This Keto Life: It’s nice to be validated

When you tell people you’re eating keto, you get some weird responses. Sometimes those responses are perfectly normal, like “what the hell is keto?” and sometimes there’s a lot of “hmmm, and you say you eat a lot of fat…?” and a lot of reserved judgement (which is fine; at least it’s being reserved) and people privately considering that they’re going to have to visit you in hospital when you have a heart attack and how on earth are they going to resist saying “I told you so, you pseudo-scientific noob.”

That’s okay. I have some of those thoughts about other people’s decisions, and most people handle this in a pretty mature way with the understanding that what goes in my stomach is my business, and what goes in their stomach is their business.

However, at the moment, I am wallowing in a giant pile of smug. The disclaimer is that this is not “smug” meaning “I am doing a sensible thing and you are all idiots who are not doing that thing” – different things work for different people (and there’s hopefully a good explanation for why carbs make me feel sick, and I’m pretty damn aware that most people don’t have have that experience). This smug is more “I am doing a sensible thing for me and it is working stupendously well.”

I just had a checkup with my doctor, and we had a gander at my most recent lipid panel. My total cholesterol is, unsurprisingly, what would be considered “high” by most standards. Not dangerously high, but high. This would be a concern if the scientific thinking on cholesterol hadn’t undergone a massive shift over the last decade or so, where even LDL vs HDL is a vast oversimplification (not even all LDL is actually problematic; just small pieces of LDL).

My ratios, however, are amazing. My LDL/HDL ratio is very low. My triglyceride/HDL ratio is staggeringly low. And my GP said that my HDL was some of the best she had ever seen. And my raw triglyceride measurement is also very low.

I said that was a relief, because even though I’d done enough research and trawling of the primary literature, when you go against popular medical advice, there is always a kernel of doubt (you sometimes feel like you’re being treated as an anti-vaxxer when you feed yourself eggs and hollandaise as a perfectly sensible lunch).

“Well, if you really want to double check, we’ll do a cardiovascular risk assessment.” So she took my blood pressure (96/66 – BAM!), and ran the numbers, and it all came back in a big fat green zero. Some of that is because I’m a pre-menopausal, 34 year old woman – my risk is pretty damn low as it is – but a lot of it is these improved ratios. One day I might sum up my discoveries about cholesterol and how it seems that how it actually works is significantly different to what was thought thirty years ago (and salt), and that will involve a lot of reading and referencing and an actual kind of science journalism that I haven’t really attempted on this blog before.

In summary: my GP, who is marvellous, but not particularly radical, is quite happy with me eating keto. She’s happy with my numbers; and since I have a great deal of trust in her, I’m happy with my numbers.

Now, if this had panned out another way – if it looked like my situation was getting worse while on keto, and if this doctor that I trust was concerned – I would have felt extremely conflicted. I don’t want to go back on a standard diet, or try a low fat/high carb diet. Not only does it make me feel sick (and break out in acne, and get more abscesses, etc.), but my palate has gotten quite used to regular doses of flavoursome fats, and I think it would be difficult to manage. I also still have my fun sensory processing issues which make it impossible for me to eat a lot of raw veggies (ie, vegetables that haven’t been prepared in fats, which these days is how I consume them).

I suppose I would have tried to find a way to make it work, but it would have done a number on me.

It turns out that keto really is my path to health. And honestly, although I mostly trust my research, I’m also aware that I’m not a biomed-head, I don’t have that background in human health, and it’s a load off my mind to have it all confirmed by a medical practitioner who knows what my numbers mean.

Now, if I could just stop eating muffins when I’m on holiday, I’d be set.

 

Advertisements

Diagnosis Roulette: “Wow, that was unpleasant,” and “What next?”

In our previous exciting episode, we learned that Dr Kate is flailing around trying to work out what chronic condition #3 is. In terms of impact on her life, Dr Kate isn’t sure whether #1 (hypermobility – pain exercising, lack of coordination, pathological physical dorkiness) or #3 (multiple trips to the emergency department, crippling abdominal pain, surgery after surgery) is more severe.

#2 (endometriosis) is periodic and mild (edited to add: for me! My endometriosis is relatively mild. Painful and awful, but mild as it goes).

But – abandoning this attempt to talk about myself in the third person – I’d really like to know what #3 is. It’s been making my life socially awkward and physically painful for 20 years now, and if I’m going to be constantly getting strangers looking at my butt (medical professionals, I’ll have you know), I’d at least like to know why.

So I got a colonoscopy (note, you don’t have to stop reading if you’re squeamish – I’m not going to provide details of prep).

As a side note, every specialist I’ve spoken to on this front over the past few weeks has uttered the phrase, “…and you’ve never had a colonoscopy?” in tones of shock, closely followed by, “Who has been handling all this for you?” with an implied undertone of “Whoever your family doctor is, they’re a fucking hack and should be suffocated with adhesive dressings.”

(there’s probably something more scary to be suffocated with, but since I’m allergic to most adhesive dressings and I get a painful nasty rash, I feel that’s pretty bad.)

At which point I explain that I’ve gone a long time without a regular GP, due to moving house a lot. I’ve probably had two over the past ten years – one of whom I lost faith in (and yes, although I liked and respected him for a long time, he should have recommended me for a colonoscopy while I was on his watch. I had a ludicrous number of abscesses during that period), and the other of whom changed clinics (and did recommend me mildly for a colonoscopy, but I chickened out, and she never had a chance to nag me about it before she left). After about a year, I followed the previous GP to her new clinic. It’s half an hour away, but she’s awesome, and having one person in charge is clearly the way to go.

Anyway.

There are numerous horrified personal accounts of colonoscopy prep on the internet. If you’re a person who is about to undergo their own delightful experience and wants to know what to expect, I refer you to those. In terms of the elimination side of things – ahem, the “bowel cleanse” – it wasn’t too bad, but then again, I’ve done something mildly similar before on a smaller scale and knew what to expect. My study is right next to the bathroom. I played a lot of Mass Effect. The Pico-Salax didn’t taste vile and my nausea was mild. End story.

The part I will write about is that the combined factors “not eating for over 30 hours”, “having nothing in your gut” and “not drinking any liquid for six hours before the procedure” leads to feeling like a fucking zombie.

The thing is, I’ve fasted before. I was toying with 5:2 as a way to deal with some of my comfort food snacking impulses (it was very effective on that front), and giving my poor mysterious gut a bit of a rest a couple of days a week did make me feel better. So I didn’t actually expect the “not eating” aspect of things to get to me so intensely.

It turns out that when you combine “not eating” with “powerful laxatives” (and dehydration), you actually end up feeling fairly hideous. By the time I actually turned up to the clinic for the procedure, I was dopey, dizzy, uncoordinated, and suggestible (Husband was talking to me while I was filling out paperwork, and I kept writing down whatever the last word he said was, instead of, say “State” or “Title”. The receptionist eventually told him off). I tried to read in the waiting room, but only got through a few pages before I lost focus and just gave up and played Freecell on my phone.

Look, I was a teenager in the 90s. For mindless distraction, it’s either Freecell or Minesweeper, and Minesweeper can be quite stressful. WHICH SQUARE DO I PICK OH GOD… So, yes. Freecell.

I think if I had to do it again, it wouldn’t be so bad, because I would know what to expect. It turns out that fasting for a colonoscopy is much nastier than a light day-fast for 5:2, and it’s not just the duration. Forewarned is forearmed.

The actual procedure

I was unconscious! I remember nothing!

Well, that’s not entirely true. It’s sedation, rather than a general anaesthetic. The anaesthetist said that in terms of personal experience, the distinction is semantic (not his words), but the difference is that I’ve never woken up under a general, and I sort of woke up under sedation.

This is not a horror story, don’t worry. I just came to a bit, heard them talking (they were gossiping about colleagues I think. Not malicious. Don’t remember what was said. Just smugly thought to myself “I knew this was the sort of deep, intense scientific discussion that happens during routine procedures! I knew it!”), and mumbled.

“…hello?”

Gossip continued.

“…umm… I’m awake here…”

“Oh!” said the anaesthetist. “No worries.” And I dimly saw another syringe being attached to my cannula. The liquid went in, I went out.

Propafol, man. That’s the good stuff. I did get a few seconds of feeling quite high before I passed out. I do live for these medical silver linings

I wonder if this is the redhead gene acting up again. I know we’re more resistant to analgesics and local anaesthetics, but I’ve never heard that about sedation. Go figure.

Anyway, I woke up eventually, feeling pretty ordinary in the belly region (full of gas), and then they gave me coffee and biscuits. Which I ate. Because fuck keto, I’ve just had a goddamn colonoscopy.

Then I ate more biscuits. Because fuck temperance, I’ve just had a goddamn colonoscopy.

The coffee was Nescafe. I drank it black, with sugar. Because fuck standards, I need caffeine (this is actually surprising. Even when I’m desperate, I usually find Nescafe literally undrinkable. I can’t get it past my tastebuds. I can only assume that my body shut down said tastebuds in desperation during this temporary crisis).

Anyway I sat around for a bit, and was reminded I couldn’t drive, operate heavy machinery, or sign legal paperwork for the next 24 hours (or rather, I could, but it wouldn’t be a solid plan).

Eventually I picked up my report and Husband took me home.

The result

Being me, I read the report in the car.

Normal colonoscopy.

I have really mixed feelings about this. On the one hand, not having Crohn’s disease of the colon (and remember that phrasing, it’s important) is a pretty good thing. As I said previously, by all reports, Crohn’s disease sucks.

But having unexplained abdominal pain and recurrent abscesses for twenty years also sucks; and I’d started to make my peace with a Crohn’s diagnosis. A moderate presentation, based on my symptoms, seemed like a survivable diagnosis; and the possibility of medication that might mean I wouldn’t have to turn up to the emergency department for surgery on a regular basis was appealing. Especially if that medication would prevent the severe abdominal pain that sprinkles itself randomly throughout my life. Also, having unexplained symptoms suggests that something might get worse if it is untreated, and you can’t treat it if you don’t know what it is.

Anyone else who has been on the diagnosis rollercoaster will understand this feeling. You get attached to a potential diagnosis, and when it’s taken away, you feel adrift and confused and upset. “But if that’s not what’s wrong with me, what is?” you wonder, lost once again as you have been since before this whole process got going.

And there’s also this other issue: any diagnosis that isn’t cancer starts to sound pretty good. Cancers come in a dizzying array of varieties and an extraordinary raft of potential symptoms. Any time someone has weird, unexplained symptoms, it occurs to most of us that maybe it’s a tumour. Hence the long term appeal of the classic Schwarzenegger denial: “It’s not a tumour!”

The other issue is this:

A normal colonoscopy doesn’t actually mean I don’t have Crohn’s.

Crohn’s disease can affect any region of the alimentary canal, although admittedly Crohn’s of the mouth, oesophagus and stomach are pretty rare, and Crohn’s in these areas are usually also found elsewhere in the intestinal tract.

About 70% of Crohn’s patients experience some Crohn’s involvement in the colon, which would mostly be detectable by – naturally – a colonoscopy. 50% have what is called ileocolitis, which involves the colon and the ileum (small intestine). 20% have colitis only, affecting only the colon. I actually don’t have many of the symptoms of colitis.

This, of course, leaves a whopping 30% of cases that affect only the ileum. Approximately. That’s 30% of patients in which the disease can’t be detected by a colonoscopy. A gastroscopy – ahem, going in the less personal end – isn’t too useful either, since that stops at the stomach.

There are a number of other ways in which Crohn’s of the ileum can be diagnosed, but it’s a piecemeal affair. Generally, they look at other symptoms and issues, blood tests and the like, and in many cases it rests on the idea of inhibited absorption and deficiencies. Since I’m not anemic, I’m not sure how useful some of these tests would be.

My last panel did have elevated liver enzymes and B12. I stupidly put this down to another cause, since I’m (a) an idiot, (b) not a doctor and (c) in complete denial and wussed out of talking to my doctor about it (this wasn’t the awesome GP that I followed. I would absolutely have talked to her about it).

And I just found out that Crohn’s can cause elevated liver enzymes and disfunction in that area.

Crohn’s can also cause inflammation of the gall bladder and gallstones. While I’ve never been diagnosed with gallstones (an abdominal MRI failed to show any, but then maybe I passed them by that point?), I have had stabbing agonising pain in the gall bladder region. It’s one of my two “agonising gut pain” patterns (the other one is lower right stabby pain).

The other option is a capsule endoscopy. This is the one where you swallow a little device that takes footage of your small intestine and walk around with it for eight hours. This sounds super cool to me.

Basically, between the recurrent abscess/fistula problem (and points go to my last surgical consultant who said “perianal disease is a shitty thing to have”, because I don’t think she meant to make a joke, but it was hilarious anyway), the lower right abdominal pain, the upper right gallbladder-ish pain, and my crazy liver blood test result, I suspect my next “diagnosis roulette” entry will actually involve a capsule endoscopy.

Today, I’m going in for surgery to correct the fistulas that are resulting in recurrent abscesses. Hopefully this will work. Fistula surgery can, apparently, sometimes be a bit of a crapshoot (heh).

I got up early to have coffee and breakfast (a protein cookie and a bag of nuts, since I haven’t been to the supermarket in a while), and now I’m considering going back to bed until my admission time. It’s been hard to work on any projects at the moment, as I’m constantly distracted by this medical business.

Look forward to the next exciting episode…

O Bendy Gymster: The Problem with pain tolerance

I always feel weird when I mention my high pain tolerance/threshold, as though I am making some glorious announcement of stoic macho toughness; hinting that everyone should fear my badass berserker attack, or poke me with needles and watch me grin evilly (I’m not sure where I’m getting this. I’m on painkillers).

Saying I have high pain tolerance feels like a brag, but it absolutely is not. When I say I’m not feeling pain properly, I’m not saying I’m being stoic and tough. Not feeling pain doesn’t indicate stoicism to me (double negative). Stoicism (applied colloquially, rather than referring to the philosophy of the Stoics) refers to a lack of reaction to pain. Pain is still felt. It is still experienced. It is simply not expressed. Toughness, on the other hand, might be interpreted as the ability to work through experienced pain when necessary.

But pain is important. Pain is information. If we absolutely must work through pain, then we must, because sometimes shit happens, but generally speaking, it’s not a good idea.

I end up working through pain – sort of, because it’s pain that I don’t experience fully – not due to necessity or toughness, but due to simply not knowing about it.

My high pain tolerance and threshold make life complicated sometimes. While I absolutely feel pain (there’s a lot of ouch in my uncoordinated life), I don’t usually process it in the way that people expect, unless it is very severe (and even then it is, apparently, bumped back a notch – or so I am told from my behaviour). This means that when a doctor is poking and prodding at an injury, asking “Does this hurt? How about this? And this?” I end up staring at them in confusion, because I don’t know if “slightly tingly” or “a bit fuzzy” or “I guess it’s sort of tender” or “I don’t feel a goddamn thing” is going to be useful.

I am worried that I won’t feel pain where and how I am supposed to, and will miss out on a correct diagnosis. This means that I have some very odd emotional reactions to blood test results, X-rays and the like.

Here’s the most recent example.

Yesterday, I went for a couple of shore dives. The water – this being Melbourne, and now being winter – was a chilly 12 degrees celsius, which is the sort of temperature I wouldn’t normally go near without a dry suit. Recently, I sold my dry suit, because I hadn’t used it in well over two years (I hadn’t even attached the inflator hose to my newest first stage regulator).

My (now sold) drysuit had boots attached, so when I dived in it, I was normally pretty warm, from neck to toe. My scuba booties were reserved for summer diving, for which they were perfectly adequate, even though they were a paltry 3mm.

I forgot how thin my booties were, and yesterday, when I went diving in cold water, wearing a 7mm neoprene suit and a Lavacore thermal undergarment, my feet went numb in under ten minutes.

Now, as a bendy person, I already don’t get quite as much proprioceptive feedback from my body as I need to maintain physical co-ordination. It’s why I have a tendency to trip over things, and bump into things, and fall on my arse on a regular basis (and probably why in the past 12 months I’ve broken a finger, pulled a calf muscle, injured my shoulder, and sprained my wrist). While you can train proprioception, at this point all my training is focusing on getting feedback from my core muscles and glutes. Working on kinetic awareness of my wider range of motion in arms and feet is probably going to be further down the line.

So after the dive, as I sauntered off to the toilet block with my clothes to get changed, I was walking with numb feet. I’ve done this before. I know the risk of falling over or spraining something is high. Feet are not just flat lumps you throw at the ground – you need to place them carefully, which you can’t easily do when you can’t feel them.

I was being super careful about how I placed my feet. I was paying solid attention.

And I still stubbed my toe on the gutter.

Given that my feet were still mostly numb – the pain penetrated but it was a dim, fuzzy thing – I simply said “Ow, that really hurt!”, frowned in surprise, and moved on.

My feet didn’t warm up until I’d been in the car for a while, on my way back to the dive shop to return the tanks, and the toe didn’t really start to hurt until I got home.

“Huh,” I thought. “Must have hit it hard. Oh well.” Since I was now coming down with a cold in earnest and feeling like crap, that was distracting me from anything else. Also, Husband was away, and I was grumpy about it.

It wasn’t until I woke up the next morning (this morning, at time of writing), that I realised the throbbing, spreading pain was actually constant and inescapable and had started to overwhelm the pain from nasal congestion.

I had two conflicting thought processes:

  • “If it’s broken, you’ll know about it. Stop sooking.” That would be the attitude I was raised with, and to a certain extent that’s fair enough given that I fell over every day as a kid, and it’s probably exhausting for a parent to have to comfort a child that falls over and hurts themselves all the time. So I always thought that broken bones would be really quite obviously agonisingly painful and that if I could actually function it couldn’t possibly be broken, and if I went to emergency to get it checked out I would just be wasting everyone’s time and being a big attention seeking git. This is reinforced by the fact that when my finger fractured last year, I felt it snap, and it obviously twisted.
  • “People can walk around on fractures and not know about it.” In high school, a friend of mine broke her ankle and walked on it for a week before someone insisted that the limp wasn’t improving and maybe it should be looked at. I’ve since had friends who had similar stories involve stress fractures and the like. It turns out that fractures to bone don’t actually come with gigantic neon signs.

I eventually decided that embarrassment was less problematic than walking around on a broken toe, so I got into the car and I drove down the mountain. I got some cold and flu meds from the pharmacy, stocked up on breakfast nuts (we were running low), and took myself to the local Emergency department (this gets stressful, as Husband is away this weekend. Taking oneself to emergency is never ideal).

I got the X-ray. I chatted to the doctor before he’d seen the X-ray. I had the familiar experience of him poking and prodding the toe and it not hurting, and me panicking because I’d just taken Codral, and what if I wasn’t feeling the right sore spot because I had codeine in my system, in addition to my usual inability to work this stuff out?

I couldn’t even point to where the pain was. That’s how bad I am at this.

However, when I thought “Okay, what would I do if I wanted to make it hurt more?”, suddenly I could process it, and I pressed at the outside of the first knuckle on my big toe and bang, ta-da, choirs of really mean angels singing, PAIN. Muted, codeine-soaked pain, but definitely the close cousin of the pain I’d been feeling all morning.

“There,” I said triumphantly. “It’s there.”

So when I saw the X-ray at last, my eyes arrowed into the side of the joint and there it was.

A little splinter of bone detached, pulled off by the tendon (avulsion fracture!).

And my first reaction was not “Oh shit, I’ve broken it, I’m fucking injured again, I’m so freaking sick of this…” No, that was actually my second reaction.

My first reaction was, “Thank god. There’s a cause for my pain. It’s visible. It’s provable. I’m feeling pain in the place where the injury is and one thing correlates to another thing and it makes sense and no-one is going to tell me I’m making it up.”

And that is all sorts of messed up.

And now I have a space boot.

“Why do you want me dead? What did I ever do to you?” , or, A Personal Experience Based Guide to the Fallacious Appeal to Nature

I admit I don’t always have the greatest amount of patience when it comes to encountering the appeal to nature. A great deal has been written concerning this most common of human logical errors. In case you’re not familiar with the term, the appeal to nature is the generalised assumption that something that is natural (term poorly defined) is always going to be better (term poorly defined – better for physical health? For mental health? For long-term job security? For basic rhythm? For syncopated rhythm and a 3/4 time signature?) than something that is unnatural (term poorly defined).

Don’t misunderstand me. I’m not just a scientist – I’m a marine biologist. I have a deep love for the natural world. I love bushwalking. I love watching David Attenborough documentaries. I am a fan of the carefully-researched-for-appropriate-ethical-practices eco-tourism par excellence. I am quite happy to spend several hours underwater with a tank of air (although for reasons of not wanting to die, I’ll have to take a few breaks throughout that period). I am sometimes slack on my slacktivism, but I do care, and nature is important.

I just don’t happen to think that that nature is there to help me personally. As glorious as nature is, it’s glorious in a terribly chaotic and amoral way; or, to put it another way:

Study evolution for five minutes and you quickly realise that Nature Is A Douche.

And as a consequence of this, the “appeal to nature” is pretty easy to knock over.

When the home birthing crowd start crowing about how medical intervention in childbirth is unnecessary because women have been doing it for millennia, just point out maternal and neonatal mortality rates over recorded history, i.e., say, “Yes! We’ve been doing it for millennia. We’ve also been dying the whole freaking time.

When people start blathering about chemicals as ingredients in food, it’s a quick moment only to point out that water is a chemical. As is oxygen. And sugar. And, alright, every molecular structure ever. This is how we define chemicals: “a distinct compound or substance.” Then people say, “I mean unnatural chemicals. That didn’t come from nature.” And then you have to point out that all chemicals ultimately came from this poorly defined concept of nature. Even if the end product was synthesised under laboratory conditions, the ingredients were no doubt extracted and refined from natural resources. Or perhaps the ingredients were synthesised from other ingredients extracted and refined from natural resources… and then we quickly run into definitional problems. Yes, to a certain extent, that’s a naive argument from the other end as well – but we really need to address why some additives could be a problem without saying “They’re unnatural!” because that misses the point entirely.

But that’s all fine. Really. It’s when we start to get into the anti-vaccine, anti-medications-especially-antibiotics crowd that I start to take the whole thing very personally indeed.

And I start to ask, why do you want me dead?

When I was about eighteen months old, my mother noticed that I was having difficulty breathing. I don’t have any more details about how the rest of that day went because she flatly refuses to talk about it. My mother loves drama, so this is very telling. My father gets very grim as well, and my father doesn’t generally do grim, as a concept. He runs the emotional gamut from jolly to furious, but grim is not in his repertoire. The memory of that day still apparently scares them both shitless.

This is because I nearly died.

Here’s how: we have a little flap of flesh in our throats that stops us from inhaling our food. It divides your oesophagus (stomach tube) from your trachea (breathing tube) and is called the epiglottis. When functioning correctly, it’s a nifty little structure. Mine was swelling up and blocking my throat, essentially choking me, and it wasn’t just doing this for shits and giggles. In 95% of cases, this response (epiglottitis) is caused by a bacterial disease called Haemophilus influenzae B. Surgical medical intervention was required to stop me from essentially choking on my own throat.

This particular disease has a high mortality rate in children. If epiglottitis is not caught in time, it is generally lethal. Then a vaccine was developed, and in 1993, it became part of the regular schedule of vaccines for infants in Australia. Then – and this may shock you – children stopped dying from it. There was a 95% reduction in reported infections, meaning that less children died from epiglottitis and other resulting complications like meningitis and pneumonia.

I know. Colour me stunned. If there had been a vaccine when I was a baby, I wouldn’t have nearly died. And if I hadn’t had surgical medical intervention as a choking infant, I would have died. Guaranteed. To paraphrase Dr House, “Oxygen is so important to a developing brain, don’t you think?”

So when people talk about how bad and evil and poisonous vaccines are, I want to ask them if they prefer that doctors have to cut into the throat of an 18 month old infant to save their life, or, if they’re really not a fan of that level of medical intervention, if they wouldn’t perhaps prefer the aforementioned infant to choke to fucking death.

And then I want to say, “So that infant was me. Why do you want me dead?”

Not long after that, I developed juvenile asthma – I never actually suffered a wheezing attack and was always able to get the minimal air in, but my asthma attacks presented as severe coughing fits and often led the way to secondary lung infections. Bronchitis episodes were scattered regularly throughout my childhood, and were best treated with antibiotics. Without these, I would quite likely have ended up with scarring in my lungs. There’s a lot that I wouldn’t have been able to do, not the least of which is SCUBA diving.

And it’s even possible that, again, I would be dead.

When I was fifteen, I began to present symptoms of a very unpleasant condition called hidradenitis suppurativa. It’s a pretty unattractive thing, so don’t click the link unless you have a really strong tolerance for pus. It’s a poorly understood autoimmune condition with a genetic component, and I have perhaps the mildest possible presentation of it.

This means I am only hospitalised for it – on average – once every two years. And I probably need medical treatment for it in a GP clinic about – rough guesstimate – once a year. Regardless of whether I end up being surgically treated or whether we can avoid this with the application of copious amounts of broad-spectrum antibiotics supplied in pills the size of which would send your average donkey wandering off for a large glass of water, intervention of some sort is ultimately required.

It’s not a lethal condition. Really, it isn’t. It can be excruciatingly painful, really exhausting (a massive infection site puts a drain on the immune system), extremely gross, and quite embarrassing to deal with, but it won’t kill you… not now, anyway.

However, the main symptom is abscess formation. If an abscess is untreated, then it could burst outwardly and leak infected pus everywhere – which is painful and gross, but manageable – or it could break internally and then you end up with septicaemia, a.k.a. sepsis, i.e. blood poisoning, and you die in considerable pain.

Wow. Guess we hate those evil antibiotics. Guess those bastards are just sooooo bad to have because they’re unnatural. Guess I should have just taken some fucking echinacea.

And died of sepsis.

Here’s another one! A few years ago, I managed to slip on a wet floor, go flying through the air, and land spectacularly on my back. It was hilarious and sore and a bit embarrassing, but I wasn’t worried until the next afternoon when I started peeing blood and passing out.

Lo and behold, someone (who may have been me) thumped their kidney, busted something, and ended up with a kidney infection. I spent the night in hospital on intravenous antibiotics and heavy painkillers, vowing never again to run across a wet kitchen floor, no matter how much I might want to get the shampoo from the shopping bag and then get back in the shower.

But a kidney infection without antibiotics? Why, it’s your old pal sepsis again!

I honestly could not tell you how many times I’ve been on antibiotics for a condition that might otherwise have killed me, but it’s at least fifteen.

I don’t have a genetic predisposition to any of these things other than the HS. They were just bad freaking luck. They couldn’t be prevented with echinacea, St Johns wort, or a few more gallons of breastmilk. This is real shit that happens, and before we had the antibiotics and other various medications, we died from these things. We died in large numbers, and we died in pain.

People who subscribe to these appeals to nature and natural treatment seem to believe that none of these bad things could ever happen to them, because they’re just so very healthy. These diseases don’t happen to them, or anyone down the street. No-one gets sick. No-one needs antibiotics or vaccines, according to them, because they’re so healthy.

I assure you, measles can cause encephalitis in very healthy people, and then they are not healthy anymore. There’s a cause and effect problem here: you are healthy because you lack disease. You don’t lack disease because you’re so healthy. It’s the wrong way around. It’s true that there are some less robust pathogens that are opportunistic and will only really get on board if you’re immunocompromised or a little bit run down, but we don’t vaccinate against those. Measles, pertussis (whooping cough), chicken pox – these are not those diseases. Those can and will kill formerly healthy adults, children and babies, no matter how much breastmilk was provided in childhood.

I’m here now because of these unnatural interventions. I’m here, and I’m relatively healthy. I like to go to gym five or six days a week. I do weights. I run (admittedly not well). I swim. I SCUBA dive. I’m an active person in spite of all those things I’ve been through, and it’s due solely to the wide availability of basic medical care.

Nature is a beautiful, amoral killing machine. It is not better for us. It’s been trying to kill us for a very long time, and we’ve been simultaneously trying to thwart it. So when I run into someone who doesn’t believe in vaccinations or antibiotics, I take it personally. I want to know what I ever did to them, and why they want me dead.

And if they don’t want me dead, and they don’t want other people who get sick to die, maybe a little more thought is in order.

Diving Fit!

[Note: I was in New Zealand for a few days for work-related business, and at the moment I am wrestling with a particular blog post that requires more attention and editing and fancy pictures than I can generally churn out on short notice, so here is something I prepared earlier. -KN]

Before getting my dive ticket, I agonised over whether I was “diving fit”. I spent most of my childhood and adolescence being more-or-less sedentary, and had this notion in my head that people had to be extremely buff gymsters in order to be able to SCUBA dive.

This is… not the case. Of course, the more fit you are, the better: diving will be easier. Walking down the pier wearing weights and tank will be easier. You will be more efficient with air. You may be asked to carry other people’s tanks, and thus earn their eternal gratitude and numerous blackmailing opportunities. Your tendency to get fatigued and dehydrated and develop some form of DCI (decompression illness) will be reduced.

Fitness isn’t, as a concept, well defined. It is better to apply fitness to a particular goal.

Take yours truly. I am not spectacularly fit. I go to gym a few times a week, I do my weight training, I spend a lot of time on flexibility, and at the moment I am trying to get through the Zombies! Run! 5k training app. I am probably stronger than most of my cohort (age/sex/etc.) and have an advantage in terms of muscle mass. But if you watch me running, you will be appalled. I am slow. I am ungainly. I have bad feet. I have hypermobile joints. I am, basically, horrifying to watch. My podiatrist referred to me, in slightly awed tones, as “the most flaily runner I have ever seen.”

In short, I am not running fit.

Fortunately, I am diving fit.

To be basically diving fit means that you can accomplish the following things:

  • You can swim 200 metres (any stroke; I like backstroke) without stopping. You can take as long as you like to do this.
  • You can tread water for ten minutes (this can be quite soothing).
  • You can lift and carry your own tank (it’s okay to need help getting it on. That shit is heavy and awkward right there. Park benches, fence posts, retaining walls and dive buddies are popular aids for this process).
  • You can walk around wearing the unit and the weights that you need to descend (more on that in a moment).
  • You can climb ladders onto boats and piers wearing the unit and the weights.

A standard sized 12L steel tank weighs slightly under 14 kgs, although this varies depending on the manufacturer and how much air is actually in it at the time. For most people this is a bit uncomfortable, but not a major obstacle.

The real problem comes down to weighting.

If you are diving in warm, tropical waters, you may not need thermal protection. It’s warm and pleasant, so you might dive in a lycra suit or, if you’re not concerned about jellyfish and fire corals, a bikini. Bikinis and lycra suits are not particularly buoyant, so you won’t need much weight.

If you are diving in cold waters (Melbourne. Sigh), you need thermal protection. I dive with at least a 7mm neoprene semi-dry wetsuit. These are, to use a technical term, very floaty. In cold months, I wear a drysuit. These are even more buoyant, since they don’t take on water. You don’t sink in this gear; you just bob around on the surface of the water. That’s not diving. That’s just very expensive snorkelling.

Because of this flotatious thermal protection, I need to wear more weight. The amount of weight you need to use is reduced as you get more experience in diving: you relax, you breathe more slowly, you learn to control your buoyancy. I am down to about 7 kgs in my 7mm suit, which suits me just fine (I used to wear about 10 kgs). That means that, including the tank, I’ll be wearing over 20 kgs strapped to my person, not counting the wetsuit itself and other accoutrements; and let’s remember that it is not strapped on in a particularly ergonomic fashion. I can walk in that without getting exhausted, but it is a workout not to be sneezed at.

In my dry suit I wear about 11 kgs of lead – so over 24 kgs in total. That makes a difference. Again, I can walk in that, but I do so very slowly, and have a breather before I descend (note: descending while out of breath or with an above-resting heart rate is not a great idea. You’ll guzzle air on the way down).

This is me. I am of a very average build. You might think that if you put on weight, you’ll have to carry less lead – because, naturally, you’ll be heavier.

Unfortunately (and believe me that I curse this), fat is positively buoyant in water. So even if you are very heavy on land, if that heaviness is fat rather than muscle, you will need more weight. I’ve known people who wear upwards of 20 kgs of lead alone, not counting their tank. This doesn’t mean they can’t dive; on the contrary, people of all sizes and shapes can master our not-so-ancient art, since people of all sizes and shapes can be diving fit.

But it does mean they have to be very strong if they are going to do cold water diving, because they are going to be walking around wearing that gear. You don’t usually park on the pier. Generally, you walk at least a hundred metres from the carpark to the water entry, and frequently it’s further than that. Not only are you walking, though; you’re bending down to pick up things if you drop them, or put your fins on if you are doing a jump entry; you’re helping your dive buddy get their own gear on; you are still bending and moving and doing heavy work, it’s just that now you’re wearing a metric fuckton of weight. You need to be able to do these things and help your buddy do these things if they get stuck.

This is not meant to be discouraging. I found it embarrassingly difficult to do anything in full kit at first. You get stronger, and it gets easier, and then it feels fantastic. It’s better to go in with your eyes open, though.

This is the main reason why diving requires fitness – for the most part, it’s not the actual diving and swimming. You wear fins when diving, and most of the time people swim quite slowly so they can look at things. In fact, you are encouraged to be relaxed and breathe slowly; diving is exercise, but it’s not supposed to be work when you’re under water (unless you are actually diving as part of your employment, which may involve diving in crappy conditions). The biggest risk is before and after you get in the water.

My recommendation for “stay dive ready” exercise is weight training focusing on back, legs and core work. Those are the muscles you use to handle your gear, get it on, walk around in it, and swim against current if necessary. Cardio is obviously a net benefit, but that is always true, and it’s not everything. I’ve seen numerous divers with excellent cardio fitness struggle to get onto the boat at the end of the dive because, when gravity reasserts itself, their glutes and hamstrings start to give out.

That’s right. You need a strong arse. You can climb a ladder wearing weights, but you need to take it slowly and use the big muscles.

I nearly met my match on a particularly awful ladder in Albany, Western Australia. It was an old, slightly rusted ladder hanging from the town jetty, and only the bottom rung was in the water; this meant I had to hook my knee over it to even get leverage. There was a moment where my supervisor looked at me and offered to take my weight belt so I could get up the ladder. I am nothing if not bloody-minded and managed to get my feet under me and straighten my legs (not without some cost and limping and very sore muscles for the following couple of days), but it was touch and go for a moment. This was also back when I was wearing a lot more weight, and, not coincidentally, I had less muscle strength than I have now.

Essentially, if I can do it – even at the cost of some wincing and whimpering for a day or so afterwards – it is pretty much achievable for most people, barring some particular circumstances.

There are a few conditions and situations that make SCUBA diving a spectacularly bad idea, and some that merely make it slightly more tricky, including but not limited to asthma and diabetes, as well as some temporary advice. I am not a doyenne of diving health or general SCUBA safety, but I plan to do some research and post some more general and basic information on the above conditions and general Thing You Should Not Do but which some people do anyway (much of this would be covered in an Open Water course, but refreshers are always good). If you want a heads up in the mean time, I suggest contacting someone listed among the South Pacific Underwater Medical Society (www.spums.org.au).