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"We have nothing to offer each other, except a haven." — K. Nafziger

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Health

Heroes of the faith

 

Job was restored.
Hannah was answered.
Even Thomas got to see.
“Look to them in your arid times!”

Nobody esteems Hagar.
She is forever the slave woman.

But sometimes, it is enough to say
We didn’t die in the desert.

No more rat poison for me!

(At least for now.)

First, the brief background – I’ve had two DVTs in my left leg: one in 2003 and one in 2010. My various physicians don’t have an explanation, but since it has happened twice, I’m now on a blood-thinning regimen for the rest of my life.

Up until now, that blood thinner has been coumadin – a drug that was originally developed as a rodenticide. The nice thing about this drug is that is well understood. It is true that it caused the demise of some unfortunate cattle (sort of), but it has now been on the market for sixty years. And my grandmother always liked to get a rise out of people by telling them that she needed to ingest her daily dose of rat poison.

The problem, however, is that coumadin requires constant monitoring and dosage adjustments. Eating too much or too little of certain foods (specifically, things with vitamin K) will counteract the drug. Would you like a fresh arugula salad on a warm, sunny day in mid-May? I would, but until now it would require a blood test and an increase in my coumadin intake. (In practice, I could get by with blood tests every month or so.)

xarelto_logoEnter Xarelto, the wonder drug!!! Well – almost. Like coumadin, Xarelto* is an anticoagulant. Unlike coumadin…

Rivaroxaban has predictable pharmacokinetics across a wide spectrum of patients (age, gender, weight, race) and has a flat dose response across an eightfold dose range (5–40 mg). Clinical trial data have shown that it allows predictable anticoagulation with no need for dose adjustments and routine coagulation monitoring.

Furthermore…

Rivaroxaban is well absorbed from the gut and maximum inhibition of factor Xa occurs four hours after a dose. The effects last 8–12 hours, but factor Xa activity does not return to normal within 24 hours so once-daily dosing is possible.

(Rivaroxaban from Wikipedia)

* Or ‘rivaroxaban’, if you prefer the generic name. Except that you can’t get Xarelto as a generic yet.

The FDA just approved Xarelto for the prevention of the recurrence of DVTs in November, and at my doctor’s appointment in January, my physician suggested I switch from coumadin.

So there you have it. I can eat my salad and not worry about it, since Xarelto works on a different part of the coagulation cascade. No problems! No worries!

Well… maybe one little one. Or two.

It turns out that there isn’t any way to stop the bleeding in an emergency. With coumadin, you can give a dose of vitamin K. With Xarelto, you can only wait until the effect wears off. Which means that if I’m ever in an accident, it would be better if it occurred in the late afternoon (right before my daily dose) and not during the night (when the anticoagulation is greatest).

The other little concern is the price. Brand-name drug with a legal monopoly status, since it’s under patent?

$10 per pill.

But I have insurance and a big-pharma subsidy for at least a year, so I’m paying $10 per month instead of $10 per day. We’ll see what happens after that.

I might just be back on rat poison.

The practice of walking on the earth (“An Altar in the World”, chapter 4)

Thanksgiving has passed for the year; Christmas and New Year’s are a month away. Do you know what this means?

It means that my family only has one month to finish reading our book of the year! The annual discussion is just around the corner!

This year, it was my turn to choose the book, and I’ve been trying to blog through it. I’m not sure that I’ll make it before Christmas arrives, but let’s continue on…


“Solviture ambulando,” wrote Augustine of Hippo, one of the early theologians of the Christian church. “It is solved by walking.” What is “it”? If you want to find out, then you will have to do your own walking…

So says Barbara Brown Taylor in the fourth chapter of An Altar in the World. It’s a pretty bold statement, and I confess to be seduced by it. But what does she actually mean? How does walking help? Or any other spiritual discipline, for that matter? Taylor says…

The only promise [spiritual practices] make is to teach those  who engage in them what those practitioners need to know — about being human, about being human with other people, about being human in creation, about being human before God.

I’m not a disciplined walker. I’m not disciplined at much of anything – at least not anything that you might call a “spiritual” discipline. But walking is important to me, and has been especially so for the last decade…

In 2003, I experienced a DVT. In 2010, it returned. The DVTs were painful – more painful than anything else I’ve experienced. At their worst, I could hardly move. And they resulted in some permanent damage to my leg. Because of poor circulation in my leg, I now get tired more easily than before.

As a result of this of all this, walking has become something of a motivating challenge for me. I love strenuous hikes, not because I’m a good hiker, but because when I’m hiking I feel especially in touch with life. I’m keenly aware of my own limits and my mortality, and so I also am thankful to be alive.


At Laurelville, I get many chances to walk. My morning walk from home to the main part of camp helps to ground the rest of my day. I joke frequently about how the “commute” is awful. The traffic crawls along at about two miles per hour. Sometimes it even comes to a complete stop as the commuters gawk at everything going on around them. (It is really an incredible blessing.)

We also have a labyrinth on Sunset Hill, but I don’t actually use it too frequently – which is a testament to my lack of discipline. On the other hand, we have lots of trails, and I love to get out onto those. Sometimes, we follow unmarked trails, which is an exercise in getting lost (coming up in Chapter 5 of An Altar…!).

The most challenging of these trails – the one we call the Silver Trail – is the one I like most. For about half a mile, the trail goes up at a 25% grade. When I hiked it this fall, I had to stop multiple times on the way up, but along the way I reflected on how I have seldom felt more alive than I did in the midst of that hike. At the top, I was rewarded with a view of Pittsburgh, 35 miles away…

The view from the top of LaurelvilleWithout a tidy way of wrapping up these thoughts, I’ll simply give thanks for walking – for the opportunity to walk frequently where I live and work, for the groundedness of a day begun by walking, and for the awareness of life that comes with walking. Amen.

A “snip, snip” here, and a “stitch, stitch” there!

After a recent biopsy came back positive for basal-cell carcinoma, my physician wasted no time in scheduling an operation to get the cancer removed. Today, I took a long lunch break for a relatively quick outpatient procedure.

The surgery center had me come in an hour early as they would most patients, but since I was having a minor procedure, it turned out that I had a sizable chunk of extra time. I hung out in a pre-op room in my stylish hospital garb for about half an hour, waiting for an operation room to become available. When space opened up, things moved along quickly.

The most painful part of the whole thing was the injection of the anesthesia. While it was being injected, it felt like my face was being stung by a swarm of bees. But after that was done, I was good to go.

It was a local anesthesia, so I was alert throughout the operation. This led to the discovery that the doctor and her team kept a pop radio station playing in the operating room. I just figured that operating rooms would be very serious and business-like places. Apparently they like some background music. The bad news was that the pop songs were predictably annoying. The good news is that the team worked so quickly that I only had a chance to hear three of them*. Based on that, I’m thinking that they had the tumor out and the wound stitched in roughly fifteen minutes.

* Justin Bieber, Maroon 5, and Katy Perry were on while I was lying on the table. Even the nurses were making fun of their music selection.

I spent about as much time in the recovery area as I would for a blood donation. After a quick stop at home to snap a picture, I was on my way back to work.

My wound

(Here is my mostly ordinary wound. It turned out that it got a bit more disgusting as the day went by, but nothing too bad.)

Throughout the afternoon, I was feeling great, and this evening I went to my congregation’s Wednesday night supper and prayer. And that’s when the anesthesia decided to wear off. So I left early, came home, and avoided doing anything else this evening (except blogging!).

Now I’m going to try to sleep off this dull throb that I’ve got going. Hopefully, I won’t roll over…

Tomorrow, I’m allowed to wash things off. In a week, the stitches come out – just before I leave for Pennsylvania.

As if things weren’t crazy enough already…

Life is a bit crazy right now… finishing one job, starting another, moving our family to Pennsylvania, trying to sell our house.

And then I found out today that I have cancer.

Ok – that sounds pretty bad. In my case, I’m told by my physicians that it’s not.

What I have is a basal-cell carcinoma. These things are slow-growing and rarely cause problems (except that they might look ugly). Thirty percent of Caucasians will supposedly get one in their lifetime, and 80% of the cases will be on the head or neck. (Thank you, Wikipedia.)  So there you go – that describes my situation pretty well. (Mine is right beside my ear.)

My doctor says that we don’t worry about it; we just get rid of it. So next week, I’ll have it removed, have stitches for a few days, and maybe have a little scar to remind me to always protect myself from the sun.

And pray that I don’t need to blog about this again.

Late nights

One day ago at this time, I was beginning one of my unpleasant late-night experiences at the synchrotron. I worked way past my bedtime, left at 3 a.m. this morning, and didn’t get much sleep. It could be worse, I suppose. I occasionally have to work all-nighters.

One year and one day ago at this time, I was also beginning an unpleasant late-night experience… in the emergency room. I was up way past my bedtime, finally got admitted into a hospital room after midnight, and didn’t get much sleep. That also could have been worse. I’m thankful that it wasn’t.

Suddenly, late nights at work aren’t quite as bad.

 

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