Comments on life, the universe and everything from an aging Sixties survivor.

Location: Massachusetts, United States

Ummm, isn't "about me" part of the point of the blog?

Sunday, April 27, 2014

Conditioning for marathon viewing, 1

It has been a few years since the last time I went to watch the Boston Marathon, and after a sedentary winter, I found I was in less than ideal shape for it. There was no question of not going, because my daughter was running.

All my daughter's athletic life we have had to deal with the corrosive cynicism of other adults who assume that a) we forced her into this or b) we're bragging about whatever she does. Somehow this  cynical response doesn't come into play if one's child is a doctor, lawyer,  computer scientist, chef, ambassador or leader of a religious revival. No, only athletics. Excuse us for talking about it, but an athletic child can no more help being athletic than she/he can help breathing. It's a major part of that person's life, and often parents either talk about it or say nothing. So if you don't like it, fuck you.

In this case, our child is past 30, and has wanted to run Boston since she was 11 or 12. She is long past the point of worrying about parental approval. Like her other athletic undertakings, it's one she chose for herself and has pursued for her own satisfaction. Neither of us is a runner, and we both find the wish somewhat incomprehensible. I've done bicycle and Nordic ski races, so I have an inkling of what goes into it, without getting why someone would subject their lower limbs to 26.2 miles of constant pounding.

Em's forte isn't speed but endurance and preparation. In the language of coaches and trainers, her muscles are slow-twitch dominant. She's run half a dozen marathons over the last ten years, and more shorter races than I can easily recall, so she knew what she could count on accomplishing and what she might be able to accomplish if her luck was in. A personal qualifying time was a bit out of reach, so when she had a chance to run for a charity, she took it, prepared for months, and raised more than the necessary funds.

When she arrived, some days ahead, we were recruited as local talent, soigneurs and scouts. This included dietary planning, scouting the course, and reading everything we could find written by people who had run the course. In the course of this we all got some perspective on the event from non-New England runners. It's popular amongst area residents who aren't New England natives to disrespect any New England athletic activity as overblown and comparatively insignificant. That sentiment is greatly misplaced in the case of the Boston Marathon. Runners from every part of the world come to this race to test themselves on a course that is challenging in ways one can't appreciate without actually running it. The race lives up to its hype. Em, having run marathons in widely scattered locations, also confirmed that the crowd in Boston is more involved and supportive than what she had previously experienced.

That gets me back to spectator conditioning. Em's bus left South Boston about 0600. That meant we got up at 0415 to pack and make it downtown. The parent's plan was to go back to Wonderland, take the subway downtown, get breakfast and a rest room.

Downtown Boston is chronically short of rest rooms. It is especially so at six-something a.m. Thus we were able to get breakfast, but then had to walk to the Pru before we found open johns (all the race Porta-johns were still locked). To get there, we had to negotiate all the monuments to Boston's post-bombing (over?)reaction* until we found relief at the Pru and an open Green Line station at Hynes. By this time our old legs had walked some little distance, and we weren't even in the agreed-upon viewing location yet. Not by 'arf.

*It is worth noting that, up until 2013, Boston was one of the few marathons anywhere that didn't forbid unattended gym bags or backpacks. A little caution in advance would likely have forestalled the need for what may be an excess of caution after the horse has left the barn. Just as a little cooperation between FBI and local police might have forestalled the brothers Tsarnaev from blowing up something else.



So, yesterday I had a good day after a run of not-great days, which was spoilt by a crappy (Mankoski 8) evening. In the course of my usual right hemisphere monologue, it occurred to me that this is something like my yoga.

The objective of the exercise is not to be well. That doesn't seem to happen with TN. The purpose, an important one, is not to succumb to the pain. Remember, I mean "succumb" literally. To let the unaffected hemisphere do its work, enabling some peaceful thought and walling off the Beast, one has to banish any thought that doesn't accomplish those ends: sometimes, it's banishing one at a time. One of the irrelevant thoughts is suicide.

Oh, my: there's that nasty word again. Just to repeat, for people with trigeminal neuralgia, the point comes, and comes early, when suicide is just another treatment option. The point is, when one devotes all of one's neurological resources to keeping the pain that swallows up one hemisphere of the brain from washing over into the other, suicide stops being a treatment option: it's just another distraction to be set aside.

These are inevitable reflections at the end of my fifth month at the end of my twelfth year entertaining this  creature. I once described this as hanging from a roof gutter, trying to go along it finger over finger to safety. Sometimes you just want to let go. Sometimes you keep trying for safety because you remember what safety is like.

The way my TN manifests, safety is a tease. No matter how rotten the episode is, it will be like  it never happened in 12 to 24 hours. Until the next one...and the one after that, until a nice day comes when it doesn't come back. Then for a few months there's only the odd jab and stab and you get to thinking it won't come back. You never want to think that.


Back on my own machine

Various news. First, the Beast is gone away. That is, as gone as it ever is these days. The winter I've had gives one perspective. The past couple of remissions have been punctuated with the classic paroxysmal stabs that shoot right through the left hemisphere, and are gone before I can do anything medical about them. Compared to days with the same thing running non-stop for eight to twelve hours, these sucker punches are a picnic. We take gratitude in what benefit we can achieve.

Next, I'm writing on the netbook. I'm pleased about this for a couple of reasons. I like the little thing, of course. Parts cost about a third what a new Chromebook would cost, and a tenth the cost of the average tablet. And I don't have to drag my greasy fingers over the screen to make this work. Finally, I did the repairs myself. This is no small thing for someone who spent his childhood being railed at for being awkward, clumsy, mechanically hopeless, etc.

For my next trick, I'll finish the password changes for HeartBleed defence where necessary. By "where necessary" I mean it's valuable to do some homework and identify sites that are not and never have been users of OpenSSL, and update those passwords on a less frantic schedule.

Saturday, April 05, 2014

Mad as hell

Congress and the POTUS, in their wisdom, have once again "delayed" implementation of the new diagnostic and inpatient procedure coding system, ICD-10, by a full year. The coming deadline, October 1, 2014, was sworn by CMS to be what is called in IT a "drop-dead" deadline.

The entire idea of modernising the system is anathema to certain well-funded interests in the medical industry. Evidently those interests have more clout than the interests who think it would make a great deal of sense to have the same system as the rest of the world, because they did more than kill the deadline. They turned this reform into a political bargaining chip, and made it obvious that implementation can--and probably will--be delayed indefinitely.

The other day, whilst having a beverage with friends not in health care, I alluded to the subject. This led one of them to indulge in mockery he had picked up somewhere. He had heard that the new system was full of ridiculous codes, far more than necessary.

Let us back up. This system, called the International Classification of Diseases, began as a method of keeping track of medical statistics, and broadened into one system for identifying diagnoses and another (used in the US for inpatient settings) for procedures. The details of the system vary from country to country, but the codes are much the same. When an American tells you that ICD-10 is absurdly detailed, it's a bit of American arrogance at work. To use my friend's example, why is it necessary to have a code for parrot bites? If he lived in a country with wild parrots, he might not ask. Those charged with tracking disease need to keep track of such things as psittacosis and avian influenza. The 35-year-old system America clings to only allows us to code "open wound." If the patient later presents with either of those diseases, it can be a mystery where it came from. Likewise, if you're Australian, codes that specifically identify a crocodile bite experienced whilst surfing is very important, as encounters between surfers and sea-going crocodiles appear to be on the increase in that country. Such things involve the integration of the actual diagnosis code with an entirely separate class of codes specifying where and why an injury happened or a disease was contracted. This is not new. It's been a feature of ICD coding for 50-plus years. My friend is keenly interested in statistics involving accidents between cars and bicycles. Given that cops (around here at least) are notoriously slack about reporting the details of such accidents, where does one think those statistics come from? They come from the coding of the circumstances of an accident. ICD-10 introduces a greater degree of granularity that is more and more needed in a complex world.

Since it appears the forces of reaction have won this one, let us think about why they are opposed.
First, it's one more change being presented to people unable to handle change. Second, it costs actual money up front, whereas the deficiencies of the present system cost theoretical money later--as in a malpractice suit that may or may not involve deficient diagnostic records. Third, physicians and surgeons have always had a problem understanding coding. This change places much higher demands upon clinicians to put detailed description in their notes. I find it hilarious that American doctors, who are seldom deficient in ego, are tacitly admitting that they can't learn a system that millions of secondary school graduates have learnt and are using around the world. So much for their conceit.

Since the next system, ICD-11, is already in beta in other countries, and since ICD-10 is already 10 years old, there are those who ask why the US shouldn't just skip to ICD-11. Short answer is learning curve. The principles and underlying technology of ICD-10 and 11 are much the same,  although 11 takes them several steps further. Both are very different from ICD-9. Going from ICD-9 to ICD-11 is like changing, in a few weeks, from Ancient Minoan to any modern language. The present transition isn't nearly as daunting (unless you're a doctor). Keep in mind that those who oppose this change, and have now smelled blood in the water, will continue to oppose any transition.

So when you read snarky remarks about ICD-10, and are asked to pass them on, remember to ask cui bono? And don't be made a tool of reactionaries. The current decision is, as 3M Corporation says in its press release, a vote for the past.