Monday, January 30, 2006

In the news: 'Conscience protection' for health care workers

WaPo's got an article about state laws aimed at protecting the right of certain health care workers to refuse to participate in certain activities on the basis of moral objections. Snip:
Most states have long had laws to protect doctors and nurses who do not want to perform abortions from being fired, disciplined or sued, or from facing other legal action. Conflicts over other health care workers emerged after the morning-after pill was approved and pharmacists began refusing to fill prescriptions for it. As a result, some lost their jobs, were reprimanded or were sanctioned by state licensing boards. That prompted a number of states to consider laws last year that would explicitly protect pharmacists or, alternately, require them to fill such prescriptions.

The issue is gaining new prominence this year because of a confluence of factors. They include the heightened attention to pharmacists amid a host of controversial medical issues, such as the possible over-the-counter sale of the Plan B morning-after pill, embryonic research and testing, and debates over physician-assisted suicide and end-of-life care after the Terri Schiavo right-to-die case.

Do any of the state 'conscience laws' protect the right of patients to know, for instance, that their pharmacist refuses to dispense certain drugs, or that their physician refuses to honor an advance directive to withdraw a feeding tube under certain circumstances? As a patient, I would want to know ahead of time if the medical professionals involved in my care intended to exercise their rights under such a law, and I'd want to know if they had a plan for transferring responsibility to someone else.

Research: Gene controls earwax type- wet or dry

The NYT reports that Japanese scientists have identified the gene that determines which kind of earwax a person has. Didn't know there were different kinds of earwax? Me either. Read and learn:
Earwax comes in two types, wet and dry. The wet form predominates in Africa and Europe, where 97 percent or more of people have it, and the dry form among East Asians. The populations of South and Central Asia are roughly half and half. By comparing the DNA of Japanese with each type, the researchers were able to identify the gene that controls which type a person has, they report in today's issue of Nature Genetics. They then found that the switch of a single DNA unit in the gene determines whether a person has wet or dry earwax. The gene's role seems to be to export substances out of the cells that secrete earwax. The single DNA change deactivates the gene and, without its contribution, a person has dry earwax.
But earwax seems to have the very humble role of being no more than biological flypaper, preventing dust and insects from entering the ear. Since it seems unlikely that having wet or dry earwax could have made much difference to an individual's fitness, the earwax gene may have some other, more important function. Dr. Yoshiura and his colleagues suggest that the gene would have been favored because of its role in sweating.

They write that earwax type and armpit odor are correlated, since populations with dry earwax, such as those of East Asia, tend to sweat less and have little or no body odor, while the wet earwax populations of Africa and Europe sweat more and so may have more body odor. Several Asian features, like small nostrils, are conjectured to be adaptations to the cold. Less sweating, the Japanese authors suggest, may be another adaptation to the cold in which the ancestors of East Asian peoples are thought to have lived.

Link (free reg req'd)

Thursday, January 26, 2006

Research: Virtual reality feedback aids walking for MS patients

I'm not sure exactly how this works, or who it works for, but it's way cool. Notice that it appears to improve walking speed and, to a lesser extent, stride length, even after the VR apparatus is switched off. For how long, I wonder?

Neurology. 2006 Jan 24;66(2):178-81.
Virtual reality cues for improvement of gait in patients with multiple sclerosis.
Baram Y, Miller A.

Department of Computer Science, Technion-Israel Institute of Technology, Haifa, Israel.

OBJECTIVE: To study the effects of visual cues, provided through a portable visual-feedback virtual reality (VR) apparatus, on the walking abilities of patients with multiple sclerosis (MS). METHODS: On-line (display-on) and residual short-term therapeutic effects on walking speed and stride length were measured in 16 randomly selected patients with gait disturbances predominantly due to cerebellar ataxia. RESULTS: Patients whose baseline walking speed (BWS) was below the median showed an average on-line improvement of 13.46% in their walking speed, while patients whose BWS was above the median improved their speed by 1.47%. The average short-term residual therapeutic improvement in walking speed was 24.49% in patients with BWS below the median, and 9.09% in patients with BWS above the median. Similar results were obtained for improvements in stride length. These results of improved functions in patients are particularly noteworthy when compared with the lack of change in healthy control subjects. CONCLUSIONS: Patients with multiple sclerosis showed improvement in walking abilities using virtual reality visual-feedback cues.

Link to abstract

Health policy: "Prognosis Is Mixed for HSAs"

As the administration announces plans to expand health savings accounts (HSAs), the NYT reports on how HSAs have fared so far: not so good. Snip:
As the plans were conceived, people using their own money could be expected to spend less on health care, switching to lower-cost drugs, for example, and adopting healthier lifestyles. Employers were promised savings as they shifted responsibility to workers for thousands of dollars in costs. Uninsured employees of small companies and self-employed people would be able to set aside pretax dollars for low-cost, limited coverage.
But in many cases, people have evidently signed up not because they are eager to direct their own medical spending but because the plan looked cheap or they had no other insurance option. And at least half of those enrolled have not put money in their health savings accounts. So there will be no money building up for next year's out-of-pocket expenses — a big selling point for these health plans.
UnitedHealth Group, the largest provider of the savings plans, says that of the 24 million people insured under its various types of policies, 654,000 now have health savings plans. But so far, only about half have started setting aside money, a spokesman, Daryl Richard, said.

Link (free reg req'd)

Wednesday, January 25, 2006

In the news: NYT review barley wines

Unless you're an enthusiast of craft-brewed beer, you've probably never heard of barley wine. It's not something you'd pop open after mowing the lawn, but it's a lot more interesting than that sort of beer. If you're adventurous and don't have plans for the evening, now's a good time to find and try one. Not mentioned by the Times is a local favorite produced by the New Glarus Brewing Co. called Tail Wagger. Snip:
Barley wine is not a wine at all but a beer, or to be geekishly precise, a top-fermented ale of exceptional strength, power and length. Barley wines are not for chugging after a workout. They are not refreshing but thought-provoking, sip by contemplative sip. Many even benefit from cellaring, most for a year or two, but some for a decade or more. Barley wines are sometimes dated with the brewing equivalent of the vintage year, and, even more so than wine, vintages can be entirely different. I like to think of Bilbo Baggins, comfortable and secure in his paneled Hobbit hole, with a cupboard full of seedcakes and a mug of barley wine.

Link (free reg req'd)

In the news: Bush to announce health care tax breaks (yawn)

WaPo says that President Bush plans to announce a number of health-care related initiatives, starting with tax breaks for personal health spending. Snip:
The new tax breaks for personal health spending, to be included in the 2007 budget Bush will release in less than two weeks, are designed to help the uninsured and to allow people with insurance to write off a greater portion of the money they spend on co-payments, deductibles and care that is not covered. Under current tax rules, people can deduct medical expenses only if they exceed 7.5 percent of their adjusted gross income.
The president also plans to call for an expansion of health savings accounts, an idea long favored by conservatives and approved by Congress slightly more than two years ago, in which people who buy bare-bones insurance policies are allowed to put money into tax-free accounts for their medical expenses.
In addition, Bush intends to propose changes to allow people to keep their insurance, without extra cost, if they change jobs or decide to start a business, building on a decade-old law that was designed to make health coverage more 'portable.'
The three proposals -- and possibly others -- are part of a renewed effort by the White House to tackle medical costs, a theme that administration officials said yesterday Bush intends to emphasize in his State of the Union address next week. The health initiative also represents one of the few areas in which the president will try to create new domestic policies through what he and aides have said will be an austere budget.

1. Tax deductions: if Bush does away with the 7.5% floor, that will most likely mean nothing to those of us who participate in flex spending accounts. FSAs allow participants to pay qualified expenses from pre-tax earnings. If you're participating, you're already getting the same benefit that you would get from a deduction.
2. HSAs: It's a nice tax shelter for those rich enough to "self-insure" out of their own pockets. Will it lead to a net increase in the number of people who have health insurance? Doubt it. Will it lead people to make better choices about when and how they incur medical expenses? Doubt it.
3. Portability: Interesting. Could it lessen "job lock"? Maybe, but what good is it to be guaranteed the right to buy insurance if you can't keep up with double-digit increases in the cost?

Research: Genetic clues to MS treatment

Here's an interesting bit of research connecting differing response to interferon beta to genetic differences:
J Neuroimmunol. 2006 Jan 19; [Epub ahead of print]
An IFNG polymorphism is associated with interferon-beta response in Spanish MS patients.

Martinez A, de Las Heras V, Mas Fontao A, Bartolome M, de la Concha EG, Urcelay E, Arroyo R.

Clinical Immunology Department, Hospital Clinico San Carlos, C/ Martin Lagos s/n 28040 Madrid, Spain.

Interferon-beta is a biological treatment widely used in multiple sclerosis (MS). However, not every patient responds equally well to this therapy. In this study, our aim was to evaluate the influence of a dinucleotide microsatellite located in the first intron of the interferon-gamma gene on relapse eradication in a group of interferon-beta-treated patients. Our results show a very different allelic distribution when patients with relapses were compared with relapse-free patients.

Link to abstract.

Tuesday, January 24, 2006

Journal: Back to school

At the urging of my neurologist, I've enrolled in a bi-weekly fitness class at the University for the spring semester. In this class, though, I'm not so much a student as a subject. This is a class designed to teach a crop of undergraduates how to work with a disabled client. I'm one of a dozen or so 'clients' who are participating. Each of us will spend the semester working with a couple of students in the Kinesiology department, getting individual help in attaining our fitness goals. I'm making time for this by taking an extended lunch hour twice a week.

The class is held in an old gym/fitness complex deep in the heart of campus. It's a ten minute drive from my office, but I give myself a half hour to get there today because it's the first day of class and I'm uptight about being in the right place at the right time. I arrive twenty minutes early and am assigned a tiny locker in the labyrinthine locker room. After a brief flashback to 5th grade nightmares about forgetting the combination to my locker and being naked in front of strangers, I change out of my work clothes and into sweatpants, a T shirt, and tennis shoes. After a few minutes of wandering around, I find my way to Gym 6.

Gym 6 is big low-ceilinged room with odd pieces of exercise equipment scattered along the walls: bikes, weights, machines, floor mats. Inside, a bunch of people are milling around. There are maybe half a dozen people in wheelchairs and scooters. There are some people who appear to be developmentally disabled. There are a couple dozen sportily-dressed undergraduates sitting around. I spot the instructor, whom I'd met before, say howdy, and find a chair. The class doesn't start for another ten minutes.

I sneak furtive looks at various people in the room. There are a number of people who are obviously taking care of the obviously developmentally disabled people. They make small talk with their charges, using the exaggeratedly happy and articulated speech that is reserved for such conversations. "Heeyyyy, Sally! What's up, there? I haven't seen yoouu around here for a while." The undergraduates check their cell phones, shuffle papers. They look so young. They're almost all women, pretty and fit. In my mind, I'm feeling conspicuous: I'm not young and pretty enough, and I'm not disabled enough. A bell rings; class will now start. Wow. I'd forgotten about that.

Of course, we'll start by going around the room and introducing ourselves, talking a little about our goals for this class. I go second, saying something about how I'd like to improve my fitness generally and also figure out whether there are MS problems that exercise can help with. There's a woman in a scooter who has MS too. She looks friendly. She'd like to work on, among other things, standing.

Each client is assigned a couple of students to work with for the semester. I'm soon joined by two young women: A, who strikes me as a bit too earnest, and D, who strikes me as not really interested. We go through a form that requires, among other things, that I list the medications I'm taking. I grab the pen, start with Rebif, and then I can't remember the rest. I mutter to myself, and eventually come up some more: Provigil, Lyrica, baclofen, Oxytrol, Flomax, seems like there are others, but I can't remember them.

I talk with A and D briefly about my goals, what I'm doing currently. They suggest that I try water aerobics, and A disappears to find a schedule of water aerobics class offerings. I talk a little bit about some of my functional limitations: fatigue, weakness, etc. I talk about my efforts at swimming, about feeling guilty about not doing yoga anymore. I spot D's eyes wandering around the room, and I start feeling self-conscious. Finally, we are saved by the instructor, who tells me to try the bicycle contraption with the fan-flywheel and alternating arm-lever things. He demonstrates how it works, how you can do arms-only, or legs-only, or use just one leg, etc. He thing the fan will keep me sufficiently cool.

I hop on the thing and have a go. After a couple minutes, I notice I'm tending to make the thing go using my arms, not my legs. Is that okay? How long should I go at this? The contraption looks old-school, and the LCD counter/timer display doesn't work. I joke about it, suggesting that next, we should go over to the butt-jiggler-belt thingy. A and D don't know what I'm talking about.

The instructor tells us to wrap it up, and A, D, and I head over to the mat to do some stretches. The bell rings, and class is over. I say see you next time.

I'm committed to staying with this thing, because I think the best way to get me to exercise is to put me in a class. I'm too cheap to quit and lose my small fee, too conscientious to leave A and D without a client to work with for the semester. So I'll be back on Thursday, perhaps with snazzier workout clothes. But I think I've probably already learned something: I'm not that bad off; things could be worse.

I'm definitely the 'ablest' of the disabled in the class. My physically-disabled classmates are paraplegic, a woman with ALS, a young man who has suffered a traumatic brain injury, an older man who speaks slowly and walks, slowly, with a quad can. My developmentally disabled classmates are each accompanied by one or two caregivers. I don't think any of my classmates will, after class, head off to their good-paying full-time jobs.

It's hard not to focus in particular on B, the woman in the scooter with MS. She looks to be in her mid-40s, pretty, tired-looking, with a fragile half-smile. I guessed she had MS before she introduced herself. A part of me wanted to go to her and introduce myself, felt like we were members of the same club, the way you greet someone you learn went to your college. Didn't we have some deep thing in common? But I'm wary, and shy. I feel something akin to survivor's guilt; what have I done to deserve to escape the scooter? But then I remember that I shouldn't assume that, just because I'm not using a scooter, I'm necessarily happier or better off than B.

Whatever A and D can teach me about fitness, it feels like this class is really going to be about sorting out what I think it means to be disabled, to identify as disabled, to hang a blue tag on the rear-view mirror? I don't look anything like the stick figure in the wheelchair on the parking tag. But who does?

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Monday, January 23, 2006

In the news: "The Animal Self"

There's a great article in the New York Times Magazine by Charles Siebert about research into animal personality. The article begins with an examination of personality in the giant Pacific octopus (GPO), and quickly gets to the real problem: what the hell do we mean by 'personality'? How is it different from mere behavior? Can a critter that does not engage in self-reflection have a personality?

It sounds faintly nutty, this stuff, but read on and it starts to make sense. Snip:
Advances in fields like genetics and molecular and evolutionary biology have lent to the study of psychology something that it really didn't have when behaviorism first came to the fore: a better understanding of the biological and bioevolutionary underpinnings of behavior. No longer is the study of animal behavior rooted in that inherently naïve and anthropocentric desire to see ourselves in animals or to project upon them our thoughts and feelings. Animal personality, along with such integral fields as animal behavior, behavioral ecology and evolutionary biology, all pivot now around what might be called deep analogies. The more detailed and specific our knowledge has become of the animals and of the many differences between them and us, the more clearly we can see what is analogous about our respective behaviors.

Animal personality, in other words, is now redirecting psychology's focus in a direction the behaviorists would most appreciate: away from airy abstractions about personality and down to its very tangible and widely dispersed roots. It might be thought of as a kind of biological Buddhism or muscular mythologizing or armed anthropomorphism: a more disciplined and detailed form of that idle speculating we have all done in front of the head tilt of a dog or the sudden skyward shift of a flock of sea gulls or the comings and goings of ants around their respective mounds.

Link (free reg req'd)

Friday, January 20, 2006

In the news: Richard Pryor, elephant lover?

According to his wife, Richard Pryor's favorite cause wasn't multiple sclerosis research, it was preventing cruelty to elephants. People for the Ethical Treatment of Animals (PETA) just named an award after him.

Well, how about that? Snip:
Pryor's wife says, 'Of all the issues Richard worked on over the years, cruelty to elephants was dearest to his heart. He felt for elephants who are robbed of their freedom and families and sent to circuses where they endure chains, bullhooks, and beatings or banished to zoos where they spend a lifetime of boredom, confined in small, concrete enclosures.'


Thursday, January 19, 2006

Journal: Lyrica update

I've been taking Lyrica for a few weeks now, and I'm up to about 400 mg a day. I've also cut the Neurontin to about 600 mg a day.

Pain-wise, I think I'm finally starting to feel like I've made a bit of an improvement over Neurontin-only. It's 2:00 in the afternoon, and I'm feeling just a bit of burning pain in my thighs and bottom. Just a few days ago (with a lower dose of Lyrica), at this time of day, I was quite uncomfortable and squirmy.

As far as side effects, at first, I'd felt noticably less dopey as I dropped the Neurontin dose, but after bumping the Lyrica up last nite (more on that in a bit), I've felt a bit goofy this afternoon: hard to walk a straight line down the hallway, a little slow on the uptake at lunch, etc. Perhaps it will moderate as I continue at this dose.

Right now, I've still got the splitting headache I woke up with. Last nite, instead of taking 100 mg of Lyrica, I took 300 mg. I'd been told that I could go from 100 mg three times a day to 150 mg in the morning and 300 mg at nite. I probably shouldn't have gone to 300 mg last nite the same day I'd taken 100 mg in the afternoon. Anyway, I went to bed early because I'd gotten precious little sleep the nite before, and I was dog tired. Just to make sure I got to sleep promptly, I took a diphenhydramine at bedtime, too.

I woke up at 5ish this morning with absolutely the worst headache I've ever had- worse than any hangover when I was in college, worse than after my lumbar puncture. When I looked at myself in the mirror, I looked at one of those dejected migrant workers in a Dorothea Lange photograph. Ug. It's a little better now, but I need to take some more Tylenol to get through the rest of the day. The plan for today is: 150 mg in the am, 50 mg in the afternoon, and 200 mg at bedtime, then switch to 150 mg in the am tomorrow and 300 mg tomorrow nite.

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Tuesday, January 17, 2006

Research: Vibrating insoles help improve balance

Got balance problems? I do. I wonder if vibrating insoles would help. I bet I could whip something up with parts from Radio Shack.
Snip from NYT:
In a study being published in the January issue of The Annals of Neurology, researchers report that vibrating insoles allow diabetics with numb feet and stroke victims with uncertain balance to stand quietly without swaying and losing their balance. The random vibrations, which were so subtle that people did not have any conscious awareness of them, effectively stimulated the neurons on the bottom of their feet. That provided their wobbly balance system with missing information about how their stance was changing moment to moment.

An earlier study using the vibrating insoles had a similar result, said James J. Collins, a professor of biomedical engineering at Boston University who led the research. In that experiment, the vibrations helped elderly subjects stand as steadily as most 20-year-olds.

Link (free reg req'd)

Puppy love: Dogs sniff cancer with 99% accuracy

Is there anything dogs can't do? The NYT has a piece on a study that shows trained dogs can detect cancer in samples of patients' breath. I'm skeptical, but I really want this to be true. Note that the NYT has very obviously misidentified Kobi, the Yellow Lab in the photograph, as a Golden Retriever. I bet they'll be deluged with angry e-mails pointing out the error. Stupid New York Times...

In the small world of people who train dogs to sniff cancer, a little-known Northern California clinic has made a big claim: that it has trained five dogs - three Labradors and two Portuguese water dogs - to detect lung cancer in the breath of cancer sufferers with 99 percent accuracy.

It has been known since the 80's that tumors exude tiny amounts of alkanes and benzene derivatives not found in healthy tissue. Other researchers have shown that dogs, whose noses can pick up odors in the low parts-per-billion range, can be trained to detect skin cancers or react differently to dried urine from healthy people and those with bladder cancer, but never with such remarkable consistency.

The near-perfection in the clinic's study, as Dr. Donald Berry, the chairman of biostatistics at M. D. Anderson Cancer Center in Houston, put it, "is off the charts: there are no laboratory tests as good as this, not Pap tests, not diabetes tests, nothing.

As a result, he and other cancer experts say they are skeptical, but intrigued. Michael McCulloch, research director for the Pine Street Foundation in Marin County, Calif., and the lead researcher on the study, acknowledged that the results seemed too good to be true. (For breast cancer, with a smaller number of samples, the dogs were right about 88 percent of the time with almost no false positives, which compares favorably to mammograms.)

Link (free reg req'd)

Monday, January 16, 2006

Journal: "Estranged Bedfellows"

Do you and your mate snuggle happily together under the comforter of your choosing, drifting off to sleep in a lazy half-embrace, each dreaming of the beloved bed-buddy? Or do you, like me and mine, sleep apart? An article in the WaPo today chronicles the stories of some of those couple who share homes, checking accounts, bathrooms, even, but not beds.

We starting sleeping solo a few years ago after struggling for several years with the hey-shut-up- you're-too-noisy-hey-quit-poking-me-well-you-sound-like-a-drowning-water-buffalo-over-there-and- what's-with-the-nocturnal-calisthenics-well-I-don't-know-I-was-asleep-which-I'm-not-anymore thing. My dearest turned out to have restless leg syndrome (RLS), which was driving me crazy, and my thrice-nightly trips to the bathroom were not helping matters. It started out with one of us (usually she) leaving in the wee hours at the other's invitation. Eventually, we decided it might be easier if we just started out that way. Now, every so often we accidentally drop a reference to "my bedroom" or "your bedroom" in the company of someone who's not in on the arrangement, and feel a bit foolish.

Do I regret it? Well, yeah. There's a level of intimacy built in to sharing a bed that disappears when you sleep separate. And I'm not just talking about going bump in the night. It's also about the incidental touches, the occasional after dark conversations, the glimpses of skin. I miss all of that. And for that reason, I'll sometimes declare a truce in spite of the potential of lost sleep.

But it's more complicated than that for me. MS has put a real damper on our sex life. Sometimes I feel like by sleeping separately, I give up the few moments of intimacy that separate us from simple housemates. I miss waking up in the morning and hearing my wife mumble about how she dreamed she was appearing in a revival of Oklahoma or how I had appeared at Thanksgiving dinner dressed up as a woman (my wife has a very vivid dream life). I have to admit that I started in getting in the habit of letting the dog sleep on the bed with me because it felt nice to have a warm, breathing thing next to me in bed.

Multiple sclerosis places so many of its own burdens on intimacy. I wonder if by sleeping apart in the interest of uninterrupted sleep I'm playing right into its hand.

According to a 2005 National Sleep Foundation survey, 23 percent of partnered adults frequently sleep solo because of their loved one's snoring, kicking or other sleep problem. That number doesn't include those who bed down apart because of mismatched schedules or desire for different room temperatures, or to let an exhausted spouse avoid a tyke's wake-up calls. And though a small number of couples who opt for separate beds do so to recapture a sense of romance, for most, there's one simple fantasy: some decent rest. In fact, according to the National Sleep Foundation survey of 1,506 adults, disruptive bedmates rob their partners, on average, of 49 minutes of shut-eye each night.


Saturday, January 14, 2006

Research: FDA moves to promote 'efficiency' of early drug research

Is this a good idea? From the NYT:
In part, the suggestions detail ways to make small batches of experimental compounds to test tiny doses in people. Previously, researchers had to meet costly requirements for large-scale manufacturing to do early tests, Food and Drug Administration officials said.

Studying small doses can be useful because new technology lets scientists see if an experimental drug behaves as expected in the body and reaches its intended target, like a tumor, officials said. Patients should be spared side effects at that stage because doses are small, they said.

Link (free reg req'd)

Friday, January 13, 2006

In the news: Audit says MS charity solicitor spent money on booze, gambling, gardening supplies

From the Salt Lake City Tribune:
The director of a Salt Lake City multiple sclerosis foundation who sold art, supposedly to raise money for MS patients, pocketed thousands of dollars for day-spa treatments, Internet gambling and liquor, the Utah Division of Consumer Protection says. At a public hearing Friday, Corinne Turner - director of the Desilynn Multiple Sclerosis Foundation and The Art of Giving gallery - was denied an application for a charitable solicitations permit because it was 'incomplete or misleading.' She was also alleged to be in violation of the state's charitable solicitations act.

Per the audit:
* Turner stated in her records that she spent about $1,700 on supplies to build wheelchair ramps. Receipts from Home Depot, however, show she actually purchased bedding plants and gardening supplies.
* Turner and her husband, Stacy Turner, used $1,600 in foundation funds to purchase a sideboard with marble top, a 75-gallon water heater and lawn services for their home.
* The Turners made about $20,000 in cash withdrawals.
* The Turners made payments to vendors unrelated to the operation of a gallery, such as Beyond Spas, Clark Planetarium, DirecTV, Les Schwab Tires, Pokernet and the Utah State Liquor Store.

Link to story in Salt Lake Tribune.

Wednesday, January 11, 2006

In the news: "Let's Get Serious About Relieving Chronic Pain"

Jane Brody had a great article in the NYT about how the federal government is making it harder for patients to get relief from chronic pain:
In addition to a case before the United States Supreme Court, Gonzales v. Oregon, that threatens to undermine Oregon's Death With Dignity Act, the D.E.A. has recently increased raids on doctors' offices, confiscating files and arresting doctors on charges of overprescribing narcotics to patients who are addicts or drug dealers. Most of these physicians are compassionate people trying to help suffering patients but are sometimes fooled by clever addicts, drug dealers or undercover agents who fake their pain.

Should the court rule against Oregon, the D.E.A. could turn to all physicians whose patients die while getting prescribed opioids or barbiturates, even if the drugs were administered only to relieve intractable pain, not to hasten death. Yes, there are bad apples among members of the medical profession. There are some doctors who charge for medical exams that they never do and provide phony patients with prescriptions for narcotics to feed their habits or sell on the street. But should all physicians be subject to intense scrutiny by the D.E.A. and risk arrest and prosecution, leaving legitimate patients to suffer intensely or scramble to find other doctors willing to risk taking them on?

If the government caused this kind of interference with, say, cancer drugs or birth control, there would be a huge outcry. But the public doesn't regard pain relief as being quite as serious an issue as cancer therapy or contraception. Pain, after all, is not life-threatening. The problem is that people who have not experienced chronic pain understand only temporary pain, and chronic pain does not equal a permanent headache. Chronic pain is not just temporary pain extended through time. It's qualitatively different- it reaches beyond the physical experience of the pain and wraps its tentacles around your marriage, your friendships, your job, everything.

Can we please get rid of our cultural baggage about the nobility of suffering, can we formulate a drug policy that's not influenced by the veneration of the suffering Christ on the cross?
Link (free reg req'd)

Journal: Surviving Christmas

There's just something about Christmastime: something about taking some time away from work, something about reconnecting with family and old friends, something about observing the wonder and excitement of kids, something about good memories jostled back to life. In quiet moments, it whispers something to the depths of your soul, the gist of which is this: "You know, things aren't really as bad as you thought. Actually, they're a lot worse."

I took some vacation between Christmas and New Years Day, intending to catch up on a couple of things around the house, spend some quality time with my wife, and get a little fresh air, maybe doing some ice fishing or heading to a ski hill for the first time in a couple years. Instead, I spent a couple exhausting days obsessively working on stuff around the house, resenting that my wife was not similarly obsessed and getting tired and cranky. Then weather turned warm and crappy and spoiled any prospects for winter sport. On January 3, I returned to work, feeling unrested and cheated, wishing I made enough money to afford a vacation that included palm trees and tropical drinks served in coconuts by friendly natives who ask, in heavily accented English, "Are you ready for your next massage, señor?"

But this past weekend, I took a vacation of a very different kind. I drove six hours north to spend the weekend with a buddy and two guys I didn't know in a 10'x16' ice shack on Mille Lacs fishing for walleyes. We fished with jigging poles all day long, stopped for dinner, and set the 'rattle reels' in the shack while we played Euchre until we could no longer remember what was trump, then went to bed. The fishing was lousy--only a handful of perch during the day, and some hideous eelpouts on the rattle reels--but the male bonding was outstanding. Let's just say we should have saved the baked beans for the last night.

Over the holidays, it felt like everything I did reminded me how old, weak, sick, and bald I've become. This week, it feels good to be back at work, to be busy, to feel useful, to come home at the end of the day and hug my wife and my dogs. The days are getting longer. And after a couple of weeks on Lyrica and weaning myself off of Neurontin, I'm feeling a bit less dopey and sluggish. I don't yet feel like it's made a significant dent in the pain vs. the Neurontin, but I'm still at a low dose, just 150 mg per day.

Yesterday, the sun came out. Initially, people around here were frightened, having forgotten that blazing orb in the sky meant us no harm. Soon, though, we remembered the John Denver song, felt the sun's warmth on our shoulders, and were happy.

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