162 lines
9 KiB
Plaintext
162 lines
9 KiB
Plaintext
File: consent.txt
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Cont: (pre)venting one's spleen : fine art of consent and legal obfuscation
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Date: 18 Nov 2003
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If you take your top off and feel your belly below the left lower margin
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of your rib cage, you won't feel anything much, but that's because you're
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probably normal. I can, and I'm a bit curious about it. I normally sleep
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face down with a forearm across my abdomen, and of late, stuff has been
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moving about inside my guts when I do this, to accommodate a change. This
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is 'cos my spleen has become large and relatively rigid, taking up more
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room than is normally allocated to it, a condition known by a word which
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rolls delightfully off the tongue - splenomegaly. I knew that's what it
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was called, 'cos when, years ago, I did honours and (deliberately) became
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acquainted with cytomegalovirus III (which is present in about 90% of the
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human city dwelling population, and has called me home for about 20 years)
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splenomegaly was one of the listed symptoms of active CMV infection. CMV
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usually does fuck-all as long as you're not immunosuppressed or a neonate,
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in which case it raises all kinds of hell. I sure as shit don't feel
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immunosuppressed and am exhibiting none of the signs associated with that
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state (like, being sick all the time). So what's going on?
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Spleens (a few people have more than one, some are born without them) are
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the centrepiece of your lymphoid system, wherein is trained an
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astoundingly complex army of highly specific, molecular recognition
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capable, cellular attack dogs. Spleens are connected to the lymph nodes
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(most people call 'em glands, such as the ones in your neck, armpits and
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groin which swell up when you're sick) via specialised lymphatic plumbing
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wherein these attack dogs (lymphocytes) roam in search of specific things
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to kill. You can live without a spleen but you tend to be an easier target
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for massive bacterial infection if you lack one.
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I waddled off to retrieve me ol' Merck Manual (any time you're feeling
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hypochondriacal, DO NOT READ THIS BOOK) and had a gawk at the shitlist of
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conditions associated with splenomegaly. The 'Manual is best read when
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you're in perfect health, since it's pretty depressing if you're not. The
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list is extensive and distasteful. It includes EBV (gives you glandular
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fever, close viral rello of CMV). CMV (hello old friend, hope it's you).
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Polycythemia Vera (broken erythropoiesis leading to too many red cells in
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the blood, the spleen has to expand to provide sufficient resources to
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destroy 'em). HTLV-3 (which is what they used to call HIV before they
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realised HIV was an RNA retrovirus). Wilson's disease (inherited disorder
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of copper metabolism). Lymphoma (malignant cancer of the lymph system,
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ooh, yummie). Spleens also enlarge for other reasons... sarcoidosis
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(nobody really knows what causes this), chronic parasitisation,
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spherocytosis, sickle cell anemia, kinks in their associated vasculature.
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Various bone marrow fibroses which, on account of their preventing
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erythrocyte synthesis, can also provoke the spleen to start making these
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cells instead, but spleens aren't very good at it and tend to release
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erythrocytes before they're really ready to do their job. With the
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exception of CMV, all of these things are probably far too exciting to
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apply to me.
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So... what's doing it?
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I arranged to go and have a full blood count, electrolyte analysis, and
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hepatic function test. The analytical processing used in haematology is
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heir to knowledge won by humans struggling to understand chemistry and
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biochemistry over a period of centuries, but nowadays is mostly automated,
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so it's pretty simple, you just pop along, give 'em a few mL of venous
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claret (it's always encourgaging that they send it off to the lab in a bag
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prominently labelled `Biohazard') and wait for the results to come back.
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Inbetweentimes, machines separate your blood into several different
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components, humans peer intently at the nature of the isolates, and ponder
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upon wether or not your metabolism is broken in some significant way.
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I got the sheet back a couple of days later and according to it I am,
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haematologically speaking, very reassuringly boring, within expected range
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for pretty much everything. For a guy who does little exercise, I am
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stuffed full of haemoglobin. The things I wanted to know are all there -
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specifically, lymphocyte and erythrocyte counts and morphology are
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goodish. I'm not gonna turn into a life support system for a load of
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tumors just yet (that'll happen later when the mesothelioma starts).
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This test ruled out a lot of things, but still doesn't tell me anything
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about why this is idiopathic splenic bloat is happening. The final bit of
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interrogation will be an abdominal CT scan, in a day or two. These use
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X-rays, so in order to make oneself more radiopaque, one is required to
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selectively stuff oneself with heavy atoms in advance of the scan. One
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gobbles down a load of barium sulfate the night before (I know all about
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that stuff from my Merck Index - same publisher as the Merck Manual,
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different topic) to make one's intestines less transparent to the incoming
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electromagnetic rays. On the morning of the scan, though, they inject you
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with ... well ... something.
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The consent form doesn't say exactly what it is with which one is going to
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be injected. It mentions that the stuff which will be injected into you is
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a radiopaquing agent, implying it's a vasculature contrast medium, and
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alludes that the material contains iodine (makes sense, iodine's a heavy
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atom, the sort x-rays cannot penetrate) and is non-ionic (exists in an
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uncharged state... so what?). Nowhere, however, is the molecule or mix of
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molecules actually specified. Iodine in its native aqueous diatomic
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state would kill you stone dead if you were injected with it, so
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it obviously isn't that. But what is it, exactly? They give an associated
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death rate when using this stuff intravenously as less 1 per 180,000. But
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which stuff? How can I give them informed consent to shoot me up
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with some or other crap if they won't tell me what it is? If they tell me
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what it is, I can investigate its metabolic half-life, LD50 and eventual
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fate perfectly well in the existing literature, and make a decision.
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I'd normally go looking in my Martindales 38th pharmacopoea, but opaquing
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agents are not, strictly, pharmaceuticals, so they don't list any, as far
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as I can see.
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The mention of iodine, lower down in the form, is an important giveaway...
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one can whiz off to the Merck Index and directly observe structures of any
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molecules whose names start with io- or iodo-, and grep immediately at the
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bottom of these entries looking for the words `opaquing agent'. This won't
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get all of them (I mean, there's a heap of different ways to iodinate any
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of a squillion different molecules for this purpose) but one can at least
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acquire something like a clue about their probable natures.
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It appears most of the ones in this section of the Merck are variations
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on, or oligomers of, 1,3,5-triiodobenzene. Don't get the idea there's
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anything spooky about iodine, one needs it for thyroxine synthesis, and
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one gets goitred without it, among other things. I think I'm going to be
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shot up with any of iobenguane, iobenzamic acid, iocarmic acid, iocetamic
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acid, iodamide, iodipamide, iodixanol, iodoalphionic acid, iodopyracet,
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ioglycamic acid, iohexol, iomeglamic acid, iopamidol, iopanioic acid,
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iopentol, iophenydylate, iophenoxic acid, metrizamide, metrizoic acid,
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iopromide, iopronic acid, iothalamic acid, iotrolan, ioversol, ioxilan, or
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ipodate. I could sieve these entries by their water and lipid solubility
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to narrow it down to ones likely to stay in the blood rather than be
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incorporated into my cell walls for the next few years.
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None of these are radioactive (of course, they just scatter the x-rays,
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they don't emit anything themselves) and I think I excluded all the ionic
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ones from the list (and who in hell invents these names?!) But which one?
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I got LD50's for mice, rabbits, and just about everything else that moves
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there in the Merck, some of these things are actually moderately poisonous
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(especially if you're an experimental mouse or rabbit) though you'd have
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to shoot a lot more of them up your arm than the equivalent mass of
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diacetylated morpine required to kill a heroin user.
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I wonder what percentage of the population in general knows what is meant
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by non-ionic contrast agent anyway? I know what it means, but don't know
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why non-ionisation matters to the procedure.
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By signing this form I effectively say to these people, I don't care what
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you're gonna shoot me full of, go right ahead. This is, actually, an
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_uninformed_ consent document, wherein you put your signature on a chunk
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of paper that says that you neither know or care what is going to happen
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in this procedure. If, subsequent to some mishap in the scan, you wanted
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to get up MayneHealth for compensation, and had made the mistake of
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signing this thing, they'd piss their pants laughing you out of court.
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And, interestingly, they're right. I actually don't care. So shoot 'em up
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and pass the bremsstrahlung, I wanna know what's goin on in my guts.
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<predator>
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(the next .txt in this series is conway.cat.org.au/~predator/gutful.txt)
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