Disagreeable firsts

It hasn't taken long to lose track of the numbers, but on Wednesday I had two firsts with the Beast. For the first time I had an episode at work so severe that I had to leave the office. The other first was the reason for the severity. For the first time  Clonazepam had no effect at all on the symptoms. It is understatement to say this was disturbing: it led pretty quickly to panic. Level? Mankoski 9+, McGill over 10: that's to say concentration for more than a minute or so was impossible, I was dizzy and disoriented, and feeling some nausea. Being absurdly self-conscious, I apply what little self -control I have left in these situations to repressing an almost irresistible urge to moan. If I'm alone in bed at times like this, I don't mind so much

I have a new PCP, who hasn't seen the symptoms, so that was my first stop. One is extra careful driving even on a low dose of Clonazepam, but also I found my sense of time was completely fucked up. It's less than 15 minutes from my office to theirs, but it seemed like three hours. Fortunately, she would be available as soon as possible. Again, I'm not exactly sure how long that was. My face was beginning to tic in the waiting room, I remember that. I don't like frightening the villagers, so I mostly hid my face behind clenched fists during the wait.

The perky medical assistant who took my vitals had clearly never seen TN in full cry before. I think I took her aback when she routinely asked "how are you?" With what voice I could muster I said " I feel like hell," and went over the symptoms. One trouble with a full-on breakthrough is how hard it is to communicate more than the simplest thoughts. Kept it brief, impressed the MA with the gravity of the situation, and begged her to turn off the light in the examining room (the Google experts don't tell you how much light can hurt). Sitting in the dark did so much to relieve the worst: it has done so since Hippocrates,

My young physician was all one could ask for. It must say somewhere in my chart that I'm an "informed patient." As my voice came back I described what had been happening for the last two weeks. It's my personal and professional policy never to tell a physician anything; rather to inform them what I have experienced. That's how you get along with M.D.s, and it is a fine line. Mine picked up quickly on the background questions that have been growing in my mind these last two weeks. She proposed some changes in my meds: some small, some pretty substantial that went at first a bit beyond my comfort zone. We talked those through and in the end I agreed, and we agreed how how to ramp up the dosages. One should not go jumping up rapidly in doses of anti-convulsants, nor cut them down rapidly. Either can make one very miserable or even very dead.

That was two days ago. Yesterday was less rotten than the day before, having applied only the small changes. Today is the start of the larger changes. One is never exactly well when a TN breakthrough is on, but there are degrees of pain, and for us many of those are tolerable.

In this, and in my work life, I have to deal with the fundamental problem of pain management, which is that pain experiences are subjective. It does little good, for instance, to explain to people that the only pain equal to or greater than the upper levels of TN is inoperable brain cancer. Most people will be lucky enough to be unable to make the comparison. But I read a better analogy the other day, for the moderate levels anyway. It is like experiencing childbirth. With a broken leg.

On Wednesday, I blew past that level about an hour into the episode...or so I'd say. Let's hope the revised meds do the job.

Trigeminal Neuralgia 2016 7 & 8

Monday. a doubleheader again. The morning session blew by quickly and with great intensity, and contributed to kacking my blood platelet appointment. The evening session was equally intense, but I only missed out on things I wanted to do.

The resolution to keep taking notes on this is fading rapidly. This pain is a very private experience, and only people who have it can understand. On Sunday night, I pulled the plug just as "60 Minutes" was doing something or other on the "Make a Wish Foundation."

I'd like to make a wish. I'd like the TN to be over and stay over, but that's not going to happen.

Trigeminal Neuralgia 2016 5 & 6

I'm including number 5 just to keep the string going, because pain levels in the 4 to 5 range hardly count any more.

It was interesting because it was followed by two entirely pain-free days. What a cheat that experience can be! It's a treat like low gas prices; you think it will last, you hope it will last, but part of you realises that it won't.

It didn't. With my triggers, running a snow blower is a roll of the dice, even the Dead Bunny bomber hat and three layers of hoods. The warning shot was kind enough to wait until I was done and inside. Then I waited to get a grip on how bad this episode was going to be. When it became clear that this was going to generate sensations above average, I popped a Clonazepam and went to bed.

Blessed be Clonazepam. Before it kicked in (tablets take about 20 minutes to dissolve and enter the bloodstream) The zaps were Mankoski 7, some up to 8, or McGill 9. This is the start of the "Holy Shit" range, if your brain could spare the energy to get your mouth to speak. The drug did what it was supposed to do, bringing the pain down to an manageable level before it got out of control.

I don't know how it is for others, but without Clonazepam, my breakthroughs can spiral up to levels that are near unconsciousness. The scariest episode I had like this hit me when I was driving, some years back. I knew the road, and I knew as the Beast rampaged, that there was a place I could pull off not far away and ride it out. I just made it. One of my oaths with all this is no matter what happens to me, I don't want to harm anyone else before I regain control. I'll put up with a great deal of pain to prevent that.

Everyone who lives with this knows that it is rare, and consequently few clinicians know how to treat it or how, exactly, it manifests. I was just reading a well-meant but hilarious piece by a neurosurgeon on the fine distinctions between idiopathic and atypical TN. Atypical, he says, is likely to point to a physical cause. Then, he said that any pain ("zaps" to the cognoscenti) lasting longer than five minutes should be investigated for that cause.

Ayah well. In breakthroughs, my zaps last from one to five seconds. But they are spaced only a few seconds apart, and one's grey matter is reeling from the assault during the time between zaps, so much so that one could be forgiven for thinking the TN pain is constant for the 30 minutes to several hours of the episode. One neurosurgeon I was sent to had heard of this manifestation, and called it the trip hammer effect.

All this is much better than it used to be, before we got the regimen that helps. Then, the zaps flashed in every half-second or so, at increasing intensity. Just leave it at that and be grateful for small blessings.

Late news. Had another breakthrough of similar intensity in the evening. This was self-inflicted: I forgot to take my meds with supper (a danger of getting wrapped up in sports). All the same, I don't know why I'm cruising on the edge. Carbamazepine is lipid-soluble and I should be building up a reserve. Going without even one dose right now is like driving with the gas gauge warning light on.

The woo! It hurts!

I'll skip the latest TN instalments, which are much the same anyway, except for moving into twice-daily episodes, to reflect on a strange phenomenon.

First, by turning my back on Facebook, I've cut myself off from the latest news on food woo and quackery. As a result, trends can fly right over my head unnoticed.

Second, I do our basic grocery shopping at a local market every Thursday morning before 8. The prices are a little higher than the mega-chains, but the variety is good, and I can get in and out in 15 to 20 minutes, because there aren't that many customers stirring at that hour

Generally. This morning, I arrived at the checkout to find one person (of the well-heeled, well clad, first world entitled variety) making a great deal of to-do over her purchase. It says much that her environmentally responsible grocery list was packed in store bags, because her social responsibility didn't extend to bringing her own bags. It was also interesting that a large portion of her purchase included bananas. I didn't think much of that until another person of the same persuasion pulled into line behind me, with bananas. Before I had checked out, a third entitled person carrying bananas pulled into  line, and before I left the store, someone equally entitled was approaching the checkout with bananas.

Have bananas become a thing?

Trigeminal Neuralgia 2016 3 & 4

We'll  call this a doubleheader, with no pun intended.

Number 3 was Monday night. It was slow gaining traction, then got lively, with some 7+ zaps thrown in for entertainment. This and the previous one had one thing in common: I'm pretty certain eating was the trigger in both cases. It backed down with only a little help from Clonazepam, but I did notice one thing. I had recovered enough to try some bedtime reading before the drug kicked in. That was no good. Granted, my choice of reading matter wasn't great. Histories written in the 19th century are heavy going at the best of times. Under the twin influences of Special K and TN, the words just clumped together and fell off the page. Times for some lighter reading.

Number 4 began at work. Because I don't like doing Clonazepam at work, this one dragged on for around three hours, subsiding once and coming back. It's a tossup whether to rate this as one breakthrough or two. Still going on.

Trigeminal Neuralgia- Breakthrough 2016-2

So, here we are again: regular Beast walks. I had not yet finished posting the account of number 1 when number 2 came calling. Neither as as nasty or as long as the opening round, but rather stubborn, taking two Clonazepam to tame. This was not so much classic as retro. The first experiences I had with TN featured pain in the stem, and I got a load of that, along with the temporal pain. It limits one's options lying down when one can't bear to lie down on the back of one's neck. The second Clonazepam finally put me down, lying on my right side, concentrating on keeping up that barrier between the hemispheres.

Maybe I'm doing this wrong. Maybe I should keep track of the days when nothing happens.

Trigeminal Neuralgia: Breakthough 2016-1

The opening gun of the new salvo began during that little experiment with curling, near the end, at about 1440. Classic (for me) onset and development at first. By the time I got home, took  my .5mg clonazepam and got into my dark room, things began to get different.

The sensations (about five seconds apart) were about Mankoski 7 and McGill 8 (see above) However, instead of diffusing over the whole nerve, they descended the main stem to the posterior neck, and ascended to the ends of the peripheral branches (below).

Previously, clonazepam and a darkened room have reduced the pain well below my tolerance level and usually put me to sleep briefly. Neither happened. After  about an hour and a half, the pain was in the same location and barely tolerable.

I got up awkwardly. I have a nightstand made of those coated wire segments with press-on attachments, and I managed to bang into it and knock it into several segments. Normally, assembling these things is a kindergarten-level exercise. I stood there stupidly and couldn't figure out where to start. Noted since inability to perform basic tasks goes with both nastier TN breakthroughs and clonazepam. With that experience behind me I went to the kitchen to make supper. Decided to skip dicing fresh tomatoes and opened a can of diced tomatoes instead.

The basic pain level gradually transitioned to pain hangover, as the clonazepam wore off, then began to come back. I took a second 0.5 mg, and while I could focus enough, fixed the nightstand. I fell in bed, and again there was no sleep, and kept having level 7/8 zaps every few seconds, now on my classic pattern. This time, they were punctuated by extreme zaps, brief but disorienting, incredibly painful, and capable of eliciting involuntary moans. If I had to put a number on the big ones, it would be 9+. This went on for almost two hours.  Eventually the zaps, big and small, subsided below tolerance level. Since I was still awake, I thought I could handle a little light, and I read a little as things fell under control. I finally slept.

Total duration of the episode was 7+ hours, and it was the worst in several years both in maximum intensity and duration. The current course is troubling, as it differs in several ways from my past experience. One lives on hope; the hope in this case that this was an isolated breakthrough.

I post all this chiefly for the community of people who share this disorder, and interested clinicians. One can tell the latter apart from the rank and file, because they're the ones who flinch when you tell them what you have. Most laypeople can't comprehend the experience. Some few are convinced we are all faking. They are too stupid to bother with.

If it's tourist season...

My heart sank when I read this item about the (hypothetical) discovery of the exact site of the Salem hangings of 1692, so I can't help posting about it. In the warm months, every Wednesday, my midday walk takes me across the top of this hill, where a shady path provides a few moments of respite from the nuttiness of the work day.

It is a loathsome prospect that this island of sanity might be invaded by swarms of tourists towed around by the collection of professional liars who form Salem's tour guide corps. It would be worse if the adjoining quiet parkland and (at midday) quiet residential streets were invaded by tourists on the loose.

As they say back home, "if it's tourist season, why can't we shoot 'em?"

Where I don't want to go here

A plan is evolving to focus here on issues of chronic pain and treatment, perhaps in earnest once I get to that title change. Since I have to deal with these topics personally and professionally, and since the wisdom is to focus a blog, it seems like the place to be.

That means:

1. No politics except those related to the focus. There are plenty of political statements on chronic pain treatment, the majority pandering and ignorant.
2. No gun control. Shortly before I left Facebook, I commented on a piece about the open-carry idiots as a former gun owner. The author of the piece earnestly invited further input and I refused. He said they needed voices like mine, which is true. That makes it too bad that so many supporters of gun control have done all they can to sling toxic invective at voices like mine. Like many others, I will say no more, and supporters of this worthy movement have only themselves to thank for that.
3. No travelogues. They're fun but irrelevant. Maybe I'll open another blog for fun stuff.
4. No cat tales: ditto.

As for what I want to have here:

1. Professionally, my interests are in the varied set of problems related to pain management in general and opioid abuse in particular. Personally, my interests lie in documenting my own disorder, and in looking at the unique problems posed by the entire evil family of neuropathies. Most don't respond to opioids at all, which makes us bystanders to that issue as patients. The opioid problem does affect my work directly.
   
2. I think this blog should deal with mental illness from time to time. It's another subject that mingles personal and professional interests. It may also touch on the whole area of medical pseudoscience, woo, and quackery now and then. In my own space I can control the first world types who believe the best way to close an argument is to issue a death threat. As I shut the door behind them here, I may remind them that throwing death threats around the Wild West of the Internet is bringing a knife to a gunfight.
   
3. By the way, a reader told me that I sounded a little intimidating. The civil have nothing to fear. I mean to show the uncivil the door, but I may take a moment to publish their comments and indulge in a little humiliation at their expense.

PS: Does anyone else find it odd that Blogger.com's spell check doesn't recognise blog?

Round the bend

My associates have often found reason to shake their heads at my fondness for outre sports. Well, I have finally gone round the bend and participated in several ends of curling.

Yes, curling. This is a more benign form of a sport passionately followed throughout the northern latitudes, to the utter confusion of Americans saturated in industrial-scale athletics. Floor curling is suitable for basketball courts. The stones are relatively small. Instead of riding down the pitch on a surface of ice stimulated by sweeping, they ride on a triad of large ball bearings. But the concentration and enthusiasm is the same, and I can see where much of it is excellent training for the real thing.

After seeing a notice for the sport, I had dropped in at the Senior Centre to see if they were for real. Alas, one side were one short of the required four, and in short order I was surrounded and persuaded to take part.

I sucked.

However, it was enough of a learning experience that I'll be back when I can. Och aye.

PS: Murphy's Law has long dictated that as soon as I congratulate myself on keeping the Beast under control, it slips its chains. Things are not so good on the TN front.

Ah, so that's it

One of the things one loses when entertaining Trigeminal Neuralgia is an appreciation of the horror most ordinary people, and most clinicians, feel about suicide. I've been looking for a good summary of those feelings for quite a while, and now I've found this.

As of this writing, the blog is marred by several paragraphs at the end on chronic pain. I say "marred," because the lack of transition suggests that the material wasn't meant to go with the copy on suicide. Yet I appreciate the irony, because there is an association between suicide and some forms of chronic pain, a connection that may have eluded the author.

My cushion of Carbamazepine and Gabapentin allows me objectivity. It also allows me to write, because when things are bad it hurts to concentrate...it hurts to talk; to eat, or brush one's teeth; to open one's eyes. Yet I'm fortunate. I was born into a time when my medication exists, and fortunate that much of the time it works well enough to allow me to function fairly well.

Medication doesn't help everyone. I found the following recently.

While no one quoted here actually says "when I finish this, I'm going to stick my head in the gas oven," something else is clear. There are degrees of bravery, and degrees of bravado. When you live in a world in which suicide is just a treatment option, those degrees matter a lot.

Be patient with us: we see things through a different prism.

What activism may really be about

Reading social media  for information is getting to be like searching for diamonds in a dung heap. Once lift one's eyes from that obsession, and one can find signs of intelligent life elsewhere: such as this from Terry Daynard's blog.

The piece is one of the most insightful I've ever seen on the motives of those people who are anti-science in general, and anti-biotechnology in particular. Daynard has done what I know I should do, and what I find increasingly hard to do. He has carefully considered the opinions of his opponents.

The conclusion of the article is discouraging, because it suggests that there is little to no hope of finding common ground on this topic. At least, there is little to no hope if scientists go on presenting mountains of evidence for their position, because this may really not be about the science at all.

I have written many times that I'm no friend to anyone's ideology. I regard it as a lazy or self-interested person's substitute for critical thinking. The biotech topic is a good example. Opponents certainly seem to be operating from ideology, and at times some biotech supporters cross the line. The topic also touches a particular piece of my life experience.

Ask most people why not-for-profits or non-governmental organisations (NGOs) exist and they will either come up with an partial answer specific to the ones they know, or no answer at all. The actual, b-school* answer is that they exist to fulfil a mission. However, their great weakness is that they need supporters and money to fulfil that mission. Without constant vigilance at the executive and board level, these organisations are prone to lose sight of the mission, and concentrate on the support and the means of getting that support.

Greenpeace is the NGO I most have in mind here, but it probably applies to several others in this debate. A number of anti-biotech social media pages or blogs come from activist individuals or organisations who have been around for a long time, and who have totally gone round the bend on this weakness: they will get behind any cause du jour as long as it keeps the money rolling in.**

In all these cases, the support tail is wagging the dog so hard that the poor mutt is at risk of a concussion. Daynard makes the Greenpeace position very clear. It's all about keeping the discussion as black and white as possible. Originally, Greenpeace aggression and vandalism had specific objectives besides getting headlines and entertaining the base. It's been noted elsewhere that the vandalism has become the objective.

Knowing this is nice but it changes nothing. NGOs/not-for profits that have become totally means-focused tend to stay on that path until they get to the edge of self-destruction or beyond. It's a question whether the current lot involved with anti-biotech propaganda will destroy themselves before they succeed in destroying the agricultural tools needed to stave off starvation on a global scale. I look for reasons to hope but so far they're elusive.

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*I took a certificate in not-for-profit management taught at Columbia School of Business. This is one of the lessons that stuck.

** The archetype of this is the March of Dimes. Who remembers that its original mission was a cure for polio? Success in the mission can be a not-for-profit's worst nightmare.

Things Beastly

The Beast is of course still with me. Trigeminal Neuralgia can and does go away for a while, but it is never really cured. It's those random remissions that make TN such a magnet for quacks. They can pitch their woo until the poor sucker has a remission, disappear, and be nowhere in sight when it comes back.

It's frustrating to those who have it, and even more perhaps to their loved ones and healthcare providers, that triggers and the course of the disorder can change over time. Time was that a big part of my containment plan was simply being a near shut-in for five months a year. It's no longer enough.
It also used to be that the year's first episode of breakthough pain brought on a couple of months of horrors once or twice a day. So far that hasn't been happening, and we should be grateful for what blessings we can get.

In place of that one gets something more like the usual picture of TN. This is what I've started to call sucker-punches that can hit at any time of day, several times a day, year-round. Again, so far the pain level hasn't been anything that my drugged-up nervous system, with its ridiculously elevated pain threshold*, can't handle. What this would be  like without enough carbamazepine and gabapentin to flatten a normal person doesn't bear thinking about. It's a rough ride.

We shall see what the rest of the winter brings.

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*Last summer I had an ancient ladder fall apart under me. After falling several feet and managing to land upright, I used a few words from my Navy vocabulary and moved on to another ladder. I limped for a fortnight, and the bruises from this are just now fading away.  I reflect that someone not floating on a cushion of anti-convulsants would probably have ended up in the Emergency Department. This happens all the time: collateral damage of TN treatment.

F 60.9*

Let me offer a notice to trolls, or even mere jerks, who wander in. I”ll be showing you the door quickly, very quickly if it appears you are particularly stupid. I avoid pissing contests with skunks.

Let's take the example of a genius who wandered in here last June and started ranting about my comments in support of ICD-10. Only trouble was, this fool couldn't read a calendar. I had posted those remarks 14 months earlier. I didn't expect to be blogging again and I didn't keep track of my last posts. So I replied, none too nicely, asking WTF had set this jerk off and pointing out the 14 month lapse.

ICD-10 was introduced on October 1 last, with about the same amount of sturm und drang which accompanied Y2K (remember that manufactured hysteria?) It's now a very done deal, so let's recap who was agin it and why.

1. First, people in the health professions who had fears, legitimate and otherwise, about the effect of introducing a new diagnostic coding system. Some were older coders who didn't want to face learning something new. Most of them were gradually won over by discovering that it's not that much different to what they were already doing. Others were physicians who were afraid implementation would cost too much. Well, it hasn't: chiefly because coders and other health information specialists had planned for a process of holding physicians' hands during the transition.
   
   
2. One special interest group in particular opposed it. ICD-10 CM (the diagnostic system) is just one part of the coding toolbox, as was ICD-9. There is also an ICD coding system for inpatient procedures, and Current Procedural Terminology (CPT), a procedural coding system for physician practices and outpatient services. Whilst ICD is an international standard, CPT is a proprietary system owned by...wait for it...the American Medical Association (AMA). Guess which organisation has been at the forefront of opposition to ICD-10? And why? Chiefly because of persistent rumours and fears that a version of the ICD-10 procedural system could supplant CPT, at great financial loss to the AMA. In the post my anonymous ranter hated so much, I posed the question cui bono? Who benefits from the opposition to ICD-10? Well, there, now I've named the favourite heavy of most ICD-10 proponents.
   
3. Journalists of the snarky and simple-minded variety didn't exactly oppose it, but mocked it, and my troll had clearly got hold of the mockery, As a proudly recovering reporter, I don't mind saying that most journalists today are both snarky and simple-minded, and show a consistent failure to get the whole story. It's true that of itself, the introduction of ICD-10 is a non-story, less interesting than the introduction of a new brand of men's underwear. But add a clever story line that makes it look like a bureaucratic boondoggle, and it has legs.
   
   The legs are supplied by a chapter of ICD (9 and 10) called External Causes of Morbidity. In ICD-10, this is just one of 21 chapters, and the only one that doesn't deal directly with clinical diagnosis. It exists chiefly for compilation of statistical data on morbidity. Because of that, this chapter, as in ICD-9, tries to anticipate all possible external causes of morbidity, based on previous evidence. In other words, the people who put those wacky things into code did so not because they guessed that some strange thing or other might happen, but because it had happened somewhere. We work from evidence, and we don't guess. To take two examples that cause great hilarity, patients in the third world can acquire a deadly fever from being pecked or bitten by a parrot. If an one airport worker has been sucked into a jet engine, it is an indictment of that airport's safety record. The funny or supposedly useless things in this chapter are neither, although we in the business laugh too. The media neglect to mention that ICD-9 contains equally incomprehensible codes in its External Causes chapter, for that would spoil the story.
   
4. Then we have trolls like mine (let's call him Mr. Dunning-Kruger) who only know what Google tells them, and then regurgitate it like a bird or animal vomiting food for its young. Neither reporters nor the Dunning-Krugers grasp that medicine is vastly more complicated than it was in ICD-9's heyday, 30 years ago. Some people who do grasp it are offended by the increase in complexity. I think it's fucking fine that we need a diagnostic system that matches the granularity necessary in the clinic today: one that vastly increases the possible descriptions of cardiovascular disease, for example, and also simplifies the list of diagnoses for hypertension. That's what's going on in the other 20 chapters of ICD-10, and it's not foolish at all.

I'm not going to make the same mistake the troll made, and post a rant six months old. These things have a shelf life. In this case, the successful adoption of a coding system whose purpose is beyond a troll's comprehension makes his rant especially rancid.

*The title is an ICD-10 code I chose in honour of Mr. Dunning-Kruger. He threw at me the classic troll line of “Do your research,” completely overlooking the context: that I've done done my research on this topic for six years: real research, not half an hour on Google, and sat an examination on the subject. Although (disclaimer) I do not diagnose or treat disease, the code in the title seems to fit the average troll admirably. Do your research, pilgrims, and see what you think.

Titles

When Charles Schulz submitted the comic strip that would make him famous to United Features Syndicate in 1950, they liked about everything but the title. It wouldn't do. It was too much like several other strips. It didn't stand out, and it might lead to infringement problems. So the syndicate did what they had done before and chose a name for it. Schulz didn't like the new name, but he wanted the strip out there. So he agreed to "Peanuts."

I don't like "Scratches," so that must change. On the other hand, I remind myself that Schulz was a better artist than creator of titles. His idea was "L'il Folks."

I need to consult a girl in a booth labeled "Insights, five cents."

Back again. And why?

The initial post or two in the revival will be chatty because I have a lot on my mind. However, the longer I go without saying anything on Facebook (even “liking” anything) the easier it gets. I want to take one thing away from Facebook once I've vented, and that is brevity.

Why am I leaving? First, there was some activist attempt to gin up sympathy for people who had taken over a public wharf in my town and were being told to push off. The suggestion was that they were poor downtrodden immigrants, or poor widdle kids who couldn't go fishing with Daddy. They were immigrants all right, and would have been more than welcome if they hadn't made a godawful mess, hadn't shoved off the real neighbourhood kids who have been swimming off this wharf since forever, and if half or more hadn't been unlicenced professionals trying to cut out the licenced fishermen, whom they also tried to shove off.

I was pleased to see that the campaign was over almost before it began, but it was a classic example of how Facebook, by paying no interest to accuracy, encourages such nonsense. There's nothing like having a personal acquaintance with an issue to show up how worthless is most social media content.

Second, about a year ago I began observing the conflicts (can't call them debates) over organic vs. bio-engineered food. I waited to see which side won me with evidence and style. Those sceptical of organics and supportive of biotechnology won me over with evidence and had a slight edge in class. But my interest inevitably (on Facebook) got me tagged as a potential follower of some of the more toxic pages on the other side. When I politely asked a couple to get my name off their lists, I was inundated with hate mail, and trolled for a while until the fools lost interest. Fortunately, they have the attention span of a dog in a wood full of squirrels. Third, I've been trying to aid my mental health by limiting my exposure to news, and I found that exposure to social media was having the same negative effect on me.

Finally, I was trolled for a perfectly benign bit of humour by one of my own relations, whose sensitivity presumably had been honed to a sharp edge by excessive exposure to social media. That's when I said “fuck this.” So I'm back here, in what is generally my personal echo chamber.