Histamine Memory

Seeking help…

Jeff: I used AI to generate a list of questions a doctor might ask me.

Dr Sirinat: Hmm. Very helpful. You’ve had hives for three months?
Jeff: I moved to an old house, a dusty one and developed urticaria. 
Dr Sirinat: Possibly dust mites. Still itchy?Jeff: I’ve cleaned the dust, rooms are almost sterile with all the dust gone for two weeks. But I’m still itching.
Dr Sirinat: Maybe you’re suffering histamine memory.
Jeff: Like muscle memory?
Dr Sirinat: Yes. A metaphor. The immune system remains sensitized after the initial trigger.Cells can keep releasing histamine for weeks. Hives and itching continue even without bites or allergens.
Jeff: And for how long?
Dr Sirinat: Can be weeks. Even months.
___________
Voice-over
Jeff is prescribed low dose prednisone and antihistamine tablets. Also cream. Told to report back in two weeks.

Progress of a cold

Cough, cough…

Umeko: How long have you had it?

Hachiko: A week.

Umeko: Not Covid?

Hachiko: Nope. I tested.

Umeko: Began with a sore throat?

Hachiko: Then a runny nose which progressed down into the lungs. Now this cough.

Lulu! Attack!

_________

Voice-over

Pickled plums, honey, radish, ginger, lemon, okayu together with Kakkonto for the beginning of a cold. If that doesn’t work, then you need Pabron, Lulu, Bufferin, Eve, Stona or any of the many pharmaceutical symptom-specific options. Stay hydrated.

An Eye Operation

The day after…

David: Replacing the lens under a local anesthetic was more dramatic than I’d anticipated. Think travelling through landscapes like Matrix and Space Odyssey. Bright lights, vivid colors. HAL as doctor, machines pumping and screeching and beeping, nurses flying about like bird flocks. 

Helena: A robot doc?

David: No, he’s a 30 something human doc, joking around with colleagues, and as he installed the artificial lens I could see pink fish, green corals, and a yellow sunset in a turquoise sky.

Helena: A Lucy in the Sky with Diamonds chamber?

David: Yes, but I was certainly conscious that he was putting a knife in my eye. Then at the end he said the op went as planned. Could have been my imagination but he sounded a bit disappointed. He admitted to me once he likes ops that go off like fireworks.

Helena: But now you can see clearly?

David: Plaster removed from left eye this morning. WOW, the clarity, with no glasses. Like when I was a kid. Time travel!
_________

Voice-over

David passed the doctor’s rolling eyeb
all test the morning the plaster came off the eye. Not out of the woods yet though, pressure still up in the eye. Check on it next week.

Last day of Radiotherapy

Beeper: ENTER THE CONSULTING ROOM

Well done!

Dr Samuelson: Session 32. Your last day. How do you feel?

Paul: Not too bad. Bit weak each day after treatment.

Dr Samuelson: Understandable. Radiotherapy is a bit fatiguing, especially towards the end.

Paul: The nurses gave me a graduation certificate.

Dr Samuelson: Let me see? Oh, that’s nice. Lots of pink stamps.

___________

Voice-over

 

Graduation Certificate issued today. Roughly translated it says something like: “Patient has completed 32 take offs and landings on LINAC the Cyclotron. He is now cleared to ride his electric bicycle (with trainer wheels).”

Waking from a train nap

Meeting at the club after an absence...

Paul: Yeah, well, there’s been some hospital visits.

Olaf: Something major?

Paul: A bit. Radiotherapy.

Olaf: Oh. Sorry to hear that. Takes it out of you a bit?

Paul: Mornings are OK, pretty much a box of birds. But then there’s a train ride to the hospital, the treatment and then the ride back.

Olaf: Is it far?

Paul: Hour and a half. Each way.

Olaf: You can sit on the train?

Paul: It’s off-peak, so there are seats. Usually I fall asleep, but when I wake up the people sitting in the opposite seats seem like demons and devils.

Olaf: Radiation induced delusions?

Paul: I don’t think radiation causes delusions, it could be just sleepy brain or foggy eyes.

_________

Voice-over

 

Radiotherapy can cause fatigue and for some, a train ride can bring on a sudden nap and an abrupt wakening. And it might take a moment for the shapes of nearby passengers to reset.

LINAC and the Iron Lung

The treatment has a pattern...

Analog treatment

Paul: I wake in the morning perky as a box of birds. Work the morning until 11 then hop on the e-bike with a Heigh Ho Silver to the hospital. After the treatment and into the evening, I feel a bit as if my brain has been hacked.

Dr Samuelson: A zombie?

Paul: Not that bad. The drop in chirpiness comes after being loaded into the LINAC. Reminds me of those iron lungs used in the 1950s.

Dr Samuelson: But your head is inside the LINAC isn’t it, while the head is outside the iron lung?

Paul: I didn’t mean it is an iron lung, just that it reminded me of one.

Digital treatment

Dr Samuelson: An iron lung is a mechanical respirator. A LINAC is pumping X-rays into you.

Paul. Granted. And a patient spent weeks or even years in
an iron lung and only spends minutes in a LINAC.

____________

Voice-over

Quite different technologies. Analog vs digital.

Beginning Treatment

A follow-up…

Paul: I followed your advice to get it over with. Saw the doctor and told him I’m ready. 

Dr Samuelson: How long does it last?

Paul: Seven weeks, for a total of 32 sessions. I’ve talked to the doctors, nurses, technicians and administrative staff. They’re all very friendly and supportive. Treatment starts tomorrow.

Dr Samuelson: Are you prepared?

Paul: I know my way around now the radiology department. Signage is generally good, though locations can be puzzling. I asked whether I should go right or left and the receptionist checked my record and replied, “In your case, you can go left if want to speed up treatment.”

________

Voice-over

Putting one’s trust in technology to treat a cancer requires considerable research. Weeks. Then one can elect not to take treatment, and try some life changes. Or one can try life changes and undergo treatment. As the man was told who fell into the sea: Pray, yes, but swim too.

Joining a research project

At a clinic…

Doctor: Read these (hands over 10 sheets of paper). This is a peak flow meter. Blow into it morning and night. Record where the indicator stops.

Patient: So it’s an experiment?

Doctor: Yes. We’re testing a new medication. It might stop your night wheezings.

Blow harder...

Patient: You give me meds and I give you data? A quid pro quo?

Doctor: Yes. You could put it that way. Just fill in the graph mornings and nights on how far you can make the peak flow meter rise. Add the weather and any side-effects you experience. Bring the graphs back to me after 4 weeks.

_______

Voice-over

An exchange of treatment for data. Trying out new treatments by getting patients to record their symptoms. Data collected, papers are written. Progress.

When Breath Becomes Air

Breaking the news at a hospital bedside…

Doctor: How do you feel?

George: Dreadful night. Didn’t think I’d make it. What is it?

Doctor: I was puzzled why we weren’t making progress. We ran some more tests. We got the latest results.

George: And?

Doctor: George. It’s cancer. In the lungs.

George: (blinks) Well, that’s a relief. We know what it is now.

Doctor: We can approach this two ways. One, stitch up the lung, buy you a little more time. Or two, give you medications and make you feel more comfortable.

George: Not keen on intervention. I’m 99. Give me some relief.

Doctor: Then let’s do that.

________

Voice-over

George had Stage IV adenocarcinoma. At 99, he was not in his thirties like Paul Kalanithi, suffering from the same cancer who with his youth, vitality, knowledge, top-line attending doctors didn’t make it past 37. His memoir, “When Breath Becomes Air” was an inspiring bestseller. At 99, the chances of coming through an operation are very low, and surviving more than a year lower yet. Palliative care: make the patient comfortable.

Overtalking

Chance meeting crossing a street…

.

William: Professor Goldman. I say, Professor Goldman!

.

Prof. Goldman: (under his breath): Discovered! William, didn’t realize it was you. How you doing?

.

William: OK. OK, I guess. Well, maybe not OK. Just been to my GP and he said I have this cancer. HUGE, he said. HUGE.

.

Prof. Goldman: Oh, so sorry. Where?

.

William: In here. What you call it? Easy way. O solo mio.

.

Prof. Goldman: Oesophagus?

.

William: That’s it. I googled it but the computer broke.

.

Prof. Goldman: There are computers in the city library.

.

William: It’s closed. The virus.

.

Prof. Goldman: Sorry. Of course. Look, try the National Cancer Hospital. Central Station.

.

William: They’re good?

.

Prof. Goldman: They’re a research hospital, have the latest equipment, good doctors.

.

William: You’re a life saver.

.

Prof. Goldman: You’ll need a referral from your GP.

___________

Voice-over

A conversation edited down from 30 minutes. William is an overtalker as Professor Goldman well knows. Overtalking is often due to anxiety or being overactive. Enter into labyrinthine anecdotes. Sometimes mix words up. The speaker is often not aware of their problem, although William was self-monitoring. “I’m probably talking too much,” and “Thanks for listening, most people are just in a hurry to leave.” But sometimes they need to be listened to, especially if there’s something you can help them with.

...

Data miners and Vinca minor

A visit after the robot operation…

Patient: Very competent team. Very caring staff. Always had my details on their iPad screens.

Visitor: They have a reputation for being a research-oriented hospital.

Vinca minor

Patient: I had no problem signing the releases to use my data. Cancer research is a good cause. And, you know, the garden was filled with medicinal herbs. Like periwinkle or Vinca minor. It has 50 alkaloids. Also worth investigating for memory problems!

_____________

Voice-over

A hospital where the nursing staff are trained to meticulously record data while monitoring patients. And botanical researchers collect data on medicinal herbs. A true research hospital.

...

Second opinion

Ian thinks he needs a second opinion on what is causing his burping. Kingsley advises him advisedly.
...

Ian: I just know it’s a peptic ulcer.
Kingsley: Have you had one before?
Ian: No, but I looked it up on the Internet and the symptoms correspond.
Kingsley: And yet your doctor doesn’t think so?
Ian: Just keeps saying it’s no more than gastritis. I need a second opinion.
Kingsley: Maybe you do. But let me suggest something. Tell the doctor you’d like him recommend someone for a second opinion.
Ian: He’ll suggest someone who would agree with him.
Kingsley: Maybe. There are some rascals. But if you ask him to suggest someone, he’s more likely to stay involved and he might listen to another professional.

________
Voiceover
It can be easy to alienate a professional. Not always but some get miffed when their opinions are questioned.
“I’m going to get a second opinion,” is like dashing water in the face of some sensitive souls.
Kingsley’s suggestion maintains the dialogue. And it becomes a discussion. The doctor doesn’t lose face and doesn’t lose the patient. The patient doesn’t lose the doctor and may form a team.
...

Overheard

Voices of two silhouetted figures down a corridor are faintly heard.
...

Taller: There was a rumor, don't know how true it is, think I read it in Forbes, that Steve has pancreatic cancer.

Shorter: No! He still bounces on stage and does his rock star thing launching new products.

Taller: Some say he hasn't been looking well but the PR division keeps saying he's fine.

Shorter: If it were true, and it's a big if, since people that rich have access to the best medical resources, and he, let's say, withdrew from the company, think what it'd do to the stock value.

Taller: It's all just conjecture. What would happen if word got around that you had something like that?

Shorter: I'd be fired and the company stock would rise.

___________
Voiceover
People hedge more when reporting a rumor. Qualifying phrases like "...don't know how true it is..." "...it's a big if..." protect the speaker from being scoffed at or even challenged with a supplementary rumor. And the future however it may turn out.
...