Category Archives: medical practice

Recommended Reading for 24 December, 2010

Gentle reader, be cautioned: comments sections on mainstream media sites tend to not be safe and we here at FWD/Forward don’t necessarily endorse all the opinions in these pieces. Let’s jump right in, shall we?

The Broken of Britain: The GP’s Story by Dr Jest

So there you have it. Neither Pete nor Dud would have chosen to be where they are now, and neither has asked not to work when they were capable. Indeed both have rather struggled on when reason would have suggested they ought not. And I could name you a dozen others in a similar position. All present talk of making it more profitable to work than rely on benefit may sound very noble and high minded in the marbled halls of power, where hard graft means having a lot to read and a few late meetings to go to. It completely misses the enormous efforts made by the likes of Pete and Dud to keep going against the odds, and any move to impoverish them is little short of scandalous and should be relentlessly pointed out for the evil narrow minded bigotry it is.

Sarah at Cat in a Dog’s World: PWD and TSA

From information I’d heard from TSA administrators, I thought that the body scanners would reducethe need for physical pat-downs. Little did I know that TSA would use the new technology as an excuse to conduct more invasive pat-downs! It is obscene, especially when one considers that many people with disabilities don’t have any “choice” at all. If someone is unable to stand independently for ten seconds with their arms up, or if one wears any number of medical devices or prostheses…there is no “choice.” (And no, for many people, “don’t fly” is not a realistic choice.) There is, additionally, reason for concern about the radiation from the body scanners, particularly for cancer survivors and people who have a genetic predisposition to cancer. It is now pretty clear that body scanners, far from being a panacea, are making things worse. And people with disabilities are being affected disproportionately.

At Spilt Milk: Thanks for your help, doctor.

Make no mistake: I know that this only happened to me because I am fat. If I were a thin person and I walked through his door with the symptoms I described, he would have been forced to dig deeper. To ask me more questions, to hopefully come up with a wider range of options. Maybe run more tests.

United States: Megan Cottrell at ChicagoNow: Got a disability? You’ll see the difference in your paycheck

A lot of people might assume that if you have a disability, you might not make as much money as someone without a disability. But how much less? How hard is it for people with disabilities in Illinois to get by compared to their neighbors?

India: An unnamed special correspondent at The Hindu: Social barriers keep the disabled away from workforce:

Persons with disabilities are the last identity group to enter the workforce, not because their disability comes in the way of their functioning, but because of social and practical barriers that prevent them from joining work, a study on the ‘Employment Rights of Disabled Women in India’ carried out by the Society for Disability and Rehabilitation of the National Commission for Women (NCW) has said.

Guillermo Contreras at Chron.com: State sued over care for disabled Texans

The federal lawsuit, filed Monday in San Antonio, alleges the state isn’t providing some mentally and physically disabled Texans the opportunity to move into community-based settings, which advocates say are less restrictive and more rehabilitative than nursing homes.

Lastly, here’s a transcript of a story on Australia’s 7.30 Report program called Setting Sail:

Known as the ‘Everest of sailing’ the Sydney to Hobart race challenges the most seasoned of yachtsmen on what can be a treacherous ocean voyage.

Most of the focus is on the big maxi-yachts competing for line honours. But a unique crew of blind and deaf sailors is also commanding attention.

The charity organisation, Sailors With Disabilities, has been gifted a half-million dollar fast yacht, making them eligible for the first time in the prestigious Rolex Cup.

Send your links to recreading[@]disabledfeminists[.]com. Let us know if/how you want to be credited. And have yourself a fabulous weekend.

Recommended Reading for 10 December, 2010

Well, if it isn’t Friday again. I suppose it is for you, readers of the future, but I am writing this from Tuesday, in the past! Such is the power of the blog’s scheduling function.

Gentle reader, be cautioned: comments sections on mainstream media sites tend to not be safe and we here at FWD/Forward don’t necessarily endorse all the opinions in these pieces. Let’s jump right in, shall we?

An Actor Finds Truth & Power Negotiating her Vision Loss by Marilee Talkington guest posting at Brains of Minerva.

So I decided I wouldn’t tell the directors or anyone on the casting end that I was visually impaired. Which always felt like a betrayal. And I would show up as early as I needed to to re-write the entire script by hand in large print.  I hadn’t learned how to vocally advocate for myself yet in a way that didn’t feel angry or demanding, so at times I flat out lied. I remember calling an audition hotline once using a different name and asked if someone who was visually impaired could get the script ahead of time to memorize.  I was told that they couldn’t because it would pose an unfair advantage over the other actors.

Why CART in Government? by Martha Galindo at CCAC In Action:

1. Good government leads the way for all its citizens by setting best standards for equality and inclusion.

2. To reduce discriminatory gaps which now still exclude many able citizens (who happen to be deaf, deafened, or have a hearing loss, or who need quality text for many other good reasons) from regular and important government meetings, workshops, rallies, advisory committees, and public input to city, state, or federal bodies.

Lene Anderson at The Seated View: Disability Time

So there I am, sitting in the waiting room a full hour and half before my appointment and although I had a book, I was annoyed, so instead I started thinking about Disability Time. You don’t find it mentioned much in Google in the way it’s used in the disability world, but maybe some day, it’ll make its way into search engines. Disability Time refers to the way in which most things take much longer when you have a disability. There is personal Disability Time, as in it probably takes me double the time to make a cup of hot water in the microwave that it would you and then there is the Disability Time that’s imposed by others and there are a couple of those.

Donna Jodham: Out of sight out of mind

A few months ago I had a meeting with some officials of a financial institute to discuss making more financial planning services available to blind and sight impaired persons and at that time I raised the issue of making information available in alternate formats such as Braille, large print, and electronic text. To my chagrin but not to my surprise, the officials admitted that they had never thought of doing so. I also had a similar meeting with a major supermarket chain in Toronto to discuss making their weekly specials more available to their blind and sight impaired customers either online or through a phone service and again, I was told that this had not been thought of up until now.

Claudia Dreyfus for the New York Times: A conversation with Julian L. Seifter, Nephrologist and Patient. It’s an interesting interview with a physician, Dr. Julian Seifter, who just cowrote a book on living with chronic illness.

Q. Has being a patient helped you be a doctor?
A. I’ve certainly learned things I’ve brought back to the clinic. I have a retinopathy, for instance, which can be a complication of diabetes. I don’t have good vision in my right eye, as a result. When this first happened, I said to my ophthalmologist, “I can’t lose vision. I need to read.” And he said, “Any vision is better than no vision.”
That was important. I started thinking, “Concentrate on things you still can do and develop some new things.” I’ve since started gardening, which doesn’t require the most acute vision. It’s something I probably wouldn’t have done otherwise. I counsel my patients to replace what they’ve lost with something new.

Send your links to recreading[@]disabledfeminists[.]com. Let us know if/how you want to be credited. And have yourself a fabulous weekend.

5 Ridiculous Big Pharma ads

I have an ongoing peeve that relates to medication and social attitudes surrounding it: often, for some people on various sides of the political spectrum, trashing Big Pharma translates into trashing people who use prescription medications at all, for a variety of health conditions — especially for chronic conditions, both of the mental health and physical varieties. As a woman with multiple disabilities — a few of which require me to be on medications manufactured by Big Pharma (OOOOOH, SCARY) — I am not, how shall I put it, too excited about this. It’s really nice that stereotypical Extremely Naive Hippie Liberals and Rugged, Anti-Government Bootstrapping Conservatives can, theoretically, bond over how much they mutually hate those of us who take medications for legitimate medical reasons — but even those of us who, normally, would like and/or encourage all of this talk about “building alliances across the [political] aisle” have limits.

In short, there are a lot of things for which you can take Big Pharma to task without also treating the people who depend on these medications like total shit. One of these things is advertising and direct-to-consumer marketing, at which Big Pharma seems to be really quite good! And by “good,” I mean totally ridiculous. Let’s take a look at five different ad campaigns that should never have left a pitch meeting, much less been made with gargantuan budgets, professional actors, and voice-overs that calmly inform the viewer/listener of possible side effects.

5. Cialis: Yes, the one with the make-out music in the background and the couple sitting side-by-side in the bathtubs out in a meadow or something. Why is it so difficult for these folks to find a tub big enough to fit them both?

4. Uloric: Granted, this one may not be as ridiculous as some of the others on this list, but the visual of a dude carrying around a giant beaker of green liquid (which looks suspiciously like it should be in some sort of fancy alcoholic drink that costs upwards of $7) is pretty bizarre, as is the voice-over that helpfully informs viewers that side-effects may include flare-ups of the very condition that Uloric is used to treat. This might be the entire point of the ad, though; since Uloric is a medication intended to help with Gout symptoms, wouldn’t it be more accurate to have the guy wear shoes to which giant beakers are attached? Perhaps we could see a live-action depiction of the 16th-century drawing included in the Wikipedia article on Gout, instead of a guy with a big beaker of neon-green energy drink? That would be awesome, and might get the Gout-is-horribly-painful-and-this-medication-could-help message across in a way that actually makes sense.

3. Lyrica: Every time I see this one, I want to yell at the TV, particularly when the one featuring the classy middle-aged lady who bakes bread has somehow made its hellish way into my precious rerun of Dirty Jobs or another show that I don’t like to admit to enjoying. The actress in this ad pronounces “Fibromyalgia” like it’s a seasonal root vegetable or something (like “FYE-bro-MY-al-GEE-AH”) and all I can do is give the television my most hateful death glare. Oh, and even better is when she says that “My doctor diagnosed it as FYE-bro-MY-al-GEE-AH muscle pain,” and I want to scream, “Lady, IF YOU KNEW what fibro was actually like, you would not be saying that. You would probably be in too much pain on some days to do very much.” Or baking loaves of crusty bread en masse, for that matter. As someone who’s dealt with fibro for the past few years of my life, I only wish I had enough energy to bake many loaves of bread, like the woman in this commercial. Sweet, delicious carbs might help my pain, or at least give me something to focus on other than constant pain and fatigue.

2. Cymbalta: My personal favorite moment is when a kid runs up to hug the woman (presumably a relative?) and the camera focuses on her face, and she just looks so sad that the explanation just has to be terrible acting (or depression, according to the good folks at Eli Lilly). Depression’s symptoms are much, much more complex than walking around looking like the emoticon for sadface [🙁], but you wouldn’t know it by watching this commercial. I think someone should make a parody of ads like this, except that some other person approaches the woman, tells her to “Snap out of it,” and then the woman gives that person the finger–or, more accurately, gives them the 😐 face, because that is what certain aspects of depression make you feel like doing. You’re not only sad all of the time, but often you feel too hopeless to respond to people’s asshattery when they feel the need to comment on your depression and/or tell you that you Just Need To Buck Up.

1. Viagra (“Viva Viagra” spot): Truly the stuff of nightmares. The first time I saw this ad, I was awake at 3 or 4 AM due to pain (go figure, right?) and thought I was hallucinating when the opening chords of “Viva Las Vegas” started up in the opening seconds of this ad. I was, at first, confused as to what that particular song had to do with a medication used to treat erectile dysfunction. And then four middle-aged dudes–one playing a guitar–appeared on the screen and started to sing “VIVA VIAGRA!” to the tune of a song that most people associate with Elvis Presley, or any buddy comedy that has some sort of drunken Vegas montage. If you’re sure that this one won’t give you nightmares, I urge you to find it on YouTube, because it must be seen to be believed. Unfortunately, it’s been replaced in recent months with 30 seconds of yet another middle-aged white dude driving a car around in the dark. The penis = car association makes more sense than hanging out with your best buds and singing about Viagra, I suppose, particularly if you know anything about psychoanalysis.

Readers, what are your least favorite Big Pharma ads, and why? Short descriptions (and links to videos, if you have them) can be helpful for people who may have not seen the ads; please include them, if possible, so that we may all share in the unintentional hilarity.

Thyroid Cancer Treatment Affects the Abled, Healthy. Everyone Panic!

I have a little bit of a problem with people being handed down a mandate that insists they behave in a certain way or adhere to a certain set of guidelines for which they are not provided the means to do so. Usually, these rules or mandates are set by people whose lives the rules will never affect. I see it all the time here on the Garrison — rules that restrict the lives of military spouses set by Upper Brass who wear uniforms and sit in offices all day being briefed by people who don’t have to figure out how to tote around a couple of toddlers, diaper bags, strollers, car seats in case they might need a taxi while running to appointments, getting groceries, and picking up or dropping off older children at school without having a vehicle. I recently witnessed it in hospital policy regarding patients on long-term controlled substance use (something I should write another post about, eh?) — a pharmacist notices a patient prescribed a certain medication for a certain length of time, alerts a committee who sends out a generic letter triggering a “Single Provider” program without anyone actually meeting the patient involved.

Now, I read that a Congressional committee has noticed that patient being treated with radiation for thyroid cancer have been possibly exposing other people to, yes, radiation.

Well, let’s think about this for a moment. In the past, people who had thyroid cancer and who were insured and who were given this treatment were allowed a hospital stay so that the very strict regimen of sterility could be followed without putting extra strain on the patient. Then, someone got an itch and decided that it was just too costly to keep this up and that these leaches could just go home and do their own laundry every day. Not to mention, I am not sure what they are supposed to do with their garbage, how they are supposed to quarantine themselves from their families if they don’t have separate wings in their homes to live in, or how they are supposed to get home if they are weak from treatment and live alone.

The new regulations are supposed to discourage patients from taking public transportation, from staying in hotels, and from a whole slew of other things that really don’t take simple practicality into account. I think we can all agree that not exposing people to radiation is all around a good idea. I have no idea how much we are talking about, and the hyperbolic pictures of HAZMAT masks on the paper edition article I read didn’t help, but it must be significant if it is causing such a stir. Though, spokesman David McIntyre says it is “unclear” if the levels are harmful.

I remember getting a bone scan a few years ago and the tech had to wear a suit, and the dye they injected into me came in a lead tube. I was told I had to avoid metal detectors and public transit for a few days and was given a card to show that I was recently injected with radioactive substances. But I was a single mother, and a sailor, and I had no one else to help me out. Back to work I went, showing my card to security, who walked me through the non-metal detector way. I picked up my kid from daycare later, and drove myself home. I imagine that someone who has no support system who might be in a similar or worse situation would have to make similar decisions. So, I can see how people would disregard directions to go straight home.

Perhaps home is a day’s drive. Perhaps home is filled with young children and has only one car available. A hotel and train ride might be the only option, since the loosened restrictions mean that insurance will not pay for a hospital room that is no longer required. Or perhaps there is no insurance at all, and it was all a patient could manage to scrape up the cost of the treatment in the first place. There are so many reasons that these restrictions are not being followed, and I feel like this article, this committee, and this investigation are looking more at the people who are ‘violating’ the rules and less at the systemic problems that cause them to do so.

So, yes, those poor, unsuspecting people who have fallen victim to the carelessness of these cancer patients who have been so selfish to expose themselves to the world are who we should be focusing on. They are the true victims here, not the people who are trying to get healthy again, whose bodies are fighting cancer, and living with poison in them, and who are also now having to deal with the extra burden of a cumbersome set of rules of conduct for how to navigate live with a poison inside their bodies. The conversation is not, nor never is it, about them, but about the people around them whose lives are affected by their treatments, the ways those treatments impact their lives. All about the abled body, never the chronically sick or disabled unless it somehow affects the healthy and able.

Unless Congress is willing to establish a way to provide a place for these people to stay — all of them — I don’t see how a more enforced set of restrictions is reasonable. You can’t force a person to stay in a place they have to pay for against their will, and you should not be able to punish them because they had to use the resources available to them to survive.

These are just my own personal musings. I, of course, have no personal experience with these situations, but I grieve at the idea of restrictions that people might not be able to handle through no fault of their own.

I wonder if Representative Edward Markey (D – MA) and the Subcommittee on Energy and Environment are interested in hearing any of our thoughts on this matter while they re-think the policy.

Recommended Reading for 17 September, 2010

Gentle reader, be cautioned: comments sections on mainstream media sites tend to not be safe and we here at FWD/Forward don’t necessarily endorse all the opinions in these pieces. Let’s jump right in, shall we?

From BBC’s Ouch, by Charlie Swinbourne, Deaf country life v deaf city life:

I’m soon to become a Dad for the second time, so we’ve started thinking about the long term, and where we want our children to grow up. With houses on the pricey side for anything bigger than a shed in our area of West London, we’re currently wondering whether we’d be better off bringing up a family outside the city. […] The capital is full of opportunities for deaf people, with weekly deaf pub meets, regular events, accessible cinema and theatre performances, and numerous deaf centres and sports clubs.

Badgermama presents Kids and wheelchair manners:

Please stop yelling at your kids just because they’re 20 feet away from a wheelchair! Nothing bad is going to happen. It really pisses me off when someone grabs their kid, yanks them “out of the way” and yells at them, just because I’m in the same grocery aisle or on the same sidewalk. Usually, the kids are nowhere near me. All these people are doing is teaching their children that people in wheelchairs are scary and weird.

Some good news from ysobel of i hear the voices when I’m dreaming in *sags in relief*:

So, there’s been this whole saga with trying to get a ramp to the front entrance of our church, made vastly overcomplicated by the fact that the church is a designated historical site blah blah blah. […] The church appealed to the city council, who had it on the agenda for tonight, after several postponements on their part.

Leah at Cromulent Words writes You Can’t See My Pain:

You don’t see me not talking about disability in class because I’m fraid of being silenced again. You see someone who doesn’t care about the assignment.

At random babble…, our own OYD writes Medical Autonomy Chronicles: The Virgin Pap Smear (do be warned, it’s graphic):

For all the talk of how having sex outside of marriage or whatever message had been pounded on me for however long, and how it would leave me hollow and leave me feeling worthless and damaged, and for all the ways I had been told that casual sex would leave me reeling and feeling depressed and with a hole of missing self-esteem, nothing I did in my consensual sex life has ever compared to the way that pelvic exam and pap smear felt to me, a fourteen year old girl. A person rising on the crest of womanhood, not yet there but ready to fly, and having had myself violated before I took my first steps.

Send your links to recreading[@]disabledfeminists[.]com. Let us know if/how you want to be credited.

Reactions, part 1

[Warning for somewhat graphic discussion of medical procedures and adverse allergic reactions.]

I have been dealing with weird, severe, and inexplicable allergic reactions since the age of 14.

Most of these reactions have been to food items; my known food allergies include peanuts, various tree nuts, and (wait for it) green bell peppers. Of course, I take great caution to avoid these foods and my exposure to them. Unfortunately, with my immune system, such caution is no guarantee that I won’t have an “attack” out of the blue.

The first “attack” I had, in fact, was one of those not caused by food. I was a teenager at the time, in Paris on vacation with my family. I don’t remember much about my initial symptoms other than I felt overly-warm very suddenly, and decided that it would be a good idea to take a cold bath in order to rectify the situation. My mom found me in the bathroom of our rented apartment, facedown on the tile floor and missing several items of clothing. I had figured, somehow, that putting my face on the tile floor as a method of cooling down would look less weird than sticking my entire head into the freezer. My face, which had initially turned bright red, swelled up so much that I soon found myself unable to see. I had quickly begun to resemble the Bob’s Big Boy logo; I should note here that if you ever start to resemble a famous food-related logo, you should probably go to the nearest hospital post-haste.

My Bob’s Big Boy transformation was quickly followed by giant, blotchy pink hives that appeared on my neck and shoulders. Joining the party somewhat late was a hot, almost volcanic feeling in my lungs that quickly morphed into breathing trouble. Severe breathing trouble. So my family (my mom, my dad, and my younger brother — who suggested that I not look at myself in any reflective surface so as not to become more freaked out) and I took to the streets of Paris in search of a hospital. We found one — after a quick visit to what we thought was a hospital but which actually turned out to be a convalescent home. At the ER, the staff took one look at me and immediately put me at the front of the queue; I was quickly whisked away to a magical land where a nurse tried to calm me down, completely in French, when I loudly protested the insertion of a large IV needle into the underside of my forearm. The only English-speaking doctor on staff, as it turned out, was on his day off, but came in to examine me and assure my family that I was going to be okay.

When we came back from vacation, I had another attack about a month later. And then another. And a few more, until one ER doctor suggested that I get a full round of allergy tests, more commonly known as “scratch tests.”  The scratch tests revealed a substantial peanut and tree nut allergy. I took care to avoid these foods, or any foods that may have come into contact with them. Unfortunately, I still kept having attacks, even when I avoided the dreaded peanuts and tree nuts. I still have them, approximately once every 3-4 months.

Sometimes, I get them as a result of cross-contamination if I eat at a restaurant. Sometimes, I get them for no reason at all — even if I haven’t eaten for a while. The symptoms tend to be fairly consistent: first, a scratchy feeling will start in my throat and lungs, followed by wheezing. Then comes breathing trouble, which tends to feel like an elephant is standing on my chest. Usually, my eyes will then swell up to the point that I cannot open them all the way, or see. Sometimes, I get gastrointestinal trouble as well, the symptoms and signs of which are not things that I can discuss in polite company due to general grossness and/or TMI.

The first five to ten minutes of these attacks are, generally speaking, the worst part(s). By now, my battle plan for dealing with these attacks is well-established: Take a shot or two of my inhaler at the first signs of trouble (usually breathing difficulties plus another symptom), then four or five antihistamine pills. Of course, it takes a few minutes for these things to kick in, which is part of why the “waiting” part is so physically painful. During these first few minutes, I am in some sort of hellish allergy-limbo: it feels like someone or something has put some bricks on my chest and torso, I can’t see or can barely see, and it feels like my intestines are being vacuumed out of me — and the only thing I can do is wait for the medication to start working. I generally consider myself to be a patient person, but nothing will sap your patience like having to wait out a potentially life-threatening medical emergency.

And if that doesn’t work, I have to go to the next level, which is using epipenephrine, a self-contained steroid shot to be injected into the thigh in case my breathing is so severely compromised that I pass out or am in danger of not getting enough air into my lungs.

For these sorts of attacks, there is really no pat, inspirational or life-affirming end, so much as a screeching halt after the medication actually starts working. And this total lack of inspiration or an end in sight is also reflected in some of the responses I have gotten from many abled people in regards to my “allergy issues” (to be addressed in part two).

Pap smears, fat-shaming, and the lithotomy trap

[X-posted at Hoyden About Town]

So I’m sitting watching the evening news, and on comes a chap telling us women and girls that we oughtta go and get more Pap smears. Then on comes a woman to talk about how Pap screening rates are going down in young women, and to speculate about possible causes for this. The cervical cancer vaccine comes up, as does the “awkwardness” of the test, and our inappropriate embarrassment, which we apparently need to get over.

What I don’t hear addressed in the mainstream media in these discussions of Pap screening? Well, lots of things, like heterosexism, and ignorance about Pap age/sexual experience guidelines, and sexual assault (inside and outside the medical system). However, the one that really stood out in my mind today is also a factor that isn’t going to be fixed by lecturing women. Fatphobic abuse in the medical system.

There has been a fair bit of talk around the feminist traps about some of the other factors, especially the aftermath of sexual assault and its effects on medical interactions. I’m not going to go into that in this post, but it’s a huge, huge issue. What I would like to talk about for a moment, not because it’s more important but just because I have a first-person anecdote, is medical fatphobia.

We know fatphobia kills. In all sorts of ways, in all sorts of settings. And one way in which it can kill is the horrendous tendency of doctors – quite a few doctors, from the stories I hear around the place – to trap women and girls on their backs so that they can shame them while they’re vulnerable. And what they don’t realise, or don’t care about, is just how long-lasting the effects of this can be – and not in a good way.

Medical education materials abound with motherhood statements about ‘Preventive Medicine’ and ‘Lifestyle Intervention’ and ‘Opportunistic Behavioural Education’. General practitioners are exhorted, over and over again, to take any and all opportunities they can to tell people they’re fat. Really, over and over. And OVER. And doctors, labouring under the mistaken impression that this will cause said people to magically become skinny and therefore ‘healthy’, go ahead and do it, then smugly boast about it between themselves, sighing about how no-one ever listens to them. Or, perhaps, under the impression that they can then self-satisfiedly sit back and tick a box on the chart about how they’ve engaged in initial Lifestyle Education, which they learned all about at the last Lap-Band seminar.

Medical education is a powerful, powerful matrix of fat hate, based on the twin premises that telling people they’re fat is (a) helpful and (b) harmless.

So let’s talk about how that plays out in practice:

When I was 19, I had a Pap smear. It was my first. I went to the nearest available doctor, who worked in a setting where they dealt with a late of people in late adolescence and early adulthood. I wasn’t particularly concerned about it; a very little vague unease at the unknown, but no particular trepidation. I didn’t bother taking anyone with me, and I just booked the appointment in between other things I had to do, like med school classes and whatnot. And off I went.

I got my Pill script, had my BP taken, then assumed the position. And the doctor came up into his position, as they do, then stopped.

He looked at my thigh. “Not quite the right spot,” I thought, “but hey, he probably knows what I’m doing more than I do.”

Then he touched my thigh. Around the middle, underneath (in lithotomy position).

Then he JIGGLED IT.

He jiggled my thigh.

And then he grimaced.

And then he did the Pap smear. I was frozen, completely unable (by my inexperience, position, and by general medical disempowerment) to say anything.

And then I fled.

Was I ‘traumatised’? I didn’t have nightmares. I went and got my next Pap smear dutifully, largely because I really didn’t have any choice – no Pap smear, no Pill script. (Ask me about contraceptive hostage-taking! You know you want to!)

But every time I get a Pap smear, every single time, even now more than twenty years later, I see his face. I see him jiggling my thigh with that look of disgust. Every time I lie down and spread my legs for the speculum, I am reminded of exactly how repugnant my body is.

My first impulse is to tell you exactly how fat I wasn’t, back then. To tell you that it wasn’t ok for him to do that because I was physically fit at the time. To tell you at length about how my aerobic capacity was at the 95th centile, that I could do a hundred pushups, that I could swim a k without stopping, that I was beating my fit male friends at squash, that I was getting State medals in my chosen sport. But that’s all irrelevant – because fat-shaming isn’t ok for people who are actually fat any more than it’s ok for people who aren’t. Fat-shaming doesn’t get a pass when it’s limited to people as fat as I am now, or twice as fat as me, or whatever. Fat-shaming isn’t bad because it’s directed at inbetweenies as well as at fat people. Fat-shaming is harmful for EVERYONE. Fat-shaming is not.ok.

As long as some doctors keep seeing lithotomy position as a prime opportunity to ladle on the shame, girls and women are going to avoid Pap smears. So hey, ball’s in your court, medical profession. Fix it. Get your own house in order, and meanwhile, stop telling US we’re the ones doing it wrong.

A.I. spotlight: Keepon and Paro

At the risk of understatement, exciting things are happening when it comes to robotics and artificial intelligence and the potential applicability of these fields in the lives of PWDs.

[Description: A small, bright yellow robot with two eyes and a black nose stands in front of a white background. Outlined in orange and bright blue, the robot leans slightly to the left while it sits atop a small black pedestal]  Image courtesy of this page on the CMU website.

The little ‘bot pictured above is Keepon, developed by Hideki Kozima and Marek Michalowski at Carnegie Mellon University’s Robotics Institute, located in Pittsburgh, Pennsylvania. Keepon’s purpose is to interact with children with emotional, neurological or sensory processing disorders, and who otherwise may have difficulty interacting with other children, relatives, or caregivers. However, Keepon has become something of an internet sensation in recent years, most notably when a 2007 video of the robot dancing to Spoon’s “I Turn My Camera On” became extremely popular on YouTube, and inspired a Wired Magazine-backed promo video for Spoon featuring Keepon. As this 2008 excerpt (accessibility warning: video is not close-captioned) from Discovery Channel’s show “The Works” demonstrates, there is quite a bit of potential for Keepon’s original purpose; it may be cute (and a great dancer), but the potential for this sort of technology to help children with disabilities is worth further exploration.

A New York Times article from this past July, written by Amy Harmon, discussed another A.I. creature, Paro, which is made to resemble a seal cub. Paro was first developed by Takanori Shibata, a researcher working at Japan’s national science institute AIST.  The NYT article describes Paro thusly:

Paro is a robot modeled after a baby harp seal. It trills and paddles when petted, blinks when the lights go up, opens its eyes at loud noises and yelps when handled roughly or held upside down. Two microprocessors under its artificial white fur adjust its behavior based on information from dozens of hidden sensors that monitor sound, light, temperature and touch. It perks up at the sound of its name, praise and, over time, the words it hears frequently.

The whole article is worth a read, as it covers the success that some senior residential communities in the U.S. have had with using Paro as an assistive device — sort of akin to animal therapy without an actual animal (which might cause problems for, say, residents with allergy issues) — for some residents.  There is also a video at the NYT’s website (unfortunately, sans transcript) that shows Paro in action. The article also discusses at length some of the benefits of this sort of technology, as well as some of its limitations.

Of course, Keepon and Paro are only two examples of the amazing possibilities of artificial intelligence, and it remains to be seen as to whether this technology — which, like many new technologies, currently comes with a rather hefty price tag — can be made more accessible to people or organizations that cannot afford to pay $6,000 U.S. for a Paro. Hopefully, these A.I. breakthroughs will not be as pricey in the future, and will be made accessible to a wider variety of people — including PWDs.

…And At This Point, I Don’t See It Stopping Anytime Soon

Courtesy of amandaw I bring you this stellar article that once again rubs in my face how brilliantly miserable the VA is scratching the surface of realizing what is wrong with they way they even see women veterans. If you read along carefully you can even see the lightly sugar-coated condescension artfully woven in TIME writer Laura Fitzpatrick’s story. It really is a piece of work, from the dismissive way she re-counts the testimony of the “presumed” treatment of a victim survivor of sexual assault at the hands of a medical professional (because they NEVER do THAT) down to the detailed description of the very girlie attire of the staff at the impressively mostly women-run facility in Palo Alto. I crave to read the way a man’s shoes click-clack on a hospital hall’s floors in such a manner. But it is a very cliche description etched in the halls of descriptive-writing history, INORITE, so who am I to argue with the laws of good writing. I am, after all, only an amateur.

The news isn’t that the VA is failing women veterans. I’ve known that for quite some time. Really, I have. I have encountered some of the treatment described to some degrees first-hand:

I remember having to hunt around for a toilet in an ill-fitting paper gown at my own exit screening, past several other open, occupied exam rooms. I was the only woman there. They had no sanitary napkin to offer me and it was an embarrassing scene trying to find a place where I could insert a tampon. I was fighting back tears when I finally found a (presumably) unisex bathroom.

So My Dear Friend Ms. Fitzpatrick’s dismissal of Anuradha Bhagwati’s story, the one she gave as testimony before the House Committee on Veterans’ Affairs is ill-received. It isn’t too far-fetched for me to imagine the way she recounts “the ham-handed manner in which a male gynecologist, upon being told by a patient that she had been sexually assaulted, left the exam room and — presumably to beckon a female staff member — yelled down the hall, ‘We’ve got another one!'”. I can easily see the inept professionals at the inadequate facilities just stumbling over how to even grasp a way to provide basic courtesy to a patient who isn’t like them. And failing. Miserably.

The news here is that they seem to have no idea how to fix it, and no set, immediate time line in mind for seeing progress. Sure, Secretary of the VA, Eric K. Shinseki recently, at a forum at the Women in Military Service for America Memorial in Arlington, Virginia, has said that he hopes to have the VA ready to serve 100% of veterans in 25 years, but what is going to happen to this generation of women veterans who are already being ignored? To the women veterans of the wars past who have been fighting for help all along already?

Because their concerns are already being swept aside. You can already see as things like their urinary-tract issues being categorized as simple “gender differences”, because women react to the desert differently. Sure, possibly. I’ve seen this intimated a few times. People looking to explain away womanly behavior in high stress situations. Oh! They didn’t want to stop the convoy! Well, why is that? Maybe because we know that women are far more likely to be killed by their fellow servicemembers than by combat in combat zones that they learned defense mechanisms, as confessed to by Col. Janis Karpinski. Women tended to drink less water, as little as they thought they could get away with, to avoid using latrines or having to stop roadside alone with men out of fear of sexual assault. And it killed some of them. If you remember, though, Karpinski was even dismissed as a woman scorned because of the Abu Ghraib scandal, anyhow, so we can’t win for losing. She was just ratting out her old boss because she got in trouble.

Some of it is true, though. Most of the VA’s 144 hospitals do not have the proper facilities to even offer privacy to non-men patients, let alone provide gynecological care, or as I mentioned above, pads. The TIME article notes a hospital in Salt Lake City which announced that it delivered its first baby this past October (the article mentions that its average patient is 78 and male), but the day after the little girl’s arrival they didn’t know how much she weighed (I cringe to think how much more they couldn’t provide) because they didn’t even have an infant scale.

Women veterans are spiking in numbers. They, funnily enough, are not the same as men. That means they are not the same as the average patient, such as that the Salt Lake City hospital are used to dealing with, and their health care with be different. Even if you line up the matching parts, the treatment for heart disease and blood pressure, to my lay knowledge, is not the same. The numbers have been growing since The Great War, and surged after we had the need to call the next one World War II. It took until 1988 for the VA to start providing even limited care to women veterans.

Today, women veterans in need of help from the VA are of an average age far younger than the average male veteran (for obvious reasons) and have different needs. They are at least twice as likely than civilian women to be homeless (with only 8 facilities in all the U.S. available to help homeless women veterans with children). They are likely to be mothers when they are. Many of them returning from combat zones — yes, combat zones, why do you ask? — are coming home to families and are more likely than their male counterparts to get divorced following combat connected tours. They are really damned likely to get asked if that is their husband’s or boyfriend’s shirt they are wearing, or asked for their husband’s social by a thoughtless agent on the phone. They are the forgotten in war. Doubly so if they served in a branch of the military that isn’t on the forefront of the public’s mind as “really the military” (as slave2tehtink has said, Aircraft carriers tend to not be zipped around by civilians, yo). Extra-specially so if you had a thinkin’ job, like “nuke” or “spook”, and your Traumatic Brain Injury (TBI), Post Traumatic Stress Disorder (PTSD), or Military Sexual Trauma (MST) didn’t happen “In Country” (Iraq or Afghanistan), the only sanctioned places where these things can occur, you know.

It’s frustrating as hell. And while I don’t believe that the VA is intentionally forgetting about us, I don’t believe that they are doing everything that they can to make sure that it gets better faster.

And honestly, I don’t think writers like Ms. Fitzpatrick are helping. But maybe I am jaded and have been at this for too long. But the VA needs an overhaul, stat. Pretty words from the Secretary of the VA and promises that it will be better in a couple of decades just aren’t good enough.

Why am I surprised by this?

To begin, rather pithily: I have had very mixed experiences with medical professionals throughout my life. Some have been fantastic. Some have been middle-of-the-road. And, as you might expect to hear from a person with a chronic pain condition, some have been absolutely awful.

Recently, I had a fantastic experience in a consultation with the oral surgeon who will be — at the time of this writing — removing the three wisdom teeth that I have in my skull [note: by the time this post is up, I will be recovering from the surgery and therefore on a bit of a break from blogularly goings-on]. Given my past experiences with medical professionals, I was not optimistic going into the consultation. I have a pretty spotty history when it comes to dental sensitivity, have been labeled an “anxious” patient in the past because of said sensitivity issues, and thus have a mountain of concerns about surgical procedures because of the medical conditions that I already have — cerebral palsy and fibromyalgia among them.  I was fully expecting that the surgeon would either minimize and perhaps outright dismiss my concerns during this appointment; worse, he might actively resist giving me anything other than over-the-counter pain medications for what is known as being a very painful procedure, as fibromyalgia patients seem to have a reputation as being “drug-seeking” among some people in the medical community and in the popular imagination at large (to say nothing of the ridiculousness of getting one’s wisdom teeth removed as a method of obtaining prescription drugs).

Interestingly, this was one of those times where I would be happy to be wrong. The oral surgeon not only explained the actual procedure to me in great detail, but listened very patiently to my concerns about possible issues due to increased pain (possibly relating to fibro, as it tends to flare up after any medical procedure that involves high doses of medication that I do not normally take) and muscle spasms (that would be the cerebral palsy, which has left me with muscular weakness on the left side of my body and occasional spasm attacks in my left leg). He also asked many questions about both the fibro and the CP, and reassured me that he and his staff would watch for things relating to each condition that could possibly occur during and after the procedure.

This consultation — and the oral surgeon’s taking my concerns so seriously — was a welcome break from the fighting-an-uphill-battle-with-my-bare-hands sort of feeling that I’ve gotten from some past medical and health-related consultations. I am, of course, of the opinion that these sorts of positive experiences should not be this unusual, and that they apparently are so unusual gives me pause for a myriad of reasons.