Please visit our home site at www.TRILOBOATS.com.

Anke and I live aboard WAYWARD, and wrote about it's design and construction at ABargeInTheMaking.blogspot.com.

Access to the net comes and goes, so I'll be writing in fits and spurts.Please feel free to browse the archives, leave comments where you will and write... I'll respond as I can.

Fair winds!

Dave and Anke
triloboats swirly gmail daughter com

Showing posts with label Medical. Show all posts
Showing posts with label Medical. Show all posts

Wednesday, April 14, 2021

OVERVIEW: Being Mortal by Atul Gawande

 


Words to live by.
Words to die by.

Really, what's the difference?

Being Mortal by Atul Gawande

See also this review by Maria Popova

All boldface below are quotes from Dr. Gawande's book.

In Being Mortal, Dr. Gawande writes:

This is a book about the modern experience of mortality -- about what it’s like to be creatures who age and die, how medicine has changed the experience and how it hasn’t, where our ideas about how to deal with our finitude have got the reality wrong.

Our main take-aways from the book:

Quality of life is preferable to mere quantity for the vast majority of us.

Care should be determined - in discussion with one’s family, doctors and care-givers - by asking...


  • What is our understanding of the situation?

  • What do we fear?

  • What do we hope for?

  • What are the trade-offs we are willing to make?

  • What are the trade-offs we are not willing to make?

  • What is the best course of action which serves this understanding?

Consider, answer and communicate, if possible, before the onset of care…

  • Do you want to be resuscitated if your heart stops?

  • Do you want aggressive treatments such as intubation and mechanical ventilation?

  • Do you want antibiotics?

  • Do you want tube or intravenous feeding if you can’t eat on your own?


Hospice approaches and attitudes appear to serve the terminal patient much better than standard medical interventions.

In the Epilogue, Dr. Gawande writes:

We’ve been wrong about what our job is in medicine. We think our job is to ensure health and survival. But really it is larger than that. It is to enable well-being. And well-being is about the reasons one wishes to be alive. 


Those reasons matter

not just at the end of life,

or when debility comes,

but all along the way.



Thursday, April 2, 2020

COVID-19: Ozone Generators for Sterilization

Diagram from PrimaZone

COVID-19... Some dis-assembly is required.


 COVID-19: Ozone Generators and Sterilization


We've been using an ozone (O3) generator for several years, now, to sterilize our boat cabin and holds against various fungi including dry rot, mold and mildews. We also blow into a garbage bag to sterilize small items, now including masks, gloves and other PPE.

 << Our EnerZen unit costs about $85 as I write.

An advantage over UV sterilization is that it fills a space, where UV is line-of-sight and won't work in the 'shadow'.



While several studies suggest that ozone (O3) 'kills' COVID-19, this hasn't been fully established.

A word of caution... this type of generator sterilizes the space by elevating O3 concentrations to lethal levels for a short time. No People, Plants or Pets while working and until fully aired out. Don't even want to breathe a little of it. We amateurs should probably leave the building, even if you're only doing a single room within it.

Here's a quick article that hits the main points. And another in more depth.

There is another kind of ozone generator on the market which uses low levels of O3 to ionize particles to help purify air with people in the room. Some are being marketed as helping against CV19. These are not recommended by most medical authorities ever, and especially not now.

If breathed in, ozone irritates, inflames and even kills cells all along the respiratory tract. This makes the cells even more susceptible to virus and bacteria, and if infected, inflammation is a serious co factor for worse outcomes. 'Safe' levels for O3 can be understood as merely 'negligible damage' even when threat of infection is low.

Incidentally, ozone also clears away smells from such maritime nuisances as locker funk, diesel or gas, wet dog, bilge, etc..

Thinking of you all, especially in these somber times.



NOTE: Most hospitals have ozone generators for sterilizing operating and patient rooms. PPEs can be treated for re-use in room-sized batches. Even if it only reduces viral load, it is better than some of the desperate measures (such as paper bags between re-uses!). Please help spread the word your health care professionals.

NOTE: For sailors using ozone in the Spore Wars, be aware that ozone is extremely oxidizing, the heat-producing reaction behind spontaneous combustion. Be sure there are no oily rags lying about!

Monday, March 16, 2020

COVID-19: Circle the Wagons

Important, but is it happening in time?
Treatment capacity lines seem optimistic, to me...
assumes healthcare is exceeded vs overwhelmed.

James gave the huffle of a snail in danger,
And nobody heard him at all.

-- A. A. Milne


COVID-19: Circling the Wagons

For those of you who don't know it, I've been huffling since the run up to Y2K about TEOTWAWKI - The End Of The World As We Know It.

Now I believe we're watching it unfold.

The basic factors are these
  • A fragile, Global Industrial Economy (GIE)... our tightly coupled, deeply indebted Complex Adaptive System (CAS).
  • A vast, overshot, human population which depends on a functional GIE for its livelihood.
  • Exponential spread of COVID-19 pandemic which will almost certainly overwhelm the healthcare system.
  • Failed containment and failing mitigation measures.
  • Exponential growth of associated problems.

Exponential growth of anything catches humans by surprise in almost every case. Windows of opportunity for meaningful action / preparation are snapping closed at a rate that's difficult for human beings to grasp intuitively.

NOTE: See here (~4 min vid... visceral impact of exponential growth) and here (~9min vid... exponential spread of COVID-19 vs flattening) to get a taste of the challenge.

David Korowicz lays out the general issues in his paper Trade-off (77 pages for the very interested) and specifically, pandemic based analysis in Catastrophic Shocks in Complex Socio-Economic Systems: A Pandemic Perspective (10 pages for the interested). Both are challenging reading, but, I believe, provide a foundation for viewing current events.

CAS's - such as the human body - have a range of stability. Within that range, they can be astoundingly resilient. But if events drive them beyond that range, a tipping point is reached and the whole system settles into a new equilibrium.

In the human body, an infection can lead to the loss of a critical function (breathing, say), and in a rapid cascade it collapses (and without rapid, correct intervention, dies). In a just-in-time economy, supply-chain interruptions block down-chain production and can rapidly paralyze the economy. In finance, disturbing the mountain of debt can bring currencies and institutions crashing down.

All of these are underway. [Or, for a less detailed and challenging glimpse of the problem, try this article.]

This is my long-winded way of saying that this is both serious and moving faster than we imagine.


 My Urgent Advice...

>>>  Get together with those you most love RIGHT NOW. Stay together for the duration.

>>>  Get together provisions RIGHT NOW (food, water, essential medicines, cooking/heating fuel) for a minimum of two weeks (CDC advice). Longer is better.

>>>  Make an isolation / infected plan and put it into action RIGHT NOW.

>>>  Don't panic, but GET MOVING.


Whether I'm right or wrong about larger consequences... even if the GIE manages to function beyond the crisis... even if your area has no known cases...  whether you are riding this out or hunkering down for trouble...

Containment and mitigation measures are shutting down travel and contact for unspecified periods. If flattening the curve is successful (our best chance), lockdowns will be in place for months, not weeks.

I say again, windows of opportunity are snapping closed.

Fair winds, health and happiness to all of us,

Dave and Anke




P.S. Here's some good advice from a guy who's been there.

Sunday, March 17, 2019

Hot Toddy, Hot Schnotty: A Cure for What Ails Ya

Vinegar over Honey
plus spices,
before topping off with hot Water

I will use those dietary regimens which will benefit my patients according to my greatest ability and judgement...
-- From the Hippocratic Oath


Hot Toddy, Hot Schnotty: A Cure for What Ails Ya

By sheer coincidence, these two recipes came to us within a week of the other. The former is recreational, while the latter is medicinal. And without further ado...

Hot Toddy (from S/V VALIANT)
Whiskey (start with a finger or two?)
Apple Cider Vinegar (a splash, to begin with)
Squeeze some lime or lemon (or leave a twist)
Water (to top off)
Honey (to taste)
Salt around the rim (if that's how you roll)

All ingredients adjusted to taste/tolerance.

This one does for the recreational end of the spectrum. The whiskey is 'rotgut' (aka cheap)... no point mixing 80 year old Scotch with vinegar. The citrus can sometimes be found in your local, neighborhood dumpster, but we buy concentrate by the quart.


Hot Schnotty aka Fire Cider (amalgamated from the internet)
1 part Honey
1 part Apple Cider Vinegar
1 part Water (hot)
Heavy squirt of Hot Sauce
Pinch of CinnamonPinch of
Ginger
Pinch of
Tumeric
(if ya have it)
Twist of Lemon (if ya have it)

This one's medicinal. Blasts snotty nose, sore throat and eases a cough. Useful stuff when sailing into the social proximities of civilization. Serve warm or hot for best effect, taking a sip every so often. I don't recommend drinking it down! Listen to your stomach. I find it works best when gargled for a bit. It settles, so stir or shake it before use.

Interesting overlap between the two recipes. Their taste definitely has a family resemblance.
Both harken to our (great?)grandparents' use of vinegar and honey as home remedies.

Vinegar is acidic (generally 7% acetic acid), so should be taken in moderation. It has been used to treat or ease many external conditions, and is anti-fungicidal. Taken internally, it has been considered a blood tonic (my G'parents said it 'thinned' the blood) and, especially in the throat, an anti-bacterial and anti-fungal agent. But be aware that acid has internal effects on the teeth and stomach. A cup or so is a very potent emetic (makes us puke).

Honey is high in sugars with all their pros and cons. Local honies, especially, help prepare the body for pollens, reducing allergic reactions. In the throat, it can (like any sugar concentrate) discourage bacterial growth via osmotic action. On the other hand, once it's diluted (by saliva), it's food for growth. I personally let it sit thick for a bit, and then clear it out.

Cinnamon, Ginger, Tumeric and Peppers are all traditionally medicinal along with many others you can experiment with, and considered to be anti-bacterial and anti-fungal. Cayenne has even been mixed in with cheap bottom paint to up its anti-fouling properties!

Whatever the case, it sure seems to help!


*****

Bonus Yarn:

My Mom used to make us honey lemon teas for a cough suppressant.

One night, I had it bad, but didn't want to wake anyone up. I was six, after all... nearly a man.

I filled a pot with honey and brought it to a boil, then added a squirt of lemon. I carefully decanted the mix into a mug.

Then burned the bejeezus out of my lips, waking all in the house with my wails. I suppose it could have gone so much worse.

An early lesson in the importance of proportion and expert advice!


Saturday, October 11, 2014

Doctors Without Borders: Friends in Need




Doctors Without Borders: Friends in Need

Sometimes, the world scares me.

A howling gale, driving seas, lee shores -- these can leave me dry of mouth and knock of knee. 

But I have some experience in these. A boon companion. Tools at my command. A refuge downwind.

I can face them.

For many years now, Anke and I have supported Doctors Without Borders, aka Medecines Sans Frontieres (MSF).

Since their founding, they have walked the walk through the valley of the shadow of death. In the face of natural disaster, war and disease, their staff and volunteers have risked their very lives in service of populations in dire need.

Now, they are embroiled in the desperate West African fight against the Ebola Virus.

Ebola. The modern world's first biosafety level 4 epidemic. Spreading exponentially.

My mouth is dry. My knees knock. My heart bleeds.

MSF is in the field, facing what I cannot and perhaps dare not.

It's unofficial, but to date, we've managed to put aside 10+% of TriloBoats' earnings toward helping others. Doctors Without Borders has been the chief recipient. Thus, many of you have already made a contribution.

Please consider an extra donation to this extraordinary organization in this extraordinary time of need.

A stitch in time, if there's still time.


*****

Click HERE to visit Doctors Without Borders donation page.

Tuesday, March 6, 2012

Sailing at Twilight: Thoughts on Aging Aboard

Allen and Sharie Farrell, life-long sailors.


Don't mind the rain, nor the rollin' sea.
The weary night don't bother me.
But the darkest hour of a sailor's day,
Is to watch the sun, as it fades away.

-- From The Grey Funnel Line 
by Cyril Tawney


Sailing at Twilight: Thoughts on Aging Aboard

No one looks forward to getting old, but it sure beats the alternative!

Anke and I are both in healthy middle age - as of this writing, I'm 53, and she's 10 years younger. As women currently outlive men by about five years, on average, our life expectancy gap is roughly 15 years.

We have no health insurance, and no particular prospects for it. We pay our (few) medical and dental bills out-of-pocket. But this means that we have no safety net, as our society now thinks of it. All our insurance is onboard, in our hands and in the good will of our friends.

In this, we join a long Alaskan tradition of old-timers who have lived out their lives in the backwaters.

These are characters of varying tolerance for others. Independant old cusses - male or female - they do for themselves until they can do no more. Most often, they live passably long and healthy lives. As their years go by, their cirque of activities contracts, their pace slows. If they've been friendly and hospitable, chances are they've made younger friends along the way who stop in once and a while, just to see how they're getting on.

Comes a day they slow to a stop.

The watery world has its share of elders whom age did not keep from the sea.

Allen and Sharie Farrell, for example, lived on a shoestring, and sailed the waters of British Columbia, without an engine right up until their deaths in ripe, old age. They were loved and supported by many, but maintained their independence afloat.

There is a clear distinction between the merely aged (who might be hale and spry), and those who have become enfeebled or worse, infirm (persons ill, or in some cases, disabled).

Age is not so much the issue as is enfeeblement and infirmity.

Enfeeblement - the loss of strength - is most often a long, slow decline from one's prime of life. Being slow, there is most often time to work out solutions, alternatives and compromises.

Pace may be slowed; expectations lowered. Mechanical advantage may be introduced or increased. Safety margins widened, with more time spent at anchor. Efficiency is favored, avoiding wasted motion. Forethought and planning supplant the impulsive action of youth. Physical care becomes habitual as the strength to recover from imbalance and injury wanes. Tasks may be more often shared, or delegated, in cases of partnership or community. It takes ingenuity and persistence to keep on in the face of enfeeblement.

Past some threshold in the decline of strength, enfeeblement becomes infirmity.

Infirmity - illness, a chronic condition or disability - is little different whether young or old. If it is treatable, we treat it. If not, we live with it as best we may; succumb if we cannot.

Not so long ago most folks handled the vast majority of their own health issues. Near towns, a General Practitioner might have contributed some higher level care or advice.

Prior to 1920, the state of medical technology generally meant that very little could be done for many patients, and that most patients were treated in their homes.

--Melissa Thomasson of Miami University

Since that time, medical advances have done much to prolong life. Some of these are accessible to us, DIY, as individuals. Others are only available through the medical establishment. Up to a certain point, we can cover the cost of medical assistance, out-of-pocket.

Beyond that point, these interventions come at price.

Debt is a form of enslavement. To prolong one's life in this manner, one must trade a portion of that life to servicing the debt incurred. This might be directly, or previously in the form of insurance premiums. While in debt, no one is free.

This is not to say the bargain may not be struck on behalf of one's self or loved ones. In many cases, the return of life outweighs life invested in covering the debt. At least we hope it does, and many have good reason to hope. Each must find their own way.

Here is ours...

Death lies in wait at the far end of age. Sooner or later, death welcomes us. This is the current of years, the concomitant of age, entropy. No insurance, no intervention, no prevention will save us from it.

Because death is coming, my life is in short supply.
Because my demand for life is high, I value my life.
 
Because my one precious life is precious, I choose not to trade quality life for poor.
Because I will not trade, I accept my death in its due course.
Because I accept death, I am free to live.

Accepting death, Anke and I choose to forgo the bargain which exacts much life in hopes of a little more.

We bet our lives on health, so long as it may last... it's a bet we cannot lose.

For us, it means joining most of humanity, past and present, in living day to day. Each as fully and deeply as we can. Each day like the wheeling gulls, gleaming and golden against the onrushing dark.

Until such time as our sun fades away, and we go, gently, into that good night.




*****

PS. Just 'cuz this all sounds so somber and serious, which I don't intend it to be, I'll leave you with this:


How do I know that my youth is all spent? 
My get-up-and-go has got-up and went!
But in spite of it all I'm able to grin
When I think where my get-up has been!

-- Anonymous