Tag: health

So what is the Plan?

~ quantumdreamer ~ Leave a comment

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No specific dreams overnight. I have started painting the end of the room near the log burner. The winter wood situation is now ready and good to go until February. There are a few items left on the checklist.

It seems to me that as I enter my 62nd  year tonight around midnight there is not a lot of change foreseen.

There are a number of medical things upcoming. The wife may / may not stop the lenalidomide maintenance therapy for her multiple myeloma and will soon get back the post breast cancer genetic screening tests. The treatment of myeloma is evolving and the epidemiology complicated by diverse treatment protocols and disease presentation. It seems that the better the initial depth of success with first line treatment the greater the disease free longevity. Studies on stopping lenalidomide maintenance are sparse and of low number participation. Drawing reliable conclusions is tricky. In France they tend to stick to agreed {collective} protocols so we will soon find out if that has changed since the last visit to the haematologist.

It seems to me that a fair proportion of the tests that I have undergone will be let slip “laisser-tomber”. I have a repeat prostate specific antigen test upcoming. Any increase in  number will trigger another MRI and possible biopsy. I need a dental infection all clear before the scheduled hip operation. In the pipeline is a cardio ECG stress test. Assuming all is OK I should sliced and drilled in autumn with round two pencilled in for spring next year. After that I will complete my job application at the Bolshoi. I may start treatment for osteoporosis. The French budget deficit is big maybe they need to spend less on some aspects of healthcare. I will have to do physiotherapy.

We could get a nationalist anti-immigration government which will cast a cloud over our right to stay in Brittany. We could be booted out if they raise the financial threshold for residency.

Being positive we might hope for no recurrence of myeloma symptoms and some enhanced mobility for me for summer ’26. We do need to downsize house. The window of opportunity is before the second hip operation or after it. We have a short visit to blighty booked during which we wish to find out how the UK now feels. From the news here and on UK TV it looks to have gone somewhat down the shitter since we left. We need to see for ourselves. The expectation is that it will be cramped and expensive. The wife managed to grow cavolo nero so we sourced one of the things we missed.  At £4 a coffee for an Americano it could be painful.

Irrespective of the dream content which tends towards the highfalutin, life here will probably carry on much as normal. The lack of mobility will increase over the next few months. The circles I move in are very unlikely to change. I will not be at the fromagerie meeting with big cheeses any time soon. Some people my age are still pursuing high-octane careers and being all stressed out and busy. I have been “retired” for five years and am miles from the greasy pole hamster wheel. It was another world.

Unless anyone is reading the blog in a surreptitious manner, what I type here is read by only a small handful of individuals. If people are snooping and want to get in contact, how might they broach the subject? People do not often think things through.

Of late we have watched a number of Netflix series and in all of these smartphones and social media play a significant part in the plot, the so-called story line. It is another alien world to me. Weird to see text messages as part of a film plot!! We look at a ‘phone on a bigger screen. Seems a bit desperate. And they say Fentanyl is bad.

I guess I have reached the part of life when I have turned into my father, at odds with the current version of modern life. Maybe I’ll start harping after Bing Crosby next. I already think people need to shave and get a haircut…pull their trousers up.

The plan then is to increasingly turn to DIY as the autumn rains arrive. Our pampas grass has just grown fluffy bits, as usual in time for the Atlantic winds to blow in from the wet West. There are some more jobs in the garden but soon the bulk growing will slow.

We have to navigate the medical merry-go-round and that is about all on the dance card so to speak. Aside from the blighty trip it is unlikely we will leave our prefecture.

The plan is not overly complicated…

Can a Jaguar Changes Its Spots?

~ quantumdreamer ~ Leave a comment

People can have very fixated images and perceptions of others. They may shoe-horn others into well out of date perceptions. How they remember them can be stuck in a time warp.

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We are watching a TV programme with Eddy Redmayne acting as The Jackal. Even though he is not the same actor, I keep wondering where Wellard or Well Hard the dog is. At the moment in the series  highly armed MI6 agents have just been engaged in a  massive shoot out near Budapest. The sort of thing that is likely to be an international incident but which serves for dramatic purpose.

Not everything makes sense.

It is very easy to get typecast in the eyes of others. There could be a wildly inaccurate narrative circulating which sticks like glue. Once a visiting Japanese postdoc. famous for his drinking prowess back home decided that he wanted to out-drink me competitively because he had heard my legend. We started drinking after I had already had six pints of Stella unbeknownst and unrevealed to him. I stopped drinking a bit before him and he claimed victory. So there may be a story back in Japan of how he beat a champion drinker in the UK. Not all stories are true but it does not stop their circulation.

People can have their perception locked, very locked.

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Many are not a lot like they once were. Some people change. It is said that the warrior’s path is one of transmutation,  transformation and transfiguration. This suggests that the change may be more radical than a cosmetic tinkering.

I’ll wager were I to meet people I was acquainted with two decades ago they would initially interact with me using that out of date context, if they even remembered me at all. There is and was a whole side of me of which most were completely unaware. One student thanked me for my 9 AM winter morning lectures because they gave them a chance to catch up on their sleep in a nice warm lecture theatre. Others have told me that they doubted that boring dead-pan me could be any use to them when they were unwell. After half an hour of quiet chat they were off to see the GP for a mental health consultation and had provisionally booked a session with the on campus councillor.

Few would imagine that I have had dreams of shaman and Jaguars.

Jaguar Dream Link

People struggle to a) notice and b) fully accept change in others, particularly those who they think they know well. Radical change is considered impossible. After all a leopard cannot change its spots.

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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…

Myeloid Bone Biopsy – Charlie Chaplin Cars – Elephant – Blood Tests Dream 22-06-2025

~ quantumdreamer ~ Leave a comment

Here are last night’s dreaming segments.

The dream starts in a hospital operating theatre. There are people dressed in blue medical scrubs and with face masks and gloves on. On the screen is an X-ray like image of my right hip joint. They are using the apparatus to guide the placement of a long needle like structure into the ball of my femur and what remains of the gap between. I am awake and partially sat up. I am watching the procedure. A nurse is assisting the man doing the procedure others are monitoring vital signs.

He is saying to me that he is taking a tissue and bone sample for a Myeloid biopsy. The word is specific. They are going inside the bone to take this biopsy. It is important that they do this. This Myeloid sample will be sent off to the labs so that they can get a better understanding of what is going on. The scene is in colour and I can sense the cool air-conditioning in the “operating theatre”.

The scene changes and I am now in a black and white film in an urban setting. I am being chased by people driving black old school Charlie Chapin style cars. It is all very slapstick and the film being projected has a few flaws. The chase is semi frantic on the part of the pursuers. It is keystone cops and farcical. There is much skidding around corners. Although they are pursuing me, I am not interested. I am waiting for the results of my Myeloid biopsy. They will not leave me alone even though I am unwell. They are foolish.

The scene changes and, back in colour, I am at the edge of a field. Along the edge of the field is a fence. The other side of the field is a wood / jungle. The field has just been harvested. In the distance the gap between the wood and the field increases. I can see a small baby elephant. It is standing next to some saplings which are waist height to me. As I move towards him he moves, unhurried, off into the jungle. I arrive and there are two short rows of these saplings with green leaves. They are in a line and each row has several plants. I understand that these saplings are medicinal.

I am now on a Caribbean island; there is a sense of windward. The care home / hospital buts up against a white sandy bay and has a promenade. It is tropical. On one side to the left is the ocean and on the other a well-kept dark green lawn. There are water sprinklers going on the lawn. There are coconut palms. I am a little late for my appointment. I enter the building and there are two women dressed in starchy crisp 1950s style nurses uniforms with little hats. They woman on reception welcomes me very warmly. I am a regular and they like me, care for me. One tall nurse who is white welcomes me in a strong Jamaican patois. I respond in a like dialect only mine is play. She says that even though it is her lunch hour she will see me her “favourite” patient. She is teasing me playfully. She takes blood from the vein in my left elbow joint and from the artery on my right hand. She injects the arterial blood into a gas chromatograph. She says that even though I am something of a pin cushion these days she can always find a blood vessel. There is a sense that these blood tests are a very regular occurrence.

The dream ends.

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Notes:

Myeloid tissue, in the bone marrow sense of the word myeloid (myelo- + -oid), is tissue of bone marrow, of bone marrow cell lineage, or resembling bone marrow, and myelogenous tissue (myelo- + -genous) is any tissue of, or arising from, bone marrow; in these senses the terms are usually used synonymously, as for example with chronic myeloid/myelogenous leukemia.

Social Discomfort – Social Anxiety Disorder

~ quantumdreamer ~ Leave a comment

I think it fair to suggest that social discomfort is a pillar of comedy. We all find it funny if sometimes uncomfortable.

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The more uptight, pompous and status oriented one is the more likely one is to experience social discomfort. Heaven forbid that someone do something inconsistent with their social position, something gauche, something off trend. A pleb should kneel and kotow. They must know and accept their place.

At the Babraham Institute once, one Ph.D. student wrote in the feedback for a course that I gave, that it was unprofessional for me to say that my former employers, Imperial College, were a cold efficiency employer. They were not a hugs kisses and birthday cake bunch. He felt perhaps that I was slagging them off. Though many would have been happy to be called cool {cold} and efficient, competitive and perhaps ruthless. As a young man he had a lot to learn about reality and maybe his idealism would soon be tarnished.

Psychologists have a fundamental assumption, that people like to socialise and that they SHOULD do so. It underpins much psychological diagnoses according to my non-erudite and hence inexpert eye. It is clear to me that my unwillingness to play the social game has impacted on my career advancement. One could say that socialisation is a societal pre-requisite for promotion, a needed social skill.

On the DSM-5 social anxiety scale one is asked if one avoids social contacts, extensively prepares for them and self-medicates in order to face them, the so-called Dutch courage. It suggests that one is fearful of social situations. Maybe one simply does not like them and therefore avoids them {like the plague}. It is not uncommon for people to get pissed, smoke weed and snort Charlie in social situations.

Does that make them psychologically ill and diagnosable?

I’ll postulate.

Modern psychological wisdom is prejudiced against introverts and introversion. Such behaviours are seen as faulty and in need of fixing.

As usual it is the extroverts who dominate the “air time” or soap box.

In terms of the anxiety disorder, I meet the avoidance criteria but not the fear.

Is it bad not to want to surround yourself with gobshites arseholes and knobheads? To not share a finger buffet and talk endless shit with them?

Why not avoid something that you do not enjoy?

This kind of avoiding seem pretty darned sane to me.


In general I dial back on the boffinaciousness because it causes social discomfort and nobody likes a know-it-all. Which means that you often have to wait for people to catch up. I used to self-handicap with a lot of weed, which also enhances patience in all areas apart from munchies.

In France some are seemingly embarrassed to speak poor English, where no English are embarrassed with their appalling French. It is weird. Is it about control? There is social discomfort. They do not slow down {in French} and talk to you like a moron as is common {in English} in the UK. I sense a discomfort.

I went to see the zebra at the zoo.

I’ll postulate further.

Social discomfort and the fear thereof is very limiting and causes many problems. Things that need to be broached and discussed are avoided in case of social awkwardness occurring.

Fear of loss of face {FOLOF} is almost as big as fear of missing out {FOMO}.

Even though I am very introverted I have good interpersonal skills as a part of my chameleon toolkit. Strangely the most important social skill of all is being able to listen. It puts people at ease.

Is being uncomfortable with BS a clinically diagnostic malady? This is a social discomfort but not one of awkwardness of embarrassment, simply preference

Is there a DSM-5 criteria list for the Avoidance of Bull Shit Personality Disorder?

Do we need to train people to better accept tolerate and otherwise believe bull shit?

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Getting Psyched Up for Hip Replacement

~ quantumdreamer ~ Leave a comment

It seems that the bulk of the next year will encompass bilateral hip replacement surgery. That is with one big proviso, namely that someone is kindly willing to go ahead with the knife and the drill. I have already had pseudo-emergency hip surgery to mend a fracture in the neck and ball of my left femur. I had to wait three days morphed out of my head for the operation. There was an innate knowing that each day I waited the outcomes would be worse. To get prepped for operation in the morning and then to be told it is not going ahead is not the greatest of tidings to hear. In September 2019 I started my 55th year post-op with a titanium prothesis. I was awake during the operation which felt that someone was at my skeleton with an industrial grade civil engineering jack-hammer. Your whole skeleton resonates. I have an inkling and would prefer a general anaesthetic next time.

As can be seen from my April X-rays the situation with my left hip is complex.

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There has been a bony growth {blue arrow} over the top of the implant. This will need to be chiselled off to enable the pin to be unscrewed.

We could be talking three operations. One to remove the metallic pin, one to fit the right hip and one to fit the left hip. It will be up to the surgeon to decide what to do. You can see from the X-ray images that I am bone on bone, so to speak, on both sides. My range of movement is very limited. My arthritis is classified as severe or to use a lovely turn of phrase, end stage.

In my mind it is not clear how easy or otherwise it will be to have a successful complete hip replacement on the left hand side. The right hand side seems more common or garden.

At the time of the accident, a fall from standing in the kitchen, I was not checked for any bone weakness such as osteoporosis. There was a lot going on. The age at which the major fracture occurred for a male was young given a relatively minor trauma. The GP has kindly prescribed a bone density scan just to check if there are any bone strength anomalies we need to consider. If there is weakness there are some further blood tests including testosterone and calcium levels etc. A weakened bone has implications for hip replacement.

If you search for hip replacement personal stories on Dr Google you are confronted with masses of marketing and PR from various outfits offering butchery and repair. They are nearly always upbeat and scant in detail on the downsides. There must be some horror stories out there but these are not easily found. Why not? Without being overly macabre I would like to read some to get more balance. They have been somehow redacted. I get it that in most cases the surgery is transformative. I am always a little wary of one-sided reporting. It irks and poses the question.

I have no idea as to how well I tolerate pain compared to most. My speculation is that I can tolerate and endure better than average. Thus, my arthritis has progressed this far without me whinging and moaning too much. At the moment the pain levels are boring and wearing. They do grind you down a bit just as the joints grind away. Movement can feel like a pepper mill at the end of the day or a long walk. The 3 AM pain and subsequent medication is a tad intrusive. We have a supply of mid-to-high level analgesia in the pantry {given to the wife} which I have not touched yet. The possibility of a “trainspotting” red carpet moment exists.

I do not imagine myself doing a pogo to the Sex Pistols post op. It remains to be seen to what extent movement returns and pain diminishes. If you read the glossy bigged-up articles and watch the videos my career at the Bolshoi can restart, soon enough.

I have enough upper body strength to use a Zimmer frame with ease whilst sporting my Crips gang colours. This strength is on the one hand enabling and on the other limits my need to do recovery leg exercises. A mixed blessing.

We will need to pay for a gardener to do the hard labour I once did. It looks like we will stay here for the next year. To attempt to move house in the middle of getting sliced would be lunacy.

On the one hand there could be enhanced movement and a “new life” or at least a better few years. More likely the improvement will not be step function but an obvious improvement.

I know that I can hack lying around post-op with sexy compression stockings and daily anti-clotting injections. I will lose weight because muscle mass will go. I will not eat much at the hospital. The biggest worry would be a Myeloma relapse for the wife. That would make things very tricky. Two ill and disabled people in the same house. We already have a well-used loyalty card at the local hospitals. We could write a “Michelin” guide to French health services.

I don’t really have fear, yet. I have had general aesthetics near half a dozen times. In a weird way I quite enjoy the coming to process.

Again, the district nurses are likely to be regular visitors chez nous.

Yup it looks like close on a year for two {three} operations and the recoveries therefrom.

Life will kind of be on hold…

Quality of life

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Quality of life is defined by the World Health Organization as “an individual’s perception of their position in life in the context of the culture and value systems in which they live and in relation to their goals, expectations, standards and concerns”. Standard indicators of the quality of life include wealth, employment, the environment, physical and mental health, education, recreation and leisure time, social belonging, religious beliefs, safety, security and freedom.

Health related QOL (HRQOL) is an evaluation of QOL and its relationship with health.

In healthcare, quality of life is an assessment of how the individual’s well-being may be affected over time by a disease, disability or disorder.

Measurement

Early versions of healthcare-related quality of life measures referred to simple assessments of physical abilities by an external rater (for example, the patient is able to get up, eat and drink, and take care of personal hygiene without any help from others) or even to a single measurement (for example, the angle to which a limb could be flexed).

The current concept of health-related quality of life acknowledges that subjects put their actual situation in relation to their personal expectation. The latter can vary over time, and react to external influences such as length and severity of illness, family support, etc. As with any situation involving multiple perspectives, patients’ and physicians’ rating of the same objective situation have been found to differ significantly. Consequently, health-related quality of life is now usually assessed using patient questionnaires. These are often multidimensional and cover physical, social, emotional, cognitive, work- or role-related, and possibly spiritual aspects as well as a wide variety of disease related symptoms, therapy induced side effects, and even the financial impact of medical conditions. Although often used interchangeably with the measurement of health status, both health-related quality of life and health status measure different concepts.

Activities of Daily Living

Activities of Daily Living (ADLs) are activities that are oriented toward taking care of one’s own body and are completed daily. These include bathing/showering, toileting and toilet hygiene, dressing, eating, functional mobility, personal hygiene and grooming, and sexual activity. Many studies demonstrate the connection between ADLs and health-related quality of life (HRQOL). Mostly, findings show that difficulties in performing ADLs are directly or indirectly associated with decreased HRQOL. Furthermore, some studies found a graded relationship between ADL difficulties/disabilities and HRQOL- the less independent people are at ADLs- the lower their HRQOL is. While ADLs are an excellent tool to objectively measure quality of life, it is important to remember that Quality of life goes beyond these activities. For more information about the complex concept of quality of life, see information regarding the disability paradox.

In addition to ADLs, instrumental activities of daily living (IADLs) can be used as a relatively objective measure of health-related quality of life. IADLs, as defined by the American Occupational Therapy Association (AOTA), are “Activities to support daily life within the home and community that often require more complex interactions than those used in ADLs”. IADLs include tasks such as: care for others, communication management, community mobility, financial management, health management, and home management. Activities of IADLS includes: grocery shopping, preparing food, housekeeping, using the phone, laundry, managing transportation/finances. Research has found that an individual’s ability to engage in IADLs can directly impact their quality of life.

Importance

There is a growing field of research concerned with developing, evaluating, and applying quality of life measures within health related research (e.g. within randomized controlled studies), especially in relation to Health Services Research. Well-executed health-related quality of life research informs those tasked with health rationing or anyone involved in the decision-making process of agencies such as the Food and Drug Administration, European Medicines Agency or National Institute for Clinical Excellence. Additionally, health-related quality of life research may be used as the final step in clinical trials of experimental therapies.

The understanding of Quality of Life is recognized as an increasingly important healthcare topic because the relationship between cost and value raises complex problems, often with high emotional attachment because of the potential impact on human life. For instance, healthcare providers must refer to cost-benefit analysis to make economic decisions about access to expensive drugs that may prolong life by a short amount of time and/or provide a minimal increase to quality of life. Additionally, these treatment drugs must be weighed against the cost of alternative treatments or preventative medicine. In the case of chronic and/or terminal illness where no effective cure is available, an emphasis is placed on improving health-related quality of life through interventions such as symptom management, adaptive technology, and palliative care.

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Extracted from Wikipedia.