Archive for Ease and Disease

Thank you for your support

Provided, of course, you don’t have tusks:

I blame Lindsey Buckingham.

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Where things stand

And I don’t see them improving any time in the near future, either:

Lots of contributing factors — idiot customers, horrible summer heat, and ongoing bodily-function failures — and at best, only one of those is going away any time soon, if “soon” can be stretched to 90 days or so.

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Dreaming of full service

You may remember this from just about a tankful ago:

[L]ast month, when I pulled up to my usual filling station, did my usual painful exercise to get myself out of the car, and only then discovered that the card reader was inoperative. None of my cards would save me in this case. Rather than go through a second round of contortions, I pulled the Walking Appliance out of the back seat, wheeled myself into the store, and peeled off three twenties. This of course necessitated a second trip into the store to retrieve $17 or so in change, but it demonstrated pretty clearly who rules.

This week, I pulled up to a different station, closer to home and dealing in E0. (You want ethanol, you go to the beer display.) I did my usual painful exercise to get myself out of the car, and only then discovered that the card reader was inoperative. The Walking Appliance would not get me up the very steep path to the retail store. With a little help from passersby, I managed to get into the store proper and swipe $60 on the old Mastercard. Forty-five dollars later, another neighbor pointed out that at the far end of the building was an actual ramp, which up to that point I hadn’t noticed, and while I’ve lived around here for a decade and a half, I didn’t need a ramp for most of that time, which explains why I hadn’t noticed it.

Later this week, I assume the store will change that sixty-dollar debit to a forty-five-dollar debit.

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$911 a yard, or something like that

Tam pries open the bill for an ambulance trip, and perhaps wishes she hadn’t:

Literally a hundred times more than I’ve ever paid for an Uber going twice the distance. Hell, I could have Uber’d back and forth between Indianapolis and Lafayette every day for a couple of weeks for that money.

Next time, no matter how much I’m writhing on the floor and screaming in pain at 0300, just tap me behind the ear with a hammer and throw me in the car.

Undoubtedly this was discussed in a boardroom somewhere:

“How much would this trip cost via Uber or Lyft?”

The new kid begins, “Well, it varies with how busy they are. Something called surge pricing.”

“We can’t do that. Bad optics. Find the average and multiply it by 200.”

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Cold day in hell

Miracle cures abound in these days of ultra-modern medicine, but we’re still knocked flat by the common cold — for now, anyway:

UK scientists believe they may have found a way to combat the common cold.

Rather than attacking the virus itself, which comes in hundreds of versions, the treatment targets the human host. It blocks a key protein in the body’s cells that cold viruses normally hijack to self-replicate and spread.

This should stop any cold virus in its tracks if given early enough, lab studies suggest. Safety trials in people could start within two years.

How’s that again?

The Imperial College London researchers are working on making a form of the drug that can be inhaled, to reduce the chance of side-effects.

In the lab, it worked within minutes of being applied to human lung cells, targeting a human protein called NMT… All strains of cold virus need this human protein to make new copies of themselves.

In the US, availability will presumably be contingent upon whether the drug can be used to manufacture other drugs; were there a way to make meth out of meatballs, American drug warriors would ban spaghetti.

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Reversion to form

“Have you had this before?” the doctor asked, pretending to shuffle through the 800 or so pages of my file folder.

“I have,” I said.

“Well, you’ve got it again.”

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A dog-paddle of sorts

He can’t help it, he was born this way:

A remark from Vetbook, a sort of wiki for veterinarians:

In most cases, euthanasia is not recommended as restoration of normal movement eventually occurs as the pup grows, provided the walking surfaces are firm such as carpet, grass, soil, etc.

There’s a lot to be said for not recommending euthanasia.

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We said your time was up

And $DEITYdamnit, we meant it:

Alfie Evans, a British toddler with a degenerative brain condition whose parents lost a legal battle to keep him on life support at a Vatican hospital, was mourned with balloons set free in the sky and prayers from the pope after he died Saturday weeks shy of his second birthday.

Much of the criticism of the National Health Service came from the United States; while Twitter would not permit the topic to be listed as “trending” because of course they wouldn’t, American tweeters were keen to point out that It Can’t Happen Here.

One might not want to be too sure about that:

Orwell would be proud: QALY (quality of life years) criteria are how the death panels the NICE (National Institute for Health and Care Excellence) decides if you should live or die.

and with the growing “elderly” population (and fewer kids/immigrants to support them by their taxes) you can see how this cost control idea could rapidly expand to active killing of the old, senile, and those denied treatment.

But before you point fingers at the UK, maybe you should read about the “futile care” law in Texas that has gotten little publicity. From Wikipedia:

“The Texas Advance Directives Act (1999), also known as the Texas Futile Care Law, describes certain provisions that are now Chapter 166 of the Texas Health & Safety Code. Controversy over these provisions mainly centers on Section 166.046, Subsection (e), which allows a health care facility to discontinue life-sustaining treatment ten days after giving written notice if the continuation of life-sustaining treatment is considered futile care by the treating medical team.”

Unlike the UK, if the family wants to, they can move the patient and pay their bills.

Or they can ask the hospital “ethics committee” to decide. The problem being that most “bioethics” types already believe in the “QALY” mindset, so good luck to you fellah.

I assure you, my interest in this topic is not entirely academic; I am, after all, sixty-four years old.

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Please don’t clap

So it’s finally come to this:

A man in the UK has caught the world’s “worst-ever” case of super-gonorrhea.

He had a regular partner in the UK, but picked up the superbug after a sexual encounter with a woman in south-east Asia. Public Health England says it is the first time the infection cannot be cured with first choice antibiotics.

Health officials are now tracing any other sexual partners of the man, who has not been identified, in an attempt to contain the infection’s spread.

The main antibiotic treatment — a combination of azithromycin and ceftriaxone — has failed to treat the disease.

This is also the course of treatment recommended by the CDC in the US, although:

Treatment of patients with gonorrhea with the most effective therapy will limit the transmission of gonorrhea, prevent complications, and likely will slow emergence of resistance. However, resistance to cephalosporins, including ceftriaxone, is expected to emerge. Reinvestment in gonorrhea prevention and control is warranted. New treatment options for gonorrhea are urgently needed.

That was 2012. Didn’t take long for the bug to evolve resistance, did it?

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Busted cycle

During recent spates of insomnia, I assumed that my circadian rhythms were totally out of whack. I am currently not quite so sleep-deprived, but this old body persists in traveling to the beat of a different drum.

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Oh, by the way

A really dreadful gurney-side manner, this is:

Laura Cameron, then three months pregnant, tripped and fell in a parking lot and landed in the emergency room last May — her blood pressure was low and she was scared and in pain. She was flat on her back and plugged into a saline drip when a hospital employee approached her gurney to discuss how she would pay her hospital bill.

Though both Cameron, 28, and her husband, Keith, have insurance, the bill would likely come to about $830, the representative said. If that sounded unmanageable, she offered, they could take out a loan through a bank that had a partnership with the hospital.

I got hauled to the ER twice in 2016. The first time, an underling who came off like Truman Capote’s taller brother let me know that I was facing a hundred-dollar copay, and would I like to take care of that now? I was sufficiently conscious to nod assent, and dug out my debit card.

An hour later, part two of the Truman show: “They’re telling us you haven’t met your deductible yet this year.” I shrugged, handed over the plastic, and signed for a thousand. Shortly thereafter, I was wheeled to an actual room.

[P]romoting bank loans at hospitals and, particularly, emergency rooms raises concerns, experts say. For one thing, the cost estimates provided — likely based on a hospital’s list price — may be far higher than the negotiated rate ultimately paid by most insurers. Sick patients, like Cameron, may feel they have no choice but to sign up for a loan since they need treatment. And the quick loan process, usually with no credit check, means they may well be signing on for expenses they can ill afford to pay.

I suppose I was fortunate in that I actually had $1100 in the bank. Not everyone is in such a position.

Here’s an option I heartily endorse when possible:

If you should find yourself in hospital unexpectedly, and confronted with this sort of aggressive approach, I suggest you tell them to talk to your significant other, or ask them to wait until you’re in a proper mental and physical and emotional state to make such decisions. If they persist, tell them what they can do with the paperwork. After all, they’re in a place where it can be extracted once they’ve done that!

Damn straight.

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Those bloodsuckers must be around here somewhere

The story begins here:

In July of 2017, 13-year-old Olivia Goodreau was on vacation in Missouri with her family. While outside Olivia noticed a tick on her dog, Mo (short for Missouri). Olivia & her mom watched the tick start to burrow into Mo’s leg. They quickly found needle nose tweezers to properly remove the tick from Mo. As Olivia was removing the tick she asked her mom, “”s there an app that can show what ticks are around us?” That night Olivia looked online and found that currently there was no app to help track, report, and educate people about ticks. This gave Olivia the idea to create the TickTracker app to help keep everyone safe.

TickTracker development teamI understood. Forty-five (!) years before that, I was stationed at Fort Leonard Wood in Missouri, where, according to the popular jape of the times, the state flower is the rock and the state bird is the tick. God knows I saw plenty of both over the two seasons I spent there.

The LivLyme Foundation was set up to develop the app and aggregate user data. TickTracker is offered at no charge. And if you ask me, they ought to be selling some of these spiffy black caps worn by the development team.

(Dear Brad Paisley: would you be interested in lending your name to a Good Cause?)

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To go without the flow

First there was meth, and it was bad, and the powers that be were forced to admit that they couldn’t possibly make it any more illegal than it already was; desperate to appear to be doing something, they eventually hit on the idea of making pseudoephedrine (Sudafed and its friends) hard to come by, apparently reasoning that the way to foil thousands of methheads was to inconvenience millions whose heads were merely stuffed up.

Now comes phase two:

As part of the fight against the nation’s opioid epidemic, the US Food and Drug Administration said Tuesday, one common antidiarrheal drug should be given new packaging.

The agency is working with manufacturers to change the packaging of the drug loperamide to include blister packs and single-dose packaging, which could reduce the likelihood of overdose, according to FDA Commissioner Dr. Scott Gottlieb.

Loperamide, sold under brand names such as Imodium, is an over-the-counter opioid medication used to treat diarrhea. However, it is sometimes taken in large doses by those seeking to suppress symptoms of withdrawal from such other opioids as heroin. In such high doses, loperamide can lead to cardiac problems and even death, Gottlieb said in a statement Tuesday.

Because nobody, but nobody, would ever bother to punch a dozen pills out of a blister pack when the monkey’s on his back and laughing out loud.

(Sent me by Holly H.)

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You deserve to hurt

Sam Quinones, a former Los Angeles Times scribe who wrote the book Dreamland: The True Tale of America’s Opiate Epidemic, was in town this week to talk about our Dreadful Addiction, and this is some of what he said:

Quinones traced the origins of the epidemic to indiscriminate prescribing in the 1990s as doctors came to believe they were undertreating pain — an argument that had some merit. The problem began when pharmaceutical companies and some doctors underplayed the addictive potential of opioids, he said.

Well, yeah, dependence does come with the package. But then:

“We began to believe that we were entitled to a life free of pain,” he said.

The more I repeat that, the worse it sounds. What say you?

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From the Something Must Be Done files

And this definitely qualifies as something:

Walmart is helping customers get rid of leftover opioids by giving them packets that turn the addictive painkillers into a useless gel.

The retail giant announced Wednesday that it will provide the packets free with opioid prescriptions filled at its 4,700 U.S. pharmacies.

The small packets, made by DisposeRX, contain a powder that is poured into prescription bottles. When mixed with warm water, the powder turns the pills into a biodegradable gel that can be thrown in the trash.

Research has shown that surgery patients often end up with leftover opioid painkillers and store the drugs improperly at home.

I dunno. I sort of sympathize with the Fark submitter, who asks: “But who has leftover opioids?”

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Just like it says

Still, it’s startling to see it in print on an actual product label:

Coprophagia remedy for dogs

And I suppose you really don’t want the dog in the picture to be grinning.

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When your brain hurts

Apparently there is now surgery to reduce migraines:

Surgical decompression of the peripheral sensory nerves around the skull can have a beneficial effect on the frequency, severity and duration of the migraine headaches. Surgery is performed as an outpatient procedure under local or (usually) general anesthesia and usually takes one to two hours. Some patients have multiple migraine triggers and surgery may take longer if the trigger sites are on different areas of the head. Surgery is not on the brain and we do not remove or go through the skull bones.

How well does this actually work?

Most studies have shown success rates above 70 percent, with roughly one-third of the patients experiencing total relief of their migraines. When successful, patients report an improvement in migraine frequency, duration, intensity and in health-related quality-of-life.

One thing’s for sure: I don’t know anyone with migraines who wouldn’t rather be someone without migraines.

(Via Finestkind Clinic and fish market.)

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One shot, so to speak

Two shots, if you’re doing both sides:

A transformative genetic treatment for a rare, inherited form of blindness will come with a price tag of of $425,000 per eye, or $850,000 for both, said Spark Therapeutics Inc., the tiny biotechnology company that is bringing the therapy to market.

Since Spark’s Luxturna was approved by the U.S. Food and Drug Administration last month, speculation over the price has grown as it became clear the therapy would be one of the first in a wave of medicines that yield remarkable results after a single treatment — and would carry a commensurate cost.

No quantity discounts, apparently.

Luxturna (Voretigene neparvovec) is one of those few pharmaceuticals for which the trade name and the generic name have roughly equal plausibility as a name for a minor Star Trek character.

There are admittedly not many patients for whom this stuff is indicated:

Leber’s congenital amaurosis, or biallelic RPE65-mediated inherited retinal disease, is an inherited disorder causing progressive blindness. Voretigene is the first treatment available for this condition. The gene therapy is not a cure for the condition, but substantially improves vision in those treated. It is given as a subretinal injection.

Now: is it worth $850,000 to not be blind anymore?

In an agreement with the Boston-area insurer Harvard Pilgrim Health Care, Spark will get the full price of treatment up front. If patients don’t get an immediate benefit — measured at 30 days, or a long term one — measured at 30 months, Spark will have to give some of the money back in a rebate.

There’s a new wrinkle.

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The reward for doing without

For certain values of “reward,” I suspect:

Prostate cancer is the most common cancer among men, hitting about one in eight at some point — with 43,000 UK cases each year.

Oxford University researchers studied 220,000 men aged 40 to 69 over six years.

They found those who had never had intercourse had a 47 per cent lower rate of the disease, dropping the risk to about one in 16.

Explaining why, lead researcher Prof Tim Key said: “Infections passed during sex, raising prostate cancer risk, could be a possibility.”

Out of any given sample of 220,000 men, 40 and above, how many are going to admit to having never had sex? Admittedly, university researchers are not likely to tell any of your friends at the pub, but this is a difficult thing to admit, unless you’re one of the Involuntary Celibates who have nothing else to distinguish themselves.

Dig a bit farther down, and there’s the answer:

Prof Key admitted: “It is a huge study but there were only about 20 cases of men who had never had sex.”

I might have known.

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It was one of those nights

I’ve had more of these than I perhaps ought to admit:

I wake up cold — but sweating. I’d had nightmares again. My heart felt heavy in my chest, my limbs felt entirely useless. Every time I stood up I thought I was going to fall, and my brain was blank and numb. I hate this, I hate feeling like I’m getting somewhere with my health, and then one morning it completely takes me by surprise and pulls me back in.

The only advantage I’ve had in such matters is that I can sometimes see them coming. If I crash into bed at eleven and I’m still running full-tilt thought patters at twelve-thirty, I can pretty well assume that “Well, this night is ruined.”

There’s no telling what mood I’ll wake up in, and there’s no guarantee that mood will stick around all day.

After many years, I have become conditioned to expect, if not The Worst, something Worst-Adjacent.

Morning ablutions are supposed to take me half an hour. To get the time down that far, I have to make sure that I don’t fall down in the shower, because I have this morbid idea that this is how I die, despite having survived one already, and I have to do without socks, which take me longer to put on than anything else. (This latter may be troublesome come Tuesday, when it’s supposed to be somewhere around 5°F during the morning commute.) The fact that these conditions exist at all tells me that I’m a long, long way from being out of the woods.

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Our shareholders want Lamborghinis, goddamnit

Where have we heard this before?

Since 2013, the price of a 40-year-old, off-patent cancer drug in the U.S. has risen 1,400%, putting the life-extending medicine out of reach for some patients.

Introduced in 1976 to treat brain tumors and Hodgkin lymphoma, lomustine has no generic competition, giving seller NextSource Biotechnology LLC significant pricing power.

The U.S. Food and Drug Administration is seeking to encourage more competition for drugs like lomustine, one of at least 319 drugs for which U.S. patents have expired but which have no generic copies, according to a list the agency published earlier this month.

What makes this drug so suddenly expensive?

For many years, lomustine was marketed under the brand name CeeNU by Bristol-Myers Squibb Co., which charged about $50 a capsule for the highest dose, before selling the product in 2013.

Now, the same capsule costs about $768, after nine price increases by a little-known Miami startup, NextSource, which supplies lomustine in a deal with the drug’s new owner, manufacturer CordenPharma.

Not a lot of lomustine is sold, so it’s hard to blame BMS for selling the rights to the drug. What hasn’t happened, of course, is an increase in production costs:

Robert DiCrisci, chief executive of NextSource, said in a statement the company bases its pricing on product-development costs, regulatory-agency fees, and the benefit the treatment delivers to patients. The company provides discounts to uninsured patients and those with financial limitations, he said.

“Product-development costs?” Is he kidding? The most they’ve spent on this stuff is whatever it cost to change the name on the box and the cost of PR announcing the price increases.

I am persuaded that the major cause of price-gouging like this is the desire to make a killing before the Feds come down and sweep the last vestiges of the marketplace under the rug.

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Why, he’s no fun, he fell right over

I spent enough time in the hospital in 2016 to know I didn’t want to do it again in 2017. However, I am growing older and probably more fragile, so I’m not sure I’ll manage to do the same as 2018 looms. If I must, though, I hope I have this much brain activity going for me:

It’s a blank to me — my last memory ahead of time was laying on the table in the OR and having a nurse ask after my name and birth date, to which I replied,

“I was born on Roberta X and my name is twenty-eight May, nineteen hundred and…”

She laughed and looked at her clipboard. “Do you know why you’re here today?”

“If it doesn’t say ‘sinus surgery to open up the sphenoid, erthymoid and left maxillary sinuses, with a side of turbinate reduction as needed’ on your form, I think we should lock the doors, order pizza, and hang out for a couple of hours.”

The anesthesiologist thought that would be a good idea, if his snicker was any indication, but alas, the fancy anatomical Latin was what it said on the form the nurse was holding, so it was too late to change plans, and besides, the ENT surgeon was on her way and we’d never have got the doors locked in time. And you know surgeons — she probably would have wanted anchovies or blue cheese or something. Might as well get operated on instead.

“No anchovies? You’ve got the wrong man. I spell my name DANGER.”


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On the Richter scale

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Emptiness ensues

In late October, Sarah Sloan Macleod put up a video called “The Realest I’ve Ever Been About My Depression.” It was frightening in spots, and some of those spots were entirely too familiar to me:

A week later, things got realer:

Both of these contain occasional rough words, so watch where you play them.

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How it’s done down under

An American expat meets up with Australian health care:

Off to the ER I went. After a wait of 4 hours, I was brought into a procedure room, where I was examined other doctors brought in, and was told immediately that I’d be scheduled for surgery. They had me in a ward within 20 minutes, and began pumping me full of anti-biotics. The next morning, they had me prepped and the anesthesiologist asked me if I would prefer to be sedated with a mixture of ketamine and other fine drugs, or epidural. I’ve had an epidural before. That did not go well. IV cocktail it is.

There followed the actual surgery, and then:

I was made to stay another night for more antibiotics being pumped in while they looked after me. The next day, the nurses did a repack and bandaging. From there, it was a matter of getting me scripts and arranging for a care nurse that will come to my home everyday for the next month and deal with dressings until it’s no longer needed.

His one out-of-pocket expense was for those scripts:

Individual pharmacy bill from an Australian hospital

Ten antibiotic, ten painkillers, 100 acetaminophen. Twenty bucks American. About what you’d fork over for a single antibiotic in the States, if you’re lucky.

(Via Fark.)

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In case you couldn’t find the tablet

Just follow the otherwise-empty arrow:

A box of two? Wow.

Wikipedia semi-helpfully points out that “[i]n the United States, it is available only by medical prescription (and is frequently limited, without prior authorization, to a quantity of nine in a 30-day period).” A quantity of nine, per, runs $92.52. To someone with a migraine, a condition for which this drug is indicated, ten bucks and change for a single tab is probably worth it. Maybe the two-tab version is intended to get you through a particularly bad weekend.

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Technically not a black-and-white

Dothan Alabama police car wrapped in pink

Oh, yeah, it’s the same old Panther-bodied Ford Crown Victoria Police Interceptor you’ve known and feared for years, but this one is for a cause:

The idea behind the pink car came from Chris Lee who is the owner of Shift Designs in Dothan.

After serving the Dothan community for eight years, he wanted a way to give back to the community that has been so great to him and his team.

So, he volunteered to wrap a patrol car in honor of Breast Cancer Awareness month.

With the help of Avery Dennison Graphic Solutions, a premiere vinyl and wrap company, they were able to have the supplies donated for the cause.

Pretty spiffy, though the standard Ford dog-dish hubcaps look even tinier than usual.

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That damn night fever

In the event of something happening to me,
There is someone I should probably go to see:

Please tell me this is not the result of someone starting a joke.

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In sickness and in, um, more sickness

I ran this little poll on Twitter, and I am not heartened, if not surprised, by the results:

CFI Care (not its real initials) isn’t dropping the group, necessarily; but the group policy we had is being discontinued, to be replaced by God Knows What. And God, presumably wisely, is keeping His mouth shut.

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Up to the minute

She set her computer on her lap and crossed her legs. For a moment I wondered how she was going to type like that.

“So how do you feel right this minute?” she asked.

Something like this, I thought.

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