Pelvic exam

Whatever the liberals say, men and women are different, and that is nowhere clearer than in the "pelvic region" which is where "pelvic exams" are carried out.  It may seem like an absurd euphemism to refer to a process whereby a woman exposes her private parts to her doctor. But as a rectal exam is often carried out at the same time (while it is available), perhaps "pelvic exam" is the best title to cover an investigation of all the soft-tissue between the hips.  Doctors love inventing kit to make their jobs easier - stethoscopes for starters and they have to buy a speculum [R] to carry out a pelvic exam. As well as kit, doctors have a tendency to baby-talk to their patients - the Consultant Paediatrician we had occasion to visit ten years ago persisted in calling me The Dad. It wouldn't surprise me if some Ob/Gyn chaps say to their patients "I'm just going to put Daffy Duck up your wee-wee".  And did you know that they need a set of specula as well as a couch with stirrups? No, me neither.

It would not surprise you to hear that the tail gets to wag the dog. If the medico has all this gear, then he (it's still mostly he) is determined to use it; so vast numbers of, particularly American, women have for the last generation been subjected to regular, often annual, pelvic exams.  They justify this invasive procedure in the belief that they can detect asymptomatic infection and growths early and expedite their treatment. Well, the American College of Physicians has just issued new guidelines in the Annals of Internal Medicine to say that routine pelvic examinations are unnecessary if not counter-productive in normal asymptomatic healthy women.  In particular, the bi-manual (one in, one out) physical palpation of the uterus and ovaries is useless for early detection of ovarian cancer, although a pap-smear from the cervix may still have utility for detecting uterine tumours.  But a pap-smear is only recommended every 3-5 years rather annually and poking around "down there" leads to referrals to other specialists as benign masses get confirmed in their status as . . . benign masses.  Needless to say, it wasn't difficult to find a gynaecologist who found the new recommendations laughable. “We continue to urge women to visit their health care providers for annual visits, which play a valuable role in patient care” said John C. Jennings, MD, President of the American College of Obstetricians and Gynecologists, and that will be at least $125 each time, thank you. The average annual renumeration for gynecologists in the US is North of $200K.

We've seen similar turn-arounds on prostate palpation - last (and second) time I went for my M.O.T. with my G.P. he said he'd wield his proctological finger if I requested it but as it identified so many more false positives than true positives the current best practice was to rely on a test of prostate-specific antigen that would be carried out on the blood and urine samples that he took off me.  Same for routine mammograms where the detected tumours were just out-balanced by the new tumours induced by the X-rays send through millions of breasts.

Pelvic exam is held to be handy for detecting STIs like Chlamydia by the observation of a "strawberry cervix" despite the fact that only 2% of Chlamydia infections result in the inflammatory expansion of capillaries than give it a reddish glow.  Because they don't have a cervix, men are just asked for a urine sample. It's always structured easier for men.

In Ireland a fantastic amount of the annual budget (€13bn) is sent off to the department of health and every year they over-spend their allocation and rapaciously ask for more. Reducing the number of annual pelvic exams will reduce the number of Ob/Gyn blokes and they could be retrained to operate a comprehensive programme of preventive medicine.  For starters levering 8 year old children off the sofa to run 2 miles to go and buy cigarettes for their mothers.  The children are less likely to get obesity, diabetes and cardio-vascular insufficiency, the treatment of which consumes 70% of the healthcare budget AND their mothers will die earlier and be a shorter time on the pension.

Louis Blériot

25th July 1909 was a big day for my Grandmother.  The town of Dover, where she lived from the age of 2 to 108, was hopping from one foot to the other all through that Summer. The previous October, the Daily Mail had offered a prize of £1000 for the first person to fly across the English Channel in a heavier-than-air aeroplane. Several daring young men in their flying machines lined up (or lounged about throwing shapes and smokin' cigars) between Calais and Sangatte getting ready to have a try.  To put the £1000 prize in perspective, the previous year, old age pensions had been introduced in the United Kingdom at 5/- a week or £13 a year.

On 19th July 1909 Hubert Latham took off from his base at Sangatte but had to ditch in the sea when his engine failed 10km from the English coast. He was picked up by a French destroyer. Amazingly, the plane was salvaged from this first sea-landing. The weather closed in after that, but at 0300hrs on 25th July, Louis Blériot was woken up by his colleague and told that the day was auspicious. As soon as the sun rose (it was already light but the Daily Mail rules stated between sunrise and sunset) at 0441 hrs he took off and landed, hard, 36 minutes later on a bit of meadow near Dover Castle. There was nobody there except Charles Fontaine, the correspondent with Le Matin, who batted him with an enormous tricoleur. It was the first time a plane had flown across La Manche. Vive La France! Vive les aéronaute français!  Later that day, along with the whole town, my Granny scooted up to the cliff-top to rubber-neck at the latest arrival, she would have been 16.  From that small adventure, she lived long enough to see Neil Armstrong make his one small step onto the surface of the Moon.  That's a lot of change in a life time. They later put a heavier than granite memorial down at the spot - it's hideous.

Compostella 2004

On the afternoon of 25 July 2004, after taking four days to walk 105km North from the city of Tui just across the Rio Minho/Miño from Portugal, The Boy and The Blob pulled into Santiago de Compostella in NE Spain.  Here we are at the doors of the cathedral:

The chap on the left clearly has a spare tire.  Six walking weeks and 700km later, the golden-tan hat had acquired a dark organic-rich band from boiling 12kg of fat up through the top of my head, and I was in France.  The picture was taken ten years ago. Today, I have no intention of walking 20km.

Fancy cat

I went down to visit the outlaws yesterday and one of the items on the To Do List was a visit to the Pet Vet with the grossly obese cat which was foisted on them by one of the grandchildren when that child moved house a few years ago. I've been fortunate in my own health, so that I have been to visit my GP 3 times in the last 20 years: one broken wrist, and two middle-aged-bloke check-ups. Thus, while I'm aghast at having to shell out €50+ for five minutes of medical time, it happens so infrequently that it's not too painful.

Last night we shelled out €70 to service the cat!  And I don't mean stud fees. That's the second or third visit this year.  We were persuaded that the cat needed to get her annual immunization against cat-flu and feline infectious enteritis - that was €40. When I say "we", I mean Herself was persuaded because that kind of attention for a cat is more than my thrifty Scottish granny would have been able to countenance; and I can't have the old dear turning in her grave. Immunization wasn't even on the agenda when we left home, either. Me, I think this is a bit of a bill of goods which vets push at their customers in the same way that undertakers gently persuade you that Great Aunt Maud deserves an oak coffin rather than one made out of particle-board. Nobody I know gets their healthy kids a flu jab every year. That aside, the cat was weighed in at 6 kilos and another 1.5kg bag of Royal Canin Reducing feline diet control pellets was purchased for €20.  It is a rare day indeed that I buy food for myself or my family at €13+ /kg.  Even in Ireland you can buy some fancy cheese at that rate and butcher's meat is way cheaper.  But baby's formula milk (another con) is about the same price.  On our farm, additional food for adult animals works out at 25c/kg.

The bulk of this reducing concoction is: "Rice, chicken meal, corn gluten meal, potato protein, corn, natural flavors, herring meal, flax meal, dried beet pulp, powdered cellulose, calcium carbonate, dried brewers yeast, chicken fat . . . and a smidgeon of . . . rosemary [Rosmarinus officinalis] extract ".  I draw attention to the rosemary extract because another Royal Canin product is called CALM and is marketed thus: "has been specially formulated to assist in the management of stress and anxiety in the feline patient." this has "Chicken by product meal, corn, brewers rice, wheat gluten, corn gluten meal, wheat, natural flavors, powdered cellulose, dried plain beet pulp, chicken fat, fish oil . . . and . . . marigold (Tagetes erecta) and (less) rosemary extract".  There are lots of vitamins, minerals, and trace elements but I have to conclude that Marigold extract in minute quantities is claimed to clam neurotic felines.  Is there a difference between dried plain beet pulp and dried beet pulp? And what the heck is brewers rice?  Oh they mean brewer's rice: a harmless cheap filler.

The reducing diet requires the current minders of this feline pillow to feed it not more than 50g a day of the concoction until the beast starts to shed some weight.  I don't see why the old couple can't give the cat 50g of best herring instead or 50g of pork chop for half the price.  It's surely a question of quantity rather than niceties of ingredients if it is a crash-diet.

Throwing shapes on the map

Argentina declared its independence from Spain in 1816 and Chile two years later. The default position for establishing a 5600km boundary between these two neo-nations was uti possidetis juris: the scope of the existent Spanish provinces should determine who owned what. It's fairly straight-forward if extremely wiggly for the bulk of this border which is defined by the Andes Cordillera: the peaks and water-sheds of the mountain range delineating the issue. That should be clear except when the water-sheds tell a different story from the peaks. The last glaciation (before Spaniards and possibly before people came to S South America) shifted enough rock that some lakes which used to empty East to the Atlantic (and so be Argentine) now flow West through the Cordillera into the Pacific.

It mattered not a jot at the time because nobody was interested in recreational skiing or mountaineering.  It matters a bit more now because there is a cluster of brine lakes [R] right at the top of the border which are loaded with lithium and lithium is vital for the future of electric cars.  It's quite amicable up there so far because each country (and one for Bolivia too) has its own exploitable salars. The Lakes further South, where there is a dispute, have in general been divided in half with a straight north-south line, without much fuss.
In 1818 Patagonia was a wild and woolly place inhabited by native South Americans and fur-trappers. Darwin passed through the region 20 years later and was shocked at the lack of amenities with which the local people fended off the brutal weather.  In 1881, representatives from the Chilean and Argentine governments sat down to sort out all the disputes so that they could get on with governing and not fussing about any trifling bits of territory which were probably wholly untaxable because nobody lived there, no mineral resources were apparent and nothing profitable would grow. The "Great Powers" - in this case primarily the USA, France and Great Britain - had an interest in the outcome because they wanted to ensure that the Straits of Magellan would be freely available to their merchant shipping.  Weirdly and confusingly the US ambassadors to Santiago and Buenos Aires were called Thomas A Osborn and Thomas O Osborn respectively, and they along with their British counterparts put their oar in the water in an advisory capacity which probably meant the threat of gun-boat diplomacy.

The upshot of this desire not to put the Straits of Magellan under the jurisdiction of a single nation led to the apportionment of half of Tierra del Fuego to Argentina, so that the Eastern end of the Strait at least should be not-Chile. There had been some slack surveying of the area, including by Darwin's HMS Beagle, so that the border as stated in 1881 would have given Chile access to an Atlantic coast at San Sebastian Bay: the bright blue indentation at the N of the Atlantic coast of Tierra del Fuego (map L]. This would never do, so the border was shifted 40" of latitude West, winning Argentina some 600 sq,km of tundra which is less than 4km wide at its narrowest point beside the Bay. Everything South of the Beagle Channel (the narrower wigglier navigable strait between Atlantic and Pacific) was assigned to Chile while Staten Island, 30km East of the point of Tierra del Fuego, became definitely Argentinian.

Those old enough to remember the Falklands/Malvinas War in 1982 will not be surprised to hear that the 1881 treaty, which was signed on 23rd July in that year, was not the end of all disputes. "All the islands south of the Beagle Channel" depends on where the channel ends and the open ocean begins.  The map [R] shows Picton, Lennox and Nueva island, which have at various times all been claimed by Argentina as being not Chilean. The yellow arrow identifies Snipe Island, an uninhabited islet which in 1958 came close to precipitating a war between the two nations over who had the right to erect a navigational aid in the form of a lighthouse.  For the last 30 years the Tratado de Paz y Amistad de 1984 entre Chile y Argentina, mediated by the Pope JP II and his representative Cardinal Antonio Samorè, has held the peace in the region. Huzzah!

Nighthawks

Because it's Edward Hopper's birthday, it's time to tribute-by-parody his best-known painting. You can google up works inspired by Nighthawks 1, 2, 23. But don't be fooled into thinking that Hopper was only about slightly depressed, gritty-realist urban scenes.  For far horizons to the imagination check out his lighthouses.

Mountain goat, mountain sheep

A weekend in intimate contact with a competent guide took me back 25 years. Towards the end of our stint in Newcastle, The Beloved and I crossed the Pennines for a weekend in the English Lake District. We stayed in a farmhouse B&B, which had been in the same family for several  generations. Then, as even more now, it's impossible to make a living from traditional farming and the B&B was part of the economic diversification that enabled that family to continue to live and work where their people were buried. The man of the house also acted as a guide on the fells and on the Sunday he offered to take us to the top of Scafell Pike, the highest point in England (not the same as the top of Scotland or Wales both of which are higher).  At the end of the day, we were a little taken aback to be asked to stump up £60 (or some such king’s ransom) for the pleasure of our host’s company for a day.  But that was his business and we sh/could have seen it coming.  ANNyway, I learned a lot that day about local history, geology, geography from the sweeping view from the top but I can’t remember a thing about that.  Two things have, however, stuck with me: the first is sticks.  This professional hill-walker in his late 50s used two ski-poles to spread the load as his limbs propelled his frame uphill.  When he was younger, he said, he’d yomped across the hills like a mountain goat but now he felt that his knees could use a little support.  He was an early adopter of these props.  Now, in the Blackstairs ‘mountains’ , the modest rise of which surrounds our home, every third person uses them.  But most of these same pole-carriers are kitted out for months in the Yukon: gaiters, gortex and a compass, maybe a survival bag, water, food for two days. When she was seven, Dau.I, admittedly on a sunny day, walked barefoot to the top of Mt Leinster 620m vertical / 5km horizontal above us.  Which kind of begs the question: How difficult can you make it?  How much clobber do you wish to encumber your day?  Not to mention the fact that, with all this back-up and a mobile phone with GPS, hill-ignorant folk are tempted to take risks that put them beyond their competence and in danger.

The other thing I learned that day is that you don’t need to be a sheep. The Lake District is within 90 minute’s drive of maybe 5 million people which makes for a lot of foot-traffic.  As we approached the top of Scafell, the grass got more worn, and the path more obvious.  We came across a cairn of stones beside the path and in the clear summer air noticed a line of these mini-mountains pointing towards the summit.  We both paused a dutifully paused and added a stone to the cairn.  Our guide stepped forward, picked up another stone and cast it away.  He explained that, while we could do as we pleased, he was against making man’s impact on the lonely hills so obvious and also implying that there was only one way to the top.  His vocation, in this small matter, was to act contrariwise.  It showed me that you can critically evaluate anything that everybody knows and sometimes come down agreeing with Mark Twain: “It ain't what you don't know that gets you into trouble. It's what you know for sure that just ain't so.”

Twenty years later, walking the Camino Frances to Santiago, I had many occasions to remember this revelation.  On that pilgrim highway, the flechas amarelas get so intrusive and so managing that people come to a bemused halt at any fork in the road, unable to proceed unless the route was confirmed, eventually a critical mass of pilgrims would agree that left (or indeed right) is the correct way to the City of God.  What you come to realise after 500km is that the correct way to the City of God is The Way itself.