i love me some medicoliterary geek humor.

i suppose, since i have the post editor open and all, that i should take this moment to apologize for the dearth of posts in recent months. i know i’m letting my loyal reading audience of 3 down, and i’m sorry. it’s just a bit difficult to tread water and type at the same time.

i had signed up for NaBloPoMo with the best of intentions. a post a day for a month? i could handle that. even with some light holiday travel, i could post from my phone. i’m not working right now, so what better way to exercise my photography and writing muscles?

who was i kidding. this is 2009. if there’s been a consistent theme this year, it’s been this: make a plan, have it fucked with. it’s amazing we even got to mexico (the asshattery of acapulco notwithstanding), all things considered.

so what happened to my plans this month? well, i learned two new medical terms, of course. (i hate learning new medical terms. “fetal bradycardia” was the first one of the year, and it’s been a constant suck since then.) these are the new two:

giant cell tumor of the tendon sheath; and
pigmented villonodular synovitis

there’s a school of thought that they’re really the same thing, just in different sites. from a treatment point of view, it doesn’t matter which one it is. neither is malignant; they’re both benign aggressive soft tissue tumors.

and i have one or the other in my right foot. it’s about the size of a golf ball. it wasn’t always so big, and only recently has it begun to cause any pain. by now, though, it has enveloped the two peroneus tendons and eaten up part of the cuboid bone (the x-ray and MRI look amazingly like a mouse has been at it). because of this, it needs to be removed before it causes major permanent structural damage. it needs to be removed NOW, because i’m still trying to get knocked up, and i’m not about to undergo general anaesthesia while newly preggers – again (we saw how well that worked out back in april). or, for that matter, hugely preggers (i know i’m getting ahead of myself, but i’m still hopeful). and since it’s an aggressive tumor, if it’s not removed, it’s going to keep growing, getting more painful, and doing more damage to my dainty (okay, size 9 – but it’s long and elegant at the moment) foot. even with the tumor removed, there’s a 45% chance it will grow back. grmpf. the upshot is that the week after thanksgiving (and two days before my birthday, no less – those plans certainly got screwed too), i’m going back under the knife.

that’s right. i’m headed for four surgeries in oh-nine. one for each quarter. yay me.

so i’ve been too grumpy to blog daily, and for the last week i’ve been gimpy due to pain and swelling following an exuberant core biopsy that angrified the tumor and the foot, which cut in on photography, and my plans to start working out again, and my plans to look for a job.

and there you go. the universe is mocking me. doing a damn good job of it, too.

the colorado senate recently passed a bill, 32 to 1, requiring pregnant women to submit to HIV testing. the lone dissenting vote came from a republican who believes that the measure would “remove the negative consequences that take place from poor behavior and unacceptable behavior.”

apparently the senator believes that living with the consequences of untreated HIV appropriately punishes poor behavior. on the other hand, the rest of the state’s senators apparently believe that a fetus’ medical needs outweigh a woman’s right to privacy. according to one of the bill’s sponsors, “What this bill will do and why it’s so important to test the woman when she is pregnant — if she is HIV-positive, treatment is started immediately to protect the baby, the unborn baby.”

now, don’t get me wrong – i think HIV testing is a good idea. it’s a good idea if you’re sexually active and if there’s a possibility you could be exposed to HIV. it’s a good idea if you’re a pregnant woman who wants to make the most informed choices about health care for yourself and your fetus. so it’s a good idea to require doctors to offer the test, and to either require health insurance to cover it, or to pay for it out of government coffers. but requiring women to get tested – which is the likely outcome of an opt-out system – bothers me. interjecting the government anywhere in a woman’s reproductive health care bothers me, because in this country, it’s a quick jump to measures that limit reproductive choice, and that impinge on a woman’s right to conduct her life as she sees fit.

i believe the wording of the bill is highly problematic, even though it’s basically the existing syphilis law with HIV tacked on:

25-4-201. Pregnant woman to take blood test. (1) Every licensed health care provider authorized to provide care to a pregnant woman in this state for conditions relating to her pregnancy during the period of gestation or at delivery shall take or cause to be taken a sample of blood of the woman at the time of the first professional visit during the first trimester for testing pursuant to this section. The blood specimen obtained shall be submitted to an approved laboratory for standard serological test for syphilis and HIV. Every other person permitted by law to attend pregnant women in this state but not permitted by law to take blood samples shall cause a sample of blood of each pregnant woman to be taken by a licensed health care provider authorized to take blood samples and shall have the sample submitted to an approved laboratory for a standard serological test for syphilis and HIV. A pregnant woman may decline to be tested as specified in this subsection (1), in which case the licensed health care provider shall document that fact in her medical record.

(2) If a pregnant woman entering a hospital for delivery has not been tested for HIV during her pregnancy, the hospital shall notify the woman that she will be tested for HIV unless she objects and declines the test. If the woman declines to be tested, the hospital shall document that fact in the pregnant woman’s medical record.

25-4-203. Birth certificate – blood test. In reporting every birth and stillbirth, physicians and others required to make such reports shall state on the certificate whether a blood test for syphilis and HIV has been made upon a specimen of blood taken from the woman who bore the child for which a birth or stillbirth certificate is filed and the approximate date when the specimen was taken. In no event shall the birth certificate state the result of the test.

first, they’re requiring a sample of blood to be taken for the purposes of the HIV test, whether a woman agrees to be tested or not. then, the bill allows women to opt out, rather than requiring affirmative assent to the procedure, which would provide more protection for the woman. nothing will prevent a provider from taking the blood and “oops!” either “forgetting” to give the woman the option to decline the test, or “losing” any documentation of her refusal. finally, if they do offer her the option to decline, and she does, the fact of her refusal must be documented. why? and how will that information be used down the line? will providers be allowed to refuse to treat women who decline the test? will health insurers refuse coverage to women – or their infants – who have not tested negative? and what is the purpose of recording the fact or absence of the test on the child’s birth certificate?

the legislation is broadly written to cover all providers treating women for “conditions relating to … pregnancy.” this would require that a woman seeking an abortion must go through the HIV rigamarole. and to what end?

while this legislation might have evolved from good intentions, the potential for abuse seems very high, and the rationale behind requiring the testing, flimsy at best. i can only hope the house shows better sense than the senate and defeats it.

i came across diary of a dying mom while reading an article on “difficult patients.” more commentary on (among many other things) the sorry state of american health care and the doctor-patient “relationship.”

the author is a former professor of public health at unc.