Thursday, April 23, 2009

Undifferentiated Mush

I haven't slept in 44 hours. Oddly enough, I find myself fighting the urge to sleep. This tends to happen when I'm stressed -- but really, if this is stress, then I am one lucky person. The surgery on Monday, and the tedium of being in the hospital, probably in isolation again, is exacting its toll -- in advance.

How do I know I will be stuck on the other side of people floating in yellow paper gowns with shockingly bright blue latex-free gloves? Because I have assurances it won't happen from my internist and his Supernurse Sidekick, from the admitting orthopedic surgeon, his PA, *and* his nurse, from the Infectious Disease doctor and *two* of his PAs, as well as from the Director of the Infusion Center.

Each person is quite sincere and well-meaning -- and all of them make reference to "common sense." And yet, not one of them is willing to do the leg work of ordering cultures, then checking on the results, and writing orders implementing or discontinuing the innumerable ickitudes of isolation. I know this because of the previous four admissions during which we danced this same dance.

La Bonne et Belle Bianca Castafiore refuses the paper and plastic garb. She either sneaks in without them to begin with, or dons them with great fanfare out in the hall, only to rip them off like a cheap costume once inside the room. Ah, ah, ah! Je ris! Oui, je ris! Simplement de me voir, si si si, si belle dans ce sacré miroir, ah-ah-ahhhh! I know, I know! Out of the bonny blue she has begun to produce operatic riffs...

Anyway, I have plugged my nares with antibiotics, washed every inch of my body with Hibiclens, lanced the multitude of dark, oozing, stinking boils... just kidding about that last part. "Multitude" is kind of an overstatement, used for shock value.

So this afternoon, as the preregistration nurse is doing her thing an d swabbing the nares and the axillary hot spots, I will be smiling my secret smile, secure in the knowledge that Science is going to fail me, once again.

I bet you a dollar. The results will be negative, no growth -- but because hospital protocol requires two successive negative results, that is where the ball will get dropped. I can orchestrate the production before surgery -- but after? That's a different ball of sealing wax.

It is within the realm of the possible that you've no idea what I am babbling about. Don't worry, for you are not alone in falling short of perfection. I have a clusterfuck of medical issues -- lupus, avascular necrosis (which engendered three joint replacements and several pinnings, plates, and screws of fractured bones), adrenal (and renal!) insufficiency, and the everlovin' CRPS/RSD. Oh yeah, and a fair amount of aortic regurgitation.

Also an aortic aneurism.
And a partridge in a pear tree.

The short version of the pertinent? Somewhere along the line, pathogens moved into both of shoulder prostheses -- and then developed into a more classic osteomyelitis. Last August/September, my awesome orthopedic surgeon removed my right shoulder prosthesis due to massive infection and "replaced" it with a silly little antibiotic-impregnated spacer. This surgery did not go very well, and resulted in schtuff like ventilators, pressors, ICU, and an extra visit to the surgical theatre. Despite having lots of evidence for the lab to work with, nothing grew in the cultures. In December, he had to remove the left shoulder prosthesis, and gifted me with another spacer. The infection spread into the entire shaft of the humerus, which -- in ShoulderMan's words -- "pretty much exploded." Mid-February, he went back in on the right side, and put in another total shoulder prosthesis. We are hoping to repeat that achievement this coming Monday on the left side.

I know that my navel is not the center of the universe. Trust me, I am as disgusted as you by this constant worrying and teasing of details over which I have no control -- and about which you have little interest.

How did I miss that the Taliban are within spitting distance of Islamabad? Was it because of that navel thing, or maybe fever, pain? No. I was, quite simply, derelict in my duty as a Planetary Citizen.*

ISLAMABAD, Pakistan — Pushing deeper into Pakistan, Taliban
militants have established effective control of a strategically important district just 70 miles from the capital, Islamabad, officials and residents said Wednesday.

The Taliban pushed into Pakistan from the Swat Valley. We are assured that Islamabad is not in imminent danger, and yet:
Buner, home to about one million people, is a gateway to a major Pakistani city, Mardan, the second largest in North-West Frontier Province, after

“They take over Buner, then they roll into Mardan and that’s the end of
the game,” a senior law enforcement official in North-West Frontier Province
said. He asked that his name be withheld because was not authorized to speak to
the news media.

My God. I think it is time to focus on what matters.

*"The beliefs I have to defend are so soft and complicated, actually, and, when vivisected, turn into bowls of undifferentiated mush. I am a pacifist, I am an anarchist, I am a planetary citizen, and so on." Kurt Vonnegut

Wednesday, April 22, 2009

Deninel: A Stream in New Hampshire

I can usually riddle my way through misspellings.

But I am tired of a certain woman's insistence that her husband is in a state of: deninel.

The first time she typed it out, I smiled indulgently (my most obnoxious smile, unfortunately). By the third repetition, I was mouthing deeeee-nigh-yul,deeeee-nigh-yul,deeeee-nigh-yul.

There ain't no damn word DENINEL.

dee-nin-ul? dee-nin-ul?

Do not mess with Retired Educator when she has not slept a wink, nor a nod, and she ain't a' blinkin' none, neither.

Bless this lady's heart. She goes on to write:

"My husband has cirrhosis of the liver and hep c, he is also bypolar! He refuses to take meds and is in complete deninel!!! The stress is about to kill me , my faith is strong but he wears me down!!! We have two children at home 17, and 15 , I have went to work to help support us."

Before I lapse into a pool of melted Jello (somehow I picture a very red mix of cherry, watermelon/kiwi, and raspberry, all pulsating at roughly 120 beats a minute) out of sympathy for her situation, my God, why can't people manage to make verbs agree with subjects? Is it hard? No, it is not.

Sorry, I meant: No, it are not.

She can spell CIRRHOSIS but not bipolar?

Her screenname involves use of one of my favorite words: poot. As in: I pooted, you pooted, he/she/it pooted, we pooted, you pooted (again), and they pooted. This is a Free Poot Nation.

And, of course, in addition to being slang for flatulence, "poot" has a history of diplomatic implementation, because the Venerable Bush preferred "Pootie-Poot" as sobriquet for Putin, the former {*cough*} President of Russia. You know, the guy who is now {looooong *fart*} Prime Minister of Russia? Second-in-command {baritone *belch*}?

Oh, the hilarity, back in February of 2001, when we could afford to yuck-it-up but good:

INSIDERS are admitting that President George W. Bush's penchant for bestowing his own nicknames on close associates has provoked the first crisis of his new administration.

"Internal communications are in turmoil," confesses a high-ranking Bush aide known as Frenchy, though he doesn't know why. "The president says get me Knuckles on the line, or where's The Eskimo, or let Bones and uptown handle this," he laments, "and nobody has a clue as to who he's talking about."

Vice President Dick Cheney, a seasoned Bush handler, refuses to confirm or deny reports that he plans an internal White House telephone hot line where senior advisors, cabinet members and others can call in to find out their current presidential nicknames and those of their colleagues.

But knowing who's actually who among themselves has become a high-stakes guessing game for the Bush team members — as was underscored by a recent trip to Kansas City by a bewildered secretary of state, Gen. Colin L. Powell.

The president had ordered that Bullets be sent to represent the administration at a town meeting on farm subsidies. Assuming Bullets to be Mr. Bush's informal name for the only ex-military figure among his top aides, a member of the White House staff conveyed the word to General Powell. He was halfway to Kansas City aboard Air Force One before the goof was revealed: Bullets is the president's nickname for the secretary of agriculture, Ann M. Veneman. Mr. Bush's response to the snafu was quoted as, "Why for heck's sake would I send Balloonfoot to do Bullet's job?"

The first lady herself is reported to be "baffled" by her husband's nickname for her. "I hung up five times yesterday when he called to ask what was for dinner," said a flustered Laura Bush. "I thought it was a wrong number when the guy kept asking for Stretch."

Meanwhile, President Vladimir V. Putin of Russia is reportedly both baffled and incensed that on his first call to the new American president, Mr. Bush addressed him not as Mr. President or Mr. Putin but Ostrich Legs.

Mr. Cheney, who is said to believe his own Bush nickname to be either Hopalong or Crash-Dive (signed presidential memos evidently differ), has reportedly come to dread full cabinet meetings. "When George W. starts with the `Good morning, Skeezix' and `Let's ask The Undertaker," says one cabinet member, who thinks he himself may be Spinach Man, "they all look over at Dick for help, and he's as lost as they are. And if Dick doesn't know who the president's talking to, who does?"

A White House nickname hot line, should Mr. Cheney set one up, would be helpful but no panacea. High- ranking administration officials are still likely to refuse the call when their secretaries announce it's The Pecos Kid for Snooky. Foreign leaders beyond nickname-hot- line range will surely bridle at being called Nine Pin or Hound Dog by a fellow head of state.

And what of Mr. Bush's intimate circle? One old friend returned as Not Known At This Address a 50- pound shipment of Texas barbecue beef bearing the presidential seal, addressed to "The Big Goober." His name is Darryl.

Compounding the confusion is Mr. Bush's creativity with sobriquets, verging on free association.

"His nickname style isn't anything you can decode," points out a close observer known only as Four- Eyes. "Like, say, calling tall guys Shorty and right- handers Lefty. Why is Attorney General John Ashcroft Snake Hips — or is that Rumsfeld? No, he's Pistol Pete. Wait a minute, maybe Rumsfeld is Chickenman and Pistol Pete is Christie Whitman. Aw, I give up."

Asked by reporters about the impending nickname hot-line project, the president himself expressed surprise at the idea and said he had no information he was aware of.

"For that," he replied, "You'd have to talk to Stilts."
I have been up all night, which explains the incredible profundity of this post, but somewhere in the steel trap that is my mind, an analogy, nay! A causal relationship was forming. Okay so some of it was forced. A lot forced.

Poot (yes, that is this distressed woman's *chosen* moniker)? Meet the man secure enough in his... um, masculinity to come up with "Pootie-Poot," and the Author of Much of My Discontent, and perhaps the Author of Some of Yours. I sincerely hope that you will be able to access some meaningful help for your husband and your entire family.

Tuesday, April 21, 2009

Long-lasting nerve block:::Slow-release technology

This research may well improve the usefulness of nerve blocks, which are often used in the management of CRPS/RSD pain. I'm unclear as to whether this translates into the preferred sympathetic block. (Of course, I maintain that the continued emphasis on SMP, or Sympathetically Maintained Pain, is a colossal waste of time and resources unless the treatment response is in the very early months of CRPS. I am pretty sure that I progressed to SIP, or Sympathetically Independant Pain, within the first six months or so of onset.)

Of course, there is the ever distinct possibility that I don't know my ass from a hole in the ground

Long-lasting Nerve Block Could Revolutionize Pain Management

ScienceDaily (Apr. 16, 2009) — Researchers at Children's Hospital Boston have developed a slow-release anesthetic drug-delivery system that could potentially revolutionize treatment of pain during and after surgery, and may also have a large impact on chronic pain management.

In NIH-funded work, they used specially designed fat-based particles called liposomes to package saxitoxin, a potent anesthetic, and produced long-lasting local anesthesia in rats without apparent toxicity to nerve or muscle cells.

"The idea was to have a single injection that could produce a nerve block lasting days, weeks, maybe even months," explains Daniel Kohane, MD, PhD, of the Division of Critical Care Medicine in the Department of Anesthesiology at Children's, and the report's senior author. "It would be useful for conditions like chronic pain where, rather than use narcotics, which are systemic and pose a risk of addiction, you could just put that piece of the body to sleep, so to speak."

Previous attempts to develop slow-release anesthetics have not been successful due to the tendency for conventional anesthetics to cause toxicity to surrounding tissue. Indeed, drug packaging materials have themselves been shown to cause tissue damage. Now, Kohane and colleagues report that if saxitoxin is packaged within liposomes, it is able to block nerve transmission of pain without causing significant nerve or muscle damage.

In lab experiments, the researchers evaluated various formulations--various types of liposomes containing saxitoxin with or without dexamethasone, a potent steroid known to augment the action of encapsulated anesthetics. The best liposomes produced nerve blocks lasting two days if they contained saxitoxin alone and seven days if combined with dexamethasone.

Cell culture experiments and tissue analysis confirmed that the formulations were not toxic to muscle or nerve cells. Furthermore, when the team examined expression of four genes known to be associated with nerve injury, they found no up-regulation.

"If these long-acting, low-toxicity formulations of local anesthetics are shown to be effective in humans, they could have a major impact on the treatment of acute and chronic pain," says Alison Cole, PhD, of the NIH's National Institute of General Medical Sciences, which partially funded the work. "This slow-release technology may also have broader applications in drug delivery for the treatment of a variety of diseases."

Kohane is currently optimizing the formulation to make it last even longer, while avoiding local and systemic toxicity. "It is conceivable we could have a formulation that is suitable for clinical trials before too long," he says.

The research is published online on April 13 by the Proceedings of the National Academy of Sciences. The study was supported by the National Institute of General Medical Sciences. Hila Epstein-Barash, PhD, was first author on the paper.


Journal reference:

Hila Epstein-Barash, Iris Shichor, Albert H. Kwon, Sherwood Hall, Michael W. Lawlor, Robert Langer, and Daniel S. Kohane. Prolonged duration local anesthesia with minimal toxicity. Proceedings of the National Academy of Sciences, 2009; DOI: 10.1073/pnas.0900598106

You and Your Breasts

Yoo hoo! Over here, over here!

You probably know this already. I didn't.

I was cruising around over at YouTube, watching very sober, intellectual-type videos that all involved, for some inexplicable reason, seriously cute kittens (my preferred sort of Talking Head: The Feline Pundit).

Then it happened. It happens a few times a day. For someone like me? That means daily surprise...

Directed-at-me advertising (also known as: targeted, customer-directed marketing).

I hate it. Rather than broadening my horizons, these ads do nothing but remind me of restrictions, limitations, foreshortening -- "the effect of perspective causes distortion." Do I want to be reminded that my browsing choices reflect an intense interest in things like low carb snack foods, veterinary anesthetics, neurological disease, Indonesian wedding cake decorating, kitty litter (and other human-oriented bowel regimens)?

In addition to holding the key to my personal financial future, Google just plain impresses me, which is, of course, why it remains my favorite bit of equity.

Anyway, I saw a link that I'd never noticed before that took me gently by the puffy hand and led me to: YouTube Interest-based Advertising and You.

This reminds me of one of The Fredster's favorite Early Job stories. He was working as an engineer for a smarmy doctor, T.R. Shantha, M.D., who owned a collection of rental properties and motels. (This guy was -- rather belatedly -- convicted of medical fraud just two years ago. He did things like infuse patients with hydrogen peroxide. His clinic laid claim to "safe and effective, nontoxic, scientifically-based alternative” medicine that could “cure or control most cancer and other chronic disease.") Shantha was incredibly money-hungry*. He authored several erudite monographs, of which Fred retains one exceedingly rare copy that we hope to be able to cash in for a small fortune some future rainy day: You and Your Breasts.

Until that time, it will remain one of our most consulted works of reference.

(Choo! Choo? Have you seen my train of thought?)

Back to YouTube. The next click led me to Google Ads Preferences which, in turn, led me through the steps necessary to opt out of interest-based advertising!

Then, loving my readership as I do, I rushed "here" to tell youse guys about it in my usual, straight-up, clear-as-crystal way.

If you are bugged by ads purporting to represent your burning interests, this is one way to blend back into the tepid sea of anonymity.

*Umm, Fred quit when approached to burn out a family behind in their rent. Not in the job description. (Not to worry, My Guy did the right thing...)

Monday, April 20, 2009

The S-Word

First, I hope it is as beautiful a day where you are as it is here. The eyes rest on flowering trees -- the colors! The sky draws them up to a crystalline blue that goes on forever.

Okay. Snap out of it.


Second, this proposal of the Obama administration strikes me as stupendous -- and in more ways than are initially apparent. [I woke up *deep* -- a reg'lar Think Tank. Actually, I woke up to a barrage of the nimble-tongued Captain Haddock's verbiage. More on our, um, conversation in the minute or so it takes you to read this article.]

U.S. May Convert Banks’ Bailouts to Equity Share

Published: April 19,2009
WASHINGTON — President Obama’s top economic advisers have determined that they can shore up the nation’s banking system without having to ask Congress for more money any time soon, according to administration officials.

In a significant shift, White House and Treasury Department officials now say they can stretch what is left of the $700 billion financial bailout fund further than they had expected a few months ago, simply by converting the government’s existing loans to the nation’s 19 biggest banks into common stock.

Converting those loans to common shares would turn the federal aid into available capital for a bank — and give the government a large ownership stake in return.

While the option appears to be a quick and easy way to avoid a confrontation with Congressional leaders wary of putting more money into the banks, some critics would consider it a back door to nationalization, since the government could become the largest shareholder in several banks.

The Treasury has already negotiated this kind of conversion with Citigroup and has
said it would consider doing the same with other banks, as needed. But now the
administration seems convinced that this maneuver can be used to make up for any
shortfall in capital that the big banks confront in the near term.

Each conversion of this type would force the administration to decide how to handle
its considerable voting rights on a bank’s board.

Taxpayers would also be taking on more risk, because there is no way to know what the common shares might be worth when it comes time for the government to sell them.

Treasury officials estimate that they will have about $135 billion left after they follow through on all the loans that have already been announced. But the nation’s banks are believed to need far more than that to maintain enough capital to absorb all their losses from soured mortgages and other loan defaults.

In his budget proposal for next year, Mr. Obama included $250 billion in additional spending to prop up the financial system. Because of the way the government accounts for such spending, the budget actually indicated that Mr. Obama might ask Congress for as much as $750 billion.

The most immediate expense will come in the next several weeks, when federal bank
regulators complete “stress tests” on the nation’s 19 biggest banks. The tests
are expected to show that at least several major institutions, probably
including Bank of America, need to increase their capital cushions by billions
of dollars each.

The change to common stock would not require the government to contribute any additional cash, but it could increase the capital of big banks by more than $100 billion.

The White House chief of staff, Rahm Emanuel, alluded to the strategy on Sunday in an interview on the ABC program “This Week.” Mr. Emanuel asserted that the government had enough money to shore up the 19 banks without asking for more.

“We believe we have those resources available in the government as the final backstop to make sure that the 19 are financially viable and effective,” Mr. Emanuel said. “If they need capital, we have that capacity.”

If that calculation is correct,Mr. Obama would gain important political maneuvering room because Democratic leaders in Congress have warned that they cannot possibly muster enough votes any time soon in support of spending more money to bail out some of the same financial institutions whose aggressive lending precipitated the financial crisis.

The administration said in January that it would alter its arrangement with Citigroup by converting up to $25 billion of preferred stock, which is like a loan, to common stock, which represents equity.

After the conversion, the Treasury would end up with about 36 percent of Citigroup’s
common shares, which come with full voting rights. That would make the
government Citigroup’s biggest shareholder, effectively nudging the government
one step closer to nationalizing a major bank.

Nationalization, or even just the hint of nationalization, is a politically explosive step that White House and Treasury officials have fought hard to avoid [....]

Where did I leave my helmet? The vociferous bloggers who enjoy scaring themselves and others with the big, bad S-word (Saltimbanco, sidereal, soprano, stellar, sorrow, sideshow, setters, Suzie Q? -- Oh, a psychiatrist would have a field day with such a list!) -- Okay, so strictly speaking, Edmund L. Andrews, the author and unacknowledged second cousin to Julie Andrews, she of potty-mouth fame, prefers the N-word -- which is just silly.

Yeah {cough} -- the vociferous bloggers in double knit polyester pants and stiff yellow polo shirts, through which one can determine the inny-or-outy situation of the navel, hissing away like the nasty snakes that they are! Whoa, Nelly, Retired Educator -- Settle down, there, Champ!

Puh-leeze. Vociferous double-knitted bloggers don't scare me. I just got off the phone with none other than Our Benefactor, in whose Ancestral Manor we are living, and whose generosity we enjoy. I mean it; We really enjoy it.

I was still half-asleep but hearing The Captain's voice booming in my ear brought me to wakefulness in an instant. Believe it or not, he's still hanging out in Africa with the good and faithful Bongi -- apparently, they enjoy regaling one another with Tales of Glory Days. Not that their present endeavors aren't Story Worthy, mind you.

Why am I speaking of The Captain, why of Bongi? It is a question of curses, creativity, catharsis, and, probably, but unconfirmed, the odd crumpet. Well, okay, *strictly* speaking -- something I endeavor to no longer do, in my felicitous retirement -- Bongi's concern is less The Art of Cursing and more the management of the surgical theatre, and saving lives.

Which is not to say that The Captain hasn't saved his share of lives.

You wanna talk Pirates? The mere mention of Captain Haddock makes their blood run cold. No need to have Navy SEALS pop 'em in the head -- no, they abandon ship as well as booty when they hear the Captain approach. One is more likely to hear him first, see him second. (I love the word "booty": A nautical term for treasure; American slang for buttocks...)

So anyway, half-asleep, I put the phone to my lovely cauliflowered left ear (too many years of MMA) to hear: Army of bachi bozouks, why are you still abed?

Oh, Captain, My Captain, is that you? mumbled lazy-ass me.

In the name of billions of blind whales -- who else would call on the Emergency Red Phone in the Visitor's Wing of Marlinspike Hall? Sub-products of ectoplasm, who's been using my minutes? Hairy cucumbers! Stinking goat-bearded dolphins!

He was on a roll.

Toward the end of our rollicking conversation, he inquired as to my reaction to Obama's performance, these first hundred or so days.

"Courageous and Bold," I proffered.

"Christ of a Commie Bleating Bolshevik," he countered, in a scary **whisper**.

"Whatever floats your boat, Captain," I hissed.

"Ship. Ship. Whatever floats my God-damned SHIP!"

Note the day and time. Even Captain Haddock becomes crass when discussing politics.

I think shifting ownership from common cash to shares is... very American, smart, and -- what I like most -- it drastically decreases the opportunity for graft chez some of these smarmy corporations.

I am going back to bed. Clouds are moving in. We may have to find a new place to live.


Sunday, April 19, 2009

Aaden Gosselin

When I grow up, I want to marry Aaden Gosselin.

Cry Me A River ::: Susan Boyle

Wow. At first, I didn't recognize her voice but about a third of a way in... Yes, that is her.

It is still very difficult to believe that this is an untrained voice -- but the more biographical articles continue to insist upon it.

The frumpiness, I believe, and hope that they will leave Ms. Boyle to her own frumpitudinal devices. If she wants to make herself over, cool. Pluck that brow! Style that hair! If she doesn't, I believe the world has learned the heavy-handed Book/Cover lesson. Oh, who am I kidding? We've learned the lesson only as it applies to *her*.

There were only 1000 copies made of the 1999 charity album -- funded in part by the Whitburn Community Council in West Lothian, where there must be something in the water.... I'd pay top dollar to hear The Broxburn Public Band cover Bohemian Rhapsody.

Doesn't every copy have a master? Let's start pressing those babies!

I know so little about music, only what the Brother-Units taught me, and what Fred has spent years refining (He is a Recovering Audiophile), and yet, like anyone, I know what I like. I like this version of Cry Me A River, and am astonished by things like her phrasing and -- perhaps most astonishingly? Her *restraint* -- the lack of which ruins a good many bluesy ballad.

Those who can, sing. Those who can't? The blither and blather on about phrasing and restraint.

In summation: Wow.