Tag Archives: health

Scoliosis

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At the age of 49 I was diagnosed with scoliosis. Scoliosis is normally diagnosed far earlier in life. My scoliosis is not some sort of weird adult onset type. In fact my neurosurgeon pointed out evidence on some of my spinal images that showed how long it had been there, but I am getting ahead of myself.

I can remember in junior high when everyone had to go to the gym in shifts, separating the girls and the boys, to be checked for scoliosis. My maternal grandmother had scoliosis, so I was at increased risk, yet it was not caught when I was young. I have never had good posture, but now I look back and wonder if my bad posture was really a symptom. Now, sitting with really bad posture is a mechanism to avoid pain. Basically curving my back puts the spine in an alignment to relieve the pressure, I now realize, based on the x-rays.

I have had back pain for so long that I don’t even know when it started. It has been increasing in pain level and consistency though. I can remember what was my first attack of sciatica and related muscle spasms. It was about twenty years ago, and I was in graduate school. I was having serious nerve pain in the hip area, and I went to the student health center. The physician prescribed a muscle relaxant and pain meds. I went to the bathroom while I waited for the pharmacy to fill the prescription. When I tried to get off the toilet, the muscle spasmed with such intensity, I was not sure when or if I could stand up. I finally did. I didn’t need the pain meds really. I just needed the muscles to stop firing.

Since then, the back pain has gotten worse, and a variety of others issues have come about. Several years back frustrated by the constant back pain, my physician prescribed physical therapy. I needed to build my core muscles I was told. A physical therapist pressed on my back in places trying to get the muscles to release. The muscles generally refused to release, and I give the physical therapist the benefit of the doubt that she never pressed in the correct location to feel my spine in the not correct location.

A couple of years ago, I started having hip pain. My physician sent me to an orthopedic specialist, who ordered x-rays. Sadly the x-rays were aimed at my hips and just out of range of the lumbar region of my spine. Another missed chance to see the scoliosis. The specialist said I had IT band syndrome. Basically I was walking funny because of my back pain and/or sciatica, so that caused the hip pain. I just needed to stretch the IT band, and I would be fine. He said I needed more physical therapy. I declined to go because I had been there, done that.

For years now, I see a dermatologist annually for what she calls “mole patrol” to check for any signs of skin cancer or other issues. She checks my entire body. I give her the benefit of the doubt that they way I lay down on my stomach while she checks my back does not make the spinal deformity obvious. I have had physicians and nurses on countless occasions listening to my lungs with a stethoscope. I get annual physicals. I give them all the benefit of the doubt that they never noticed the spine out of alignment.

Two years ago, as I was once again pressing my hand to the part of my back that always hurts, it dawned on me that my back has a lump of sorts where the pain is. Why it just occurred to me then I have no idea. I am sure it had been there longer. Feeling around my back, and I know something is wrong. Is it my spine I wonder? The lump is such that when I lay on a flat surface, I cannot lay flat. My left side touches the surface when I lay flat, but not the right side. I go in for my annual physical and ask the physician. I hadn’t seen this physician but maybe once before because the physician I normally saw at the same practice had recently moved, and I needed a new physician. The new physician asks if I have scoliosis. I don’t know I say. She has me bend over and check my spine. No, she says, the lump is just soft tissue.

The coincidence of the location of the lump and my pain is too much for me to ignore. I am also slightly concerned that I have soft tissue lump on my back. Is this a giant cyst? I go back to the same practice but see a different physician. I explain the issue. She says, let’s just get an x-ray. The radiology report says “Some height loss at the right aspect of L1 vertebral body. Accompanying approximately 50 degree leftward curvature centered at L1-L2, accompanying advanced multilevel disc height loss, endplate degenerative changes. Mild wedge compression deformity of L1, with mild accompanying increased kyphosis.”

“Some height loss.” Did I mention I used to be 5’7″, but a couple of years ago during a physical they said I was 5’6″. I remember arguing that no, I was 5’7″. It never dawned on either the nurse, doctor, or myself why in my late 40s I had lost an inch.

So yeah, I have scoliosis. That’s the problem. The radiology report was a shock to say the least. My physician sends me to a neurosurgeon. He orders more images, more x-rays, CT scans, and MRIs. The radiology reports all agree on scoliosis, but some say 40 degree curve, and some say 50 degree curve. No matter which, it’s a lot. When I viewed the images with the neurosurgeon I started crying. They say a picture is worth a 1000 words. Seeing an image of my spine was somehow far more emotional, devastating, and hard to handle than reading a very clinical radiology report with lots of words that I had to look up. My neurosurgeon pointed out bone spurs on two vertebrae at the apex of the curve on some of the many images. The bone spurs formed to try to protect the vertebrae from rubbing against its neighbor he says. That’s how we know this scoliosis started a long time ago.

I used use a standing desk at the office. Until several years ago, I used to go for five mile walks. I used to go for 20 mile bike rides. I can’t anymore. I can barely walk more than a couple of blocks before the back pain starts. On my road bike, I have to stop after 15 minutes or so to stretch my back because of the way the road bike forces me to lean over in a manner that stresses my spine. At least my hybrid bike is better because of the way I sit in it. It wasn’t always like this. The back pain used to be on and off. Now it is constant. I used to run. Less than a decade ago, I ran fairly regularly, and in fact I once could run 10 miles. I was never fast, but I had endurance. Knee pain forced me to stop. Now I have to wonder if the knee pain was at least somewhat related to the scoliosis.

I feel like I have been gaslit by the medical community for at least a decade. For as many times as I have complained about back pain, the solution was always to lose weight and build my core muscles. I am overweight, but I eat a healthy diet, and I am very active. I exercise near daily. Elliptical machine, walking, biking, weight and resistance training, rowing machine, etc. At least I used to. There is only so much exercise you can do when the pain is so intense and constant. However, core muscles and weight loss was always the issue I was told. How much stronger did my core have to be before the pain ends? I am not even sure if they believed me when I said I work out every single day. Maybe they did, but they just didn’t care. More to the point, I will also never understand how the one physician could possibly feel the lump on my back and call it soft tissue. How can anyone, especially a physician, feel my spine in a completely incorrect location and not realize it?

My neurosurgeon said that with scoliosis of less than 30 degree, surgery may not be necessary. Mine is severe enough that surgery is really the only option other than “putting out fires” as he says. My quality of life is degrading to such a degree that I decided surgery was my only option. I want to be able to continue to travel. I want to be able to go for long walks or long bike rides again. Surgery is no guarantee that my quality of life will return to what it was a decade ago, but I feel like I have to take the chance.

My neurosurgeon and I discussed the surgery options. I agreed with him that the more invasive surgery is better if only because my spine is not just curved, it is also rotated, which adds more complexity to the surgery. He said there is a less invasive option, which divides the surgery up over two days, but he was worried with the spinal rotation, he still might have to go more invasive for the second surgery day. I agreed it was better to just do everything in one go with the more invasive surgery. Two neurosurgeons working on me at once for a surgery that will probably take six hours.

Surgery is tomorrow, and I am terrified. I am scared of dying. I am scared of becoming paralyzed. I am scared I will still be in constant pain. I am scared of going through all of this, and I can’t resume the life I used to have years ago. I am not afraid of months of physical therapy. I am just scared because there is no guarantees. I can’t do my engineering calculations with safety factors and redundancy to have a high degree of confidence that my design will work. I can only trust in a medical team because almost everything is out of my control. About the only thing I can control is donating two units of blood to myself in the past week and a half because my neurosurgeon said with the more invasive option I might need a transfusion. I donate blood on a regular basis. One unit of blood doesn’t really phase me anymore. Donating a second unit of blood to myself one week after the first, per the schedule given to me by the blood donation service, rather zapped me of my normal energy. I plan to tell my surgeon and anesthesiologist that even if I don’t quite need a transfusion, I would rather like some of my blood back.

I have been preparing for tomorrow for several months now. Pre-operative exam with blood tests and EKG. Autologous blood donation. More blood tests at the hospital. Now I type this blog post to try to sort out my emotions and keep myself calm because I am terrified. I really don’t want to have this surgery, but I don’t want to live the rest of my life with my quality of life rapidly decreasing with constant back and hip pain, sciatica, and who knows what else may start. I have to have faith. Faith in God, and faith in my neurosurgeons, anesthesiologist, nurses, and everyone else to fix me. God, please be with my medical team and make me better.

How I Spent My Christmas Vacation

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I remember in school when I would come back from Christmas break or it was the start of a new school year, and my English teacher would have us write a paper on what we did over our break. I have always assumed the entire point was just to get us to write. Here was a topic that surely everyone would have some material to use to write something. Generally a good assumption I suppose. I haven’t written a paper like that in a long time. Then again, it has been a very long time since I was in some sort of English class. However, this Christmas break necessitates me writing one, so here goes.

Normally for Christmas, I go to Houston. It is where I grew up. It is where my mom and sister live. It is where much of my larger family lives. However this year, we weren’t sure how much of the larger family was going to be there for Christmas, so my sister and I decided we should somewhere fun, with my mom of course. We ultimately decided to go to Baja California. We would spend a few days in San Jose del Cabo, then join a tour group that would take us to La Paz for a four-night cruise in the area. The cruise would be a tour company that we have traveled with before and we like. The cruise ships are small. This one had maybe 60 passengers or so. There tour company is on the higher end of price, but they do a first rate job with lots of naturalists and fun activities.

We made the decision somewhat last minute, so there were lots of things to get done quickly. The main problem was my mom’s passport had expired, so we all had stress that she could get it renewed in time. [They gave her an appointment a little to close to our departure date for comfort, but then she went in a Friday and had the new passport on Monday. They never said they could do it that fast.] Her passport renewed, we just needed to get there. I was so excited to get away. I was loaded with work that had to be done for my job, I was working overtime to get it done, then frantically packing, then finally the day came to leave.

Looking back, the passport was a sign of things to come. I got up at 4 a.m. to catch my flight. I had to change planes in Dallas-Ft.Worth (DFW), so I had picked an early flight to make sure I would make the connection and have time to eat. I caught my first flight that was supposed to leave at 7 a.m. We left the gate on time. Then we sat on the tarmac for 1.5 hours. The pilot came on a couple of times to say there was a maintenance issue, and they could not figure out is some maintenance had been done. They were on the phone with Dallas (presumably where the maintenance was supposed to be done), but couldn’t get it resolved. We returned to the gate. It wasn’t clear if we were disembarking, but a third of us got up to use the restroom. Very shortly after returning to the gate, maintenance had come on board and done whatever needed to be done, but then the pilots needed the log books back. Then we got the log books back, and finally we left over two hours late. Finally we are on our way.

Luckily I had packed a couple of protein bars in my purse. We arrived at DFW, and I went as fast as possible to my connecting flight. No time to stop for the restroom or buy some food. I got there on last call. I sit back and relax. I made it. I am on my way to Baja. I arrive in Cabo and meet my mom and sister, who arrived on an earlier flight. Amazingly my luggage made the connecting flight also. Also amazingly, my sister’s luggage did not make her direct flight. She and our mom arrived plenty early for their direct flight to Cabo. Our mom’s luggage made it, but hers did not. We all made it safely to Cabo though. The airline says it will deliver her luggage to the hotel the next morning, so at least she will get it before we leave for the cruise.

Before we even left, my mom was really worried about us getting sick from the water in Mexico. My sister and I are not really worried. We just won’t drink the water, and we are careful about the food we eat. We buy bottled water. We stay at this adorable, authentic hotel in center of San Jose del Cabo, which also supplies bottle water, and we all enjoy ourselves thoroughly. My sister’s luggage finally arrives the morning after we arrive. We enjoy some wonderful food. We all buy more stuff than we need. We all love the wonderful handmade goods we find, much of which we are told is from Oaxaca. We don’t get sick.

The second morning of our trip arrives, and it is time to pack, do last minute shopping, and get a taxi to the airport where we will join the cruise group. The cruise representatives meet us, take our luggage, show us to the nice buses, and give us more bottled water. Now we relax for the three hour drive to La Paz. Not very long after we leave the airport, an older woman on the bus goes to the restroom at the back and starts vomiting. We are near the back and can hear clearly. She vomits numerous times during the ride. I feel bad for her, but I try to relax, read, and enjoy the countryside.

We arrive in La Paz and board our U.S. owned, registered, and crewed cruise boat. The boat is on her maiden trip in Baja. It is just lovely. That night at dinner, we see the woman who was vomiting on the bus in the dining room. She appears to be better, so that is good. The next day we cruise in the area, and then we anchor near shore, where there is kayaking, paddle boarding, snorkeling, and hiking. I do some hiking. The scenery is beautiful. I am eager for the next day, when there will more shore time. I have brought a bunch of camera equipment including my tripod, and I hoping to have some fun playing with my camera. That night I talk to one of the photography experts on board, who is there to help guests with photography if they want it, and he says he can show me a couple of filters and such. Vacation is good.

That night the real trouble begins. My sister and I share and cabin, and my mom is in a cabin next door. My sister is up all night sick. I am fine though. The next morning, I find the ship’s doctor, who in his real job is an emergency room physician in the U.S., and he gives my sister some pills for vomiting and advice.

The next morning, we are snorkeling with sea lions. There is a small island (giant rock really), where there is a sea lion colony as well as birds and fish of course. There are a lot of rules, but you can snorkel (not allowed to dive) alongside the rock. The sea lions like to swim around the humans, and as we have been warned, like to naw on them also, like a puppy might. My sister is sick, but I go and have a blast. [Photos and more on that to come.]

After my snorkeling trip, I find out the reason I didn’t see my mom at breakfast was that she is sick also. The ship’s doctor has seen my mom already. I play nursemaid for my mom and sister getting them drinks and asking for some food to be delivered to their cabins. Later the physician starts on IV on my mom because she is so dehydrated. She is not in immediate danger, but he just wants to get fluids in her. I think he is worried more about her simply because she is older. My sister has stopped vomiting. However both my mom and sister are losing a lot of fluid to diarrhea.

Later, the ship arrives at another island, and I go ashore to do some hiking. I am not there for very long, when nausea starts. I fight it, but then I start really salivating, and I find the next Zodiac back to the ship. I know I am probably going to start vomiting soon. I get back to the ship and sit down to read. The nausea subsides, and then it comes back with a vengeance. Now I am vomiting. My sister by now is well enough to at least walk around the ship just a little, so she plays nursemaid to me. I vomit once again that night, but then my stomach calms. That night both of us (and my mom next door) are up with diarrhea. The next morning the physician sees me. I say to him, both of us knew I was going to get sick also. Yes, he agrees. He confirms what I have suspected that this is most likely norovirus. I learn a few other passengers and crew are also sick. He tells me what he had already told my sister, which is mainly to stay out of the dining room.

I spend the entire day in the cabin. Luckily we had a cabin with a little balcony, so I spend some of the day sitting on the balcony reading and watching the lovely landscape. My sister who has been walking around a bit and trying not to touch anything sees the hotel staff wiping all the railings on the ship. That night the hotel staff arranges for mom, sister, and I to eat in the lounge away from everyone else. None of us eat much, but we are well enough to eat a little bit of food. We talk with the hotel manager, and she says two crew members and one other guest are also sick. This seems to exclude what I am quite sure was Patient Zero, the woman on the bus vomiting. She says when we all disembark the next day, there will be extra cleaners brought on board to help the crew disinfect the entire ship.

The next morning we leave for the three-hour bus trip to the San Jose del Cabo airport. My mom, sister, and I are not completely well, but none of us are vomiting and the diarrhea has subsided for the most part. At the airport, my mom and sister hug me goodbye, and I board my plane to DFW looking forward to getting home.

The plane ride is uneventful until we start getting near Texas when we start flying near and through storm clouds. The ride is rather bumpy, and the pilot informs us we have to circle for a bit as there is a back up because of the weather. Finally we are cleared to land. We start our approach, the landing gear is down, and I am looking at Christmas lights on the house below and also getting worried about the lightening I am see in the clouds we are in. All of the sudden we start accelerating fast and gaining altitude. After a bit we are clear well above the storm clouds and not in them. The pilot informs us we are going to San Antonio. I never learned if the pilot or the control tower called off the landing, nor what the precise problem was (obviously the weather, but I mean the specific issue since we had lending gear down). We land in San Antonio about 30 minutes later. We join about 12 other diverted flights. We sit. We were originally supposed to land at DFW a bit after 5 p.m. It is after 7 p.m. now. We get refueled. We sit. The pilot gives us updates, but he doesn’t know what is going to happen either. I text my sister and find out they were diverted to Austin. They sat on the tarmac for 45 minutes before being refueled. [She later texts me they finally left Austin and landed safely in Houston.] Also while sitting on the tarmac, I call and email the petting company I use to get someone out to feed Ferdinand. Luckily they are fantastic and could and did even though by the time I called it was well after office hours.

Finally the pilot tells us the crew has reached the end of their duty tour and are not allowed legally to fly anymore. We are going to a gate and have to go through customs. We taxi to a gate and sit. They have to find a jetway operator. We disembark and go to customs. We wait for our luggage because I am quite sure there was no one over there to get it to us. We go through customs, and I wonder exactly how fast and how they got the customs officers there because San Antonio is not a bustling international airport, and I have my doubts that any international flight was expected. We are officially in the country around 10 p.m., and now we go stand in line for over two hours at the ticket desk while they patiently help us individually to get us to our final destination.

When I finally get to speak to a ticket agent, it is midnight. My connecting flight from DFW to DCA has already been cancelled, and the airline app helpfully informs me I have been rebooked on a flight, but it can’t seem to recognize that I am in San Antonio not DFW. I tell the ticket agent to just get me to the Washington DC area. We start with DCA and Dulles, but the earliest she can get me there is midnight of the next day (i.e. 24 hours later). She finds me a flight to Baltimore that gets in around 6 p.m. More inconvenient, but I take it because everything is booked with all the cancelled and diverted flights. She gives me a voucher for a nearby hotel as well as all my boarding passes.

I get to the hotel sometime before 1 a.m., and I am on a 8:45 flight to DFW. The airport promises to be a madhouse with all the diverted passengers as well as normal holiday travel, so I know I need to get up early. I think I got 3.5 hours sleep, but at least I got a shower and a little bit of sleep.

The airport is a madhouse the next day. My flight as well as a few others are considered to be the continuation of the flights from yesterday. They are not planned flights, so are not showing up on boards, and I have to ask to find my gate. I am fairly sure it is the same plane and crew. I arrive safely in DFW to a madhouse that made San Antonio look calm. DFW is packed. Everyone’s gates keep changing. Flights keep being delayed. Flight crews are just as confused as everyone else. I overheard a pilot say he was called to come fly this morning on overtime pay because he wasn’t scheduled to work, but he doesn’t have a plane or crew. Flights have crews but no plane. Planes don’t have crews or gates. Gate agents are amazingly calm even when it is clear they are just as much in the dark as everyone else. Electrical outlets are hot property. Restaurants are selling lots of alcohol.

I have three or four hours between flights. My gate changed at least two times. My flight was delayed by at least a half hour. I get lunch. I get to my gate, and blessedly finally, I get to board, and we are on our way to Baltimore. We are warned that we will hit turbulence over Tennessee over the same storm cell that reeked havoc yesterday. We do hit a little rough air, but nothing compared to yesterday. Finally, finally, I land at BWI at 6 or 6:30.

Just as wonderfully, my luggage arrives also. I find out how to get to the MARC trains (commuter train between Baltimore and DC) and make a mad dash to the train. I make it with about 10 minutes to spare. If I hadn’t made that one, I would have had to wait another two hours. I could have tried to catch an Amtrak train at that same station, but Amtrak is more expensive, and it could be sold out with the holiday travel. It is a over 30-minute ride to DC. Finally I arrive at Union Station. I get a Lyft. I get home. I have never been so happy to be home from vacation. Ever.

So how was your Christmas vacation?

Waterborne diseases

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I am still irritated by the one sided New York Times article on people who think “raw water” is better than treated water. I wrote previously about the various microorganisms and chemicals that can be found naturally in groundwater, but I wanted to expand a bit on water borne diseases and why we treat water. Not all water borne diseases are a result of microorganisms.

High nitrates in water can lead to blue-baby syndrome, more properly known as infant methemoglobinemia. Nitrates is associated with human-related water contamination, especially agriculture.

Arsenic occurs naturally in many groundwater sources. The United States Geological Survey (USGS) has mapped arsenic in groundwater based on a great deal of sampling. Arsenic in groundwater is particularly problematic in southeast Asia. Arsenic can cause cancer, cardiovascular disease, and skin lesions, among other issues.

Other naturally occurring metals and radioactive elements can be found in groundwater that can cause long term health problems. Groundwater and surface can also become contaminated from human activities with volatile organic compounds, pesticides, and other chemicals that you don’t generally want to ingest.

Then there are all the illnesses caused by microorganisms in water. According to the Centers for Disease Control and Prevention (CDC), the most common waterborne disease outbreak for 2013-2014 was Legionella, which I admit surprised me. Legionella causes respiratory illness due to inhalation of it, which is why it is normally associated with people inhaling the mist of cooling towers and air conditioning systems. [This is how it was first discovered and named when members of the American Legion got sick at a convention in Philadelphia hotel with unsterilized water in a cooling system.]

Most waterborne microorganism caused illness cause gastrointestinal illness though. Most people have heard of Giardia lamblia, which can cause diarrhea. There is Shigella which causes diarrhea, fever, and stomach cramps. E. coli is another common microorganism that can cause gastrointestinal illness found in both food and water. Cryptosporidium is a nasty microorganism that can cause illness. The reason I call it nasty though is because the parasite is protected by a shell that makes it particularly difficult to kill with disinfectants.

While luckily not a problem in the U.S., cholera, another waterborne disease, has killed many people throughout history. Yemen is currently in the midst of a horrible outbreak that has killed thousands and infected a million people. The cholera outbreak in London in 1854 is considered by most to be when the field of epidemiology started when John Snow, a physician, removed the Broad Street pump handle to show that that pump was the cause of most of the cases.

Point of all this is, be thankful for modern water treatment. There are very few waterborne illnesses in the U.S. It is rather rare for a person to get sick from water that comes from a public water supply, and when they do, most often because something has gone wrong at the water treatment plant. There are other issues of course, such as old water systems with lead in the pipes or solder. The source water can also become contaminated with something that the water treatment plant was not designed to treat. On the whole though, you are much more likely to become ill from untreated water then from treated water.

Raw Water

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The New York Times ran an article about people who like to drink “raw water.” Evidently there are people who do not like tap water and like to drink unfiltered, untreated, unsterilized water. According to the article, some people like the taste. Fair enough. Most of the time when people object to the taste of tap water, what they are objecting to is the taste of chlorine or chloramines that are added to kill bacteria that can make you sick. Using a filter at the tap or simply putting the water in a container and letting it sit in the refrigerator overnight will solve the taste issue. One of the parts of this almost completely one-sided article that I find the most telling and amusing is this paragraph.

“He said “real water” should expire after a few months. His does. “It stays most fresh within one lunar cycle of delivery,” he said. “If it sits around too long, it’ll turn green. People don’t even realize that because all their water’s dead, so they never see it turn green.””

Water does not turn green unless there is something growing in it. The person quoted understands that there are microorganisms (algae most likely because it turns green) growing in the water but thinks that is good thing. There is a reason why water purveyors are required to disinfect water. Bacteria and other microorganisms can cause illness. Not all microorganisms call illness, and some can have beneficial effects (i.e. probiotics). Groundwater does normally have less microorganisms than surface water, but it is not sterile. Further, hot springs does not mean sterile. Scientists have been studying the microorganisms in hot springs like the geysers at Yellowstone National Park for years. Those microorganisms are often called extremophiles because they are so different from the “normal” microorganisms we normally find in less extreme settings.

Some people are concerned about the fluoride that is added to water to help dental health, and a person quoted in this articles believes it is a mind-control drug. Fluoride does help dental health, and it is not a mind-control drug. I really don’t even know where to go with the claim that fluoride is a mind-control drug, so I have decided not to address it right now. Also fluoride can be naturally occurring in groundwater.

However, here, I would like to address the issues with not treating or filtering water and all the other contaminants that can be in water, including but not limited to the microorganisms. The Environmental Protection Agency (EPA) sets limits on microorganisms, disinfectants, disinfectant byproducts, inorganic, organics, and radionuclides. Bottled water is regulated by the Food and Drug Administration (FDA), not the EPA, and the regulations and testing requirements are different. Tap water is tested more frequently and has more monitoring requirements.

Just because water comes from the ground does not mean that it is pure or clean. Bacteria naturally grows in groundwater. Groundwater normally has ions including metals in it, and not all of those metals are good for people. The only way to know if it is free of contaminants is to test it. The United States Geological Survey (USGS) studies and samples groundwater and surface water across the United States. I randomly pulled several reports by searching on water quality and groundwater at USGS’s website. This report of sampling from 2014 found heavy metals in almost all groundwater samples, as well as pesticides and volatile organic compounds (VOCs). “Groundwater Quality in the Yuba River and Bear River Watersheds, Sierra Nevada, California” indicates that while the groundwater is mostly clean, a few samples had high concentrations of four elements (arsenic, barium, molybdenum, and strontium), a few samples had high radioactivity, and coliforms were detected in over 20% of wells. This report on groundwater quality in Lycoming County, Pennsylvania shows 52% of the samples exceed the EPA standard for total coliform, 12% of the wells exceeded the Maximum Contaminant Level (MCL) for arsenic, 67% exceeded the MCL for Radon-222, and a few exceeded the reporting limit for various VOCs.”Groundwater Quality in the Northern Atlantic Coastal Plain Aquifer System, Eastern United States” found fluoride, arsenic, and manganese in high concentrations in some of the samples. [Note this is naturally occurring fluoride.] Radioactive constituents were present at high levels in about 1% of the samples and at moderate levels in about 12%.

This is the reason why water treatment plants are not one size fits all. All water treatment plants have to disinfect the water. They can’t test for all microorganisms, but they test for indicator microorganisms like total coliform to determine how much disinfect is needed. They also have to test for VOCs, radionuclides, and numerous other indicators. They also test for smell and taste. Common processes at water treatment plants include flocculation and filtration to remove dissolved and suspended particles (this includes microorganisms). The source water will dictate what processes are used and the amount of treatment. The point of the treatment is to clean the water, make sure it meets the requirements set by the EPA and whatever respective state the plant is in, and prevent the people from drinking it from getting sick because of the water. The people of the United States can thank water treatment for better health. Drinking “raw water” means returning to the taking chances on acquiring an illness that people of the past were happy to do away with when water treatment plants became standard and laws like the Safe Drinking Water Act were passed. Edited to add: The EPA sets National Primary Drinking Water Regulations (NPDWR), which are legally enforceable primary standards and treatment techniques that apply to public water systems, and clicking on this embedded link will take to you a list of them along with the health problems that can occur if the water contains one of those chemicals or microorganisms above that limit.

Author’s Note: When I originally wrote this, I referred to microorganisms that live in extreme settings as xenophiles. I meant to say extremophiles. I have corrected it, and I apologize for any confusion. This is what happens when I edit my own writing. I think I had xenobiotics in my head. Xenobiotic is term generally used to describe chemicals that are foreign to body or ecosystem. In my field, I often use that term when speaking of a contaminant in the environment that needs to be cleaned up. You might find xenobiotics in raw water.

It’s Not Rocket Science

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I subscribe to my county’s weekly police report just in case there might be crime in my area I want to know about. I don’t live in a high crime area, so normally the police report is a bunch of car break-ins and drunks in the bar area of town. Today though I found this interesting report.

“MISSILE INTO AN OCCUPIED DWELLING, [location of incident]. On January 18 at approximately 6:51 p.m., a resident reported a known suspect threw a brick and rock into her residence, shattering two windows. [Suspect name] was arrested and charged with missile into an occupied dwelling, destruction of property, drunk in public and violation of protection order.”

What I found interesting is that legally speaking, a brick and/or a rock is considered a missile. To me this is another reason why rocket science should not be the go to science and engineering field for things that are hard. I hate the phrase “it’s not rocket science” with a passion. Rocket science is not that hard. It involves controlled combustion and trajectory. Missiles, a term which is generally used to mean a rocket that will cause destruction, is quite frankly easy. Science fields that are hard involve things that can’t be controlled near as easy as rockets, like biological systems, like fields trying to predict what stupid humans will do, like basic science where we are still trying to understand all the forces involved. You try doing an environmental and human health risk assessment on a hazardous waste site where toxicologists are unsure what level of exposure to a contaminant is acceptable, where you can’t be completely sure what humans will really be doing and for how long at a site, where people want to know they will be not be subject to undue risk for the next 70 years, and where you can’t be absolutely, completely positive just how much of each contaminant is there, but the polluters don’t want to clean up more than necessary. Then come talk to me about how hard rocket science is.

In summary, as evidenced by this police report, missiles are easy. Rockets are easy. Stop comparing things you think are hard to rocket science.

WMATA L’Enfant Plaza Fire

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Today there was a fire in a WMATA subway tunnel near L’Enfant. The National Transportation Safety Board (NTSB) is now investigating, and I have confidence that they will do a thorough investigation. I have some questions about actions taken right after the smoke was reported that no one, or at least no one in the media I have seen, has asked. The station filled with smoke, and they evacuated it. WMATA stopped running green and yellow trains through L’Enfant. However they kept running blue, orange, and silver trains through, but these trains did not stop at the station, as they normally would. For those not familiar with L’Enfant Plaza Metro Station, orange, blue, and silver lines share the same track on the lower level, and yellow and green share the same track on the upper level. My question is, were they sure it was safe to keep sending the orange, blue, and silver trains through? I am not asking from the standpoint of the fire, because presumably, they traced the location of the smoke enough to know it was not in the lower tunnel. By safe, I mean because of the potential inhalation of smoke in the lower level tunnels. If the station filled with enough smoke that it needed to be evacuated, then how were they sure that smoke would not enter the trains running through it?

A couple of quick points:

  • Just because air smells bad doesn’t necessarily mean it is toxic or hazardous, but conversely, just because air smells fine doesn’t mean it is safe.
  • Particulate matter in air and/or smoke is in general not something you really want to breath, but there are different levels of toxicity associated with it. That is, some particulate matter is not more than just an irritant. However, the effect particulate matter has on a person is also affected by that person’s health. People with respiratory issues are more susceptible to any effects.
  • Exposure to hazardous or toxic materials can cause effects on different time scales. People who were trapped on the WMATA train in the tunnel, would have acute (short-term) effects from breathing the smoke, such as coughing and having trouble breathing. However, they were probably also exposed to chemicals whose effect is not immediate, such as carcinogens.

The questions I have, that I have not heard anyone ask include:

  • What is the air exchange rate between the subway trains and the surrounding air? Can the ventilation be turned off manually, so that there was no air exchange between the train and the surrounding air while the trains were near L’Enfant?
  • Were there any measurements taken of the air in L’Enfant, particularly on the lower level where the orange, blue, and silver trains were still running through? If so, what were the measurements of? Just measuring particulate matter will not indicate almost nothing about organic compounds or other chemicals in the air.
  • How far did the smoke spread?
  • Assuming air measurements were taken, did anyone calculate the amount of contaminants that people in the trains would be exposed to while running through the station based on time and air exchange rate?

My educated guess is that no air measurements were taken. There are probably some sensors in place to measure smoke, but depending on how that measurement is taken, it will tell you information about the particulate matter and that is it. I seriously doubt there was initially any sensors that measured organic compounds or any other type of compounds in the air. I have my doubts that any portable system was put in place during the response. The priority would have been evacuating people (as it should have been). It is possible that WMATA had some qualitative data that there was not much smoke on the lower level. That is, someone may have looked at a video screen and decided the air didn’t look bad. However, unless they had actual quantitative data of what was in the air, then visual assessment of air is a really bad way to make assessments on the quality of the air.

The early statements by WMATA and all other sources, like the fire departments involved, was that they did not know the source of the fire, location or cause. Thus they could not have possibly known what was burning and what would be in the air. For example, if wood is burning, you can expect certain chemicals in the air. If rubber is burning, you can expect different chemicals in the air. WMATA probably decided that the air on the lower level didn’t look that bad, and the trains would go through the station quickly enough that very little exposure would occur. They very well may be right, but with no data and no statements about any calculations, they have no way to prove that. Also, did they inform their passengers of this? If I was on a train, and I knew that the train was going to go through, but not stop, at a station that was filling with smoke, I would get off the train. I don’t feel the need to expose myself unnecessarily to hazardous substances, even if in small amounts. I do not like standing near people who are smoking. The second hand smoke may only minimally increase my risk of disease, but I still don’t see the need for that tiny increase. Thus, was WMATA considering passengers’ exposures at all? Furthermore, did they communicate the possibility of exposure to their passengers on the orange/blue/silver lines to allow their passengers to make their own educated decision about staying on the train? My guess is the answer to both those questions is no, and that is another thing to which WMATA should be made to respond.

Run the Chesapeake Bay Bridge 10K

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View of the Chesapeake Bay Bridge near the start of the race

View of the Chesapeake Bay Bridge near the start of the race

On November 9, 2014, I ran the inaugural Across the Bay 10k Chesapeake Bay Bridge Run. The point to point course includes 4.35 miles across the bridge, which reaches 186 feet at its peak. The run across the bridge provided amazing views of Chesapeake Bay. As an engineer, I really loved being able to examine the bridge up close at a slower pace than when driving across it. I wore a GoPro Hero 3+ on my head during the race to make a video of the run. I have edited the video to only include the start, bridge portion of the run, and the finish, and I have also sped up the video. My official run time was 1:16:24, and nobody wants to watch a video that long of me running across the bridge. I removed the sound due to a weird noise that was created when I sped up the video. Also, I took a few photos with my iPhone and made a few photos from freeze frames from the GoPro video.

View of the bay from the bridge

View of the bay from the bridge

View of both bridges

View of both bridges

In the truss section of the Chesapeake Bay Bridge

In the truss section of the Chesapeake Bay Bridge

They also gave us a pretty cool medal for completing the race.

Completion medal

Completion medal

HAZWOPER Training

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Last week I attended 40 hour HAZWOPER training. HAZWOPER, an acronym for Hazardous Waste Operations and Emergency Response Standard, is OSHA mandated training for employees who may potentially be exposed to hazardous substances and who are engaged in cleanup operations or other certain other activities involving hazardous waste. Normally I work in an office, and the closest I come to hazardous materials or waste is sitting at a computer and analyzing data from hazardous waste sites. However, there is a possibility that I may sometimes be asked to go to a site where HAZWOPER training would be necessary, and I had an opportunity to take the training, so I did.

HAZWOPER training includes topics such as basic chemistry, toxicology, biology, radiation, environmental science, analytical sampling, and law and regulations. Truthfully, I could have taught a good portion of the training. It also includes hands on training with some of the sampling methods and instruments that are used in the field. Personally, I think playing with instruments and sampling materials is fun. As part of the training, you are required to get dressed in various personal protective equipment (PPE) that would be required under various circumstances at sites. In general, you look rather ridiculous in the PPE, but of course PPE is not supposed to be fashionable or make you look good, it is supposed to protect you from hazardous materials that could kill you or cause injury or illness. What PPE does not do, is keep you cool. It was in the 90’s °F when we were dressing in the PPE. While the suits protect you from most hazards, ironically they can cause potential health hazards if you over heat. There are different levels of PPE that are used depending on what the potential hazards are. The most protective is Level A, which is a fully encapsulating chemical-protective suit with positive pressure, full face-piece self-contained breathing apparatus (SCBA), inner and out gloves, and boots.

Me in Level A PPE

Me in Level A PPE

The next level, Level B PPE, is slightly less protective and includes chemical-resistant coveralls instead of the fully encapsulating suit, as well as SCBA, inner and outer gloves, and boots.

Me in Level B PPE

Me in Level B PPE

The next level, Level C PPE, is less protective still. It includes an air purifying respirator instead of SCBA, but other than that is fairly similar to Level B.

Me in Level C PPE

Me in Level C PPE

There is one final level, which is Level D PPE, which is minimal protection from physical hazards but does not include respiratory protection. This may sound strange, but if it is hot, Level A is actually easier to wear than B or C. The fully encapsulating suit is roomier, and the compressed air is continually blowing through your mask and then through the suit itself before it exits an exhaust vent. This air flow helps to cool you. In the chemical resistant suit for Level B and C, I just felt like a turkey that had been baked in a cooking bag. Side note, the SCBA tanks we used were made of a composite material and weighed  about a third of the weight of the metal SCUBA tanks I have worn before. Also, for as cumbersome as it was to get dressed out in all the PPE, I think it was easier to dress in and walk around in the PPE compared to the SCUBA drysuit I was wearing a month beforehand while SCUBA diving Silfra. Obviously once underwater, the tank weight is negligible, and the drysuit becomes less cumbersome, but above water, they are really difficult to get into and move.

For HAZWOPER training, you don’t just have to get dressed in the different levels, you need to get used to actually moving and doing various tasks in them. Hence, when we first wore them, our tasks were to play with balls, as one would normally do at a hazardous waste site.

Playing ball in Level A PPE

Playing ball in Level A PPE

Playing ball in Level C PPE

Playing ball in Level C PPE

Note in the above photo, the person in the center is wearing proper head protection in the form of a straw cowboy hat. No, he actually just being fashionable. Wearing hazardous material PPE is no reason to not be fashionable.

We also did a few exercises to practice tasks at a hazardous materials site, including decontamination. There are set steps and tasks to make sure decontamination is done properly. The first pair of people wash the worker, the second pair wash the worker again, the third set inspect the cleaning, and the fourth set help the worker out of the PPE. Notice the use of walkers for the worker to hold onto while the decontamination team washes the boots. There is no dignity in any of this.

Decontamination practice

Decontamination practice

We also practiced emergency decontamination of an incapacitated worker. We actually did not finish this task. This was due to the fact that after they started decontaminating him, someone loudly said, maybe we will have to do mouth to mouth. At that point, the incapacitated worker suddenly regained conscienness and took off running.

Emergency decontamination of an incapacitated worker

Emergency decontamination of an incapacitated worker

Since this was practice and not a real situation, we did a few things you can’t do on a real site. For example, the decontamination team stayed inside when not needed outside and did various things to stay cool. One thing that we did was lay on the concrete floor because the concrete was cooler than the air, and it absorbed some of your body heat. Sure, we looked like casualties at a hazardous waste site, but it worked and helped keep us cooler.

Cooling off by laying on the concrete floor

Cooling off by laying on the concrete floor

We also took “hits” of the compressed air from the SCBA. The full face masks we wore were interchangeable for either air purifying filters or for the hose from SCBA. In between tasks, we didn’t wear either. However, we would attach the SCBA for short periods of time because the compressed air blowing into your mask helps to cool you.

Cooling off by attaching the SCBA to the mask

Cooling off by attaching the SCBA to the mask

Another thing that should never be done at a real site was drinking water through the mask via a straw. Actually it might be acceptable to do this, assuming someone with clean hands put the straw in the bottle and then into your mask. It is not acceptable if you are doing this with your gloves.

Drinking water through the mask

Drinking water through the mask

For as hot as I was while in some of the PPE, I still had fun. I was out of the office, and that in itself was fun. Also, I learned a bit, and that is always fun.

For My Safety

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Like probably many health insurers, my health insurance company encourages me to use a mail order pharmacy for my maintenance drugs. As encouragement to use it, with the mail order pharmacy, I can order a 90 day supply, but only pay a co-pay for 60 days. Most of my maintenance drugs are actually generic, and I get generic drugs for free, so the only real advantage to me using the mail order pharmacy is laziness. I admit it is kind of nice just to log onto the website, hit refill, and have the drugs sent to me. At the beginning of the year, my insurance company switched to a different mail order pharmacy, so for most of my prescriptions, I have had to submit requests to my doctors for new prescriptions. Annoying, but no big deal, until I started getting them filled. I have rosacea, and I take one oral medication for it as well as using two face creams and one face wash, all prescriptions for it. I had my dermatologist call in a new prescription for the oral medication, and when it came from the mail order pharmacy, they only sent 34 pills with a note saying they had reduced the amount for my safety. The pill (Oracea) is designed and approved by the FDA as a maintenance drug for rosacea. It is supposed to be taken everyday. It is a low dose antibiotic taken for its anti-inflammatory properties. I don’t know of any way to get high off of it, not that I have tried. After a long conversation with the pharmacy trying to ascertain why they deemed this not safe enough to send me more than 34 pills, even though I have been taking this pill for well over a year, or for that matter why they sent me the strange amount of 34 pills, as opposed to 30, the pharmacy stated it was my insurer who decided this was not a maintenance drug. A call to my insurer resulted in me being told I would essentially need to petition them to recognize what the FDA calls a maintenance drug, as a maintenance drug. They also said I could go to my retail pharmacy and get the same deal they offer through the mail order pharmacy of a 90 day supply for the cost of 60. Why they offer this deal through the retail and thus what is the point of trying to get me to use the mail order pharmacy is not something I could understand, and if I continued to try to talk to them, I was going to need a drink. I gave up.

Now, however, my health insurer’s and the mail order pharmacy’s concern for my safety has gone to comical levels. As I said above, I also use a prescription face wash for my rosacea. It is a cleanser with sodium sulfacetamide and sulfur in it. It is an old formula and has been used by rosacea sufferers and people with other skin issues for decades. I have used it for at least two years, and I think it helps a bit. Because it is such an old formula, there are of course generics, to which my insurer automatically switches my prescription. I don’t care, and I get the face wash for free because it is generic. I had my dermatologist send in a new prescription to the mail order pharmacy, and it arrived today. Just in case you can’t guess, enclosed with the 12 oz bottle of face wash, was a note that reads as follows.

“Enclosed is a reduced quantity of your prescription drug. Your prescription drug coverage has quantity limits for certain drugs. This is a type of drug coverage review that limits how many doses you can receive. The goal is to make sure you get a safe amount of your drug.”

That’s right, they sent me a reduced quantity of my sulfur face wash for my safety. Thank goodness because otherwise I might wash my face too many times. It’s true. Washing your face with sulfur can get quite addictive. I love the smell of sulfur. (It actually does have a slight smell of sulfur but nothing repulsive.) I get in the shower and just keep washing my face knowing that the wash is free. Of course, it bears pointing out that they sent me a 12 oz bottle. The earliest I can refill it according to the label is in three weeks. This 12 oz bottle will probably last me three months or more. I don’t really count. I just reorder when I need it. I really don’t know what my pharmacy and insurer thinks I do with this stuff. Maybe they think I have a really dirty face. I have no idea. I can’t fantom how someone misuses sulfur face wash. I don’t think I want to know. Maybe they are afraid I am going to drink the stuff. All I know is that if my health insurer and mail order pharmacy think they have to protect me from too large an order of sulfur face wash then there probably is no hope for humanity. As an engineer, I have stated on many occasions, I have to design for the stupid. Not even I thought people were this stupid. I guess I overestimate people.

Book Review: “The Immortal Life of Henrietta Lacks”

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I finished reading The Immortal Life of Henrietta Lacks by Rebecca Skloot today. In 1951 when Henrietta Lacks was 30, she developed extremely aggressive cervical cancer. When she went in for surgery for cancer treatment, the doctor took a sample of the tumor. The cells from the tumor were cultured in a lab that had been trying unsuccessfully to find a way to keep human cells alive in culture. Ms. Lacks’s tumor cells, named HeLa by the lab, were the first cells they were able to keep alive in culture. Because they were able to keep them alive and growing, the cells would later become a vital tool for medical science. The scientist who first kept HeLa alive in culture gave the cells away for free to numerous other scientists who used them for various research. The cells helped in part to develop drugs for herpes, leukemia, influenza, hemophilia, and Parkinson’s. They helped develop the polio vaccine and in gene research, including most fittingly genes that cause and suppress cancer. Companies were created to use and produce the cells. Ms. Lacks’s family, however, did not know that the cells had been taken nor that they were being used for so much research. They did not know they existed until 20 years later and received no benefit from all this research. Sadly and ironically, they were so poor they couldn’t afford health insurance, and most were not educated enough to really understand how part of Ms. Lacks could still be alive or what it meant. To make matters worse, shortly after learning about the research on her cells, researchers asked family members to give a sample of their blood to them to aid them in their research. The researchers didn’t explain to the family what the samples would be used for, or at least they did not explain it in a way that the family members could understand.

Anyone who does research involving humans should read this book. Actually, everyone should read this book. It is incredibly interesting and well written. I loved learning some science from it, but it was also nice to learn about the people involved, both the Lacks family and the scientists involved with HaLa. The book gives recognition and a voice to Ms. Lacks and her family who for far too long had none. It is simply horrible how they had been treated in the past, and it is an important lesson to researchers on how not to treat research subjects and their loved ones. The book discusses a little bit of the history of human medical research and the ethics and techniques involved. The introduction of informed consent in medical research is discussed to a great degree. The concept of when a person loses ownership of their own tissue or fluid once the tissue or fluid is no longer a part of their body is discussed.

I, personally, am conflicted about the issue of ownership of body tissue once it it removed from the body. For my dissertation I did research that involved humans. Our research plan was reviewed by an Institutional Review Board as all human research studies are now. Our subjects gave informed consent. They willingly participated, allowed themselves to be outfitted with an air sampling device and to have medical tape placed on and then removed from their skin, and gave urine and blood samples. They knew the risks of participating, which really was only a possible reaction to the medical tape (which none had) and the prick of a needle if they gave blood. We explained what we were doing and why and hopefully they all understood in general what we were doing, even if they did not fully understand the details of the research. We took various steps to protect their identity and information. We made no money off of the research, but my advisor applied for grants based on it, and several of us obtained Master’s and Doctorate’s based on it.

Years ago I had two dental implants put in my mouth. The dentist who implanted them was a professor at the local school of dentistry, and because of certain characteristics of my dental history, I made an interesting case for her to operate on and later teach about. I was awake the whole time, and the surgery took much longer than it needed to because every 15 minutes or, she stopped what she was doing to take photos of the current status of my mouth. I get amused thinking about her students sitting in class viewing photos of my mouth while she discusses my case. However, I am confident my identity is protected, and furthermore I gave informed consent. I was awake. I knew full well she was taking photos and planning to use me as a case study, and I am rather pleased that I might be able to help some dentist and their dental patient in the future.

However as someone, who like the vast majority of people, who has ever given a sample of my body fluids analyzed for medical reasons, the idea that I don’t know what happens to the sample after it leaves me and who can run tests on it, makes me concerned. I once had an infected sebaceous cyst removed by a surgeon. I know it went to pathology to confirm the diagnosis that it was just a sebaceous cyst, but after that I have no idea. From what I have read in the book, it could have then gone on to an academic or commercial research lab. As a scientist, I certainly want scientists to have access to samples that can further science, but it bothers me a great deal that someone could potentially make money off of something found in my cells or fluids. If something unique is found in my tissue that can lead to the cure or treatment for a disease, I can support that, but the idea that a commercial research facility could use it to make money seems wrong to me. At the very least, I would like to know what ultimately happens to any of my tissue or fluid samples. Are they simply destroyed after analysis or are they stored somewhere or transferred somewhere? Who can analyze them and for what? I think that is another reason to read the book, so more people will talk about this subject.