Medicine


Keep on Trekkin

As I did at the end of 2013 & 2014, so I do again here at the end of 2015 to recount some travel experiences, which I don’t normally write about here. I need not give the whole setup again for the premise of such entries and see my blog from the end of 2013: Travels of Spocklogic. The notables this year (travel blogs I finished or made additions to) include:

feature-Erice2014-lgFeature-Indian_Wedding

Feature - Washington DC-1

Feature-China_2014

Feature-Spocklogics_TravBuddy_Meetups

 

That’s the summary for 2015. Some are carry overs from 2014, but I finished the blogs in 2015, after my last post on travels (see: Travels of Spocklogic II) in December 2014 or earlier if I made additions. As I alluded to in recent entries, I will take a break from this Cogito Ergo blog for a while in 2016. I’ve had 20 years of internet exposure and been blogging for 10 years (see: 20 Years of Internet and Mapping the Internet). I hope to return again with a fresh perspective down the line. There’s plenty to explore in the Cogito Ergo blog archives until then (see the link to: Browse Blog Posts). Best wishes for the New Year 2016! See you in the future…

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kirk-and-spock-travel-back-in-time-to-2014

As I did at the end of 2013, so I do again here at the end of 2014 to recount some travel experiences, which I don’t normally write about here. I need not give the whole setup again for the premise of such entries and see my blog from the end of 2013: Travels of Spocklogic. The notables this year are a couple of blogs I finished and some reviews that may be of interest:

spocklogic_Lyon-France_travel_blog.
spocklogic_Wroclaw-Poland_travel_blog.

spocklogic_Kirin-Hot-Pot_review.spocklogic_Long-Chao-Shou_review.
spocklogic_Ram-Pam-Pam-Pam_review.spocklogic_Raclawice-Panorama_review

That summarizes some travel selections for 2014. I did travel to Italy also in July 2014, and have some links to share for photo collections I put together for a special year in Erice to celebrate a 40th anniversary of the International School of Atomic and Molecular Spectroscopy (ISAMS):

Rino: 40 Year Erice Celebrations (2014) – Erice, Italy
2014 Erice Workshop: 30 July – August 5 – Erice, Italy
People (2014) – Erice, Italy
Places (2014)
– Erice, Italy

In addition, I traveled to China again this year in November 2014, but am still working on my travel blog for that, so it will have to wait until my 2015 account of my travels. I will make this type of entry something traditional at years end to cover where I have been and what I have done in travel ways. It’s all rather like the City on the Edge of Forever perhaps…

city_on_the_edge_of_forever-kirk&spock

 

 

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I don’t often write about my travels in this WordPress blog (Cogito Ergo) as I have another site for that (TravBuddy). In this year of 2013, I completed a number of travel blogs on that site that are worth noting and I give the links to them here. Mind you, I don’t know that any of my travel blogs are ever really completed. Each one is like a child I nurture and raise up, but always needs attention in future ways. Anyway, I suppose I list them here for my own reference and also to offer it to others who may be interested in my travels. There is some connection of the blogs, one to another in embedded personal ways, but are also self-contained. Here they are:

Spocklogic_DC_Travel_Blog

.

Spocklogic_Italy_Travel_Blog.

Spocklogic_Switzerland_Travel Blog.

Spocklogic_Germany_Travel Blog.

Spocklogic_Travel_Topics.

Spocklogic_China_Blog.

Some of these blogs have been posted for some years, and I either added to them, made them more complete, and/or formed connections between them. Some of them are entirely new in 2013. They do tell a story in total I suppose and maybe that’s why I decided to make a sort of review of the Travels of Spocklogic here. They were also all the blogs featured on TravBuddy for me this year. My Italy blog (L’Avventura Dell Italia) seems never-ending and I have some more work to do on it, but the majority of important events are there for the most part. The last one in this list, the blog on China, is something I am still working on too, but intend (or hope) to complete it before the end of 2013. I suppose this collection of blogs forms a personal journey of sorts that I tried to form this year regarding my life and relation to travel. When I finish the China blog, maybe I will know what I have been endeavoring to understand and ultimately discover in my life. It’s not a teaser, or cliffhanger, but maybe more a matter of what I will embrace. Sounds enigmatic I suppose, but not really. It’s my personal perspective, the choices I make and what is ultimately best for me in a world of possibilities…

knowyourspock-1

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The Pain of Cluster Headache by Agnes Cecile

It’s not a headache, it’s not a migraine, it’s a cluster headache.

There are two classes of headaches, primary and secondary, the later being caused by an underlying medical condition, while the former are not. These primary headaches can be subdivided into three types. Tension headache is the most common, migraine headache lesser common and cluster headache the least common. What I would like to discuss in this blog is the cluster headache, as it is what I have and, unfortunately, been afflicted with for more than a decade now. Clinically, occurrence of cluster headaches normally occur 1-3 times a day for a few weeks to a few months period with months or years of remission in between. In addition, a cluster headache will often occur two hours after going to sleep and the severity is generally worse at night than in the day. Occasionally there will be a headache free day or two now and then for welcomed relief, but generally they are consistent and relentless during a cluster cycle. The underlying cause is not known, nor is the impetus that stimulates the pain spontaneously. The source of the pain itself comes from something called the trigeminal nerve, an autonomic reflex pathway governing sensations in the face and jaw and the largest crainial nerve, of which there are 12 in total. Activation of this nerve comes from the hypothalamus, an almond shaped gland just above the brain stem, responsible for metabolic and autonomic nervous system functions, such as body temperature, hunger and our ‘internal biological clock’ responsible for the sleep/wake cycle. Once the nerve is activated, severe pain occurs behind the eye, described as piercing or burning in sensation, which further induces a response from another group of nerves resulting in discharge from the eye (watering & redness) and nasal passages (congestion). Stabbing pain is often felt in the temples (usually on one side of the head) accompanied by a burning sensation on the face. They have been characterized as the worst pain a human being can feel and are sometimes referred to as suicide headaches, due to cases where people have killed themselves as a result of the condition. Fortunately they are rare, afflicting less than 1% of the population, with statistical estimates around 69 of 100,000 people. A good resource on a variety of statistics on cluster headaches collected through a non-scientific survey at the Worldwide Cluster Headache Support Group is here:  Cluster Headache Survey.

The_Cluster_Headache_by_JD_Fletcher

The Cluster Headache by JD Fletcher

I began suffering from Cluster Headaches around 1998 or 1999. The first time I had one it was not long in duration, but I remember thinking, “what was that?” It was the worst headache I had ever had and thought it medically alarming. Subsequent ones came over the next couple of weeks, but I thought there was little to do, take some advil, grin and bear it. Suffice it to say, my first occurrence of a cluster cycle was not that severe, compared to subsequent ones. I suffered a couple more bouts of increasing severity until 2004 when I was finally diagnosed with cluster headaches. After another bout in 2005 which lasted 2.5 months, my cluster cycles have occurred every couple of years for about 2 months in duration before going into remission. During that time I tried many of the available drugs for treating clusters, but only Imitrex injections (sumatritan) and prednisone seem to be helpful for me. Sumatriptan (a vasosuppressant) is an extremely expensive drug. It is about $90 per 6mg ampule, but with insurance the cost is reduced to $12 per ampule. The recommended dose is one 6 mg ampule per headache, so you can see that even with insurance the cost can add up. I have literally spent thousands of dollars on this medicine over the years. My 2005 bout was a very severe one and I suffered what is called Medication Overuse Headache (MOH), or rebound headache, where use of sumatriptan actually worsened the frequency and severity of the attacks. It was then I began to really research my condition intensively. I began limiting the doses to 1/2, 1/3, and 1/4 ampule per headache. In the end 1/3 ampule (2 mg) seemed adequate and that is what I use to this day. Even at this level, the frequency of the headaches and use of sumatriptan can still induce rebound. In such cases, I immediately stop using the medicine and suffer the pain of the attacks for a day or two. It is not pleasant, but a necessary evil to break the rebound cycle. Sumatriptan is also risky to use with frequency because it is a vasosuppressant and can cause heart attacks in patients at risk. The other drug I mentioned, prednisone, is a corticosteroid that works as a powerful anti- inflammatory agent, but can suppress the immune system. I take two 20mg tablets per day for two weeks, then 1 per day for a week surrounding the cycle peak and while it does not provide a pain free existence, it does lessen the severity of the pain to a level I can tolerate. I try to save the sumatriptan only for the most severe headaches. It’s all about managing the condition. Perhaps sharing my experience is a benefit to others.

sumatriptan-script

The treatment and management of the pain caused by my cluster headaches is something I have at least some control over, but in other life aspects such as work, relationships, and getting enough sleep to function properly, it has been problematic during my cycles. In my job, I have found that by communicating my condition to those I work close with, they are generally understanding and do not expect my usual level of performance & behavior during a cycle. This is a stress reducer for me and I allow myself not to feel guilty about it as it is only temporary. In my relationships I have tried the same approach, with varying degrees of success. Sometimes I feel the level of sympathy is there, but I am still held to a level of activity or emotional involvement that I am uncomfortable or unwilling to maintain during the duration of a cycle.  I can become selfish, distant and uncooperative in these situations when pressed to behave as I would under normal circumstances. This is an unrealizable expectation to hold for the cluster headache sufferer, and it is important your partner, friend or such allows you the freedom to seek your own space and comfort zone for a time, without adding to the burden of suffering with emotional stress as well. After all, it is only a temporary situation that will pass in time. Failing to follow such a course can potentially disrupt in adverse ways the course  and harmony of a relationship if the cluster headache sufferer feels resentment at not being understood, so to speak. I have certainly felt this way toward one girlfriend who expected more of me than I was capable of doing during a cycle, so I have some personal perspective on the dynamics involved with regards to personal relationships. This brings me to getting enough sleep to function properly. I generally suffer from sleep deprivation during a cycle obtaining only 3-5 hours of sleep out of every 24 hours for as long as a week or two at a time. The headache free days allow for extended sleep, but it’s never enough to feel totally rested. There isn’t much can be done for it as the cluster determines how long they allow you to sleep. I just try to stay alert and keep my mind focused as much as I can on tasks. I have found computer work such as blog writing, social media, or other related computer tasks a helpful aid in between periods of feeling pain,  in getting me through the night. Pacing is the activity of choice for me when feeling some pain. Activity as a way of focusing on something is therapeutic for dealing with cluster headache.

Video Playlist (5 videos to stream regarding Cluster Headaches)

Headaches (Migraines, Cluster, Tension):  While I am not sure it is constructive to compare pain as a measure of relative suffering in terms of tension, cluster, or migraines, all headache sufferers (regardless of the type) feel pain and sympathy for them is warranted in equal degree. Nevertheless, it is important to draw a distinction between the types because they are not the same things. For a comparison of the first two, see Cluster Headache vs. Migraine. Another difference of note is the response of the sufferer to the type of headache. A migraine sufferer may want to lie down, go to a dark room or just stay quiet to deal with pain. A cluster sufferer cannot stay still, may pace around, clutch or bang their head, moan, groan or otherwise yell at times. This is a distinguishing difference sometimes in response behavior to diagnose a patient. I am not sure about migraine sufferers, but with cluster headaches for me, I feel discomfort all the time during a cycle and it is like having a mild headache for 2 months straight with several severely painful ones each day. It can be quite disrupting in day-to-day normal life.

There must always be hope for a cure someday beyond the treatment for sufferers of all types of headaches. To conclude, I offer some useful links for reading. There are many resources today via the internet for the sufferers of cluster headaches. Here is a short list:

(1) Worldwide Cluster Headache Support Group
(2) Mayo Clinic – Cluster Headache
(3) Management of Cluster Headache (medical study)
(4) Organization for Understanding Cluster Headaches
(5) Medscape – Cluster Headache (technical)

I am currently in the midst of a cycle (6 weeks so far) of cluster headaches.

cluster_headache

You can feel them coming,
 but you can’t feel them going.

risk-game

This may be a touchy issue, but I thought I would weigh in on the news that seemed to be somewhat ubiquitous regarding Angelina Jolie and her prophylactic mastectomy. She wrote an article in the NY Times about it entitled My Medical Choice. It’s a personal choice and Jamie Lee Curtis seemed to praise her brave steps and quiet dignity in a Huffington Post article entitled Freedom of Choice, Freedom of Privacy. I can respect that, Angelina’s choice and some opinion on her bravery and dignity. I do, however, worry about what kind of message this sends. Yes, it is good to have a choice for health and longevity, but it’s not just a matter of statistics (but I will touch on the statistics here too). Being ‘at risk’ is not a disease. Even genetic or hereditary indicators does not account for exceptional cases where a gene is present but causes no disease. The science on this is all so very new in the last decade or two and I worry that decisions are being made based on incomplete science and misinterpreted statistics. There are social psychology issues involved here too in such so-called risk reduction surgery. My big concern with a high profile story like this is that it starts a wave of actions without thinking fully and just following a celebrity, who is really just a person like me, you or anybody, making personal decisions based on their perspective and private reasons. That’s something to think about.

stacked-stats

I’d like to discuss statistics now. Do you know the difference between a single event probability and  a conditional probability? Is there a difference between the chances of something happening versus the frequency of occurrence of that same something happening? If you don’t know the answers to these questions then you are not alone. The medical community uses statistics to inform their patients, but your doctor probably does not really understand the statistics. He or She is a physician, not a mathematician, right? I’ll trust my doctor any day to prescribe an antibiotic for me, but to compute my odds for survival given a serious disease – no way! The doctors get these statistics from consensus in the literature. I will take the doctors numbers and then go investigate them. Let’s take the case of Angelina Jolie. In her article she says (because she tested positive for the BRCA1 gene):

“My doctors estimated that I had an 87 percent risk of breast cancer and a 50 percent risk of ovarian cancer, although the risk is different in the case of each woman. Only a fraction of breast cancers result from an inherited gene mutation. Those with a defect in BRCA1 have a 65 percent risk of getting it, on average. Once I knew that this was my reality, I decided to be proactive and to minimize the risk as much I could. I made a decision to have a preventative double mastectomy. I started with the breasts, as my risk of breast cancer is higher than my risk of ovarian cancer, and the surgery is more complex.”

She says later in the article:

“I wanted to write this to tell other women that the decision to have a mastectomy was not easy. But it is one I am very happy that I made. My chances of developing breast cancer have dropped from 87 percent to under 5 percent. I can tell my children that they don’t need to fear they will lose me to breast cancer.”

jolie-cancer

Was the choice Angelina Jolie made the correct one? Personal feelings aside (and that’s a self analyzing choice), it is hard to say and depends how you look at the statistics. Lets look at the absolute and relative probability. The absolute probability reduction says from 5 to 1 in 100, which means a risk reduction of 4 in 100, or 4% reduction in risk. On the other hand, the relative probability says 4 saved out of 5, or 80% reduction in risk. That is, the relative risk reduction is the absolute risk reduction (4/100) divided by the patients who die without treatment (5/100). Do the math (4/5=0.80). Another way of saying all this is the Number Needed to Treat (NNT). The number of women who undergo prophylactic mastectomy to save one life is 25 because 4 in 100 (1 in 25) is prevented by such surgery.

What can we really say about the statistical numbers presented by Angelina Jolie? She was speaking from a relative probability perspective (I think), going from 87% to 5% and reducing her chances of cancer by 82%. In terms of absolute probability it’s still only 4-5% risk reduction at best. The number needed to treat is important because it builds the population – 1 life saved in 25. What does it mean? It means that the life of one woman was saved, but the other 24 had no benefit from the mastectomy. Most high risk women don’t die of breast cancer, even though they keep their breasts, and few die of breast cancer either after having their breasts removed. I have considered the high risk category for discussion here like Angelina announced as a point for discussion, not judgement. I’d like to take the opportunity to extend good wishes for Angelina, Brad, their children & extended family during this time. Take care of each other!

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My personal advice – Make YOUR own choice and know the numbers to make an informed one on Risk Reduction. Don’t just know the numbers, but know what they mean too! Remember there is absolute risk reduction, relative risk reduction and numbers needed to treat. We also have the single event and conditional probabilities too. It’s a head full to be sure, but not such an egghead thing when your life is on the line and body parts are involved. Kind of a serious post from me with a message. It’s not personal, it’s just something I wanted to say in a logical way, but I can’t help thinking (after writing this) that it has affected me in an emotional way too.