Random raves

I've had a day of feeling somewhat "off", but put it down to having a few glasses of wine at a work celebration last night. However, as I was walking out the door to go home, I started feeling decidedly crook - everytime I moved, I felt exceedingly nauseated.

( Cut for moderate grossness )
 
Having sat rugged up at home for a few hours, I've not thrown up since, and I've had some soup and toast. I hope like fuck it doesn't happen again tomorrow. I was also feeling fairly angstful about having made a mess of my car, but on thinking of it, riding a jerky bus home would have been worse. Walking was out of the question.

The really irritating thing is that I was going out to dinner at the swanky Courgette restaurant this evening - we finished off a major project last week, and the project team were having an exclusive dinner celebration, and I was one of the select few invited (the general drinkies for everyone involved at all levels was last night). So, missing out on a free dinner there with fairly pleasant company (the project team are quite a nice bunch of people) really really sucks.

And while I'm grizzling, I've run out of soy milk. I really want nurturing cups of tea tonight, and I actively dislike normal black tea served without milk (teas like jasmine and green are of course fine without, but I don't actually call those nurturing). Fuckity fuck.

Part of the reason last week was so speshul for me was that I went to get my lovely lady parts checked up by the doctor. Possibly not the best time to do it, but it was a bit overdue, and I specifically wanted to get screened for HPV, and get the vaccine if I'm negative (the vaccine only covers a few HPV strains, but vaccinating against some of the more virulent kind is better than nothing, and it would be really annoying to develop cervical cancer later on if I was clear up to now). The doc reckons my risk is low - his method of asking was, "Has there ever been PEEN in here?", heh, and while there has, there hasn't been much - but it's good to know one way or the other.

The other thing I wanted to find out about was getting a genetic test for the two genes that have been associated with increased risk of breast cancer (BRCA1 and BRCA2). My mother's sister has had breast cancer twice, when she was under 50, and my grandmother died of cancer (I don't know where it started, but she was apparently riddled with it when she died). And, of course, I don't know anything about my paternal side. This puts me in either a "moderately increased" or "high risk" category. I need to find out what kind of cancer my grandmother died of.

The doctor would have been delighted to refer me for it, but it would cost up to $3000. Fucking jesus christ hell. He says that while most genetic testing comes in at less than $200, the BRCA test has not reduced in price since it was first developed. I bumped into saluqi at lunchtime afterwards and grizzled about this fact, and she observed that it's probably due to the procedure still being patented. Of course, and if I hadn't been so discombulated by the morning's events, I might have twigged myself.

Now, on doing some research, it turns out the licencee of the BRCA tests (licensed from Myriad Technologies in the US) in Australia and NZ, GTG Technologies, was planning to assert its patent rights, but backed down because of the uproar that took place over it. Prices still haven't dropped, though. And this epitomises what is fucked up about the patent system. I certainly understand granting a patent for developing a new genetic assay method (although I think 20 years is excessive - 10 would be more than enough). What I strongly disagree with is patenting a diagnostic system based on a specific gene (or set of genes). They didn't invent the fucking genes, and any genetic researcher, on knowing the association, would be able to test for exactly the same thing. It's like patenting a business method, or thought process, neither of which are legally patentable in many jurisdictions. Or software patents, but we won't get into that one (because I naturally disagree with such things - should I patent every regular expression I write to filter a log?) What's even more galling is that in Europe, the patent for the BRCA1 test was revoked years ago by the EU Patent Office.

So, what does this all mean for me? If I was an Ashkenazi Jew, there would be no question of my running into the genetic testing clinic and demanding a test. Of course, I don't know what half my family background is. The other thing is that 8% of women will develop breast cancer in their lifetimes, but only 0.4% of women will develop a breast cancer associated with either of the BRCA genes (I don't know how much that number will change as more women get genetically tested - I don't even know if it's routine these days for any women with breast cancer). So what I'll do is find out from my mother what kind of cancer my grandmother died of, and ask my aunt whether she was ever genetically tested after developing breast cancer in both breasts. And maybe during the next few years, the price of the test will reduce.

If I did have such a test, and it was found to be postive for either of the mutated genes, I think I'd have prophylactic surgery. I initally thought that such a measure was pretty extreme, but I'm not exactly attached to my breasts (although I feel fonder of them than I used to), and better to get rid of most of them before trouble arises. Well, we'll see - I'm not exactly looking forward to either of those conversations with my mother or my auntie.

Thank you all so much for your birthday wishes the other day; it was lovely. It was nice getting all those good wishes when I was feeling a bit feeble.

I am slowly getting to grips with online stuff after only just getting to eating real food today. I was going to work this week, but the bug (and the fact I was only eating when I felt I was going to keel over from lack of energy) certainly kept the old energy levels down. Still, I imagine I'll be bouncing back over the next few days and boring you with my normal levels of comment and rantings.

Oh, and the miracle cure for actually eating real food today was my finally hitting on taking a probiotic supplement via capsule. I'd been desultorily eating good quality yoghurt (it's too cold, really), and faxon suggested the wee Yakult-type shots, but since I don't drink milk, the idea of sculling one of those made me pukey just thinking of it. Taking the capsules - duh! - gets around that particular problem, there are generally more organisms in a dose, and the capsule design supposedly delivers more of them intact to the lower intestine (rather than mainly the stomach).

Anyways, whether or not it's a coincidence, my digestion seems a heck of a lot more normal today, after starting them yesterday (no TMI, blergh), and I actually had an appetite for lunch and dinner. With protein. And fats. OMG!

Man, I am completely and utterly wiped, still. At least I don't have any doubts whether the remedy is working or not. Often, with homeopathics, you have an "aggravation" where your body is stimulated to launch into action to fix itself, but because it's all out of whack still, that stimulus means you feel a bit worse for a while. Later on, everything starts coming into balance, and you feel better. Also, the nice thing is that if you're already at your lowest ebb, the balancing thing starts right away (you can't get worse if you're already at rock-bottom).

But, wow, I've never had such a strong physical reaction. Interestingly, I've just been loaded up with a pile of work - I have to migrate 9 or so Exchange servers to new hardware by the end of the month, and the boxes arrived on Friday - but I'm not feeling particularly stressed about it right now. Or, I kind of am, but it's not stressy stress. However, one of my sidekicks has been piping up about clustering the Canberra (and maybe Brisbane) servers now - which I've been lobbying for for only 3 years - and maybe with his support, we might be able to force it through. That does add an element of a bit more stress, but in the end, we will either be able to do it... or we won't. We shall see.

On that note, though, I will be hitting my bed. I've been zonking out between 9pm-10:30pm since Thursday night - which is at least an hour earlier than my usual bedtime. Velly interestink.

Jesus, it all happens at once, doesn't it? I had that lurgie last weekend, my period this week, and I've spent the last 36 hours contending with a fairly vile gastrointestinal something. I may have to thank homeopathy for the fact I didn't throw up or have unfortunate episodes in the loo, but the fever and chills, stinking headache, painful shoulders, back and hips, constant nausea, painful stomach (with xtra bonus cramps last night), and inability to eat anything other than 3 mouthfuls of porridge and 12 Japanese-style rice crackers since yesterday morning have been sufficiently bothersome all on their own. In fact, I have never felt so ill in my life as I did last night, except perhaps when I had hepatitis as a kidlet (I had the horrible thought that somehow I was having another dose, but I'm not jaundiced, or, indeed, vomiting, thank god).

Also - and this is a symptom of how my energy's been worn down - while I'm fine with living by myself almost all the time, things like that make realise how difficult it could be if I were ever seriously ill. I felt rotten enough last night that I was laying plans for how to get to the A&E clinic if I felt I was getting severely dehydrated or more feverish. Sure, I have a couple of people to call on if it gets that bad, but it's awkward. And embarrassing actually. I suppose I just need to suck up the fact I can't be capable all the time. Hah.

Come to think of it, though, if it was a norovirus-type something, it's better to not have anyone else around. I haven't done anything projectile-ish with my body fluids, but reducing the amount of potential exposure to the greeblies is a good thing. At least I'm clean in my personal habits.

Must get myself a thermometer, though. I didn't have a clue what my temperature was at its worst, and it might have helped some of my more paranoid thoughts if I knew it wasn't high enough to be something like meningitis.

You know, I had much more fun plans for my weekend. It sucks.

(And I'm not just saying that because I'm being painfully visited by the goddess, only four days late, only one day before I'm joing on a fun jaunt overnight to Sydney with the CDL, oh no!)

HRT puts you at a much more elevated risk of getting cancer, especially breast cancer. I knew this 15 years ago, when my aunt (who'd been on HRT for nearly a decade due to a full hysterectomy) had to have both breasts removed due to malignant growths. When she went on the HRT, there was no mention of that risk. When she developed the breast cancer, there was some feet-shuffling and some muttering about "higher incidence due to artificial estrogen" from the doctors. Oh, and my grandmother, her mother, died of cancer, so it's not as if there were no other risk factors at all. Fuckers.

So, how many of you knew that fact? How much is it in the public consciousness that HRT will appreciably up your risk of cancer? From the amount of of prescribing in that area going on for menopausal women, I'd say it's not very much in the public consciousness at all.

What about the transwomen out there who have been or are on HRT? How much was it mentioned that your risk is greater too? And what about those high dosages (higher than for menopausal cis-women) that are often prescribed for transwomen for the first several years? What about the risks there? Even the usually-comprehensive T-Vox site is fairly quiet on the risks associated with artificial estrogens.

The reason I'm on about this is due to the release of a recent study that shows that users of HRT are at 63% higher risk of developing ovarian, uterine or breast cancers than women who have never had HRT. Apparently, regulatory bodies in the UK have said in the last 5 years that HRT should be used as little as possible and for as briefly as possible. I'd say that message hadn't trickled down either.

Perhaps the fact that The Lancet is publishing the study, and that there is obvious media interest, will get the word out. Finally.

My thoughts? Don't use HRT unless you have to. For me, it won't be until I'm 80, and suffering from brittle bones (if I ever do).

For MTFs, if your treatments weren't carried out in conjunction with anti-androgen measures (and thus incurred higher estrogen doses), you'd probably want to reduce as many of your other risk factors as possible. Check your breasts regularly (I suppose not having a uterus and ovaries is a help, in this instance). And I bloody hope that someone gets off their arses and specifically studies the kinds of risks MTFs are exposed to in this realm. Perhaps reaching puberty in a male body helps? Or hinders? Who the fuck knows, at this stage?

Perhaps a higher profile will lead to some research on the causes of the elevated risk. Is it something about the artificial form? Taking a hormonal substance that isn't produced by your own body? The dosage? The delivery of that dosage (which would be more homogeneous than the body's natural cycle, with its daily, not to mention monthly, ebbs and flows)? Let's hope some momentum starts happening in this area.

So, it's choppy-choppy day for my knee on Friday. I seem to be alternating between totally forgetting about it and quite a bit of nervousness. I've never had surgery of any description before, nor anaesthetics. However, it's not quite that part that bothers me. I'm more worried about how it will be after. Will it hurt too much? While I've got a decent pain threshold, there is definitely a value of too much that I don't want to exceed. Will I be ambulatory enough? The idea of being totally incapacitated gives me the squicks, to be frank. And, if something stressful does result in that realm (eg. not being able to go back to work on Tuesday), will I manage that well enough? And not unload all over the wrong objects?

While I had chronic bronchitis (which laid me up for weeks at a time) and undiagnosed asthma as a kid, as an adult I've been pretty robust and strong. I suppose it might be an opportunity to learn some humility. Not actually a lesson that has any appeal to me whatsoever (since I don't exactly have a problem with a swollen ego).

However, everything's pretty much at the ready. I have food laid in for when I get back home. The OGF will be driving me there (Sydney) tomorrow and back on Sunday and mopping my fevered brow in between. The king-sized hotel room with kitchenette is booked, although I found out today there is no offstreet parking. Gah, I didn't check when I booked (too late now). The CDL has offered many supportive words and to spring into action if at all necessary when I'm back in Canberra.

The nice thing is that I know that I actually am not a bad patient, I'm exceedingly grateful, even when I feel (rarely) ratshit. Well, we'll see how it goes.

ETA: Anyways, there are always the puppays of extreme preciousness to perve at. They make everything better, and there are even some yappy dogs that can make me laugh.

So, I went to see the knee surgeon in Sydney today. He basically took one look at it and said, "When do you want me to operate? I've got slots Friday week." In my somewhat-bemused state, I agreed to next week, in the spirit of getting the thing over-and-done-with.

It was funny, though. He had some little junior doctors trailing him, and they got to look at my scans and tsk at them. So, it's the area to the outside of the meniscus which is on the right side of my knee joint. Other than the tear, the thing has degenerated over the last few years, and the cysts are the things that cause the pain. I feel the pain under the tendon that goes up the side of the knee. The largest cyst is right under that, and it also explains why the pain comes and goes - it's the cyst flaring up. He's going to take that out explicitly as well - normally they'd leave them to shrink naturally since they're not being "fed" with more fluid with the meniscus repaired, but this one is too large. Bah.

So, after waiting half an hour for one of the junior docs to track down the receptionist who was doing the booking, she went through the details with me. And this is why I'm starting to have second thoughts about the timing.

Firstly, I won't be able to put much weight on it immediately after the op, and that will take more or less time to heal, depending on what they do. If he repairs the meniscus rather than chopping the bad part out, it will be months of hobbling around, as opposed to a week or two. Still, I decided that I could probably manage myself onto taxis and trains (flying back to Canberra after knee surgery doesn't appeal), so that part's not too bad. What is badder, though, is the fact I'm living up two flights of stairs. Since I probably won't be able to bend my knee much for at least a few days after the surgery, getting inside my flat could be a little challenging.

Secondly, how much time will I need off work? More than a couple of days will be difficult. Surgery days are always a Friday; I could take an extra couple of days for a very long weekend. I suppose that's not too much pay to lose...

Except, thirdly, the cost. Nearly $6000, of which I'll get less than $500 back from Medicare. The surgeon is $2500, then there's the assistant surgeon (about $500) and the anesthetist. That's the part I'll get the $500 back on. Then there is the hospital charge, which is $2500, of which I will get nothing back. Not bad for a few hours in a bed and the use of an operating theatre, eh? (It's same-day surgery - I wouldn't be staying overnight).

I could go public, but there are big waiting lists, and I don't want any old surgeon tinkering about with my knee. Getting private insurance now would be pointless, since everyone has about a 12-month waiting period for pre-existing conditions. If I'd thought of it when I first got here, I'd be over the hump by now, but I didn't. One of the curses of not thinking of oneself as requiring major treatment. Yes, I know I'm stupid. However, they won't cover 100% of the costs anyway, so I don't know if I'd have saved much in terms of excess payments + premiums.

So, getting it out the way now is feasible - I'd need an overdraft, and it'd put back my debt-repayment schedule, but it's feasible.  Alternatively, I could see if he has slots available in the two weeks I have to take off for Xmas. I don't really care if I don't make it home to the family do. Then there's another 60 days for final payment (for the surgeon's part, the hospital is cash up front), which would take some of the pressure off. Or I could postpone it entirely until after next Feb, when I should have virtually all of my evul debt paid off. And perhaps have done something about my living arrangements - ie. be living in a place where I only have a few steps to get up.

I have to decide tomorrow. Well, I don't have to - I'd just rather let them know sooner if I want to delay things. Hm. Agh.

Unless you've been living under a rock these last few years, you'll be aware that the HPV virus is positively linked with cervical cancer incidence in women. Most women who get HPV don't develop cervical cancer, but it majorly ups your risk of gettting it. 70% of cervical cancer patients test positively to one of two strains of HPV infection. 97% of cervical cancer patients in another study showed the presence of any of a dozen strains of HPV. 4 out of 5 women will have an HPV infection some time in their lives - it's mostly silent, although a few develop genital warts. Interestingly enough, the strains that tend to produce warts (which manifest in about 10% of cases) are not the ones which are associated with later cancer. This article from the EMJA sets out all the implications.

On the good news front, an HPV vaccine has been recently developed, which seems to offergood resistence to HPV infections (of the strain in the vaccine). There have been many calls made recently for girls to get vaccinated routinely, generally before puberty (and sexual activity, presumably). Of course, the "wages of sin are death" crowd are jumping up and down and saying that this would encourage sex before marriage and all kinds of other nasty nasty things. My understanding - possibly limited, I admit - is that marriage is not magic protection against HPV either. Maybe married couples are all engaging in safe sex these days.

That's all well and good, despite the rumptions of the religious right. However, there are two things that are bugging me. One is that the vaccine is naturally only effective if one hasn't already been exposed to the virus. Are they going to test every girl before mass vaccination, because there will be a significant proportion (a small minority, but significant, nonetheless) who will already be infected? It's disgusting to consider, but, if there are negative consequences if the vaccine is given to someone already infected, these need to be thorougly explored before going gung-ho giving it to every girl.

The other is that while an HPV test is available in Australia (of course), it's only offered to women who are already showing cervical abnormalities in a smear. I presume that one could pay the full price for such a test, but I haven't tracked down any pricing information. While 4/5 women have already been infected with HPV, that means 20% have not. Since the only sex I've had with a man as an adult has been safe sex, I think my chances of not having contracted it are good. Yes, lesbians can pass it too, but like many STIs, I'm sure it's harder (I haven't found any comparative statistics tho'). I would like to know whether or not I have been infected. I would also like access to the vaccine if I have not. Obviously, it's early days, but I haven't yet seen any discussion on that.

There would be a cost associated with providing an HPV screening test to all women, and then vaccinating them if they're clear. If there is a latency period between infection and testing positive, that could prove difficult to manage. Assuming not, though, if all goes well, and you get vaccinated, you're presumably at much less risk (3% of the usual risk, going by the above stats, assuming they develop a multi-valent vaccine that will take out the 6 major cancer-associated strains) of developing cervical cancer. If you consider the cost of providing all those 2-3 yearly pap smears to the women who bother to have them, surely it'd cost much less in the long run to vaccinate the fortunate few and then call them in for pap smears at much-reduced intervals? If you say that 5 years is a suitable period for a vaccinated woman  to go between smears (and research might show longer is fine), you've just reduced your cervical screening costs by 10%. Over the course of a woman's lifetime, the savings would be much greater. Not to mention the reduced costs of treating women who do go on to develop cancer. I'm fairly confident that the reduced costs of regular smears (and reduced treatment costs) would more than offset the costs of mass HPV screening/vaccination.

So, how long till the Powers That Be start doing the sums? Not too long, I hope. And not too long for us adult women who might have some options. I'm definitely going to try and track down HPV testing via the private route. We'll see what happens after.


ETA: I just realised that my assessment of HPV infection risk was a bit over-optimistic. There has been at least one instance of the "safe sex" I engaged in failing catastrophically. Huh. Well, there's still a 1 in 5 chance of my point applying to me. It certainly still does to women as a group.

I have big issues about getting pap smears done, but I don't think that's so unusual. But I loathe loathe loathe going to the dentist even worse.

Part of the problem I have with that problem is that it's irrational. I have precisely two fillings, which I got nearly twenty years ago. My wisdom teeth haven't come through at all (no laughing in the cheap seats!), so I don't have any horror tales about getting them extracted. It's not even as if I have a full-blown phobia, which would make it somewhat excusable.

There are are some things I can identify as being particularly icky for me. One is that I'm stuck in a place I can't move from. I immensely dislike having to "open wide" and have people shove things into my mouth. (ah. eureka.) Also, that scraping they do to get off the gritty stuff erodes my last nerve.

[...See, this is the nice thing about l/j - one can set down all one's most stupid thoughts, and sometimes, sometimes, there is illumination from it. So, there you go, after my entire lifetime, I finally get to the root of what bugs me about dentists. Interesting. But it's ancient history I don't need to blurb about here.]

On the more prosaic front, I got the hygenist telling me I could get braces. Like hell. My front teeth are straight, they all function, why bother? Also, the dentist reckons I must grind my teeth? Odd. I don't think I clench them that much, and I'm fairly sure I don't grind them in my sleep. I'm positive I would have been informed by interested parties by now if I did so. Will have to think on that one.

Still, all clean and shiny now, until the next time I can work up the fortitude to visit.