Barrelhaven – Page 8

Brain Radio

A somewhat different impetus for this episode of brain radio, in that the song running through my head reminded me of an album that I had (almost inexplicably) forgotten about entirely.

For a few days I had a song by Laurie Anderson running through my head. I couldn’t remember the name of the song (it turned out to be Langue D’amour) so I went to my music library, sorted by artist, Laurie Anderson, and totally failed to find what I was looking for.

This was puzzling to me. I’ve been a fan of Laurie Anderson since I was in my early teens and I was reasonably sure I had all her music from the mid-‘80s to late-‘90s in my library. So I went to [$online_music_store] and my jaw dropped. I had totally forgotten about the album Mr. Heartbreak.

Somehow, at some point in the remote past, during a shuffle of data from one hard drive to another, Mr. Heartbreak fell out of my library without me noticing and it’s existence just slipped from my mind. The oddest are thing about the situation is that Mr. Heartbreak is still probably my favorite of Anderson’s studio albums.

The album was released in 1984, which was probably about the time I discovered it. Unfortunately I have absolutely no memory of how I got connected with Anderson’s music. I’m almost positive I didn’t hear it on the radio, although c. 1986 the song O Superman (For Massenet) from her first studio album Big Science did get a little airplay on the new wave station in Seattle (KJET 1590 AM). Anyway, the album has vocals by Peter Gabriel and (of course) William S. Burroughs in addition to Anderson and is about as mainstream as her material gets, in the sense of being considerably more accessible than, say, some of her spoken word/poetry performances with John Giorno. Which is sort of like saying an airport is more accessible than the high security areas of the Pentagon; the former you can get in to, but it takes work, whereas attempts to get in to the latter will, best case scenario, result in nothing but frustration and, worst case scenario, may result in serious head trauma. But I digress.

There is still a share of surreal imagery, experimental sounds, and examples of Anderson’s fascination with Bible stories and literature, but they’re hidden a little better. On some tracks anyway. The whole album is amazing, but this is the track that stuck in my head;

Oh right. That.

I suppose people might be curious about the outcome of my visit to the urologist today.

The news is not bad. Dr. Urologist was happy with how everything looked right now and wants to wait another three months for the inflammation from round 1 to really get gone before starting round 2. There are still some cytology results that we’re waiting for but Dr. Urologist is not really expecting anything to show up.

This is pretty good news under the circumstances. The fact that he is willing to wait three months before more treatment is reassuring. The only down-side is that I will probably have to go back to my real job for at least a while until round 2 starts.

Nothing is perfect.

I can’t even with this

This popped up on one of the nursing forums I lurk on so I can’t absolutely vouch for its authenticity, but it seems unfortunately plausible. Someone wants to put themselves on extracorporeal membrane oxygenation at home rather than get vaccinated.

As a point of information, this is what someone on ECMO looks like:

I assure you there is a patient under all that equipment

And just for further fun, this is what happens when a component on the ECMO circuit fails and you have to swap it out for a new one:

That was a real patient (I was filming) and once my two colleagues there put the clamps on the circuit the patient was, by some quite reasonable definitions, dead and wasn’t really alive again until they took the clamps off.

So yeah, go ahead and do this at home. Good plan. WAY better than getting vaccinated.

Edited to add – Looking at the picture and video above, I am almost positive they are the same patient. I remember when we were getting set up to change the oxygenator there was a great deal of unease because the patient was entirely dependent on the pump to keep his blood circulating. His heart was not actually beating at all.

A normal person with even a minimally functioning heart will produce a tracing on an arterial blood pressure line that looks similar to this;

The red line there measures the pressure changes in an artery (usually the radial artery in the wrist, the same place you feel for someone’s pulse) with every beat of the heart.

If you look closely at the two monitors in the picture above that have an art-line tracing on them, you will see this;

Those lines are, in fact, flat. This is not all that unusual for people with bad hearts that have a pump doing all the work for them but what it does mean is that if something stops the pump, like someone clamping the circuit so they can change the oxygenator, all the patient’s blood pressure goes away. Not “low blood pressure” but “no blood pressure”.

So again, go ahead. Do this at home. What could possibly go wrong?

If you want to learn more about extracorporeal membrane oxygenation, check your local library!

Or just ask and I’ll talk about it for as long as you’ll let me.

Two days until round 2

Time for some brief updates on everything.

I had previously decided that I was going to take a short break from school during the month of October and that has gone through, been approved and is all taken care of. I’ll be back to working on my degree in November. I’m not terribly excited about the delay, but I think it will allow me to get enough other fires put out that when I do go back I will have a much easier time focusing on schoolwork, so I think this will be a good thing.

The basement is frustratingly close to being done. We have been wrestling with the people who are going to replace the bits of the floor that are missing since the second week of August with almost nothing to show for it. Supposedly they’ll have all the flooring tiles, adhesive, baseboards, etc. this week and the installers are tentatively scheduled for Thursday. If everything goes well. Maybe. It’s not certain.

I’m trying to remain optimistic that the floor will be done by the second week of October and then The Great Unpacking will commence. The Great Unpacking should only take a few days, a week at most, and then the basement will be done.

Side effects; the fatigue is way better. I’m still not 100%, maybe more like 75-80%. Just in time to get scoped in two days and start round two of treatment. Round two will not necessarily kick off right away, but this is what is going to set the schedule. I am hoping that with only three treatments instead of six, maybe I’ll only be half as fatigued afterwards. Time will tell.

Work; I will confess to being somewhat anxious about work, likely for no good reason at all. As previously mentioned, My doctor wrote me a note authorizing essentially indefinite light duty and I plan to take advantage of that. I don’t think there is anything that my employer can legally do to pressure me to return to my usual job but I also have to wonder what kind of reception I’m going to get after slacking off for 2-3 months. Time will tell.

Events may be aligning such that I will only have to deal with work and treatment during the month of October which will almost be like a vacation compared to the last six months. Of course the last time I said something like that we ended up having a global pandemic, the country elected one of the top three worst presidents in the history of the United States, the basement flooded (again) and I changed jobs three times.

I’m keeping my mouth shut this time.

In the spirit of transparency

Too much information alert!

Proceed at your own risk

This is another one of those things that I would ordinarily keep to myself, both because I didn’t want people around me to worry, and because I genuinely don’t know how much it should be worried about at all.

Since Friday I have been having symptoms very much like a urinary tract infection. This was kind of curious. While I have more reason than some to have a uti, it’s pretty much been life as usual for me for the last month or so and I would think that any infection issues related to the BCG treatments would have popped up before now.

So I went in to urgent care (my primary care doctor was scheduled out for the next month or so), dropped off a urine specimen, picked up a prescription for nitrofurantoin and went on my way. A couple of days later I got a call reporting that my urine culture was negative. Which would almost certainly mean I didn’t have a uti.

And yet I continued (and continue) to have symptoms very much like a urinary tract infection, only thing missing is fevers. So what is causing the symptoms?

The answer is, of course, “I don’t know, but probably not anything I’m going to be happy to find out about”. I already have an appointment with the urologist in three days and I don’t think three days is going to make any difference with anything one way or the other.

We shall see.

Okay, fine…

If you run into an asshole in the morning, you ran into an asshole. If you run into assholes all day, you’re the asshole.
Raylan Givens; Justified

Not saying I’m the asshole (not meaning to imply that I’m not the asshole either) but when different people are all independently telling you the same thing, you may want to pay attention to what they’re saying.

As mentioned in the previous post, nearly every person of significance in my life that I talked to about the question of whether or not to come off light duty said the same thing with surprisingly little variation. The common theme seemed to be a general concern that I was going to scramble my brain if I didn’t ease up on things a little.

I will certainly admit to having felt overwhelmed and overcommitted for most of the last three years or so, but I always assumed that was because my life was a disorganized mess and I couldn’t get my shit together. It is possible that I have been feeling overwhelmed and overcommitted because I actually have been overwhelmed and overcommitted. And then I got cancer.

The point to all this is that my primary care doctor gave me a note that appears to authorize light duty for me indefinitely and I may take advantage of that to stay on light duty until I actually feel better. As one particularly insightful person pointed out to me, I have obligations to my family that should carry at least as much weight as my obligation to work. It has been altogether too easy for me to forget that and I needed the reminder.

I’m still not sure what needs to happen before I feel like I’m ready to go back to work but I’m going to make an effort to find out rather than just going back whenever.

To return, or not to return…

As previously mentioned, I went and saw my primary care doctor on Friday. He didn’t really have any concrete ideas about the fatigue. He ordered a few basic blood tests to see if I’m anemic (I’m not), or hypothyroid (I’m not), or have any kind of unusual muscle damage (I don’t). In spite of that, he was somewhat equivocal on whether or not I should go back to work in the unit. He felt that I probably could go back to work but it would also be understandable if I stayed on light duty for a while longer, without a great deal of specificity on what “a while longer” might mean.

Being that I appear to be almost completely incapable of making this decision, and have been required to do so more times than I care to think about for school, I decided to make thing as complicated as possible and create an evidence table for whether or not I should go back to work. I’m leaving out any judgement on the quality of the evidence because I don’t think anyone I interact with on even a semi-regular basis has much to show in the way of an impact factor.

SOURCE	SUMMARY OF EVIDENCE	CONCLUSION
Friends and family	Stay the f*** home, doofus	Stay on light duty
Critical care management	We’d like to have you back but take whatever time you need	Indeterminate, leans return to work
Employee health management	We want you to get better of course, but we really need the help	Indeterminate, leans stay on light duty
Mental health provider	You’ve been through a great deal recently and there is nothing wrong with staying on light duty if you feel like you need to	Stay on light duty
Urologist	Nothing we did should be making you fatigued at this point	Return to work
Primary care provider	You could go back to work, but you really are being treated for a legitimate medical issue so you can certainly stay on light duty if you need to	Indeterminate
My brain	There isn’t anything wrong with you, stop malingering, STFU & GBTW	Return to work

With it laid out like that, the conclusion is pretty clear; I should listen to my brain because it appears to have the loudest and most annoying voice.

Okay, not really. But I reserve the right to feel like a slacker for staying home.

The List of Medications

One of the more common objections to the covid vaccine is that no one who claims to be a Good Christian™ (and it’s always Christians) can get the vaccine because it was made using “aborted fetuses”.

As anyone with more than two functioning neurons could guess, reality is a bit more complicated. The Oxford-AstraZenica vaccine was, in fact, developed using Human Embryonic Kidney 293 (HEK-293) cells. These cells are commonly used to replicate viral proteins which are then used to deliver mRNA sequences. The HEK-293 cells themselves are not a part of the finished products.

“But wait,” you might say, “If the AstraZenica vaccine is the only one that is manufactured using HEK-293 cells, why don’t they just take one of the other ones?” Well here’s the thing, HEK-293 cells are also frequently used in the early stages of development to test the function and potential toxicity of a new drug, and every single one of the covid vaccines was tested on HEK-293 cells. What can a Good Christian™ do but decline to take these vaccines that were tested on ~~the cloned cells of an immortalized cell line originally derived from the kidneys of a fetus that was either aborted or miscarried, no one is quite sure which, in 1973~~ poor innocent murdered babies.

The problem is that there are a METRIC CRAPTON (2.2 imperial craptons) of drugs that are tested for safety using HEK-293 cells.

(Blatantly stolen from https://www.patheos.com/blogs/throughcatholiclenses/2021/01/if-any-drug-tested-on-hek-293-is-immoral-goodbye-modern-medicine/)

Common over the counter medicines tested on HEK-293 cells or derivative cell lines.

Tylenol / Acetaminophen (1, 2)
Advil / Motrin / Ibuprofen (1, 2)
Aspirin / Acetylsalicylic Acid (ASA) (1, 2)
Aleve / Naproxen (1, 2)
Pseudoephedrine / Sudafed / / SudoGest, Suphedrine (1, 2)
Diphenhydramine / Benadryl (it is used so much with HEK293 that it has a page for using it and HEK293 together for further studies on the FDA site, 2)
Loratadine / Claritin (1, 2)
Dextromethorphan / Delsym / Robafen Cough / Robitussin (1, 2)
Guaifenesin / Mucinex (1)
Tums / Calcium Carbonate (1, 2)
Maalox / Aluminum Hydroxide and Magnesium Hydroxide (1)
Docusate / Colace / Ex-Lax Stool Softener (1, 2)
Senna Glycoside / Sennoside / Senna / Ex-Lax / Senokot (1)
Pepto-Bismol / Bismuth Subsalicylate (1)
Phenylephrine / Preparation H / Vazculep / Suphedrine PE (1, 2)
Mepyramine / Pyrilamine (1, 2)
Lidocaine / Lidoderm / Recticare (1, 2)

Common prescription drugs tested on HEK-293 cells or derivative cell lines.

Levothyroxine / Synthroid / Tirosint / Levoxyl (1, 2)
Atorvastatin / Lipitor (1, 2)
Amlodipine / Norvasc (1, 2)
Metoprolol / Toprol XL / Lopressor (1, 2)
Omeprazole / Prilosec OTC / Zegerid OTC / OmePPi (1, 2)
Losartan / Cozaar (1, it is used so much in testing the FDA has a page on using it with HEK293)
Albuterol / Salbutamol / ProAir / Ventolin (1, 2)
Sacubitril / Valsartan / Entresto (2 studies mentioned in FDA application)
Tenapanor / Ibsrela (1 study mentioned in FDA application, 2)
Enbrel / Etanercept (1, 2)
Azithromycin / Zithromax (1, 2)
Hydroxychloroquine / Plaquenil (1, 2)
Remdesivir / Veklury (1, 2)
Dapagliflozin / Farxiga / Ipragliflozin / Suglat / Enavogliflozin / Jardiance (1)
Ivermectin / Stromectol (1, 2)
Canagliflozin / Invokana / Sulisent / Prominad (1 study mentioned in FDA application)
Metformin / Glucophage / Riomet / Glumetza (1, 2)
Cerivastatin / Baycol / Lipobay / Fluvastatin / Lescol / Pitavastatin / Livalo / Pravastatin / Pravachol / Rosuvastatin / Crestor (1)
Simvastatin / FloLipid / Zocor (1)
Oxbryta / Voxelotor (1 study mentioned in FDA application)
Lisinopril / Qbrelis / Zestril / Prinivil (1, 2)

Take particular note, if you will, of numbers 12 and 15 on the list of prescription medications and you may spot some familiar names if you’ve been following the trends in quack covid treatments.

Essentially, if Good Christians™ are going to take a moral stand against being vaccinated because of their opposition to abortion, they’re pretty much going to have to give up on modern medicine. Fortunately, at least one employer is asking anyone requesting a religious exemption from the vaccine to do just that.

If it’s a sincerely held belief, you have to be consistent, right?

Brain radio

One of my professors when I was in nursing school told us that we should pay attention to the songs that are running through our heads because sometimes they can be an insight into what out subconscious is doing. She taught psychiatric nursing and was herself a few bananas short of a bunch but that one thing has stuck with me over all these years.

For the last few days I’ve had Medicine Show by Big Audio Dynamite running through my head.

So how am I doing?

Recalling that the original purpose of this blog was to be a platform for updates on my cancer treatment and not really a platform for me to bitch about Covid, and realizing that I hadn’t actually made mention of my condition for a while, I have decided to try and rein this thing in a bit by combining a rant about Covid with a brief update on how I’ve been feeling.

I am still on light duty at work. The fatigue has definitely improved but only to the point that it is limiting instead of debilitating. I asked the urology clinic nurse about this, given that it has now been a bit over a month since my last treatment and I still haven’t bounced all the way back. The urology clinic really had nothing to offer other than to say that it would be unusual for the fatigue caused by BCG treatments to last this long. I have an appointment with my primary care doctor to rule out any other possible cause and after that, who knows? There is also a good chance that part of why my activity tolerance has gone to shit is that I am completely deconditioned from sitting on my ass for the last month plus.

Whatever is causing it, I still don’t feel like I would have the endurance to make it through a 12 hour shift in the ICU, especially under current conditions. Which brings me to my rant about Covid;

The two incidents I posted about below (and there are plenty more stories like those circulating around) made me realize that I simultaneously feel profoundly grateful that I am not working on the unit right now and incredibly guilty because I am not working on the unit right now. Every hospital in the country is desperately short of ICU staff and I am, in my own small way, totally not making that situation even a little bit better. Especially if there isn’t an identifiable physical cause for my continued lack of energy, I am going to have a really hard time justifying sitting things out for much longer.

I’m scheduled on my light duty assignment through next week, which will give me time to see my primary care and make sure there isn’t anything weird or unlikely going on physically and then I have a somewhat difficult decision. I would really prefer to not dive right back in, but things out in the world are not likely to improve much any time soon and I am not going to be able to stay on light duty forever, so a return to the ICU is inevitable. With that being the case, is there any point to putting it off?