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Like a Rolling (Gall)Stone – Part Deux

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Wednesday

Morning started at 6 a.m. with the Procession of Medications, a pill to prevent reflux, and my nurse noting my lipase level was down to 2,000. A tech took my temperature, blood pressure and pulse oximetry. The day shift nurse, Katrina, brought more meds around 7:30 a.m. which I took with the water I wasn’t supposed to be drinking.

“Uh, didn’t they tell you not to drink?” Nope, this is the first I’ve heard.

She also injected a dose of Lovenox®, an anticoagulant to prevent a deep vein thrombosis (DVT), because it had been ordered, not because I really needed it. I didn’t have the presence of mind to question it because I was tired but it seemed superfluous. My risk for a clot was low since I hadn’t had major surgery, I wasn’t bedridden, I don’t smoke and I’m not pregnant. Yeah, I’m old and fat but so what? (I refused it the next day, which is good because that little sucker was $119!)

An hour later a woman from Respiratory Therapy, who looked and talked like the commandant at a German women’s prison, appeared with one of the newer brand name steroid/long acting bronchodilator inhalers. Remember what I said about hospital meds costing a lot more? This one retails for about $450 and lasts 14 days; the hospital charged $570. My generic version, which lasts a month, is $40 with GoodRx®.

“I have an inhaler for you and I’m going to teach you how to use it. You pull back the cover and it’s very important that you hold it correctly with the vent side up. Then you take a deep breath and hold it.”

I pulled out my albuterol rescue inhaler. “I’m a physician. I’ve been using inhalers for a long time.”

She snapped at me. “You should NOT have your own inhaler! We are responsible for you and must know every medication you are taking! Another respiratory therapist would turn you in.”

Now she reminded me more of General Burkhalter from Hogan’s Heroes. Turn me in? What is this, Stalag 17? Are you going to send me to the Russian Front?

She watched while I inhaled like toking from a bong, then put it in a plastic bag which she placed on the shelf below the TV. “Someone will come back tomorrow for your next dose.” You think I’m so stupid that someone has to watch me? 

No, it’s because the hospital can charge $424 to “administer” the medication and $323 to “demonstrate” how to use it! What the hell do people without insurance do with those kinds of charges?

The Parade of the Grey Coats began around 9 am. Doctors (usually men) in white coats often cause spikes in patients’ blood pressures, so now most wear either grey or blue lab coats to minimize the psychological trauma. Or maybe it’s because white coats are a bitch to keep clean. (I have a royal blue lab coat with a Grateful Dead patch on the pocket.)

The internal medicine hospitalist showed up first. Now, I’m not sure what a hospitalist does other than generating revenue and confusion while making it possible for office-based internists to never set foot in the hospital. I’m sure I’ll get a lot of shit for that but my sister-in-law’s experience with hospitalists, who are usually much younger than the seasoned staff physicians, was exasperating.

He asked me to recount the events that ended with my admission, the third request if you’re keeping count.

“How are you feeling?”
“Better than when I came in.”
“Well, your lipase levels have come down nicely to around 2,000 with the I.V. fluid flushing it out. Do you mind if I examine you?”

He poked my abdomen in a few places. “Does that hurt?”
“Not much but you’re not as rough as the ER doc last night. Do you know Dr. Nell?”

He chuckled, “Yes, I like her, but she can be a little, uh, enthusiastic.” That’s a polite way of putting it.

“Your lipase levels suggest you have pancreatitis. You’re not an alcoholic and you don’t smoke so it’s likely caused by gallstones. That pain you had may have been a stone passing, especially since it didn’t last too long and you’re feeling better. I’m going to order an ultrasound of your gallbladder. We might be able to send you home later today, but we’ll have to wait for the GI guy to see you.”

We interrupt this tale for a moment of education and enlightenment.

THE PATHOPHYSIOLOGY OF BILIARY PANCREATITIS 

The gall bladder is a pear-shaped organ that lies below the liver. It stores and stores bile, which digests fats. Bile leaves the gall bladder through cystic duct. The pancreas also secretes digestive enzymes through the pancreatic duct which joins the cystic duct, forming the common duct. Both empty into the duodenum through the hepatopancreatic ampulla, also known as the Ampulla of Vater (Darth Vater?), which is controlled by the Sphincter of Oddi. Sounds like something out of Norse mythology.

The gall bladder also provides a source of income for general surgeons when it becomes inflamed (cholecystitis), full of stones (cholelithiasis), or both. Stones form when, for unknown reasons, stuff in bile crystalizes and forms gallstones, in much the same way stuff in urine crystalizes to form kidney stones. If a stone gets stuck in the common duct, it blocks secretions from both the gallbladder and pancreas, resulting in gallstone pancreatitis, which is what I had. Pancreatitis can also result from excess alcohol consumption, smoking, prior abdominal surgery, obesity, infections, injuries, and pancreatic cancer.

Abdominal ultrasound is the easiest way of finding gallstones and often cholecystitis, as inflammation thickens the gallbladder wall. Other, and far more expensive, diagnostic methods include nuclear medicine scans, Magnetic Resonance Imaging (MRI), or Endoscopic Retrograde Cholangiopancreatography (ERCP), looking directly into the duct with an endoscope.

A common home test for cholecystitis is consuming a greasy meal which results in excruciating upper abdominal pain; however, this is not medically recommended.

Now, back to the program already in progress

Peg arrived around 9:30am.

Did I ever mention Peg hates hospitals? No, she REALLY hates hospitals. Her mother said, “Hospitals are where you go to die.” If Peg has the big one at home, she wants me to just hold her hand and stroke her arm until she passes. Then, and only then, can I go through her office looking for the lam money.

She also thinks there is a lot of waste and abuse, albeit mostly inadvertently because no one thinks about cost in a hospital. This is largely true. I worked for a staff-model HMO thirty-five years ago. “Managed care” was withholding care from patients for profit and employed physicians weren’t good enough to work with “real doctors.” Forty years later most physicians are employed by heartless entities, and I got the last laugh.

“So, what’s happened so far? I talked to your nurse about 5:30 this morning and she said you had a good night.”

“Yeah, my lipase level has come down to two thousand something. I saw the hospitalist earlier; he thinks I have pancreatitis from passing a gallstone. He ordered an ultrasound and said I might get to go home…depending.”

“Do you have any pain?”
“No, I feel pretty good right now.”

Just then a guy from Patient Transportation appeared in the doorway. He took me down for ultrasound on my bed, reversing the previous night’s course. I stared at the ceiling again as we went left out of my room, into the elevator, down to the first floor, out and a couple of left turns before backing me into a cramped ultrasound exam room. The ultrasound tech introduced herself, squirted warm ultrasound gel on my abdomen and started the exam. About fifteen minutes later she finished.

“And….?”
“You’ve got gall stones, but you didn’t hear that from me.”
“My lips are sealed.”

As the transportation guy wheeled me out someone from nuclear medicine said: “We’re going to see you later.”

Once back in the room I told Peg what we’d both suspected. Then the gastroenterologist showed up – not exactly a fount of wisdom. At his request I repeated the events of the previous 12 hours for the third (or was it the fourth) time. He pushed on my abdomen, and I winced.

“Well, at least it’s in the right place. Your ultrasound showed you’ve got gallstones. We’re going to get a CT (Computed Tomography) scan to confirm the diagnosis and a general surgeon will see you later today.”

“Ok, how about not giving me another liter of fluid? I’ve had three in the past ten hours, and I’ve been peeing every two hours.”
“Yeah, that’s probably a good idea. We’ll also try you on clear liquids.”

Peg and had a discussion after he left.

“You told me it didn’t hurt, and you told him it did.”
“It didn’t hurt when you asked me. It hurt after he reefed on it because it’s inflamed, not because I’m lying to you.”
“Getting a CT scan to confirm what we already know is a waste of money! The ultrasound showed you have gallstones; a CT scan is redundant. It’s not going to give any better information. And THIS is why healthcare is so expensive!”

Peg had a point. If you’ve already made the diagnosis with a $1,000 ultrasound scan, why tack on another $3,000 for a CT scan to tell you the same thing? If an ultrasound might be difficult because of extreme obesity, then just do a CT. (Side note: Later that day the general surgeon told me the CT scan was used because ultrasound can’t evaluate the pancreas very well for things like fluid collections or tumors, which is important when considering surgery.)

We saw the cardiologist next and recited my history for the fifth time. I recognized his name; he is the “electrician” who did my sister-in-law’s cardiac ablation. She absolutely loves him, and his partner is my cardiologist, so I trusted whatever he had to say.

“Your EKG and troponin levels were normal. You haven’t had a recent stress test and we’ll have to clear you if you’re going to have surgery.”

I had a stress test in 2017 because I’ve no reliable family history and I was going to start work as a hospitalist. Unfortunately, a normal stress test doesn’t mean you won’t drop dead a few weeks later like Tim Russert.

There are two ways to do a stress test. The time-honored tradition is to hook a patient up to a 12-lead EKG, run him or her on a treadmill until the pulse is at least 130, and see what happens. ST segment changes suggest coronary artery blockage. (So does grabbing one’s chest and having the big one.) The test runs a few hundred bucks.

The other way is a cardiolite stress test, injecting the subject with a radioactive tracer and scanning the heart before and after the treadmill. A decrease in uptake after exercise suggests blockage and may indicate which artery/arteries are affected. The tracer and scan add several thousand bucks to the procedure, even though it is of questionable benefit in someone who has no history of coronary artery disease. Coronary angiography, injecting dye through the coronary arteries, is still the definitive test for detecting blockages.

The charge for an outpatient study is considerably less than doing the same thing in a hospital:

Itemoutpatientinpatient
Treadmill$325.00$1,200.00
Tracer$720.00$918.00
Scan$1,634.00$5,532.00
Interpretation$300.00$300.00
TOTAL$2,979.00$7,950.00
Cardiolite Stress Test: Comparing outpatient and inpatient charges

A nuclear med technician came in with a syringe containing the isotope in a shielded container and transportation took me down in a wheelchair instead of a gurney. This time I could at least see where I was going. The cardiac evaluation unit was below the first floor and reminiscent of the Batcave.

One of the women in the scanning room explained the procedure, then had me lay on the slightly uncomfortable scanner bed.  The initial images took about six minutes, then they wheeled me across the hall to the treadmill room. Another tech applied twelve more EKG leads on my chest and abdomen, on top of the six leads I had for the portable monitor. The woman running the test explained what was about to happen.

“You’ll be on an incline on the treadmill. It will start out slowly for a few minutes, and then I’ll increase the speed until your heart rate gets to 130. You’ll have to keep that pace for at least a minute. Try to go as long as you can. When you need to stop, I’ll slow the treadmill for a one-minute cool down phase.  I see you have exercise-induced asthma. Do you have an inhaler?”
“Yes, I do but the respiratory Nazi told me I shouldn’t have it in the hospital.”
“Well, she’s wrong; we like treadmill patients to have their inhalers on hand.”

Left hand, have you met right hand?

The incline was fairly steep, more than I’ve ever tried at home. I held onto the bar across the front of the treadmill to keep from falling backwards. The pace was manageable despite feeling I was hiking up a mountain.

Then, to quote Emeril Lagasse, she “kicked it up a notch.” Actually, several notches. It didn’t take long for me to hit the target heart rate. I managed two minutes at that speed before I told her I had to stop.

“Are you having any pain or trouble breathing?”
“No, I’m just way out of shape and too old for this shit.”

I went back into the scanner for about three minutes before being wheeled back upstairs. I napped for a while, while Peg sat in the corner playing with her Kindle and looking at the news feed on her phone. I figured no news was good news.

The day nurse came in a little after 1pm to tell me the CT scan was scheduled for around 4pm and I’ll get oral contrast to drink around 3pm. The guy from transportation arrived a little before 4, followed by the nurse.

“Wasn’t I supposed to drink some contrast?”
“Uh, you didn’t get it?” Would I be asking you if I had?

She sputtered a bit and disappeared, possibly to give someone an ass-chewing, and to get the CT scan rescheduled. Peg rolled her eyes.

“If you were just a regular patient, you would have gone for your scan without asking any questions. They would have done the CT, discovered you didn’t have the oral contrast, and sent you back upstairs, and repeated it later. And you wonder why I hate hospitals.”

I saw the surgeon around 6:30, after Peg had gone home to feed Baxter. We hit it off immediately. He extolled the virtues of removing gallbladders with a laparoscope and I told him about assisting on an open cholecystectomy when I was an intern. Back then they made an autopsy incision from the breastbone along the right rib margin, then pried the muscles apart to get to the gallbladder. The guy I helped with was fat and needed a very large retractor called a Joe’s Hoe for exposure. Yeah, it looked like one could till soil with it.

“There are two options. The first is to have the surgery since you are already in the hospital, and you’ve gotten cardiac clearance. The other option is letting you go home and scheduling this as an outpatient. I’d recommend doing it now because we know you have gallstones and you’re likely to have another attack within three months. It’s better to take care of it now, because I’ve seen people wait and then come in with a necrotic gallbladder. They end up in ICU on I.V. antibiotics and sometimes a ventilator because they are really sick.”
“My wife works long hours. I need to talk to her and make arrangements. What is the chance of passing another stone in the next two weeks?”
“It’s likely pretty low but not zero. You might want to just get it over with.”

Well, that sounded good to me; I wouldn’t have a lot of time to think about going under again. We talked about my prostatectomy; he said taking out my gallbladder wouldn’t take as long, and I could probably go home a few hours later.

“I know your surgeon. We’re actually very good friends, even if he did go to Ohio State.”
Oh God, he’s a Wolverine. They can be sooo insufferable! But he seems like a decent guy.

“In the meantime, you can have a clear liquid diet tonight. Don’t have anything after midnight in case you decide on surgery. I have one case in the afternoon.”

I called Peg.

“He said we can do it now or do it later. I told him you had to work and could we do it in a couple of weeks. He said we could but there was a chance of another attack before surgery.”
“Well, what do you want to do?”
“He’s coming back in the morning and you’ll probably be here before him, so you can ask him any questions. If I do it tomorrow, I won’t have a lot of time to think about it.”
“I’ll go along with whatever you want.”

Katarina brought me two cups of contrast just before 7pm.

“Drink these now and I promise you’ll be downstairs for your CT scan around 8pm.” Well, this better happen!

Someone arrived just before 8pm and took me down to the CT room. It was cold, probably to protect the equipment which can become very warm. The tech who met me was a scruffy guy who reminded me of the dude that drove the school bus down to the water when a bunch of us went canoeing at Turkey Run State Park in Indiana during college. (His “mandatory safety instructions” were “If the brakes go out on this bus, put your head between your legs and kiss your ass goodbye!”)

“Marian will help you lay on this skinny bed while I get everything set up. I’ll let you know when I push the I.V. contrast because your head will start to feel warm and then you’ll think you’ve peed your pants. You’ll have to hold your breath a few times but that doesn’t last long. Do you have any questions?”
“Nope, let’s just get this done.”

The scan was as he described. I held my breath a few times while the scanner did its thing. The I.V. contrast created a brief sensation of warmth in my head and nether regions, passing quickly. I was back upstairs by 8:30 and I called home to say goodnight to Peg and to Baxter, who wasn’t taking this very well at all. He paced Tuesday night until 2am and this promised to be another fitful night.

Maybe tomorrow would bring a reprieve from all this fun and excitement.

JOIN US NEXT TIME FOR THE SERIES FINALE!

Illustration Credits: All © Can Stock Photo
Pancreas: Blambs
Pancreatitis: alila
Pear: yayayoyo
Burger and Liver: FabioBerti

Like a Rolling (Gall)Stone – Part 1

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Tuesday

One minute I’m sitting on the couch watching 911: Lone Star and the next we’re hauling ass down 22nd Street on our way to Our Lady of the Suburbs Hospital thinking I’m gonna die from a heart attack.

I’ve had one hell of a case of reflux from three decades of stress, heavy caffeine intake and being fat, so occasional epigastric “discomfort” doesn’t set off alarms. But this time the slight ache turned into a constant squeezing pressure just below my xiphoid, that triangular bone below your sternum (breastbone) and pain that ran up to my right jaw. I went to the dining room table and sat for about 10 minutes and, like every other guy facing the prospect of a life-altering illness, hoped it would go away.

It got worse.

Peg was on the phone with her sister when I said, “I need to go to the hospital right now!” I was clutching my chest and had that I’m-not-pulling-your-leg look.

“Oh, shit, I gotta go!” She hung up and asked, “Do you want me to call 9-1-1?”

Hell, no. My first and hopefully last ambulance trip cost about fifteen hundred bucks and we could get there faster by driving. We got into the car and for once Peg didn’t drive like my grandmother. We were at Highland Avenue in about five minutes; the hospital was another five minutes south.

I thought back to the time Peg’s mom Gloria took Michele’s husband to the same hospital with his second heart attack. She didn’t like the maniacal drivers on Highland and took the back way through Finley Square Mall. Despite being potentially on death’s door, Dave still had the presence of mind to backseat drive.

“This isn’t the way to go.”

Gloria snapped, “Well this is the way I go!”

Best not to piss off the woman who has your life in her hands.

Peg pulled into the circular drive at the Emergency Department entrance. I got out and slowly walked into the reception area, still clutching my chest. The pain wasn’t as bad, but it hadn’t gone away. Peg said, “Possible MI here!” which impressed no one behind the glass.

“Have you been here before?”
Does it fucking matter right now?

Peg whipped out the all-important insurance card while I grabbed the nearest wheelchair. A few minutes later someone came out to reception and wheeled me through the ED double doors. The desk clerk, whose duties include traffic control, said, “They’re just finishing cleaning up nine. You can take him in there in a couple of minutes.”

Even though I’ve done it a couple of times, I’m still not used to being the one being wheeled into an exam room. Usually, I’m the one strolling in after all the folderol is over and the patient is prepped. Now I’m the one climbing onto the gurney while a couple of people swarm around me like worker bees around the queen. 

My shirt came off and someone put EKG leads on my chest, a blood pressure cuff on my left arm, a pulse oximeter on my left index finger, a thermometer under my tongue and an IV catheter in my right antecubital space (elbow joint), one of the worst places to put it. A lab tech took several tubes of blood before the nurse ran heparinized saline through the catheter before plugging the end. I put my gown on sometime during this onslaught. Someone else came in for a nasal swab for a COVID test.

A tech did an EKG and I figured I wasn’t having a cardiac issue since he didn’t go running down the hall for the crash cart team. Modern EKG machines print out a preliminary reading; mine was normal sinus rhythm. A radiology tech pulled a portable x-ray machine into the room, put a plate behind me and said, “Deep breath and hold it.” Imaging is all digital now; no more 55-gallon drums full of used x-ray film. The image appears on a computer monitor and the ability to zoom in and out means the radiologist doesn’t have to squint nearly as much.

The nurse started taking a history of my episode; this would be the first time of many that I’d recite the same story. This is not surprising since patients will tell nurses one thing and doctors something else. My story went like this:

“So, tell me what brought you to the hospital / what happened / what’s been going on?”
“I was sitting on the couch about a half hour after dinner and started to feel this pain right here (points to mid-epigastric area) that felt like someone was squeezing me really hard. I waited about ten minutes thinking it was going to get better, but it only got worse, so we came here.”
“When did it start?”
(Looking at the clock) “About 30 minutes ago.”
“Did the pain go anywhere else?” This is important because cardiac pain generally radiates to the left jaw and/or the left arm.
“It went up into my right jaw.”
“Any nausea, vomiting, sweating?”  The first heart attack admission I saw when I was a 17-year-old hospital orderly was sweating like a pig*. Some have nausea and/or vomiting, making them think “it’s just a little indigestion.”
“How do you feel now?”
“Better than I did before I came here but it still hurts!”

*Before someone says, “Pigs don’t sweat,” that phrase came from iron smelting. Molten iron poured onto sand forms “pig iron” which resembles a sow and piglets. Moisture from the ambient air condenses onto the “pigs” as they cool, which looks like sweat. I didn’t know that before, and now you know it as well.

The nurse left and the ED physician, Dr. Nell, walked through the privacy curtain covering the exam room doorway. She was short and stocky with short blond hair peeking out from under her surgical cap; her last name suggested she was of Eastern European descent. She asked me “So, what happened?” (Go up two paragraphs for the recap.)

Before I answered I made a point of telling her I was a retired physician. Normally, I don’t advertise but I’ve found it comes in handy since physicians don’t treat their brethren with the same dismissive attitudes and skepticism reserved for the great unwashed.

She began her examination by listening to my heart and lungs, then pushed on my abdomen REALLY hard, like one of the old Soviet Union’s female weightlifters.

“AAAAAH!”
“Does this hurt?”  Well, now it does!

She was quiet for a few minutes.

“You don’t have any of the classic heart attack signs like sweating or nausea and your EKG is normal, so it might be GI. I’m going to try nitroglycerine to see if it makes any difference while we’re waiting for your labs to come back.”

She left and a few minutes later the nurse returned with a small oval pill in a medicine cup.

“Put this under your tongue.”

Nitroglycerin is a vasodilator, a substance that relaxes smooth muscle and blood vessels, increasing blood flow to coronary arteries and is absorbed more rapidly from the mucous membrane under the tongue. The tablet itself irritating if left in one place too long and tastes like crap after disintegrating.

A few minutes passed and I didn’t feel any different. The pain had been slowly ebbing since I’d arrived, and my blood pressure dropped slightly. Dr. Nell returned.

“Did the nitro do anything?”
“No.”
“I didn’t think it would.”
“Yeah, neither did I.”
“Well, your troponin levels are stone cold negative, so I don’t think you’re having a heart attack.”

Troponins are proteins released into the blood when heart muscle is damaged. During my internship forty-some years ago we used to measure blood levels of lactate dehydrogenase (LDH) and creatine kinase (CK) when evaluating heart patients, but levels can be elevated with damage to other tissues. Troponins are much more specific.

She continued: “If it’s not cardiac, we start thinking of other causes, specifically gastrointestinal. Esophageal spasms (painful contractions of the esophagus) can mimic cardiac pain. We’ll have a GI evaluate you, but I want to try something else in the meantime. I’m going to give you a solution to drink.”

My nurse returned with a little turquoise container resembling a salad dressing packet, containing a solution of antacid and viscous lidocaine, a topical anesthetic. “We call this Magic Milk.”

I’m probably not going to like this, am I?

“It’s a combination of lidocaine and an antacid. You’re probably not going to like it.”

I’m used to downing Bicitra, something we gave to women before doing an emergency Cesarean section after a long, fruitless labor. It’s a solution of sodium citrate and citric acid with a fluorescent yellow-green appearance and tastes like thick, unsweetened Mountain Dew®. A friend of mine compared it to battery acid, but it cooled the burn expeditiously. It would probably be even better over ice with a little gin or vodka.

I tossed it back like a tequila shot, grimaced, and then roared, causing Peg to immediately panic.

“Are you OK??? Is something wrong???”
“Yeah, this stuff is really awful!”

Dr. Nell returned about 15 minutes later.

“Your labs are normal. Your EKG and chest x-ray are normal. I don’t know what’s causing the pain but it’s not likely cardiac. We’re going to keep you overnight and get consults in the morning.”

A woman from Admitting came in with a tablet and had me sign several forms, including “You’re responsible for any charges not covered by insurance. Don’t be a deadbeat or Vinnie will come visit you.” My nurse hooked me up to a telemetry EKG monitor. I got another wrist band and someone from transportation started pushing me down the hall.

I’ve seen friends and family in this hospital, so I knew my way around a bit, but that was walking upright. It’s almost impossible to know where you are looking at the ceiling, passing under fluorescent lights and acoustic tiles. Left, then right. Down one hallway, right and down another. A bell announced the elevator’s arrival; two bumps as the cart rode over the entrance.

A short trip up and I was on the 5th floor. The transportation dude wheeled me into the observation room.

“Can you make it to the bed?” Yeah, I’m not dead yet and I’m not as old as you think.

After I got settled I looked around at the luxury that was the observation room. I’d bet the Cook County jail had better holding cells.

There was a single hospital bed in what used to be a double room, a bedside table next to the bed, and a single utilitarian vinyl-upholstered recliner in the corner. A laptop was bolted to a mobile desktop between my bed and the bathroom wall. I think there was an unremarkable print on the wall, the kind whose eventual familiarity drives one insane. The walls were painted in either celery or baby diarrhea brown which, combined with the yellow tint of the fluorescent lighting, made the room even more dismal. The mattress was lumpy and about two inches thick; it alternately inflated and deflated in different spots, probably to prevent bedsores or blood clots in skinny, immobile old people. One could probably die from despair in here.

My nurse, Meghan, came in shortly to get me settled. She was tall with dark brown hair, grey eyes, not much of a butt and yes, I could be her father or grandfather. Just because I’m on a diet doesn’t mean I can’t look at the menu. What the hell else am I gonna do at 11:00 pm after thinking I was going to go to the Great Beyond?

We chatted a bit between the obligatory nursing documentation questions, including going through my medication list for the third or fourth time. Here’s a hint: if there are any meds you can do without for a few days before you get back home, don’t mention them. The hospital will give them to you while charging outlandish rates.

About 1am she came in and said, “Your lipase level came back 30,000 and the doctor thinks it might be pancreatitis, so we’re going to start I.V. fluids.” (Lipase is an enzyme the pancreas secretes to break down fats in one’s diet; an elevated level indicates inflammation from a number of causes, including alcoholism, gallstones or tumors.)

Pancreatitis? The only person I ever saw with pancreatitis was when I was a resident. She’d been deposited in our Labor Unit because some genius in the emergency room figured the woman in triage was (a) female and (b) in pain, so she must be in labor. She was actually 49 and had acute pancreatitis; and our nurse manager reamed someone a new one. I wasn’t in that much pain, but even I realized 30,000 was, if not an error, something terribly wrong.

Whoever gave the order also wanted me NPO, nil per os, meaning nothing to eat or drink. However, no one passed that on to me, so I kept drinking all night. And, not wanting to be a bother, I’d unplug the I.V. pump when I needed to urinate, wheel it to the bathroom, do my thing and hook it back up before getting back into bed, after figuring out how not to get tangle in the I.V. tubing. Two days passed and NO ONE asked why the bedside urinal was never used.

The bathroom was another disappointment. Commercial toilets are wall-mounted and, if done more than ten or twenty years ago, were lower to the ground than today’s “comfort height” toilets. Hospital toilets also have a rod connected to the plumbing that pulls down to spray out bedpans. Whoever does maintenance put in a six-inch lift between the bowl and the seat to raise the height but neglected to caulk the lower part of the lift. Anyone peeing sitting down (including me because it’s easier since my prostatectomy), ends up drenching the floor. It took a few trips to figure out why my feet were wet.

The lab took blood sometime during the night, but I wasn’t aware of it and figured they’d taken it out of the I.V. port.  I wondered what fresh hell daylight would bring.

TO BE CONTINUED…

Featured image: Chest Pain.  © Can Stock Photo / yekophotostudio

Bare Bones

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“And why do you worry about clothing? Consider the lilies of the field, how they grow; they neither toil nor spin, yet I tell you, even Solomon in all his glory was not clothed like one of these.
Matthew 6:28-29

“Naked I came into the world, naked I shall go out of it! And a very good thing too, for it reminds me that I am naked under my shirt, whatever its colour.”
E. M. Forster

We come into the world, cold, naked and wet. It’s downhill from there.
Some anonymous cynic

I’ve done two things in my life that might be described as adventurous, daring, courageous or stupid, depending on one’s perspective. The first was jumping out of an airplane at 3000 feet, not once, not twice, but three times. (I was sure I was gonna die the last time because I had to pack my own parachute.) I’ll write about it in a future blog.

But telling people I’ve been to a nudist resort raises eyebrows and prompts some tittering, no pun intended.

Little kids don’t have a problem with nudity. They’ll tear their clothes off without warning, which isn’t a problem unless Mom is in a ZOOM meeting with a two-year-old running around naked in the background. But as we get older, we learn, directly or by inference, that unclothed bodies are shameful and if you don’t agree, you’re a pervert.

Americans can’t disassociate nudity and sex, which isn’t surprising given they descended from the Puritans, a group that was so uptight it outlawed Christmas celebrations. That “nudist colonies” even existed provoked righteous indignation from some and snickering from others.

Public nudity enjoyed tacit acceptance briefly in March 1974. Much warmer than normal weather induced thousands of college kids to run naked across public spaces for the sheer thrill, a phenomenon immortalized by Ray Stevens’ hit “The Streak.”

Now, before I go any farther, I should point out I’m not a narcissist or an exhibitionist. Far from it. Poor body image and self-esteem isn’t restricted to women. I couldn’t look into a mirror from about 7th grade until my late thirties. I don’t recognize the reasonably attractive guy in pictures from decades ago as me. As I’ve gotten older, fatter, and greyer with far less hair, I’ve learned to accept my dad bod.

My interest in outdoor nudity, (naturism to the faithful) was born out of 25 years of life-sucking Midwest winters. I lived in Arizona until I was 11 where we had abundant sunshine, occasional rains, and the rare sun shower, an odd mixture of both. Snow was rare and exciting and usually melted by noon.

Then we moved to Illinois, the Land of Lincoln and the Never-ending Winter, when clouds obscured the sun from November through March. Clouds obscured the sun from November through March; snow a month earlier or later wasn’t unusual. I moved to Michigan for my residency and then stayed in the state to practice for another 13 years.  More snow, less sun and -30° in January. Strolling naked in a warm climate while everyone else froze their asses off sounded better.

I joined the American Sunbathing Association (which became the American Association for Nude Recreation – AANR – in 1995) in the early 1990s. I don’t remember how I connected with them since there wasn’t much of an internet back then and websites were more than a decade away. They didn’t advertise on the backs of matchbook covers like the “Learn to Draw” folks.

I bought Lee Baxandall’s World Guide to Nude Beaches & Resorts, back when we still had bookstores. I discovered that, with few exceptions, naturist resorts are family oriented. Some are permanent residents. Men do not wander around with a cup of coffee in each hand and stacks of donuts on erect penises. Women aren’t an endless parade of Playboy bunnies. Naturists come in a wide range of ages, shapes and sizes. They are just regular people who don’t wear clothes.

There are a few rules when visiting a resort:

  • No lewd behavior
  • No gawking with your tongue hanging out.
  • Don’t take anyone’s picture without consent
  • Carry a towel with you at all times, just in case you sit somewhere
  • Be a decent human being.

I planned to visit a resort outside of Tucson in 1992 during a trip to Arizona for a conference. The now-defunct Jardin del Sol (Garden of the Sun) lay off a dirt road outside of Marana. It was a modest place with a few wooden buildings, a swimming pool, a place to play volleyball and sites for camper hookups. I parked my rental car and checked in with the owner, a short older woman who looked at my AANR membership card.

“You’re here alone?”
“Yes, I’m on a business trip and my wife couldn’t make it.”
She eyed me for a minute and said, “Well, you look all right. The pool is down the hill, and there’s a group having a picnic.”

At that moment a guy in a well-worn white Chevy pickup, who looked and sounded like George Kennedy, stopped and excitedly said something to my host about pending naturist legislation before driving down to the picnic area.

I went back to my car, stripped down to my shoes, grabbed my towel, and headed back. Footwear is essential in the desert; desert sand can become very hot.  Goat heads, the hard, pointed seeds of an obnoxious weed that seems to grow everywhere, prey on bicycle tires and bare feet. And while crawling predators like the scorpion are largely nocturnal, one might run across the foot-long giant desert centipede.

And don’t forget sunscreen.

Thirty years ago, I was uncomfortable around strangers, nude or otherwise, and I wasn’t interested in small talk. I just wanted to sit by myself, work on a sunburn and forget about sub-zero temperatures back home.

I started on a foot path that led away from the pool and stopped at a miniature Boothill Graveyard. The tombstones bore amusing names and the nature of the departed’s crimes, namely violating resort rules (one took pictures without asking). They reminded me of a fake memorial in Boothill:

“Here lies Lester Moore
Four slugs from a .44
No Les, No more.”

Just then an older gentleman, short, bronzed and the spitting image of Buster Keaton, walked up to me.

“Hello, young feller! Can I help you find something?”

“I’m looking for a place to sit awhile and read my book.”

He pointed towards a trellis farther along the trail. “There are a couple of lounge chairs over there. Is this your first time?”

“Yeah, I was born here but I live in Michigan. I miss the sun.”

“Well, there’s plenty here. Welcome!”

I thanked him and headed for the loungers. I put the towel across the seat, lay back and enjoyed the desert, naked as the day I was born, as they say. I stayed for a couple of hours, reading, napping, and baking before driving back to my hotel.

A couple of years later I visited Forest Hills Club in Saranac, Michigan, just outside of Grand Rapids. The resort sits on a heavily wooded hill off a two-lane blacktop and isn’t visible from street level. I drove by it twice before noticing a small sign by a dirt road into the trees; there was an intercom next to the utility gate that blocked the entry.

I pressed the button and a young woman answered. “I’d like to visit for a bit.” The gate opened and I drove up to the site. I showed her my AANR card, and she gave me a brief tour. I went back to my car and took off my clothes and my shoes (no goat heads in Michigan), then grabbed my towel and a textbook. (A textbook? Seriously? How anal-retentive can one be?) I helped her move a large folding table before settling into a lounge chair.

The day was overcast and warm and I lost interest in the book. I lay back in the chair and closed my eyes, forgetting how burned out I was becoming being one of three physicians trying to manage a patient load that demanded five. I imagined spending the rest of my life sitting naked on a beach sipping margaritas and staring out at the ocean.

I haven’t had any further opportunities to indulge, although I maintained our membership in AANR partly to shock a family friend whom we call the Bald-Headed Stepchild. I worked as a traveler for more than twenty years; spending time at home decompressing with Peg was more important that trying to find the nearest resort (there’s only one in Illinois).

If I had my druthers, I’d buy a condo in Mira Vista Resort and try to establish my reputation as a renowned writer-slash-curmudgeon. For now, sitting naked in bed in the morning with coffee and my Kindle while my faithful companion (no, it’s my 15lb Shih-Tzu Baxter, not Peg) eats cookies will have to suffice.

For More Information

American Association for Nude Recreation

AANR: Social Nudism: Behavior Guidelines and Etiquette

Mira Vista Resort

Nude Hot Springs Around the World

Big Think: Nudist Beaches of Central and Eastern Europe

New York Times: Articles on nudism and nudity

World Naked Bike Ride

Featured Image © Can Stock Photo / chrisbradshaw

Writing Exercises

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Disciplined writers commit to writing something every day, but that’s been a struggle. This is my latest attempt.

March 15-16, 2021

Beware the Ides of March.
I admit to being a chronic master procrastinator when it comes to writing, which should not be confused with a chronic masturbator. I am not the disciplined writer who gets up at the butt crack of dawn every day and writes furiously for two, three or more hours.

I’m not a new writer; I’ve been putting pen to paper for more than 50 years. I don’t carry a Moleskine journal, furtively writing everywhere because a newly found voice and sense of outrage is brimming with ideas. My outrage started with an alcoholic stepfather and increased exponentially with the Vietnam War. I’m old and tired and cranky.

I often think of things when I’m driving or out for a walk, neither of which is conducive to putting pen to paper. (Also, my handwriting is so bad I have to ask Peg if she can figure out what I’ve scribbled: “You wrote ‘small Bailey’s’, not small barley.”) I roll things around in my brain, editing and revising until I finally have something to record for posterity.

That, and I’m a poor judge of my own writing. I’m never sure anyone will want to read what I have to say.

I’ve tried to analyze my reluctance with little success, but I can attribute a lot of it to two things: I hate trying to write when the muse isn’t there, because it just makes me frustrated and angry, and I hate being interrupted when I’m in the groove.

Until I alter my habits to something more productive, my days look like this:

I get up after a fitful night’s sleep made difficult by annoying and sometimes terrifying dreams (I was a psychopath being taken to a mental hospital in the last dream I remember). I shower, take my meds from the seven-day pill case I keep in my nightstand, and make coffee. If Baxter is still sleeping – sometimes he won’t get up until 10am or so – I will sit at my desk and try to write or waste time, knowing he’ll be up soon.

When His Lordship has awakened from his slumber, I will take him downstairs and out to pee, then we will negotiate breakfast. Sometimes he is hungry; other times he tries to run back upstairs because he’s just not interested. Occasionally I can entice him with sliced turkey but if he has a case of the fuckits, it’s an exercise in futility. If he does eat, I have to catch him to give him his insulin before he bolts. If I’ve thought fast enough, I put the gate up in front of the stairs.

That being done, I will sit in bed, drink coffee, and play Kindle games or read while Baxter buries, then eats cookies on the bed. I started doing this because if I go directly to my office to work, he yells from the bedroom until I return. When he finally settles down for his all-important early morning or mid-morning nap, I will go to my office and engage in the usual timewasters.

I approach Facebook as the 21st century morning newspaper. My FB friends and acquaintances post news links, often from sources outside the United States. I’ve contacts in the UK, Australia, and New Zealand, as well as one guy in Norway, but he doesn’t appear very often. Reading how the rest of the world sees us is sobering and sometimes infuriating, especially when some asshole here says we shouldn’t have universal health coverage because, “it’s socialism and I don’t want to pay for some illegal’s health care.” Presumably, his own financial ruin, the result of unpaid catastrophic medical expenses, is just dandy.

Then I’ll read the notifications for previous posts which, more often than not, draws me back to running arguments with die-hard contrarians. Common topics include:

  • how Joe Biden is wrecking the country, and how that other guy was so great,
  • people who wear masks are sheep, and coronavirus is a hoax,
  • how the Democrats are coming for your guns,
  • why the national debt is now a problem when it wasn’t during the past four years,
  • poor people are poor because they don’t try hard enough, or they are lazy.

I’m trying to limit myself to thirty minutes as I can spend hours foaming at the mouth.

Next, I’ll check my email and then the ADD kicks in. I get distracted, remembering something I wanted to look days ago, or something I’d promised to send someone.  Last Saturday my lack of progress prompted me to start reorganizing my office. I tossed some shit but just shuffled most of it around.

I’ll give some thought to what I’m going to make for dinner. If I’m really busy I’ll default to takeout. Famous Dave’s on Tuesdays when they have the Feast for Two deal. Popeye’s, El Famous Burrito or Chinese from the Golden Wok on other days.

I have my weekly routines. Tuesday is getting recycling and garbage ready for pickup on Wednesday. Thursday is towel day – washing all the dirty towels. Saturday is for changing and washing the sheets. Somewhere in there I’ll empty the hamper and do my laundry. Peg is particularly finicky about her laundry; for some reason she doesn’t like delicates dried on “incinerate.”

I’ve tried to do the shopping strategically. I’ll do a Costco run once a month, as soon as they open, because otherwise it’s insane. Same with Aldi. I’ll go to Mariano’s nearer to dinnertime when most people are home. Peg and I made up printable shopping lists for Aldi and Costco.

Housework is done as needed. I’ll empty the dishwasher if it’s been run. I vacuum the rug next to our kitchen island as it picks up crap from walking or eating. Getting the Dyson vac we keep in the family room was the best purchase we’d made in a long time. Light, quick and efficient.

After dinner Peg and I collapse on the couch and binge-watch something on Netflix or Amazon Prime until the master realizes it’s around 9pm and starts barking until we go upstairs to the bed.

This all brings me to “The Finite and the Tangible,” a blog post I started years ago and still haven’t finished. Medical school had no definable end in sight. We were expected to acquire useful information from textbooks numbering hundreds, if not thousands, of pages. (Harrison’s Principles of Internal Medicine was about 1,500 pages in 1975. It’s now a whopping 4048 pages in two volumes weighing 13.2 pounds!)  I felt like there was a mountain of books, papers and trash piled into the middle of a school gymnasium and I was the janitor with a whisk broom and dustpan.

Writing provokes the same anxiety and trepidation.

Long ago I learned to derive a sense of accomplishment from simple things like housework, laundry, and cooking. They are finite tasks with tangible results. I don’t have to wait months or years to see the final product. I especially like cooking because cutting things into little pieces is very therapeutic (and, unlike murdering one’s tormentors, legal). I’m a reasonably good cook but I am not a chef by any stretch of the imagination, even though Peg chastises me for doing “cheffy-chef” things like trying to flip a large pancake using just the pan. Hey, practice makes perfect and at least I did it over the sink instead of the bare floor.

A good friend of mine is an artist who, in retirement, has committed to finishing one drawing every day.  I spent the 30-40 minutes writing this when I started, another hour revising the following day, and about 20 minutes just before posting. I’m trying to force myself to write something every day, but it’s still a struggle.

Maybe I’ll ignore the call of the long list of timewasters and go back to “The Finite and the Tangible.” But let me check my Facebook page for just a minute…

Smallpox

VACCINATION CONSTERNATION

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On February 4, 1976, a nineteen-year-old army recruit at Fort Dix died of what the CDC determined was an influenza strain genetically similar to the 1918 H1N1 swine flu virus that caused a worldwide pandemic. Fearing another pandemic, CDC pushed for mass vaccination Then-President Gerald Ford (who facing re-election) figured mass American deaths would be politically unforgivable if nothing was done, agreed and fast-tracked a vaccine.

A few months later the pharmaceutical industry demanded federal indemnification against liability for any adverse reactions before releasing the vaccine. Then, as now, such a move created public suspicion and distrust of both the government and the vaccine. That skepticism was furthered after several reports linked the vaccine to recipients developing Guillain-Barre syndrome,  a rare disorder in which the body’s immune system attacks nerves causing weakness and sometimes paralysis severe enough to require ventilator support.

The pandemic never materialized as that flu strain was far less dangerous than initially thought. But the damage to the idea of vaccines being lifesaving miracles had been done.

That fall I had the dubious honor of being interviewed on camera by one of the local TV stations in Rockford, IL after getting a swine flu shot. When asked why I wasn’t hesitant to get the vaccine, I said something stupid like, “I should know about these things; I’m a medical student!”

But the real reason I got that vaccination and continue to do so was because I grew up during the 1950s and 1960s. Our parents lived through the times of no vaccines and witnessed the devastation. Immunizations were miracles of science and our parents were determined we would have a better (and healthier) life than they did.  

The current anti-vaccine movement started in the 1980s and has only grown since then, thanks to the Internet, anti-science politicians and Andrew Wakefield’s thoroughly discredited claim that vaccines caused autism. Most of those people either didn’t experience or chose to forget what life was like prior to vaccines, which calls for a review of pre-vaccine devastation.

In 1892 Canadian physician Sir William Osler called pneumonia “the old man’s friend” because it often claimed the elderly already suffering from debilitating disease. (Osler died of pneumonia in 1919.) Thirty to 40 percent of people who developed pneumonia died before widespread use of antibiotics. Even now, antibiotic resistance among the more than 90 serotypes of Streptococcus pneumoniae can make treatment difficult.

A polysaccharide vaccine against 23 streptococcal serotypes, PPSV-23 (Pneumovax ® Merck), was released in 1983. A pneumococcal conjugate vaccine (PCV7) was released in 2000; it was replaced in 2013 by PCV13 (Prevnar13 ® Pfizer). So now us old people can die of slower, more expensive diseases like Alzheimer’s, chronic congestive heart failure and cancer.

Smallpox, a contagious disease caused by the variola virus, produced fever, vomiting, generalized body aches and a characteristic pustular rash that frequently resulted in terrible scarring. Sometimes smallpox infections left the victim blind or dead. A vaccine became available in 1961 and was given until 1972 when it was declared eradicated in the United States. In 1978 Janet Parker, a 40-year-old photographer, was the last smallpox fatality.  The WHO declared smallpox eradicated in 1980.

All of us who received a smallpox vaccination have a cratered scar on our upper arms. Mine has all but faded but I wore it like a badge of honor.

Polio, caused by the poliovirus, is a disease whose symptoms range from none (75%), through common viral symptoms such as fever, headache, nausea and stomach pain (20%) to progressive, devastating neurological damage (5%). Many victims suffered weakened and deformed limbs or outright paralysis. (President Franklin Roosevelt was 39 when he contracted polio in 1921 and became unable to walk, but he hid it well from the public.) Sometimes the virus affected the ability to breathe, requiring patients to spend a good deal of their lives in an iron lung, long before the invention of modern ventilators.

Our parents were terrified because everyone knew someone who had contracted polio. People blamed cats, dogs, public drinking fountains, swimming pools and beaches for spreading polio before its fecal mode of transmission was identified. One of my high school classmates, born in 1954, contracted polio which weakened one leg. Sixty some years later he still wears a heavy leg brace.

Jonas Salk is remembered for created the inactivated polio vaccine (IPV) which was released in 1955. Albert Sabin created an oral polio vaccine (OPV), released in 1961. Kids my age got the OPV on a sugar cube that had been dosed with the vaccine. Currently IPV is the only vaccine available in the US but OPV is still used in other countries.

Diphtheria, a bacterial illness caused by the Corynebacterium diphtheriae, creates a toxin that destroys respiratory tract tissue. The resulting grey “pseudomembrane” makes breathing and swallowing difficult and gives the breath an odor described as a “wet mouse.” The toxin can wreck the heart, kidneys, and nervous system if it circulates in the blood. About 10% of victims died from diphtheria before a vaccine was developed.

Pertussis, also known as whooping cough, is a contagious bacterial respiratory disease caused by Bordetella pertussis. Infection produces a severe hacking cough that can last for 10 weeks, accompanied by a “whoop” sound with inhalation. Severe coughing fits can lead to fractured ribs. It was sometimes fatal in infants prior to a vaccine; it is still common in underdeveloped countries.

Tetanus, once commonly known as “lockjaw,” is caused by the bacterium Clostridium tetani, found mainly in damp soil. (My mother always told me one developed tetanus from stepping on a rusty nail, which never made sense. It was due to bacteria in the soil around old, rusty nails.) It produces a toxin that causes painful muscle contractions (tetany), often affecting jaw and mouth muscles.

DPT, a vaccine for diphtheria, pertussis and tetanus was developed in 1949, combining diphtheria and tetanus toxoids (inactivated forms of toxins) with killed pertussis cells. I got vaccinated when I was five years old and spent a couple of nights in the hospital after developing hives. I never got a tetanus booster after that, but the hives were more likely a reaction to the pertussis component. A newer vaccine, TDaP, which used pertussis antigens rather than killed bacteria (aP = acellular Pertussis) was released in 1981 and replaced DPT in 1997.

Measles is a very contagious viral illness caused by the rubeola virus which has gone by many other names: red measles; English measles; hard measles; seven-, eight- or ten-day measles. Infected people, mostly children, develop cough, fever, runny nose and itchy eyes followed by a generalized flat rash 3-5 days later. While most recover without any problems, measles complications include ear infections, bronchitis, pneumonia and encephalitis. (Adults often do poorly with childhood diseases, especially measles.) About 100,000 people around the world, mostly children under 5, die from measles every year. Measles was declared eliminated in the United States in 2000 but there were 1,282 cases in 2019, largely due to people lacking vaccination.

Mumps is a viral illness that causes parotitis (swelling of the salivary glands) but can also affect the breasts, pancreas, meninges (the tissue covering the brain and spinal cord), ovaries and testicles. Mumps used to be a common cause of aseptic (non-bacterial) meningitis and hearing loss in children before widespread vaccination. Death from mumps is rare.

Rubella, also known as German measles or three-day measles, is a viral disease that causes fever, headache, runny nose and a distinctive fine rash that spreads from the face to the trunk and then arms and legs. The infection is usually mild, and most children recover quickly, but complications include pneumonia leading to death, encephalitis causing deafness or intellectual disability, or a ruptured spleen. Up to 70% of women with rubella develop arthritis.

Congenital rubella syndrome (CRS), characterized by cataracts, congenital heart disease, intellectual impairment or hearing deficits, can occur in babies whose mothers contracted rubella during pregnancy. There were 12.5 million cases of rubella in the United States during the 1964-1965 rubella epidemic with a staggering toll.  Women lost 11,000 pregnancies from miscarriage, stillbirth, or abortion and 2,100 babies died after birth. Of the 20,000 cases of CRS identified, 11,000 were born deaf, 3,500 were blind and about 1,800 suffered intellectual disabilities.

Varicella (chickenpox), another annoying but potentially dangerous childhood infection, is caused by the varicella zoster virus (VZV). It produces small blisters that eventually turn into scabs. Complications include skin infections from open blisters, pneumonia, encephalitis, bleeding and sepsis. There were over four million infections and around 100 deaths annually before a vaccine was released in 1995. Shingles (postherpetic neuralgia) is a painful re-activation of VZV along nerve paths.

MMR/MMRV: In 1963 inactivated and live attenuated measles vaccines were released in the US.  The inactivated vaccine didn’t offer sufficient protection and was discontinued in 1967. The live attenuated vaccine caused fever and rash in recipients and was withdrawn in 1975. A combined measles, mumps, and rubella vaccine (MMR) was released in 1971; varicella was added (MMRV) in 2005.

Zostavax, a live, attenuated vaccine to prevent shingles, was released in 2006. Shingrix, a recombinant, adjuvanted zoster vaccine, was released in 2017, replacing Zostavax in November, 2020.

I had chickenpox, because DPT, polio and smallpox were the only available vaccines at the time. When a neighborhood kid developed chickenpox, other mothers would send their kids to a “chickenpox party.” We’d pass around a contaminated drinking glass to contract chickenpox and “get it over with.” Some parents still engage in the practice despite having a vaccine, thinking “natural” immunity is preferable.

I also had all the other childhood viral illnesses – measles, rubella and mumps. When I developed mumps, my mother chastised me for any activity, saying “You’ll be sorry if it goes down on you!” She was talking about mumps orchitis (painful testicular swelling from the mumps virus that can lead to shrunken testicles and, rarely, infertility) but I had no idea what she was talking about and she didn’t bother to explain. That I have three kids indicates no apparent gonadal damage.

MORBIDITY AND MORTALITY
BEFORE AND AFTER
VACCINE DEVELOPMENT

Other communicable diseases and vaccines

Hepatitis A, formerly “infectious hepatitis,” is an acute liver infection caused by the Hepatitis A virus (HAV). It is acquired by ingesting virus passed through feces, usually from contaminated food or water. It causes fever, nausea, abdominal pain, jaundice, and dark urine. Complications are rare but infection can lead to acute kidney failure as well as hemolytic and aplastic anemias. Fulminant hepatitis, which leads to liver tissue destruction, is rare and has a death rate of up to 80%.

A vaccine against HAV was released in 1996 and infection rates declined until 2016. The US has struggled with a Hepatitis A outbreak which began in 2016 and was linked to person-to person contact (drug use and homelessness) rather than contamination. There have been 37,121 cases reported across 35 states with 348 deaths as of December 18, 2020.

Hepatitis B, formerly “serum hepatitis,”is an acute liver infection caused by the Hepatitis B virus (HBV). It is acquired through

  • unprotected sex with an infected individual
  • sharing drug paraphernalia or personal items
  • tattooing with unsterile equipment
  • passed from pregnant mother to fetus
  • human bites

Signs and symptoms are the same as for HAV; however, about 50% of infected people may have no symptoms. Complications are similar to those of HAV; about 200-300 people die of fulminant hepatitis each year. A vaccine was released in 1986. It is recommended for all newborns and anyone not previously vaccinated.

There are about 800,000 to 1.4 million people in the US with chronic hepatitis with and additional ,5000-8,000 becoming chronically infected every year. Most annual deaths linked to HBV are due to the consequences of chronic infection: cirrhosis (3,000-4,000) and liver cancer (1,000-1500).

Hepatitis C, D and E are forms of viral hepatitis caused by Hepatitis C (HCV), Hepatitis D (HDV)and Hepatitis E (EV) viruses. There are no vaccines for these three viruses. HCV can be treated (the Hep C medication for which its creators incessantly run commercials costs $94,000) but there are none for HDV and HEV. HEV infection usually resolves spontaneously.

Employers often require healthcare workers to provide evidence of immunity to HBV and other communicable diseases prior to employment. I got the HBV vaccine in the early 1990s

Haemophilus Influenza type b (Hib) is a bacterium, not a virus. It primarily infects infants and children under 5 years, and can cause meningitis, pneumonia, bacteremia (bacteria in the blood), and epiglottitis, a potentially life-threatening swelling of the epiglottis. There were about 20,000 cases of Hib and 1,000 deaths annually before a vaccine was released. The polysaccharide vaccine released in 1985 did not work well in children under 2 years and was replaced with conjugate vaccines in 1987.

I recently got my first COVID vaccination; I’m a healthcare worker who still has contact with mostly older people. I expect there will be more adverse reactions reported as there’s a big difference between several thousand people in a vaccine trial and tens of millions of people being vaccinated.

None of us should want to live in a world in which easily preventable diseases with significant morbidity and mortality run rampant because we no longer have sufficient herd immunity.

Featured Image © Can Stock Photo / joloei