who only by moving can balance

You win some you lose some:

okay, well, actually I'm only most of the way to losing my voice. And in fact I am losing significantly less blood than I was yesterday! Which is almost the same as winning!

I have also actually won tranexamic acid (... I am fairly convinced the prescription was written more as a low-risk safety blanket than as something that was actually considered necessary, but Whatever), and putting a lot of seeds into compost, and the lemongrass being happy. All of which I will take.

(And as a bonus, the current stall on Penelope's Gloves: I cannot work out where the darning needle's gone, which is alarming because it suggests one might at some point e.g. sit on it, and I want to stick a lifeline in because I am accepting the inevitability that I'm going to wind up making Several More Attempts before I actually get these decreases working the way I want them to. Obviously I have more of them, but that's not the point. I am not yet prepared to consign this one to the "lost" column...)

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• the Lincoln Ostomy Output Consistency Scale (and, relatedly, the Bristol Stool Chart chocolate cake [nb FB link])
• a selection of Journal for Minimally Invasive Gynecology papers (feat. videos of the kind of surgery I'm likely to be having) (which I have not yet watched because logging in is Difficult) [ 1 | 2 ]
• the role of CGRP in hunger signalling (awake at 4 a.m.; had moment of INSIGHT or, well, potential insight)
• the part where heart rate is affected by CGRP, and varies over the course of the menstrual cycle, and unshockingly Does Things during migraine, and I have Fitbit-provided heart rate data since a few weeks before I started having regular migraine attacks, for the purpose of Writing Myself Up...
• thenatureofpaper (WHICH flowers do I want to buy myself. HOW long will I be inpatient. HOW many decorative things is it reasonable for me to take.)
• and, completely unrelatedly, British stick insect populations

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BUT as a consequence of thinking about all of this I realised the absolute best thing to change the title of my medical README to: Patient Information Leaflet.

So that at least cheered me up.

Realisation while wrangling laundry, presented as a series of facts:

• I have both migraine and endometriosis
• migraine means that I am limited to 6 days (or 8 if I push it and am willing to stare down my migraine team) of painkillers (which includes paracetamol, NSAIDs and codeine, as well as triptans) per month
• a thing that Mostly works to head off incipient breakthrough migraines is The Frovatriptan Protocol, which consists of frovatriptan + mefenamic acid (an NSAID) + paracetamol (optionally) + (in my case) prochlorperazine (definitely)
  • each time I use The Frovatriptan Protocol I use up one (1) of my Six (6) Days Per Month
• migraine is. not. my only source of chronic pain.
• but I'd rather deal with endometriosis- and joint- etc etc etc-related pain than migraine fuckery, so I am currently significantly undermedicating my non-migraine pain
• BUT
• ON THE 14^TH OF SEPTEMBER, NICE APPROVED RIMEGEPANT FOR ACUTE USE
  • rimegepant, as the name suggests, is not a triptan -- it is a gepant
  • this is a class of drug that works on the same basis as the stabs I'm currently using and responding generally pretty well to -- it targets CGRP signalling/pathways/thingy
  • crucially, it has been conclusively demonstrated in clinical trials that this medication DOES NOT contribute to so-called medication overuse headache, so taking rimegepant does not count toward the six-day budget
• my next headache clinic appointment is on the 18^th of December
• which is more than 3 months after the NICE approval was issued
• so I will theoretically be able to switch from The Frovatriptan Protocol to rimegepant, thereby freeing up all my six-day painkiller budget for managing non-migraine pain

AT WHICH POINT I might even be happy cancelling my pain clinic referral? We'll see.

(For starters, I don't have a migraine! I am just dealing with more familiar pain, which is much more tolerable in no small part because it comes with less of the distressing cognitive impairment.)

We wandered out to the allotment a little while after dinner, when the temperature had dropped all the way down to 27 °C. We watered plants. I had a bit of a rummage; I didn't find any fake snakes but I did see what I am pretty sure was a field vole, based mostly on the relatively short tail -- I didn't get a good look at how pointy its snoot was.

And we picked berries, and we came home, and we sat on the decking for a little Detecting A Bat, and admiring the Moon, and trying to work out who the probably-a-planet was, and I saw what I am pretty sure was a (remarkably orange) meteor and then reminded myself that yes, in fact, it's Perseids o'clock.

Somewhere in the middle of all that, the vintage-fountain-pen-in-need-of-restoration I'd accidentally ended up bidding more than I intended on -- I was mid-migraine, I was curious about how much I'd been outbid by, I kept nudging up my max bid until I was the high bidder and then went "... fuck", but it was only a tenner so it'd have been fine -- got sniped back off me in precisely the way I'd been hoping for. It has been very satisfactory all round, and I am very contented.

International travel on the first day of my period is such a uniquely horrible experience that I can remember every single instance of it. Today's shaping up to be a good one: after a sensibly early night, I woke up a little before 4 in enough pain it was half an hour before I managed painkillers, whereupon I necked 100mg of tramadol on an empty stomach and it just about took the edge off. I can't actually tell to what extent the persisting significant wobbliness is pain, sleep dep because of the pain, an opiate high, or not having eaten enough yet because sertraline. FUN FOR ALL THE FAMILY.