Balls and Walnuts
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A public service announcement
On an intellectual level, I’ve been aware of an increased rate of oropharyngeal cancers in nonsmokers in the last ten years or so, but I only really woke up to it after having two such patients fall into my lap within the last several weeks. Seems I can no longer say, “If you’ve never been a big smoker or drinker, you have extremely little chance of getting throat cancer.” I’ll have to modify it to say, “If you’ve never been a big smoker or drinker, and if you’ve never had sex, you have extremely little chance of getting throat cancer.”
Yeah, you heard me. This is the bugger:
That’s the human papillomavirus, or at least it’s a fetchingly colored depiction of HPV. And for today’s public service announcement, the key facts are these:
1. HPV is an important cause of cervical cancer. Apparently, and not surprisingly (since mucosa is mucosa, after all), it’s also associated with many oropharyngeal squamous cell carcinomas.
2. The HPV2 and HPV4 vaccines protect against most of the HPV serotypes causing cervical cancer and genital warts. Safety data is quite favorable:
Serious adverse events and deaths were evaluated in a pooled safety analysis that included 29,953 females aged 10 through 72 years (16,142 received HPV2). Proportions of persons reporting a serious adverse event were similar in vaccine and control groups (5.3% and 5.9%, respectively), as were the types of serious adverse events reported. In the pooled safety analysis, including 12,533 women who received HPV2 and over 10,730 in the control groups, incidence of potential new autoimmune disorders did not differ (0.8% in both groups).
3. HPV-related oropharyngeal cancers are on the rise. Unlike the typical throat cancers, which are associated with heavy alcohol and tobacco use and poor oral hygiene, HPV-related oropharyngeal cancers are associated with having multiple sexual partners. (But all it takes is one bad apple, you know?)
4. It does not seem like such a great stretch to argue that boys as well as girls should receive the HPV vaccine, particularly since HPV is also associated with anal and penile cancers. It’s safe and effective, so why not do it? Seems logical to me, but there are people who take the other side. (For the “pro” side of the vaccinate-boys argument, click here.) As best I can tell, the arguments against vaccinating boys comes down to: it’s too much trouble, it’s too expensive, boys will benefit anyway if enough girls get vaccinated, and HPV-related cancers really aren’t that big of a deal.
5. On that last point: while it is true that the HPV-associated throat cancers are more sensitive to radiation therapy and have a better prognosis than the smoking-and-drinking throat cancers, people can still die from HPV throat cancer.
So I think it boils down to “what is the worth of a life.” Cost effectiveness arguments make a lot more sense when there are two edges to the sword*. For example, should all men above a certain age be tested for PSA, the tumor marker for prostate cancer? It’s a little controversial, and it’s more than the cost of the test that is debated. The issue is whether an elevated PSA leads to unnecessary tests or treatments, all with potential for harm. (The LA Times has a good piece on this issue.)
I don’t see the double-edge to this sword. These are safe, effective vaccines.
I know what I’m recommending to my son.
D.
*In which case the cost, as a matter of public health policy, is still only one small part of the overall debate.
Another discovery
Let’s see: my anticipation of the upcoming Alice sequel led me to wonder what Chris Vrenna (former NIN collaborator, who scored American McGee’s Alice) was up to, and I discovered Rasputina, with whom Vrenna worked on their CD How We Quit The Forest. Here, give this a chance:
You can find Rasputina’s covers of Bad Moon Rising, Barracuda, and Wish You Were Here over at YouTube. There’s also a “Rasputina collection” by crushedbyeyeliner, and that led me to Portishead.
Gotta love all that theremin.
Two interesting finds from one meandering search. Ah, the Internets!
D.
Going the way of Danny Elfman
I don’t know: do any of you give a damn about NIN’s Trent Reznor? Am I the only nailhead in this place? With his marriage last year to Mariqueen Maandig, I’ve been worrying that Trent will fall prey to Happily Married Man syndrome. Case in point: Talking Heads’ David Byrne, whose “Life During Wartime” was a pile of edges; then he gets married in 1987 and then turns out the atrocity “Stay Up Late” (you know, the one about the peeing baby crawling across the floor, keep baby up all night, yatta yatta?) in 1985, so the marriage effect was so potent it backwashed Byrne’s talent by a full two years. Yes, I know that makes no sense, but the chronology is inconsistent with my thesis. And here I’ve been blaming Byrne’s wife all these years.
Trent and Mariqueen have produced an EP for their band How To Destroy Angels, which I dutifully bought for my iPod. Must say I’m not impressed with Mariqueen’s vocals. I’ve wanted Trent to write music for a female vocalist for some years now, but I’ve had in mind someone who could belt out a song. Garbage’s Shirley Manson, for example. (Rather than Trent’s estranged protege Marilyn Manson. Not the same thing at all.)
Anyway, Trent’s into movie sound tracks now. (I really am looking forward to Abraham Lincoln, Vampire Slayer.)
Gotta go. Jake needs the computer.
D.
Pain in the ass
Yup, that's where it hurts.
Always cool to rediscover something that I’d learned in med school then promptly forgotten. Not so cool when I learn it the hard way. It seems I’ve developed piriformis syndrome.
Piriformis syndrome is a neuromuscular disorder that occurs when the sciatic nerve is compressed or otherwise irritated by the piriformis muscle causing pain, tingling and numbness in the buttocks and along the path of the sciatic nerve descending down the lower thigh and into the leg.
I try to exercise anywhere from three to five days a week, and generally stick to low impact aerobics such as using the elliptical trainer or fast walking on the treadmill. Last Wednesday, though, I wanted to see what it would feel like to run. So for two bloody minutes, I upped the speed to 5.2 mph. Not even six. I see people twenty years older than me running at 6 — surely I could handle 5.2 for a couple minutes? Apparently not.
What started out as a sore ass got progressively worse. For the last 24 hours I’ve been living on ibuprofen, and the pain was still enough to wake me up. Figuring I had done some major damage to my hip joint, I wormed my way into Urgent Care and begged for help. My doc, a great guy who recently received our organization’s highest clinical honor, diagnosed me in about two minutes. Got a shot of Toradol, a prescription for steroids, and some exercises on stretching, but of course I had to surf the net for more information.
From this website, for example, I learned that I may have had piriformis syndrome for a very long time. I can remember having similar pain as an undergraduate. The chief causes of piriformis syndrome: sitting on your ass all day, exercising only the muscles of forward motion (I biked a lot in college, and nowadays I do the elliptical far more often than I use the adductor/abductor machines), and having weak abdominals. Guilty on all three counts, then and now. This also explains why exercise helps my lower back pain, since when I’m doing it right, I do exercise the abdominals and stretch things out fairly well — both important for piriformis health.
And if I needed any more motivation to keep my piriformis in good shape, here’s Wiki again:
The result of the piriformis muscle spasm can be impingement of not only the sciatic nerve but also the pudendal nerve. The pudendal nerve controls the muscles of the bowels and bladder. Symptoms of pudendal nerve entrapment include tingling and numbness in the groin and saddle areas, and can lead to urinary and fecal incontinence.
I’ll close with a stretch.
D.
Up and coming
and eagerly awaited by my son and I: the sequel to American McGee’s Alice.
They’ve made three teasers, all of which are worth watching full screen. This one is gorgeous:
I’m hoping they bring back Chris Vrenna for the score, or someone of comparable quality. The teasers don’t give us much idea of the game play, but given the fact that the original (released in 2000) is still very playable, they’d have to work at it to ruin the game play.
But next up for me is Dragon Age 2. Shameful to buy the sequel when I never finished the first game, but it’s just too much fun to start new characters and work through each one’s origin story (they’re very different for different races, classes, etc.) Why, just the other day I sweet-talked an elf maiden into my bedroom. Then we heard a ruckus beyond the door and she stuuupidly said, “Oh, hey, I’ll go see who it is!”
Hmm . . . my romantic conquests usually don’t meet such gory ends.
D.
I keep thinking . . .
that a modicum of talent should translate into the ability to create something of comparable quality to the things created by folks who have dedicated their lives to this sort of thing.
Should I be surprised that after throwing myself into writing for five or six years I might come up with stories that are readable but not necessarily publishable? And should I be surprised that I can’t become a comics artist overnight?
Perhaps I should confine myself to the visual vocabulary of stick figures*. I could tell my story (relatively quickly) and stop being so damned frustrated all the time. Who knows, perhaps a real artist will find my story, like it, and offer his services. Such things do happen in the world of web comics
Still, it disappoints me that I’m only capable of stick figure comics, but I want to do something more of this quality.
D.
*xkcd is self-supporting, after all.
Am I going to have to host another contest
to get y’all to listen to Cortney Tidwell?
Here, she sounds a bit like a mad hybrid of Bjork and Shirley Manson, but the music is Pink Floyd circa Ummagumma. And honestly, when was the last time someone produced new psychedelic music?
And here she is with a very different sound in “Watusii,” on her album Boys.
My main regret is that she only has one EP and two CDs. Three if you count her most recent CD, “Invariable Heartache,” which as best I can tell is more country-western.
Do I like her well enough to listen to C-W? I never would have thought it possible, but my resolve is weakening.
D.
Fun with Gimp
As I have mentioned, I could have spent several hundred dollars on Photoshop, but the ambient wisdom of the Internets suggested Gimp (freeware) was every bit as good, if not better, since it’s not a resource hog like Photoshop.
Here’s a cute trick (see tutorial here) employed on one of my favorite pictures of my son, shown here at age 12:
Compare to the original:
Not quite as dramatic a change as the examples given in the Gimp tutorial, but then I’m not an amazing photographer. But I’d love to see what Dean could do with this stuff.
D.
Four hours later . . .
I was doing fine.
Really, I was.
Then Gimp refused to let me add a “rifle layer.” No rifle. So poor Messy seems to be waving his hands, or something. (Compare to first panel below.)
Also, I must say that while I like my starry sky (done manually, mind you — no clever gimmicks there), I’m not at all sure this was worth the extra effort compared to the black and white version. You tell me if you think it’s that much better. If anything, it looks even more amateurish. I’m developing an even healthier respect for comics artists.
D.