Weaponizing H5N1; wouldn't that suck?

Back in the day (not so long ago) the old USSR had a program called Biopreparat. Seriously heavy-duty biological weapons were being created under the guise of a vaccine program. I recall a quote from the now infamous Judith Miller upon seeing the giant fermenters used to create anthrax in an old Soviet bioweapon lab. "I thought, 'My God, Ronald Reagan was right, it really was an evil empire.' " Hearing a NYT reporter say that certainly caught my attention. Biopreparat hasn't gone away, though. Hard economic times mean that though much smaller they are still in business. Bad enough. Worse yet is knowing thousands of bioweapon experts are unemployed. Worst of all is knowing just how many nations and NGOs (i.e. Al Qaeda) would love to get some of that expertise working for them.

Plague would be a problem. Anthrax would be a larger problem. Smallpox a very big problem. Just imagine how hellish a weaponized bird flu (H5N1) would be. H5N1's rate of mortality is over 50% now. For the most part the only (somewhat) effective treatment has been Tamiflu and existing stockpiles would dry up quickly. The death toll in poor countries could be astronomical. The United States is better prepared than most nations but even here a pandemic would be devastating. I can't speak for the rest of the country, but here in Madison, Wisconsin many of the hospitals run pretty close to capacity much of the time, especially the intensive care units. Nurses are in short supply and the health care system would be completely overwhelmed in no time. Where would all the sick people be treated and who would treat them?

Am I the only person who has thought of this? Are our enemies even now trying with all their evil hearts to turn this disease into a weapon? A biological weapons factory and research facility doesn't have to be very big and isn't terribly expensive; well within the reach of many bad people. Being able to grow something nasty is one thing, turning that nastiness into a weapon is something else altogether though. Just ask the friendly folk of Aum Shinrikyo who eventually gave up on anthrax and tried sarin instead. Weaponizing biological agents has proved to be technically difficult for the amateurs who have tried, thank goodness. Just to make sure your sleep is less sound tonight though, scroll back up this post and reread the part about unemployed biological weapon researchers from Biopreparat. The expertise to cause the world way too much grief exists and it would be a mistake to believe that nobody is trying to exploit that knowledge for the gain of evil. The question is, what should be done about this? Full steam ahead on vaccine research I say. How about making it legal for drug companies to sell a course of treatment for specific threats over-the-counter? Increased demand from consumers would lead to greater production capacity of necessary medications and might save time and lives in a true pandemic. I can see some issues with that idea but it's intriguing nonetheless. Imagine picking up AnthraxStomper and Plague-Me-Not along with your groceries! In the long run the best defense will probably be a robust counter-terrorism capability augmented with sensible public health policy and preparedness.

Playing rugby again

I just played my first full game of rugby in several years. My vascular surgeon cleared me to start running and I took that to mean "running after those fast little bastards carrying the rugby ball." I whored in as a second row for the Wisconsin Rugby Club; hereafter known as the WRC. I huffed and puffed around the field like an asthmatic cape buffalo but it felt great anyway. I got in a few good runs and my play led directly to a couple of tries. Not shabby for my first full 15-on-15 40 minute-a-half with real referees and everything game in three years. Now the trick is finding a way to get to at least one practice per week and working my way onto the A-side.

*Disclaimer* if you don't understand any of the rugby jargon above, I'll summarize. I finally played a real, full, rugby game for the first time in three years. I played in an unfamiliar position but still played well. I'm terribly out of shape though and I suffered.

The Packers ... (fill in the blank)

After all these years I finally understand what a paradigm shift is. More on that in a minute. Its five weeks into the 2005 season and my GBPs have pretty much sucked. Why is that?

For a decade now my beloved Green Bay Packers have been a very good football team and sometimes a great one. A combination of aging stars, poor draft position, poor drafting, and poor free agent signing have combined to gut my team. Like a Hollywood building facade, the side facing the camera may be pretty but the other side is just a couple of 2x4s and plywood painted nice.

The better a football team's record, the lower their draft position and no team has been more successful than the Packers since 1995. Dating back to 1995 the GBPs average draft position has been 25.75 out of 30 and (after expansion) 32 teams. Put another way over 80% of the league picked before the GBP after expansion and 85% before. I can't overstate how much consistently poor draft position can cripple a football team. From the starters to the backups the players drafted were judged lesser players. For every Mark Tauscher (high-quality right tackle picked in the 7th round) there'll be twelve Rondell Meallys; a 7th round nobody. The better your picks the better your players.

Poor draft position is part of the price for success, and is a price happily paid by all. Still, when you draft lower it becomes even more important to draft wisely. Ron Wolf seemed to have a knack for finding great players in the lower rounds but his 1st and 2nd round players were sometimes suspect. I'd rather not even talk about Mike Sherman's first round picks. Sometimes a team gets locked into trying to find a particular kind of player and it leads to disaster. Ever since Reggie White retired the GBP has been trying to replace him. The trouble is that great pass-rushing defensive ends are always signed high in the draft. Picking lower you have to take chances to find great players. Those players are there to be had, for sure, but everyone else is looking for them too. Enter one Jamal Reynolds. By trading away players and picks the GBP were able to move up to #10 from #28 in 2001 and pick Jamal Reynolds, an undersized speed rushing defensive end from Florida State. Reynolds never reached the potential that was hoped for him and was eventually traded to another team to avoid the embarrassment of having to cut a former first-round pick. The Packers were desperate for a great defensive end and they gambled on him. On this gamble the house won and Reynold spends his days fishing and hanging out with his friends while the Packers are still looking for that great pass-rushing end.

Joe Johnson was picked up in free agency with the hopes that he could be the pass rusher so desperately needed. But in the few years he was with the GBP he spent most of his time on injured reserve with serious injuries. He was clearly at the end of the line and when cut by the Packers he retired. The money wasted on Johnson could have brought in several mid-level free agents or been used to help keep other players lost because they couldn't match offers by other teams.

I mentioned aging stars, but thinking on it now the GBP don't have any. Brett Favre is still one of the better quarterbacks in the league and all of the old guys are gone except William Henderson; a fullback who is still better than most in the league at what he does.

So, back to the paradigm shift. In the last ten years I've always looked at the Packers and felt that they could go deep into the playoffs and contend for Super Bowls. Now, I watch them play and I say to myself "Well they lost but they looked good doing it." The shift is in my expectations of the GBPs success. I no longer expect them to go far in the playoffs; hell I don't even expect them to make the playoffs. I hope for them to play hard, win the games they should and pray for them to win the games they shouldn't.

Maybe next year.

The Varmint

That's what I call my daughter; The Varmint. When her mother was pregnant I thought it unseemly to call the fetus "it." After all she wasn't a brick, tree, or other inanimate object. I took to calling the fetus "critter." After my lovely daughter Hannah Elizabeth made her way into this world of man her true nature became evident and as time went by she became known as The Varmint.
She started kindergarten this year and I love to go to her school and watch her during recess when she's running around outside. If you're a glass is half empty sort of person you'd say that she's bossy. If you're the half full person you might say that she is a natural leader. She has a little posse that she runs around the playground playing this and that kid game. As a father more biased than NPR I see a pre-school Patton leading around her armored divisions. She even has a little boy who is a friend. As she points out to me; "He's not my boyfriend!" She can spell his name, takes her naps next to him, and knows that he has blue eyes "...like mine." Someday a real boyfriend will steal her away but for now I won't worry. Much.

New Orleans and thereabouts

I've held out as long as possible. Thank goodness I did. What a waste of time anything I could have said about the Hurricane Katrina disaster would have been. Property damage was extreme. Loss of life was large though not as bad as that boob Nagin predicted. Forget the Foot Locker; federal disaster relief money is coming. Let the REAL looting begin!
Every level of government failed the people of New Orleans. It seems like everyone wants to find someone (else) to blame for the problems and there's more than enough to go around. I'll never forget the reporter asking the homeland security dude about exactly whose heads were going to roll. He must have repeated that thought six times; '...whose heads are going to roll?" The question was asked during the peak of the crisis when actual non-metaphorical heads really were rolling. Quite sensible I think. And if your dad is in the hospital and he's had a heart attack you should have your lawyer interrupt the doctor performing CPR to take depositions too.
For better or worse its both too late and too early to start the real investigation into what went wrong. No mistake, a real investigation should be done, responsibility fixed, flawed procedures uncovered, and criminal behavior prosecuted mercilessly. Getting large-scale disaster response is just too important to get bogged down in trying to make Nagin, Blanco, and Bush look as bad as possible. If we let the autopsy on this whole sordid event turn into a chance to grind our respective axes then nothing will really get fixed.
If fixing the problem isn't the most important consideration then we'll end up with some sort of Disaster Dare Program. It makes legislators feel good and lets them tell the voters that they did something but in reality makes absolutely no difference.

Painful Knives (continued)

So my surgeon tells me that those big lumps of clotted blood in my wounds just wouldn't do; it was off to the operating room to open up the surgical wounds then clean them out with the medical version of a squirt gun filled with "bug juice" or antibiotic-laced sterile water. I reported to the hospital like the dutiful little patient I am, got an IV started (eventually-my nurse wasn't so good at this task) then went to sleep anticipating another day of post-surgical mental haziness.

Morning came and I went to the OR as planned. The surgical wound-cleaning went well and soon I was back in my hospital bed feeling like shit. I had a PCA pump filled with dilaudid running, IV fluids flowing in, I couldn't pee, and my legs hurt. A PCA (patient controlled analgesia) pump has a large syringe of pain medicine hooked directly up to an IV line. Every time the patient presses the control button a small dose of pain medicine squirts into his veins. Now, I barf when I take two Vicodin and dilaudid is much more powerful. I had the nurse cut the dose I was getting in half hoping not to puke. No such luck; I puked like a champion anyway. I struggled with a urinal for hours trying to pee. Success finally came and I was a bit happier. If I couldn't pee within six hours or so post-op I might have had to had a catheter inserted and I sure didn't want that. The leg pain wasn't too bad but it was still there. Anyway, the night just seemed to last forever. I just couldn't get to sleep and my nausea wouldn't go away. I took some anti-nausea medicine but it didn't help. I just laid there all night writhing around trying to get comfortable without success.

Finally I fell asleep around 6:00 am. At 7:15 am the doctors woke me up to see if I were still alive. I found that they had left the leg wounds open with a full roll of kerlix soaked in bug juice stuffed inside the wound to keep it moist. A roll of kerlix is about the size of a roll of toilet paper that is 1/3 gone so they must have really had to jam that stuff into the wound to let it all fit. The plan was to leave the kerlix in for two days to let the swelling go down and the bleeding to stop then pull it out. By that time it would be fairly dry and probably stuck to my abused calf muscles and wound tissue. Getting it out promised to be pretty brutal.

I spent the next two days laying around in bed doing nothing. It truly sucked. The same crappy TV channels, the same crappy hospital food, the same crappy hospital bed. Fast forward past the boredom two days and one of the surgical interns comes by in the morning. He'll be returning soon with another intern and the attending surgeon (the guy I saw in the office and basically the big cheese.) He had the nurse give me five mg of valium to help out with the procedure and promised to make sure I got some pain medicine just before the kerlix came out. A half-hour later the trio of vascular surgeons reappear. The chief surgeon tells me that the interns are going to remove the kerlix and he was going to keep out of reach because "After this I won't be your friend anymore."

Though my legs look filthy, its just bruising and iodine staining the skin.

The interns unwrap the dressing on my legs and I start to feel like a mouse being played with by a particularly sadistic cat. They yank out the dried-up dressings and I'm feeling pretty miserable. I don't actually holler but If I had less pride I might have. For the next couple of days they nurses just pack in wet gauze to keep the wound from drying out then I go back to the OR to get the legs closed up for good.

The wound closing goes well and I'm discharged the next day with puffy, stitched-up legs. Hopefully they heal well and I'll be running in no time.

Painful running leads to painful knives

One day while sniveling to an orthopedic surgeon about how my calves would begin to tighten up progressing rapidly to excruciating pain and numbness after about five minutes of rugby or 1/2 mile of running I learned about Chronic Compartment Syndrome. He hooked me up with a local vascular surgeon who is an internationally recognized expert on this malady.

When I arrived in his office he took my history, asked questions; the usual thing. Then he brought out a little pressure meter with a big needle. He stuck the pointy end of the needle into the muscle on the front of the calf on each side and read off the internal pressures to the nurse assisting him. After a bit of discussion we set up a surgical date to repair the problem since the pressures were way out of line.

The day of surgery arrived and eventually I entered the oblivion that midazolam and fentanyl bring on. I awoke with sore calves and bandages from toes to knees. The surgeon had created a slit about four inches long running up and down on my calves then removed an oval piece of the fascia (inflexible connective tissue covering muscles) about that size. He then pried up the skin above and below that hole and gave the fascia a slit about 1-2 inches as well. Pretty straightforward. Another hole was created above the incision and a long drain tube was inserted into each wound running its entire length. The drain was connected to a little bulb to help pull out the inevitable post-op bleeding. I got a bottle of Vicodin, some dressing supplies, some care instructions, and an appointment to return to the clinic in a few days. Pretty old hat since I've been a nurse about twelve years now.

This is pretty uncomplicated surgery but its bugbear is bleeding. The surgeon told my family that the calves looked terrible; lots of inflammation, adhesions, etc. and that I had really needed this surgery years ago. Sure enough, my wounds just kept bleeding and hematomas (think big chunk of clotted blood) developed inside the wounds. The hematomas would eventually become scar tissue which would leave me worse off than before. I had to go back to the operating room for a little tune-up surgery. (to be continued)

Spending time in the hospital

I've been away from the console for some time now, spending some time in the hospital. What was supposed to be a quick 1/2 day outpatient surgery turned into a week in the hospital and three trips to the operating room. Stay tuned for some stories from The Wrong Side of the Hospital Bed.

London Calling

...London calling to the faraway towns

Now war is declared - and battle come down

London calling to the underworld

Come out of the cupboard, you boys and girls...

Out of context and years ago The Clash wrote that song. Just what does and what will the London terrorist attacks mean? As to damage and death the Underground and bus bombings were nothing more than a bad day in Bagdad. In terms of lives lost and physical damage the four bombings were strictly old news under the Iraqi standard but clearly the Iraq standard doesn't apply here. As to the meaning of why did the individual bombers do what they did, it appears that the bombers were firmly entrenched into the British middle class so economic opportunity or poverty aren't to blame. No danger of those men being compelled by a draft to go fight in Iraq or Afganistan so it isn't that.

What's left is ideology. An ideology that the four learned and expanded on while living in England which echos the sentiment shared by their brothers-in-arms who drive car bombs into crowds of children in Iraq for the crime of liking chocolate. I'll not expand on the ideology that drives radical elements of Islam; that has been covered so well by so many others, here for instance.

There appears to be no significant damage done to the war-fighting capability or political will of the UK; it appears that this attack was a failure on all fronts. Indeed, Europe's significant muslim population will likely see increased scrutiny of its radical elements. So, this is basically a loss for the European muslims and a gain for the various state's security apparatus.

(edited for style issues)

Is a new Cold War coming?

I’ve been hearing a lot lately about the coming cold war between the USA and China. Links here, here, and here. I see more reasons to believe in a possible trade war than a cold war but I’ll only discuss the cold war here. China and the USA have maintained somewhat an uneasy neutrality towards each other since the “end” of the Korean War. The Chinese sat out the cold war and were never very evangelistic about their communism while America’s attention was fixed firmly on Europe and the USSR. China was spared the crushing expense of trying to field advanced military hardware built with obsolete industrial technology. Instead, they built an industrial base that has become one of the most powerful in the world. If needed China could rapidly shift vast resources into defense production much as the USA did during WW2. I needn’t elaborate on the economic, industrial, and military might of America. Democracy and Communism have shared a mutual antipathy through much of the 20th century and continue to do so in a low-key sort of way. Conditions seem ripe for the rise of a new bipolar world power relationship.
But not so fast. Assume for a moment that a new cold war has sprung up. After WW2, the USSR was a very menacing neighbor indeed. Friendly European nations almost mortally weakened by a destructive general war. Buffer states occupied, fortified, and garrisoned by Soviet troops. Jingoistic rhetoric daily. Tanks poised at the border. Very scary. I just don’t see any of that in Asia right now. Sure, Taiwan feels insecure but they really were part of China before the revolution. Japan, South Korea, India, and other regional powers are militarily and economically strong enough to give any would-be attackers pause. Realistically, China’s domestic issues are enough for it just now. Invading neighboring nations just isn’t a viable option now. How about America? Is there any power bloc on earth that really wants the USA to build an even more capable and larger military force? Using two carrier battle groups (CVBGs) the USA could completely wipe out Europe’s entire navy and probably their air forces as well. America has twelve CVBGs at its disposal. America could cripple any nation’s military in a straight-up war. I cannot think of any nation who would encourage the American forces to get even more powerful.
Any new cold war with China and America opposing each other would end up looking a lot like Mutually Assured Destruction, that quintessential doctrine. Either both nations can prosper economically or they can destroy each other. China is heading for serious demographic problems as well as political upheaval as Chinese citizens clamor for more freedoms. It is in the best interest of all the principal players to help facilitate the Chinese transformation to a more mixed economy and democratic society.