Sunday, October 23, 2016

Blast from the past

A comment on yesterday's post dredged the following out of the memory banks. And since I seem to be looking down memory lane with my rosa parks colored glasses on...

Why not?

Saturday, October 22, 2016

Snips and Snails and Grumman Tales

As I research Jolly Roger history in an effort to learn more about my first squadron, VF-84, I'm turning up a wealth of information. There's enough to write several books, and in fact several books have been written on the topic. I'd like to produce one or two or three blog posts with the aim of sharing a historical overview of squadron I joined nearly 40 years ago, and I'd also like to clear up a bit of the confusion about the lineage of what is arguably one of the most recognizable naval units of the twentieth century. Whether I'll succeed or not remains to be seen.

Today I'm going to post up a couple of videos. They're a bit longish for a blog post in general and really not suitable for a historical overview. I think they're quite interesting and entertaining, however, and perhaps you will too.

The first one, US Navy Air Power at Sea, was produced by Grumman and gives a very good look at the cutting edge of naval power projection circa 1980. The film showcases the stable of Grumman aircraft which were the backbone of US carrier aviation at the time. Five of the eight types of aircraft assigned to Carrier Air Wings came from the Iron Works on Long Island; the F-14A Tomcat, A-6E Intruder, KA-6D Intruder tanker, EA-6B Prowler, and E-2C Hawkeye. There were only three non-Grumman types in the Airwing; the LTV A-7E Corsair II, the Lockheed S-3A Viking, and the Sikorsky SH-3H Sea King. Non-airwing Grummans around the boat were the C-1 Trader and the C-2 Greyhound. Other non-airwing/non-Grumman types included the Douglas A-3 Skywarrior (Whale) and from time to time a Phantom or a photo-sader. And the helos. CH-46, CH-53, H-2.

The next one, F-14 Air Combat Maneuvering, is another Grumman film, shot at Miramar in about 1978. It's mostly about ACM/BFM.

Finally, One of a Kind is about F-14 weapons tactics. It's fun for me to watch these films. They're about as close as I can get to a time machine. Those were pretty cool days, when the nation faced an external existential threat, rather than an internal one.

Friday, October 21, 2016

One week in the books

One week of IV antibiotics, that is.

Interestingly, it seems the bugs are mutating into a vanco resistant form, so yesterday we changed to Invanz (ertapenem).

My system didn't seem to like the change. I had some nausea and vomiting, hot flashes, racing heartbeat, etc. I toughed it out and those things gradually subsided and I actually ended up sleeping pretty well. I've just returned from the second infusion and so far so good. We'll see how it goes.

As for the bugs developing resistance, well, that's just what bugs do. There are untold millions of them and their individual life cycles are short. When they're entrenched within the bone where it's hard for the antibiotic to reach, new generations inevitably develop resistance. That's nature at work, and nature doesn't give a flying firetruck about human fads, politics or ideologies. Treating this kind of infection is battle, and as the bugs change tactics, so must the docs and pharmacologists.

One thing the vanco did for sure is hammer the infection in the soft tissue. That abscess is clearing up nicely.

All in all I'm confident that we're on the right path. It'll take time, and this isn't the most fun I've ever had, but it's just what it is. On the bright side I'm getting a lot of practice at being a good patient!

The other day I came across this excellent cartoon by Maki Naro, and I thought I'd share it here. It's a very good message about the differences between reality and fantastic ideology. Though this deals directly with vaccinations, the underlying message is the same when it comes to antibiotics and resistant pathogens. Think of it as public service ad. More later.

Wednesday, October 19, 2016

Something you don't see every day

Time is weighing heavily as I endure the enforced slothitude of being treated for an infection in my left heel bone. Each morning I trudge (figuratively of course, I actually drive) over to the hospital to be infused with a couple of grams of vancomycin through an IV. This two-to-three-hour ordeal is rather the high point of my day, for it's about the only time I'm allowed to be up and about. I've got strict medical orders to spend the remainder of each long day's dreary hours in bed or in the recliner.

This should be heaven, for I never have enough time to read or write or track stuff down on the interwebs. And it would be heaven, if there weren't chores piling up and if I didn't feel so crappy and, most of all, if I had a choice. If my slothitude weren't enforced.

And there lies the rub. I have my cake, but I can't eat it.

It's not as bad as I make it out to be. Things seem to be trending in a positive direction, and so long as I'm a good boy I can spend my slothful hours at home, rather than chained to a hospital bed. Which is something to be thankful for.

At any rate, I decided to spend some time tracking down and becoming more familiar with the history of my first squadron, the VF-84 Jolly Rogers. When I showed up the squadron was part of CVW-8, deployed in Nimitz (CVN-68), flying brand new block 95 F-14A Tomcats, and preparing to make a movie

VF-84 had a lot of history behind it. The squadron lineage began on January 1, 1943, when VF-17 stood up as part of CAG-17. In those days squadrons and air groups took their designation from the hull number of the carrier they deployed in, so CAG-17 was the Air group in Bunker Hill (CV-17), and VF-17, the second navy fighter squadron to be equipped with the Vought F4U Corsair, was part of that air group. Squadrons didn't have names in those days, either, and VF-17 was simply "Fighting 17." In the months ahead, though, somebody started painting small skull and crossbones pirate flags on Fighting 17's Corsairs. The tradition of the beloved "bones" was born, and eventually, the name.

For the moment I'm going to step forward and dance past a lot of history. That'll come later. But let's move ahead to 1953, when the VF-84 Vagabonds, flying F9F Panthers, were deployed in Coral Sea (CVB-43) as part of CAG-8. Different squadron with a different lineage, but soon to assume the bones. That hadn't happened yet in 1953, but all this backstory leads to a single picture, which really has nothing to do with VF-84 or the Jolly Rogers.

In perusing the online cruisebook for Coral Sea's 1953 Mediterranean cruise, I found this. Remember, this was June, 1953, only 11 years after the Battle of Midway. Carriers still had straight flight decks, and if most of the aircraft were now jets, carrier flying hadn't changed all that much. As an aside, a bit more than 30 years in the future I'd be part of CVW-13 and deployed to the Med in the same carrier, albeit with an angled deck and slightly updated aircraft and practices.

Anyway, take a look at this. There are Panthers and Banshees and Skyraiders stuffed everywhere on the roof of Coral Sea in June, 1953. And right in the center, a single SNJ. It's a -3C or a -4C or -5C. Probably a common sight in 1953, but I don't recall having seen a picture like this before.

Anyway, just a teaser. I'll spend some more of my slothidude researching the Jolly Rogers and try to put together a couple of interesting posts. For the moment, it's off to the hospital.


Sunday, October 16, 2016

Bloggin' from the horsepistol (((updated with video and peekshures)))

When you catch me cursing the newfangled modern communications technology, don't be afraid to remind me of this episode.

I'm sitting in the infusion room at Kimball Health Services, vancomycin running into my arm while I'm "bangin' on the keyboard like a chimpanzee" (to paraphrase Knopfler.)

I've got my phone set as a hot spot and I'm working on a chromebook. KHS actually has wee-fee but it's not of the highest quality, so my phone works better.

I'm more than a bit jaded by having such magic at my fingertips, as I suppose many of us are. Doing this in this place under these circumstances reawakens a sense of wonder though.

I just shot a vid and some images and I've just discovered that I didn't come prepared (with usb cable) to download, process and include them. Be a stretch to upload a video with my phone as the hot spot anyway.

Perhaps I'll post this as is and update later with the vid and snaps.

The vanc infusion is going quite well and I've had no side effects or adverse reactions. I'm taking that as a good sign.

The heel has become devilishly painful though, and part of me wonders if that increased pain isn't being manufactured by my mind which is now a bit more informed as to the cause of the malady.

Well, I'm rather sure it's not all in my mind, but perhaps my mind is contributing a bit. Much of the deep bone pain is obviously from the infection, and I'd guess (although I don't know) that there's some necrotic tissue in there.

Well, I suppose I'll go ahead and post this up. Later, after I've dealt with the images and video I'll do an update.

If you can spare a few moments today, you might perhaps send some good thoughts toward the family of Wayne Cornell, my former Coral Sea shipmate who would have turned 50 years old today. If you could find a way to commit a random act of kindness in his memory -- perhaps a smile for a stranger -- that would be awesome.

Take care all.

Friday, October 14, 2016

MRI Sez...


And the whackopaedia entry...

Not exactly the "survey sez" clip I wanted, but it'll do.

At this point, about 40 days after onset and no real improvement following antibiotics and several visits to the doc, including the discovery of old suture material left in the joint following my 2007 surgery, that's pretty much what I expected.

It's unlikely that the suture material is the proximate cause here. Most likely it only provided a home for bacterial growth which then spread to the heel bone, perhaps via the titanium screw holding part of the tendon in place. Interestingly, the bacteria probably entered my system from barbed wire scratches I got while working on fence.
Long way from the heelbone...

So. Fairly serious condition which will require IV antibiotics and most likely surgery. I'll be seeing the ortho surgeon on October 27, and we'll work out the surgical plan at that time.

As for the IV antibiotics, the drug of choice is vancomycin, which is a pretty powerful antibiotic which carries a somewhat serious risk of grim side effects, including kidney and liver damage. The risk will be well managed, and it's worth facing considering the potential downside of osteomyelitis (think Gus McCrae after "the injuns shot them arras into him").

In the morning, at 0700, I'll have labs drawn to confirm kidney and liver function and establish baseline values. Assuming my internal organs are up to it (I suspect they are), they'll calculate the dose, start an IV, and infuse the drug over about 4 hours. Then it'll be rinse, lather, repeat every 96 hours for 6-12 weeks.

That's the AB plan as of now.

They'll most likely put in a PIC line next week to make the drug administration easier. That's got it's own potential side effects, but it's probably the best course to take.

I'm going to have to work very hard at being a good patient. I tend to be a terrible patient.

All in all, this isn't something I'm looking forward to, but there are a lot of folks suffering with much more severe problems, and that's the context and perspective I need to keep in mind.

I also need to keep in mind that as recently as 1960 osteomyelitis was considered to be essentially incurable. It's good to live in a time of miracles and wonder.

Thursday, October 13, 2016

It's a gas

No, it's a liquid!

Sarge had an interesting post over at The Chant the other day. All about dermatology and ideal gas laws, more or less. Give it a read, it's great stuff.

His post, which featured warts and liquid nitrogen, reminded me, as everything does, of a navy story.

I have no idea how they do things in the navy these days, but BITD you couldn't operate tactical aircraft without LOX (liquid oxygen) for aircrew breathing and very pure nitrogen for tire inflation and pneumatics. I think liquefied gas was also required for Sidewinder and avionics cooling, but I disremember exact details. (A quick dash through googleland leads me to believe that early AIM-9 models were uncooled, followed by CO2, then LN2 cooled versions. Today's AIM-9X actually has an onboard Stirling engine to provide cooling. Which I have to admit is very cool (pun intended, sue me.)) At any rate, every carrier and air station had an O2/N2 shop BITD.

Here is a short video of activity in USS Saratoga (CV-60) in 1985. Brings a pang of longing to the old heart. You can see some gas servicing and work on LOX carts.

If you're interested, here are navy press corps stories from 2003 and 2015 regarding O2/N2 production.

Making LOX and LN2 (liquid nitrogen) is a fundamentally simple process. First, you liquefy plain ol'/reg'lar ol' atmospheric air by taking advantage of the Joule-Thomson effect, which is basically how your refrigerator-freezer works. You compress the air to about 150 psi, then flow it through an orifice into a container. As the compressed gas expands its temperature plunges, and if you do it right with the right setup the air becomes cold enough to liquefy.

The liquefied air, just like ambient atmospheric air, is about 78 percent nitrogen, 22 percent oxygen, and the remainder noble gasses, hydrogen and helium, and carbon dioxide. There will also be some quantity of water present, depending on the humidity of the air when it was collected.

Separating the molecular components is rather complex in execution but simple in theory and is called cryogenic fractional distillation. That's a mouthful, but you've probably done fractional distillation in junior high or high school science or chemistry lab. The process is the same and relies on the unique properties of the various components, or "fractions,"  each of which boils (shifts from liquid to gaseous phase) at a different temperature (CO2 -57C, O -183C, N -195.8C, H -252.9C, He -268.9C). By carefully warming the liquefied air in precise increments you can remove the pure "fractions" as they "boil off." For the purposes of making pure molecular fractions the water component is considered a contaminant. Water boils at 100C, but it's usually filtered out rather than boiled off.

With the right equipment and correct procedures in place, making LOX and LN2 is dead simple. As I recall the navy O2/N2 plants bitd were operated by a couple of E-2's under the supervision of an E-3.
Filling a LOX cart in CVN-72. Image wickamaedia commoners.

But I digress.

As Sarge alluded to in his post, LN2 is also used in medical cryotherapy, including the removal of superficial skin growths such as moles and warts.

Warts are caused by a virus, which takes up residence in the outer layers of the skin and cause formation of rough growths. Warts are, by definition, benign, self-limiting tumors. In most cases they can be safely ignored, however, they can be cosmetically unpleasing and/or physically irritating. In some rather rare cases they can lead to less benign forms of cancer. For these reasons people often seek to have warts removed, and one approach to this is cryotherapy.

Cryotherapy is a big word, but the idea is simple and straightforward. Warts -- including the HPV (human papilloma virus) which causes them -- are present in the outer layers of the skin. In cryotherapy a freezing agent such as LN2 is applied to the wart and a small portion of the surrounding healthy tissue. This freezing causes a thermal injury which is little different than a second degree burn. The frozen area blisters, which lifts and separates the outer layers of the skin. During the healing process the outer layers slough off, taking all or part of the wart with them. Small warts may be cured with a single treatment, larger warts usually require a series of treatments over time.

There's gonna be an amusing navy story at some point, right?

On the beach at Oceana, when I was an E-3 for the first and second time, I worked mostly in sick call. I stood duty back in the ER, but my regular daily job was sick call. As with most noobs I started at the check in desk, then advanced to vital signs, and finally to seeing patients and doing patient care. I wasn't the dumbest corpsman to come down the pike so I ended up in patient care pretty quickly. Which does not mean that I was in any way smart. I lacked the experience to be anything other than stupid.

Small digression here, I was reading a story from "We Were Crewdogs III" the other evening and I came across a superb line. "I was pretty stupid back then, and might still be, but that's for another book." J.J. Parker, USAF.

One day a week at sick call -- I want to say Tuesday but I'm probably wrong -- we held wart clinic. We dealt with all kinds of warts, and for each kind the treatment aim was quite similar, that is, to gradually take away the wart and a small bit of surrounding tissue a little at a time until the wart was gone. Treatment techniques varied. Most could be treated with LN2 and cryotherapy. Some required electrocautery. Still others relied on the application of a caustic or acidic compound, such as salicylic acid or podophyllin.

On wart clinic days, directly after morning quarters, a couple of the sick call E-3's would be sent to collect liquid nitrogen. When I was on the beach my number was usually chosen. So myself and another fellow would check out a vehicle, grab the LN2 containers, and head for the O2/N2 shack. The LN2 containers were Stanley stainless steel thermoses. They didn't have stoppers, which were air tight and would have turned the containers into bombs, but they did retain the screw-on cup, which wasn't air tight. Each thermos was housed in a clever, varnished wooden box with a wide base, designed to hold the thermos vertically and prevent it from tipping (or being knocked) over.

On the ship the process for collecting LN2 was pretty much the same, except you walked to the O2/N2 shop, rather than driving.

But this first one is about wart clinic on the beach, at Oceana.

We did all the usual stuff, freezing and smashing all manner of objects, from superballs to flowers to latex gloves to insects and amphibians. But that got boring pretty quick.

What was fun -- really fun -- was making LN2 bombs.

It's a simple process, really. Take an empty hydrogen peroxide container. You know, the small brown plastic bottles with white caps. They look like they hold between a pint and a quart of peroxide, but they actually hold a pound of the fizzy stuff. Well, that's how they were measured and labeled back in the day anyway.

So, to the empty H2O2 bottle add a few ounces of LN2. Screw the cap down tight, then place the container out of sight but in rather close proximity to some of your co-workers. It's best to do this after hours when just the duty section is in the building, for obvious reasons. Then it's just a matter of waiting.

The peroxide containers are perfect for this job because they are built to be tough enough to take quite a bit of internal pressure and the caps are designed to vent a certain quantity of gas. This is because H2O2 naturally decomposes over time, releasing gaseous molecular oxygen.

The important point is that a peroxide bottle is a lot tougher than a regular plastic bottle, and will therefore contain a lot more pressure before failing. When they do fail, well, more pressure equals bigger boom.
Potential boom of doom. Just add junior sailors. Stolen from the interwebs.

Few things are funnier than the reactions of your shipmates when the quiet of late evening is split by the roar of a reverberating LN2 explosion.

One thing that is funnier is when the explosion occurs at the moment an O-8 (Rear Admiral) is checking in to the emergency room to have a laceration on his hand treated.

I'll leave it to your imagination, but I will note that back in the olden days, not every Admiral was a pure martinet, and some of the lower ranked enlisted folks could think and explain with lightning speed and sincerity. 

I've saved the best (or worst) for last.

This happened on Nimitz on my first deployment. I was a reasonably bright lad and my head was absolutely crammed with knowledge. At that point in my life I had little or no experience to go with the knowledge, so while I thought I was pretty smart, I was in fact pretty stupid. From time to time dangerously stupid.

Anyway, one evening following wart clinic I was on duty and tasked with straightening up the treatment room at the end of the day. The LN2 thermos still contained a few pints of liquid nitrogen, which, being a clear liquid, looks rather like water. I was in straightening/cleaning mode and decided to dump the LN2 down the drain of the treatment room scrub sink. This produced a small cloud of water vapor, and as I turned on the taps to flush the nitrogen down the drain the cloud grew and grew until it filled the treatment room with fog.

That was cool!

Thereafter, whenever there was leftover LN2 available I repeated the exercise. What can I say? The days underway are long and tedious and can be crushingly boring. Little things like a cloud of vapor can provide a bright spot in the midst of the interminable blah sameness of being at sea. A real boost to morale, you might say.

After several weeks of this, however, the treatment room began to smell funny. Then the drains began to back up. Ruh-roh.

Bring on the turd chasers! Turd chaser was the common nickname for Hull Technicians, or HT's. Among other things, they were in charge of the ships plumbing system. Of course there are no more HT's in the navy these days. Everyone is now a sojer.

At any rate, the turd chasers quickly found and solved the problem. The drain piping beneath the deck plates had, of course, broken when the LN2 I poured down the sink froze the water in the p trap. Water expands when it freezes, as we all learned in Kindergarten. This was knowledge I'd long possessed, however, it didn't spring to the fore in my mind until we were all examining the broken fitting. Remarkably, no one in the immediate chain of command was able to connect the dots between wart clinic and a frozen pipe. And I wasn't about to give any hints.

You might recall that some time passed between the beginning of my magic fog show and the drains backing up. IIRC it was two months or so. Where did the water go?

Well, a Nimitz class carrier is a warship, built to soak up damage and still operate. The drain piping beneath medical was contained in an armored chase, about two feet by two feet by 150 feet. As it turns out, that chase can hold a hell of a lot of water.
Dewatering. Wickimaedia commoners.

It wasn't quite this bad.
And there you have it, a couple of Cold War cold air sea stories.

Foot report

Since my last post I've been quite ill. Fighting this kind of thing is not for sissies and takes a lot of energy. Right now it's looking like MRI time tomorrow followed most likely by the knife. I'm not dead yet, though on Tuesday I thought dead might be a desirable improvement. Felt a good bit better yesterday and today isn't too bad so far. I'll sure be glad to get this behind me.