Hot

I filled up my medicine box, straightened up all my medicine bottles and put them in order of expiration, consolidated some, put the expired ones in a bag to go into the Med Toss they're having in Lexington on Saturday, and then got the clothes off the couch and went through a box of things and put them where they should be. I took the reusable bags that were in a pile in the living room, put them together in one bag, and put them in the hall closet, where they belong. Now I'm terribly hot. I have the windows open, but the breeze has stopped, and where I've been up and down, it's warm. That leaves one box of papers to go through later and a box of things to give away. I even managed to get the star-shaped fairy lights back up and turned them on for fun, which really hurt. I think that's enough for tonight. That just leaves a few things in the dining room on the table and finding a place for a few things that are stacked up in boxes in the bedroom (most of those being holiday decorations).

Up for a bit

I decided it was time to:

• Go to the bathroom for the first time since early, early this morning
• Get a bite to eat (veggie sausage, egg, and cheese biscuit)
• Take my insulin
• Take my oral medications
• Ice my knee

and generally try to get back into a routine. I'm finishing up the last of the Diet Root Beer YKWIA gave me after surgergy, which was very welcome. Believe it or not, when I did that grocery shopping yesterday, I didn't get soda. A didn't want any, and I decided water would probably be best.

I walked over to the hospital this morning, which meant both knees were in pain before the surgery. The one is, now, even with the pain pill they gave me earlier, but it's not horrible. I can walk a limited amount of time on it, like from one end of the apartment to another. Getting up and down is best done in a sort of straight-leg fashion, leaving most of the bending for the 'good' knee. When I'm elevating my knee, though, I tending to rotate the knee out a bit, and my feet go out on the pillow. That happened with the ankle surgery and it was fine, but the knee seems to hurt worse when I do that, so I'm trying to prop it up in ways it won't rotate. My knee apparently has the equivalent of Band-Aids on it, but is wrapped from above the knee to my foot in an ACE bandage. I'm looking at my post-op instructions, and if I wrap the area with plastic wrap thoroughly and keep the incisions dry, I can shower tomorrow. I'll do that while A is still there, and probably use the shower chair just to be safe. I can then change the Band-Aids. It sounds like if I can tolerate the pain enough without the meds in a couple of days, I should be able to drive and hence return to work, barring any problems. Yay!

My stomach was just a tiny bit upset when I laid down in the bed after getting home, but the Pepcid they gave me before the anaesthesia did pretty well--I've never gotten sick from that or pain meds. I know one poor lady who had cancer and was given pain meds that made her throw up horribly.

Apparently the main reason my surgery was moved is due to the need for latex precautions. I react to latex, usually as itching, but I once had a dentist who re-gloved with latex gloves and my mouth and tongue began to swell. So they're fairly careful with me now. At the time, the dentist wound up taking me to the sink and rinsing my mouth out with soap, which stopped the reaction, thankfully, bu it tasted horrid.

I managed to get up by 4:15 this morning and finish a lot of the home stuff that I couldn't the night before. The only two important things I forgot were to take out the trash (I'm going to ask A to take it out--I put it all together and got it ready and then walked off without it) and then putting on deodorant, which I rectified a little while ago. Funny the little things that slip your mind and then bug you later.

Okay, I'm still a little sleepy and I should really be elevating this knee now that I've eaten. Actually, I'm having trouble keeping my eyes open. Back to bed! Hope your day is going well. It's so odd to be off from work on a Friday. Have a happy weekend.

Finally home

and munching on some string cheese and herb bread for dinner. Today I was off, and it was a very busy day. I:

1. Went to Kroger to get a product that I needed where the type I've used for years either has latex in it, or I've developed an allergy to something else in it, so I'm trying a different brand.
2. Renewed some library books.
3. Did some work on the house for about an hour and a half.
4. Mailed my mother's day card (not sure if she'll get it in time; pickup wasn't till about 3:30 pm).
5. Mailed four books (all Robert Jordan) for Paperback Swap.
6. Mailed a friend's mother's day card and some bills.
7. Took a couple of friends to the doctor and credit union.
8. Picked up some medicine at the pharmacy.
9. Took a wrong turn onto Waller rather than Virginia, turned around in a daycare parking lot, and went through some deep water. I didn't realise how deep until I'd gotten past it.
10. Ate at Long John Silver's with my friends, their treat.
11. Made/assisted with four Derby pies.
12. Unloaded and loaded the dish washer there.
13. Took care of a medical issue with one of the dogs that someone has to do every few days.
14. Texted with another friend, who's ill with pinkeye, a double ear infection, and strep throat. I am not coming near him.
15. Went to Good Foods Co-op. It was an Owner's Discount Day, so I got 10% off my order. Got some fennel and caraway seeds for the herb bread, some yummy yoghurt, vanilla bean for YKWIA, some incense, that sort of thing.
16. Stopped at a gas station to get some soda for caffeine to keep me awake for cleaning tonight and tomorrow.

Now I'm kind of pooped, but I have stuff to do. Tomorrow is the deadline regarding cleaning the house in order to play in the game. I know this is sounding like a broken record, but I'm not sure I'll make it. We'll see. On the one hand, I'm enjoying getting the house in order and de-hoarding. On the other, I'm so tired of doing it. :( But I do have to, and it's good in the long run to do it. :)

Tomorrow's agenda:

1. Cords and random electronic stuff (small things, but a good size box of them) to the electronics recycling place on Versailles Road.
2. A few more things for Goodwill.
3. Finish the bedroom.
4. Clean the tub/shower.
5. Rearrange the bathroom closet and under the sink.
6. Rearrange under the fish tank.
7. Fill the fish tank and work on getting more filtration going through. (The power went off yesterday and I couldn't get it pumping again.)
8. Go through the house and get random things put away.
9. Do the dishes.
10. Work on a chest of drawers.
11. Vacuum.

I think that's enough. Oh, and game notes, assuming I can finish everything else!

Who controls the information about your genes?

The Immortal Life of Henrietta Lacks, the Sequel by Rebecca Skloot

Last week, scientists sequenced the genome of cells taken without consent from a woman named Henrietta Lacks. She was a black tobacco farmer and mother of five, and though she died in 1951, her cells, code-named HeLa, live on. They were used to help develop our most important vaccines and cancer medications, in vitro fertilization, gene mapping, cloning. Now they may finally help create laws to protect her family’s privacy — and yours.

The family has been through a lot with HeLa: they didn’t learn of the cells until 20 years after Lacks’s death, when scientists began using her children in research without their knowledge. Later their medical records were released to the press and published without consent. Because I wrote a book about Henrietta Lacks and her family, my in-box exploded when news of the genome broke. People wanted to know: did scientists get the family’s permission to publish her genetic information? The answer is no.

Skloot's book, The Immortal Life of Henrietta Lacks, details the various ways science, in its press to go forward, did so with certain degree of ignorance and disregard for the people who were genetically connected to the most successful cell line in history. The HeLa line saved millions (among so many other things, it was used to develop the polio vaccine), but science never seems to be able to get it right when dealing with the family Henrietta Lacks left behind. Now they've stumbled yet again. At least the team did apologise when they heard of the family's reaction, and took down the data they'd made public, but of course that's like shutting the barn door after the horses have escaped, as it was downloaded and most likely deseminated.

In the United States there are laws that protect seemingly every bit of medical privacy, laws that weren't extant when Lacks lived and died. But laws related to research are still a bit murky. Can someone take tissue or samples from you, remove direct connexion to your name and then publish your genome or use your cells in research without your consent, patenting the result, reaping billions? Science is moving fast, and our legal and ethics system isn't necessarily moving fast enough. Even with consent, most people don't realise what they're signing; they don't understand the legalese or the medicalese, not because of stupidity, but because it's complex and they're untrained in it. So ethics would suggest that we protect those who don't have the knowledge to truly make informed consent by at the very least requiring it be said in simple terms, and, respecting the wishes of those who would rather not participate. Personally I think it's rather wrong to profit from a person's material without compensation or knowledge, unless expressly donated. I recognise the cells are doing nothing sitting in a tube without the scientific manipulation and development, but at the same time, the person or heirs should at least share in the ownership of the cells, which came from his or her body. Would that cripple scientific research? Probably not.

When I was a kid

There was a young girl I met at church one Sunday. She was a classmate of mine, but she'd been absent a lot and I'd never really gotten to know her. By that Wednesday she was dead, bleeding as a consequence of the leukaemia she'd been fighting with the help of St Jude's Hospital in Memphis. She was my about my age--9 years old.

It was the first time I'd heard of leukaemia, and the very first time it really hit me that little kids get sick and die. It was a profound kind of thing, the sort of thing that hits you in the gut and changes your outlook bit by bit.

These days, thanks to researchers and clinicians at places like St Jude's and others, childhood leukaemia is much more survivable than it was then. But it--or for that matter, any form of cancer--can still be a devastating disease for anyone, child or adult.

So I found this story of interest:

In Treatment for Leukemia, Glimpses of the Future

What is important, medical researchers say, is the genes that drive a cancer, not the tissue or organ — liver or brain, bone marrow, blood or colon — where the cancer originates.

One woman’s breast cancer may have different genetic drivers from another woman’s and, in fact, may have more in common with prostate cancer in a man or another patient’s lung cancer.

Under this new approach, researchers expect that treatment will be tailored to an individual tumor’s mutations, with drugs, eventually, that hit several key aberrant genes at once. The cocktails of medicines would be analogous to H.I.V. treatment, which uses several different drugs at once to strike the virus in a number of critical areas.

In 1976 this would sound like science fiction, up there with the flying cars. Tailoring medicine to your genes? And now it's achieving reality. It amazes me what scientific breakthroughs have come about in my lifetime. It really is exciting to watch. This is a good time to live in, I believe. I don't have utter faith in science, by any means. It's a double-edged sword. But with every discovery we get closer to understanding how things work, and that's great, but also we can apply it to real-life situations make a difference on a smaller, yet equally important scale, or could save greater numbers or whole species.

Cool site

Came across this blog today:

Morbid Anatomy: Surveying the Interstices of Art and Medicine, Death and Culture

I'm definitely subscribing to it in Google Reader.

Sounds interesting enough to ILL

The historians. Physicians find that studying medicine's past prompts critical thinking about the present.

Minn Med. 2010 Mar;93(3):28-32

Authors: Ledger K

PMID: 20429174 [PubMed - indexed for MEDLINE]

Wow

US doctor takes live ammo from soldier's head

A U.S. military doctor removed a live round of ammunition from the head of an Afghan soldier in an unusual and harrowing surgery.

Doctors say a 14.5 millimeter unexploded round — more than 2 inches long — was removed from the scalp of an Afghan National Army soldier at the Bagram Air Field hospital last month.

A mixed blessing

Medicine's Future Could Lie in Each Patient's Genome: In two studies, scientists quickly scanned individuals' DNA to get at causes of disease

On the one hand, single-gene disorders such as Charcot-Marie-Tooth disease could be detectable earlier and help doctors hone in on correct treatments. It's not so helpful for more complex yet common diseases such as diabetes or Alzheimer's. But it holds possibilities of targeted prevention as our technology grows and the cost of DNA sequencing goes down.

The article doesn't, however, address privacy concerns and what happens in terms of a person's chances of getting insurance in a world where newborns' genes are sequenced and their potential disorders are catalogued in their medical record. Even now, for example, there are women whose families have a strong history of breast cancer who are afraid to test for the genes--even though the test has been around for awhile--because of what it might do if it fell into the hands of insurance companies. The idea is that you could be blacklisted for conditions you might develop. That's not so bad in a healthcare system where everyone is treated equally (such as with socialised medicine). But for one based on health management organisations and the like, where costs to the insurer are very important--it could be devastating.

Still, the two studies are remarkable. The future is now, as the saying goes.

Something to know if you're prone to seizures

Ginkgo biloba's epilepsy seizures warning

Ginkgo biloba is a common herbal remedy for memory and mental focus, among other things. It comes from the same tree that is very popular here in Lexington thanks to the great statesman Henry Clay, who had them imported from China.

I once had a woman tell a group I was in that herbal remedies were natural, and therefore safe. That is, of course, hogwash. A tincture of aconite would kill a person. Belladonna, too. Even beneficial herbs have contraindications, just like pharmaceutical medicines, because they have compounds in them, some of which can work very well, and some of which may have side effects. Apparently the evidence indicates that ginkgo may increase the risk for seizures in those with epilepsy or other seizure disorders.

You should always take care to research herbal medicines if you have health conditions. The Germans in particular have codified a lot of information on herbal remedies. There are guides in English as well. Please be careful about information you find on the Internet though, and learn to evaluate websites carefully. Finally, be sure to ask your doctor about them and list them as a medicine you take. Ginkgo, for example, can increase bleeding in surgery, according to what I've read. It's important they know that as much as whether you're taking aspirin.

Ways to use technology (and even Web 2.0) to collaborate to better serve patients: a list of articles freely available for reading

A scientific collaboration tool built on the facebook platform.

AMIA Annu Symp Proc. 2008;:41-5

Authors: Bedrick SD, Sittig DF

We describe an application ("Medline Publications")written for the Facebook platform that allows users to maintain and publish a list of their own Medline-indexed publications, as well as easily access their contacts lists. The system is semi-automatic in that it interfaces directly with the National Library of Medicine's PubMed database to find and retrieve citation data. Furthermore, the system has the capability to present the user with sets of other users with similar publication profiles. As of July 2008,Medline Publications has attracted approximately 759 users, 624 of which have listed a total of 5,193 unique publications.

PMID: 18999247 [PubMed - indexed for MEDLINE]

Web screening of US nursing homes by location and quality.

AMIA Annu Symp Proc. 2008;:576-80

Authors: Pearson G, Gill M, Thoma G

To assist American families who will one day need to find a nursing home for a loved one, NLM is developing a Web 2.0 interface to important evaluative information about nursing homes in the US. Currently in prototype form, our Nursing Home Screener locates homes on a Google Map. It allows nursing home quality, indicated by map icons, to be surveyed in any of four major categories: staffing, fire safety deficiencies, healthcare deficiencies, and quality of care inferred from residents health. Within each category, options can be tailored to user preferences. Furthermore, home attributes can be used to selectively hide home markers of less interest. The goal is to offer the public a timely, easy to use site for the rapid location and comparison of nursing homes, thus identifying those worth further review or a personal visit.

PMID: 18998890 [PubMed - indexed for MEDLINE]

A prototype system to support evidence-based practice.

AMIA Annu Symp Proc. 2008;:151-5

Authors: Demner-Fushman D, Seckman C, Fisher C, Hauser SE, Clayton J, Thoma GR

Translating evidence into clinical practice is a complex process that depends on the availability of evidence, the environment into which the research evidence is translated, and the system that facilitates the translation. This paper presents InfoBot, a system designed for automatic delivery of patient-specific information from evidence-based resources. A prototype system has been implemented to support development of individualized patient care plans. The prototype explores possibilities to automatically extract patients problems from the interdisciplinary team notes and query evidence-based resources using the extracted terms. Using 4,335 de-identified interdisciplinary team notes for 525 patients, the system automatically extracted biomedical terminology from 4,219 notes and linked resources to 260 patient records. Sixty of those records (15 each for Pediatrics, Oncology & Hematology, Medical & Surgical, and Behavioral Health units) have been selected for an ongoing evaluation of the quality of automatically proactively delivered evidence and its usefulness in development of care plans.

PMID: 18998835 [PubMed - indexed for MEDLINE]

These are all in PubMedCentral, NLM's FREE depository of articles.

Another attempt to apply medicine to history

What killed Mozart? Study suggests strep infection

The Annals of Internal Medicine has published a report linking Mozart's death with kidney disease brought on by a streptococcal infection. Although such attempts to practice medicine retroactively are fraught with uncertainty, I always find the attempts to diagnose symptoms from the descriptions left behind interesting. I'll have to look this one up.

Fascinating

Girl Who Doesn't Age 'Infant' of Family [video]

Doctors Baffled, Intrigued by Girl Who Doesn't Age: Years Pass, but Brooke Greenberg Remains a Toddler. No One Can Explain How or Why [article]

Some news of interest (to me, anyway)

Octopus sets off flood at aquarium (ah, the wily octopus!)

1.5 million-year-old human footprints found

Fungus threatens famed Lascaux cave drawings

Philip José Farmer, Science Fiction Writer, Dies at 91

Poll: 1 in 4 delaying medical care due to cost

13,000-year-old tools dug up in Colorado yard

Best Reason To Get A Kindle 2

Bizarre fish poisoning sparks alarm

Injured good Samaritan ticketed for jaywalking

Iraq to reopen museum looted in US invasion chaos

First Solar Eclipse Recorded From Moon (story has a link to a video which showes a glowing ring around the earth much like the ones seen when the moon passes between us and the sun)

Cache of Ice Age fossils found in Los Angeles

Okay, obviously getting to the library to blog didn't really work out

but that's okay, because I have my connexion at home again! Yay! I thought I'd give you a 'hey, I'm alive post' before going to work. Well, I almost wasn't yesterday. Some crazy driver from Virginia passed me using a right-turn only lane at Easthills and then had the gall to wave at me as she nearly clipped me off. I so wanted to ram her backside. But hey, I can manage my anger pretty well. Okay, I admit it, though, I did honk the horn soundly and flip her off, which is certainly not conduct becoming a lady but better than my normal wussy honks or passivity.

I'm looking forward to a day off Friday for the 4th of July. I'm off at both jobs. I hope to go to the downtown festival as normal and then to the fireworks that are held right across from the hospital. The forecast is for possible storms each afternoon for the next three days, so let's hope that won't be the case when the fireworks are scheduled.

Still no sign of the stimulus cheque. I'm trying not to fret, but I really do need the money (but then again, I suppose most people do). A couple of co-workers who were also supposed to get theirs around the same time already have theirs. Oh, well, I won't really start worrying for a week or so. But I have the money earmarked for something pretty pressing. My brakes need to be checked out. They're starting to grind. I don't want to let that go; it'll be costlier in the long run and potentially unsafe, but they seem to be working alright for now, just making noise. But they're making me nervous.

So you can see, I'm a ball of anxiety over things I can't really do much about right now. The cheque's arrival (or even existence) is out of my hands. In other words, I am generally operating as per normal. :) So I'm trying to focus on what I can affect, and I'm throwing in a little prayer, too.

Well, it's 9:35. I should go on in to work; I'll be a little early. Actually I need to pick up some medicine from the pharmacy, but I don't want to risk being late. But anyway, I'm back, sorry to have dropped things for so long. I've been pretty busy and it was hard to get over to the library during their hours. (I think you've noticed, I usually blog late at night, or in the morning before work, when they're not open). Take care.

See what happens when you aerosolise pig brains and blow them onto people?

A Medical Mystery Unfolds in Minnesota

You could not pay me to do this job, even without the nerve damage.

Two scientific 'Wow!' moments

Team Creates Rat Heart Using Cells of Baby Rats

and

Reversal Of Alzheimer's Symptoms Within Minutes [The direct link to the paper on this is: Rapid cognitive improvement in Alzheimer's disease following perispinal etanercept administration, with a commentary also available for free download (both can be viewed through HTML or PDF).]

Interesting, ethically and medically

Face-Transplant Patient 'Satisfied': Some Who Criticized Procedure Are Impressed With Results

One of the US centres that is mentioned in the story as being interested in doing face transplants is Kleinert Kutz and Associates, who did the first US hand transplant. The Lexington office branch of that practice did my carpal tunnel surgery. I feel a bit like I'm playing six degrees of separation. My surgeon's in a different practice now, but I'd recommend either Kleinert Kutz or Dr William O'Neill of Bluegrass Orthopaedics if you ever need hand surgery.

It's funny, I'm very lucky that I live in a very medically- and specialist-dense town, and since I live within a couple of blocks of a major hospital (St Joseph East), there are a plethora of physicians and specialists whose offices are nearly in my backyard. Not to mention the fact that I have top-notch insurance through UnitedHealthcare. They paid every penny of my surgery, which ran about $10,000 altogether. I had no idea how crippled I'd become. Now I can use my hands freely. I've heard horrible stories of how much nerve conduction studies hurt since I had mine. I had no idea. My carpal tunnel was so bad I didn't really feel any of it. So I'm glad to have my mobility back, to be able to feel my hands, and to have them not draw up in pain at night. Plus, if I were ever to have children (let's face it, it's not bloody likely), it would cost me $10. Period--just the co-payment of the first office visit. Wow.

Of course, I went for years without insurance, so I really appreciate it more. I probably had a broken foot years ago, for example, when Bill fell on me. I just hobbled around in pain for months. Not to mention the various blows to the head I've had that I never went to see about. Hmm...maybe that really is part of my problem.

I'm not out of the woods in terms of medical expenditures, though. I have a flexible account that helps with any of my co-payments. But I'm on a slew of medications that are in the upper tier of what the insurance will pay for, so my co-payments are mostly $45 a pop. My flexible spending account ran out at the end of November (so at least I used it all--you lose the money if you don't--and it was much better than last year, when it lasted until May); but for December I really am struggling with enough bills that I simply can't get all my medicines. There are 2-3 absolutely vital ones; the rest I'm not filling until January. I normally take 7-9 depending on time of year (I take Lasix and potassium in the summer, when my ankles swell). I'm taking the opportunity to chuck Avandia entirely. I haven't felt any difference than when I took it, and there are just too many studies stacked against it. If my blood sugar tests show my sugar still up, I'll see about going on Actos. Otherwise I'll keep with just the Janumet, if Dr Nesbitt concurs. I found some samples of one of my drugs 'my smart medicine' as one friend puts it, so I'm using those for now. And of course, there's one I take that can cause a horrible skin-sloughing rash if you stop and go back on it, so I'm staying on that one as a priority. :) Plus I have plenty of metformin, so I'm temporarily on that instead of the combined Januvia/metformin Janumet. And I found some extra strips so I can check my sugar levels.

I know, it's not ideal, but it means $45 in drug costs this month rather than the normal $277 I'd spend a month out of pocket (with insurance!) ($291 in summer), with the occasional albuterol ($7) and then any over-the-counter medicines I get. (I'm off the aspirin, for example, now that I'm out of the boot). That flexible spending account is a lifesaver. I opted for the same amount next year since part of the expense this year was my glasses, which I shouldn't need again. That should get me through the year okay. I do have one doctor's appointment this month, too, but I've budgeted for that.

Okay, didn't mean to make this all about me, but I guess the article was just a jumping point for my thoughts. Hopefully January will bring a new debit card (we're going with a new provider this year--I hope they're as good as the last one) and I'll get back on track again.

I have been poked, prodded, and positioned

spending about five hours today seeing to my knee, which I hurt in that fall on Monday. It was complicated by being workman's compensation rather than my normal insurance, so there was a lot of paperwork (and I'm not even counting the calls I made ahead of time.) Dr Nesbitt noticed (I hadn't) that I was bruised along the whole front of my lower leg, too (it was a very light discolouration), so he ordered views of my knee, my tibia, and my fibula. He also gave me a prescription for Darvocet for night-time, since it's been bothering me then, but to be honest I may just be okay with ibuprofen. It's not that painful as long as I stay off it--although I have to admit, after going through the exam and testing the range of motion, it did hurt quite a lot, and then after being given assisted yoga in getting the x-rays and then walking a long trek back to the car around some construction, I was ready to go home and rest for a bit.

That's been my day so far. Now I'm getting ready to go do laundry, do notes, and work on character sheets, so I'll be off both foot and knee for that. Then there's the big grocery run I take a friend on when he's paid, and that's definitely time for the boot. I'd hoped to get some stuff at home taken care of, like the dishes and some of the paper that's lying around, or even watch a DVD that was given to me weeks ago, but I didn't expect the medical stuff to take quite so long (I was figuring maybe three hours. Silly me.) Oh, well.

Maybe a little hope for a cure

Chronic fatigue syndrome linked to common stomach virus

I've never been diagnosed with chronic fatigue syndrome, but I have fibromyalgia, which some people think may be different presentations of the same disease. I'm glad researchers are taking it seriously. Early in the era of diagnosis (and sometimes even today), some doctors thought it was all in the patient's head (an entire episode (2-parts, if I remember) of 'Golden Girls' was written around Dorothy's CFS, where she went to dozens of doctors who kept saying she needed a psychiatrist, and a psychiatrist who said there was nothing wrong with her mind.) Anyway, I thought I'd include this bit of medical news here.