The tactic of pressuring civilians has been tried before, and more than once. The Lebanese, for example, are very familiar with the Israeli tactic of destroying power stations and infrastructure...
In the end, Israel was forced both to negotiate with Hezbollah and to withdraw from Lebanon. Now, the government appears to be airing out its Lebanon catalogue of tactics and implementing it, as though nothing has been learned since then...
Israel also kidnapped people from Lebanon to serve as bargaining chips in dealings with the kidnappers of Israeli soldiers. Now, it is trying out this tactic on Hamas politicians...
...But this is not merely faulty reasoning; arresting people to use as bargaining chips is the act of a gang, not of a state...
Friday, June 30, 2006
"The act of a gang, not of a state"
Brilliant editorial in Haaretz.
It's official...
I'm going to be taking rat poison for the rest of my life.
Well, maybe not. The hematologist said that there might be some new anticoagulants coming on to the market in the next five years or so that might be more convienient than warfarin, which interacts with over 186 foods and medicines and requires that I get my blood checked at a minimum of once a month (right now it's once a week).
But having an unprovoked pulmonary embolism, particularly one as serious as mine in which both of my lungs were affected, puts me at high risk for having a fatal PE. The risk of bleeding on the anticoagulants is far less than my risk of dying from a clot in my lung(s). However, he did allay my fears of bleeding. Yes, I have a history of bleeding on anticoagulants. But I was post-operative then and my risk far higher. And indeed, my INR (the number that measures how long it takes for me to stop bleeding) has been higher this time around than it was seven years ago, and I didn't start hemorrhaging like I did then.
So, not the news I wanted to hear but it sounds like it's maybe not as bad as I'd feared.
Now we just wait to see if the 7 tubes of blood they took out of me tell them anything.
Well, maybe not. The hematologist said that there might be some new anticoagulants coming on to the market in the next five years or so that might be more convienient than warfarin, which interacts with over 186 foods and medicines and requires that I get my blood checked at a minimum of once a month (right now it's once a week).
But having an unprovoked pulmonary embolism, particularly one as serious as mine in which both of my lungs were affected, puts me at high risk for having a fatal PE. The risk of bleeding on the anticoagulants is far less than my risk of dying from a clot in my lung(s). However, he did allay my fears of bleeding. Yes, I have a history of bleeding on anticoagulants. But I was post-operative then and my risk far higher. And indeed, my INR (the number that measures how long it takes for me to stop bleeding) has been higher this time around than it was seven years ago, and I didn't start hemorrhaging like I did then.
So, not the news I wanted to hear but it sounds like it's maybe not as bad as I'd feared.
Now we just wait to see if the 7 tubes of blood they took out of me tell them anything.
Thursday, June 29, 2006
How to get around democracy
Ha'aretz: Justice Ministry: More arrests of Hamas figures
Right. So basically the plan has been to starve the popularly elected Palestinian government of revenue (withholding tax money Palestinians have paid, getting other countries to cut aid), continually provoke Hamas, and when Hamas finally lashes back, arrest it's Cabinet and Members of Parliment to make the government fall (though some of the MPs elected were already in prison).
Well, ya know. Gotta give them credit. When you don't like democracy, there are clearly ways to get around it.
The detention of Hamas parliamentarians in the early hours of Thursday morning had been planned several weeks ago and received approval from Attorney General Menachem Mazuz on Wednesday. The same day, Shin Bet Director Yuval Diskin presented Prime Minister Ehud Olmert with the list of Hamas officials slated for detention.
Right. So basically the plan has been to starve the popularly elected Palestinian government of revenue (withholding tax money Palestinians have paid, getting other countries to cut aid), continually provoke Hamas, and when Hamas finally lashes back, arrest it's Cabinet and Members of Parliment to make the government fall (though some of the MPs elected were already in prison).
Well, ya know. Gotta give them credit. When you don't like democracy, there are clearly ways to get around it.
Wednesday, June 28, 2006
Letting a gang of rocket launchers destroy peace
I have to admit that I've been a little distracted when it's come to Palestine/Israel at a time when a lot has been going on there. Between doctors appointments and sharing my laptop with A. while he waited for his new power cord to arrive in the mail (not to mention that it was hellishly hot a few days ago and my laptop is like a radiator), I haven't had the time or motivation to read the stuff I bookmarked regarding the debate going on among Palestinians regarding the Prisoners' Document.
While the media here in the US has not paid much attention to it, this is a significant document in that prominent members of Hamas, as well as other factions in Palestinian politics, have implicitly agreed to recognize Israel within the pre-1967 borders. And over the last few days, Hamas has been coming to a tentative agreement with Mahmoud Abbas, who insisted that Hamas agree to the principles in the document before creating a unity government or face a referendum on the document in July. Polls suggest that Palestinians overwhelmingly support the document.
Then came the kidnapping of Gilad Shalit and Israel's violent response.
Yes, of course it's awful that Shalit was kidnapped. That his collegues were killed. That there have been an increase in the number of Qassem rockets shot over the Gazan border into Sdeirot. But, well, whole families have been killed by the Israeli Defense Force in the last few weeks. Children who don't fly F-16 fighters or drive tanks. There have been daily shellings and arrests. Not to mention the 16,000 in Rafah who have been made homeless in the last few years. But as Tanya Reinhart states, Israel will insist that they are the ones who have shown restraint.
Until now.
Akiva Eldar of Ha'aretz, said that Ehud Olmet has been "kidnapped by emotion."
But, of course, Olmert is not at all blessed with courage. Just rage and one of the greatest militaries in the world. While the Damascus-branch of Hamas, which doesn't have to live with whatever the Israelis met out, wants to block any political agreement, the Israelis are clearly not interested either.
A prisoner exchange is not an unreasonable request. Israel has been in essence kidnapping Palestinians all along with its arrests and detention without charge. And not just young men, but women and children as well.
Instead nearly a million Gazans have lost their electricity and water. And young Gilad Shalit is sure to lose his life along with other Israelis and Palestinians as the IDF invades ostensibly to save Shalit's life.
And the Prisoners have already changed their Document to reflect a more defiant stand.
And God only knows how long it will be before Hamas can be pragmatic again.
Sigh.
Right. I need to go and fill out the paperwork for the hematologist tomorrow.
While the media here in the US has not paid much attention to it, this is a significant document in that prominent members of Hamas, as well as other factions in Palestinian politics, have implicitly agreed to recognize Israel within the pre-1967 borders. And over the last few days, Hamas has been coming to a tentative agreement with Mahmoud Abbas, who insisted that Hamas agree to the principles in the document before creating a unity government or face a referendum on the document in July. Polls suggest that Palestinians overwhelmingly support the document.
Then came the kidnapping of Gilad Shalit and Israel's violent response.
Yes, of course it's awful that Shalit was kidnapped. That his collegues were killed. That there have been an increase in the number of Qassem rockets shot over the Gazan border into Sdeirot. But, well, whole families have been killed by the Israeli Defense Force in the last few weeks. Children who don't fly F-16 fighters or drive tanks. There have been daily shellings and arrests. Not to mention the 16,000 in Rafah who have been made homeless in the last few years. But as Tanya Reinhart states, Israel will insist that they are the ones who have shown restraint.
Until now.
Akiva Eldar of Ha'aretz, said that Ehud Olmet has been "kidnapped by emotion."
The goal of the soldier's captors was to kidnap the cease-fire and the chance for a resumption of the dialogue between Israel and a pragmatic Palestinian coalition. If Olmert really was blessed with the courage of his words in New York, he would offer to trade Shalit for the signatories of the Prisoners' Document, Marwan Barghouti of Fatah and Abdul Khaleq Natshe of Hamas. Their release would be the decisive blow to Khaled Meshal, who is ready to fight Jewish children down to the last drop of Palestinian children's blood. There could not be any clearer signal of Israeli intent to effect a real change in relations with the large Palestinian population that is also tired of fighting.
But, of course, Olmert is not at all blessed with courage. Just rage and one of the greatest militaries in the world. While the Damascus-branch of Hamas, which doesn't have to live with whatever the Israelis met out, wants to block any political agreement, the Israelis are clearly not interested either.
A prisoner exchange is not an unreasonable request. Israel has been in essence kidnapping Palestinians all along with its arrests and detention without charge. And not just young men, but women and children as well.
Instead nearly a million Gazans have lost their electricity and water. And young Gilad Shalit is sure to lose his life along with other Israelis and Palestinians as the IDF invades ostensibly to save Shalit's life.
And the Prisoners have already changed their Document to reflect a more defiant stand.
And God only knows how long it will be before Hamas can be pragmatic again.
Sigh.
Right. I need to go and fill out the paperwork for the hematologist tomorrow.
Sunday, June 25, 2006
Bad hearts?
CFS and Diastolic Cardiomyopathy - Paul Cheney, M.D., Ph.D.
Very interesting video in which one of the foremost researchers/physicians dealing with CFIDS discusses his theory that CFIDS is caused by diastolic dysfunction in the heart. Answered a few questions for me, like, why I felt better the day after I was admitted to the hospital but have gradually gone back to feeling that icky, flu-like feeling (all the morphine they gave me was providing better vasomotor tone/function), or why my oxygen saturation level never went below 100% despite having clots in both lungs (CFIDS patients have learned how to breath less to maintain higher levels of CO2 to offset the higher levels of nitric oxide we have because our mitochondria are screwed up).
Beware though: this video is looooong. I've only managed to make it through the first hour and a half-two hours. Needless to say, it is not for those with dial-up.
Also, the BBC picked up the Sophia Mirza story. If you want to read the horrific story in detail, check out this from the Co-Cure archives. It will truly piss you off. I know it made me cry. For all my bitching about the doctors I've had through the years, none of them have made it to the level of cruelty that this woman's doctors did.
Very interesting video in which one of the foremost researchers/physicians dealing with CFIDS discusses his theory that CFIDS is caused by diastolic dysfunction in the heart. Answered a few questions for me, like, why I felt better the day after I was admitted to the hospital but have gradually gone back to feeling that icky, flu-like feeling (all the morphine they gave me was providing better vasomotor tone/function), or why my oxygen saturation level never went below 100% despite having clots in both lungs (CFIDS patients have learned how to breath less to maintain higher levels of CO2 to offset the higher levels of nitric oxide we have because our mitochondria are screwed up).
Beware though: this video is looooong. I've only managed to make it through the first hour and a half-two hours. Needless to say, it is not for those with dial-up.
Also, the BBC picked up the Sophia Mirza story. If you want to read the horrific story in detail, check out this from the Co-Cure archives. It will truly piss you off. I know it made me cry. For all my bitching about the doctors I've had through the years, none of them have made it to the level of cruelty that this woman's doctors did.
Tuesday, June 20, 2006
"Lather, rinse, repeat. Always repeat."
Haven't posted anything on the Middle East for awhile, but there have been a few things going on in the Levant worthy of note.
As the world saw recently, picnicking with your family on the beaches in Gaza can end on a real down note when the Israeli military decides to drop a bunch of rockets in between the falafel sandwhiches and Fanta. The Israeli military, of course, says it would never so rudely disrupt a day on the beach, but Human Rights Watch rightly says that's a load of bullshit. Chris McGreal at the Guardian also isn't buying the "Hamas left a bunch of land mines in the sand" line either.
Imagine if the passengers on United 93 managed to kill the hijackers and safely land the plane and were then later charged with the murder of the hijackers. Well, something similiar happened to some Arab Israelis when they killed a Jewish Israeli terrorist who had just killed a bunch of people on a bus. Gotta love double standards, no?
For east of the Jordan River, I shall direct you to my godfather's blog where he discusses the reaction of Jordanians to Zarqawi's death, as well as a talks about Lebanon and Syria. Last year when Rafik al-Hariri was murdered in Beirut, the question on everybody's mind was whether or not Bashar al-Assad was the one who ordered it or whether it was the muhabbarat (secret police). Well, Talal believes Bashar is definitely the one calling the shots in Damascus.
Okay, none of these developments are really all that different than what's been going on for the last fifty years or so I lifted a quote from an episode of the Simpsons.
As the world saw recently, picnicking with your family on the beaches in Gaza can end on a real down note when the Israeli military decides to drop a bunch of rockets in between the falafel sandwhiches and Fanta. The Israeli military, of course, says it would never so rudely disrupt a day on the beach, but Human Rights Watch rightly says that's a load of bullshit. Chris McGreal at the Guardian also isn't buying the "Hamas left a bunch of land mines in the sand" line either.
Imagine if the passengers on United 93 managed to kill the hijackers and safely land the plane and were then later charged with the murder of the hijackers. Well, something similiar happened to some Arab Israelis when they killed a Jewish Israeli terrorist who had just killed a bunch of people on a bus. Gotta love double standards, no?
For east of the Jordan River, I shall direct you to my godfather's blog where he discusses the reaction of Jordanians to Zarqawi's death, as well as a talks about Lebanon and Syria. Last year when Rafik al-Hariri was murdered in Beirut, the question on everybody's mind was whether or not Bashar al-Assad was the one who ordered it or whether it was the muhabbarat (secret police). Well, Talal believes Bashar is definitely the one calling the shots in Damascus.
Okay, none of these developments are really all that different than what's been going on for the last fifty years or so I lifted a quote from an episode of the Simpsons.
Friday, June 16, 2006
Scary
New Scientist Breaking News - First official death from chronic fatigue syndrome
As one of the comments in the last post stated, CFIDS has now been officially listed as the cause of death for a British woman named Sophia Mirza. You may remember last year Casey Fero of Wisconsin also died essentially of CFIDS, though in this case the coroner listed cause of death as myocarditis from a long standing infection of unknown etiology.
Um, yeah CDC. We're dying because we just don't know how to handle stress...
As one of the comments in the last post stated, CFIDS has now been officially listed as the cause of death for a British woman named Sophia Mirza. You may remember last year Casey Fero of Wisconsin also died essentially of CFIDS, though in this case the coroner listed cause of death as myocarditis from a long standing infection of unknown etiology.
Um, yeah CDC. We're dying because we just don't know how to handle stress...
Thursday, June 15, 2006
Link garden #1: Bugs, Batterers, and Bread
Boy am I getting behind in my blogging these days. Both in writing and reading.
Part of that is because I've had so many doctor's appointments since getting the blood clots in my lungs. Last week I had appointments every single day, as well as my mom's wedding on Sunday (ever the optimist at marriage number 4!). This week I've gotten a bit of a break with only three, though I've got my sister's college graduation on Sunday. Next week I'm back to four appointments, including an in-office cystoscopy (yep, just want to be extra sure my bladder wasn't the cause of the PEs). For someone who usually only leaves her apartment twice a week, it's a lot of activity.
But I have had a number of things I've been meaning to blog about over the last couple of weeks. And since they are about a number of different subjects, thought I'd borrow Alas, A Blog's idea of a link farm and start my own link garden. :)
There have been a couple of interesting developments regarding CFIDS/ME. First was the news from Professor Jose Montoya, M.D., an infectious disease researcher and Associate Professor at Stanford University, who reported at the HHV-6 conference last month that he treated his 12 CFS patients with the antiviral, valganciclovir, and 9 of them had almost a complete recovery. Valganciclovir is a drug frequently used for AIDS patients with cytomeglovirus.
This was particularly interesting when coupled with the announcement from the National CFIDS Foundation that they believe a variant of parainfluenza virus-5 may be the cause of CFIDS, Multiple Sclerosis, and Idiopathic Epilepsy. Like HIV, parainfluenza virus-5 attacks the immune system, but instead of causing catastrophic dysfunction, it takes out two specific parts of the immune system, the STAT-1 proteins and interferon regulatory factor-3. A prominent CFIDS researcher in Belgium, Kenny DeMeirleir, has also talked about this and put it into a handy PowerPoint presentation. Now, I have to admit my microbiology is a bit rusty, so it's difficult for me to do any critical analysis of their lengthy discussion. But it feels a bit promising.
Moving on to other topics was a couple of interesting articles in AlterNet. One was an op/ed piece by a former CIA analyst. While his points were mostly about the war in Iraq, there was this striking quote from his work with African-Americans at the Servant Leadership School in Washington, D.C.:
Indeed. Time to stop hand wringing and pull our freekin foot up already.
There was also a poignant story from a Marine who, in an act of desperation to avoid going for a third tour in Iraq, took some cocaine the night before his drug test and was Other Than Honorably discharged. In many ways it feels like Bush is an abusive husband and the military his abused wife who keeps smiling in public and completely enables his behavior but in private is getting the shit beat out of her.
Lastly I wanted to share a snippet from Bill Moyers's speech to this year's graduating class of Hamilton College.
Part of that is because I've had so many doctor's appointments since getting the blood clots in my lungs. Last week I had appointments every single day, as well as my mom's wedding on Sunday (ever the optimist at marriage number 4!). This week I've gotten a bit of a break with only three, though I've got my sister's college graduation on Sunday. Next week I'm back to four appointments, including an in-office cystoscopy (yep, just want to be extra sure my bladder wasn't the cause of the PEs). For someone who usually only leaves her apartment twice a week, it's a lot of activity.
But I have had a number of things I've been meaning to blog about over the last couple of weeks. And since they are about a number of different subjects, thought I'd borrow Alas, A Blog's idea of a link farm and start my own link garden. :)
There have been a couple of interesting developments regarding CFIDS/ME. First was the news from Professor Jose Montoya, M.D., an infectious disease researcher and Associate Professor at Stanford University, who reported at the HHV-6 conference last month that he treated his 12 CFS patients with the antiviral, valganciclovir, and 9 of them had almost a complete recovery. Valganciclovir is a drug frequently used for AIDS patients with cytomeglovirus.
This was particularly interesting when coupled with the announcement from the National CFIDS Foundation that they believe a variant of parainfluenza virus-5 may be the cause of CFIDS, Multiple Sclerosis, and Idiopathic Epilepsy. Like HIV, parainfluenza virus-5 attacks the immune system, but instead of causing catastrophic dysfunction, it takes out two specific parts of the immune system, the STAT-1 proteins and interferon regulatory factor-3. A prominent CFIDS researcher in Belgium, Kenny DeMeirleir, has also talked about this and put it into a handy PowerPoint presentation. Now, I have to admit my microbiology is a bit rusty, so it's difficult for me to do any critical analysis of their lengthy discussion. But it feels a bit promising.
Moving on to other topics was a couple of interesting articles in AlterNet. One was an op/ed piece by a former CIA analyst. While his points were mostly about the war in Iraq, there was this striking quote from his work with African-Americans at the Servant Leadership School in Washington, D.C.:
"If someone has their foot on my neck, I will say once, please get off my neck. If you continue to stand on my neck and explain how you didn't know you were there and why you were there and how difficult it is to move, I cannot be nice about it any more. It's not about conversation; in the end it's about getting your foot off my neck."
Indeed. Time to stop hand wringing and pull our freekin foot up already.
There was also a poignant story from a Marine who, in an act of desperation to avoid going for a third tour in Iraq, took some cocaine the night before his drug test and was Other Than Honorably discharged. In many ways it feels like Bush is an abusive husband and the military his abused wife who keeps smiling in public and completely enables his behavior but in private is getting the shit beat out of her.
Lastly I wanted to share a snippet from Bill Moyers's speech to this year's graduating class of Hamilton College.
Bread is the great re-enforcer of the reality principle. Bread is life. But if you're like me you have a thousand and more times repeated the ordinary experience of eating bread without a thought for the process that brings it to your table. The reality is physical: I need this bread to live. But the reality is also social: I need others to provide the bread. I depend for bread on hundreds of people I don't know and will never meet. If they fail me, I go hungry. If I offer them nothing of value in exchange for their loaf, I betray them. The people who grow the wheat, process and store the grain, and transport it from farm to city; who bake it, package it, and market it--these people and I are bound together in an intricate reciprocal bargain. We exchange value...
...Civilization sustains and supports us. The core of its value is bread. But bread is its great metaphor. All my life I've prayed the Lord's Prayer, and I've never prayed, "Give me this day my daily bread." It is always, "Give us this day our daily bread." Bread and life are shared realities. They do not happen in isolation. Civilization is an unnatural act. We have to make it happen, you and I, together with all the other strangers. And because we and strangers have to agree on the difference between a horse thief and a horse trader, the distinction is ethical. Without it, a society becomes a war against all, and a market for the wolves becomes a slaughter for the lambs. My generation hasn't done the best job at honoring this ethical bargain, and our failure explains the mess we're handing over to you. You may be our last chance to get it right.
Friday, June 09, 2006
Snapshot of conflict and possibility
AlterNet: World War on the Soccer Field
While most Amerians are oblivious, the most celebrated event in sports began in Germany yesterday. A., being a good Englishman and a huge football (i.e. soccer) fan, woke up this morning at 6 am to watch England beat Paraguay in its first match in the World Cup. Me, being a good American, slept. :)
But I did enjoy the above article from Alternet, which is a nice little essay on the various political, historical and sociological elements that go into the World Cup.
While most Amerians are oblivious, the most celebrated event in sports began in Germany yesterday. A., being a good Englishman and a huge football (i.e. soccer) fan, woke up this morning at 6 am to watch England beat Paraguay in its first match in the World Cup. Me, being a good American, slept. :)
But I did enjoy the above article from Alternet, which is a nice little essay on the various political, historical and sociological elements that go into the World Cup.
Sometimes more than just a game, the World Cup nonetheless remains a contest whose outcome is never certain. Winners are still determined by an alchemy of balletics and poetics, skill and cooperation, athleticism and sheer luck. Orchestrating the movement of a ball and eleven players across the field with such rapidity would be hard enough, even without eleven other players trying to disrupt them. The power relations that prevail in the real world count for little in those 90 minutes of play -- and, no matter how fierce the "combat," at game's end, in a time-honored World Cup ritual, players from both sides exchange shirts in a mark of respect and friendship. A snapshot, then, not only of a world in conflict, but also of the possibilities of resolution by means other than war.
Wednesday, June 07, 2006
When a tummy ache is so much more
It started with a tummy ache after eating a salad from Meals on Wheels Monday night that was a couple of days old. I mean, it smelled fine and tasted fine so I didn't think there was a problem until that uncomfortable trip to the bathroom. By the end of the night I was curled up in bed with my heating pad feeling that hot, burning sensation throughout my body that I get whenever I'm fighting some sort of acute infection.
The next day I canceled my appointment with my massage therapist/acupuncturist/Magic Lady and just slept. But the pain in my belly kept getting worse. And more focal. By the end of Tuesday night it was quite distinctly focused on my upper left side, just below my rib cage. I was too tired to go to the ER and figured since I didn't have a high fever it could wait until morning. Not that I got all that much sleep. My combination of hydrocodone and oxycodone barely made a dent in the pain.
The advice nurse the next morning was able to set me up an appointment with my nurse practioner, K., that afternoon. It wasn't until I walked downstairs to catch the Medical Transportation taxi that I realized just how much pain I was in. When I got to my clinic I was in tears and after listening to my belly for a moment or two, K. said that she wasn't hearing much sound in my lower bowels. That and the fact that I was clearly in a great deal of pain made her suspect that there was some sort of blockage and that I should go directly to the Emergency Room.
Upon arriving up at Oregon Health Sciences University hospital around 3 pm, I groaned when I saw six ambulances in front of the ER. K. had wanted me to go there instead of the closer Good Samaritan because I'm already seeing a uro-gynecologist up there and if it was something related it would be easier to share records, etc. But OHSU is also the primary trauma center for the Portland metropolitan area. And the public hospital where those without insurance are more likely to go. Needless to say, you wait a hell of a lot longer there than at Good Sam.
After spending an hour in the waiting room, I was in excruciating pain. And it's funny to watch how egocentric you become at a moment like that. Why the hell does she get to go before me? I mean, she can actually walk! Clearly my pain is worse. My case much more dire. Me, me me, damnit! Finally -- FINALLY! -- my turn to be herded back behind the sacred steel doors of the ER came.
I was dumped into a tiny room towards the back with no clock, a kid's plastic toy truck and some sort of magazine. You know, along with all the regular hospital stuff -- boxes of purple nitrile gloves, sharps boxes, machines that measure blood pressure, oxygen, etc. I sat on the gurney and tried to find a position that wasn't unbearable. I finally laid on my right side with my left leg and arm slightly askew and cried while I waited the next hour for the doctor to come in.
A tiny little Asian girl with a bouncy ponytail and faux horned-rimmed glasses eventually opened the door and introduced herself as my doctor. She sat down next to me and asked like a kindergarten teacher to a little child, "why are you crying?"
Apparently they never taught her in medical school that people go to an ER when they are in PAIN!
After explaining where I was in pain, her next question was "so, like, how do you handle pain? Are you, like, one of those people who has, like, a low tolerance?"
If I wasn't so damned incapacitated at that moment, I would have slapped the little bitch.
We moved onto my medical history. As I deal with doctors so much, I've made a good-faith effort on my part to help them out and learn their language a bit. I mean, I've studied five languages (not that I'm fluent in any of them) so it's not that big of a leap, you know?
"So, like, are you one of those people who likes to read the Internet about diseases and stuff?"
Again, somebody needed some serious bitch-slapping here.
"No, I'm a grad student. I'm reasonably intelligent and I find it's a hell of a lot easier for me to pay attention to what's going on with me than to expect you all to just magically read my mind and know what's going on."
"Oh."
Then she became tolerable. But I have to say she wins the prize for the most annoying doctor ever. Hmm...well, now that I think about it, she wasn't as bad as my pediatrician was, but she's definitely worse than my old orthopedist. And God knows it takes a special talent to be more annoying than an orthopedist.
She ordered a chest X-Ray and a CT scan of my abdomen. And left. And I waited. I got my X-ray. My CT scan. A nurse came in at one point and gave me some morphine, which helped a bit. By the time I saw a doctor again it looked to be dark outside from what I could see behind the blinds -- sometime after nine.
This new doctor was an older woman who looked like my boyfriend's sister accompanied by another resident. We chatted about my medical history. She asked some more about my CFIDS. At some point I'd mentioned off-hand that I'd had a parasite when I was in the West Bank and knew what serious diarrhea was like, as well as that had been one of the few times in my life I couldn't poop after they gave me some sort of industrial strength anti-diarrheal. The conversation turned to my graduate work. About how I had to drop out of my program last year (something she seemed genuinely sorry to hear). About how so far all of our testing just turned up little bits of odd stuff here and there leaving me with this placeholder diagnosis of Chronic Fatigue Immune Dysfunction Syndrome. She seemed to share my frustrated bafflement but said that I was in good hands with the MD I see at my clinic, whom she knew, in addition to my nurse practioner. And while there hadn't been any news yet from radiology, she explained that there isn't much on the left side that causes a lot of pain (well, aside from the spleen but as I had no fever that was improbable) so the most likely explanation was that I was constipated. I knew that couldn't be it as I don't get constipation like that, but she assured me that it can be extremely painful. When the CT scan finally came back, it showed I was indeed constipated, but the chest X-ray also showed that I had fluid in my left lung.
Huh? WTF? I mean, sometimes I'll have a little cough in the morning when I wake up but, I mean, nothing that's even felt like so much as a cold.
Well, that left them baffled. She called the doctor on call for my clinic, who apparently told her I could be seen the next morning. So she gave me a prescription for Lactulose and sent me home with instructions that I was absolutely to go into my clinic in the morning.
By that point I had called my mom and when I told her about the fluid in the lungs she insisted that I stay the night with her. I was in so much pain I knew I really wasn't capable of staying on my own so I relented so long as she took me to my appointment in the morning as her place is way out in a suburb far, far away from my clinic.
And getting that appointment was a pain in the ass. Whatever that on-call doctor told the ER doctor was a load of crap because getting a same-day appointment is apparently one of those serendipitous events akin to finding a dollar on the ground. It does happen sometimes but you should never count on it. Eventually we did find one and as we raced to get downtown in time, I happened to re-read the discharge papers from the night before, which included instructions about how they may contact you later if they get further results from the tests they did in the ER. Since I hadn't been at home I realized I might want to check my voice mail. Lo and behold there was indeed a message from the radiology department saying that I needed to call them back or return to the emergency room as soon as possible.
They probably found that blockage my nurse practioner suspected.
I called and immediately reached the lady who had called me.
"We took another look at your CT scan," she explained, "and it looks like there might be a pulmonary embolism in your right lung."
PE? Again? How? But it's my LEFT side that hurts...
I started crying a little and told her we could be there in the next twenty minutes or so. That's when it finally dawned on me that it was hurting a great deal to breath. I mean, I did know that it hurt but I had just assumed that it was because of the pressure from my belly. And crying was even more painful so I composed myself quickly.
I don't remember there being an ambulance in front of the ER when we arrived, but it was still pretty busy. They checked my vitals and signed me back in. My oxygen saturation level was 100% so even if there was a clot in my lungs, I was still getting plenty of air. Which was good because there was, of course, the requisite wait in the waiting room, after which I found myself in the room across the hall from the one I spent all day in the day before. And the doctor I saw this time was thrilled to have a patient who could give him a decent medical history. However, they inject a radioactive dye into your veins when they do the CT scan and since it hadn't been 24 hours since the last one, they needed to flush my system with as much fluid as possible so I'd pee it all out before they injected anymore or else my kidneys wouldn't be too happy.
IV fluids mean, of course, getting an IV and my veins seem to have their own rules regarding how much they'll cooperate in a 24 hour period. After two unsuccessful pokes, the nurse got somebody from phlebotomy to come in. The phlebotomist managed to get the IV in so that the fluids could go in, but it wouldn't let her take enough blood out for the blood tests that they needed. Another stick in my right wrist did the job.
While they waited for the fluids to clean me out, they did an ultrasound of my legs to see if there were any blood clots, i.e. deep vein thrombosis. Most pulmonary emboli start there. That's how I got the PE I had seven and a half years ago. I had had surgery on my right ankle and knee and within a week ended up with clots in three veins between ankle and knee. But this time my legs were just fine. So, we just had to wait for those IV bags to empty into my arm. It meant my mom and I had some mother-daughter bonding time. And when her fiance came after work, I also got to know him a little better. Definitely beats sitting in a room alone for 11 hours.
After a clean pee test showing that my kidneys were doing fine, I finally got my CT scan and awhile later got my diagnosis: pulmonary embolism at the base of each lung. Yep, not just one lung but both. Combined with the fluid in my left lung, it was all pressing down on my diaphragm, which was then putting pressure on my colon which is what was keeping it from moving properly.
I knew I was right about my colon not moving for a reason. Though, have to admit, PE was nowhere on my radar screen.
At any rate, I got to spend the night in the hospital where they continued to give me lots of strong narcotics as they had been in the ER. The idea was to make it as comfortable as possible for me to breathe so I wouldn't get pneumonia. And once we got the pain under control, I was actually fine. Completely sleep deprived, but fine. Which meant I got to go home the next day. My oxygen level was stable. I know how to give myself the Lovenox shots in my belly as I'd done seven years earlier. And I was desperate for a good night's sleep -- which ya sure as hell don't get in a hospital!
Of course, I'm supposed to go on and have a hematologist run a bunch of tests once I'm stable on the anti-coagulants to see if I might have some sort of blood disorder. And the doctor in the hospital warned me that the rule is generally two PE events and it's automatic lifetime anti-coagulation (whatever happened to the whole "three strikes" thing?). I have to admit this scares the fucking hell out of me. Six months on this shit is a bitch. But spending the rest of my life having to worry about whether or not I might start hemorrhaging if I bump my head too hard is just a bit hard to face at the moment.
Yet I have to say, I woke up on Saturday morning after a solid twelve hours of sleep (well, the alarm clock woke me up every four hours to take some Dilaudid) very grateful for whoever it was that took a closer look at my CT scan. He or she saved my life. (The doctor I saw Sunday night/Monday morning in the ER when I had a scare with pain in my right lung said PEs are what keep doctors awake at night: they can be hard to find and tragic if you miss them.) I mean, I'd like to think that at some point I would have thought "hey, I'm not breathing very well." But God only knows if I would have done that in enough time to make a difference. Thankfully, God didn't make me wait that long.
The next day I canceled my appointment with my massage therapist/acupuncturist/Magic Lady and just slept. But the pain in my belly kept getting worse. And more focal. By the end of Tuesday night it was quite distinctly focused on my upper left side, just below my rib cage. I was too tired to go to the ER and figured since I didn't have a high fever it could wait until morning. Not that I got all that much sleep. My combination of hydrocodone and oxycodone barely made a dent in the pain.
The advice nurse the next morning was able to set me up an appointment with my nurse practioner, K., that afternoon. It wasn't until I walked downstairs to catch the Medical Transportation taxi that I realized just how much pain I was in. When I got to my clinic I was in tears and after listening to my belly for a moment or two, K. said that she wasn't hearing much sound in my lower bowels. That and the fact that I was clearly in a great deal of pain made her suspect that there was some sort of blockage and that I should go directly to the Emergency Room.
Upon arriving up at Oregon Health Sciences University hospital around 3 pm, I groaned when I saw six ambulances in front of the ER. K. had wanted me to go there instead of the closer Good Samaritan because I'm already seeing a uro-gynecologist up there and if it was something related it would be easier to share records, etc. But OHSU is also the primary trauma center for the Portland metropolitan area. And the public hospital where those without insurance are more likely to go. Needless to say, you wait a hell of a lot longer there than at Good Sam.
After spending an hour in the waiting room, I was in excruciating pain. And it's funny to watch how egocentric you become at a moment like that. Why the hell does she get to go before me? I mean, she can actually walk! Clearly my pain is worse. My case much more dire. Me, me me, damnit! Finally -- FINALLY! -- my turn to be herded back behind the sacred steel doors of the ER came.
I was dumped into a tiny room towards the back with no clock, a kid's plastic toy truck and some sort of magazine. You know, along with all the regular hospital stuff -- boxes of purple nitrile gloves, sharps boxes, machines that measure blood pressure, oxygen, etc. I sat on the gurney and tried to find a position that wasn't unbearable. I finally laid on my right side with my left leg and arm slightly askew and cried while I waited the next hour for the doctor to come in.
A tiny little Asian girl with a bouncy ponytail and faux horned-rimmed glasses eventually opened the door and introduced herself as my doctor. She sat down next to me and asked like a kindergarten teacher to a little child, "why are you crying?"
Apparently they never taught her in medical school that people go to an ER when they are in PAIN!
After explaining where I was in pain, her next question was "so, like, how do you handle pain? Are you, like, one of those people who has, like, a low tolerance?"
If I wasn't so damned incapacitated at that moment, I would have slapped the little bitch.
We moved onto my medical history. As I deal with doctors so much, I've made a good-faith effort on my part to help them out and learn their language a bit. I mean, I've studied five languages (not that I'm fluent in any of them) so it's not that big of a leap, you know?
"So, like, are you one of those people who likes to read the Internet about diseases and stuff?"
Again, somebody needed some serious bitch-slapping here.
"No, I'm a grad student. I'm reasonably intelligent and I find it's a hell of a lot easier for me to pay attention to what's going on with me than to expect you all to just magically read my mind and know what's going on."
"Oh."
Then she became tolerable. But I have to say she wins the prize for the most annoying doctor ever. Hmm...well, now that I think about it, she wasn't as bad as my pediatrician was, but she's definitely worse than my old orthopedist. And God knows it takes a special talent to be more annoying than an orthopedist.
She ordered a chest X-Ray and a CT scan of my abdomen. And left. And I waited. I got my X-ray. My CT scan. A nurse came in at one point and gave me some morphine, which helped a bit. By the time I saw a doctor again it looked to be dark outside from what I could see behind the blinds -- sometime after nine.
This new doctor was an older woman who looked like my boyfriend's sister accompanied by another resident. We chatted about my medical history. She asked some more about my CFIDS. At some point I'd mentioned off-hand that I'd had a parasite when I was in the West Bank and knew what serious diarrhea was like, as well as that had been one of the few times in my life I couldn't poop after they gave me some sort of industrial strength anti-diarrheal. The conversation turned to my graduate work. About how I had to drop out of my program last year (something she seemed genuinely sorry to hear). About how so far all of our testing just turned up little bits of odd stuff here and there leaving me with this placeholder diagnosis of Chronic Fatigue Immune Dysfunction Syndrome. She seemed to share my frustrated bafflement but said that I was in good hands with the MD I see at my clinic, whom she knew, in addition to my nurse practioner. And while there hadn't been any news yet from radiology, she explained that there isn't much on the left side that causes a lot of pain (well, aside from the spleen but as I had no fever that was improbable) so the most likely explanation was that I was constipated. I knew that couldn't be it as I don't get constipation like that, but she assured me that it can be extremely painful. When the CT scan finally came back, it showed I was indeed constipated, but the chest X-ray also showed that I had fluid in my left lung.
Huh? WTF? I mean, sometimes I'll have a little cough in the morning when I wake up but, I mean, nothing that's even felt like so much as a cold.
Well, that left them baffled. She called the doctor on call for my clinic, who apparently told her I could be seen the next morning. So she gave me a prescription for Lactulose and sent me home with instructions that I was absolutely to go into my clinic in the morning.
By that point I had called my mom and when I told her about the fluid in the lungs she insisted that I stay the night with her. I was in so much pain I knew I really wasn't capable of staying on my own so I relented so long as she took me to my appointment in the morning as her place is way out in a suburb far, far away from my clinic.
And getting that appointment was a pain in the ass. Whatever that on-call doctor told the ER doctor was a load of crap because getting a same-day appointment is apparently one of those serendipitous events akin to finding a dollar on the ground. It does happen sometimes but you should never count on it. Eventually we did find one and as we raced to get downtown in time, I happened to re-read the discharge papers from the night before, which included instructions about how they may contact you later if they get further results from the tests they did in the ER. Since I hadn't been at home I realized I might want to check my voice mail. Lo and behold there was indeed a message from the radiology department saying that I needed to call them back or return to the emergency room as soon as possible.
They probably found that blockage my nurse practioner suspected.
I called and immediately reached the lady who had called me.
"We took another look at your CT scan," she explained, "and it looks like there might be a pulmonary embolism in your right lung."
PE? Again? How? But it's my LEFT side that hurts...
I started crying a little and told her we could be there in the next twenty minutes or so. That's when it finally dawned on me that it was hurting a great deal to breath. I mean, I did know that it hurt but I had just assumed that it was because of the pressure from my belly. And crying was even more painful so I composed myself quickly.
I don't remember there being an ambulance in front of the ER when we arrived, but it was still pretty busy. They checked my vitals and signed me back in. My oxygen saturation level was 100% so even if there was a clot in my lungs, I was still getting plenty of air. Which was good because there was, of course, the requisite wait in the waiting room, after which I found myself in the room across the hall from the one I spent all day in the day before. And the doctor I saw this time was thrilled to have a patient who could give him a decent medical history. However, they inject a radioactive dye into your veins when they do the CT scan and since it hadn't been 24 hours since the last one, they needed to flush my system with as much fluid as possible so I'd pee it all out before they injected anymore or else my kidneys wouldn't be too happy.
IV fluids mean, of course, getting an IV and my veins seem to have their own rules regarding how much they'll cooperate in a 24 hour period. After two unsuccessful pokes, the nurse got somebody from phlebotomy to come in. The phlebotomist managed to get the IV in so that the fluids could go in, but it wouldn't let her take enough blood out for the blood tests that they needed. Another stick in my right wrist did the job.
While they waited for the fluids to clean me out, they did an ultrasound of my legs to see if there were any blood clots, i.e. deep vein thrombosis. Most pulmonary emboli start there. That's how I got the PE I had seven and a half years ago. I had had surgery on my right ankle and knee and within a week ended up with clots in three veins between ankle and knee. But this time my legs were just fine. So, we just had to wait for those IV bags to empty into my arm. It meant my mom and I had some mother-daughter bonding time. And when her fiance came after work, I also got to know him a little better. Definitely beats sitting in a room alone for 11 hours.
After a clean pee test showing that my kidneys were doing fine, I finally got my CT scan and awhile later got my diagnosis: pulmonary embolism at the base of each lung. Yep, not just one lung but both. Combined with the fluid in my left lung, it was all pressing down on my diaphragm, which was then putting pressure on my colon which is what was keeping it from moving properly.
I knew I was right about my colon not moving for a reason. Though, have to admit, PE was nowhere on my radar screen.
At any rate, I got to spend the night in the hospital where they continued to give me lots of strong narcotics as they had been in the ER. The idea was to make it as comfortable as possible for me to breathe so I wouldn't get pneumonia. And once we got the pain under control, I was actually fine. Completely sleep deprived, but fine. Which meant I got to go home the next day. My oxygen level was stable. I know how to give myself the Lovenox shots in my belly as I'd done seven years earlier. And I was desperate for a good night's sleep -- which ya sure as hell don't get in a hospital!
Of course, I'm supposed to go on and have a hematologist run a bunch of tests once I'm stable on the anti-coagulants to see if I might have some sort of blood disorder. And the doctor in the hospital warned me that the rule is generally two PE events and it's automatic lifetime anti-coagulation (whatever happened to the whole "three strikes" thing?). I have to admit this scares the fucking hell out of me. Six months on this shit is a bitch. But spending the rest of my life having to worry about whether or not I might start hemorrhaging if I bump my head too hard is just a bit hard to face at the moment.
Yet I have to say, I woke up on Saturday morning after a solid twelve hours of sleep (well, the alarm clock woke me up every four hours to take some Dilaudid) very grateful for whoever it was that took a closer look at my CT scan. He or she saved my life. (The doctor I saw Sunday night/Monday morning in the ER when I had a scare with pain in my right lung said PEs are what keep doctors awake at night: they can be hard to find and tragic if you miss them.) I mean, I'd like to think that at some point I would have thought "hey, I'm not breathing very well." But God only knows if I would have done that in enough time to make a difference. Thankfully, God didn't make me wait that long.
Monday, June 05, 2006
FYI
My trip to the Emergency Room on Wednesday for stomach pain since Mondy ended up with a diagnosis of pulmonary emboli in both lungs by Thursday night. I've been trying to write up a narrative about it and hope to finish that once I get caught up on sleep. Staying out of the ER would probably help that, of course...
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