April 5, 2016

New Drug Alert - Epidemic declared!*

Today we have become aware of a new, terrifying drug trend sweeping the nation. Teenagers are combining ED medications with Minoxidil for a fast, crazy high lasting well over four hours. Kids refer to this combination as "Drug X". 

Teens everywhere are succumbing to the siren call of Drug X, and health officials are declaring a new drug epidemic as it sweeps the boulevards and gated communities of our nation. 
Most worryingly, this drug is easily manufactured by simply combining the two drugs, which are often easily obtained at home. Parents may not realize there is a problem until "date night" when they discover the missing ingredient.
Public Domain, https://commons.wikimedia.org/w/index.php?curid=472336

DrugX and Addiction*

Doctors say compounds like DrugX are highly effective for treating ED. And patients are much less likely to get addicted if they use these drugs in just the dosage necessary to treat their ED.
But when a person starts taking compounds when they are not in ED, or in doses beyond what is required to treat their ED, doctors say the drugs have a different metabolic impact on the brain. In those situations, addiction is highly likely.
Many teens crush up DrugX pills and snort them to get high, getting a hefty dose of drug all at once when they are not having ED to begin with. This form of taking in the drug is much more likely to lead to addiction.

 A Pricey Habit*
DrugX is very expensive on the street: $80 for one pill. To pay for his habit, Ryan says he cashed $7,000 in savings bonds his aunts had given him on birthdays. He sold his PlayStation, leather jackets, cell phone — everything he had — just to stay high and keep from getting sick. He finally broke down and asked his parents for help.
Looking back on it, Ryan says he didn't think using DrugX would be that dangerous because it was a prescription pill — that made it seem safe. Many different kids at his high school were playing around with it, he says: "People from every sort of group — the burnouts, athletic kids, the geniuses and, like, girls playing wicked-good softball [who were] offered scholarships to places — they would be using it."
That sentiment is echoed by 18-year-old Mike, a recovering DrugX addict in Winthrop, Mass. Mike says he was always an athlete and played football. Until his sophomore year in high school, he attended a prep school with wealthier students; he later transferred to the local public school. He says that, if anything, he saw more DrugX at the prep school.
"All the popular kids — that was the cool thing to do," Mike says. "It seemed like it was cool because it was so expensive, this big rich drug. And a lot of rich kids were doing it because the poor kids couldn't afford it."
DrugX is so expensive that many teens turn to stealing to support their habit.
"I stole so much money from my parents," says Katie, 18, who is also a recovering DrugX habit. She says she and a friend both stole their parents' ATM cards to support their habits. "I stole $5,000 from my parents in two months."
Katie also wrote checks from her mother's checkbook. Katie's parents say she and her friends stole cameras and jewelry from their house. Somebody stole her father's wedding ring out of his top drawer.
"It's like someone just punched you in the stomach," Katie's father said in an interview with NPR. "You know you're never going to get it back. And what did it get used for? The addiction." 

In the face of such a monumental problem, Congressmen are being called upon to offer some solutions. After consultation with many experts and industry representatives, millions of healthcare dollars are being earmarked for education and treatment programs to address the issue. Congressman
Richard Priap responded to questions at a press conference yesterday:
Obviously, any sort of ban on the drugs being used illicitly to create this compound is impractical and does not address the root problems. Denying millions access to these needed and useful drugs solves nothing and simply creates a more profitable market for smuggling rings to fill. Law abiding citizens will be denied needed treatments while criminals continue to have access, which is always counterproductive. Prohibition simply does not work, as we have demonstrated again and again.

 Obviously the above is satire. Please note that the paragraphs colored yellow are taken from an NPR story on OxyContin that can be found in its whole and unaltered state HERE .
 As a hospice nurse, I have seen how the panics over OxyContin abuse have negatively affected patients who NEED these drugs for severe pain, with little impact on overall narcotic abuse nationwide. I watch huge numbers of people suffering the effects of bans on psuedoepinephrine based drugs in an attempt to address methamphetamine abuse, again with less effect on drug manufacturing than it has on law-abiding allergy and virus sufferers.
I picked on NPR for the *protected* satire above because the article for me highlights the reporting that goes along with issues that affect the wealthy white and educated demographic. It is an emergency, an epidemic, requires immediate action. I mean these kids are moving on to HEROIN for heavens sake! Poor people use heroin. 

So I wondered - what would happen if Richie Rich started getting high from a combination of Dad's hair restorer and impotence meds?

 Please note - this is not a real thing and if you try this then you are stupid and deserve whatever horrific mutation results. 

March 8, 2016

Nurse's musings on weight issues

Several recent Plurk conversations are gelling in my head so I am gonna think aloud here for a bit.
Discussions of the fallacy of the "average" discussions of challenges with healthcare and another discussion about the horrors of flying when obese. And I think I sometimes I come off as judgemental or unsympathetic because of the limitations of the medium. So here goes!
First, medicine (in the US) as it is currently practiced is a high volume business that makes its money via tests, imaging, labs, surgery and other interventions. All those things pay the bills, which is why so may practices do those in-house now. Providers are required to see a minimum number of patients a day, carry a large census of patients they are responsible for, and as a result visit times are brief. Medicine is essentially practiced as a game of averages. This test result usually means diagnostic code xxx, which is treated with treatment regimen y. So everyone with a blood pressure over a predetermined norm get drug A, then if that doesn't work drug B. etc. And if 900 of your 1000 patients benefit from your treatments then that is a great success rate. Unless you happen to be one of those 100.
The other side of the coin is patient expectations. We spent a lot of years selling the idea of the miracles of modern medicine. Add popular culture on television and movies to that and you wind up with expectations for healthcare and interventions that are WAY off. The ER team on TV does some chest compressions and the patient is well! Johnny wakes up from his three year coma in perfect health. If the brilliant but curmudgeonly doctor puts his mind to it they can diagnose you by the end of the 30min episode. And cure whatever it is just in the nick of time. Dying is especially elegant in popular media. Great lighting, makeup, fully conscious until you say something profound and slip away. RL is so much messier than that.
Patients often expect that if the doctor would only do ALL the tests, they could find out everything that is wrong with you RIGHT NOW (and sometimes even in the future) and fix it all today. And it doesn't actually work like that. At all.
Human beings and human bodies vary a lot in many parameters, and the idea that there is a "healthy" perfect state is a fallacy. Weights vary quite a bit, as do blood pressure, blood sugar, pain tolerance, and on and on.
Genetics plays a big role - you can have the textbook perfect weight, exercise, eat an ideal balanced diet, go to church every Sunday and still drop dead at 40 of a heart attack. Or get colon cancer at 50, or MS at 35...
Weight is an issue for a number of reasons - heart disease is a combination of genetics and damage from blood pressure, plaque buildup, high blood sugars, etc. Diabetes is the biggest risk of long term obesity, in the insulin resistant form. Genetics play a smaller role in that type. Diabetes leads to blindness, multiple organ failure, amputations, and was a very frequent end stage diagnosis I saw in hospice, usually from kidney failure (dialysis only works for so long).
Most universal issue with weight is one I personally deal with and that is joints. Joints are engineered in humans to work within a certain weight range, with body type and sex playing a role. But your joints WILL wear out eventually at any weight. What excess weight does is speeds up that process. And obviously the more weight you carry the faster it happens.
So back to provider and patient expectations. Providers need a different approach. Currently the attitude is that I am going to educate you on what you need to do in order to improve the health profiles that are outside the norm. Your goals and limitations are not even on the table in most cases.
What needs to happen is a discussion that starts where we are right now. What is it that keeps you from doing what you need and want to do? What does the provider see as a big issue or concern? What is available to help you as a patient meet your goals, if your goals are unreasonable then WHY are they and what would be reasonable goals? And there should ALWAYS be a nurse CM or a social worker available if needed who can direct patients to resources in the community.
As a patient, understand that everything is not fixable. And that anything that stresses your body's ability to maintain balances or does long term damage is going to have consequences no matter WHY that is. Some people CAN'T lose weight, but those people are also going to have to deal with the consequences of that. And the best way to approach that conversation is not to pass judgement. It is to acknowledge that these are the challenges we face and make plans on how we can mitigate the inevitable damage and give some really good quality of life.
Because ultimately sitting down to a nice steak or having an ice cream cone should be a delight, not a prelude to shame.

March 6, 2016

The Scourge of Adblocking software

Back in the day, visiting a website often involved being exposed to some random advertising in a banner across the top of the page.
Something like this.

Over time, online ads began to creep down pages, filling first the left margin and then the right.

I know that article I'm looking for is in here SOMEWHERE

Of course, we had been able to ignore the banner ads after a time, and eventually were able to ignore all the kibble surrounding the content we sought. So the advertisers escalated their pitches. Ads flashed, jiggled, popped up in middle of your screen, marched around over the page. Much harder to ignore, and should you break down and click on one of them it did not make them stop on your future visits. If you bought every single item being advertised there, you would still be facing that mess on every visit.

Then came the video ads. These are sneaky because they may not be there when you open the page. But the advertising feed on that page will serve them up randomly, and they play immediately. Some arsehole just woke the baby, scared the shit out of you, and froze your computer squawking about paper towels.

If that wasn't enough to drive you into the arms of your nearest adblocker, this did. Doing research, surfing, shopping, looking at newsfeeds or working on the web only to suddenly have every page you visit covered with ads related to what you have been looking at. Now conventional wisdom says that targeted advertising is much  better than just random products, and we are all pretty much aware that our web usage is tracked and reported. But having your nose rubbed in it is creepy as hell.

And do NOT get me started on commercial shopping sites that have obnoxious ads flashing and popping up all over the place WHILE I AM TRYING TO BUY YOUR DAMN STUFF.

So - THAT is why my lazy butt took the time and trouble to find and install an adblocker. Because the escalating war for my attention was actually becoming nauseating. And since webpages I have contacted about it disavow any control over their ads, I am going to have to just skip them.
Can we go back to this? This was nice.

February 16, 2016

Dreams and cogitations

As a child, she was surprised and wounded by the first rock that struck her. But she picked it up and put it in her pocket, and contemplated it later.
As the years passed, the rocks became more frequent and her collection grew. She was no longer surprised by them, but still dreaded each one. Her collection grew into a little wall that she could shelter behind when she needed it.
Over time, her wall grew into cottage where she could go for safety, a place to breathe and just be.
Decades passed and the rocks sometimes became less frequent, but were often larger. Her cottage began to take on the aspects of a Manor. There was not just room for herself there, but offer safety and comfort for those she loved as well.
By the time she was old, she had created a Castle. Within its walls she could provide shelter, compassion, and safety for any who required healing. The giant stone fireplace contained a roaring fire where she could tell stories and share wisdom. Children play in the gardens of that castle, and it is a rare stone that makes it over the wall.

Tree of Life On the Allendale Nature Trail, about 100 yards along the riverside path from Bridge End, is this carved sandstone tree set into a drystone wall. Inspired by the Celtic name Allen, which means shining water, Sarah Turnbull, aged 8, designed this tree. It is inlaid with lead as a reminder of Allendale's lead mining past, and its roots, which become rapids, are brushed with silver leaf.

Worlds and stories and songs, the strata of all that we have been and all that we believed of ourselves layered and overlapping. Pangaea, Laurasia, Gondwana, Panthalassa. Primeval forests teeming with life. Vast plains of flora and fauna competing, breeding and dying.
Dark World below Blue World below Yellow World below White World. Shambala, Eden, floodplains and mountain valleys. Deep caves with ashes from countless fires and energetic shapes dancing across the walls in their flickering light.
Vast kingdoms spreading across plateaus, blood soaked battlegrounds and rivers running red with blood. Troy, Ur, Atlantis, Pompeii, Alexandria, Timbuktu, Giza, Babylon, Teotihuacan, Cairo, Carthage.
Each layer covers the one below, and yet those beneath are sometimes incorporated into those above. A pyramid pierces them all, thrusting up into today, still reaching towards the sun. Some things are lost, and some things break out at unexpected times and places.
The strata of all that has come before sits below the plane of now.
And the World Tree, in whose shadow and branches and roots we make our way, has a taproot that extends down through every layer.

December 27, 2015

Some New Year's Makeover hints for 2016

We are fast approaching the new year, 2016. Twelve months bursting with potential and promise stretching out ahead of us. In the spirit of the New Year's Resolution tradition, I offer some suggestions for some easy tweaks to beautify your world and your lighten your soul.

Weight loss is easily accomplished by dumping all the baggage currently hauled around intended to weigh and judge whether those in need are deserving of help.
By dumping the requirement that people have "earned" compassion, the ability to reach out and help everyone who needs help is achieved. Feeding people because they are hungry, comforting those who are in pain, offering healing to the sick, and a roof to the homeless. Without worrying about anything besides identifying the needs.

Work out more by exercising your right to vote in every election. Strengthen our democracy by making your voice heard on every issue that is important to you. Email your legislators, petition your government and make your representatives accountable to you.
Get your heart rate up by doing things that scare you, that make you feel uncomfortable and that push your boundaries. 

Increase your vocabulary by having conversations with people who are different than you are. People with different interests, different backgrounds, different beliefs. Speak up about your values, and discover how enlightening assuming the best of people's intentions can become. Add the words "why not?" and use them frequently to follow any statement that contains the words "of course we can't"...

Meditate on the awesome smallness of specks of stardust, and the hugeness of the universe. Open yourself to infinite possibility. Wrap yourself in the patchwork quilt of humanity, in all its beautiful variations.

And in the words of the great philosopher Wil Wheaton: Don't be a dick.

November 16, 2015

Another shout into the void

*Disclaimer: I do not identify as religious, but I am very spiritual. I belong to no organized religious group, and prefer to choose my teachers based on their teachings rather than on their sect. I live in a culture that identifies predominantly as white, western and Judeo/Christian. I also write this stuff primarily to organize my thoughts and make them easily accessible, not to advise others on how to relate to the ineffable.*

Religion does not cause violence. So many folks believe this to be the case, make art and write songs about how getting rid of religion would make a peaceful world. Sorry.
We create religions as a means of sorting "us" from "them". Because as trooping primates, that is what we do. Identifying who we fuck versus who we fight.

National borders are there to mark where our troop has staked a claim on the local resources. If those resources start to get low, we go to war with someone who has more of the resources we need. It is more obvious when we were fighting with rocks and clubs - but it is still what we are doing. We create political constructs to explain why our region of resources is vastly superior to the other guy's. And it makes a handy excuse when we need to go "liberate" his resources for the use of our own.

When any of these groups get too big, whether they are religious or secular, schisms have to occur to allow smaller subgroups to form that are viable units to maintain what has been termed the "monkeysphere" Dunbar's Number.

We will use religion, or political systems, or historic grudges, or assumed territorial violations to rationalize war against the "other". But ultimately it is always just some variation on a resource grab.
Even the seemingly stateless terrorists we see today are quick to declare a "state" and to start attempting to move into and take over regions to acquire their resources. They recruit women to populate those regions with their offspring. Same old story whether it is chimps, Visigoths, or Exxon.

We have evolved socially and culturally quite rapidly, and now with technology our culture is evolving even faster. Our bodies and brains are on a MUCH longer timeline. So no small number of our impulses, coping mechanisms, instincts, etc were developed in a vastly different environment.
And our drive to name, to categorize, to sort is a product of this need to identify what constitutes a threat versus what is "us".

Survival as a species is going to require us to understand and accept this, and to utilize that knowledge using the beautiful large frontal lobes we now possess to guide us going forward. Maybe there are just too many of us and we are not ready for a monkeysphere that encompasses the entire planet. It could be that we will wind up decimating our populations via war-related disease and famine back down to a size that has enough space to keep the current model.

If you assume you are in a group likely to survive, it probably doesn't sound so bad. And hey, maybe it won't happen in your lifetime.


November 14, 2015

For the Lost

Grieving for all those lost to hatred.

Those whose lives are lost in acts of hatred
Those who are lost fleeing hatred
Those who are lost seeking sanctuary from hatred 
And those who have allowed hatred to turn their hearts to cold stone.

May I be strong enough to protect my own heart from that fate.