• Updated my CV last night, for no particular reason, and put a link to it on my LinkedIn profile (http://jonathantullett.com) #
• Well, there was a reason, I was 100% bored and irritated with writing a WordPress theme. My HTML/CSS knowledge isn't what it use to be! #
• Chiropractic then another appointment to help with the insomnia. Probably with hot chocolate and book reading inbetween. #
• Appears I texted people during my sleep last night. Nothing embarrassing thankfully, but explains my tiredness today. #
• Unfortunately, twicca's usability problems (no auto caps, spelling correction) are a deal breaker. Back to twidroid for now. #
• Visited Waterstone's and blessed them with nearly £100! Now have books on pharmacology, CSS and two on finding a chap called Wally. #
• .@Jaruzel I think today is a actually a Monday disguised as a Wednesday which is pretending to be a Tuesday. Be afraid. Be very afraid! in reply to Jaruzel #
• .@bensmithuk for my entire life, my family, when asked by anyone what I do for a living, reply, 'something with computers.' *sigh* in reply to bensmithuk #
• Dr Appt was good. Modification to prescription and a letter to Bupa telling them not to be retards. #
• http://www.lamebook.com/wp-content/uploads/2010/03/wedphoto1.jpg – best cake ever? #
• Great chat with Harry. Am looking forward to either seeing him in Spain in a few months or hanging out with him in London during the summer! #
• Having trouble sending SMS via @O2. Any known issues? #

After my morning chiropractic appointment – where the Caribbean theme is in full swing – I headed to Waterstone’s for some reading material.

I picked up a couple of ‘Where’s Wally?’ (‘Where’s Waldo’ in the US an Canada) books for Zachary, Sitepoint.com’s book HTML Utopia: Designing Without Tables Using CSS and book on Pharmacology. The latter so I can research fully the medication Jeremy Broadhead is prescribing, and also get a better understanding of the causes of the conditions.

I saw Dr Broadhead in the afternoon and we discussed my (lack of) progress. I put forward the hypothesis that the anxiety I’m suffering is causing the insomnia which is then causing further anxiety; a Catch 22 if you will. He agrees with me.

I am, unfortunately, very quickly becoming tolerant to the usual treatments which would help break this cycle: benzodiazepines stop becoming effective in 3-4 days, hypnotics (which help induce sleep quickly, but can interfere with REM sleep) stop becoming effective within 5-6 days, and even the antihistamine effect of the mirtazapine stops doing its thing in around the same period. So the pattern is: 3-6 days of good sleep where I feel fantastic, then a regression to the old sleeping pattern (previously.)

We’ve mapped out a future plan of action in terms of altering (switching) medication, if necessary; but we’re going to persist with slightly modified doses of my existing lorazepam and mirtazapine prescriptions.

From initial instructions of 1mg lorazepam twice a day, I’d altered that to 0.5mg four times a day in an effort to maintain the levels in the plazma and too because 1mg was knocking me out for 4 hours when I took it in the morning. As my tolerance has now increased, the sedative effects should be greatly reduced and it’s been recommended I try switching back to 1mg twice a day – morning and mid to late afternoon (but I’ve been given leeway to dose as I find most effective, within the bounds of 2mg max per day.)

The mirtazapine has been increased to 45mg, which in trials has shown frequent improvement in encouraging sleep compared to the 30mg dose.

In addition to the above changes, I’m to get 30 to 60 minutes exercise (eg. running) a day. This will help counter the weight gain from the mirtazapine and is one last sleep hygiene tweak I can make in terms of lifestyle changes.

On the non-pharmaceutical side of things, I’m still on the list to receive CBT which will aid the management of anxiety symptoms when they occur. This is also key for my getting better.

He’s encouraged by my academic interest in what’s happening and my being able to suggest some alternative treatments or question his theories and ideas.

In a potential bit of good news on the Bupa front, Dr Broadhead has written a letter explaining I’m not being treated for any ‘mood disorder’, eg. depression, which were their grounds for refusing to pay for my treatment initially. This has been forwarded to them and will hopefully result in them agreeing to pay for the (very expensive, but necessary) treatment.

My next appointment is in two weeks.

• Filed a bug report against YARPP: http://wordpress.org/support/topic/373616 #
• Wishing @Mewliette a fantastic time in Orlando over the next year. She will be missed! #
• Nothing quite like pouring your cereal, adding fruit to the top and then finding you're out of soya milk to start the day. Off to the shops! #
• Disabled the YARPP plugin until the bug (http://bit.ly/dm6MPj) is fixed. This will stop 'related posts' showing on x-posted tweet posts too. #
• Updated various DNS records to hide address details or point them at another address. Now http://bit.ly/bGzLY6 can remain active. #
• My vasectomy post is no longer appearing on friends' LJ 'friends' pages. Opened support ticket (http://bit.ly/LJ-bork) to find out why. #
• Someone at Google obviously read my tweet about the Location Badges not working on Safari, because they are now. Hurrah. #
• Going to pick up The Boy, take him for lunch somewhere in Bromley and then perhaps for some hot chocolate. #
• At Pizza Express with the boy. Cheeseless pizza, coming up! #
• Really pushing the dairy intolerance theory by eating a cream heavy banoffi pie. Wish me luck! #
• Argument with a short twat and his girlfriend(sporting pink tracksuit!) because I happened walk by the lift as it opened. Idiots. #
• Dipping my toe into WordPress theme generation. Template files, The Loop, Multiple Loops, should be a giggle. #
• currently getting irritated with CSS 'issues', where 'issues' means it's not doing as it's damn well told! #
• WordPress CSS styling has defeated me for tonight. Going to read up on some stuff before sleepy time. Bedward I go! #
• test tweet using twicca on the android phone. A few bugs such as caps not going on after a period. otherwise it's looking good! #

I find my error serious but amusing, considering I’m mid way through reading Bad Science by Ben Goldacre where he points out the frequent mis-representations of studies due to stupidity, subversive agenda and other reasons.

I most definitely briefly popped into the ’stupidity’ category there, and while I’m annoyed I made the error I’m also happy to admit it publicly (semi-related: previously). If you read the original post before I added updates, it’s worth re-reading as I correct the errors end up being even more concerned than I already am.

• singing 'happy birthday' to @DancingHermit #
• Crappy night sleep; 30mg mirtazapine, 10mg zolpidem, 1mg alprazloam gave 4hr, then 10mg  diazepam gave me 3 more, with breaks midway. Gah #
• Taking Zachary to school this morning, then head to chiropractor appt. Wonder what rush hour traffic will be like today. Has been a while. #
• Redirected my http://jonathantullett.com domain to point to my LinkedIn profile (http://uk.linkedin.com/in/jonathantullett) #
• I really do not like waking up at 7am! #
• Traffic was light, 30 min journey. Now in Café Nero withabook, enjoying a hot chocolate before my chiropractor appt. #
• Very sad and disappointed that Z's.mum wouldn't accept a birthday gift from Z because I was involved in the choosing. #
• After pointing out many times that it's *Zachary* who'll be most disappointed at not giving a gift, she relented (begrudgingly). #
• Separated parenting is one of the most challenging things two people can do. In reality, the children are the only thing which matter at all #
• As long as that is not lost sight of, you're offering the children the best future possible. #
• Arrived home to find someone parked in my drive. Turned out to be the gardener. Garden looks much better than yesterday, hurrah. #
• Just noticed that the Google Location Badge code doesn't work properly in Safari. Any known solutions? problem eg: http://bit.ly/jktloc #
• …have confirmed it's not a WordPress issue (wrt integrating it into a 'page') before those 'solutions' are suggested! #
• Playing with my blog: added link to my professional site (redirecting to LinkedIn); opening photos in new window until SmugMug integration. #
• Suddenly craving sausages, beans, bacon and toast thanks to @missvix! Only have materials for a ham sandwich though, *pout* #
• Have put the heating upto 20 degrees! Is so cold in here :( #
• The domain 'small-pen.is' is available for registration. Oh the fun one could have… #
• Had to upgrade MediaWiki (http://www.mediawiki.org) as a server of PHP to v5.3.1 broke v1.11.0 due to addition of native namespaces. #
• Installed 'Subscribe to Comments' (http://bit.ly/a0PTg3) on my blog so you can be notified, via email, of replies to comments. #
• Updated last post. Seems I overlooked a key sentence from the Pearl Index which alters the math completely! #

Deferentectomy (aka vasectomy): a word which will make a lot of men wince and possibly even cross their legs at the mere thought; a procedure I know a lot of men will not even consider, despite it being a far safer operation to tubal ligation (female sterilisation).

I’ll start by saying that I know I will want more children in the future. When this may be I do not know, but I want any decision to have a child to be mutual and for it to be a planned event; absolutely no ‘accidents’¹.

There are many different contraception types available to females, each, as with most things, having positive and negative points. A (non-exhaustive) list includes: a plethora of pills, Depo Provera injection, implant (eg. Implanon or Norplant II) devices, IUDs and even the (sexily named) Femidom (female condom).

There aren’t so many options for men. The only one which comes to mind is the condom (for the purposes of this post, I’m not including methods which are currently under going trial or are waiting to undergo trial as they’re not generally available.)

‘Typical use‘ failure rate for condoms is 0.12-0.18 (the Pearl Index currently has it at 0.15). ‘Perfect use’ is 0.02 but this is real life and I’m not perfect so we’ll go with 0.15.

(As this post meanders towards its ultimate ending, I base the rest on the fact it can’t be known for certain whether the female is on contraception and more importantly that it’s working effectively.)

On the basis that a female is fertile for up to 7 days out of a 28 day cycle², thus 0.25, and there’s a 0.15 failure rate in using condoms; and on the assumption that neither the male or female is aware of which day of the cycle she’s on (as fertility awareness can be used to determine the days additional contraception should be used, or sex abstained from), this gives the following calculation:

Risk of condom error:         0.15
Risk of female being fertile: 0.25 x
----------------------------
Risk of pregnancy:            0.0375

Or, 3.75%.

Or, 15%.
See update 1, below.

Thinking that over the course of a single year there’s a 15% chance of unexpected pregnancy and all that could entail – the trauma of abortion, the stress of an unexpected/unwanted pregnancy, cost etc – even when using condoms is enough to put me out of the mood completely. It’s making me consider a ‘temporary vasectomy‘³.

The main advantage of having a vasectomy, for this scenario, is, once it’s confirmed successful, there is only a typical failure rate (pregnancy) of 0.0015. Plugging this into the calculation above yields:

Risk of vasectomy leakage:    0.0015
Risk of female being fertile: 0.250 x
----------------------------
Risk of pregnancy:            0.000375


Or, 0.0375%. A far more reassuring figure (100x, in fact).

0.15% – a far more reassuring figure (100x, in fact).

The disadvantage of doing this is that vasovasostomy, although often a very successful operation, usually results in only 30-90% of the sperm returning to the ejaculate and chance of normal fertilisation drops to 30-60% (ignoring other potential female factors.)

Should the vasovasostomy fail, I’d have a back up stored in liquid nitrogen somewhere.

So, over all, the advantages are:

• Little to no chance of accidental pregnancy

The disadvantages are:

• Requires an operation to have children naturally
• Cost of the vasovasostomy is £1500-£3000
• Cost of IVF should the reversal fail
• Possibility of not being able to have children if both vasovasostomy and IVF fail
• Emotional stress and trauma to a relationship caused by going through the above
  options and possibly ultimately failing⁴

While, in numbers of positives and negatives, it appears to be a bad idea, the sheer weighting of the advantage at least levels the playing field, in my mind.

Some questions, however, which are arising:

1. Is this a bat-shit crazy idea?
2. If you’re female, what do you think about a guy taking such an active interest in contraception:
   1. If you know you want children?
   2. If you know you don’t want children?
3. If you’re male, is this something you’ve considered?
4. Is there anything glaringly obvious that I’ve missed here?

As you can see from the above, this isn’t something I’m considering lightly, or doing without researching facts and figures. But I am genuinely interested in others’ thoughts and feelings on this subject. Sarcastic or stupid responses will be deleted, everything else will be seriously considered and replied to. Ideally I’m looking for responses from both an emotional and logical POV, both male and female.

Thanks in advance.

Update 1:

An astute reader (thanks Rosie!) saw I’d misread the tables and there’s no need to multiply the condom failure rate with the female fertility – the 0.15 is the, and I quote, ‘chance of pregnancy during the first year of use‘.

15%!

Which still remains two orders of magnitude greater than having the vasectomy, which is 0.0015, or 0.15%.

This validates my train of thought even more.

Update 2:

I’m aware that combining contraceptive methods increases effectiveness (eg the implant + male condom is 99.99% effective), but I’m thinking of this from the purely male perspective/action plan point of view.

1. I quote the word ‘accident’ as I believe what most people call ‘accidental pregnancies’ would be better referred to as ‘unplanned’. The ‘accidents’, in my experience, are due to thoughtlessness or plain carelessness, eg, forgotten pills, antibiotics rendering pills useless, condoms breaking due to incorrect usage etc rather than a genuine accident. Perhaps this is pedantic semantics?
2. Yes, I used Wikipedia for my data. Yes, I know this isn’t a definitive source, but this isn’t a dissertation, so bite me.
3. A temporary vasectomy would be where you go for the operation with the intention of having a reversal later on.
4. My logical brain thinks if a relationship can’t cope with this stress, then you shouldn’t be having kids in the first place.

For the first few days, the antihistamine side-effect of drowsiness was superb and meant the other sleeping tablets were unnecessary. In fact I was able to follow Dr. Broadhead’s instructions to the letter and was having sufficient sleep.

However, about 5 days ago it stopped this effect and my previous sleep pattern returned, meaning very broken sleep, despite often falling asleep quickly. The result of this is I feel like I’m running at a reduced mental capacity and my motor functions are mildly impaired (reduced reaction times etc and other things usually associated with sleep deprivation.)

I added zolpidem, 10mg, (prescribed by the doctor, naturally) back into my night time medication , however while this knocks me out quickly (10-15 minute onset!), I still only sleep for an initial 3 hour stint before the frequent waking starts.

Last night I included, along with the zolpidem, 1mg alprazolam (also under a doctor’s guidance), which should get me, in an ideal world, at least 6 hours solid rest. I was awake within 4.

As I’m unable to reschedule my appointment with Dr Broadhead, I’ve requested a phone call from him to discuss anything I can do between now and Wednesday when I’m booked in to see him. Meanwhile, I’ll stop the zolpidem et al. as it’s clearly providing nothing additional or beneficial to my adventures with sleep.

I desperately want to return to work this week, but fear I won’t be allowed until the root cause is at least understood, if not resolved. The only positive spin I can put on any of this is that my understanding of various classes of medication and its effects on the human body has greatly improved, and knowledge/learning is always a good thing.

• Time for sleep. Boy will be up in a matter of hours. Night y'all! #
• Woke for the second time tonight. Treated myself to 7.5mg zopiclone and will hopefully be sleeping again shortly… #
• Amazing, I did retweeting in my sleep today! Thankfully nothing too bad or inconsiderate, but still, worrying! #
• Another crappy night sleep, even with medication. Need to see my. shrink again; can't wait until Wednesday! Until then, sufferage? *pout* #
• Odd 'lucid dreaming'. Unhappy subjects though, may force myself up and awake properly shortly. #
• Seems I accidentally set Bunny to wake at 0945. That was careless :-) #
• My son believes in affirmative action: he only wants the black straws. #
• I've finally caved and decided to start doing the washing up which has been piling up in the sink for the five days! #
• What I thought were maggots, drowning, turned out to be grains of rice. Phew, close call. Washing up will be daily or bi-daily from now on! #
• Deleted my flickr.com account as http://www.SmugMug.com is far superior! http://photos.downagain.com/ for my hosted SmugMug site. #
• If you decide to use http://www.smugmug.com (it's subscription, but cheap and excellent value!), please ping me for a referral code. #
• Attempts to modify my smugmug theme so it's in line with my blog have so far been unsuccessful. I suspect CSS to be the cause. Blasted CSS! #
• Reading up on WordPress theming. Not sure I have the time to design one from scratch, or even customise an existing one. #
• Spent the afternoon at my Dad's with Zachary. Now he's watching The Sword in the Stone while I prepare something chickeny for dinner. #
• May be pushing the dairy intolerance with the Chicken Tonight I just had – it contained cream. But it was yummy. #
• http://www.youtube.com/watch?v=3sYVLHwf7JQ – Is it Michael Jackson, or a woman brushing her teeth? Maybe we'll never know the truth… #
• Attempting to feed the snakes again. Have down-sized the rats to rule out them being intimidated by the size of the food item. #
• Heading bathward then back to the old regime for sleep. Wish me luck on a solid night kip. #

• Going to sleep for real this time, none of that fake sleep like before. This Jonathan is /out! #
• Bad night sleep. Woke loads, no reason. Annoying. Trying again for a few hours. Wish me luck! #
• That was a night's sleep of the olden days, definitely a step backwards. Woke plenty of times, feeling like urgh :( #
• Recommendation whoring again on LinkedIn, seems to be the done thing these days. Good press never goes amiss. #
• Went to wake Zachary after his 14 hours asleep. He lifts his head from the pillow and says, 'five more minutes?' then falls back down. Cute! #
• Zachary's wolfing down his breakfast while watching Pixar's Cars. Heading out to my Mum's shortly, with a car full of PS3 console and games. #
• At mum's, had lunch. Now heading into Watford for a new PS3 cable :-( #
• Going to 'Hooters' in Watford with my brother. Gutted to find out it's a music shop! Oh the humanity! #
• Sneaky hamburger and large McFries on the way back from Watford town centre. #
• Had to order composite cable from Amazon. £4.95 inc postage. Hopefully arrive within a few days. Meanwhile, I have a Wii again! #
• Eagerly awaiting spaghetti bolognaise chez mum. Zachary's playing Starwars with his uncles in the garden. #
• Record breaking trip back from Mother's, fast roads all the way. #
• The Wii is now reconfigured. Using scart as it would only offer 480p regardless, thus doesn't worth the effort of outing the hi-def cable. #
• It seems the Mirtazapine has disabled the 'off switch' on my hunger. Can't stop eating. Expect a few extra kilos the next time you see me! #

When I was first invited to join LinkedIn, I didn’t pay too much attention to the site beyond creating my account and adding details of the job I was in at the time (I believe I was working for MoneyAM Ltd.)

As the years went by, more people requested ‘connections’ with me – generally all people I’d worked with previously, very few of the random “let’s add everyone even if I don’t know who they are” invites which seem to happen frequently on Facebook occurred – and my interest in its potential use grew.

Today, as I look through my list of contacts, I see many are either rising stars of their professions or people already near the top of their chosen career. Quite an address book to have, and it continues to grow regularly as I have the privilege of working with new people on a weekly basis.

I’m now using LinkedIn more frequently and professionally; recommending people’s work if requested, assuming I feel in a position to provide such recommendation, and requesting recommendations (aka references) from those I’ve worked with in the past or, in the case of freelance work, currently.

If you get a request for a recommendation from me but aren’t happy providing one, please drop me an email at jonathan (at) downagain (dot) com because I’d like to know where you feel my personal, interpersonal or professional skills need a polish before getting a seal of approval. And of course, feel free to request a recommendation from myself if we’ve worked closely together. I will be honest in my evaluation and, ultimately, it’s up to you if it’s displayed on your profile.

I will add at this point, in case my employer is reading, that I’m not looking for work as I’m very happy in my current role, but given my LinkedIn profile is the number two result on Google if you search for my name (with this blog being number one!), I feel having a solid professional online presence is time well spent.