V/Q mismatch maker

The pulmonologist running my small group revealed to us the pulmonary clinic magic bullet, V/Q mismatch.  He said if you are ever pimped on a question about a patient with lung problems, just say, "Well, I was kind of thinking V/Q mismatch".  


Although it's clearly not what the pulmonologist was thinking, she'll stop for a second, furrow her brow, look up for a bit, call the fellow over, "what do you think about V/Q mismatch?", they'll mumble for a bit, furrow an impressive amount of brow, pace around, walk out of the clinic, head back to the Pulm Cave (which is a dead space I believe) and you are totally off the hook.  It's like hitting a shark on the nose.  No one's really sure what just happened, but you still have your legs and you get to go home.

IUD, ironically DUI backwards* Part II

Continued from Part I

Some questions you might have at this point:

If it's so small and effective, how does it work?  Magic.  We really aren't sure, but it is proposed that it causes a local inflammation that confuses and incapacitates the sperm.  Kind of like a Nickelback concert.  The hormonal one has the same hormone as one of the hormones that is in every variation of The Pill, but it's only local so it doesn't work quite like The Pill.

Are there side effects? There are some side effects for sure.  If you have a current cervical infection, the placement of an IUD can lead to a pelvic infection.  But beyond the first 20 days, infection is very rare.  In fact, the hormonal option actually seems to decrease the rate of infections to the upper reproductive tract (i.e. your baby factory).  The hormonal one can cause spotting in between periods but usually this subsides by 6 months (this spotting is common in many birth control options).  The non-hormonal version can cause heavier bleeding, but again, usually subsides by 6 months.  The non-hormonal can also have some increased pain around menstruation, but this typically diminishes too.  It is possible to have the IUD expelled, which would obviously make it not that useful.  It's magical, but not that magical.  The risk isn't very high and you just check every month to make sure the strings are there.  It's also important to note that some beneficial effects of The Pill, decreased acne, decreased hair growth and the such, you don't get with an IUD.  On the flippy side, you don't get the bad parts of The Pill either, blood clots, etc.

How much does it cost?  Around $800.  That seems like a lot but let's do some math 800/(5years *12mo a year)= $13/month.  And for the nonhormonal one, $6.67/month.  Also, some insurance companies cover part or all.

But yo, I'm like super youngs now, and maybe want some babies on the late late, what happens then?  Get your provider to do the ol' pull out method.  Then do the ol' pull out method because your return to fertility (baby makin') is extremely quick, usually within a week (don't actually do the pull out method, that method sucks and is messy).  There are no long term effects on fertility provided there were no complications with the IUD's use.

So what's the problem, you ask?  There really isn't any. The real problem is it just doesn't seem to be popular here. My feeling is that people are just wary of something that other people aren't using when it comes to their bodies.  Women tend to hear about birth control from other women (friends, mom, those secret cult meetings I'm convinced exist) and the IUD isn't popular, so guess what? It isn't popular.

People get a little uncomfortable about having something sitting inside there (The "there" is a uterus.  It is next to a vagina.  Say it with me, "vagina". Now say, "penis".  Now put yo' hands in the air. Wave 'em like you just don't care, Peeenis! Vaagggiina!), even though it's extremely safe; safer than the pill (and much more effective, easier to use, and cheaper in the long run).  But people are pretty quick to have them removed.  15% ask to have it removed for irregular bleeding symptoms, even though, as mentioned, both kinds tend to subside by 6 months and the hormonal version actually decreases bleeding significantly and can even eliminate it (60% have no period after 5 years of use).  So obviously you need to choose for yourself.  And obviously you need to talk to your doctor about it, but if you are looking for cheap, easy, effective, long term birth control, an IUD just might be your guy.

I have one, and I'm loving it.

*you know, because both involve terrible mistakes and can lead to an 18 year loss of freedom when poorly handled.

IUD, ironically DUI backwards*

Women, the weight of the world is on you.  You hold the key to keeping the population (and thus the weight. Get it? You don't?  Oh you think it's a stupid joke?  Well what if that joke thinks YOUR stupid!!...I spelled "you're" wrong didn't I?) of this world down.  This is because the responsibility of birth control lays squarely on your uterus.  It's not fair and it's not right, but if you think about it, it's definitely right.  On the not fair side, we have the fact that the only male-responsible birth control option is condoms, and on the right side, we have the fact that guys fucking suck at taking care of condoms, let alone some pill or doctor's visit.  So even if there were a better male birth control option, the good lord knows we can't possibly trust those shit-head dudes to be in control of it.  In fact, historically, everything we have put males in control of has turned out pretty piss-poor.  We can't even get porn to be good and that's like, our thing.  Let's hope the recent equal opportunity employment  shows some returns soon.

Back to the subject at hand, birth control.  In 1971, a manufacturer came out with something called a "Dalkon Shield", which was an IUD  (or intrauterine device) that was extremely effective at blocking a dude's load of Dalkons.  Unfortunately, it had high infection rates and almost single handedly set the American birth control scene back far enough to be dependent on chastity belts.  This IUD debacle left a burning taste in America's mouth, and, well, their what-whats too, and since then, it has to be the most underutilized, underestimated, underappreciated device of all time. It's the William H. Macey of the contraception world.  And I think it too had a small scene in Jurassic Park III.

So what is this thing that I'm raving about?  Well it's a tiny T shaped instrument that gets placed in the uterus in a relatively easy and painless out patient procedure.  There are two kinds, one with a single hormone (a progestin) and one that has no hormones.  It sits up there with two strings hanging out of the cervix (not visible) that exist to ensure that it's still there and so that it can be easily removed when desired.

Let's see some stats.  It is the most widely used reversible birth control in the world (and basically unheard of in the US) with 156 million users in 2000. It's effectiveness is right around a 0.1% failure rate.  That puts it up there as equivelanent with a tubal ligation.  Let me repeat that.  Taking someone's anatomy and dismantling it has the same effectiveness as this device.  That is like saying it is as effective to bomb the Golden Gate bridge  to prevent people from crossing to San Francisco from Marin County (goddamn Marin Countyers) as it is to place an orange traffic cone in the middle of the road (the non-hormonal IUD is, in fact, orange).  The hormonal one lasts for 5 years (and don't tell no one, but supposedly data supports its use for 7) and the non-hormonal one lasts for 10 years (-cough12cough-).  It has no long term side-effects on fertility and is immediately reversible. It can even be used as a form of emergency contraception for up to 5 days after the deed.  Yeah.  That just happened.

Continued in Part II

*you know, because both involve terrible mistakes and can lead to an 18 year loss of freedom when poorly handled.

Hair Drug For Men

My buddy started losing his hair when he was 20.  He was in denial for a year or so before the Ghost of Christmas Bald came to him, showed him the hair in his sink and a picture of James Carville, and the next day he was like "oh fuck no" and started on Finesteride (Propecia).  Finesteride is a really great drug that works by stopping the formation of a chemical derivative of testosterone that's only purpose in life seems to be to cause men's hair to fall out and their prostates to grow (earning this chemical the nickname, "The Cock Block", or in medical terms, "Cockblocksterone", which makes Finesteride the first pharmaceutical wingman.).  Finesteride has worked great for him and it has virtually halted his hair loss.  Its only downside, 70 bucks a month.  Although that is a relatively small price to pay to not be asked if you would, "like help carrying those groceries to the car" before age 30, as I think many men would agree, but unfortunately it's a lifer drug.  So, doing the math, he is paying $33,600 to not be bald by 60.  Suddenly a boob job isn't seeming so crazy, is it?

Beef

There are some really awesome stories in the history of medicine, but I think my absolute favorite is Viagra. It was originally designed as a blood pressure med in Scotland, so they tested it on cows. Then they noticed a side effect in the cows that was medically referred to as, "hilarious".