COVID19

 Hello fellow readers.  It has been years since my last blog and so I feel I owe you an apology but life gets in the way, priorities change and I felt that my material was getting a little stale.  But, good news, with weeks upon weeks in lockdown and a COVID pandemic I have lots of new material.  This will have a mainly Australian focus with particular attention on Victoria as this is where I live and happens to be the epicentre of the Australian problem.

Currently, I have a series of posts, or chapters, in the works that will take us through all the issues associated with COVID19 and to do this I’ll start back at the point when Victoria entered “the second wave”.  Of course, this means talking about hotel quarantine.  

The is currently an investigation going on as to what happened in hotel quarantine and whilst this is happening we aren’t going to know exactly what happened until it is completed.  However, we do know a few facts:-

• Most, if not all cases of COVID19 in Victoria can be traced back to hotel quarantine.

• Private security agencies were used to monitor and control hotel quarantine.

• Premier Daniel Andrews rejected offers from Prime Minister Scott Morrison to enlist the Australian Defence Force (ADF) for this task.

It is easy to look back with the benefit of hindsight and apportion blame so, to be fair let’s ask three questions.  First, was it a reasonable decision to allow private security to monitor hotel quarantine?  Second, why was private security used over other options? Third, would it have made a difference?

So, was it reasonable to use private security?  Back in February when the seriousness of the pandemic really started to come to light there was very little, if any, community transmission and almost all cases could be linked back to overseas travellers or the Ruby Princess cruise ship.  Knowing this, returning travellers should have been of the highest priority for monitoring and control, so was private security up to the task.  We know that the answer was no but was it reasonable to have predicted that back in March?  

Private security is important in Australia, they provide private business the ability to protect and safeguard their interests in a cost effective manner.  But in order for it to be cost effective wages are low and the work is often menial.  As a result, most of the workers have only a basic level of education.  Also, private security has a large number of part time and casual workers and the recruiting process can be extremely informal.  This makes accountability hard to trace, so essentially we had a random workforce of poorly educated not providing security, but being asked to be on the coalface of pandemic management.  It was never going to end well, the authorities should have known that and I refuse to believe that Daniel Andrews and the Victorian government followed the best medical advice when making this decision.  Medical specialists would have thought about pandemic monitoring needed to be handled by professionals.

Secondly, why did we use private security over other options?  Before answering that question let’s ask what the other options for hotel quarantine were.  There was the ADF, an option that was rejected by the Premier, the police force, as was used in NSW or Corrective Service, as has been employed in Victoria after the issues of private security were bought to light.  

There were other options so why did we not use them instead of private security?  I don’t know the answer to this, only the Premier does but I can give you some theories.  First, cost, private security is a cheap option but a bad one as the cost of lockdown 2.0 is far greater.  Second, every other state refused federal assistance (ADF assistance) for hotel quarantine.  The Andrew’s government didn’t want to look like the “weak” state that couldn’t handle it by themselves.  Third, the trade unions representing the private security workers saw an opportunity to get people back to work in a time when there was a huge surge in unemployment in the sector due to the forced closure of pubs, clubs and sporting venues.  They used their leverage in the Labor Party, who currently hold government to make this happen and the state government buckled to their demands.

Last question, would using a different option to private security make a difference.  I’ll compare this to an ADF option as this seemed the most likely alternative at the time.  First, I have already alluded to private security having low levels of education and training.  This is far less than the ADF.  The ADF has qualified doctors and nurses on staff who have training in infection control and even pandemic management.  There is a need this because if the ADF is deployed to an area where there is an outbreak of disease, they need to know how to manage it.  

Second, ADF staff, even at the most basic level of rank are drilled in discipline and following orders.  In complete contrast private security does not.  Everyone in Victoria has heard the stories of security staff fraternising with the quarantined and disregarding protocol for infection control.  Finally, the ADF has clear structures and lines of accountability that have been tried and tested over decades of conflict and chaotic situations.  It has been proven to be flexible in adapting to an almost infinite amount of different situations yet doggedly rigid in maintaining the highest standard.  Private security on the other hand is completely different.  The inquiry is trying to piece together the structure and lines of accountability which still remain a mystery.  One thing we know for sure.  It didn’t work.

Until next time,

Stay well :)

So, Why is it so?

In my last post I stated that here in Australia we like to conduct "redo" not "research".  If you didn't read it I suggest you do by clicking this link.  The question remains why we do this?  In case you are expecting me to give you reasons why it all makes sense that we do it this way, I apologise.  These are not reasons that work for the greater good or are in the best interests of patients or the community at large.  They either serve a minority or make no sense.  I have four reasons:-

• First is a reason my friend and reader of my blog, aminfla, alluded to in a comment on my last post.  Big pharma.  Big pharmaceutical companies like one kind of research and one kind only. The research that leads to them making a profit.  The latest and greatest wonder drug that they can pedal to the masses for millions.  Don't get me wrong some of these drugs that have been developed over the years have changed the face of modern medicine.  But sadly, when research is available that has the potential to do the opposite to their bottom line it is seen as a threat.  So they protect their interest by pushing their own research on specific charities that specialise in funding medical research (which is quite successful as they donate quite heavily to these charities) or finding ways to discredit the other research.  Is it illegal?  I don't know, you'll have to ask a lawyer.  Is it unethical?  Absolutely.  I'm not saying that these companies should fall on their sword and support the other research, but they should certainly not actively try to hinder it.

• Politics.  Research is about knowledge, expanding our understanding and making new discoveries.  Politics should be about the successful running of a country or state but it's not.  Politics is about winning.  Therefore, whoever is the current government they don't want research, they want wins and unfortunately research involves a lot of failure or from a political perspective, losses.  As Thomas Edison said, "I haven't failed, I've just found 10,000 ways that won't work".  Politicians don't want to fund the 10,000 ways, they just want the victory, the one and in order to make sure that happens they just fund redo.  However, being politicians they do not admit to this.  No that would be political suicide.  Instead they point to my third reason...

• Thalidomide.  Most of us have heard of this drug.  If you haven't, here is a quick recap.  Thalidomide was developed in West Germany for a variety of conditions and was also deemed to be a safe drug in the treatment of morning sickness.  It was then marketed in a varieties of other countries without receiving proper scrutiny.  Only after that all happened it was realised that the drug caused severe deformities in the unborn babies.  Since then strict regimens have been in place for all research done outside Australia.  Now, I do understand that this was a horrible tragedy.  Many babies died before they even had a chance at life and those that lived had to live with severe disability.  BUT, should that mean we have to redo every single piece of overseas research?  I don't think so.  Firstly, the mistake that was made in West Germany could have been made anywhere.  Germany is actually quite strict, rational and regimented about its medical research (disclaimer: I have no idea what it was like back in the 1950's and 60's) and it is somewhat arrogant to think that we as Australians (or any other nation) are incapable of making the same mistake.  We are.  After all, money hungry pharmaceutical companies that like the idea of fast tracking their chemicals to market reside in every corner of the globe.  Lastly, there has to be better ways of safeguarding people against such problems, but more of that later.

• Lastly, the medical fraternity.  Have you ever been treated by a doctor that displayed some degree of arrogance?  There are plenty of them out there and many of them are simply too arrogant to admit they are wrong.  Doctors can formulate an opinion based on little evidence and once that has happened it is almost impossible to convince them otherwise.  Or maybe they are told that the best solution lies in a different field of medicine and they are 'no longer requires'.  Ego kicks in and hey presto!  They suddenly don't like the new idea.  There are plenty of examples.

Anyway, they are the reasons I have come up with.  If you have any more I'd be happy to hear them.  Especially if you disagree and believe you have that "all makes sense" reason.  I'd love to hear it.  Until next time, stay well:)

Damn we're good! Or are we?

Australia has a very good health system as do the two other countries (USA and UK) that I have been treated in.  But are any of them perfect?  Absolutely not!  In an industry quite as big as health perfection is impossible, especially when there are so many critics, but perfection is a noble goal and even if unattainable it will serve to make a health system as good as it can be.

But for the purposes of this blog I will focus on Australia and to narrow it down a little further, the field of medical research.  Now, Australia has an issue.  There are far more research projects than dollars which means that either some research simply does not get realised or the projects are scaled back to fit in with there available budget.  Neither is ideal and both happen with all too much regularity.

But the question then becomes who decides who gets funding and who doesn't.  In Australia this comes down to four main groups:-

1. Governments - The main source of medical research funding in Australia, both at federal and state level. The main body is the Nation Health and Medical Research Council (NHMRC)
2. Private donors - Although charitable donations are plentiful, In order to be able to make a choice as to whether a research project happens or not, the donation has to be quite sizeable.
3. Charities - Certain charities sponsor medical research and collate smaller donations to distribute them into something more meaningful.
4. Corporate - Will invest heavily in research but only if there is a buck to be made.  For example, big pharma.

One important group missing from this list is patients.  In other countries patients can fund their own treatment but not in Australia.  But this is a post for another time.  At the end of the day, the biggest contributor is the government, followed by charities.  The other two are also very hard to influence as they are autonomous in their decision making.

The next question is how does this money get allocated?  Well, the short answer is badly and I'm going to go back to the example of HSCT on this one.  Certain charitable organisations who are allegedly an authority in this area have stated that they are not interested in funding HSCT for multiple sclerosis and autoimmune diseases until stage 3 trials have been completed overseas.

WHAT!!!!!!  According to the Oxford English dictionary the definition of research is "The  systematic investigation into and study of materials and sources in order to establish facts and reach new conclusions".  If you are simply going to follow in the footsteps of someone else work and do exactly what has already been done you are not going to establish facts because these facts have already been established.  You are not going to reach new conclusions because these conclusions have already been reached.  Essentially this is not research, this is redo. 

In the meantime, while we wait for the trials to be conducted overseas and then conduct our own research, sorry redo, which is at least a three to five year wait, Australians are dying and suffering.

In my next post I'll give you some insights into why we do it this way and more importantly, what we can do to make it better.  Until then, stay well:)

HSCT and Cystinuria

For those of you that don't know, I have had two main medical issues throughout my life.  CIDP, the problem for which I was successfully treated with HSCT back in 2012 and cystinuria.  A disease that means you get lots and lots of kidney stones.

Anyway, a few times I have been asked the question "Did HSCT also work for cystinuria too?"  A reasonable question ask but what is the answer?

The short answer is no.

The long answer in no.

Ok, ok that is a little facetious of me so I will elaborate.  When I was looking for new treatments for my ailments there were always two voices in my head.  First, the cold and logical part of my brain that asks for facts and questions the scientific theory.  The second is the voice driven by emotion.  A voice that clings to hope and is fuelled by desperation.

The question is, which one to listen to?  The answer is both.  When I first heard of HSCT I got very excited.  I was like a kid in a candy store that had just found the best chocolate bar in the world ever.  I then shared this news with my doctors who were much more sceptical.  Logic dictated that I should give up now as my doctors knew an awful lot more than I did.  But I was right to listen to my emotional side which told me to carry on.

However, I then had to listen to my logical side.  Ask myself questions like "What is the medical rationale behind this?" "What have the studies to date proven?" "What has come of the patients before me?"  In all three counts the answer was positive so I decided to go ahead and made what was absolutely the right decision.

But what has this to do with cystinuria?  The brain was ticking over at the time and I did ask myself "Could this help my cystinuria?"  My emotional brain wanted it to but my logical brain new the answer.  There was no medical or scientific rationale saying it would work.  There was absolutely no reason to think it so no studies had been done and nobody had been before me.  But still emotional Andy kept saying "but maybe..." I was going to have the treatment anyway

Unfortunately, logical Andy was right.  Since HSCT my CIDP has all but gone but I still have kidney stones.  In the last four years I have had six surgeries for stones and I'm sure there will be more to come.  So to my fellow cystinurics, unfortunately this is not the answer no matter how much we wish it was but I'd also say don't give up looking.  Keep listening to that emotional side that wants to find the answer.  There is a better treatment out there, dare I even say cure? And it will take both the logical and emotional voices in our heads to find it.

Stay well:)

Does HSCT work?

Firstly, to all my dedicated readers.  Sorry.  It has been way too long since I have posted.  I'll try to keep you more up to speed in the future.

But can you believe it has been four years since I had my life changing stem cell transplant in Chicago?  And yes! I really mean life changing.  If I have one regret it is that I don't have much video of me before my transplant so that I can compare it to now, so for the first part of this post I'll describe what I was like.

When I had my first evaluation with Dr Burt in February 2012 he asked me to stand up out of my chair without using my hands.  I did it... Just.  I had to shimmy along to the end of the chair so my centre of gravity was as directly above my feet as possible and with one mighty heave I pushed up.  Instinctively I tried to use my hands but was reminded not to but after about three seconds I was standing in a vertical position.

This was with no weights or hinderances either and I only just managed to achieve it.  Fast forward four years and after HSCT and a bit (ok a lot) of gym work I managed this:-

That is an 85 Kg deadlift and three reps to boot!  HSCT works people! HSCT works.  Stay well:)

Follow up wrap

Well it's all done and dusted in Chicago now.  A caught up with a couple of people in the ward going through the process at the moment, I had lunch with Brian Hinkle, a fellow CIDP patient who was there for his one year follow up and of course I had my appointments with Dr Allen and Dr Burt.  I was there for a week so I also had time to catch up with some old friends, visit some of my favourite places and do a couple of things I wasn't able to do a couple of years ago.

However, although I would have to classify the trip as a success I still feel a little disappointed.  Allow me to elaborate.  This is my second evaluation.  When I had the first one the results were nothing short of spectacular.  Although they still demonstrated a "severe neuropathy", the improvement was marked and I felt a great deal better for it.

In this my second evaluation I was hoping that this steep upward curve would continue to climb.  I was expecting improvement albeit not as much but alas, there was none.  On the plus side, there was no degradation either.  But still, I couldn't help but be a little disappointed.  The neurological report from the nerve conduction test still said severe neuropathy although I don't feel like it.  The improvement plateaued and there it has remained.

It's not all bad though.  For the first six months post HSCT I had significant marked improvement.  This is something that had never happened before and since then there has been no improvement but most importantly, there has been no deterioration and although nobody can predict the future entirely the general consensus is that the stability will continue.

This actually solves the biggest issue I had prior to HSCT which was the uncertainty.  I never knew what the next stage in my disease progression was going to be or when.  Now I know what to expect. I can move forward knowing what the future holds.

The outcome has far exceeded what I had hoped and the disappointment is relative to my results at the six month stage.  Was it all worth it.  You Bet!  I'd do it again if I had to but for now I'll simply temper my own expectations and enjoy the improvement I never would have had without HSCT.

Until next time, stay well:)

Back in Chi Town

Can you believe it has been over two years since my transplant?  Neither can I.  But I'm back in the Windy city for a follow up and I have to say it is fantastic to be back.  Chicago is a fantastic city and I have many fond memories.  So far I have caught up with many old friends and seen Dr Burt.  I got the feeling he is really excited about how far his research has progressed.  He didn't tell me as such but I got the feeling that he is soon going to publish or finish some of his studies and will be announcing to the world some magnificent results.  But then again I may be wrong.

In terms of my follow up they were amazed at how well I was doing.  They had me fill out a bunch of disability scales and all the scores were either 1 or 0.  I had to fill out a pain survey too which I actually couldn't do because it made the assumption I had pain which I don't any more.

On another note I met up with another former CIDP sufferer and HSCT survivor Bryan Hinkle.  It was great to meet the guy in person as I had corresponded with him over Facebook but nothing quite beats that face to face interaction.  He had his wife Ann and two young children with him too and it is really nice to see the positive impact the treatment has had on not just him but his family too.

As far as enjoying Chicago goes, I have been to millennium park to watch a public viewing of This is Spinal Tap which was really fun until it started pouring with rain.  And I mean it poured.  They turned the rain all the way up to eleven ;)  Today, I must go to American girl with my shopping list or my daughter won't let me back in the country on my return and I thought I might also take a River boat architecture tour as I could not do that two years ago as it was winter.  I also have my NCV and EMG today.  I'll keep you posted on how that goes.

Stay well:)