Author: quantumdreamer

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140 keV Gamma “Ray” Bone Scans…

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My rate of emission of 140 keV photons is now down to lower levels, five radioactive half lives after injection. The concentration has been reduced by biological elution and the radioactivity by decay. It was interesting to read how few suppliers there were for 99mTc. Yesterday, she only injected a few millilitres of tracer.

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I have been reading up and watching videos on the interpretation of bone scans, I can probably note metastatic lesions, depletion in tracer localisation due to prothesis, fractures (old and new), areas of bone formation and depletion. It might be interesting to see what my damaged cervical spine looks like and if my “broken” ribs from rugby can be seen.  Osteophytes are evident on my thoracic spine and near my Titanium pin. The Diffuse Idiopathic Skeletal hyperostosis (DISH) is probably still growing and could localise tracer. {I had a full body scan.} This, if seen, can be cross referenced with an upcoming CT scan.

There could be plenty in my scans for a nuclear medicine professional to discuss with her younger colleagues.

I meet some of the diagnostic criteria for polycythaemia (probably secondary). If it is the malignant form this may interfere with bone cycling in the marrow and could appear in the scintigraphy. There are a few suggestions in the literature to use nuclear medicine to detect this. But it is not common practice.

I guess the single-photon emission computed tomographic (SPECT) images might show something like this below. My hip arthritis is much worse than in the X-ray or CT images below. It does not look like a whole lot of extra knowledge comes from the SPECT data for the hip.

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Dunn’s view of (A) right and (B) left hips of a 48-year-old male patient presenting with left hip pain only. Single-photon emission computed tomographic images shown in (C) anterior and (D) posterior coronal views display more uptake (black arrow) along the superolateral aspect of the acetabular roof on the symptomatic left hip compared with the asymptomatic right hip (white arrow).

Clin Orthop Relat Res. 2008 Dec 17;467(3):676–681

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What might however be interesting is what tips up in the rest of the body scan. The pain in my lower and mid lumbar spine has been explained in different ways by different doctors.  There might be clues as to what is going on.

I guess what I do not want to see is evidence for primary bone cancer or metastatic disease. The main diagnostic differentiation of the latter is a disordered or “random” appearance of tracer localisation. Metastatic disease is incurable and often terminal.

I have joked that I could re-train as a radiographer or a nuclear medicine operator. But you know what they say about old dogs.

It is weird, I feel very up in the air, with little or no idea if/when I will get to see the data. Something which could change the direction of life is hanging ill-defined in the aether. I am in a kind of limbo.

I wonder if people who prescribe scans have ever had to wait and hang like this…

Maybe it should be a compulsory part of training…

Pandora, what does two plus two equal?

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“A bone scan or bone scintigraphy is a nuclear medicine imaging technique used to help diagnose and assess different bone diseases. These include cancer of the bone or metastasis, location of bone inflammation and fractures (that may not be visible in traditional X-ray images), and bone infection (osteomyelitis).

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The most common radiopharmaceutical for bone scintigraphy is 99mTc with methylene diphosphonate (MDP). Other bone radiopharmaceuticals include 99mTc with HDP, HMDP and DPD. MDP adsorbs onto the crystalline hydroxyapatite mineral of bone. Mineralisation occurs at osteoblasts, representing sites of bone growth, where MDP (and other diphosphates) “bind to the hydroxyapatite crystals in proportion to local blood flow and osteoblastic activity and are therefore markers of bone turnover and bone perfusion”.”

From Wikipedia

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I have not long returned from the Nuclear Medicine suite at Yves Le Foll hospital Saint Brieuc. The pretext from my bone scan was to look at where there might be inflammation in my right femoral head / neck and hip prior to an operation. The first orthopaedic surgeon, who prescribed the scan, suggested that it might be done with an Iodine radio-tracer. That is not for bones. He became a little flustered when questioned and pressed on the subject. The second orthopaedic surgeon questioned why he might even order such a test. It seemed incongruous to him.

Nobody in France has yet mentioned the C word! Looking in Pandora’s box can have unexpected results. They could be doing a “Basil Fawlty”.

At the end of my scan today the operatives in the control room were all looking intently at my images, pointing and talking animatedly. Before the scan they did not help me onto the scanner table, after it they were very helpful with the dismount. The images changed behaviour. I was not privy to my gamma ray “only fans” content which had them talking. The secretary suggested that I will get the results in a letter at some unspecified time in the future. The results will go to the first orthopaedic surgeon and my GP.

The following outcomes are possible:

1)  The results simply show osteo-arthritic frictional inflammation in the bony tissues. What I call the pepper mill effect. In which case I will get the results through the post and I can take a good scooby at them myself.

2) There is a long delay during which a conflab occurs. I do not get the results in a timely fashion, some other follow up plan is hatched. Something needing to be followed up has been found.

3) I get a telephone call to tell me bad news. I am being followed for elevated prostate specific antigen and have had colon cancer. There are anomalies in my blood work.

4) The results arrive in a tardy fashion with bad news therein, before anyone contacts me.

This is what the Canadian Cancer Society says:

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Société canadienne du cancer

La scintigraphie osseuse aide les médecins à diagnostiquer et à évaluer différentes maladies et affections osseuses. On peut y avoir recours pour:

  • trouver un cancer des os ou déterminer si un cancer présent dans une autre région s’est propagé aux os;
  • aider à diagnostiquer la cause ou à déterminer l’emplacement d’une douleur osseuse inexpliquée;
  • aider à diagnostiquer des fractures osseuses qui ne sont pas évidentes à la radiographie;
  • voir jusqu’où le cancer s’est propagé;
  • trouver des lésions osseuses causées par une infection ou d’autres affections osseuses;
  • savoir si le traitement du cancer est efficace ou pour faire un suivi.

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Obviously, they are going to have a cancer bias. My gut feeling is that people are not being 100% straightforward with me. My gut feelings are often with substance. The French can beat around the bush so to speak.

Waffle, moi?

Whatever the outcome, knowing what the data says does not change the actual physical plane reality. It does / might affect how things move on from here…

It is out of my hands; I can do nothing…

We shall see…

Piss Up in a Brewery

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“Trompenaars’s model of national culture differences is a framework for cross-cultural communication applied to general business and management, developed by Fons Trompenaars and Charles Hampden-Turner. This involved a large-scale survey of 8,841 managers and organization employees from 43 countries.

This model of national culture differences has seven dimensions. There are five orientations covering the ways in which human beings deal with each other, one which deals with time, and one which deals with the environment.”

From Wikipedia.

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The last course, which was in design phase when I dumped it, was to address problems of cross cultural communication and the tensions inherent in it. I {we} have had plenty of instances of Franco -Britannic cultural differences. If one side imagines that the way they do things is right and dandy it can be very difficult to show to them other ways. They may get ultra-defensive and imagine themselves more highly organised and efficient than they actually are. One might have to learn new ways and adapt to the system in which one lives. These “growing pains” can cause premature baldness. One can be seen as pushy and not “sympa”.

There is a balance between nanny state control and last minute.com freeform. There is also a need to decide and stick to said decisions without continuous flexing. Making shit up on the fly can cause clusterfucks of considerable dimension. Preparation and planning prevent piss poor performance.

One of the things I never put on my CV as a bullet point was

  • Able to organise a piss up in a brewery.

It does not sound like an important life skill but it is. One of things that I am good at is organisation which needs contingency. Organisation should be, wherever possible, simple and clear. The person who has oversight needs to be updated and exercise that over sight. Although not my natural team role I have ended up being Monitor Evaluator on a number of occasions to keep things on track. Slippage is a real problem.

Trompenaars and Hampden-Turner identify France as a diffuse culture in which so-called responsibility is spread out and it is not clear who has oversight or indeed if there is any. Process has been developed and used but rarely questioned and updated. Demain, quinze jours, are not as bad as the Jamaican “soon come”. But time is vague like many other things.

As a INFJ timing is important to me and sticking to what you say about time is vital. I can’t help it but people running late irks. I have literally thought while waiting, “shall I just go home, fuck it!”

I am anticipating a hip-replacement operation. It is down to us to organise a pulmonary and cardiovascular screening before a meeting with the anaesthetics geezer / geezer-ess. We have to order and provide crutches and compression stockings. We have to organise full blood tests including blood typing. The surgeon will have blocked out a space in his diary. No bugger has yet done an assessment if it is safe for me to return home. There is a quasi-magical assumption that everything will fall into place. A couple of cardiology outfits have suggested a screen a week before the operation!! Really?

If there is a problem and the operation needs cancelled there is no lead in time and the slot will have to be abandoned. This kind of “planning” makes me nervous. It lacks foresight. It may be the way things have always been done but that is not good logic.

The possibility for fuckwittery is huge and the probability of things which are time critical going wrong, high.

In the UK no civilian would be given responsibility for collecting very expensive granulocyte-colony stimulating factor from the pharmacist and giving it to a district nurse for injection prior to a harvesting of stem cells. The factor is temperature sensitive. To trust this kind of thing to joe public is in my opinion unwise. The key thing could go very badly wrong and everything need re-scheduling. Do normal people really understand temperature dependent reaction kinetics?

“But that is the way we do things….”

The feeling that I {we} have to be on this is an unnecessary added stress.

Am I a control junky?

Am I sane?

Will this aid my post operative recovery?

Should I just go with the flow in this case?

In my view professional organisational oversight might be a better approach. I could tip up at hospital and have a whole day of tests done a couple of months out. The go / no go question would be answered and, if needed, some interim medical adjustments made ahead of time. Rather than a week before finding out some kind of unknown heart anomaly.

I understand that the summer is in the way and that everything stops for summer. Unfortunately this is not in my cultural DNA.

A bit edgy…

Siege – “Confederate” -Tarot – Dream 02-07-2025

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Here is last night’s dream. I managed to sleep until 5 AM without interruption which is unusual these days. We watched the film “Old Guard” last night.

The dream starts in the South-Eastern corner of America. It is in the recent past. It is sweltering hot, humid and sweaty. We are under siege. We can hear gunfire from the nearby town which is surrounded. There is smoke in the air and cordite on the wind. From time to time the night sky lights up with an orange light from afar due to a large munition. They are being pounded. We too are besieged but by a much smaller force. It is quiet where we are but we know that they are out there on our property in numbers.

In the dream I am very surprised to be in America. Though it does make sense.

I am sat at a large table in the kitchen or scullery. There are candles burning and several finished bottles of wine. I have a glass on the go. We are speaking Cajun or creole French. There are a few of us white and a few servants or slaves black. We have all hastily eaten something quick. Others are keeping watch. We are in some wooded “mansion” type house on a plantation of sorts. The windows are boarded up from the inside.

On the table is a tarot deck de Marseilles. On the wall there are pictures of soldiers in a kind of uniform of dull grey colour. My minds thinks Confederate but it could have been earlier. It could be militia but is definitely not redcoat.  There is an air of civil war or revolution and of tearing apart. On the table I can see the cards 0,1 and 10. The cards are le mat, le bateleur and la roue de fortune. I focus on the latter. It seems apt. Also on the table someone has been sketching a contemporary “confederate” set of cards and having them cut out. The table is like that of le bateleur in front of us. The tarot arcana have been given a modern twist. La roue de fortune is comprised two pistols intertwined head to tail to make a kind of pistol ying-yang circle. Other figures are made contemporary with white wigs sat on judicial “thrones”. One of the company is whiling away the time drawing. We all know what is coming in the morning. One of the black women in a dark blue dress clears the plates from the table. One man in the corner is drinking brandy to forget. There is a sense of impending.

The scene changes to morning. We are outside in daylight. I am wearing black riding boots, black pants and a dirty white blouson shirt with a lace up closure in the front. It is partially undone. I have blood spatters on it. It needs a wash as do I. My long dark brown hair is held at the back in a pony tail. I am partially dishevelled and have been roughed up. My hands are tied behind my back and I am being held by them. I am being brought before. I can sense a pistol very close to my right temple. I can sense an arm and a hand holding it. They are going to execute me. I see a flash of smoke as the pistol mechanism fires. I hear a loud bang.

In the dream I know that it does not kill me because I can see myself back in Europe as an older man with a white-grey ponytail and clean shirt sat at my desk. This shooting is early in my previous life.

The dream ends.

What is Safe to Ignore?

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The ongoing foray into medical things has thrown up a few things which may or may not be safe to ignore. As a part of the ongoing saga I am going to have a full cardiovascular MOT or road worthiness test. The presence of excess iron has many knock on implications and I have already been prescribed one medication which is no longer recommended.

You can call me rusty.

It is a long old haul and the garden is suffering a bit from lack of attention.

It seems so far that the Jury has decided that I don’t have five of the genetic mutations which I have tested for. I am going to discuss these further, a little. My status as a mutant has not yet been confirmed.

Traditional western medicine is based upon symptoms. By the time symptoms are apparent disease has arrived. More recently tests are done with a mind to early prophylaxis where possible. What may be, is clear in some case and less so in others. The UK mass newspapers are full of misdiagnosis horror stories.

“I went to see multiple GPs. They sent me home with a box of Rennie’s. Later in A&E after I tripped up on the way home from the pub, they found a basketball size alien tumour of extraplanetary origin growing in my kidney. I have two and half weeks to live!”

These cases are rare and anomalous. The tendency is to discount and not pay sufficient attention to things which do not fit your story, your view of how things might be.

“It is impossible to have extra planetary tumours growing in the kidneys. They are usually found in the spleen!! Everyone knows this! DOH.”

People can be very dismissive about things which later turn out to be highly important. They ignore things which are not safe to ignore.

I like to offer people options. The easiest option is that I am an eccentric borderline nut-job burn out. I suspect that as an explanation this would find purchase in the minds of many. It is a pigeonhole into which I can be fitted easily. I can then be ignored. I may be briefly entertained but never taken seriously. To develop this a little further. If one is enamoured with intrigue, one could say that whacko-nut-job-eccentric is my cover.

With a high degree of certainty one can predict answers to certain questions. This is because denial is a Pavlovian response in some. I have asked a number of people if they feel they have unresolved karma with me. To date no-body has answered that question. Nobody has tried. They have ignored it and let it drop. It is easy to discard and discount. On my part it has been a genuine and well-intended question very largely for their benefit. But of course people know best and are unwilling to do the work needed to answer a question of moderate depth and wide implication. People want to preserve face above all else. FOLOF, fear of loss of face.

Is such a question safe to ignore?

In the “normal” world and within its confines and rules, yes. But this is a world and philosophy bridging question and the limited “normal” context loses its imagined wide applicability. Ignoring such a question ignores and devalues a way of being held by hundreds of millions of people.

A lot of people think small details can be ignored. A prime minister preaching about lock down may deem it his God-given right to party. Ignoring, conveniently, the detail which he said that we didn’t ought. A small detail ignored can come back to bite you on the bum with rabid and perhaps gangrenous teeth.

“The law was not broken in its strictest and most convenient {for us} interpretation.”

Obsessing about detail can be very tiring. So knowing what is and is not important makes life easier. We all make choices and assign priorities whether consciously or by default.

People may argue the toss when it is very unwise so to do. The toss once argued for cannot be u-turned always. You may have won the toss but you can be up shit creek in a barbed wire canoe without a paddle. The toss will not keep you warm in a nuclear winter.

My own opinion is that it is not safe to ignore your dreams. Experimental evidence has suggested this to me. This morning’s dream had someone I once knew trying to manipulate a situation, to find some kind of pretext. It was suggested that some kind of trap is in preparation. It revolves around the number of conspiracy three, three people. In every conspiracy there has to be at least three. Without being paranoid I am opening myself up to the dream both at night and during the day to see what, if anything, the dreaming has to add to this morning’s dream.

It is very easy to imagine important and significant the wrong things entirely.

We can ignore the things we did not ought to. We may need to pay strict attention and focus to things which we might otherwise flippantly ignore.

What is safe to ignore?

When Professor Google Does Not Know…

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Something weird is happening at Eurofins the lab which analyses the blood tests. On Saturday they sent me the results of my alpha-1 antitrypsin survey. This came back normal, so there is no genetics causing a suppression. Yesterday evening they resent me the results twice!! This kind of thing is not normal, so it caught my attention.

The really weird thing is the low parathyroid hormone level.

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“Hypoparathyroidism is the combination of symptoms due to inadequate parathyroid hormone production (PTH) (Hypo-parathyroid-ism).  This is a very rare condition, and almost always occurs because of damage or removal of parathyroid glands at the time of parathyroid or thyroid surgery. This bears repeating: When people have too little parathyroid hormone (PTH), it is almost always because they had thyroid or parathyroid surgery and all four parathyroid glands were removed or injured.”

Source parathyroid.com

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I have the low hormone level BUT not the reduced calcium levels. I used to get cramps and have had neuropathy in my fingers. This neuropathy being probably down to the cervical spine injury ~2008 and the hernias therein. Calcium levels are however normal.

I have asked Professor Google about the PTH low Calcium normal using different sets of key words. He/she/it does not have much to say on the subject. There was one case of a Māori woman with similar numbers. It was weird enough to ask the laboratory to check the parathyroid hormone data. It was not wrong. They made a “special” report.

The endocrinologist may yet comment.

Using the above logic it perhaps makes sense to re-test the hormone level.

Because I am asymptomatic, this does not seem like a big deal. It could be a harbinger of problems yet to come. The hormone level is low; it has not dropped the calcium yet…

Like me it is a bit of an anomaly an outlier. The question is, is it safe to ignore and chalk up as just one of those things or does it need further investigation?

When You Just Know

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I have started the process of looking around for an alternate orthopaedic surgeon. I have secured a provisional appointment. I just know that should I follow through, this it is going to open a can of worms. In principle a second opinion is “allowed”. In practice it can put noses out of joint, cause gossip and stoke rivalries. I can stop it. I am going to sleep on it. But the moment I tip up for an appointment I will have to explain myself. There will be uncomfortable feelings on both sides. It will not be smooth and I will be the problem, not anyone else. I am also a foreigner now, too. I do not have citizenship and my right to stay expires in a few months’ time, March.

Way back when I lived near Farnham, I had a GP doctor who was athletic-skinny. He had a pro-forma crib sheet for calculating BMI. It was issued by the Ministry of Truth. He calculated mine and proceeded to lecture me from his soap box about the need to lose weight. Even though I was not officially obese back then. I asked him to show me my extra body fat. He could not. He said that people can be fat on the inside. Whatever that means, those were his literal words, fat on the inside. I showed him my large biceps and claimed muscle mass but he persisted. I then said that I had recently read an article in the BMJ about how raw BMI data was often over interpreted in general practice medicine. His back was up and he was affronted.

I just knew that we would never get on and for our mutual benefit it would be better for me to have another GP. I saw him a few times before I changed practice and each meeting was fractious. He is a human being, so was I. I have rarely had a reaction like this from a woman. I concluded that possession of a penis played a role in interpersonal dynamics. I am not insecure about the average size of mine, physically and metaphorically. I don’t have a whole bag of chips on my shoulder.

The caveat here is that my perception could be skewed. I perceive that I have an uncanny knack of putting people’s back up especially when they deem themselves superior, more expert, to me. I can be more frank than some like or can handle. I am just being me. I am not trying to wind them up or belittle them. I get what I perceive of as bad reactions.

In general I know when I have the early stages of a bronchial infection. I report to a GP doctor and quite rightly because there is not enough cack in the lungs, they do not initially prescribe an antibiotic. I just know in many cases I will be back soon when the cack gets cacky enough for antibiotics. They have a process to go through to limit over prescription. I just know that I have to wait until a certain severity of illness presents. They are doing their job, that is all. It is possible that I might wait too long one day.

I had a bad clash of personalities with my cancer “care” nurse a decade ago. She had severe mother superior tendencies and I met her dogmatism head on. This made collecting my results from her an unpleasant thing which I came to dread. Rather than looking forward to her support, I would dread the meetings. I asked them to send my carcinoembryonic antigen (CEA) results by email. They refused. If anything went wrong it would have to be very wrong indeed before I would reach out to my allocated cancer care nurse. I never did. I just knew that the best thing was to switch hospital care teams. It sounded simple and I could offer the reason of enhanced proximity.

However I opened a can of worms. Every time I went for a colonoscopy or to follow up blood in the faeces, they wanted to know why I had changed teams. They kept pressing me. They seemed obsessed with gaining this information. I gave the same answer that they were closer, which was true but incomplete. On a number of occasions the chimney sweep insisted that the blood was from piles. I just knew that was not the case. So we had to have an examination for piles before he agreed to a sigmoidoscopy. I don’t particularly like having endoscopes shoved up my arse but there was no way of avoiding his adamant insistence that it was piles. I just had to let him go through his process. He had all the power and I wanted to find out if I had a new cancer or a recurrence of the old one. I was not anxious I wanted data. People can see anxious when need for data manifests.

Sometimes I just know when the best thing is to drop something and walk away. It is for everyone’s benefit. Even If I am inconvenienced it can be better just to let things lie, leave them well alone.

A while back someone trying to be clever said that I was a part of the equation as to why things were not working out. I simplified his equation by removing a variable, me. I don’t know how well the equation worked out after that…If I was a/the problem at least they had the possibility of moving forward unencumbered by me.

This feeling that I am a/the problem according to others has presented multiple times in this life and it has resulted in a walk away or a door slam on more than a few of these.

If I am the problem I want to simplify things…

I just know when people are seeing or are starting to see me as a/the problem.

Maybe they are right and it is always me…

It is just one of those things…

South Africa – Richard W – Imperial College Colleagues Dream 29-06-2025

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Here is last night’s dream.

The dream starts in the South African bundu or bush. I am driving along a rough dusty unmade road. The road goes up and own and has a yellow-orange bull dust. I am in an open sided Jeep like vehicle of a classical pedigree age. It is four wheel drive and contrasts with an antiseptic modern SUV. I am dressed in faded olive green park ranger type clothes with shorts. I have a pistol in a holster on my right hip, suitable for my left handedness. It is tremendous fun driving along the road / path. We are near a fairly fast flowing deep river like at the Augrabies falls which I visited two decades ago. I can hear a waterfall.

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The sound of the water is loud. The wind is in my hair and I can smell and taste the dry bush all around me.

The scene changes and I am now in the UK. I am in a busy Tesco supermarket. People are queuing. Outside the air is dank and wet. There is a constant hum of urban traffic. In one of the checkout queues I see Richard W whom I know from school and UCL chemistry. He is miles away up in his head. I tap him on the shoulder. At first, he does not recognise me. Then when he does, he is totally surprised to see me. I motion to behind the checkouts and will wait for him there.

When he has checked out, he comes over to see me. Although he looks a lot younger than he would be now, I can see that life is getting him down and he lacks energy. I turn him around and stand behind him. I open up a battery compartment in his back by sliding off a plastic over. I take out the two AA style batteries which are there and replace them with two fresh ones from my pocket. These batteries are similar in colour and design to Duracell. I replace the plastic cover and Richard reboots.

There is a short break for a loo visit.

I return to the dream back into a dank drab UK urban environment. You can hear the noise the cars make on the wet road. I enter a large building which I do not know with some kind of large atrium. It is Imperial College and Chemistry related. The hallway / atrium is being renovated. I bump into various ex-colleagues {sequentially} who were at Imperial two decades ago, all of them now professors. There are more than half a dozen of them both men and women. They are slightly sheepish about meeting me, there is an air of awkwardness or embarrassment. They are unsure as to how to greet me and if to greet or acknowledge me at all. Two males with whom I worked are very noticeable by their absence. The absence speaks volumes. There is a weird feeling that the former colleagues are surprised to see me even though there is a sense for them that I never left.

I walk into some kind of a hallway. There are poster boards up with academic conference style poster presentations on a blue “felt” background. These are all chemistry related. I can see molecules and graphs. Walking past I think some things do not change despite modern technology. A poster is a poster. In the dream I do not know why I am there in that building with them. It seems anomalous to me if not to them.

The dream ends.