Thursday, May 31, 2007

Botox on tap

I called my urologist and scheduled the Botox procedure for next week. As it turns out, I won't be getting it in the bladder detrusor, but in the, uh, pee schincter (just now, I can't remember what you call that gizmo). The immobilization of the bladder detrusor is for those who are self-catheterizing, because you can't pee without the detrusor. I'll be getting the sphincter muscle immobilized, which won't do anything to stop the detrusor spasms that send me running for the potty. What it will do is stop my pee sphincter from closing up when I try to get my detrusor to contract, permitting me to empty properly.

I need to get clearance from the HMO, but the urology department reports they haven't had any trouble getting my HMO to pay.

Friday, May 25, 2007

What's really in my fridge?

I like to cook, and like a lot of foodies I know, my fridge and freezer are littered with little bits of the miscellaneous ingredients that make for interesting food creations and experiments. In the freezer, there are little bags of assorted nuts in various shapes: filberts, pecans, walnuts, almonds (sliced, slivered, whole, raw, roasted and salted). There's a bag full of fist-sized lumps of homemade chorizo, a smallish baggie of keffir lime leaves (essential to a good Thai-style curry), bread yeast, some beef short ribs for soup. The door of the fridge contains the usual assortment of condiments: mustards, jellies, pickle relish, homemade maple syrup, olives, pickles, Worcestershire sauce, curry pastes.

The fridge door also contains a dozen bottles of assorted Asian staples, all of them picked up at one of our local Asian groceries. I love wandering around these stores and sifting through the endless varieties of sauces, noodles, teas, fungi, and what-have-you. I don't really buy the exotic stuff, but I do keep on hand some of the basics: Thai fish sauce, a couple kinds of soy sauce, oyster sauce, hoisin sauce, chili sauce, black bean paste. All of this is imported. I haven't really paid attention to where it comes from.

This morning, I laid in bed listening to a story about the growth of foods imported from China and the questions about the safety of some of that food. It's not just pet food, of course, it's people-food, too, and it's not always possible to tell when you're consuming imported food. This is because in addition to finished products, China exports a lot of ingredients used to make the stuff we buy. FDA inspects only a tiny fraction of the foods we import. Without going into detail, it was a little spooky.

So I'm thinking about placing more importance on buying food from closer to home, even though it might cost a bit more. I can't give up oyster sauce or curry paste, but there has to be a domestic source for the stuff. That might not guarantee the safety of the product, but maybe it improves my odds.

Link to NPR story.

Wednesday, May 23, 2007

Michael Moore's new movie

So Michael Moore's new movie Sicko is being favorably received in Cannes. Sicko is about how bad the American health care system sucks and why it is that we seem to like it that way. Snip from the LAT:
"I don't have to convince the American public that there is something wrong with our health care system. I think most American people already feel that way," said Moore, who enjoys great coverage himself through the Directors Guild of America. "That's why I don't spend a lot of time in the film on the healthcare horror stories. I wanted to propose that there's a different way we can go with this. I'm hoping that the American people, when they see this film, will say, 'You know, there is a better way, and maybe we should look at what they are doing in some of these other countries..."

I appreciate Moore's viewpoint, but not his confrontational approach. I didn't see Fahrenheit 911, not because I think the present war is good public policy, but because I think instead of starting a conversation at the political center, the movie just added to the shouting match already in progress between the people at the fringes. So when I heard that Moore was making a movie about an issue that affects me deeply in a very personal way (which is not to suggest that I consider terrorism/war/foreign policy/everything else to be a garnish on the garnish of our great political ham), I was nervous, even though I'm all for single-payer and figure he is, too.

The LAT reports, however, that Moore has, in Sicko, forgone some of the confrontational episodes that marked his other films. Snip:
"When people say there is no confrontation in this movie, to me there is a big confrontation in this movie," Moore said in an interview here. "Because I am confronting the American audience with a question: 'Who are we, and what has happened to our soul?' To me, that's maybe more confrontation than going after the CEO of Aetna or the CEO of Pfizer." The reason Moore feels compelled to ask this "Sicko" question is because, he feels, the country unthinkingly settles for substandard and ruinously expensive medical treatment, especially when compared with countries with universal healthcare.

I'm looking forward to seeing Sicko, but mostly, I'm looking forward to an invigorated popular conversation about the issue. Hold the chest-poking, though, please.

3d ventricle?

These are coronal views from MRI head-shots last fall. I think the third ventricle is the little opening indicated by the red circle. Hard to believe you could tell much about the size of the little guy from a sonograph, but I'm not a professional. I've also got some MRI films from way back (1993?); I wonder how they'd compare.

Tuesday, May 22, 2007

Thinking about grandpa and physical therapy

One of the MS-related abstracts last week was something about multiple sclerosis and Guillan-Barre Syndrome. I don't remember anything about the abstract, but it got me to thinking about my late grandpa, who had GBS and died when I was a freshman in college.

He was an interesting guy, from the little I know of him. He was born in Sweden and, along with a friend, ran away to sea as a kid, in part to escape a troubled family life (troubled like Dickensian troubled, I guess). Eventually, he became a ship's captain of, among other vessels, liberty ships during WWII. On day, maybe in his fifties, he woke up while he was at sea and couldn't move. That was the end of his working life.

As a kid, I knew him as a frail-looking old guy who shuffled around a big old house in old-guy Hush Puppies and spoke heavily-accented English, which made him hard to understand. I can remember picking up the phone as an adolescent and being so unable to understand him that I thought it was a crank call. He had a passion for gadgets, mainly photographic or electronic, and liked James Galway and Miller High Life. He didn't smile or laugh much, except occasionally at the dog, an Airedale named Bingley (there were a few different dogs who played the role of Bingley). I think he was probably an alcoholic at some level.

He had about a gazillion photos he had taken during his life at sea, of places he had been and ships he had sailed. I have a copy of his picture of the Steel Maker in my office. There were plenty of pictures of him, too: a trim but muscular, stern-looking guy in a uniform, who looked like someone not to be fucked with. I remember him talking about the time he had a lion or tiger or something like that on the ship in a cage as cargo, and the lion or tiger got out of the cage and jumped overboard in the middle of the ocean.

If he was still around, I'd like to think that I would have some kind of insight into who he was, how his life had been changed by his illness, what it meant to go from sailing around the word to tending to the geraniums hanging on the porch.

I got a little taste of that feeling at my last physical therapy appointment. The thing about physical therapy is that the exercises prescribed for you will do one or both of the following: 1) make you intensely fatigued, because the whole point of PT is to find those motions that are most difficult for you, and 2) make you feel like a big sissy, because you know that the exercise you are supposed to do is something that most people do every day, maybe all day long, and think nothing of it.

Actually, PT is going pretty well. I think my therapist is very smart and conscientious, and she has been very adept at zeroing in on my weaknesses and modifying exercises if necessary. The problem is finding the stamina to do my exercises and all the other things I must do or enjoy doing. During the work week, do I do them in the morning before work, such that I arrive at the office already pooped out, or do I try to do them after work, when I've already burned most of my energy for the day and would really prefer to just veg out in front of the TV? The answer is, I do the exercises when I can, in the morning with a cup of coffee, during the work day while sitting at my desk, and I do them in the evening while watching the cast of Grey's Anatomy struggle with their screwed-up lives. I don't do them as often as I should, but I do what I have time/energy for, and I think about what it will be like in the future, when and if it becomes my full-time job to try and take care of myself and possibly the geraniums hanging on the porch.

Wednesday, May 16, 2007

Neuropsychological impairment and the 3rd ventricle

In today's batch of MS-related abstracts from PubMed (which, by the way, you can get as an RSS feed, which I do) reports that the width of the brain's third ventricle, as measured by transcranial brain sonography, has a "good correlation" to cognitive impairment in MS patients. Here's a link to the abstract.

I've never had a transcranial brain sonograph, but I've got some relatively recent (6-9 months old) MRI images. I wonder what my third ventricle looks like- maybe I'll try to post a picture that shows my third ventricle. Unfortunately, the abstract doesn't really say whether it's larger-than-normal or smaller-than-normal ventricular width that correlates to cognitive impairment, so I'll probably just end up torturing myself unnecessarily, but hey, that's what science is all about, right?

Monday, May 14, 2007

Dazed and bemused

This morning, I was so pleased to have remembered my 9:00 am PT appointment and to have actually made it there on time, notwithstanding crappy traffic, that I stopped at Whole Paycheck and picked up a box of spicy tuna rolls. A couple hours later, though, I started feeling unusually sleepy and realized I'd skipped my morning meds: Provigil and Cymbalta. Drat. Too late to take the Provigil, I think, and no Cymbalta in my desk-drawer minipharmacy.

I really, really like the Provigil, and when I forget it, I remember how dopey, listless, and bummed I felt without it. The cash price for 200 mg Provigil tabs at Walgreens is $9 and change. So help me God, if I lose my insurance for some reason, I will take to sticking up liquor stores if I have to so I can get my fix.

Sunday, May 13, 2007

Friday, May 11, 2007

More good news on Botox for bladder issues

New research shows Botox injections in the bladder detrusor remain effective after multiple injections. My urologist has mentioned this as an option a couple of times, and I'm thinking that I might give it a go some time in the not-so-distant future. My pee-pee problems are still pretty manageable, but I have noticed that things got a little worse over the last year or so. I'd say there's been a 25% decrease in the time between "I gotta go" and "I seem to be going." According to the study, participants receiving Botox got a mean maximal cystometric capacity increase of 144 ml. That's about half a beer, right?

Link to abstract.

Friday, May 04, 2007

Another go at physical therapy

I went back to the HMO physical therapy clinic on Wednesday afternoon, having been told that the HMO would not pay for a second visit to the University Hospital's PT clinic to complete an evaluation. The HMO's PT clinic is, of course, all the way on the other side of town from where we live, so it takes 30-45 minutes to get there, depending on traffic. It's at the edge of the sprawltastic land of shopping malls and big, big box retail, and it's a part of town that I just don't have any reason to go to.

I'd asked to see the therapist who had the most expertise with neurological rehab, but one of the first things out of J. the therapist's mouth was that next time, I'd be seeing a different PT, one who has more neuro experience, and, in fact, used to work at the University Hospital's PT clinic. Right off the bat, J. seemed to be aware that I'd seen someone at the University Hospital PT clinic, and that I'd wanted to go back. J. had read the notes from my visit to the other clinic, and said a few times that they hoped I'd give the HMO clinic a shot, but that if I thought after a few visits that I wasn't getting what I needed, they'd support my request to go back to the University Hopital's PT clinic. That seemed reasonable to me.

So we did some basic strength and balance testing. As at the U's clinic, J. decided I had some definite weaknesses in my legs: dorsiflexion of the feet, esp. on the left; hip abduction on both sides; and whatever you call it when, from a seated position, you rotate your leg and bring your left foot up towards your right knee. We also did some balance stuff, which was okay with my eyes open, but went to crap once I had to close my eyes.

I left the office after 45 minutes with three more appointments set up with V., the other therapist; a printout with some exercises to work on strength and balance; and a realization that things had gotten decidedly worse for me, strength and balance-wise, since my last visit to PT. I also got a free pass to the huge gym complex at the building where the HMO PT clinic is located. It's on the wrong side of town, but it has this neat donut-shaped pool with a strong current in it, and when I last went to PT, I really enjoyed bobbing up and down and walking around and around against the current. I'm thinking about dashing out there this afternoon.

Tuesday, May 01, 2007

Rituxan looks good in Phase II

Just read a Reuters story reporting on promising results of a Stage II clinical trial of Rituxan, a drug developed for treating lymphoma:
The number of lesions at weeks 12, 16, 20 and 24 was statistically far lower in the Rituxan group. At week 24, the total number of lesions was reduced by 91 percent -- to an average of 0.5 per patient in the Rituxan-treated group, compared with 5.5 lesions in the placebo arm of the trial.

"In addition, the proportion of patients with relapses over 24 weeks in the Rituxan-treated arm was 14.5 percent compared to 34.3 percent in the placebo arm," representing a 58 percent relative decrease, the drugmakers [Genentech and Biogen] said in a joint release.