Habemus plus vis computatoris quam Deus

I had a nerve conduction study this morning, at New England Baptist Hospital.

So, just in case any of you ever wondered ... "nerve conduction study" is a medical term meaning in large part "stick a bunch of needle electrodes into your leg and shoot electrical pulses into them while wiggling them around."  You know how about ten or fifteen minutes after you get a really strong cramp in your calf, you have a deep ache where the muscle cramped that feels like a horse kicked you in the back of the leg there?  Pretty much my whole left calf felt like that by about an hour after the test.  Fortunately, about fifteen minutes walking around when we stopped in Tilton loosened it up (though I could barely stand when I first got out of the car).

The good news is the preliminary verdict (pending full analysis of the results) is that while there's plenty of evidence of past damage to both my tibial and perinial nerves, I have in general good nerve conduction and good muscle recruitment in both.  (Not as good as the undamaged right, though; I could quite easily tell the muscle contractions in the right calf were stronger.)

This bodes well for being able to finally fix my ankle up a bit better and make it last this time.  (A fix has been attempted before, but I lost a lot of the benefits because my knees just plain hurt too badly to be able to complete the PT.  My artificial knees are a lot better in that regard.)

Reports out of the UK say that microneedle cryotherapy not only destroys breast tumors in minutes, but prevents relapses.  The technique is minimally invasive, and the article (brief though it is) implies that no follow-up chemotherapy or radiotherapy is required.  It's mentioned that they're experimenting with it for prostate cancer; I suspect it may prove to have general applicability to a wide range of compact/dense cancers.

Mechanically speaking, the human lower leg/ankle/foot is not just a support and a locomotive system, but also a shock absorber and energy recovery system.  In all, the human leg from the knee down actually recovers up to two thirds of the energy required to take each step.  A significant part of this energy recovery actually takes place in the foot.

Delft University of Technology in the Netherlands and the University of Michigan have recently developed an almost entirely mechanical prosthetic foot designed to recover energy in the same way that an undamaged foot and ankle does.  It's not perfect, and it's still in development, but it reduces the metabolic penalty of walking with an immobilized ankle and an otherwise undamaged lower leg from 23% above normal with a conventional rigid prosthesis to 14% above normal with the mechanical active prosthesis.  In other words, it cuts energy loss by almost half.  The paper also notes that there is added energy expenditure associated with the additional mass of the simulatore boot device used, so energy recovery in actual a[pplication could potentially be even better.  (Interestingly, the active prosthesis actually increases push-off energy by 7% above normal.  This offers the implication, unstated in the paper, that users of the active prosthetic might be able to save additional energy once they get used to walking with it.)

At the moment, it's purely a research device, not ready for medical application yet.  But it's an interesting development that shows a lot of future promise.  There may yet come a time when I need one of these myself.

Last night, someone I know pointed me at a July 2007 blog article by a Dr. William Davis, talking about why excessive consumption of processed wheat products is bad for your health.  That includes breads, cakes (see, you always knew Ho-Hos were evil!), pasta, and even those breakfast cereals with the boxes plastered with logos telling you how heart-healthy they are.¹

It’s an interesting blog overall. The title of this post comes from part of Dr. Davis’ capsule “about” text:  “You’ve been playing the health game by someone else’s rules with the odds stacked against you.”

Davis stresses that he’s not dispensing medical advice, just sharing information and discussing health issues frankly as he sees them.  But it seems to me there’s a lot of good information here.

I’ve just syndicated his Atom feed here on LJ as heartscanblog.  If you want to become a little more of an informed player in the health game, you might want to pick the feed up.

[1]  Oh, wait, wait, most of them don’t actually come right out and say that they’re heart-healthy ... they usually wrap the insinuation in weasel-words like “Supa Wonda Brekky Bikkies can be part of a heart-healthy diet” and let you draw the conclusion they want you to, without ever actually making explicit claims.  Well, cellulose packing peanuts can be “part of” almost any diet you care to name, too, but I still don’t recommend eating them.

From the Mayo Clinic:

Prolotherapy involves injecting painful ligaments and tendons with sugar solutions that are intended to stimulate production of connective tissue.  A typical course of treatment is six to 10 sessions, sometimes with multiple injections at each session.

[...]

A 2007 review of five well-designed studies involving 366 participants concluded that prolotherapy alone was ineffective in treating chronic low back pain.  However, when combined with other treatments — such as spinal manipulation and exercise — prolotherapy may improve chronic low back pain.

The question I have to ask here is, if prolotherapy "may improve chronic low back pain", but only when combined with "other treatments such as spinal manipulation and exercise" which are known to improve lower back pain, does prolotherapy actually yield any improvement not attributable to the other, known effective, therapies it's being combined with?  In the absence of any stated finding of synergism, this seems a bit like saying "Painting one's toenails blue may be effective against bronchitis, when combined with antibiotics."  The article appears to damn prolotherapy with faint praise.

Quoted directly from hrrunka:

Another day, another visit to Ashford on a pleasant sunny afternoon.  The Intensive Therapy Unit was rather busy, so I spent more than half the time sitting around waiting for them to get things done.  Such is the way with ITU.

Peter's now off the sedative, but the residual is taking a while to clear his system, so he's still on the respirator, and they're regularly clearing stuff from his chest.  As the sedative wears off he's beginning to take some breaths of his own, but mostly the respirator's still doing the work.  His legs are still rather swollen, but the excess fluid is slowly being removed.  He's on fewer drips, but the dialysis machine's still running the whole time.  However his kidneys are showing signs of functioning again.  One of the breaks in my visit was because they wanted to fit a catheter to take care of that.  I talked a while, passing on the various "get well" wishes I've read on LJ and YW but I've no idea whether he's awake enough to take anything in.  His sister arrived just as I was leaving.

Relayed from hrrunka:  Peter was put on a ventilator overnight, and is also being treated for possible deep-vein thrombosis.

We all know about the problems of antibiotic resistance, frequently aggravated by over-prescription and improper use of antibiotics.  MRSA, methicillin-resistant staphylococcus aureus, has been the bane of hospitals for a decade or more.  Other potent pathogens have emerged in MDR (multiple drug resistant) and XDR (extensively drug resistant) forms over recent years.

The latest to join the club is mycobacterium tuberculosis.  Tuberculosis, "the white plague", used to be a major killer before antibiotics.  In large part, the public health systems of the western world were put together to fight tuberculosis, and for a long time, TB was on the run.  But now it's back, worse than ever.  One fifth of TB cases worldwide are now multi-drug resistant TB, defined as resistant to both of the main first-line drugs.  For MDR-TB, four other drug families exist, but they are much more expensive, have severe side effects — starting with nausea and diarrhoea, and extending to convulsions and kidney failure — and must be taken for as long as two years to effect a complete cure.  XDR-TB strains may be resistant to as many as six of the available antibiotics, and since mycobacterium tuberculosis is lwo-growing, it currently takes several weeks to grow enough of a culture to test it for drug-resistance to find a drug to which it is susceptible — by which time the patient may well be dead.  In one South African clinic, out of 53 patients infected with XDR-TB since 2001, only one survived; the remaining 52 all died within weeks of infection.  Even in the US, out of one group of 64 XDR-TB patients, one third died.  Studies conducted to date appear to show that 2% of TB cases are XDR — in other words, one in five TB infections is MDR, and one in ten of those is XDR.

And it doesn't stop with MDR or XDR.  Since the magnitude of the drug-resistance problem became clear, doctors worldwide have dreaded the emergence of a virulent pathogen strain with complete drug resistance.  Last month in Italy, it finally happened:  a patient developed a strain of tuberculosis resistant to all currently known antibiotics.

It is estimated that one third of the world's population carries mycobacterium tuberculosis.  It is dormant in most carriers, but if the immune system is weakened or compromised by injury or other sickness, or by HIV, it can flare up and go active.  TB is the largest single killer among the HIV-positive.  On average, about one in ten people who carry mycobacterium tuberculosis will eventually develop the active disease.

One of the biggest problems here — and one of the reasons why there are no new drugs — is because TB is widely seen as a disease of the poor.  It is comparatively rare to find active TB in the western world, but in the world's poorer quarters, where sanitation is frequently poor, many patients cannot afford to see a doctor, and hospitals are frequently under-funded and under-equipped, it is widespread and becoming more so.  In 2006 there were nine million diagnosed cases of TB worldwide; 1.6 million of the patients died.

But there's little or no profit to be made in treating the diseases of the poor ... so drug companies, on the whole, aren't interested.

In recent years, an international agreement has been passed which allows poorer countries to issue "compulsory licenses" allowing them to make or import generic versions of patented drugs upon payment of a fee to the patent holder.  This program was designed to make front-line drugs available to countries that cannot afford to buy them over-the-counter from the manufacturer.  Thailand, where AIDS is now claimed by some to be the leading cause of death, recently issued such compulsory licenses for Sanofi-Aventis' heart drug Plavix and for two HIV drugs, Merck Sharp and Dohme's Stocrin and Abbott Laboratories' Kaletra, the most widely-prescribed anti-retroviral agent worldwide in its class.

[...] the Thai government has tried to talk to the companies but prices have not been reduced sufficiently.  “For the lopinavir/ritronavr we have tried several times to negotiate with Abbott in the last two years. They have reduced the price down but [it is] still too high to be affordable by our universal access to antiretroviral drug scheme,” [an official of the Thai government] said.

Abbott recently developed a new tablet formulation of Kaletra that needs no refrigeration — but, in retaliation for Thailand's compulsory-license issuance, Abbott is withholding the new formulation from Thailand, along with six other drugs.

Not all drug companies respond so poorly.  When Thailand issued its compulsory license for Stocrin, Merck Sharpe & Dohme responded with an offer to cut the price of Stocrin by two thirds.  Overall, the pharmacentical industry as a whole needs to get the message that profit is not the primary consideration when it comes to treating disease.  XDR and CDR pathogens put us all at risk, and there's no profit at all to be made from antibiotics if none of them work any more.

...since my current primary care physician is in South Nashua, 20 miles away now.  Dartmouth Hitchcock has a family practice facility right here in Merrimack, and my podiatrist is already part of the Dartmouth Hitchcock system.  On top of that, it turns out one of the doctors at the Merrimack family practice center is an osteopath, which might well mean I'd be able to find more effective care for my back problems.  (I think half the reason chiropractic treatment is viewed with such suspicion in the US is because it's so hard to find a chiropractor who isn't, frankly, a complete quack.)

Well, so much for the theory.  The practice is that the osteopath isn't accepting new patients, and the only doctor there who IS accepting new patients is currently booking appointments in early January.  This suggests that the facility is so overloaded going there might be a bad idea anyway.  I wouldn't be able to get any of my referrals transferred until after a new-patient appointment, and then there'd be the queue lead for the specialists, so the upshot of it seems to be that if I switch to a PCP at Dartmouth Hitchcock Merrimack, it's going to be five to six months before I can get any care from any of my specialists again.  (And frankly, I think I need to get my right knee cleaned up the same as the left knee as soon as I can.  The crunching noises are starting to get really unsettling.)

It's at times like this that I reflect on how screwed-up the US medical care system is.  The whole "all your referrals reset if you change doctors" thing is a pain, and when it's so hard to find a doctor who's accepting new patients and isn't totally swamped, what do you do?

Half the problem, I suspect, is the number of doctors who've retired or gone into other lines of work because they can't afford malpractice insurance rates driven by frivolous malpractice suits (parents suing their obstetrician because their child was born with a congenital defect, for instance¹).  Unfortunately, that's not going to change as long as the perception of a career in law as a get-rich-quick license endures.

This country needs twice as many doctors and engineers, and a quarter as many lawyers.

[1]  This isn't a hypothetical example.  I've read of several cases in which a child was born with what was unquestionably a congenital defect, but the parents sued the obstetrician anyway, and the obstetrician's medical insurance settled out of court because "We all know this is a congenital defect and there's not a thing you could have done to prevent it, but the instant a jury sees those photos, we've lost the case."

I want to find a good chiropractor in Southern New Hampshire.  Specifically, I want to find a chiropractor like the two GOOD ones I knew in San Jose, California.  A chiropractor who isn't into all the new-age holistic stuff, won't try to glue magnets to my back or sell me energized water, doesn't think that conventional medicine is "death medicine" and that vaccinations are deadly, won't lie to me about X-rays when I can see perfectly clearly he's drawing lines between two different sets of reference points to try to show a result that isn't true, won't try to treat my back pain by giving me electric shocks in my earlobe, and won't try to tell me that wearing a ball cap weighted with 6lb of lead will make my vision sharper.  I just want a chiropractor who knows the spine and skeleton, knows his drop table, and isn't afraid to use it.  Preferably, one who won't get bent out of shape when I say "Look, I know exactly what the problem is, I just can't treat it myself."

Anyone have any recommendations or referrals...?