One Thirty Over Eighty

It took a little longer than average, but I am officially old now. My physician finally prescribed high blood pressure medication. As one ages, blood vessels naturally become a little stiffer, but I dare say there is more to it than that. There are other factors at play, some of them beyond our control.

Image does not equal endorsement of the device pictured.

My good vascular health is the product of circumstances that not everyone is fortunate to have. Good genetics. Opportunities for physical exercise in terms of time and location. Financial privilege that allowed me to withdraw from the corporate workforce earlier than usual. Fewer pressures from external sources means lower pressure on my internal organs. That is what a modest inheritance can do for you, but there should be more avenues for escaping the rat race.

U.S. manufacturing is booming, if you count stress as a product.

My doctor would still like me to be on a low sodium diet, and less sugar and fat couldn’t hurt, either. Sorry, doc, but I’m not going to sacrifice the few things that still give me comfort and delight. Do you know how difficult that is to do, anyway? My partner cooks recipes passed down from generation after generation, and I guarantee you that salt content was not a consideration. If anything, such dishes may have originally met with “could use more salt” criticism.

Diet might be the least impactful element anyway. U.S. manufacturing is booming, if you count stress as a product. We are programmed by our culture to be living machines of productivity and consumerism, with precious little reward for either. We are hardly recognized as having any value outside of an economic definition. This is unhealthy, to put it mildly.

Indeed, we have allowed every aspect of our existence to be framed as monetary transactions. Even your personal health is a commodity. Problems, including those created by business enterprises, are viewed as “opportunities” for additional profit. We have the industrial-legal-medical complex whereby law firms specialize in either defending corporations, or representing individuals who are harmed physically or emotionally by those entities. Not paid a fair wage? No problem. Try the lottery, sports betting, other forms of gambling, and frivolous lawsuits. Apply for another credit card, or take out a loan. You can always use the debt consolidation services later.

When I went in for my annual check-up, a year-and-a-half or so late, the one that resulted in the blood pressure meds, I presented my insurance information first thing. When I departed, I asked the receptionist if I needed to pay anything, and was assured that my insurance would cover it since there was no specific “complaint” that would trigger a co-pay. I did have the on-site lab take blood for testing, since I didn’t know when I could get back to the clinic again….

I don’t think it was even two weeks later that I received a bill for nearly $1,000.00. The invoice also asserted that they had no insurance information on file. Wow. I called the number and, to their credit, reached a representative in a timely manner. He took my insurance information again and told me they would issue another statement once the matter was resolved. Awesome.

I don’t think another two weeks elapsed before I received another bill for over $400, likely related to the lab work since it was from a different division of the hospital. Again, they claimed they had no insurance information. I called again. Pretty certain I got through to the same representative (a comforting East Indian accent), and he took my information once again. So far, fingers crossed, I have not received another bill. Good thing I got those high blood pressure meds before the bill, right?!

I will be turning the magic age next year, and am procrastinating the debacle that is negotiating Medicare. Assuming Medicare still exists going forward. If I have to submit my insurance information multiple times as it is now, what am I in for next? Talk about needless stress, so insurance companies can profit from Part C, or whatever.

I have seen multiple posts to social media suggesting that we should be making personal friends with doctors, so that when the system collapses, we at least stand a fighting chance. I don’t think this is hyperbole, but it is a sad state of affairs. Oh, the diet thing? It really would pay to make friends with farmers, so that when the food supply chain goes south, you can at least eat. Stressed out yet? Yeah, me, too.

Diagnosis Social Media

© SocialMediaImpact.com

Yesterday, though I had not exercised much, I found myself with a sore hip at one point when I got out of my chair from in front of my desk. I seem to be a bit better today, but I was all ready to take to social media to determine whether it was something worth getting checked out. You know, because my friends, the majority of whom did not even attend medical school, would be so helpful in making an accurate assessment of my situation. Also, everybody else does that, so it must be an acceptable form of diagnosis.

Alas, it is probably not the best idea to run to Doctor Facebook or Nurse Twitter complaining about inexplicable ailments. God forbid you go onto Instagram ER. Thanks, dude, I can't un-see that now!

Ironically, or certainly responsibly, the Aussies have taken measures to address this, creating "A Nurse's Guide to Twitter" to insure best practices when confronted with situations like the one friend of mine on Facebook who posted that he had just been bitten by a copperhead, a dangerously venomous snake here in the U.S. The most helpful responses were on the order of "I hope you are posting this from the hospital." Really, what is the point in a situation like that when you know you are far better off to drop the phone and get yourself to medical treatment immediately? As venomous serpents go, a bite from a copperhead is rarely life-threatening, but you can still lose a digit or something if you procrastinate. It's called "complications."

If social media were a prescription drug, or even an over-the-counter remedy, its label would include the disclaimer "results may vary," in bold lettering. Maybe it depends on who your friends are. Those engaged in the same profession, hobby, or family situation may well be able to say been there, done that regarding whatever accident resulted in the injury to your body or ego, or that of your offspring if you are serving as proxy for a younger patient.

This is not to say that there are no tangible, ultimately concrete benefits to taking the social media ambulance. For starters, it beats self-medicating. You may find that one of your local friends can attest to what excellent care they have received from Dr. X, or how well the Fix-it Clinic over on Main Street treats their walk-in patients, honors (insert your insurance company's name here), and brings you coffee while you wait. Those are probably the best kinds of outcomes we can hope for when we complain about our aches and pains.

The other kind of social media post happens when you are already under care, about to undergo a surgical procedure, or facing rehabilitation and other recovery-related matters. This is when your community of social media "physicians" can do no harm. We are more than happy to pray for you, offer our sincerest get-well-soon wishes, and even come visit you if that is possible and you desire it.

The real bottom line in posting our physical and psychological woes is that we don't want treatment suggestions as much as we want empathy and sympathy. Feel-good messages are what we seek in the comments under our posts. Misery really does love company, and I think it is just human nature to act on those desires. Be careful what you wish for, though. TMI (Too Much Information) is frequently shared once you start a thread like that. Do you really want to know about Uncle Joe's infected bunion in detail?

One thing most of us should do more of is express gratitude for our current good health. I am as guilty as the next person for taking my vitality for granted, thanks to guaranteed meals, clean water and breathable air, shelter, education, a relatively stable financial situation thanks to my spouse, medical insurance coverage, proximity to hospitals, caring friends and family, and a lot of other tangibles that too many people on the planet, even here in the U.S., do not have. It really is our responsibility to look out for those less fortunate, and help them reach the standard of living that we already enjoy.

Well, I better get up and move around a bit, lest my hip stiffen up again. May you all enjoy excellent health today, and every day, and have a joyous, charitable holiday season.

Depression

My mind is an emotional train wreck right now. Depression has many faces, at least that is what I believe is true for me, and I can speak only for me. It is a condition that can be fleeting, or stubbornly entrenched for weeks or months; and it can be triggered by many stimuli. Lately, the monotonous and unseasonably cold, wet weather, is largely to blame.

© Healthination.com

Frustration

Feeling powerless to change circumstances is without a doubt one of the leading emotions that causes me to fall into despair. I truly can't change the weather. It is going to be bad until it is good again. I cannot change the marketplace. My chosen profession and its attendant skills and knowledge will continue to be devalued for as far into the future as I can see; but I also can't change who I am, which, at its core, is a writer. It is also difficult to accrue new skills and new circumstances when one does not have the financial capacity to attend classes, travel to better weather, or otherwise self-improve....because you can't earn enough at your profession.....a vicious cycle.

Anger

Frustration for me results in one of two things: sadness or anger. Usually it is the latter. Lately I have been more silent than usual because I fear nothing but a string of expletives would leave my mouth (or my fingers as they dart across the keyboard). I wish that it was more widely considered by the scientific community that violence and depression in men are strongly linked. Men have a much harder time expressing themselves verbally. Why do they smash the plate against the wall during an argument with their spouse or significant other? "There! Do you see that? That is my heart, shattered." Men want desperately to have a tangible expression of how they feel, and this often comes out violently.

Snowball Effect

One expression of depression for me is what I call the "snowball effect," whereby one negative thought leads to another and they keep accumulating until there is no stopping them and they almost bury you. During one of these episodes your life seems to stink more than it really does because the snowball is also a dredge that hauls up memories that are not necessarily still applicable to your current condition. The good thing is that I am getting better at recognizing this before the snowball builds enough momentum to be all-consuming. The bad lunch does not carry as much weight as I thought initially, and can be allowed to fall off the conglomerate of other matters.

Coping Poorly

I will assert that few people are able to cope with depression, tragedy, and other life challenges in a healthy manner. Such things usually trigger extremely bad coping "skills" such as addictions, flight (from relationships, reality, etc), suicide, and homicide. These days, another coping mechanism is "oversharing" on social media. This is understandable. Misery doesn't necessarily love company, as the old saying goes; but misery does crave understanding and empathy; and reassurance that most situations we face are only temporary. Facebook has become in many ways a 24-7 version of Oprah or The Phil Donahue Show, or Sally Jesse Raphael for those who can remember that far back (I even appeared on Phil Donahue's show in February of 1989 to talk about adult children of divorce).

Anyway, few of the ways we want to exorcise our demons are productive. I cannot go on a shooting spree when what I really want is to kill the marketplace, not its inhabitants; and the social fabric of our world already has enough holes in it anyway. We need more patches and some really good seamstresses. I can't kill myself because then I send someone else down the road I just exited. Drugs and alcohol only serve to make one more destitute financially, and more unhealthy physically.

Therapy?

Suggesting someone suffering from depression get "counseling" can seem helpful, but here timing is everything. So is type. Personally, I am so self-analytical as it is that seeing a psychoanalyst is redundant. Back in the day I eventually tried a twelve-step group for adult children of alcoholics. I was receptive enough to the idea in that particular window of my life to actually get a few things out of it. This is when I first realized my problem with "God" was actually rebellion against religion, a human social institution. I also finally started understanding how my "buttons" were getting pushed, and began rewiring the mental circuitry so that I could better articulate my own position instead of reacting inappropriately to the other person.

Both one-on-one therapy and peer therapy groups can be helpful if only because you are expressing yourself out loud and you tend to hear yourself better when you do that. Listening to the experiences (traumas, really) of others helps build empathy and creates a more holistic view of one's place in the spectrum of personal atrocities and joys. Ideally, it does this by creating a reverence for those who suffer, including one's self.

Comedy

There is a reason that you never see the theatrical "tragedy" mask without the "comedy" smile right there next to it. I find that the one sure-fire antidote to depression is humor. I think I may start building a library of stand-up comedy DVDs to have at the ready for my next low spell. A good dose of humor might not cure me permanently at any given time, but it will get my head out of itself and probably get me started writing my own material or drawing a cartoon. Comedy is also an awesome substitute for those times when the weather, lack of transportation, or other obstacle prevents you from doing equally healthy things like getting outdoors in nature, or exercising. Maybe music has the same effect on you as comedy has on me. Personally, music can be profoundly sad to me, so I have to be careful in my choices of artists and albums.

Onward

I have no way of knowing who is reading this, and what their own struggles may be. I do hope that they gain a measure of hopefulness and a sense of brotherhood out of this essay. Meanwhile, I need to scatter my eggs among less weather-dependent, market-driven baskets and reclaim my identity as something more than what I do for an occupation. We're all much deeper than we know, and far more substantial than what society tells us we are. Don't fall for it. Laugh at it instead, and be the individual example of what you want humanity to be. You'll fail early and often, but don't we all.

My Colonoscopy

That deflating sound you hear is my disappointment over the anticlimactic experience with that medical procedure that signals the beginning of old age: the colonoscopy. Here I was anticipating something similar to the ordeals suffered by the likes of Billy Connolly, Jeff Foxworthy, and Bill Engvall. Alas, there were few fireworks, but still a little comedic material in my case.

My general practitioner referred me to the Pikes Peak Endoscopy Center, and I was surprised that they could accommodate me within the month I called them. A week prior to the procedure I picked up my "prep kit," as shown in the image above. You can't say they don't have a sense of humor, however warped.

Everyone you consult prior to your colonoscopy will tell you the procedure itself is a piece of cake, but the preparation beforehand is a nightmare. In fact, the day before, you can't have cake. You can't have anything solid. The day before that you are supposed to be on a low-fiber diet. One bonus was the discovery that Ritz crackers have no fiber! It was a good excuse to go all meat and white bread, but if you like a more varied menu it was pretty boring.

The day before is the worst, though. You have to take an inordinate amount of laxatives, in a pretty short period of time. I expected this would amount to a liquid hand grenade detonating at my anus. Not so. There were maybe one or two projectiles ejected with minor force. No volcanic elimination described by our comedian friends.

Perhaps the whole "prep" thing has evolved and improved dramatically since the 1990s. Maybe I followed the dietary restrictions better than the average Joe. Whatever. The remaining laxative effects consisted of me being unable to tell if I was peeing or pooping.

So, I get to the clinic the day of the procedure. I was treated very nicely, I must say. The nurse took me into the room, told me to undress and put my gown on so it opened in the front. I told her she'd have to tip me for that show. She laughed and corrected herself, then asked if I might like a blanket. I said that would be nice, especially if my gown was open in the front.

The anesthesiologist wheeled me, in my bed, into the operating room where the doctor and another nurse were waiting. After introducing himself, the doctor dutifully re-iterated the risks of the procedure. I think I'd prefer that they leave me in ignorant bliss. Then the anesthesiologist said "Ok, this (anesthesia) works very quickly, and you will notice a metallic taste." (He shoots the drug into the IV). Me: "E-e-e-e-w, you're right, that does taste awf...."

That was the last thing I remember until I woke up in recovery. This may be why so many alien-abduction victims are over fifty. A nurse came in and offered a selection of snack items and beverages. The "Bottoms UP Cafe" provides a variety of gourmet blends, from "Lights Out Latte" to "Wake Me Up Before You Go 'Joe'." I chose a "Moon Me Mocha."

What was the result, you ask? Well, they did find and remove a small polyp that turned out to be benign but potentially cancerous. So, I'm cleared for now, but need to report back again in five years (instead of the ten year reprieve you get if no polyps are found).

I want to thank my doctor for being polite but insistent that I get this procedure done, and my friend Philip Kline for also being insistent. Lastly, I'd like to thank my wife for carrying me on her insurance from her workplace. Kaiser Permanente paid for the whole thing, which is as much of a relief as having the actual colonoscopy....dare I say....behind me.

The End (of the puns, too)

The Stroke

Warning: This post includes my blunt opinions about the current state of human sexuality in the United States. Frank language can be expected.

Sunday, August 19 of this year changed my life. While taking a leisurely walk around a pond with me, my wife suffered a stroke. We didn’t diagnose it as such on the spot. She had tingling in the left side of her face and arm, and she wanted to lean to the left when walking. She felt a little light-headed, too. I thought that maybe she was having an allergic reaction to something she ate for lunch, or was dehydrated and overheated. I had her sit down, drink some water, and tell me more about how she was feeling.

”Do you think we need to go to the hospital?” I asked.

”I don’t know.” she responded.

”Are you thinking it might be a stroke?”

”Maybe.”

We wasted no time in getting her on her feet and back to the car. I’m embarrassed to admit that I haven’t driven in a city since 1999 in Cincinnati, and I was pretty panic-stricken even back then, so Heidi drove us both to the hospital. She was admitted into the ER quickly, and then into the hospital’s neurological services unit. We were there almost exactly 48 hours while she rested and hospital personnel did tests.

Heidi is young, only 41, and the idea that she had experienced a stroke left us dumbfounded. She is not overweight, does not smoke, gets regular exercise (at her job as a zookeeper; and keeping me in line at home), and has no other pre-existing conditions that are known to aggravate a stroke.

What had changed in the previous three months was that she had begun taking oral contraceptives. The blood work on Heidi is still pending as I write this, but nurses and doctors all concede that the birth control pills probably precipitated her stroke. The high estrogen levels in “The Pill” are firmly linked to not only an increased risk of stroke, but also breast cancer. Heidi was taking these drugs as much to alleviate heavy menstruation as to protect us from an unwanted and/or risky pregnancy.

One of the nurse practitioners that talked to us said that if it was up to her, no woman over forty years of age would be prescribed oral contraceptives. No woman who smokes should ever get birth control pills, regardless of her age. Yes, the warnings surrounding oral contraceptives are explicit, but chronically downplayed by both the pharmaceutical industry and the medical community. Why do women have the burden of birth control in the first place?

Here’s the thing. Our patriarchal society continues to assert that men have a right to sexual intercourse any time they want, on whatever terms they so desire, without taking any responsibility for the potential consequences. Gentlemen: Last time I checked, aside from potential allergy to latex, there were no side-effects to wearing a damn condom! Are you really willing to subject your loving partner to potentially lethal or life-altering damage for the sake of your carnal desires?

We need a fundamental cultural shift in the U.S. that demands men take responsibility for their actions, especially when it comes to sex. Lately, there seems to be movement in the opposite direction, seeking to rob women of the few options they have to protect themselves from unwanted pregnancy, or even the opportunity to seek counsel, receive proper medical exams, and access to birth control in any form.

At least some of the roots of the problem can be traced to how we bring up our sons. The “rites” of manhood now seem to be “losing your virginity” and “getting a car,” not necessarily in that order. That sense of entitlement has got to go. It needs to be replaced with a reverence for women; and we must substitute selfishness with a code of sacrifice and toleration of deprivation. Native American rites of passage have much to teach us in this regard. Fasting, solitude, self-reflection, and testing one’s physical limits are at the core of what it means to be a man in those cultures.

Putting more women in places of power couldn’t hurt, either, provided that those women embrace the feminine qualities of compromise, empathy, compassion, and patience that seem to be missing from their male counterparts. Unfortunately, the feminist movement seems to be telling young women that to succeed in a man’s world one must act like a man. Nonsense.

I hope that I am not a lone voice in the wilderness here. Demanding accountability from men should not be simply a legal and liability issue. It cuts to the heart of who we are, or who we can become, as a society. Yes, we are animals, and subject to the same instinctual influences as any other creature; but, we also have the capability of understanding the consequences of our actions. Do we have the will to use that foresight?

Mental Illness

The headline on the front page of the Sunday Arizona Daily Star this week asked “Why don’t we help those with mental illness?” Talk about a population that is misplaced, the unfortunate individuals diagnosed with mental illness are probably at the top of the list. I think there are several reasons why we don’t help the mentally ill, and the first one is because we call it “mental illness.”

I am not a doctor, but given what I know, there really isn’t any such thing as mental illness. All diseases have a physiological cause, at least at the level of biochemistry, so it would seem more appropriate to call diseases of the mind by a name that reflects this. Perhaps “neurological disorders” or “cerebral anomalies” would be a better phrasing of such conditions. Our minds are not something disconnected from our brain and nervous system. Indeed, our mind originates from those sources.

Adding to the difficulty of diagnosing mental illness are the media stereotypes of those disorders. We continue to perpetuate myths such as schizophrenic people being violent. What does legitimately concern our society is the unpredictability of mental disease episodes. A manic or depressive period may come at the worst possible time for an employer, spouse, or friend to deal with. We are generally an impatient and selfish culture that gets frustrated (at the least) when we don’t know if we can count on someone to be there for us and our needs.

There is the stigma of mental illness to be sure, but we are also wary of being fooled. Don’t those with Multiple Personality Disorder just turn it on and off at will? There is this mistaken belief that the mentally ill still have some choice in their state of mind at any moment, because those of us without any affliction know how we are presenting ourselves to the world.

Another barrier to addressing mental illness is the notion that people bring on mental illness themselves. Drug use, for example, often leads to symptoms of mental illness such as hallucinations and erratic behavior.

Treatment is often an exercise in futility because the patient is not the best source of information on their state of well-being. Patients who are doing well because of medication may decide they no longer need the drugs, which then leads to cycles of sickness and recovery.

Patients therefore need “management,” but we have painted ourselves into an ethical corner because of our previous sins in committing mentally ill people to asylums where they were horribly abused. We are loathe to repeat such crimes, so dismiss the idea of institutionalizing “mental patients” in a society that celebrates freedom above all else.

We are also reluctant to intervene when we suspect someone may be suffering from mental illness. I see this in the entomological community whenever someone broaches the topic of “delusory parasitosis.” This condition is usually manifested by the sensation that insects are crawling on the person, or beneath their skin. The patient often brings bags of lint and dust to an entomologist, insisting that the bugs are “in there,” when even microscopic evaluation of the fibers and particles reveals there is no insect, mite, or other creature to be found. The entomologist then tries his or her best to pacify the patient or pawn them off on another expert, which leads to frustration for the patient, too, who can never get a straight answer.

What do we do, then? What is the answer? There is no single answer, but the first step is for us to become better educated on just what constitutes “mental illness.” We need to learn how to recognize it, especially in its early stages when treatment might have a better chance of success. Mostly, we need to have compassion for those who suffer from mental illness, as we do for those who have more obvious physical handicaps.

Let’s not let the mentally ill remain misplaced in our society. Let us find ways to integrate them into our places of employment, social circles, and our healthcare system.

Darwin Gets Swine Flu

I had the privilege of attending a seminar yesterday evening presented by author Carl Zimmer for the Department of Organismal and Evolutionary Biology at the University of Massachusetts (Amherst). The title was “Darwin Gets Swine Flu: Celebrating the Origin of Species in an Age of Pandemics.” Zimmer somehow managed to weave together eloquent prose with stunning graphics and a dash of humor. How else would you deftly convey something as sobering as influenza?

I must admit that I have been one of those folks who has brushed aside the hype associated with H1N1. I still wash my hands and take as many precautions as possible without unduly altering my daily life, but I may have to re-think this after learning what Zimmer knew already.

Thankfully, the death toll from influenza pandemics has steadily and dramatically dropped since the global catastrophe of 1918, but even without these periodic spikes, an average of 36,000 people die each year from the regular flu. This year, 10,000 folks have perished from H1N1, in the U.S. alone, since about April. There may be more fatalities yet to come, but we hope not, of course.

Why can’t we seem to conquer influenza? This is where Darwin comes in. Viruses simply evolve to fast for us to keep up with them, at least with our current vaccination technology. We even accelerate their evolution through our global travel, where tropical strains can mix with temperate ones and create new strains within days. The rate at which viruses reproduce is mind-boggling. The rate at which they mutate is staggering. The good news is that the majority of these mutations are fatal to the viruses themselves. Enough mutations survive, however, to create strains resistant to the latest vaccination, or otherwise insulate the virus from our ability to combat it effectively.

Ok, back up a minute. So what do the “H” and “N” and numbers stand for, anyway? “H” stands for hemagglutinin, “N” for neuraminidase, both of which are proteins that coat the exterior of a virus. These proteins are what our immune system antibodies recognize as foreign invaders. The numbers, one through sixteen, represent the known strains of the influenza virus. Where are the rest of the strains? Well, nearly all of them are carried by birds. Birds don’t seem to get sick from these viruses, at least not very often, but of course they have the potential to spread the viruses far and wide with their excrement, and dead bodies (from whatever cause of death).

Zimmer cautioned that “factory farming” of large numbers of poultry birds and pigs in relatively small, confined spaces may mean more flu pandemics in our future. Virus particles (for lack of a better, basic term) are easily passed short distances from one infected organism to another as it is, let alone when they are shoulder to shoulder.

Winter is the time at which we are most vulnerable to infection because viruses sneezed out or coughed out linger in the dry air much longer than in humid air. The viruses also drift farther, and settle on common items like doorknobs and telephones, too. No reason for paranoia here, just caution. After I wash my hands in a public restroom, I use the paper towel to open the door to leave, for example.

Time to switch gears now and encourage you to follow science through Zimmer’s books, website, and blog. The best place to start might be at Carl Zimmer dot com. Be sure to check out his award-winning blog, too, entitled The Loom. What an appropriate name for what Zimmer weaves together in a totally enthralling fashion. Keep up the great work, Carl!