Thursday 6 May 2004

Pic of the day: The doctor also told me to spend an hour each day in outdoors activity when not at work, and this I have tried to do.

Rofecoxib

Regular readers will have noticed that April and May are my arm pain months above all (except when I try to do the Novel Writing Month). At times, the pain sets in as soon as I sit down before the keyboard at work, before I even start to type. It hasn't been quite that bad this year, but actually typing has grown gradually worse. I would have taken a sick leave earlier, if I didn't hate trying to contact the doctor. And with good reason.

On Monday I got around to phoning my assigned physician. (Yes, in a rare fit of stalinism, the Norwegian state assigns all citizens to a local doctor. You can apply for a change, and it may be granted if the doctors agree and the bureaucrats don't have anything against it; but by default it is out of your hands.) I called between 10:30 and 11, because I remembered from a year or two ago, this was his phone hours. I eventually met a nice lady and told her that I wanted to talk about a sick leave. (Not sure how this is in the rest of the world, but here you need an attest from a physician if you want to take more than a few days off, or have special demands such as partial sick leave.) The lady told me that his phone hours were 8:30 to 9, Mondays, Wednesdays, Thursdays and Fridays. So I should call again on Wednesday.

Well, I called again on Wednesday at 8:35. An answering machine told me that no doctors were present at this time. I tried again at 8:40 and 8:45 with the same result. 8:50 the line was busy, as well it should be, and remained that way. After 9 I called the office again and informed them that I wasn't going to have my pay cut because their doctors didn't answer the phone. One of the nice ladies then on second thought conceded that perhaps, since I would have to see the doctor anyway, could come to the office at 11. Well, duh. I'd gladly have done that on Monday.

(I'm not sure how many people are assigned to each doctor, but I remember that it was in the thousands. So let us to be modest say 2000. With 2 hours phone access a week, that should be 1/1000 hour per person per week. Is it just me or does that sound like a really thin slice of time? There are 60*60=3600 seconds in an hour, so that would be 3.6 seconds a week. Luckily most of us aren't sick every week.)

I wasn't surprised to wait for over an hour. Actually I considered not coming until a bit later, but there is always the bus effect: If you are on time, the bus is too late; but if you are too late, the bus is on time, and will drive right before your nose. So I brought an issue of Scientific American and my pocket computer, so the time wasn't wasted.

Once I got to see the doctor, however, it was all flowers and sunshine. The guy knows what he is doing. I got a few days off from work and two weeks of reduced work, and a new painkiller called Vioxx, containing a chemical named Rofecoxib. (Actually it would make more sense if spelled backwards, in my opinion. Bixocefor is at least possible to pronounce. And Vioxx sounds like "generic Candian Viagra" in my ears, in so far as it is pronounceable at all.) But the skin deceives. This is evidently some new generation of designer painkiller.

***

My problem with non-steroid anti-inflammatory drugs (NSAID) is the stomach. With acid problems you really don't want to block the enzymes that protects the stomach lining from the intense acid in there. But this enzyme is so similar to the ones that promote inflammation in the rest of the body, so traditional drugs will treat them the same. This is where a couple new drugs come in. With a complete map of the human genome and various other pieces of information, it is now possible to design drugs to perform a specific task rather than just randomly replacing a few atoms in a known painkiller and hope the new variant will be as good or better.

Vioxx is definitely a new type of drug indeed. It didn't work immediately, but the next morning I could feel quite clearly that my body chemistry was changed. My arm was still stiff, but it did not hurt just for that. I could still feel pain as well, elsewhere. But the link between the stiff arm and the pain was broken. My new body chemistry put an end to the downward spiral where knotted muscles led to pain which led to more knotting of the muscles. (Of course, plenty of sleep and meditation could replace medication, but that would take time. Plus, there are limits to how much sleep you can get on the job before someone barges in with a problem...)

All things were sweetness and joy until Thursday evening. Then, fairly suddenly, I got acute pain in my guts on the left side. I am so glad it was on the left, because if it had been on the right I would surely have called the hospital, believing my appendix had ruptured. It was that kind of pain. But on the left, your intestines don't rupture unless you put a knife in them, and I would have noticed that. Although the feeling was highly wound-like. The pain persisted for quite a while interspersed with bouts of diarrhea, quite a disenchanting evening. It gradually faded during the night though.

I don't know that this was a side effect of the Vioxx. It could for instance be a side effect of the shrimp salad. There is a reason why those things are not kosher, you know, they degrade easily. I am going to try the medication again, but not during the weekend. Friday and Saturday are dedicated binge drinking days in Norway. Norwegians don't drink much alcohol compared to most civilized nations, but we drink almost all of it during a few hectic hours, which puts quite the strain on the hospitals and clinics, where doctors and nurses would like some time off as well. (They would probably like a drink as well, being mostly Norwegian too.) So, not a good time to get violently ill.

If the pain and intestinal dysfunction was not caused by the Rofecoxib, then this stuff is just what I've been looking for. You can hardly imagine, well most of you, how it feels to know that typing all you want is forever beyond your reach. It is like losing the love of your life. Well, supposing that writing is the love of your life, at least. Which I guess is a pretty accurate description of me.