Pain scales are a pain in my…

One of the most frustrating things from my stay in hospital is when they asked about pain.  On a scale of one to ten, with ten being the worst pain imaginable, where would you rate yourself when you’re up and moving around?  And when you’re comfortable and resting?  And right now?

Arghhhhh… This question does not work for people with chronic pain.  As I wasn’t actually in for pain I didn’t put much thought into my answers especially after I (politely) challenged a nurse about the uselessness of me answering.  But had I been in for pain related stuff, how would I respond when the first half of that pain scale never really applies to me.  This means I lose nuance and nurses who don’t know what ehlers danlos is look at me funny when I say 5, 6 or 7 – my most common pain scores according to their scale.  I no longer look in pain when my pain is 7 or below.

Also, the expected result was that when I was moving around my pain would be higher than it is when I’m in bed.  But for me that’s often not the case.  I know how to read my body and know when I’m overdoing it and I stop.  Because most of the pain isn’t an instant thing, it’s not like I stand and immediately I’m in agony, I tend to be in more pain when I’ve stopped.  Some of this is adrenaline and some is that I’ve stopped before the pain peaks.

The other really frustrating part of it was hearing other people claim to be at a 10 when they were pretty much fully functional.  In my books, a 10 has you close to passing out or passed out.

But there are options out there for improving this quantitative measure of pain.

Firstly, do the basics and show a patient the pain scale with faces on, it gives a bit more context and helps the patient have a guide to consider.

Although again, for people with chronic pain, the scale shifts.  It takes a hell of a lot of pain to make me cry or even get close to tears these days.

Maybe go one further and use this one from Hyperbole and a Half:

There are also written pain scales which patients might find useful as they don’t just look at the pain but look at the impact of said pain:

0  Pain free
1  Very minor annoyance-occasional minor twinges
2  Minor annoyance-occasional
3  Annoying enough to be distracting
4  Can be ignored if you are really involved in your work, but still distracting,
5  Can’t be ignored for more than 30 minutes.
6  Can’t be ignored for any length of time, but you can still go to work and participate in social activities.
7  Make it difficult to concentrate, interferes with sleep, you can still function with effort
8  Physical activity severely limited. You can read and converse with effort. Nausea and dizziness may occur.
9  Unable to speak, crying out or moaning uncontrollable- pain makes you pass out
10  Unconscious. Pain makes you pass out.
As an aside, according to this particular scale, my pain is always 7 or above…
A similar version exists but with colour coding to help:
Again, I’m a 7 or above most of the time with this one and I regularly hit 8 in the night.. See how unhelpful they are for chronic pain?!
You can also personalise your own pain scale which might be helpful for taking to appointments which are about pain.  There’s a tool online which can help with this and I’d recommend looking at other pain scales as well to get a flavour for things.
There is work going into pain scales, at least in America and I’m hoping that work goes into how the NHS use them as well.  They are a useful tool but they need a lot more tweaking before they can be anywhere near accurate measures of a persons pain.

The ever wise and wonderful Jo Southall has a post on her blog about painscales which I’m considering printing off and handing to the pain clinic next time I go.  Every time I have to fill in the pain scale form and draw on an outline of a body where my pain is, here’s a hint, pretty much everywhere…

As Jo suggests in her blog, much more helpful questions are about how you are coping with your pain, how it is affecting your life and whether it is disrupting your day to day activities.  Not only does this give a clearer picture to the medical practitioner but it also means you can look at making adjustments which will ease those issues caused by pain and in turn you may well make the pain more manageable.

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Winter and me

Over on Poets & Writers, a prompt came up which sounded interesting and timely for my weather focus.

In preparation for cold winter months, red-toothed shrews are able to shrink their head and brain mass by 20 percent and then regrow it as the weather warms up in spring. With this survival strategy, they expend less energy when food resources are scarce. Does your energy level or your relationship to your body change during certain seasons? Does your body feel, act, or respond differently in the winter? Write a personal essay about measures you’ve taken, whether moderate or drastic, to adjust your body to difficult times or discomfiting temperatures at various points of the year. 

I have touched on my relationship with weather and with winter a few times but this felt like an interesting angle to approach it from.  This is not an essay but rather my very initial responses to the topic of winter and me.

As winter approaches, as the icy wind creeps over the landscape, you will find me retreating.  You will find me shrinking into my flat, into my bed, into my duvet.  I am no longer an outside creature.  No longer a creature of the weather.  If I could, I would hibernate.  But to do so is not possible in a human shell.  So instead I adopt the next best thing.  A season snuggled into my warm home, blankets, hot drinks and reassuring comfort.  I will mark my days with morning chills and evenings nesting.  I will conserve my energy.  Only moving when necessary and even then, I leave my den reluctantly.

Pyjamas and jumpers become my layers of choice and I will not leave the house without a blanket.  I am bundled up, my armour against the bitter winter.  Perhaps if I wear enough layers, the wind will not chill my bones, I will not slip on black ice and damage yet more of myself, the rain will not permeate my soul only to be released as tears.  Perhaps.

I move slower.  The cold tires me out.  My joints ache with the low temperatures.  Depression pulls like a ball and chain at my ankle, holding me back as I try to step forward.  So I stay still, in my nest, in a state of dormancy.

Of course, when I worked, I could not indulge myself in my semi-hibernation.  I had to get up, brave the frosty mornings and skate on the black ice to the office.  I had to fight my body and my mind to get out of bed, to leave the house.  The darkness, the grim shadowy mornings and nights, bothered me more then.  To work in the dark, a day at a desk far removed from daylight, then home in the dark.

Now, through my windows and occasional venture outdoors, I see the slither of day.  I do not battle my natural instinct to retreat but accept it for what it is and it makes this time of year easier.  I prepare, like a squirrel collecting nuts, only I collect ideas and projects and books that can all be carried out slowly from the safety of a blanket.  I do not sleep the winter away. But nor do I expect from myself the same level of activity as summer.

I am comfortable now, secure in my knowledge that as the seasons rise and fall, so too will I.

Weather and literature

I’ve already looked at snow in literature but let’s take a step back and look more generally at the use of weather in literature.  Weather is a widely used character in literature.  It shows the mood of the location, it echoes the mood of the characters and it can play its own part in the unfolding of the tale.

For a bit of fun, have a look and see which weather represents your mood.

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One of the genres where weather really makes an impact is Gothic literature.  Here we regularly find stormy, dark conditions with rain or fog.  Violent weather is used to create an atmosphere of suspense and terror.  Think of the moors in Wuthering Heights or the storms in Frankenstein.

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Frightening or violent weather allows villains to hide, lets the protagonist sense things which are not there, means they miss things which are there.  This sort of weather emphasises the unease and thunderstorms mask the sound of someone creeping up behind you…  Weather also shows how a character is feeling, the emotional storm within reflected in the literal storm without.

In Gothic literature, weather is often used with wild nature, that is places which are remote, savage and inhospitable.  They are unfamiliar and unstable and the weather enhances the atmosphere of suspense.

From a plot perspective, weather can be used to trap characters in unsavoury situations, to restrict their freedom and to confuse them. Just when they thought they’d escaped the villain in the mist, they walked straight into them.

“Remember to get the weather in your god damned book – weather is very important.”
― Ernest Hemingway

In literature more generally, weather is used to help set a scene, give a sense of place and time and can bring a story to life.  It can be used symbolically and, as with Gothic literature, it can impact on the characters plans and actions.  We also see elements of the characters through their reaction to weather and the impact it has.  Different characters would react very differently to being trapped in a blizzard for example and here the author has the chance to demonstrate resilience or lack of it as well as resourcefulness and patience.  Weather affects us, it affects our plans, it affects our environment and it affects our health, all of which provide opportunities for authors.

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When talking of weather and literature, I feel I would be amiss if I didn’t introduce, or remind you of, pathetic fallacy.  Pathetic fallacy is a literary device that attributes human qualities and emotions to inanimate objects of nature.  So the storm may be angry, the sun happy, the rain may weep.  Wordsworth’s famous poem ‘I wandered lonely as a cloud’ exhibits pathetic fallacy right there in the title.  And all of these examples set the tone for the scene which is unfolding in the story.

Mary Shelley’s Frankenstein offers further examples of pathetic fallacy to emphasise the power of the landscape in the novel and to contrast between the setting where Victor feels happy and comfortable and the setting which is desolate and dangerous.  Weather comes into play here with the calmness of the former and the stormy, windswept nature of the latter.

We also need to remember that understanding of what weather is and how it is created is fairly recent.  This affects how literature is read.  For example, when Mary Shelley wrote Frankenstein and included the dramatic storm scene, there wasn’t a scientific understanding of storms.  With this in mind, I think reading Frankenstein at the time of writing would have been even more terrifying.  Not only are you dealing with the unknown forces of the dead, you’re also dealing with the unknown forces of the sky, or God.

And talking of scary weather, the Met Office have complied a short list of spooky weather which might provide inspiration for those of you who are writers.

“We all know that weather affects our moods. The novelist is in the happy position of being able to invent whatever weather is appropriate to the mood he or she wants to evoke.”
– David Lodge

Leaving fiction for a moment, let’s think about weather in poetry… There are lots of great words which can be used to illustrate weather.   These are used for description, for mood and to provoke emotions.  There is also something universal about the weather.  Whilst some of us will never experience scorching droughts or feet of snow, we do share our weather with those around us and with those who have come before us.  Weather can connect us and thus can connect the poet and the reader.

Just a couple of examples before I finish: Christina Rossetti writes of the ephemeral, unseeable, untouchable nature of the breeze in her poem ‘Who has seen the wind?’.  In a much more recent poem, ‘Here’s the Weather’, Stuart A Paterson uses local weather words and phrases to create a sense of place and many of these words bring to mind a strong picture of the weather.

As a bit of aside, according to the bestiaries of old, wolves are only born in thunder.

Snow, and the kindness of strangers

“I wonder if the snow loves the trees and fields, that it kisses them so gently?”
– Alice in Wonderland

I had originally planned to write this post for Christmas Day but what with my recent stay in hospital things have got a bit off plan!  I’m now home which is great and, whilst this isn’t the end of my swallowing troubles, I am sleeping in my own bed, I have my stuff around me and I’m not getting woken up at 5.30am to be told my blood pressure is low.  Side note, it’s always low, especially at that time of day…

York Minster in the snow

Whilst I was in hospital, it snowed.  The first time it snowed, it came in quite a flurry and a lovely stranger took me for a walk to see the hospital’s Christmas display in the snow.

Another side note, this guy was so lovely.  He was there to see a friend and we’d said hi a couple of times but on this occasion the doctors were with her so he pulled up a seat and started chatting.  Then he said that I must be bored of being on the ward and had I been for a walk. I explained I couldn’t cos I need a wheelchair and can’t propel myself.  So he got me into my chair and off we went!  It was so great to be off the ward and really nice to see the snow.  His friend got discharged shortly after.  Then, a couple of days later, he appeared on the ward again!  He was passing by and was popping in to see if I was still there and if I was ok.  He dropped by again earlier this week and took me for another trip around the hospital and wanted to know if there was anything I needed that he could pick up for me.  It was really nice of him.  He had no reason to do any of that and he wasn’t trying to hit on me or anything of the sort, he was just really kind and thoughtful and being retired he had the time to do that sort of thing.  

Anyway, back to snow!

“Heavy snowflakes fall, flying in all directions but when there is no wind, they descend so slowly that they seem determined not to land on the ground.  When in fact they do touch the ground, they vanish completely”
– Thomas Merton

We think of snow as being the weather of Christmas but in actual fact, Christmas is generally just the beginning of the snow season.  In the UK, we are far more likely to see snow from January to March than in December.  I find this interesting and perhaps instead of seeing Christmas as peak snow time (which I suspect most of us do) we should see Christmas as the start of snow time.  The beginning of something.  I haven’t fully formed this in my head but I like the idea of Christmas marking the start of something.  Almost everything else positions Christmas as the peak, we focus a lot on the run up to the day and then for many people, the day and the period after are sort of an anticlimax or the bit after which is less important.  I’m going to blame hospital funk and not being well for this lack of articulation!

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According to the Met Office, white Christmases were more frequent in the 18th and 19th centuries which was also when Christmas cards and other commercial concepts started to appear.  This possibly explains the heavy use of snow in festive ephemera.

It’s important to note here that for the Met Office, a white Christmas is one where at least a single snowflake is observed to fall at some point in the 24 hours of Christmas Day.  With this definition, more than half of all Christmas Days can be expected to be a white Christmas.  But in terms of achieving that Christmas card scene with widespread snow covering the ground, the chances are much lower with 4 occasions in the last 51 years, the last being 2010.

Apparently, the snowiest winter in Great Britain was in 1947. Between the 22 January and the 17 March snow fell every day somewhere across the UK.

“You go to bed in one kind of a world and wake up in another quite different, and if this is not enchantment, where is it to be found?”
– J.B. Priestly

Snow is magical.  Partly I suspect because we, in the UK, don’t see much of it and partly because of the time of year it falls and hence it’s association with Christmas and the excitement that can come with that.

It is a strange type of weather.  It is ephemeral, occupying a thin line between ice and rain.  It coats the earth in a blanket of white but is actually translucent.  There is the fascinating, wonderful nature of snowflakes each having a unique structure.  Snow transforms the landscape, concealing the familiar.  All of this plays magnificently into the hands of poets and writers.

In snow, anything is possible.  Snowmen can come to life and take you flying across the sky.  Lions and witches can inhabit a snowy world reached through the back of a wardrobe.  Snowy nights can set the scene for Victorian-esque ghost stories.

“I thought her as chaste as unsunned snow.”
– Shakespeare

Snow is often used as a metaphor for slumber, purity and renewal.  It can convey a sense of peacefulness and quiet as well as invoking nostalgia. There is a romanticised view of snow, holding hands with loved ones as you dance across ice rinks with snow falling gently around you…

“They were playing old Bob Dylan, more than perfect for narrow Village streets close to Christmas and the snow whirling down in big feathery flakes, the kind of winter where you want to be walking down a city street with your arm around a girl like on the old record cover.”
—Donna Tartt, The Goldfinch

However, snow can also be a force of nature, it has the power to disrupt as well as kill – every year in the US, about 100 people die shovelling snow and there’s obviously more deaths from traffic accidents, from the cold etc.  And as snow falls from the clouds, the flakes stop growing and start to wither.

We see the darker side of snow in writing which depicts it as bleak or uses it to echo the icy cold hearts of characters such as Dickens’ Scrooge.  In The Long Winter by Laura Ingalls Wilder we hear of how her family almost starved to death during “blinding, smothering, scratching snow”.

Snow, it seems, is a powerful tool in a writer’s toolkit.  Whether you use it to create joy, to create children laughing and playing or use it to create catastrophe, death and destruction, have fun with snow in your writing this month.

 

Good girls don’t swallow

Well. Whatever your feelings about good girls and swallowing, this girl can’t swallow much. The wait and see and surely she’ll start to eat approach of the doctors didn’t get me far. After two and a half weeks of not eating, they gave me an ng tube.  It’s not the most pleasant of things, it’s uncomfortable and at the start distressing and such. But I am now getting food in me. Which will build strength back up to my normal crap levels. 

The barium swallow test hasn’t happened yet as the machine is broken… The results may inform what happens next. And so will how my care agency feel about doing the ng feed with me.. If they are on board then I might get home at some point although timescales and hospitals aren’t very compatible so I’m not holding my breath or setting a date! 

Updated on 7th Dec, before posting: I had the swallow test which didn’t show anything especially dramatic. I have a sluggish swallow which runs out of steam and the xray guy did point out that was just with two mouthfuls of barium which is not the same as eating food or drinking a normal amount of anything. Some nurses have taken this to mean there is nothing wrong and that I should now be eating…

The next bit of the process is a meeting with social services, my care company and doctors to review my care needs. Given they haven’t managed to speak to my care company yet, I can’t see that meeting being this week. If the care company agree to take on the feeding tube then all my carers need training from the hospital (it’s easy but their policy means I can’t talk them through it). And trying to get that sorted will take another chunk of time…

This is a really frustrating sticking point. If my hands worked, they’d have discharged me by now. I miss my bed and my stuff and not getting woken up at 5.30am to have my blood pressure checked. I mostly feel OK now so I could be doing stuff… As it is because I don’t have all stuff, I can’t get my tablet in the right position to watch comfortably or my magazine in such a place I can read it… And the bed is making my pain worse and so on and so on… 

Grumble.

The science of weather prediction

Weather forecasts are used by many different groups.  You probably check it the day before you’re thinking of going to the beach, or on holiday.  Many people have weather apps on their phones which they check daily.  There are some people, such as farmers, who have a more pertinent need for accurate weather predictions.  And big businesses use weather forecasts.  Certain types of organisations, such as airlines, buy specialist forecasts from the met office to help them to plan their activity.

Today we live in a world which surrounds us with weather forecasts, where being able to predict the future is a big money maker and people are even trying to control the weather.  But before (accurate) weather prediction, extreme weather was disastrous.  A storm in 1703 hit the west coast of England blowing cows and sheep over hedges, ships all over the place chimney stacks in London collapsed.  It’s thought that 10,000 people died in a few hours during that storm.  In the New Forest, 4000 oak trees were lost and over 1,000 seamen died on the Goodwin Sands alone.  This storm was thought to be a punishment from God and the lack of warning system meant significantly more damage was done.

A lot of this area is technical and I’m not going to get into that too much.  I want to look at how weather forecasts came to be and how weather forecasting is used.

Various theories about weather were floating around including the idea that it was cyclical, that it was to do with the moon and the planets or, as was the case for most people, that weather was an act of God.  This meant that to face the weather, you needed God on your side.  So church bells were rung during storms and prayers were made.

As time went by, science began investigating and categorising the natural world; the plants, the animals, the rocks.  But the sky lagged behind, remaining the realm of the gods.  It wasn’t until the 1800s that the study of weather really took hold.

The sky too belongs to the Landscape:- the ocean of air in which we live and move, with its continents and islands of cloud, its tides and currents of constant and variable winds, is a component part of the great globe
– Luke Howard, 1837

Despite the study of weather being fairly recent, tools for the measurement of weather had been around for a while.

  • The first tool to measure air humidity was described by Nicholas Cusa in the mid fifteenth century.
  • Galileo invented an early thermometer in the late 1500s
  • The barometer, to measure atmospheric pressure, was invented by Evangelista Torricellin in 1643.

These tools were refined between the seventeenth and nineteenth centuries, alongside other discoveries about the atmosphere.  At this time more people, although still very very few, had begun to record weather observations.  These included measurable data such as the wind direction and speed, the heat of the sun and the nature of the clouds.  When the telegraph was invented, it allowed for the sharing of these notes and would of course, later, allow for the distribution of the forecasts themselves.

Slowly, using observations and records, weather maps were drawn out and analysed.  To make the data usable, it was necessary to standardise the language and phenomena being described.  Before this point, you could describe a tumultuous wind or a feathery breeze and unless the person was there, you didn’t know you were talking about the same thing.  It was Francis Beaufort who set about to standardise wind speeds in 1806, although attempts had been made before him.  He also developed weather notation coding which he used himself in his own weather diaries:

Blue skies (b), sultry (s), hazy (h), damp air (dp), foggy (fg), rain (r), squally (sq), thunder (t) and so on
– As quoted in The Weather Experiment by Peter Moore

Cloud classification was first described by Luke Howard in 1802 and was standardised in the International Cloud Atlas in 1896.  All of this standardisation would be essential in terms of making the data usable and comparable.  It meant, that like the other older sciences, meteorology had begun the work of classifying the weather system.

By the 1860s, there was enough known about the weather to start making forecasts.  But weather forecasts were a threat to the church in much the same way as the theory of evolution had been just a few years earlier.  Forecasts suggested that mere mortals could look into the future and suggested that God was not the main driver of the weather.

However, the development of the telegraph and the expansion of the network were a boost to the new weather forecasting.  It allowed messages and forecasts to be conveyed quickly, before they were out of date, and allowed for fast transmission of observations as well.

In the 19th century, weather had important implications for shipping.  Both cargo, crew and passengers could be lost at sea, like in the storm on 1703.  To be able to map and forecast the weather would make considerable differences to traders, the navy and to passengers.

The Met Office was established in 1854 as a service to mariners and began providing forecasts to newspapers in 1861.

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In the early 20th century, they focused on how to improve aviation forecasts which were becoming increasingly important, especially during the second world war.  The nature of early planes meant they were vulnerable to wind and rain so weather forecasts were vital both to the success of missions as well as the protection of the soldiers and the planes.

By the 1950s, the Met Office were producing other specialised forecasts, such as those for pigeon races, seasonal forecasts for farmers, and predicting the likelihood of train disruption from ice.  These weather forecasts were broadcast on radio and TV.  Weather phenomena which would affect aviation also continued as a major focus.

Today, we rely heavily on computer systems and mathematical mapping but we still need human involvement to interpret and judge the data.  Weather is a chaotic system and as such is difficult to pin down with any accuracy, however accurate weather forecasts have been used over and over to much success.  For example, the D Day landing was timed for a good forecast and many operations go ahead successfully today because of accurate forecasts.  It’s just we remember the ones that weren’t like the storm of 1987…

The art of weather prediction, part two

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There have been a few studies recently which looked at the use of traditional forecasting in places such as Africa and India and, on the whole, the methods fall into a number of categories:

  • Looking at the sky
  • Animal and plant behaviour
  • Astronomical observations
  • Current weather and recent changes
  • Seasonal patterns
  • Long term cyclical patterns

I had hoped to focus on traditional British forecasting but most of the information I could find was about people who still use traditional methods.  To give a flavour of these approaches, I’m going to give a few examples for each method.

Looking at the sky

This can involve the clouds and as we’ve seen, cloud type, cloud coverage and cloud movement all help to predict the coming weather.  Black clouds mean heavy rain is coming, black clouds preceding strong winds means thunderstorms.

Animal and plant behaviour

You’ll notice these methods involve specific species and this is important as the behaviour of a particular plant in one region could well signal something very different in another.

This area of observation can include migration patterns, the arrival or disappearance of a bird or animal, the different sounds they make and their behaviour.  For example, in a certain part of Uganda, the appearance of bush crickets is one of the signs that the dry season is coming and cuckoo birds starting to call signals the approach of the wet season.

High-flying swallows means stable, fine weather as they are likely to be chasing insects on updrafts of warm air.  On the other hand, bees don’t like rain so if wet weather is on it’s way, they’ll stick around the hive.  Frogs are particularly associated with the rainy season and I touched on the use of frogs to predict wet weather in Australia before.

In terms of plants, we look to when they flower, when they blossom, when they drop their leaves as well as the amount of flowers and fruit etc.  A study in south Africa reported that above average blossoming was a sign of good rains to come and farmers would plant accordingly.  If fruit was being dropped too early and unripe, it was a sign of drought and farmers then knew to plant drought resistant crops.

More locally, dandelions close when it clouds over and scarlet pimpernels close when humidity increases.

Astronomical observations

One of the studies, I think it was a UNESCO one, I really should have made note, was looking at farmers in Peru and Bolivia.  These farmers observed the Pleiades constellation on a certain date and used ancestral knowledge to forecast the timing and quantity of the rain as well as the size of the harvest.  I know that some of you will be reading this thinking that you can’t possibly predict the harvest from a constellation but:

The apparent size and brightness of the Pleiades varies with the amount of thin, high cloud at the top of the troposphere, which in turn reflects the severity of El Niño conditions over the Pacific. Because rainfall in this region is generally sparse in El Niño years, this simple method provides a valuable forecast, one that is as good or better than any long-term prediction based on computer modeling of the ocean and atmosphere.
Orlove et al, 2002

Other astronomical observations include looking at the moon.  Poor rain at the new moon was said to be followed by a dry month and a halo round the moon is a sign of rain.  The shape and the colour of the moon were also used.

Current weather

Looking at the weather now can tell you a lot about what is to come.  In parts of Uganda, winds blowing from the east to the west mean the dry season is near and when they change and blow from west to east, they signal the wet season.  Looking to the mountains can help with short term forecasts – frequent mist or fog on the mountain tops can signal rain.

The occurrence of intense hot or cold spells at certain points in the year are used to indicate the timing and amount of rainfall in the wet season.

Rainbows are another tool used in traditional forecasting.  If they are dominated by red it’s supposed to mean more rain is coming but if they’re dominated by blue it means the rain has passed.

Seasonal change

Being in tune with the seasons helps farmers to understand what weather to expect, but they don’t just turn over a calendar and say it’s spring, they tend to have seasonal markers which they use to inform their practices.  We’ve already looked at some of those which signal the arrival of the wet and dry seasons above.

Long term patterns

This is one area which doesn’t seem to be covered much in the literature but there are weather forecasters who believe that weather comes in cycles, such as the idea there will be a harsh winter every 15 years or so.

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