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Anterior Medial Meniscus Tear with Degenerative Arthritis of the Knee Joint

2015-06-27

Default type face. Times New Roman size 12.

Test document:

Describe the sensation of anxiety. It is a feeling of pressure inside, a tension, a need to do something, anything. An internal trembling that goes on and on without ceasing or lessening and makes each moment last a lifetime when you can’t do anything. Then there is physical shaking, trembling of the fingertips, the hands, the arms, the feet, the head, even the lips.

Opening.
Friday, August second, two thousand and twelve.
Having resolved to talk about what’s really going on, I hereby describe my current situation: this morning, like every morning, I got up at 5:00, took eight hundred milligrams of ibuprofen, and went back to bed. At 6:30, Mary was up, so I asked her for one of her diet pills, which she graciously handed me after asked if I didn’t want two. Back to bed again, until Mary leaves, at which time I get up to kiss her goodbye and wish her a good day. Then up for putting on pants, socks, and shoes to go for a walk. Before leaving, smoke two bowls of the leftover combustible materials. Walking time, with two eight pound dumb-bells, 26 minutes, or about one and one quarter miles. Met up with one of the cats, a big yellow male tabby, in the plum orchard almost half a mile from the house.

Also before leaving this morning I took twenty mg of the anti-cholesterol drug Crestor and twenty mg of Benicar, an angiotensin receptor blocker for hypertension. Plus nine hundred mg of Neurontin, or gabapentin. Last, fifty mg of desvenlafaxine or Pristiq. With a glass of water.

As to how I feel–uncharacteristically light, as if I’m entering a manic phase, which would just be a degeneration of the overall pattern which can be hammered in to place over a lifetime of situations, choices, and actions. I say hammered because everything can be over-simplified and turned in to “just another manic phase” or “just another depressive period” which tends to suck all the meaningfulness out of an experience from which you might actually have learned something. I say “might” because the chances of actually learning and remembering something worthwhile are small.

All the same, I still feel that I’m going to start feeling bad real soon again. Tonight.

Inserted note: as a matter of fact, I didn’t feel “bad real soon” or certainly not “real bad” but actually got sleepy and fell asleep in bed next to Mary around ten-thirty or so. I think the TV was already off.

By the way, we usually watch the Turner Movie Classics which means no commercials (except for the ones between movies for the next movie) but the movies are mostly pretty old, with the exception of “2001″ and “Lawrence of Arabia.” In the old days, until the late Sixties, there was an explicit production code which proscribed unhappy endings, at least for the good guys. Certain obscene words were also prohibited, as well as situations and activities considered unwholesome.
The intent of the Code was to make television safe for children to watch, and it had the unintended result of making almost all of the movies produced under the code come out with happy endings, or at least highly just endings.
Mary liked movies made under the Code because she liked movies to come out with a happy ending. She was very unhappy with movies like “Elvira Madigan”, in which the lovers commit suicide at the end of the movie.
So watching TMC was usually safe if you needed a happy ending for your movie.

Interlude.

Monday, August sixth.
Today started out much the same as Friday.
I went for a walk again. This time the yellow cat followed me from home as far as the distant orange orchard. When I saw the white flowers on the bank, I remembered that I wanted to take pictures of them.
So I went back home, got my camera, and drove the truck back to the spot where the flowers were coming out. They are on a plant that looks like it will grow small gourds or squashes. I took several pictures, adjusting the exposure for the fact that the flowers are bright white and nearly six inches across.
I finished the roll of film, started a new roll, and took a couple of extra pictures.
I returned to the house and decided to take the film in right away to be printed. Back in the truck, I drove into Sanger. First I dropped off the film at Walgreens, at ten minutes to ten. Next, I went to Mary’s bank (West America Bank) and checked her account balance at the ATM.
Then I went to WalMart and wasted an hour buying dry cat food, paper, odds and ends, and a couple of cheap movies. Finally, at eleven, I went back to Walgreens for the pictures.
After that, I should have gone to Costco to refill prescriptions, but I was too hot already. My shirt was soaked with sweat and my face was wet. I went home and took a shower.

Tuesday, August twenty-eighth, fifteen minutes to three in the afternoon.
Marshall is watching “John Carter of Mars” while I am typing this. We’ve reached the point where Carter and his love interest have escaped and are riding on native animals across a lovely rural landscape. The point of view switches to their antagonists for a moment, then back to Carter and the girl, with a native warrior arguing that the girl is selling them out. Shortly Carter and the native deprive the girl of her mount and leave her behind, running and yelling after them. At this point I begin to lose interest and turn to the subject of this monologue, which is still undefined.
It is now October 27. For the last two months (September and October) my right knee has been giving me terrible pain.

You’re not supposed to use the word suddenly, but that’s how it happened. I was walking through the back door into our bedroom, and as I raised my right leg to step in over the threshold, the knee turned to the side and maybe clicked a little; then agonizing pain shot through the knee. I couldn’t put any weight on my right foot. I called out to Marshall and asked him to bring the crutches, and with these I was able to totter in to the house.

For the rest of the day, I was unable to walk without the crutches. The next day I was able to switch to a cane, but the pain persisted. For the last two months, my right knee has been almost continuously painful, especially when I try to walk more than a few feet.

I found a knee brace at Walgreen’s that was real tight and had aluminum hinges. After wearing it a few days, I gave it up. It didn’t really relieve any pain although it provided a lot of support.

There is a tender area along the anteromedial aspect of the joint line; recently the tenderness has subsided somewhat, but there is marked swelling all around the joint. I think there is a large effusion now.

So I am trying to get around a little bit, but when I get up I have to be careful. Another thing that helped was a sample bottle of Pennsaid liquid; rubbing it on the joint where it was tender really helped. The bottle lasted about two days. Now I am able to walk without the cane, although the swelling persists.

At the same time, Mary was trying to buy a car. Initially they told her that her credit was good, and we fiddled around with them for two weeks trying to get a particular white 2007 Corvette. But when Mary finally got around to showing her documents, they said the pay stub was too old; they had to have a pay stub from the last 30 days.

Well, then she had to admit that she was on SDI(for the last three weeks), and that queered the deal. Even though she was getting almost as much from SDI as from the regular job, they wouldn’t consider anyone who was on SDI at all. They asked her if she could find someone to co-sign for her. I told them my pension wasn’t big enough to help.

Mary was extremely angry and frustrated after they turned her down. She was almost immobile for a day and a half. Then she started to get over it. I was not so affected by it; I had expected something to happen that would prevent her from getting the car.

Then October passed, and now it’s November first and it’s cloudy with a feeling of impending rain. I’ll be happy if it does rain, because it will confirm my theory that this year will be wet… on the other hands, odds are against things sometimes.

This is the big issue to be settled on the evening of November sixth, who will be president for the next four years, Obama or Romney? It’s almost too sickening to imagine that Romney might win. Fortunately, polls and gambling venues give Obama between 67 and 79% odds in his favor. Romney could still win, there’s a one in three to one in four chance of that, but … ugh.

Another commenter wondered why Romney has such a good chance of winning with all his negatives. It’s true, why would anyone want Romney to be their president? But then this is clearly a nation of morons, so it’s not so surprising.
At the present time, 3:20 PM November 1, 2012, I feel persistent deep seated aching in my right knee, mostly localized to the anteromedial aspect and within. I have noticed a marked swelling of the knee, which is probably an effusion. There is still significant tenderness on the joint line in the anteromedial aspect.

The constant aching pain has been wearing me down, and activities are much more tiring than before. I am often prompted to lie down on the bed with a pillow under my knee. I feel quite lucky to be retired on a disability, as I could not possibly work in this condition without massive doses of narcotics.

It reminds me a little of September-October of 2007, when I worked my last locum tenens job at the former Air Force base medical center. I was hurting immensely in the lower back, as far aaas I can remember, and I had to take enormous doses of pain pills to relieve the pain enough to work. I was in poor condition and my work suffered as a result. I felt that I never wanted to do this kind of work again.

I think it was a week before I finished the work, Dr Singh gave me an injection in my spine, I don’t remember exactly where, and I struggled through the last week as best I could. I then went home and laid on the couch for five days before the shot seemed to take effect. I can’t remember that time very well because the pain seemed to consume my entire attention. Perhaps the narcotics clouded my memory, but I don’t really think so. It was the pain that drove everything else out of my mind.

Now I have a constant, localized ache in my knee that is driving out all thoughts of going for a walk every day or even walking around the house much. It is consuming me and keeping my attention constantly focused on it. It’s not as painful as my back was, but it’s even more debilitating because I can’t walk around freely

Just now I closed my eyes and dozed off a little. I became aware of a feeling of being in another place; I couldn’t see it but I felt it somehow. The other place was a corridor, seemingly a central space for transiting a ship from fore to aft. I could sense boxes in the corridor, and people walking up and down its length. That was all I could sense at that moment.

The second time I close my eyes I become aware of some jointed machine that flexes and extends itself.

Religious Liberty and Same-Sex Marriage

2015-06-27

The moment the Supreme Court decision came down, I heard someone (a conservative pig) say: “This decision is a blow against religious liberty.”

In what fantasy universe does allowing two OTHER people the right to consummate, nay, consecrate their relationship with each other infringe on a third individual’s religious liberty?  The marriage takes nothing away from any other person’s rights to do or say whatever they please, nay, immigrate to Uganda for all I care.

How can giving two people the right to do something private (and public) between themselves infringe on a third person’s rights?  The very concept is absurd.  My right to do something is offending your sensibilities, not reducing your property values, nor doing anything else than prevents you from doing whatever you want.  This kind of talk comes from the mirror-universe of conservative lies.

 

Supreme Court, in 5-4 Decision, Agrees with US Public and Endorses Gay Marriage: The Usual Suspects Dispense With their Usual Fascist Verbiage

2015-06-27

This quote, from Justice Anthony Kennedy’s decision, said it best: (quoted from NYT)

‘“No longer may this liberty be denied,” Justice Anthony M. Kennedy wrote for the majority in the historic decision. “No union is more profound than marriage, for it embodies the highest ideals of love, fidelity, devotion, sacrifice and family. In forming a marital union, two people become something greater than once they were.”’

” ‘The nature of injustice is that we may not always see it in our own times,’ he wrote on Friday. ‘The generations that wrote and ratified the Bill of Rights and the Fourteenth Amendment did not presume to know the extent of freedom in all of its dimensions, and so they entrusted to future generations a charter protecting the right of all persons to enjoy liberty as we learn its meaning.’ ”

This quote says it worst:

In a second dissent, Justice Antonin Scalia mocked the soaring language of Justice Kennedy, who has become the nation’s most important judicial champion of gay rights.

“The opinion is couched in a style that is as pretentious as its content is egotistic,” Justice Scalia wrote of his colleague’s work. “Of course the opinion’s showy profundities are often profoundly incoherent.”

I find nothing incoherent, much “profoundly” incoherent, in Justice Kennedy’s words.  Once again, Scalia (I hesitate to call him Justice for fear of demeaning the word) has shown himself to be a word hack, writing lies in the service of his profoundly illiberal conservative philosophy.

Scalia topped himself, for the second day in a row (on the first day he denounced the court’s reading of the words “the state”) writing meaningless, shallow lies to advance his hatred for everything liberal, social-justice-oriented, and in support of the government’s need to support its own people.

If I were a provocateur, I would (and I’m NOT advising this for fear of unforeseen consequences) advocate for the assassination of Scalia, Thomas, Alioto, and Roberts as being in the way of progress and in need of immediate replacement by a black president’s better conceived nominations.

A Direct Fear Pathway in the Eye-Brain Neural Circuity in Small Mammals

2015-06-26

This article from Science News is behind a paywall, so forgive me if I tell the whole story to make sure you don’t have to visit the site.  By the way, in college, I was the junior member of a team that was exploring visual pathways in the brains of cats, specifically the lateral geniculate body, a lower brain first stopover for optic nerve impulses from the retina.  In the lateral geniculate are cells that respond specifically to single small spots in the cat’s visual field, so they are some of the simplest nerve cells in the brain that respond to light.

The Science News story is about the discovery of a path that fear takes to the brains of mice: the superficial superior colliculus.  In this brain nucleus, located on the top or dorsal surface of the mouse’s brain, are single cells that respond specifically to objects in the visual field that appear to be coming closer, and the more rapid the closure rate, the higher the response.  These cells project to the amygdala, the brain nucleus most closely associated with the sensation of fear, with a stopover in the parabigeminal nucleus.

The researchers were able to genetically engineer these cells to respond to blue light.  Thereafter, they were able to stimulate them at will, using an optical fiber implanted in the brain close to the superior colliculus.  They were able to cause generalized fear reactions, specifically “running around in frantic attempts to escape” followed by freezing for a minute or more, even after the stimulus was turned off.  This was followed, in some cases, by “depression” related phenomena: the stimulus “triggered fear responses, induced conditioned aversion, and caused depression-related behaviors.”

In addition, the abstract concludes:  “Approximately 20% of mice subjected to the fear-conditioning paradigm developed a generalized fear memory.”  Does that sound like post-traumatic stress disorder?

In other words, was the research involved in the induction of PTSD in mice?  Perhaps it was only 20% of them.  Otherwise, to be honest with you, I don’t see the point of the research.  It’s cool to genetically engineer specific small groups of cells in the brain, and it’s cool to make them light-sensitive, so you don’t have to use an electrical impulse to stimulate the brain experimentally (which is better because electrical stimulation over longer periods can sometimes cause a reduced response, tentatively put to “scarring”), but beyond that, I’m not sure I see anything remarkable.  Is this brain region poorly understood?  Apparently not, because they know where it receives signals from, and where it projects to.

So what is the point of this research?  On the other hand, maybe that is precisely the point: we did not yet know that there were such cell types in that part of the brain, cells that respond to “looming” objects in the visual field with fear.  Maybe they proved just that they can genetically engineer specifically that one type of cell, or at least that general type of cell, because I don’t see any claim that nothing else is stimulated by the light impulses to the brain.

Who knows?

Insulin Resistance: Its Relationship to Certain Types of Gut Bacteria

2015-06-25

Here’s another study on the effects of gut bacteria: done in 2008 and cited a number of times, but still not widely known.  This study treated genetically obese mice with type 2 diabetes as well as normal mice who had been overfed to induce insulin resistance with a combination of norfloxacin and ampicillin.  Afterwards, their glucose tolerance and metabolic functions improved significantly despite being fed the same diet.  Liver triglycerides dropped and liver glycogen increased.  Plasma lipids dropped, and plasma adiponectin was increased, a sign of decreased inflammation and improved insulin resistance.

This study refers to another study in humans that showed changes in the ratios of bacteria after weight loss through dietary intervention.  Specifically, the ratio to Firmicutes to Bacteroidetes was reduced.   The study also refers to another in which low-grade inflammation, induced by subcutaneous injection of low doses of bacterial wall lipopolysaccharides in mice, induced insulin resistance and excessive weight gain.

Yet a third study showed germ-free mice to maintain leanness whether fed normal chow or a high-fat diet; regular mice became obese on a high-fat diet.  The germ-free mice had the same caloric intake as the regular mice, suggesting that either the microbes contributed calories or that they induced low-grade inflammation which unbalanced the metabolism.

These studies, taken together, indicate a bidirectional relationship between low-grade inflammation and insulin resistance with weight gain, associated with specific types of bacteria resident in the gut.  The subcutaneous injections may be thought of as a simulation of the residence of large numbers of gram-negative bacteria in the gut.  Whether type 2 diabetes could be treated by antibiotics remains to be seen; it is more likely that low-calorie diets would be beneficial in changing the gut microbiome.

The 2008 study is on PDF at: http://www.farm.ucl.ac.be/Full-texts-FARM/Membrez-2008-1.pdf

Indigenous Gut Bacteria Modulate Serotonin Synthesis In the Intestinal Tract

2015-06-24

It has been known for a while that most of the serotonin produced in the human body is not in the brain but in enterochromaffin cells of the gut; this is true of mammals in general.  Now a research group at Cal Tech has demonstrated that a particular group of bacteria in the gut help the cells of the gut wall produce serotonin.

First of all, mice raised to be germ free with no bacteria in their guts only produce less than half of the serotonin that normal mice produce.  The research group tested the various genera of bacteria that normally inhabit the mouse gut and found that a certain group of spore forming bacteria specifically induce the gut wall to produce 60% more serotonin.  Finally, they were able to demonstrate that a specific metabolite produced by the bacteria modulates this effect: apparently, the enterochromaffin cells take up this metabolite, and from it, produce more serotonin.

The increase in serotonin that is found from this bacteria causes an increase in gut motility and changes in the activity of blood platelets, who depend on serotonin for clotting.

An abstract of the research article can be found at: http://authors.library.caltech.edu/56514/ and a Cal Tech news release and explainer at: http://www.caltech.edu/news/microbes-help-produce-serotonin-gut-46495

The significance of this finding is that there is a commensal relationship between the mammalian organism and the bacteria in its gut; what role the serotonin plays in behavior or illness remains to be explored.

Increasing Rate of Extremist Attacks

2015-06-24

The New York Times (NYT) has posted a story stating the conclusion of an information-gathering group in Washington: there have been twice as many deaths in the last fourteen years (since September 11, 2001) due to attacks by Neo-Nazi or other right wing antigovernment individuals as there have been due to attacks by Muslim jihadists.

In addition, there has been a dramatic increase in the rate of attacks by both groups since 2009, starting with the Fort Hood shooting.  A total of forty-eight people have been killed by right wing extremists, and a total of twenty-six people have been killed by jihadists, almost all of them in the last six years; from 2001 to 2008, attacks were rare.

The NYT story: http://www.nytimes.com/2015/06/25/us/tally-of-attacks-in-us-challenges-perceptions-of-top-terror-threat.html

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