28 June, 2010

Good news, bad news.

Today was the day I meet with my neurosurgeon.  Not the one that operated on my back originally, but nonetheless a consultant and therefore good enough for me.

Knowing that the fraternity has rules I asked “Should I call you Mr?”  He smiled as the MRI and CT images loaded on his computer monitors and replied “Dave was good enough for my mother, so it’s good enough for you.”

Dave it is.

We chatted about things in general, then about the things that mattered.  He showed me the MRI, scrolling back and forth to satisfy himself the titanium had fully bonded. The plates, the screws, the 2 delicate cages that held a donor wedge of bone in place where a disc once was.  Fusion was total and couldn’t be undone.  But he wasn’t happy.  The work Emir, my original neurosurgeon, did was first class.  The problem was not of the surgery but of my body continuing to break down.  The arthritic spine was evident, almost glowing white hot on where vertebrae rubbed on vertebrae.  However we all knew that and it wasn’t a surprise.

The surprise is that the canal which the spinal cord passes through is too narrow, and becoming even more narrow.  There is no room for spinal fluid to surround the vital bundle of nerves.  It’s like having a delicate bundle of fibre optic cables being crushed in a vice from all sides.  Without intervention the sheath that protects the bundle will rupture and the core of nerves will become damaged without prospect of repair.

Fortunately the structure is stable for the moment.  It will become less stable over time, but Dave is a conservative and won’t operate unless the vertebra above my fused vertebrae become unstable.  I like his thinking; the more of the spine that is fused, the greater the pressure on the spine overall as the forces cannot be dissipated.  That’s what discs are for, to act as shock absorbers and dissipate much of the forces on the spinal column.

In one particular type of arthritis, which mainly affects young men, the vertebrae slowly fuse together until there is no movement of the spine.  Ironically this fusion makes the spine weaker, not stronger, because forces on it cannot be distributed properly.  Also the arthritis makes the bone more brittle, so fractures are far more likely to happen.  It’s been known by many names, bamboo back being one of the most common because the spinal column looks like bamboo.  These days ankylosing spondylitis (AS) is its common name.  A progressive degenerative disease related to rheumatoid arthritis (RA) - the main type of arthritis I have - and like RA, AS is a auto-immune disease.  That is, the person’s own immune system doesn’t recognise the body’s own tissue and attacks it.  In AS, the immune system attacks the fluid in the degenerating discs and the facets of the vertebra.  In RA, the immune system also attacks the bone in the synovial fluid in, for example, the fingers.  The fluid acts as lubricant and prevents bone rubbing on bone.  In my case, the poly arthritic nature of my RA affects my fingers, wrists, and my spine.  Probably my ankles too, but I don’t worry so much about them, particularly my right ankle as I can’t feel it, and my lower right leg and foot are supported by a high tech device that stops my foot from drooping and the ankle from twisting.  On flat, solid, grippy surfaces I can walk without the aid of my walking stick.  It’s an amazing feeling to be able to do that, I can’t begin to describe how much better I feel within myself to walk without aid or fear.

So, where to now?  Pain management still goes on, as does hydrotherapy and physiotherapy and, of course, consultations and prescriptions.  More importantly, Dave has referred me on to a neurologist.  The point being?  There are other issues besides walking strangely or pain.  Somewhere higher up, near or in the thoracic vertebrae, is causing a few problems.  It’s not painful, unlike my lumbar, but it needs to be looked at.  If surgery can be avoided, I don’t mind.  If not, then I know I can trust Dave to make the right decisions after another consultation.  Of course it’s great not being in a position where a decision must be made now, that my spinal column is so unstable that intervention must happen now.  I’ve been through that before, the emergency, the temporary stabilisation, the operation, and the ongoing rehabilitation.  It’s not something I would wish on anyone.

For now I’m not sure how to feel about the idea of my spine slowly crushing my spinal cord.  It’s not a surprise to me in a strange sort of way.  I’ve already started on my “bucket list.”  Today I opened a special savings account with the goal of saving enough money to travel to Beijing then travel to catch one of the Trans-Siberian trains through Novosibirsk, onto Moscow, stay a few days, then catch the Red Arrow to St Petersburg.  Why?  To do it before I can’t.

I’m not saying that being a paraplegic would stop me from doing what I want to do, but I want to be able to do it while my legs have some function left.  In some ways when my back broke, it may have been better to have lost my legs (which I did until the operation) and not have the debilitating chronic pain that I have now - a case of being able to fool most people much of the time and a few people none of the time.  Those who have met me probably think I’m a pain in the arse, or perhaps a little too jolly.  Those who know me understand that if I stopped and thought even a little about how much it hurts physically and emotionally, I would seize up like Tin Man in the rain.

There is another driving force.  Every day I’m at Royal Perth Hospital, Shenton Park Campus where rehabilitation is the focus, I see young and old who have lost limbs, who are para/quadriplegic and are rebuilding their lives.  Some are at the beginning of their journey, some are nearing the point in their lives where they are truly independent for the first time in their life.

If the prospect of death focuses the mind, then the prospect of losing independence toughens the resolve.  My resolve has never been tougher.  This is a war I cannot win, but I can, and will, win many battles along the way.

27 June, 2010

The Dashing of Babies' Heads

This is a response to http://twitter.com/heidiraff/
@Epigrammist Ezekiel 9 Explanation - Question posed by atheists on Twitter: How can the order by god in... http://tumblr.com/xt1c64w9u

Which in turn was her response to @DanVerg’s question; How can Ezekiel 9 be justified?  I embellished the question - in order to get a response as @heidiraff was constantly stalling - with a passage form Psalms.  Psalm 137:9 to be precise.  You may remember the song as sung by Boney M; By The Rivers of Babylon:
By the rivers of Babylon, there we sat down, yea, we wept, when we remembered Zion. 2 We hanged our harps upon the willows in the midst thereof. 3 For there they that carried us away captive required of us a song; and they that wasted us required of us mirth, saying, Sing us one of the songs of Zion. 4 How shall we sing the Lord’s song in a strange land? 5 If I forget thee, O Jerusalem, let my right hand forget her cunning. 6 If I do not remember thee, let my tongue cleave to the roof of my mouth; if I prefer not Jerusalem above my chief joy.7 Remember, O Lord, the children of Edom in the day of Jerusalem; who said, Rase it, rase it, even to the foundation thereof. 8 O daughter of Babylon, who art to be destroyed;  happy shall he be, that rewardeth thee as thou hast served us. 9 Happy shall he be, that taketh and dasheth thy little ones against the stones.

Ok, so Boney M didn’t sing happy shall he be that taketh and dasheth thy little ones against the stones, but it would have made for an interesting song.  Back to Psalm 137 later.

Ezekiel 9 says (in the King James Version):
1 He cried also in mine ears with a loud voice, saying, Cause them that have charge over the city to draw near, even every man with his destroying weapon in his hand. 2 And, behold, six men came from the way of the higher gate, which lieth toward the north, and every man a slaughter weapon in his hand; and one man among them was clothed with linen, with a writer’s inkhorn by his side: and they went in, and stood beside the brasen altar. 3 And the glory of the God of Israel was gone up from the cherub, whereupon he was, to the threshold of the house. And he called to the man clothed with linen, which had the writer’s inkhorn by his side; 4 And the Lord said unto him, Go through the midst of the city, through the midst of Jerusalem, and set a mark upon the foreheads of the men that sigh and that cry for all the abominations that be done in the midst thereof.  5 And to the others he said in mine hearing, Go ye after him through the city, and smite: let not your eye spare, neither have ye pity: 6 Slay utterly old and young, both maids, and little children, and women: but come not near any man upon whom is the mark; and begin at my sanctuary. Then they began at the ancient men which were before the house. 7 And he said unto them, Defile the house, and fill the courts with the slain: go ye forth. And they went forth, and slew in the city. 8 And it came to pass, while they were slaying them, and I was left, that I fell upon my face, and cried, and said, Ah Lord GOD! wilt thou destroy all the residue of Israel in thy pouring out of thy fury upon Jerusalem? 9 Then said he unto me, The iniquity of the house of Israel and Judah is exceeding great, and the land is full of blood, and the city full of perverseness: for they say, The Lord hath forsaken the earth, and the Lord seeth not. 10 And as for me also, mine eye shall not spare, neither will I have pity, but I will recompense their way upon their head. 11 And, behold, the man clothed with linen, which had the inkhorn by his side, reported the matter, saying, I have done as thou hast commanded me.

I suggest for those who aren’t familiar with bibles or concordances (those wonderful little bits of theological academia that justify anything, link any verse to any other verse, and generally attempt to confuse anyone trying to understand the bible for themselves) to grab one and have a look at the contexts in which Psalm 137 and Ezekiel are written.

@Heidiraff’s answer breaks down into 2 parts;
1. (biblical) Israel was corrupt, and
2. was in need of cleansing.  Yes, even new-borns who had no concept of “right” and “wrong”.

Ezekiel was an old school prophet; the “oh woe is Israel, oh woe is Jerusalem!” kind of guy.  This “prophecy” is no different (but I wonder if they only remembered and wrote down the prophecies that were right and those that were wrong were erased from history; certainly many prophets were denounced as false prophets).

In essence, what Ezekiel wrote (by tradition) was “God yelled at me, saying get all those that run the city, particularly priests, into the sanctuary with all their families so he can send his messengers down to destroy them.  Ok?  Thanks!  Oh, by the way, there is this angel next to me recording this event in a very efficient, bureaucratic way with pen and paper.”

@Hiediraff claims this is the same deal as Noah’s ark.  The obvious question here is that if Noah’s ark was supposed to rid the world of corruption and evil, since Noah was a righteous man, then why would it have to be done all over again?  If the story of Noah is to be believed, then we are all a result of incestuous sex from Noah’s family, which means the “flood” really wasn’t a great idea after all, even if there was archeological and geological evidence for it.  Which there isn’t.

Did god fail?  Because it’s starting to look like the god of the Israelites, Christians and Islamists is very good at getting prophets to write down a plan for humanity to marvel at before cocking up its execution.

More worryingly is that Ezekiel 9 is held up to be an example of how god looks after his chosen people by commentators like Wesley.  If we don’t turn to god and beg and plead and do everything god says without question, our innocent babies will be slaughtered by god’s henchmen, yay!

No matter who comments, or how Ezekiel 9 is interpreted, it all boils down to sin and corruption.  Ezekiel was tasked to tell all who would listen “If you don’t get your shit in one sock, then there is going to be lots of stick and no carrot.”  That’s pretty much the message of every Old Testament prophet, only they are imprecise and verbose.  Possibly due to the tea they made from that green stuff on the side of the road.

Back to Psalm 137: It’s a psalm that was, and is, used by exiled Jews (and now Christians) to remind them that although in exile, they will take back Jerusalem.  It’s also used to reassure Jews that Jerusalem is theirs for ever, no matter where they are.  Huzzah!

That, and that they’ll have a lot of fun smashing non-Jewish kids heads in with rocks.

What wonderful examples Ezekiel 9 and Psalm 137 set.  Wander slightly and your family will be slaughtered, follow the path of god and you have permission to kill newborns of your enemies.

This isn’t discipline, as @heidiraff claims.  It’s barbarianism.  For those who wonder why the extremes of Islam are brutal, this is it.  The same god, and the same reverence for the Old Testament (Torah) as Jews and Christians.  Next I’ll be told how only Christians have a moral authority because only they are the “chosen ones”.

I’m sorry; any answer that ends with the likes of @Heidiraff’s “In this case, God used other nations to discipline His children and bring them back to Himself. This was the push-me-pull-you relationship that existed until Jesus came and brought mankind back to God through His death on the cross.” is akin to saying “I don’t really know why, and it doesn’t make a lot of sense, but to me it doesn’t matter because of my personal relationship with God.”  I’d much rather the latter, honest answer than the former Jesus-makes-everything-taste-better answer drawn from the jar labeled “Stock Answers for when you don’t know the answer.”

04 June, 2010

Why Universal Health Care is Vital to Any Civilised, Compassionate Society, and how it Benefits Everyone

There's no big secret about me having rheumatoid arthritis, or a broken back.  I tweet about it, share my experiences and get some good advice from others who know about auto-immune diseases, as well as having a plethora of specialists, including a consultant rheumatologist, taking care of me.
Due to the damage in my spine, which is currently held together with titanium pins, rods, screws, a cage and will power, I also suffer chronic, intense back pain which needs it's own management plan.  Lately the symptoms of the partial paraplegia, from the significant nerve damage, have been getting worse.  More pain, less mobility and some potentially embarrassing moments in public. (Other than my risqué conversations!)
Working out what's going on isn't that straight forward.  Physiotherapy have noticed the deterioration.  A muscular-skeletal exam confirmed what my physiotherapist suspected, an expensive custom made orthotic was made to assist me to walk further than a few metres without tripping over.  Meanwhile a pathologist investigates my blood and reports back to my rheumatologist and General Practitioner (GP, just a regular doctor).  My gastroenterologist orders Doppler ultrasound, and interprets the digital video remotely from the Imaging Services Department at the hospital.  My neurosurgeon is frequently updated with digital CT scans to look for change.
That's where the “problem” lays.  The titanium that is fused into my lower spine scatters x-rays, so high resolution images near the suspect site are not possible, but there is enough change for it to be noticed.  So an MRI scan is ordered.
I don’t know if anyone knows what having an MRI is like.  I’ve become used to them, but still they aren’t pleasant for me.  The MRI scan process for me is fairly straight forward; change into “something more comfortable”, double check for any metal I might be wearing, get wedged onto a plank, then loaded like a shell into a cannon.  For the next thirty or so minutes the sounds of thumping, banging, buzzing, and harmonics of all these all but drown out any music I’m listening to through plastic tubing.  While all this is happening the electro magnets (which resonate causing the disturbing banging sounds) are so powerful, any loose metal within a few metres of the machine would be flicked through at a velocity enough to break bones or, worse, the machine.  They are so powerful that it makes me vibrate.  Indeed, I can tell when they are focusing on my lumbar region as the titanium moves with the vertebrae to cause pinching of some nerves which results in a combinations of unpleasant discomfort and sensations of having hot pokers rammed through my feet and into my spine.  Then I’m unloaded briefly, but not allowed to move, as a contrast agent is injected into my wrist.  Normally they try and find the less painful area, but it’s not always possible. The contrast agent makes my tongue feel like someone’s put a dirty teaspoon on it.  Then it’s reload and do it all over again.
Yesterday’s little outing in the tubular coffin took no less than 90 minutes.
Now I’m not saying this is, or should be, a typical experience for anyone.  It’s simply my own experience due to my unique circumstances.  Most people that have an MRI have nothing more than a little discomfort from being in a confined space for about 15 minutes.  MRI scanning is routine in an emergency hospital, such as Royal Perth Hospital, and all across Australia’s major public hospitals.
Now, here’s the fun part.  How much do you think all this testing costs?  How much did it cost me?  The MRI scan alone costs are about AU$10,000.  Cost to me? AU$0.  That’s right.  Nothing.  Same for physiotherapy, pathology, rheumatology.  Even when I had the neurosurgery to remove the spiny growths of bone, the ruptured discs, and to reconstruct and repair fractured vertebrae using expensive titanium didn’t cost me a cent.  The room with a view that I had to myself for 2 weeks during recovery cost me nothing.  The rehab, zilch.  The fitting, construction and refitting of my high-tech orthotic?  Absolutely nothing.
Every Resident and Citizen of Australia has access to free, that’s right, free medical care at a public hospital.  There are private hospitals, but the only difference between the two is that private hospitals have more expensive art in the foyer and don’t have emergency facilities.  In fact, most consultants from all disciplines, including my wonderful rheumatologist, work in both private and public hospitals.
So how can it be free, and why?  The answer is simple.  Taxation pays for it.  It even subsidises General Practitioners so that going to a doctor is cheap, and in some cases, free.  Yes, that’s right, for some people it costs nothing to see a doctor.  Going further, most prescriptions are also subsidised, to the point that once a certain number of prescriptions have been used by an individual or family, for the rest of the calendar year all listed medications are free.  Yes, free.
Every Australian is aware of this to some point.  Most wouldn’t even think about it.
Surely this is madness!  Isn’t this socialist nonsense and surely it will bankrupt the country?  Like Greece for example?
Well, no.  It’s a vital service, Universal Health Care.  For those in the Tea Party movement in the US (referred, unflattering as “teabaggers”!) who are fighting to stop the Obama administration to trend towards Universal Health Care, countries like Canada, Australia, Great Britain, France and so on are to be pilloried for having such a blatantly evil “socialist” policy.
But if they really thought about it, why don’t they complain that the police or firefighters are part of a socialist agenda?  Or government schools?  Why should doctors become wealthy at the expense of patients when the police also have arguably difficult jobs, or firefighters or teachers?  Why is it that prisoners get better health care than they could ever hope to get outside of jail?  Or members of the US armed forces and veterans?  Or indigenous Americans?  Isn’t that also an evil socialist engineering program?
The fundamental arguments against Universal Health Care start to look pretty weak in light of the evidence.  Especially since those who make the most money out of the health industry in the US are the insurance companies are the same collection of people that make the decisions on what treatment, if any, a US citizen is entitled to, or what medication they can have.  It doesn’t take much brain power to understand that these people are making decisions based on a bottom line, not in terms of health outcomes for policy holders.
At the same time, medical services and medications costs in the US are practically extortionate.  This in turn means the insurers have to charge higher premiums, which mean less people, despite the Obama Administration’s changes to stop the practice of denying policies to people with pre-existing conditions, can afford any quality medical care.  Essentially, the US is a duality; those with money and influence get the best medical care money can buy at the expense of those who work just as hard, if not harder, for far less reward.
A civilised nation would treat all citizens as equal before the law, and enable access to all services on an equal footing, be it electricity, a police force, justice through the courts if accused of a crime, or health care.  A compassionate society would treat those who, for a variety of reasons, aren’t able to fully take care of themselves or make decisions for themselves about their welfare; this is no different to how parents look after their young children or children look after their aged parents.
Using taxes to pay for these things is money well spent.  Instead of someone who becomes horribly ill and unable to work never contributing to society ever again, they are more likely to be rehabilitated where they can contribute once again.  That in itself is a powerful incentive for the patient to become well again because no one likes to be dependent on others.
I would have thought most of this is self evident or self explanatory.  Anyone with a grain of sense would know Universal Health Care isn’t about a slippery slope to some form of evil Stalinism.  At least I believe anyone with a grain of sense would know that.
Of course, if critics wish to point out how I’m some form of bleeding heart lefty socialist, then fine.  Maybe I am.  I was born in, raised in, and live in a liberal socialist democracy.  That doesn’t mean a Laissez-faire, Marxist democracy, It means a free thinking, progressive, open to new ideas, let’s give everyone a fair go democracy.  Usually it means that governments are more centralist or left of centre than governments of the USA, but nonetheless a liberal socialist democracy is a long way right of Stalinist North Korea.
Critics are welcome, if they wish to ask me any questions they like.  I can begin by stating that currently I am on a Disability Support Pension.  It’s not a lot of money, but it’s enough for most things; rent, power, and as you can see, the internet.  And independence.  Would I rather be working?  Of course, but it’s not practical nor beneficial for myself or - more importantly - an employer at this point in my life.
Would I be just as happy if I was the one paying the tax and somebody else was on a pension due to illness or injury?  Absolutely.  Been there, done that, didn’t complain.
I leave with one final question: if you’re a US citizen and a “teabagger”, how would you like to be treated if you unexpectedly became ill for a protracted period?  Would you like to worry each day about how long the insurance is going to pay and what treatment they will pay for instead of focusing on getting better?  Or would you resign yourself to becoming homeless, even imprisoned for being homeless, when every one around you pities you but says you ought to have known this is what was going to happen and paid some faceless company more money.