can cause these problems (and in some instances especially herniations and compressions) can lead to severe and long term pain.

However, there are many incidences of long term (chronic) non specific low back pain (NSBP)where we aren’t sure of what is going on, and the original injury has cleared up (most acute back pain should clear up in 8-12 weeks). There is evidence for changes in the structure and function of the nervous system, central processing of pain signals and changes in hormonal responses to stimuli that may be involved. It is a very interesting but complex condition to treat as there are so many factors involved, not all of which are purely mechanical, so stretching / mobs / manips can get you so far for the majority of folk.

I would say if its bothering you, go to the GP, get referred on to someone in the NHS (it’s free) and see what they have to say. However, depending on their point of view, bias to treatment approach and your expectations of them (both in outcome and the type of intervention they provide) plus how well you get on with them may affect the outcome of rehab.

Ah Dez, no one likes hurting their ass badly. Hope it sorts itself out soon….

Thanks for the good wishes, am unfortunately back at work with mountains to do as was skiving off to complete phd.

Anyone have any tips to stop the missus becoming bridezilla? No signs yet but i need to be abe to spot the danger signs….