Is there a doctor in the house? (Hint: No.)

 Here's National Public Radio:

Shall we do a bit of "fact-checking" as the Kidz Today call it? First stop, Wikipedia:

"Means graduated from Stanford University School of Medicine in 2014 but dropped out of her surgical residency four years later and subsequently chose to practice functional medicine, a form of alternative medicine. Her medical license has been inactive since 2024."

Meaning "no, not an actual "medical doctor". Failed the OJT that is a critical piece of becoming a board-certified MD. 

I'm a "certified engineering geologist" because I 1) have a degree (two, actually, baccalaureate and masters) in geology, 2) passed my boards (two, actually, the state RG and CEG examinations), AND 3) worked under a licensed CEG for a period of five years to learn the important practical aspects of my profession.

Part 3 is not "optional"; it's considered an essential part of my licensure just as internship and residency is essential to medical board certification. "Doctor" Means couldn't hack it and fucked off into some sort of woo-woo bullshit at that point, which would be like me doing my CEG training as a sales clerk at Ed's House of Gems.

Wait. "Woo-woo bullshit"?

Here's Wiki on "functional medicine":

"Functional medicine (FM) is a form of alternative medicine that encompasses many unproven and disproven methods and treatments.^[1][2][3] At its essence, it is a rebranding of complementary and alternative medicine,^[4] and as such is pseudoscientific,^[5] and has been described as a form of quackery"

So, yeah; woo-woo bullshit and "not an actual medical doctor".

So what does this not-an-actual-doctor-woo-woo-bullshit-artist "believe"?

Hang on; shit gets deep here. From the first Wiki piece:

"Means and her brother, Calley, co-wrote Good Energy: The Surprising Connection Between Metabolism and Limitless Health in 2024.

(T)he book's central claim is that a single mechanism, which the authors call "Bad Energy", described as a common form of mitochondrial dysfunction caused by improper lifestyles...cause(s) disorders as diverse as depression, anxiety, acne, infertility, insomnia, heart disease, erectile dysfunction, type 2 diabetes, Alzheimer’s disease, cancer, as well as "most other conditions"...

The book asserts that the underlying causes of this dysfunction are rooted in unhealthy modern lifestyles: "too much sugar, too much stress, too much sitting, too much pollution, too many pills, too many pesticides, too many screens, too little sleep, and too little micronutrients. These trends-with trillions of dollars behind them-are causing epidemic levels of mitochondrial dysfunction and underpowered, sick, inflamed bodies."

The authors also assert that diseases such schizophrenia and depression are caused by..."leaky gut syndrome", and...claim that "researchers can identify a person with depression or schizophrenia just by analyzing their gut bacteria composition".

Oh, horseshit.

Also; fuck off, NPR. "medical degree from Stanford"? That's some real fucking sanewashing right there, you nimrods. Don't think that's gonna save you from Big Ballz and the DOGE Pounders.

"Bad Energy"? "Leaky Gut Syndrome"?

Why not "Demon Sperm"? Remember that weird Trump shit? Ohhellyeah. He's totally like that, and when you look at it that way his tapping this gimp for Surgeon General makes total sense. She's in the "wellness" grift just like he's on the "wealth" grift. Game recognize game.

This whacko has no more business being Surgeon General than I do claiming to be the fucking Dragon King of Bhutan.

There's a lot of "unhealthy modern lifestyles", yes.

None of them cause cancer. Or Parkinson's. Or acne. Or cure them.

Anymore than this freak can.

 

But she's a skinny sorta-blonde white chick that Trump would totally rage-fuck, so she's right in his ten-ring.

What a completely fucked-up country we live in.

 

Laid up in the Plague House

Two weeks ago today my Bride rolled me up to the big south doors at the Providence hospital out by the Banfield where in slightly less than three hours an orthopedic surgeon and his straphangers proceeded to hack open my left knee, part out all the worn-out bits, slam in some aftermarket replacement parts, zip me up and roll me on my way.

Since then all I've been able to do is lie around with one leg in the air, prodigiously bored, and try and distract myself from the results of someone hacking my knee open and replacing all the parts.

The distractions, unfortunately, largely consist of watching the news as the horde of diseased C.H.U.D.s fills places like Providence with sickly COVID patients and try and desperately find something to read.

(So far I've re-read Naomi Novik's His Majesty's Dragon - which was good fun the second time around - and slog through Rick Atkinson's The British Are Coming, his first volume of a general history of the army in the Revolution. So far Atkinson has been desperately disappointing; decently researched on the military history side, but marred by 1) Atkinson's fanboi pash for the rebels - the Americans are all stalwart, noble, and heroic, the British stodgy, foolish, and faintly ridiculous, and 2) writing at an almost embarrassingly low YA level. Did you know that CPT Prescott, the commander of the redoubt on Breed's Hill, was "azure-eyed"? Ugh.)

I was warned going in that knees are an order of magnitude worse than hips, so it's not so much that I didn't anticipate the long recovery time. It's that I didn't expect the way I feel; weak and sick, like a bad flu, all over - not just an achy leg. I feel utterly whipped most of the time, and it doesn't help that I have to lie in bed with my leg up all day to try and get the post-op swelling down.

The Little Cat has taken it on herself to be my constant companion, which has proved less irking than I'd thought. She doesn't ramble - much, tho when she does her little claws are a hazard - and she's fairly quiet - for her, who is a chatty, meow-y kitty generally - and mostly picks a vacant part of the bed.

But that's the boundary of my world, at least at the moment. My poor Bride is doing the work of a hero AND sleeping on the couch while I loll about in the big bed like some sort of Roman sybarite.

Supposedly the third week post-op is when things improve.

Let's hope so. This is only a fortnight and it's already REALLY old.

Except for the cats. But, then, cats...

Update 8/24: So I'm on my third week post-op and so far the various anecdotes I've heard about this procedure have been pretty much correct. 

The pain is manageable now, other than the nighttime. 

And even that's not really "unmanageable"; it's just that the discomfort level is just barely too high to sleep easily. I've been trying a combination of pain meds and a sleeping pill (technically it's an antihistamine, but it's basically a sleeping pill...) but that hasn't been particularly successful. So the only real issues at this point are 1) sleep, and 2) books, in that I'm still looking for something readable. Tried a usually-decent potboiler (one of the later Jim Butcher Harry Dresden series) and was as grossly disappointed as I have been with the recent ones - dude, you should have stopped before Ghost Story - although the latest in Lois Bujold's Penric and Desdemona series (The Assassins of Thasalon, in case you're interested...) was an all-too-brief treat. I'm still struggling with Atkinson, who is improving now that we've gotten past the Siege of Boston, but is still just not well written (and I should note that I enjoyed his WW2 series immensely; the history was solid and the writing was...well, not this purple.)

I get my first physical therapy today. We'll see how that goes; the damn thing is still really puffy and resists bending - I can do it, but it's a real fight - and I'm gonna bet I'll be sore as a boil tonight.

Now and then

Well worth reading discussion of the similarities and differences between the current pandemic and the previous one here.

"It’s really remarkable to me that the flu of a century killed 675,000 Americans out of a population of 110 million, meaning that roughly works out to the 2.2 million upper range guess of projections for COVID-19 by proportion of the population. And yet, the cultural response to it was primarily to shrug our collective shoulders and get on with our lives. It wasn’t total ignorance that created that situation. Some communities did engage in effective quarantining, for instance, and there were real death rate differentials between them. But to my knowledge anyway, sports weren’t cancelled. The World Series went on as normal (and quite famously in 1919!). There was no effective government response at the federal level."

One point I will take issue with, however, is this:

"Basically, what has changed is us. We see ourselves as something closer to immortal today." (emphasis mine) "The only two health crises even close to the flu between then and now were polio and HIV and those are very different types of events. Polio’s transformation into something much more powerful than in the past definitely scared lots and lots and lots of people, but what could you really do? AIDS certainly frightened many, but it was also classified as gay cancer early on and Reagan was happy to let them all die until his buddy Rock Hudson fell to the disease.

We have a culture of immortality. That’s not a bad thing. Science has advanced so far. We think we can protect ourselves from the outside world through eating and exercise and medicine. To an extent, we can. Even though COVID-19 has hit very old people in nursing homes and those with co-morbidities much harder than most people, it’s seen as an unimaginable tragedy to lose these people in a way that the deaths of thousands upon thousands of young parents and workers was not a century ago. To an extent, this is a reminder that human beings are incredibly fragile animals who have bodies where germs and bacteria pass in and out of all the time. We just don’t think about it. Our seeming indifference to climate change is related to this as well. We simply think we will figure it out, just like we figured out polio or the ozone layer or how to make a good television comedy."

I think this confuses correlation with causation.

Yes, we do think we'll "figure it out". But that's because we are accustomed to the - when you think about it - astounding advances in medical practice over the past century.

I mean...the docs in 1919 understood the germ theory of disease and the nature of influenza. They weren't stupid. They did what they could.

But.

At the time inoculation and vaccination was just beginning to become widespread. The notion that "oh, sure, we'll get a vaccine for that" was not just remote, it was nearly unthinkable in many cases. People died all the time from diseases we've more-or-less removed from our experience; typhus, cholera, diphtheria, measles, smallpox. That simply doesn't happen anymore.

So it's not that we "see ourselves as...immortal" or have a "culture of immortality". It's that we have internalized that what is going to kill us is a heart attack, or cancer, or an auto accident, or a random nutter with a firearm. The notion that a simple contagious disease - a sort of superflu - can kill or maim us?

THAT's insane. That's fucking creepy. That's...something that shouldn't be happening.

So we ARE not really treating this plague the way we did a century ago, but not because WE'VE changed.

It's because our fundamental baseline for medical competence and medical success has changed.

We don't expect we're going to die of cholera anymore.

So we're really pissed off and really frustrated and really afraid that this thing has become, despite all our knowledge and skills and learning, the pestilence that stalks in the darkness

Lounging Around the House - for Victory!

Here’s the deal. The closest analogy to the Plague Year is World War 2.

Except instead of getting drafted or building Liberty ships and B-24s that huge part of the public that was "the war effort" in the Forties in the Twenties is going to have to close their shops, lose their jobs, and stay the fuck home.

Now...B-24s were a dead loss to the public weal. Made nobody, everybody, every single American absolutely zero in terms of building the gross domestic product. They were crucially important for the job at hand - winning the war - but basically nothing but a huge metal hole in the sky into which the government threw money.

So the U.S. government’s job right now - right now, right fucking now - is to treat every restaurant the way it treated Consolidated in 1944, and treat every laid-off busboy and bookstore clerk like it treated a welder at Kaiser shipyards and turret lathe operator at Springfield Armory.

Pay them. They’re fighting a war. Pay them for their fight. Pay them for their sacrifices.

That means, no, Republicans, goddamnit, you don't get a goddamn payroll tax cut. That pays for Grandma and Grandpa to stay in their home and not be out under a fucking bridge catching the fucking plague. No, Trump, fuck no, you don't get a massive bailout for the damn fracking outfits or your CEO buddies. They can borrow at zero interest using their assets for collateral.

No, this goes to the troops; the baristas and librarians and truck drivers and (ahem) geologists who are idled in order to prevent this plague from wrecking the economy by getting people tossed out of their homes, gutting their savings, and destroying their lives.

Pay them...or this epidemic will wreck this country as thoroughly as any Nazi could have.

(And don't even get me started about how we're not but we should be cranking out medical supplies - everything from masks and gloves to ICU beds and ventilators - like Sherman tanks and B-24s thundering off the assembly lines in 1944.

The complete and utter clusterfuck that has been the Fraudulency Adminstration's "response" on this one would be legitimate cause for summary execution in any sane polity.)

Update 3/18 p.m.: Trump says he's going to do what he should have done several weeks ago and what I ranted about just above; activate national-defense-level production of essential medical materials under the authority of the "Defense Production Act". So the orange monkey gets "credit" for finally not flinging his poop, I guess, since that seems to be the low bar set for this dingus.

Mind you, this is Trump, so the clueless chucklefuck and his minions have no idea what to DO with this authority:

"Trump declined to say how, precisely, the Defense Production Act would be used and he suggested that the administration is still deciding. He said the administration had “targets” for equipment it wanted but did not say what those targets were."

Christ, what a maroon.

Update 3/20: So here we are, two days after I posted the first update...and Emperor Dumbfuckius Maximus still hasn't actually begun to use the DPA to, y'know, actually produce anything useful. States are still scrambling to find medical necessities like masks and ventilators. My guess? He and his gang can't figure out a way to make a profit out of it. They know if they order their CEO buddy at PharmaCorp to start cranking out masks, and their buddy follows his instincts (which will be to charge $6.95 for a mask that costs fifty cents to produce) they'll get found out and hammered for price gouging (which, in their minds, is just "being smart"; chiseling the suckers while they can which is, y'know, how it works...).

And the rest of the GOP just doesn't want to do anything to suggest that government isn't the problem.

So, yeah...we're still kinda fucked.

Update 3/24: Oh, for fuck's sake!

"From the start, the administration* has treated the DPA as though it were some sort of Damoclean weapon by which it can force compliance from American industries. "Watch out, Ford. Make them ventilators or the DPA’ll gitcha!” This is because, for politicians like Pence, a product of a Republican Party that married itself to supply-side snake oil and disdain for self-government, it is inconceivable to imagine that the federal government’s demanding that industries respond to a worldwide crisis cannot be more effective and efficient than waiting for those corporations to engage their civic consciences to do so. And they will adhere to that faith over your grandmother’s dead body."

These fucking people.

Honestly.

If I was a company commander in the 3rd US Infantry, I swear to God; I'd go through this White House and Senate like a dose of fucking salts. And after every last one of them; Dimwit Donnie and Moscow Mitch and Javanka and all the other rats had been put up against the wall I'd then surrender myself, plead guilty at the court-martial, and happily spend the rest of my natural life as the oldest private E-1 in Leavenworth knowing I had done a damn fine piece of work.

Parted out

So I'm back at home after two days at the hospital getting rid of the old worn-out hips parts and getting a shiny new metal one. True to form, the post-op pain pretty much held off until last night when I'd walked through the door and then hammered me flat; my right leg swelled up from the iliac crest to the top of the knee and I had a very, very bad night last night.

Things are better today, but not all that much. And I STILL haven't managed to get a used-food blockade runner past the Hillbilly Heroin Barrier; today has been the first stage of Operation Big Dump which has involved prune juice and several bowls of raisin bran. No luck so far, but we'll see...

(TMI Update 3/4: OBD is a go..!)

The reason for the tissue blow-up was, apparently, that when the ortho team opened me up what they found was a complete and utter mess; floating bone chips, arthritic spurs, all sorts of nasty junk. They had to clean all that up and in the process tore up a lot of soft tissue. Hence the pain and the suffering.

But I'm recovering, slowly, and having a worse time with the boredom than with the pain, at least at the moment. I'll be back in a bit with a longer update, but I just wanted to get this out so's you'd know that I wasn't food for worms, brave Percy.

Waiting for Bob...

I've got a confession to make.

I an on an artificial testosterone medication.

Yeah, I know; sorry, TMI. But that little fact is fairly critical to the rest of this post, so I had to start with it. Try to scrub the image out of your brain. I'll wait.

OK, so, we good now?

Alrighty, then.

So, anyway, the bottom line is that as I headed into my forties I noticed that I was having some problems just dragging my ass out of bed in the morning. That and, well, the usual sort of problem associated with not being packed with robust man-juices, but we won't linger on that particular issue.

I went to see my internist, who ran the usual blood tests and pronounced me perfectly functional, 100% mission-capable.

Which left the issue of "Why the hell is my dead ass dragging so badly?" and I asked for a referral to a urologist. Since it didn't cost my GP a nickel she happily wrote out the referral and off I went.

The dick-doc then ran the same blood tests and proceeded to inform me that my natural testosterone levels were down there with those usually associated with very masculine women and pre-pubescent boys. I could creep up into the low three figures on a good day with a following wind and a strong current, but that was that.

So he prescribed me one of those artificial testosterone medicines that help professional bicycle racers win the Tour de France and off I went.

And the stuff works as advertised, let me tell you. In a couple of days I felt positively bursting with masculine energy; I wanted to seduce something or go start a war.

Kidding. But, seriously, the man-juice works. I felt "back to normal"; my energy levels in all respects returned to what I expected to feel given how active I was and how hard I worked to keep in shape and eat a healthy diet.

Well, OK, except for the whole pork-rind thing. But, damn, who can resist that crackly, greasy goodness? Seriously.

And because the urologist explained that this stuff was to restore my testosterone to natural levels as a matter of health and quality-of-life issues and not because I wanted to become some sort of mad harem-tester in my off-hours my insurance - after some initial suspicious sniffing - proceeded to cover the damn stuff.

Dick-stiffeners, though? Viagra? Cialis? Not a chance. Despite the usual whining about how all those boner pills are covered and female products aren't...they're actually not. That's just so you know the deal here.

Anyway, this was some ten years or so ago. I've been taking these testosterone supplements regularly ever since and, although the damn co-pays go up and up every year, paying just a portion of the actual price of the stuff.

Which is pretty ridiculous, mind you, given that the drug is decades old and is manufactured at some sort of drug-maquiladora in Mexico for probably pennies a dose. I mean, we're talking hundreds of dollars for a little pump-bottle that lasts about a month; well over $3,000 a year at full price.

Three. Thousand. Dollars.

But the damn insurance has been paying for this, so for the cost of $500/month or so in premiums I get a reliable supply of man-juice.

Until yesterday.

When my Bride returned from the grocery pharmacy without the testosterone bottle, explaining that the pharmacist had input the prescription and it had spit out that the drug was no longer covered by my Blue Cross/Blue Shield formulary.

So.

Now I am faced with the unlovely prospect of having to call my goddamn insurance company and 1) find out why the hell they are no longer covering my drug after ten years of doing so and 2) figure out how the hell I can get the goddamn insurance company to stop dicking around (if you'll excuse the expression) and cover the goddamn drug again. This will undoubtedly involved repeated conversations with unpleasant insurance company phone-bots whose purpose will be to find reasons not to spend the money I have been ladling into the goddamn insurance company's bank account on my health care.

And to make it as difficult and unpleasant for me to find a way to jerk that money out of their ass a nickel at a time.

And as I'm staring at my phone with a sense of deep loathing for this entire process, I keep thinking: remind me - this is that "best healthcare system in the world" we keep hearing about, right? Because we don't have some faceless bureaucrat deciding what and how we will get for our health care. Right?

Because right now I'm about ready to shove every goddamn insurance company up the gigantic bung-hole of the Universe and replace them with a single faceless government health care organization just like the one I had when I was a GI that paid for whatever my docs said I needed without so much as a whimper.

That, or go score some fucking Enzyte.

What a goddamn disaster.

Primum non nocere

What can I say?



Cold and flu season used to be a LOT more fun? Make you wonder what the "other ingredients were, don't it?

(h/t/ to Pierce, who garnered this little bit of yesteryear...)

Morning comes too early

We really did have a lovely Sunday evening, and Mojo and I had a nice time together after the kiddos went to bed early (finally!) so I was on track for a pretty damn good weekend when some time around 1:20 a.m. I must have rolled the wrong way and managed to yank on the big nerve that's caught up in my arthritic left hipjoint.

Here's the thing; I've lost about 20-30 pounds - I'm as lean and fit as I've been in years - but that doesn't seem to make a lick of difference. My hips, both hips, now, are utterly wrecked, and they both contribute a degree of discomfort unlike anything I've ever experienced.

Doc Le has provided some pretty effective pain pills, but whatever this sciatic nerve thing is that is going on in my left leg cuts through them effortlessly. I rolled out of the bed and took one at 1:20 and then spent the rest of the night trying to get back to sleep without success. There was just no way to lie or sit without pain.

Finally at 5:30 I went out to the couch and got about an hour of sleep in a sort of semi-sitting position. But had to get up to go to work, so to say I'm working on some pretty decent sleep-debt is putting it mildly.

And the thing is all the sources I've read suggest that this - if it is some sort of sciatic-nerve compression related to the arthritic degeneration of my lower back and hip - has very poor resolution regardless of the type of intervention. Apparently surgery has better results in the short run but by 3-5 years is no better than PT, chiro, massage, or just drugging yourself stupid.

Again, I'm trying not to whine. But it's hellishly frustrating to have depended on my body to do what I told it to for fifty years and have it suddenly quit on me.

I think I'll go have a drink now, thanks.

An Open Letter to SEN Wyden

My dear Senator;

I'm dreadfully afraid to hear that you appear to have been drinking heavily. At least, I hope that is the reason your name appeared in the Oregonian coupled with SEN Ryan in some sort of scheme to "reform" Medicare.

Because if you ARE compos mentis I find this hard to explain. We elected you based on what we understood as your liberal principles, which include a belief that one cardinal purpose for which governments are instituted among Men is to aid those who are in difficulty. Which is, still, the principle behind such programs as Medicare.

Now given that SEN Ryan has made much of his belief that government has no such brief, and that his so-called "plan" consisted of a thinly-veiled attempt to "reform" Medicare into largesse for private insurers, I find it appalling that I find your name, a name I respected as a doughty fighter for liberal values, lending respectability to the latest Ryan scheme. If not inspired by ethanol I hope, at least, that you are attempting to infiltrate the enemy camp in order to dynamite their supplies. Given the extent to which the GOP and SEN Ryan have gone over to the raze-the-New-Deal-social-contract I can find no other rational explanation for the news of this arrangement.

Sent in hopes that with the dawn sobriety and a cold drink of water will find you abjuring the Gilded Age fantasies of SEN Ryan and a return to the bedrock principles of liberalism that have served our country so well since the days of FDR.

Yours concernedly,

John L. Lawes

Update 12/16: (Basilbeast has corrected my error: the GOP fathead-in-question is a Congressman, so I was incorrect in not identifying him as "REP" Ryan. I leave the original missive as I sent it, however, and can only suspect that the amount of drink I had taken upon reading of my Senator's betrayal affected my own judgment.)

Update 12/17: Krugman, predictably, says the same thing only better.

No, I don't want a little cheese...

Can you believe the summer is almost over?Me, neither.

Part of it is because it's been crazy busy. And another is because it arrived late, so it only seems like we've had an actual month or so of summer.It's been strange, too, in that although I don't get the sense that my company is all that busy in terms of actual work coming through the door (we're still taking really small crappy jobs we would have passed on, for one thing) but I've been working crazy hours. Out at five, back at nine, that sort of thing. Lots of dirt-nannying, which pays great but can be absolutely insane. Let me give you an example.

We have a job in downtown Portland doing a four-story building (so the foundation loads are fairly respectable) and the site is a typical inner-urban Portland city block, meaning that it's been built and re-built over the past 100 years and most of the crap that came from the buildings that were demolished earlier was just hucked into whatever convenient hole the laborers could find. So there's anywhere from two to about seven or eight feet of really nasty fill on the top. Brick, concrete, glass, dimension lumber, fly ash, charcoal...you name it, it's in there. Plus the stuff has a nasty habit of hiding open voids underneath a veneer of soil, a perfect footing-trap designed to produce ugly post-construction settlement.We found all this junk when we did the soil investigation and my engineer, not surprisingly, recommended that the contractor hog it all out and build on the native.

The contractor, also not surprisingly, is being pushed by the owner to minimize the overexcavation, so his superintendent is trying to cut back on the amount of this jumky fill we take out.

Completely unsurprisingly this leads to a certain tension between the general contractor and me, even though we both supposedly work for the owner.So the other day the excavator dug out one of the foundation footings and there in the bottom of the hole, sticking out of what otherwise would be native-soil-looking yellow silt, is a head-sized chunk of asphalt. Unmistakeable, just-pried-out-of-your-driveway asphalt.

The super sort of looks sideways at it and says in as confident a tone as he can manage;

"That looks like native soil to me."

I actually think I goggled at him; I know I must have had en exceptionally odd look on my face.

"Well, in that case." I replied, "we're going to have to completely revise our estimate on when early humans started using asphalt paving..." He had the decency to look ashamed.

We dug it out. And the other three feet of assorted brick, lumber, fly ash, china plates, glass bottles and assorted shit that somebody had pushed into a hole back in 1946.

Honestly! I may have been born at night, but I wasn't born LAST night. I wasn't sure who to be more embarassed for, him for trying me on or me for looking foolish enough to make him think he could try that on me.What else?

We had a nice visit from the in-laws in July, who got their fill of their grandkiddos and, I suspect, perhaps a little more than their fill. Our house is barely large enough for us four, so when the grands turn up they usually find a hotel or motel, but this was a month and the cost would have been ridiculous. So Mojo found them a rental place up near Kenton. And the sad truth is that it is nicer than our home. The kids loved the hot tub; I liked having the hot tub to entice the kids to stay with the grandparents.

We did get to stay over there a few nights. Any more and I'd have been too tempted to ask the landlord for a straight-up swap.There's been a little bleakness, as there always is in any sort of life. Mojo's employment is getting precarious, and we're looking at various ideas for post-gas-company paycheck days. And something's going wrong with my hip.

I don't want to sound dramatic about this. I've spent a lifetime abusing my legs. I was born with something called patellar subluxation, in which your kneecaps are canted outwards rather than sit straight on the front of your legs.

The old orthopod I went to see ten years ago when they finally began to hurt enough to slow me below the minimum time for the APFT run told me that as a draft board physician in the Sixties he wouldn't have let me within a rifle's length of the infantry for the very reason I was seeing him that day. Plus I played ten years of soccer and twenty years of squash on them, not a very healthy idea for malformed kneecaps.

So over the past five years or so my run has degenerated a sort of an angry, jerky shuffle, and when I kicked the soccer ball about with my little guy it was with the painful knowledge that I would regret the playtime later.

The ortho had a very sensible attitude about my knees.

"The two options for you are a replacement or a repositioning surgery that has a high incidence of subsequent failure. The replacement will work, but if you have it today (and I was in my forties at the time) you'll need another in twenty years, and rehabilitating a bilateral knee replacement at sixty won't be much fun. If you wait until you're fifty or sixty the technology will have improved enough that they'll last long enough for you to take them with you to the grave."

So I've put off the knee replacements and, shy a few days where too much exercise ballooned them up and required an icebag and an acewrap, have never regretted it.

But this past autumn my right hip started binding up on me. At first that's all it was; just the loss of range of motion. I had a hard time trimming my toenails, or getting my foot into my skiboots. And I noticed a dragging sort of weakness when I wore my work boots; it was like my right leg had about half the strength of my left.

I assumed that it had something to do with my knee problems, and I would knock down some Motrin when it got bad, and in a day or so of light work it would go away.

But at some point this winter it stopped leaving.

Now it hurts, in some form or another, all the time. It varies from a dull ache to a biting little stab when I turn my leg the wrong way. I have developed a visible limp, and whatever's wrong with the hip joint causes me to walk in some off-kilter way that puts strain on the right knee, which has noticeably worsened, and on the muscles of my right upper leg and butt. By the time I come home from work they're hard as an iron bar and ache like a sunofabitch.

I really hate talking about this. It doesn't do any good, for one thing, and it sounds like I'm whining and asking for sympathy, for the other. And I'm not, really; this is just a thing. It's not leukemia, it's not COPD, it's not a brain injury. It's just pain, and people live with pain all the time. It's not crippling, and I go to see another orthopedist in a week that will tell me that I need to either get opened up so that they can remove the arthritic calcium or whatever is marring the hip joint can be scraped off, or I will need a hip replacement.And that's fine. I don't like either the surgery or the rehabilitation afterwards, but if it means that I can walk again without pain? That's a good thing.

I just thought I should mention it, being as that it is sort of hard to escape. Chronic pain, like a hanging, concentrates the mind wonderfully - but only on the pain. And I have a fairly high threshold of pain; I can't imagine what this is like for people who cringe at papercuts.

So...am I whining? Maybe so.

But it's a fine whine, and I like to think I served it up in an pretty glass.

More is Better?

Interesting graph from National Geographic courtesy of Alterdestiny:The obvious story that National Geographic - as well as the various bloggers that will use this as I do - want to tell you is the really spectacular inefficientcy of the U.S. fee-for-service medical system. We really do get less for our money than pretty much everyone else in the world. Yes, even Mexico.

The clear winners here are the people inside the medical profession. Doctors, hospitals, for-profit healthcare groups...all these folks are clearly making serious bank.

But I find this interesting for more subtle reasons, too. For one thing, look at the line thickness; there really does seem to be a correspondance between seeing your doctor and staying alive. Nowhere on the graph is there a thick blue line that descends from left to right.

The other interesting thing is the change in the slope of the lines down in the "median" area. There seems to be some factors at play here that unbalance the relationship in the industrialized nations surveyed. The Swiss and the Luxembourgeois, for example, must be doing something...wrong? Different? Risky? Their expenditures are the highest of the non-U.S. nations but they get less out of it than anyone else in the group. The Danes must be at risk from some non-medical factor as well.

The Poles and Portugese are some healthy beasts, though, since despite spending relatively little they live to a respectable age for the group. And the Japanese are practically unkillable. Is it the healthy diet? Genetics? A homogeneous society?

Not sure what the others are doing, but it sure seems like we're not doing it, or not as well.

I wonder if anyone in Capitol Hill cares?

Why people hate insurance companies.

So back in October my little guy went in to the doc for a minor operation.

It really was minor, the removal of a tiny skin tag which, had it been anywhere else, would have involved a local dab of xylocaine, a snip, a band-aid and a lollipop. But this one was on his eyelid, so we had to go the entire operating theatre route to keep him still enough for the plastic surgeon to whack it and throw a single stitch.He did a great job, and you can't even see where this goofy thing was. And his classmates no longer tease the Peep about his freaky eye booger.

But while the skin tag is gone, the medical bills keep coming, reminders of the Byzantine fucking complexity of our medical system.

There's the hospital bill, the surgeon's bill, the lab bill, the anaesthesiologist's bill...

And then there's the insurance claim, and that's where the REAL frigging mess begins.

Because nothing's simple there. There's the billed amounts, the "provider's discount" (WTF? So you're telling me that the physicians, surgeons and the hospital had padded the bastard enough to knock the official billed price down 30% or so and STILL make a profit?), the amount we have to pay on our personal deductible, the amount not covered because it's part of our family deductible, the part not covered because it's part of our "total-out-of-pocket" expenses, the part the insurance plan covers at 80% and the part that it covers at 60% (forget 100%, Giacomo...that don't happen...)I've been calling the insurance company and talking to all of these very helpful, very knowledgable people...it's hard for me to hate them personally. But the entire system requires a tremendous amount of unpaid time on my part to track down this information and try and apply it to everyone's bills.

And then I talk to my parents, who lived in Dusseldorf for many years, and they tell me that when my mother saw the doctors there she got a single bill, with a cost, the amount paid by the national health (usually something like 90% or better) and the amount they owed. They were done with the nonsense when they walked out of the clinic or the hospital.

Plus there's the irritation factor. Why the hell didn't Blue Cross apply the $500 that Mojo paid upfront to Peep's deductible? And once they do, and once we pay off the remaining $750 we owe to cover our $2K "out-of-pocket" costs, why do they then not pay their expected 80% of the anesthesiologist's bill, on which they have payed nothing?Add this all together and I'm left doing a slow burn; hating the insurance company for doing what private insurers have to do - making it difficult for me to spend their money and fuck up their balance sheet - and causing me to spend all this time on the phone, hating the medical providers for complicating the billing process and padding their costs, and hating the people who are so worried that this wonderful system is going to be "changed" by health care reform.

And I'm a pretty sharp guy. Makes me wonder what the dull-normal people do when they have to deal with this stuff..?

I mean, it's better than bleeding and purging, but, still...

Eye Trouble

Big boy Peep had a skin tag.

Have you ever seen one of those? They are odd little growths, not like a mole or a wart, but rather little slender eruptions of skin cells. They are fairly benign and are generally not even enough bother to warrant excision. But this one was on little man's eyelid.

He started to get teased about it this spring, and finally by late summer he'd had enough. We went in to see his pediatrician, who recommended a plastic surgeon. The surgeon explained what would have to happen, and after a week of dithering the Peep said okay.

I think I was more nervous than he was the morning he scampered out into the predawn darkness with his mom to go to the hospital. And, sure enough, everything went fine.See how tiny the little hematoma is on his left eyelid. Teeny stuff. And he was more excited about the little stuffed dog the doctors gave him than worried about his eye. He was already smiling in Recovery.I worried about him a bit, about the injury getting infected or post-op swelling, and generally about how it would affect his usual Tiggerish bounciness. But tonight he climbed up on the couch, straddled my head and teabagged me, and, once he had me down, farted in my ear.

I suspect he's just fine.

Saturday News Blogging: Swine Flu Edition

I'm wiped. Work started at 1:30am today and went very badly, as badly as possible without anyone getting hurt.

So I REALLY want to sleep, but if I go home I will be overrun by little peepers. So that's a no-go. I'd love to blog, but that's at the back of the line behind washing, eating and sleeping. Oh, and making love to my wife. And playing with the kids.

It's not that I don't love y'all, tho.

One thing I did want to note is that it seems that the latest round of swine flu is dropping off the exponential curve that the truly Great Pandemics seem to follow. So, so far, 2009 does not equal 1918.

But...but. Let me remind you that as far as we know the 1918 pandemic followed a strange pattern. The spring flu season was extremely mild, although it was somewhat out of character due to its origin in the central U.S. and its timing in late spring rather than autumn and winter.

But that autumn the pale green horse returned and slew without mercy. The cytokine storms that typified this manifestation of the flu were the great killer of young and mature adults that made the 1918 outbreak so terrifying.

There is some uncertainty surrounding the pattern of the 1918 flu, but most sources seem to believe that the milder flu that passed that spring underwent some sort of genetic drift, a mutation or mutations, that made it so lethal in the fall and winter.

Our present flu has not yet had the chance to make this shift.

We may yet live to see whether it will or not.

(Oh, and h/t to Group News Blog, for the delightfully vile A. A. Milne parody)

LP/OP

Busy week this week: little Miss's third birthday yesterday;big Peeper's sixth this coming Sunday.

Plus all the usual work and worry.

But I'm still here listening and observing. Observing, with increasing trepidation, the epidemological news out of Mexico and now across the globe. We've already proved that 2008 can be like 1929. Are we getting set to see if 2009 can be like 1918?Brrrr...And listening to the news from the domestic political front as well.

Not good.

Despite the hysterical repetition of the lie ("We do not torture!") from the former Liar-in-Chief so many times that any discussion of the "enhanced interrogation of our helpless prisoners that occurred between 2001 and 2009 took on the surreal dimensions of discussing cell division with a three-year-old, it not appears exceptionally clear that we tortured our captives.

There's a couple of ways to look at this.

There is the way that old Tom Paine looked at it:

"But where says some is the King of America? I’ll tell you Friend, he reigns above, and doth not make havoc of mankind like the Royal Brute of Britain. Yet that we may not appear to be defective even in earthly honors, let a day be solemnly set apart for proclaiming the charter; let it be brought forth placed on the divine law, the word of God; let a crown be placed thereon, by which the world may know, that so far as we approve as monarchy, that in America the law is King. For as in absolute governments the King is law, so in free countries the law ought to be King; and there ought to be no other.

Or you can take the approach that that well known Islamofascist Teddy Roosevelt took:

"No man is above the law and no man is below it; nor do we ask any man's permission when we require him to obey it. Obedience to the law is demanded as a right; not asked as a favor."

Or...you can look at it the way that the Beltway Pundits; the Official Spokesworms for our Governing Classes would like you to look at it (this is Jon Meacham from Newsweek:

"And to pursue criminal charges against officials at the highest levels—including the former president and the former vice president—would set a terrible precedent. . . . That is not to say presidents and vice presidents are always above the law; there could be instances in which such a prosecution is appropriate, but based on what we know, this is not such a case."

Did you get that? Our Leaders aren't ALWAYS above the law, just sometimes, like when they need to waterboard you 183 frikkin' times. Because you're an eeeeevil terrorist.Or because he...SAYS...you're an evil terrorist.

It's this simple: torture is against the law. It's against the law because torture and the culture torture foments is a toxin, lethal to the rule of law and to open government. It is the Star Chamber. Not for nothing did our Founders forbid "cruel and unusual punishments" - not because they thought that Americans were noble and that criminals needed to be kissed and caressed. It was BECAUSE they understood the evil that men do is corrosive, and in certain dark ways beautiful and attractive in the way that power and strength are always beautiful and attrative, like a shining curlique of blood against a sheet-white pavement.

If we do not, if we CANnot, pursue and punish those who broke the law, regardless of their "reasons", then we are no longer a nation of laws.

Period.

And from there, it becomes harder and harder to turn away.

While my Republican friends will deny and demur, you can take it from me or you can read this powerful essay from The Minstrel Boy over at Group News Blog.

Either way, from this LP/OP it seems like the falcon is listening less and less these dark days.

What do you think?

Update 4/28 p.m.: As always, a little more, a little less...

On the "good news" side, the Ninth Circuit panel came down hard on the Bush/Obama Department of "Justice" for trying to put the entire government outside the law. Judge Hawkins' opinion pretty much sums it up: the U.S. government stated that the entire "subject matter" of rendition and torture was so secret that to merely discuss it was dangerous to the public good. This, as I've said, is the logic of the Star Chamber; we are condeming you for reasons that we cannot tell you because if we did you would know how we gained the "evidence" to condemn you and might be able to evade condemnation. As Hawkins says, this would "cordon off all secret government actions from judicial scrutiny, immunizing the CIA and its partners from the demands and limits of the law"

On the other hand, the "conversion" of Sen. Arlen Specter (once-R-now-D-PA) seems to represent everything that is dysfunctional about our federal legislative branch. Specter, who was pretty much Bush's rubber love doll throughout the past 8 years, is being challenged in his primary by an even bigger right-wing nutjob. Rather than wait for the nutjob to win and then bitchslap him with an actual Democrat, the Senate D's are welcoming Specter in the same way they have nestled down with Lieberman; Ried is on record as saying that "Specter is with us until we need him to be with us". This says to me:

1. Specter has no political morals; he is a whore that will bend like Gumby into whatever position it takes to stay in power. And

2. The Democratic Party STILL doesn't believe that it should be genuinely, openly liberal. They're rather take a hard-right Democrat they believe can win an election than stand for THEIR principles and run someone firmly in the middle of their own supposed ideology.

How the hell are we supposed to care if it's this obvious than they don't..?

One the subject of the possible flu pandemic, Meghan reminds me in the comments that we don't have any hard evidence that this flu will be either especially infectious or especially lethal. True. One problem that we have that our grandparents didn't is information overload. We're now bombed by news that isn't really "news" but a newslet, a tiny fragment of a much larger issue that was jammed unto the wires or the air to make morning newstime. Combine that with the news organs' now-endemic inability to perform analysis or discriminate signal from noise and we are buried under an avalanche of information; some critical, some useful, much completely worthless.

But I would argue that this potential pandemic may be significant for the time it arrives; in the midst of the worst economic crash since the 1930's. This disease may not HAVE to be lethal to be...lethal. If governments - and there is some evidence that this may be happening in Mexico already - act to close down the movement of humans and goods (a reasonable precaution in the case of a highly communicable, potentially high-mortality disease) the effect will be to increase the downward pressure on the global economy. ISTM that finding a balance between trade and public health may be very, very difficult. I don't know how I would do it - hopefully the people working at the CDC and the US Public Health Service and the Commerce/Tansportation/Border Patrol executive levels are smarter than me.

I'm ready for my close-up, Mister DeMille...

So we spend almost three hours last Thursday night at Emmanuel Hospital in Portland with Missy, going through the monthly initial cleft-team screening.

Our little miss saw the plastic surgeons, orthodontists, physical and speech therapists, and the ENT. It was a long evening, so we had to repair to the nearby Widmer brewpub for some spicy sausage, beer and spaetzle afterwards. Note to Kelli: if you like, they have a brie wellington in a balsamic reduction that's to die for. OMFG, that little treat redefines "tasty". Their kolsch is damn crispy, too...

Little girl was a star. She never once hid, cried, got upset or shut down. She was so patient with all the strangers peering, poking, and prodding her, talking to her, asking her to jump and play, bending her arms and legs. I'm glad we waited; ten, or even three, months ago she would have lasted about ten minutes before closing down and hiding in Mojo's lap. Now that she's been a daughter and sister for almost a year she's an outgoing little chatty cathy. She drew pictures, pointed out noses and ears, threaded beads, walked ran and jumped - in fact, she LOVED the PT "jumping" test so much that after her PT evaluation was over she pulled the little stool the therapist had used back out so she could continue to jump over and over again. Then used it to climb on a chair. Then used it to climb Daddy's knee. Then she took me by the hand and had ME jump off the stool and followed right behind me.

The good news: eleven months post-orphanage Missy is fully within the "competent" range socially, physically and medically she is developing well towards a date with reconstructive bone-grafting in about six or seven years. Her upper teeth are coming in as well as can be expected with the alveolar cleft. The medical team all felt that she was very healthy and not in need of additional medical monitoring unless the ear infection problems returned.

One interesting note was that none of the physicians felt that the "milk that goes in the mouth comes out the nose" thing we worry about was a) a serious problem, or b) contributing to the risk of ear infection.

The semi-bad news: she is developing several bad speech habits, probably related to the malformation of her upper teeth and hard palate, including vocalizing "D" and "T" sounds in the back instead of the front of her mouth. So "doggy" becomes "goggy" and "Daddy" becomes not just "gaggy" but "da-da" pronounced "gje-gje" (it's a hard sound to write, because it's not a pure "g" sound, it's a wierd,
gutteral somewhere between a "g" and a "j"). The ST liked the amount of language we were using with her - no problem chattering in this house - but gave us some tips and strategies to use for her. She wants to see her again in six months to assess the need for formal speech therapy.

Overall we came away with several thoughts:1. It's difficult to figure out from the outside where to go to get help with SN-kid issues. AND both process and results are so dependant on the right-this-very-minute kidlet stage. This assessment was SO much more complete than the one Mojo and Missy got at Shriners. And yet, I'll bet that if we had tried this with Missy 90 days ago it would have been much less productive and MUCH more difficult - picture trying to force open the mouth of a screaming, frightened, uncooperative child and you get the picture.

2. OTOH, some SNs are less special than others. Missy's is really
relatively simple.

3. Sometimes simple is hard. We could be headed for trouble if the
ear infection thing comes back. The solution apparently is artifical conduits for the eustacian tubes, but these are a surgical procedure that needs to be done under anaesthesia. Apparently circa 2008 it's usually done during the cleft repair. For some reason it wasn't done for Missy in China. This accords with my perception of baseline medical care there as 15-20 years behind: they're where we were in the 1980s.

4. She's ready for her close-up. We really have a very happy, warm
and loving little girl. We spend so much time refereeing or organizing or whatever between the two that we often don't spend much time with our little girl alone. It was a pure joy to be able to just play with her in a way that, honestly?, we haven't been able to since the playroom in the White Swan. And you can imagine the difference a year makes with that.

Hope this is of some use for those of you going or thinking of going the SN route. And, just as a by-the-by, a weary sigh for the latest round of referrals. It just seems so...so. I just don't have anything good to say. So I won't.