Rare = “$$$$$”

arareobject1rare: adjective

DEFINITION: exceptional, extraordinary, rarefied, recherché, scanty, unimaginable, few, admirable, A-OK, cat’s pajamas, commendable, cracker jack, exquisite, hunky-dory, meritorious, praiseworthy, superior, valuable, worthy, superior, 24-karat, elite, exclusive, exquisite, popular, precious, top-drawer.

I’ve never owned or bought or inherited or found or stole any thing that’s been classified, determined, researched, and stamped rare.  The arareobect2moniker rare is itself rare!  According to the free website, Rarity Guide (www.rarityguide.com), the nomenclature “Rare is far more than the number of units produced.  “Instead, we factor in many additional factors including popularity, demand, age and collectibility.”  On their website they stress educating the public and collectors about collectible objects.  The sobriquet rare is mentioned only when an object reaches the threshold of eighty-one percent (81%) to one hundred percent (100%): The most sought after objects in a collectible category.
Except in medicine where a condition or disease when codified rare indicates under-funded research meaning that the tightly budgeted, yet interested researchers exhaust their paltry budgets thus terminating further research and flatten the idyllic hope for a treatment long before it’s ever presented to the prudent pharmaceutical companies.
arare oject4
It’s simple: It’s unprofitable to manufacture a treatment which less than one percent (1%) of patients living with these diseases will be prescribed.
So, diseases are rare as well, but no one is a collector.  Now, what am I going to do with the four I have?
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One More . . .

3-One

5-One

1-One15-One

One more trip to the doctor.

One more admission of humiliating symptoms.

One more physician‘s persevering uncertainty.

One more hunch about drugs even after repeated failures of 6 week trials.

One more hopeful bottle of toxins to ingest.

One more set of side-effects to endure.

One more crippling debility: Illness’s strong swing of a sharp ax into the pulp of my dignity cutting deeply.

One more intentional assault leaving me with a staggering and teetering propriety.

One more debility before I’m disqualified from sovereignty; stripped of my liberty, freedom, and independence, my self-reliant character reverts to childhood, a time of absolute dependence for survival.

One more obedient abdication of my extinct identities and forthcoming dog’s age.

One more no more.

 

Newtown Might Be Anytown

cryingobamaSince I first heard President Obama fight back agony so wrenching it overwhelmed the indomitable propriety of his office, I sensed a depth of heartache rarely freed by a sitting president.  President Obama’s valiant attempt to sandbag the stalwart character of 1600 Pennsylvania Avenue was breached nevertheless as the surge of emotion overwhelmed his duty as the harbinger of serious information to America‘s citizens.

Every time I read an article, listen to President Obama’s painful pauses, or watch television coverage I simply cry for everyone involved.  And everyone is involved.  By everyone I mean everybody; all of us; each of us.  It’s impossible to locate anyone unmoved by this horrific incident.

It’s all part of an escalation of rights protected by the constitution, to the safety of the innocent, to the invasion of privacy at pat down check-points, to righteous citizens hawking firearms at uncontrolled, unregulated gun showgunshow free-for-alls at which anyone — anyone regardless of their background — can purchase a firearm because, by law and by money and by lobbyists and by radical firearms enthusiasts, gun shows are not gun shops, gun shows are for the gun collector, the gun enthusiast.  But what do these collectors and enthusiasts feel or imagine as they feel the firearms heft, the iciness of the steel, the clip or chamber, the single cartridge trigger or the semi-automatic trigger; what do they feel or imagine that propels them to dodge laws, drop a few hundred dollars, and leave pleased as punch.  They must imagine the kickback of that first round, the power the firearm possesses, the. . .the. . .____________ of ownership.  It’s the blank I’m curious about; the “what” as to why they insist on owning firearms.

Which is their constitutional right: “To bear arms. . .”   But the Constitution doesn’t mention ammunition.

policefront deskSo here’s my idea:  Treat ammunition for publicly owned firearms in the same manner our society treats prescription drugs.  If you want ammunition you need to go to your local police department; there pharmacythey’ll write you a legal dispense order for thirty rounds only and non-refillable within a thirty day period.  The federal government would monitor ammunition shops like they monitor pharmacies.

Have all the lawless gun shows you want!  Have all the gun shops you want!  Let everyone carry concealed weapons!  And most of all, appease the self-righteous, entitlement-wielding, insensitive and ignorant myopic NRA by letting them bear as many bloody arms as they can carry!

But you can’t have any bullets.

 

The (Un)expected Outcome(s)

Fear stops me like a two by four to the back of the head.  Real fear.  Not anxiety, not nervousness, not hesitation.  The kind of fear that rushes to a moment of quiet like children playing musical chairs.  Real Fear.  Life or Death Fear.  My fear has been the writers-block-in-residence for the past fourteen days.  My fear was a distraction; then my fear developed into an annoyance; then fear and I were bedfellows, fear being the last thing at night and first thing upon waking that knocked on my mind’s front door.  What is my fear?  I’m afraid I’m dying.

As you know, in November, 2008 I was classified as bipolar.  This determination included established and biased reasoning for my life on a seesaw: I was predisposed to life as a yo-yo by genetic roulette.  This milestone was marked by a simple psychiatric ah-ha.  Their specialty professes its ideological conjecture as formative and their ignorance evidenced by the devastating news that they can’t offer a cure, or even a likely protocol.  Instead they offer an indifferent forecast of pharmaceutical trials often resulting in failure and cautioned of a likely future weathering mania-driven misjudgments followed by the doomed deciension into a grey melancholia exacerbated by the digestion of manic destruction and attempted repair.  And then there’s that overcast statistic regarding effectual suicides: 40%.

Fear immediately hit the brakes and sent my entire life crashing headlong into the windshield. Fear sat immobilized by truths: I’ll only be free of madness if I’m one of four out of ten.  Fear’s rationale was logical and pragmatic; why endure decades of depression and delirium only to draw the same conclusion?  I’d decided to ignore Fear’s advice and try, one day at a time, to continue my membership in the sixty percent club.

But two months ago despite my determined effort to avoid that 40%, a wholly separate yet equally incurable physical condition reappeared. Its symptoms are aggravated and impairing; inexplicable weight gain (45 pounds in six weeks); undermining fatigue; breathlessness following exertion; intentional harboring of fluid forced from arteries and causes swelling and immobility.  But just like the Rambler my father owned in the early sixties, no one could determine the cause of the knocking.  That is, until the 1959 V-8 wagon blew a cylinder and sent my father’s first love to every car’s destiny: an auto scrap yard seen from the interstate.  Will my erosion be similar?  An unidentifiable murmur like a whispered yet repeated rumor one day erupts and immediately my initial litany of enigmatic symptoms is sensible, albeit much too late for prevention and most likely too late for intervention.

I’ve been blindsided by these illnesses and worse, hobbled by their improbable cures.  This simply was not my life’s expected outcome.  Or so I believed until very recently when I remembered what a mentor once suggested as a remedy to writer’s block:

“Writer’s block excuses lazy writers; Write about what’s preventing you from writing; Suddenly you’re mindlessly writing and only when you pause do you remember what was prohibiting your expression, but you can’t remember why.  When you can’t write, you must write.  The living face death every day — and then go about living!”

An Open Letter to U.S. Representative Jesse Jackson Jr.’s Mayo Clinic Physicians

Dear Dr. So-and-So, et. al.:

I read with tremendous interest and a degree of de ja’ vu the front-page story written by Ms. Michael Sneed in the Sunday, August 5, 2012 Chicago Sun-Times which reported that U.S. Representative Jesse Jackson Jr. recently collapsed and had become completely debilitated by depression.  Upon reading the story, I experienced a staggering degree of recognition, for I too, have (and continue to do so) hit the same kind of wall as Representative Jesse Jackson Jr.: A crippling mental illness diagnosis, specifically major depression (changed later to Bipolar II) following gastric by-pass surgery.

The story reported that Ald. Sandi Jackson (wife of Representative Jesse Jackson Jr.) doesn’t know if her husband’s depression is connected to his weight-loss surgery.  As a person who finds himself in a very similar situation the development of major depression after elective gastric by-pass surgery) I would like to suggest that determining the cause of this on-set of depression is irrelevant and nearly impossible to determine.   Based on the past four years of failed orally administered pharmaceutical treatment attempts, I strongly suggest that you titrate the dosing levels of psychotropic therapies dramatically (50%-75% higher) or increase the potency of the psychotropic therapies to compensate for the substantial degree of malabsorption (the basic tenet of Duodenal Switch Surgery) caused by the significant reduction in stomach volume (up to 70%) and the dissection and rerouting of a large percentage of the small intestine (which is largely responsible for caloric absorption).  If the goal of the Duodenal Switch surgery is to limit volume and reduce absorption of food ingested orally, then common sense suggests that anything ingested orally will greatly lose its effectiveness (especially if the drug’s efficacy during clinical trials was based on subjects that did not undergo weight-loss surgery).  Except now we want the body to absorb what it’s ingesting!

I endured two needless years of trial and error attempting to discover pharmaceutical regimen which would lift me from depression and put a lid on my mania.  My psychopharmacologist knew I’d undergone gastric by-pass surgery a decade earlier yet refused to consider malabsorption as the cause of the ineffectiveness of every single prescription.  Frustrated by my psychiatric team’s myopia, I returned to the care of my internist; he was the first doctor to consider that my body’s ability to absorb oral treatments had been reduced by as much as 75%.  If an increase in dosage is impossible, then a different delivery system (IV, inhalation, transdermal patch, suppository) must be manufactured.   Please don’t waste Representative Jesse Jackson Jr.’s time prescribing the usual litany of drugs at their recommended doses: It’s akin to trying to stop a charging elephant with a water pistol.

Morbidly obese patients who were diagnosed as depressed and were being treated successfully through oral medications prior to gastric by-pass surgery discovered that post surgery their depression worsened and their pre-surgery oral medication treatment failed to reproduce the expected degree of pre-surgery success and relief.   Your patient is in crisis; your patient is experiencing a major depressive episode; your patient’s natural ability to absorb what he ingests has been compromised to the degree of ineffectiveness; your patient needs an extraordinary, preposterous, wholly unimaginable antidote, not a boilerplate solution. 

I salute the Jackson family for supporting Representative Jesse Jackson Jr. through this difficult period and wish them all God’s speed.

By-(pass) & Bi-(polar)

Please note:  If you know of someone who has had gastric by-pass surgery and is having similar experiences as I’ve described, please share this post with them.  They can send a note to: questions@bypassandbipolar.info.

Fact:  We cannot predict the future.  Fact:  Life has no guarantees.  Fact:  New ideas can be both liberating and debilitating.  Fact:  Those offering a service resulting in permanent physical modification should fully understand the immediate impact as well as future consequences.

Myth:  The Medical Community at-large fully understands the alternative treatment options researched and developed by medical professionals specializing in gastric by-pass surgery due to the post-gastric by-pass patients insufficient absorption of oral medications.

It’s been ten years since I elected to undergo the radical Roux-en-Y gastric by-pass surgery and permanently remove most of my stomach and a length of my small intestine.  The alienation of these two components produces significant weight-loss because: 1) You can’t eat much; and, 2) You can’t absorb much.  Yes, there is a fair amount of adjustment, but the weight literally falls off and stays off with an average regain of ten percent.

Remnants of the “old you” are carted to resale shops or, in my case, high-end tent and boat sail manufacturers.  Everything is absolutely wonderful until you hit a bump in the road say, like a complete mental breakdown. Psychiatrist’s whip out the antipsychotics and antidepressants like they were six-shooters; their effects are hardly immediate; many take as long as six weeks to burrow into your blood stream; still crazy?  No problem, the psychiatrist’s reach for the tommy-gun and another six-weeks pass; nothing.  Up and up and up we go until finally the two of us are sitting in a missile silo and his finger hovers above the launch button.  Dabbing his ever-perspiring brow with a cotton kerchief he mutters repeatedly, “this is unnatural, this is unnatural. . .”

It is unnatural!  Post-gastric by-pass patients have been modified, re-engineered; fundamental human mechanics, basic organ responsibilities, broad physical and chemical hypothesis tested and tried and approved by the FDA have little (if any) effect; we’re the svelte yet queer abomination of opportunistic, profit seeking surgeons that prey on the desperate obese willing to do anything to permanently lose weight.  Malabsorption is the snake oil the surgeons are hawking.

If I sound particularly harsh toward the bariatric profession it’s because I firmly believe that they have abdicated a large chunk of their responsibility not only to their patients, but to their fellow medical colleagues as well.  In  the ten years since I had gastric by-pass surgery, I have learned from a very reputable source, a doctor of some notoriety in the field of obesity, that to his knowledge, no one is, nor anyone has bothered to explore and/or discover and educate the medical community as to an alternative method of transporting medications into the body when oral absorption is impossible or only 25% effective (as is my case).  Or perhaps they could propose a mathematical equation which other medical colleagues could use to increase a gastric by-pass patient’s daily dosing.

The only medication that provides any relief from my mental illness is dextroamphetamine salt prescribed in a volume that aroused the suspicion of local pharmacists who publicly (in the presence of their staff and other customers) strongly suggested that I was either A) An addict or B) A pusher, then flatly refused to honor my doctor’s authorized prescription.

I suffer from a mental illness that kills 40% of those diagnosed by suicide; the commonly practiced treatment of prescribing oral antipsychotics and/or antidepressants is impossible because I elected to undergo gastric by-pass surgery ten years ago; if I become one of those 40% because the doctor’s that promote, promise, and perform these procedures have abdicated their responsibility to provide an effective treatment alternative in ten years, do me a favor: file a class-action lawsuit against every last one of them for their gross negligence!