Tag: health

The Antibiotic Apocalypse and You

Following up on the theme established inadvertently last week: I’m still sick, though on the whole, I’m probably not feeling worse, and possibly arguably marginally better. In an effort to avoid the creativity-shattering spiral that happens when I stop writing altogether, this week I will endeavor to present some thoughts on a subject which I have been compelled to be thinking about anyway: Antibiotics.

A lot of concerns have been raised, rightfully, over the appearance of drug-resistant pathogens, with some going so far as to dub the growing appearances of resistant bacteria “the antibiotic apocalypse”. While antibiotic resistance isn’t a new problem per se, the newfound resistance to our more powerful “tiebreaker” drugs is certainly a cause for concern.

In press releases from groups such as the World Health Organization and the Centers for Disease Control and Prevention, much of the advice, while sound, has been concentrated on government organizations and healthcare providers. And while these people certainly have more responsibility and ability to react, this does not mean that ordinary concerned citizens cannot make a difference. Seeing as I am a person who relies on antibiotics a great deal, I figured I’d share some of the top recommendations for individuals to help in the global effort to ward off antibiotic resistance.

Before going further, I am compelled to restate what should be common sense: I don’t have actual medical qualifications, and thus what follows is pretty much a re-hash of what other experts have given as general, nonspecific information. With this in mind, my ramblings are no substitute for actual, tailored medical advice, and shouldn’t be treated as such.

Before you’re put on antibiotics

1) Stay home when you’re sick

This one is going to be repeated, because it bears repeating. Antibiotic resistant strains spread like any other illness, and the single best way to avoid spreading illness it to minimize contact with other people. Whether or not you are currently infected with antibiotic-resistant illness; in fact, whether or not you even have an illness that is treatable by antibiotics; staying at home when you’re sick will help you get better sooner, and is the single most important thing for public health in general.

2) Wash hands, take your vitamins, etcetera.

So obviously the best way to deal with illness is to avoid spreading it in the first place. This means washing your hands frequently (and properly! Sprinkling on some room temperature water like a baptism for your hands isn’t going to kill any germs), preparing food to proper standards, avoiding contact with sick people and the things they come in contact with, eating all of your vegetables, getting your vaccinations, you get the picture. Even if this doesn’t prevent you from getting sick, it will ensure that your immune system is in fighting shape for if you do.

3) Know how antibiotics work, and how resistance spreads

Remember high school biology? This is where all that arcana comes together. Antibiotics aren’t a magical cure-all. They use specific biological and chemical mechanisms to target specific kinds of organisms inside you. Antibiotics don’t work on viruses because they aren’t living organisms, and different kinds of antibiotics work against different diseases because of the biological and chemical distinctions.

Understanding the differences involved when making treatment decisions can be the difference between getting effective treatment and walking away unharmed, and spending time in the hospital to treat a resistant strain. Antibiotic resistance is a literally textbook example of evolution, so understanding how evolution works will help you combat it.

Public understanding of antibiotics and antibiotic resistance is such a critical part of combating resistance that it has been named by the World Health Organization as one of the key challenges in preventing a resistant superbug epidemic.

4) Treat anyone who is on antibiotics as if they were sick

If someone is on antibiotics and still doesn’t feel or seem well (and isn’t at home, for some reason), you’re going to want to take that at face value and keep your distance. You can also kindly suggest that they consider going home and resting. If you become sick after contact with such persons, be sure to mention it to your doctor.

If they’re feeling otherwise fine, you want to treat them as if they were immunocompromised. In other words, think of how you would conduct yourself health-wise around a newborn, or an elderly person. Extra hand-washing, making sure to wipe down surfaces, you get the picture. If they’re on antibiotics preventatively for a chronic immunodeficiency, they will appreciate the gesture. If they’re recovering from an acute illness, taking these extra precautions will help ensure that they don’t transmit pathogens and that their immune system has time to finish the job and recover.

5) Never demand antibiotics

I’ll admit, I’m slightly guilty of this one myself. I deal with a lot of doctors, and sometimes when I call in for a sick-day consult, I get paired with a GP who isn’t quite as experienced with my specific medical history, who may not have had time to go through my whole file, and who hasn’t been in close contact with my other dozen specialist doctors. Maybe they don’t recognize which of my symptoms are telltale signs for one diagnosis or another, or how my immunology team has a policy of escalating straight to a fourteen day course, or whatever.

I sympathize with the feeling of just wanting to get the doctor to write the stupid prescription like last time so one can get back to the important business of wasting away in bed. However, this is a problem. Not everyone is as familiar with how antibiotics work and with the intricacies of prescribing them, and so too often when patients ask for antibiotics, it ends up being the wrong call. This problem is amplified in countries such as the United States where economics and healthcare policies make it more difficult for doctors to refuse. This is also a major issue with prescription painkillers in the United States. So, listen to your doctor, and if they tell that you don’t need antibiotics, don’t pressure them.

Bear in mind that if a doctor says you don’t need antibiotics, it probably means that antibiotics won’t help or make you feel any better by taking them either, and could cause serious harm. For reference, approximately one in five of all hospital visits for drug side effects and overdoses are related to antibiotics.

It should go without saying that you should only get antibiotics (or any medication, really) via a prescription from your doctor, but apparently this is a serious enough problem that both the World Health Organization and the Centers for Disease Control and Prevention feel the need to mention this on their patient websites. So, yeah. Only take the drugs your doctor tells you to. Never take antibiotics left over from previous treatment, or from friends. If you have antibiotics left over from previous treatment, find your local government’s instructions for proper disposal.

If you are prescribed antibiotics

1) Take your medication on schedule, preferably with meals

Obviously, specific dosing instructions overrule this, but generally speaking, antibiotics are given a certain number of times per day, spaced a certain number of hours apart, and on a full stomach. Aside from helping to ensure that you will remember to take all of your medication, keeping to a schedule that coincides with mealtimes will help space dosages out and ensure that the antibiotics are working at maximum efficiency.

Skipping doses, or taking doses improperly vastly increases both the likelihood of developing resistant pathogens, and the risk of side effects.

2) Take probiotics between dosages

Antibiotics are fairly indiscriminate in their killing of anything it perceives as foreign. Although this makes them more effective against pathogens, it can also be devastating to the “helpful bacteria” that line your digestive tract. To this end, most gastroenterologists recommend taking a probiotic in between dosages of antibiotic. Aside from helping your body keep up it’s regular processes and repair collateral damage faster, this also occupies space and resources that would otherwise be ripe for the taking by the ones making you sick.

3) Keep taking your antibiotics, even if you feel well again

You can feel perfectly fine even while millions of hostile cells linger in your body. Every hostile cell that survives treatment is resistant, and can go in to start the infection all over again, only this time the antibiotic will be powerless to halt it. Only by taking all of your antibiotics on the schedule prescribed can you ensure that the infection is crushed the first time.

Furthermore, even though you may feel fine, your immune system has been dealt a damaging blow, and needs time to rebuild its forces. Continuing to take your antibiotics will help ensure that your weakened immune system does not let potentially deadly secondary infections slip through and wreak havoc.

4) Stay Home and Rest

Is this message getting through yet?

If you are on antibiotics, it means your body is engaged in a struggle, and it needs all of your resources focused on supporting that fight. Even the most effective antibiotics cannot eliminate every hostile cell. You immune system plays a vital role in hunting down and eliminating the remaining pathogens and preventing these resistant strains from multiplying and taking hold. In the later stages of this fight, you may not even feel sick, as there are too few resistant cells to cause serious damage. However, unless all of them are exterminated, the fight will continue and escalate.

Ideally, you should stay at home and rest for as long as you are taking antibiotics. However, since antibiotics are often given in courses of fourteen and twenty one days, this is impossible for most adults. At a barest minimum, you should stay home until you feel completely better, or until you are halfway done with your course of antibiotics, whichever is longer.

If you do return to your normal routine while taking antibiotics, keep in mind that you are still effectively sick. You should therefore take all of the normal precautions: extra hand washing, wiping down surfaces, extra nutrition and rest, and the like.

5) If you don’t feel better, contact your doctor immediately

Remember: Antibiotics are fairly all or nothing, and once an illness has developed a resistance to a specific treatment, continuing that line of treatment is unlikely to yield positive results and extremely likely to cause increased resistance to future treatment. Obviously, antibiotics, like any course of treatment, take some time to take effect, and won’t make you feel suddenly completely better overnight. However, if you are more than halfway through your treatment course and see no improvement, or feel markedly worse, this could be a sign that you require stronger medication.

This does not mean that you should stop taking your current medication, nor should you take this opportunity to demand stronger medication (both of these are really, colossally bad ideas). However, you should contact your doctor and let them know what’s going on. Your doctor may prescribe stronger antibiotics to replace your current treatment, or they may suggest additional adjunctive therapy to support you current treatment.

Works Consulted

“Antibiotic resistance.” World Health Organization. World Health Organization, n.d. Web. 28 Apr. 2017. <http://www.who.int/mediacentre/factsheets/antibiotic-resistance/en/>.

Freuman, Tamara Duker. “How (and Why) to Take Probiotics When Using Antibiotics.” U.S. News & World Report. U.S. News & World Report, 29 July 2014. Web. 28 Apr. 2017. .

“About Antibiotic Use and Resistance.” Centers for Disease Control and Prevention. Centers for Disease Control and Prevention, 16 Nov. 2016. Web. 28 Apr. 2017. <https://www.cdc.gov/getsmart/community/about/index.html>.

Commissioner, Office Of the. “Consumer Updates – How to Dispose of Unused Medicines.” U S Food and Drug Administration Home Page. Office of the Commissioner, n.d. Web. 28 Apr. 2017. <https://www.fda.gov/forconsumers/consumerupdates/ucm101653.htm>.

NIH-NIAID. “Antimicrobial (Drug) Resistance.” National Institutes of Health. U.S. Department of Health and Human Services, n.d. Web. 28 Apr. 2017. <https://www.niaid.nih.gov/research/antimicrobial-resistance>.

Ode to the Immune System

Context: I’m sick. When I’m sick, I get bored without being able to write properly. Consequently, I tend to write shorter things, like songs. Here’s a about how certain parts of the immune system work. To the tune of “The Red Army is Strongest” AKA “Red Army, Black Baron”, AKA “That song from the Comintern faction in Hearts of Iron IV“. Enjoy.

The deadly virus and the harmful germ
Are gathering a great dark storm
But without regard for the the malady
The immune cells defend the body

So see the macrophage, begin the war to wage
Take its enemies hand to hand
Then it engulfs them with its deadly rage
As it makes the body’s first stand

Hear great cry of the brave neutrophils
As they charge forth into great trouble
As without regard for the the malady
The immune cells defend the body

So see Dendritic Cells, ring out their warning bells
Awaking the nearest lymph gland
And activating the T and B cells
As it prepares the final stand

Watch the B lymphocytes turning the tide
Making antibodies well supplied
As without regard for the the malady
The immune cells defend the body

Now the new mem’ry Cells, in the lymph nodes shall dwell
As others die by their own hand
The body stands down, as now all is well
As it survived the final stand

Once Upon A Time

Once upon a time in a magical kingdom in Florida, a certain tourist hub instituted a policy for guests with disabilities. This policy, known as the Guest Assistance Card, allowed those who were familiar with its existence and could justify its use, powers unseen to mere mortals. With one of these mystical passes, a disabled guest and their party could avoid the long lines which plagued the kingdom. Although this could not heal the guests’ wounds, and could never make up for the challenges faced by these people in everyday life, it offered the promise of an escape. It kept true to the dream of a magical vacation unbound by the stresses and turmoils of everyday life.

Unfortunately, in a storybook example of why we can’t have nice things, there were evil-doers with poison in their hearts, who sought to abuse this system and corrupt it for everyone. Shady businessmen would rent their grandparents in wheelchairs to rich families craving the awesome power to cut lines. Eventually it became inevitable that the kingdom had to close this loophole. When it did so it shattered the hearts of many a handicapped child and their families.

Alright, I think you’re all caught up on the backstory here.

Though it disappoints me greatly that it came to this, with the level of abuse being turned up in tabloids and travel blogs, it was inevitable that Disney would have to end this program. As one who has used it myself, I will be the first to admit- it was overpowered. But from the impression I got from the guest services folks, that was part of the point. The point was never to get to the lowest common denominator necessary to adhere to federal anti-discrimination laws. The point was to enable these guests to enjoy their vacation. To enable magical moments which, for some of these kids, might never happen again.

There are many reasons why, for a long time, Walt Disney World was the default Make-A-Wish Foundation (and similar) destination, and this approach to disability is one of those reasons. The new program which replaced the GAC is workable- it basically works as a sort of on the go fastpass, giving you a return time equal to the listed standby wait minus ten minutes, after which you can go through the fastpass line at your leisure. But it is mundane compensation rather than a magical silver lining to living with disability. It is a crutch rather than a tricked out motorized wheelchair.

I don’t blame Disney for this change in policy. I know how some of the people were using the GAC, and they really had no choice. I do blame the ringleaders of these black market operations, and the people who paid them. As far as I am concerned, these people are guilty of perfidy, that is, the war crime of abusing the protections of the rules of war (such as feigning wounds) to gain an advantage. As for Disney, I am disappointed, but understanding.

I wish that this fairytale had a more appropriate ending. I wish that I could say that the evil doers faced poetic justice and were made to wait in an endless line while having to listen to the sounds of children crying and complaining about waiting. Unfortunately, this did not happen, and these few bad apples spoiled the bunch.

Revisiting the Future

A little less than three years ago I was on a seven day cruise on the Disney Fantasy. It was New Year’s Eve, and our ship had just passed into the Bermuda Triangle. The live show that evening featured the tribulations of a trio of teenagers coming to grips with the fact that they could no longer reasonably claim to be mere children, and would soon have to enter the dreaded “real world”. It struck a chord with me, even though I was still a couple years younger than the protagonists, and graduation seemed far off. Still, it was the first time that graduation, and the world beyond it, truly struck me a genuine, personally relevant concern.

Despite little of immediate, lasting consequence occurring on that particular cruise, I have nonetheless come to consider it something of a turning point in my life. About this same time, it began to become undeniably apparent to all interested parties that the school’s strategy towards my disability of masterly inactivity would most likely not be sufficient to assure my timely graduation. At the same time, I began to solidify my own doubts that the school administration would prove capable of overcoming its bureaucratic inertia. In short, it became clear that following the “normal” path would not end with my triumphant graduation and ascension to the most prestigious colleges with a full scholarship, etcetera, etcetera, as I had previously planned.

Shortly after we returned home, I began to receive fliers from various academic institutions. I chuckled at this, feeling appropriately flattered that they would deign to waste the cost of postage on one such as myself, yet nevertheless regarding their outreach as premature, and not of genuine concern. After all, with the delays which the school had made in processing various transfer credits from my online classes, it was suddenly unclear what my graduating year ought to be listed as. How could I give serious consideration to such far-off problems when I could not even confirm my graduating date?

My eighteenth birthday, which I had previously imagined would mark the milestone of my victorious conquest over public education, and the commencement of my proud campaign into the “real world”, was spent, like so many other days of my life thus far, in a hospital bed, struggling for survival. Although I knew that such an occasion ought to merit some manner of recognition and self reflection, given my circumstances, I was too preoccupied with the difficult task of evading imminent death to give much thought to the future. I promised myself, as indeed my parents promised me, that once I had recovered, and these temporary troubles with my schoolwork had been dealt with once and for all, that we would have a grand celebration for my birthday. Nothing came of this promise; indeed, I have not had a proper birthday party with a guest list and presents since.

The last day of my fourth year of high school was bittersweet, to put it mildly. On the one hand, summer meant a welcome reprieve from the daily stress of regular classes (by this point, most of my actual academic progress was being accomplished at home with the assistance of a tutor, and this would not change), and a temporary truce between myself and the administrators who, during the school year, sought to harass me daily over my apparent lack of progress. On the other hand, it was the last day I would see any of the friends I had made in school. They, unlike myself, had been able to keep their heads down, and stick to the normal path. They had graduated. All of them were college bound, and excited about it. Despite my efforts to be empathetic, I could not bring myself to subject myself to attending the graduation ceremony that I could not participate in.

Shorty before that day, I had resigned myself to the fact that I was going to remain in high school for an indeterminate period. Neither I nor the administration could come up with an estimate for my completion, owing to missing or misplaced records on their part. Guesses ranged from three months to four years. With no new data, and a history of disappointment, I gave up on guessing. With no graduation date, I could not make plans for college. With no plans, I had nothing to look forward to. Working mainly from home rather than subjecting myself to the degradation of school, the days and weeks began to meld together. With no real future to look forward to, I gave up on the future altogether.

This may sound like a purgatorial dystopia. And indeed, it was. I joked about this much with my friends over text messages. Yet I would be remiss if I didn’t last say that it was also quite liberating. With no change from day to day, I could stop worrying about anything beyond the present moment. After all, I had total job security. There was always plenty of schoolwork to ensure that I never had energy to make use of any free time I might have. There was no petty social drama; no conflict of any kind. So long as I had no expectations, I could never be disappointed. It was a dystopia alright, and a perfectly executed one at that.

Yet, within the last two weeks, something has changed. Last week, my special education case manager contacted me regarding some manner of questionnaire meant for outgoing seniors. My natural response was and remains to ignore it. If it is important enough, they will get it to me another way, and if it isn’t, I’ve just saved myself a great deal of effort. Still, this bears relevance if for no other reason then because it is the first time which they have recognized me as a senior, and on track to graduate. The same week, I received a mass email from the guidance department (where they got my address in order to spam me remains a mystery) regarding generic scholarship offers. Suddenly, it seems, my tranquil little dystopia is under siege from the “real world”.

After years of doing my utmost to avoid imagining a future outside of a weather forecast, I am suddenly being made to explain my life plans. A younger, pre-cruise version of myself would be excited. Things are back on track. Things are getting back to normal. Except, things can never go quite back to normal. Trying to relive past fantasies is a fool’s errand, and trying to navigate the coming future by the plans a different me made many years ago, or by whatever cookie-cutter claptrap the administration may find in their self-righteous self-help books, will only end with me facing the same problems as now five years from now.

Imagining a realistic future which is completely independent from both the administration and my own childhood fantasies is both difficult and daunting. Indeed, given the nature of my disabilities, and the apparent track record of my forecasting abilities, it begs the question whether a future plan which extends beyond my next quarterly hospital visit is even knowable in any meaningful capacity. Given that I cannot say with any absolute confidence that I will even still be alive in five years, does it really make sense to speculate on what a life for me might look like?

Coincidentally, on that same cruise which seems simultaneously so recent and so distant from me, I saw for the first time the filmic adaptation of “Into the Woods”. While I shall endeavor to avoid spoilers, suffice it to say that the theme of planning for the future, and having said plans go awry does come up. Indeed, one of the songs, arguably my favorite of the lot, focuses on the dilemma faced by one of the protagonists when pressed into a snap decision which has the potential to radically affect her entire future. The conclusion she reaches is to avoid the dichotomy altogether, and to keep her options open rather than back herself into a corner. It turns out to be the correct decision, as both alternatives collapse in the long run. This is interesting advice, which I think I shall endeavor to apply to my own like situation.

So, what can I say about my future? Well, I can say that even though I may not be absolutely confident in a specific graduation date, that I will most likely graduate from public school in the next year or so. I can say that I would like to continue my education and attend university, even if I do not yet know where and precisely how I will make attendance work, or how I will be able to apply given the problems with my transcript. I can say that I intend to travel and learn about other places, people, and cultures, as traveling and learning have had an undeniably positive impact on my life thus far. I can say that I intend to continue to write and speak about my experiences.

But perhaps most importantly, I can say that my path will not be the “normal” one, and as such, it is perfectly acceptable to not have every detail planned out. Just as I can learn without a grade, and have a positive role without having a neatly defined career, so too can I have a future without having a plan.

Facing Failure

I am in a particularly gloomy, dare I say, depressed, mood upon the eve of my writing this. Owing to the impending blizzard, United Nations Headquarters has been closed, and subsequently the events which I was to attend for the Women’s Empowerment Principles have been “postponed indefinitely”. The news reached me only minutes before I was to board the train which would have taken me into the city, where I had arranged for a hotel room overnight so as to avoid to having to travel during a blizzard.

This left me with an urgent choice: I could board the train, and spend a day trapped in a frozen city that was actively trying to dissuade people from traveling, or I could cut my losses, eat the cost of the hotel room, and return home to ride out the storm there. It probably surprises few that I chose the latter option; the option touted as the more sensible, strategically conservative, objectively correct option. Still, making this choice left me with a bitter taste in my mouth. It leaves me feeling as though I have failed.

I do not like failure.

Actually, that statement is inaccurate, or at least, misleading. I don’t merely dislike failure, in the same way that I dislike, say, sunscreen. No, I hate failure, in every sense of the word. I loathe it, detest it, and yes, I fear it.

This is not to say that I have such strong feelings toward losses. I feel this is an important distinction. Though I do have an adversity to unnecessary losses, sometimes, such sacrifices are necessary. What I hate is trying, making sacrifices, and then failing despite, or even worse, because of those efforts. The important distinction, at least in my mind, is that losses are a strategic principle, and a passing phenomenon, while failure is a state of being, whether for a few moments surrounding a particular exercise, or for a lifetime.

As one might expect, this makes me, in general, rather risk averse. Of course, this itself presents a paradox. Not taking a given risk also entails the inverse risk contained in the opportunity cost. That is to say, by not taking a given bet, you are effectively betting against it. This means that refusing to accept risks is always inherently itself a risk. So, for example, one cannot accept a zero percent chance of food poisoning without not eating altogether; and if one were to attempt to do so, they would quickly find themselves confronted by the more urgent problem of starvation.

The blizzard that closed the UN put me in a no-win situation. As a rational person, I can accept this, and act to cut my losses. Either I canceled my trip, resigned myself to staying at home, and ate the cost of my hotel reservations, or I purchased my train ticket, defied government instructions to stay home and avoid travel, put myself in danger, and spent the day trapped in a hotel room. I understand rationally why I chose as I did, and rationally, maintain that I made the correct decision. Yet I cannot escape the feeling that in choosing to abort my plans, I have failed my objective. Even if there was nothing to gain by getting on the train, I cannot suppress the feeling that my conscious choice invited some moral failing.

Some cursory research suggests that this particular feeling is not unique to myself, nor is it a new field of philosophical musings. Humans feel more emotional and moral responsibility for acts which are consciously undertaken than for merely following existing plans. This feeling is so prevalent it carries legal weight; binding contracts cannot be made by failing to decline an agreement; they require active assent. This might explain why I feel particularly upset with myself; If I had made no choice, then any perceived failure could only be an act of God, and out of my control. By making a conscious decision to cut my losses, I made that result a personal consequence, at least to my subconscious mind.

This leaves me at something of an impasse. I know why I am upset, yet can do little to console myself except to distract and reassure the nagging elements of my unconscious mind that I made the correct decision. I am left in conflict with myself, and left acutely aware of the fickleness of my own mind. While I suppose that this state of affairs is strictly preferable to feeling upset and not understanding why at all, I still cannot bring myself to feel in any meaningful way confident about myself in the present tense, particularly as these most recent reactions would seem to indicate that I might not be the single-mindedly rational being that I like to pretend that I am.

As I have indicated previously, I have very little intrinsic self confidence, at least in the manner which most people seem to expect that I ought. For whatever reason, I cannot seem to raise such self-evident feelings of self worth, and therefore, when I project such feelings, it is borne not of some internal passion, but extrinsic, statistical calculation. I base my self-assessment not on my own feelings, nor on others’ opinions, but on data and milestones. And though I feel that this generally gives me a better handle on the limits of my abilities, it also means that when I put my mind to a particular objective, and yet still fail for whatever reason, it becomes not only a momentary setback, but a point of evidence against my worth as a human being.

This can, and historically has, resulted in a mental loop whereby a temporary failure, such as a meeting which I had my aspirations set upon being cancelled by a snowstorm, leads to a general hardening of outlook, which in turn causes me to shift to the back foot, acting more conservatively, and taking fewer risky opportunities. Consequently, I wind up having fewer major victories to celebrate and reassure myself, and am instead left to reflect upon all of the opportunities which I missed. Because I was led to skip these choices by seemingly rational means, I cannot regret individual choices, but rather categorize them as mere symptoms of a general moral failing. These reflections promote further self-doubt, further strategic conservatism, and so on.

So, what can I do about it?

With the help of family and friends, I have come to realize that this is a viscous cycle that represents many of the worst and most self-destructive aspects of my personality and manner of thought. Of course, recognizing this fact consciously is the easy part. Hindsight is perfect, after all. The hard part is determining how to counter this cycle.

Historically my solution to such problems has been to throw myself into work, especially school work. This serves a dual purpose. First, if I am working hard enough, I do not have the time nor the energy to stew over my situation in more general terms. Second, it gives me a sense that I am accomplishing something. From primary through early high school, this approach has generally worked.

However, more recently, as the school has continued to demonstrate its gross incompetence in accommodating my physical disabilities, and as they have become increasingly distraught over the fact that my disability has not healed itself by magic, it has apparently occurred to the school administration that the correct way to inspire me to overcome medical impossibilities is to continually evoke shame each time my medical issues cause me to miss a deadline. Exactly what they aim to accomplish through this pestering continues to elude me. But in any case, this state of affairs means that greater effort on my part is more often scolded than rewarded. For, it seems, every time I attempt to reach out for clarification and assistance, I am subjected to a lecture on “personal responsibility”.

Because the school administration is apparently so “forward thinking”, and therefore does not believe in disability whatsoever, I am told that the fault for my failures is not, cannot, lie in my disability, but only in my personal moral failings. I am told by special education professionals that if I were truly dedicated to my academic performance, that my chronic diseases ought not have any impact on my life whatsoever. My promises that I will do my utmost given what I have to work with fall on deaf ears, because, allegedly, if I were to truly do my utmost, I would already be done on my own.

Needless to say, this experience is extremely stressful, and only deepens my sense of failure, self-hatred and anxiety. It should surprise no one that I am not terribly productive under such conditions, which only exacerbates the problem. Thus it comes to pass that throwing myself into schoolwork and attempting to prove myself wrong; to prove that I can indeed overcome opposition and be successful, only leads to more evidence that I am a failure.

I have looked, and am still looking, into various strategies to deal with this cycle moving forward. One strategy has been to write, and to post here. Another has been to give myself permission to engage in short “micro-vacations” as I call them, or “sanity-breaks” as my doctors refer to them. These short periods can last anywhere from a few hours to a few days depending on the severity of my initial state, particularly as they tend to coincide with when I am most physically fatigued*, but the important part is that they remain constrained to a specific time instead of drawing out into a general malaise. During this time, I temporarily do away with all pretense of productivity, and allow myself to engage in whatever petty amusement strikes my fancy.

*Sidenote: the overlap between physiological issues and mental symptoms is a recurring theme, making meaningful treatment for both all the more challenging. After all, is it really paranoia if your statistical chances of dying are vastly increased? The consensus thus far is that it isn’t. This is the reason why, despite having all of the symptoms, I do not technically qualify for any mental health diagnosis; because in my case, the source is obvious and completely justified.

In this respect, the fact that the same blizzard which set me on this spiral also shut down most everything in the vicinity comprises a silver lining of sorts. Obviously, there is no magic bullet for irrational feelings of failure. But perhaps that is beside the point. Perhaps the point of overcoming this feeling is not to wind up standing triumphantly atop the pile of slain emotions, but to reach a peaceful stalemate. I do not necessarily need to feel good about the fact that I could not accomplish my goals; merely be able to accept it without it destroying myself. Perhaps it might be enough to be able to calmly analyze and discuss my thoughts in writing, without necessarily having to reach a decisive conclusion.

Open Letter: Betsy DeVos

Today at school there was an informational session regarding the policies of the new department of education, and a letter-writing session to the new secretary of education. Unfortunately, in a bitter and illuminating irony, I was prevented from attending and participating owing to a flare-up of my disability. I have therefore resolved to make my point via online open letter.

Madam Secretary,

If I am completely honest, I hold reservations that you are qualified to hold your current post. Your lack of experience with public schools at all is disturbing; and your characterization of education as an industry rather than the duty of the government in protecting the inalienable right of the citizens in accordance with both international law and domestic precedent, is alarming.

With that said, I shall invite you to prove me wrong. I remain open to the possibility that I have underestimated your abilities and convictions, and those of your cabinet colleagues. In particular, your short-lived, halfhearted attempt to prevent the rollback of existing protections for transgender students is quite heartening, despite its failure. However, I should have to inform you that merely paying lip service to the idea of equal protection is not nearly enough, particularly for one who has sworn an oath to uphold it.

Because I do not expect much in the way of expanded services from your office, the main point of your tenure will be to ensure that existing protections for minorities and those such as myself with disabilities are enforced. Your job is to stand up for those who cannot stand for themselves. This is an enormous responsibility, and one that is arguably more critical to the continuing function of our democratic society than the jobs of your other colleagues.

I will hasten to point out, since the papers have brought it to my attention, that the primary motivation for your backing down during the standoff over transgender protections owed to your job security, that your position is most likely more secure than you may be led to believe. Yours is a senate-confirmed position. You, who were evidently the most qualified candidate the president could muster, only barely made it through senate approval. I do not expect the same senators would take kindly to you being asked to resign over adhering to your legally-mandated duty. I urge you to point out this matter to your colleagues the next time you feel pressured to compromise on principles.

In closing, I urge you, Madam Secretary, to prove me wrong; to demonstrate that you are qualified to uphold your constitutional and legal obligations. Prove that you are willing to put moral principles before money and politics. Give me reason to believe, as you put it during your confirmation hearings, that you “fully embrace equality [and] believe in the innate value of every single human being, and that all students, no matter their age, should be able to attend a school and feel safe and be free from discrimination.” Prove that you will stand by your words and enforce the civil rights legislation that ensures that our society can yet function.

Sincerely,
The Renaissance Guy
Registered independent voter, Blogger, and Student

On the Affordable Care Act

“Heal the sick, cleanse the lepers, raise the dead, cast out devils: freely ye have received, freely give.” – Book of Matthew 10:8

“Here then is the origin and rise of government; namely, a mode rendered necessary by the inability of moral virtue to govern the world” – Thomas Paine, Common Sense

I do not particularly like the Affordable Care Act. It is unwieldy, needlessly complex, and yes, it costs more than it probably needs to. But at the same time, and this is crucial, it is a vast improvement over the previous state of affairs. Not only this, but the continued coverage of our most vulnerable citizens by the Affordable Care Act is not only a moral necessity, but is critical to maintaining our democratic way of life.

While there is no law that states that a republic need aim to suppress inequality, there is a basic rule in economics and sociology that states that those who are truly impoverished; that is, those who cannot meet their basic needs, also cannot reasonably participate, in an informed way, at least, in a democratic process [6][7]. After all, if one needs to work continuously in order to continue to pay for life support, when exactly is one expected to register to vote, research candidates, call representatives, and actually vote?

It follows, then, that if the function and duty of the democratic-republican government is foremost to safeguard our inalienable natural rights against tyranny, as the founding documents and rhetoric of the United States seem to maintain [8], then the same government also has a mandate and a duty to ensure that citizens are at least not so crushed by poverty and circumstance as to effectively impugn upon those rights.

Such is the moral and constitutional basis for the Affordable Care Act. And while it may be argued that the program is not necessarily as efficient as we feel it perhaps ought to be, these are problems to be solved with a scalpel rather than a hatchet. The simple fact remains that without any sort of similar protection, millions of Americans afflicted with chronic conditions would not be in a state to exercise their rights to self-determination. Given that all but the most ardent anarchists maintain that it is the duty of the government to defend the rights of its vulnerable citizens, it follows that it is also the responsibility of the government to, if not provide healthcare outright, then to at least ensure that it does not become so much of a crushing burden as to prevent the free exercise of citizens’ rights.

To the patriotic, there is also the matter of showing that the United States is a civilized, developed nation capable of taking care of its citizens. It is no secret that the American healthcare system ranks extremely unfavorably with its fellow developed nations, and has often become the butt of jokes in such countries [9]. While the Affordable Care Act will in no way solve this discrepancy singlehandedly, it does go a ways towards closing the gap.

There are, of course, other benefits to a robust and accessible medical system more enticing to the self-interested. For starters, ensuring widespread, if not universal, coverage, will help mitigate the effects of the next major disease outbreak [5]. Given the distinct possibility that the next major outbreak will also be the pandemic that brings human civilization to the brink of collapse, a la the bubonic plague, having a healthcare system which allows for the timely containment and treatment of infected individuals is probably a worthwhile investment [1][5]. Given this, it is not unreasonable to equate the funding of the Affordable Care Act to that of Civil Defense, now under the auspices of Homeland Security. Notably, very few seem eager to defund the DHS.

It is also worth reiterating that the additional government investment in healthcare subsequent to the Affordable Care Act, has in fact brought in net savings. It is estimated that each dollar invested yields a return of approximately $1.35 [2],either in direct savings, fewer welfare payments, or increased tax revenues from newly enabled workers. Money spent on preventative care, such as vaccinations, well-visits, and related, which are notably the things least likely to be purchased by those who are not covered, yield returns of $5 for every $1 invested [3]. Spending on care for those with chronic preexisting conditions, who are only covered in the first place because of the Affordable Care Act, yield an ROI of approximately $3 for every $1 invested, not including additional benefits gained from the prevention of such conditions in vulnerable populations [1][2][4].

But all of this pales in comparison to the moral imperative to help one’s neighbor. Fascinatingly, many of the same figures who now exalt the Bible as the ultimate source of governmental direction seem to also be selectively ignoring the biblical mandate to help the poor and vulnerable. The Bible, for its part, is quite clear on the responsibility for all Christians; indeed, for all moral people, to provide for the humane treatment of the sick.

When I lived in Australia, healthcare was provided by the government as a matter of course. After all, how could a government provide freedom to a citizenry that was crippled by disease? How could anyone support a government which had the means to save the lives of its citizens, but chose not to for political reasons? How could anyone be proud of, or be expected to serve that country? Providing healthcare was viewed as part of what it meant to be a functional, first-world government.

As stated previously, I do not particularly like the Affordable Care Act. I think it was a lily-livered compromise. I am in agreement with the Universal Declaration of Human Rights that health, like life, liberty, and the pursuit of happiness, are inalienable human rights, and that anything short of a full guarantee to protect these rights is a failure of our government and society at a fundamental level. However, given the choice between the Affordable Care Act and what existed before it, I feel compelled to defend the ACA. If is a stopgap, to be sure, and an unwieldy one at that, but until such time as a reasonable replacement emerges, it is in the best interests of all involved to ensure that it remains in effect.

Works Cited:

1. “How Americans can get a better return on their health care investments.” Centers for Disease Control and Prevention. Centers for Disease Control and Prevention, n.d. Web. 13 Jan. 2017.

2. Abrams, Melinda Abrams, Stuart Guterman Guterman, Rachel Nuzum Nuzum, Jamie Ryan Ryan, Mark Zezza Zezza, and Jordan Kiszla Kiszla. “The Affordable Care Act’s Payment and Delivery System Reforms: A Progress Report at Five Years.” (2015): n. pag. Web.

3. Armstrong, Edward P. “Economic Benefits and Costs Associated With Target Vaccinations.” Journal of Managed Care Pharmacy 13.7 Supp B (2007): 12-15. Web.

4. “Sustained Benefit of Continuous Glucose Monitoring on A1C, Glucose Profiles, and Hypoglycemia in Adults With Type 1 Diabetes.” American Diabetes Association. ADA, n.d. Web. 13 Jan. 2017.

5. “Infection prevention and control in health care for preparedness and response to outbreaks.” WHO. World Health Organization, n.d. Web. 13 Jan. 2017.

6. “Poverty Traps.” Research – Knowledge in Development Note: Poverty Traps. World Bank, n.d. Web. 13 Jan. 2017.

7. Whitley, E., D. Gunnell, D. Dorling, and G. D. Smith. “Ecological study of social fragmentation, poverty, and suicide.” Bmj 319.7216 (1999): 1034-037. Web.

8. United States of America. Continental Congress. The Declaration of Independence. By Thomas Jefferson. Washington, DC: National Archives and Records Administration, 1992. Print.

9. Munro, Dan. “U.S. Healthcare Ranked Dead Last Compared To 10 Other Countries.” Forbes. Forbes Magazine, 03 Feb. 2015. Web. 13 Jan. 2017.

Compulsion to Quarantine

I have a sign in my files which is pre-designed in case I should ever need to print it and place it on my door. It is one of many similar contingency plans I maintain just in case conditions should become such as to require immediate action on my part. Unlike most of the other contingencies which I maintain standing plans for, this one has actually happened to me before.

Here is a screenshot of the sign in question:

As you can see, this sign is designed to help enhance our house’s notably robust health precautions. Given the fact that I am not only immunocompromised, and thus more vulnerable to infections of all sort, but also physically disabled in such a way that makes treatment of acquired infections all the more difficult to treat, these relatively mundane precautions really are a matter of life and death.

In a perfect world, this would be a non-issue. In such a world, the appearance of any kind of infectious disease in a community, such as, to pick a relevant example, my high school, would result in an immediate and coordinated response to isolate and care for those affected, and to ensure that the disease is never allowed to spread. In such a world, the burden of ensuring that the sick receive adequate treatment to, if nothing else, avoid further spread of contagion, would be shared among all those potentially affected, which is to say, among all those that use community services and participate in community life.

Work would be provided for students who missed class, and absences due to illness would not be held against student advancement. Students would be encouraged to stay home and recover when sick, minimizing the overall impact of infection on the entire population. In such a world, it would be easy for me to attend school without fear of contracting illness and being hospitalized for a prolonged period, or worse, owing to the complications of my legally recognized disabilities.

Of course, this is not the world we live in. In our world at the present time, students rarely, if ever, stay home when contagious, or even when attending would be detrimental to their health. Having spent a considerable amount of time in my school nurses’ office, I can state categorically that it is vastly more likely for a given sick student to be sent home forcibly by the nursing staff than to be voluntarily taken home by parents, even when said students already have a clinically high fever and are obviously contagious. There are, of course, plenty of solid reasons why this is the case. Quite simply, the incentives created by the school administration are to blame.

For starters, ours is a terribly competitive school, where students are advised and compelled not only be parents and peers, but by staff advisors and counselors to take as many advanced placement and honors courses as can be logistically fit into a single schedule, without great regard for student interest or workload capability. This, in addition to a myriad of recommended extra-curricular activities and volunteer work. The nature of such courses is, obviously, to be quite intensive, and often unforgiving.

Furthermore, the fact that so many students, many of whom would probably be better served by courses that are “merely” honors or college-prep, are bumped up into higher echelon courses means that teachers are given the unenviable task of having to weed out those who oughtn’t be enrolled in the first place from those with genuine ability. This is accomplished primarily by a relentless onslaught of busywork designed to be taxing to even the best of students, and sufficiently crushing to those who lack the necessary conviction that they become compelled to drop those courses.

Naturally, this kind of curriculum is rigidly inflexible and unforgiving in such a way that missing one class becomes a major setback, and missing a week (the CDC’s recommended recovery time for seasonal influenza) is an effective death sentence. Teachers, who are as much burdened by the need to keep consistent and challenging curricula as the students are to keep up with it, are either too busy to meaningfully accommodate students who have been ill, or else are so jaded from years of having students cheat and evade work by any means in order to maintain a competitive edge, that they simply cannot effectively empathize.

Subsequently, it remains in the short term rational self interest of each individual student to continue coming to class for as long as they are physically capable, regardless of contagion risk, regardless of the long term harm that such exhaustion wreaks on an ill body. And after all, in the unlikely event that such a normally-healthy student is rendered so wretchedly close to death that they are forcibly removed from class, such a traumatic event will undoubtedly attract sympathy and support from the administration, only then providing the necessary accommodations.

This is, of course, only one part of a systematic incentive system which compels students to maintain their attendance regardless of health. There is still the larger problem of recorded absences. In our school, every absence after a certain number of days must be accompanied by a note from a licensed physician – even if standing orders exist from certified specialists to cover such eventualities. Failure to provide such documentation to the school’s liking results in automatic referral to Child Protective Services. This is still true, regardless of the age of the student. So, an eighteen year old who is completing high school will still require a parent to call in each day with a note from a licensed physician, under threat of referral to CPS.

As noted previously, even where absences are “excused”, actual class accommodations for said absences are never forthcoming. Thus, a culture of working oneself to death emerges, with students extolling the virtues of “working through a cold” unto one another. As with most discussions between adolescents, this naturally evolves into a sort of competitive posturing, with students all working to prove that they are the most devoted, most strong-willed, most likely to prevail against all other kinds of adversity.

And of course, if through this manner of working, one’s rivals should be exposed to some nasty pathogen that causes them sufficient pain to nudge the grading curve into a more favorable state, or else knock them out of the running for valedictorian, it might come to be seen that the proliferation of infection throughout the school is not entirely at odds with one’s own academic and political ambitions. In which case, what incentive is there for a rationally self-interested person to do anything but continue to attend regardless of contagion?

Thus it comes to pass that my school is, as my immunologist calls it, “the germ factory”, with seasonal outbreaks as reliable as the teachers’ quiz schedules. For most students who have normal physiologies and the robust immune systems to defend them, the occasional coronavirus or sinusitis is no great pain. At worst, it means a couple days carrying a box of tissues everywhere. But for me, these remain plan-derailing, life threatening catastrophes that likely end with me in the hospital.

Except as much as I wish myself to be above the stubborn self-damaging habits of my able-bodies comrades, I find myself in the same dilemma with regards to missing class. After all, why ought I to have to isolate myself, when I’m not even contagious? At a certain point, after a certain number of reported outbreaks, the strategic calculus changes enough to justify my own voluntary self-quarantine. This is especially true when the illness in question is a GI bug, which are, for a variety of reasons, my Achilles heel. But until that point, what can I do to balance my own safety against my education?

This is a question without a proper answer. In an ideal world, the burden would not be on me to sequester myself, but on others to ensure that they are not spreading contagious disease. But this is not the world we live in. We live in a world where the right thing to do, and the economically sensible thing to do are at odds. Ideally, this would be set right by a coordinated societal effort to realign the incentives with the morally and socially responsible choice. For the time being, I will keep my sign on the door.