bugs and biology, plans and perigee

Plans change

I was scheduled to have surgery last Friday, November 11. At the last minute there was some kind of problem with the insurance, which seems to come down to a lost authorization email and fax.

Well, it’s not the end of the world, just a delay. Disappointing though.

I’ve been struggling with osteomyelitis in my left heel since September 5. The daily IV antibiotics are holding it in check for now, and the PICC (peripheral intravenous central catheter) line makes getting the antibiotics much easier, but the whole thing is getting old fast.

I had some hope that the antibiotics might do the trick and allow me to avoid surgery, but the surgeon says the infection won’t go away until the infected hardware from my 2007 surgery is removed, along with some of the necrotic (dead) bone tissue.

I keep wanting to feel sorry for myself but with my medical background I know that I’m fortunate indeed to be suffering this malady in 2016. Thirty years ago, back when I was a navy paramedic, osteomyelitis was much harder to treat. Today’s antibiotics are much more advanced and efficacious. A similar surgical delay back in 1986 would likely have been a serious problem. Today it’s potentially a problem, but unless I take a turn for the worse the delay is nothing more than an inconvenience.

As recently as 50 years ago -- 1966 -- a similar infection would have been essentially untreatable with antibiotics. Most likely I’d have lost the foot to amputation, and even with amputation there would have been a frighteningly high chance of a fatal outcome.

This is a good example of the power and efficacy of modern antibiotics, and it rather tosses a bucket of water on the commonly espoused narrative regarding the “crisis” of antibiotic resistance.

While it’s completely true that pathogens can and do develop resistance to antimicrobials, resistance is neither as simple nor as one-sided as we often hear. There are a great many variables involved. Perhaps the most important is the fact that our immune systems are no more as static as bacteria. While bacteria can adapt and evolve resistance to antibiotics, our immune system can also adapt and evolve the ability to respond. This ability to adapt is one of the basic characteristics of life.

Antibiotics are wonderful, life-saving medicines. They have completely changed the face of medicine. Today we scarcely give a thought to dozens of diseases that were nearly universally fatal less than 80 years ago. But antibiotics are not magic, and they are not really the thing which cures disease. The thing that actually cures disease is the body’s own immune system. Antibiotics give the immune system a critical assist by slowing the progression of the bacterial assault. This gives the body the priceless gift of time -- time to muster more energy and more and better defenses. In the absence of a functional immune system, antibiotics have no chance of curing bacterial disease.

We modern human beings can do some amazing and incredible things. It’s good to remember our limitations though, and keep things in a reasonable context. We can produce life saving pharmaceuticals, yes, but we cannot “make” an immune system. Perhaps we’ll gain that ability in the future, but for the present we must rely on nature.

Distances vary

As I write this on Monday morning, November 14, I’m looking at some of the pictures I took just after sunset last night. The pictures are beautiful, but they don’t come close to replicating the experience of last evening’s moonrise. That’s the limitation of photography, which yields only a two-dimensional representation of a four-dimensional event.

This month’s full moon, which is often called the Beaver Moon, happened to be a “supermoon.” By definition a supermoon is a full moon which coincides with lunar orbital perigee. In other words, when the moon comes closest to the earth in its orbit.

The moon orbits our planet in an ellipse, rather than a circle. So far as we can tell all of the planets, moons, asteroids, dust clouds and even stars trace an elliptical path through the heavens.

The distance between earth and the moon averages out to just under 240,000 miles. At the farthest point of its orbit it’s nearly 255,000 miles distant. This point is the apogee of the orbit. Perigee, which we saw this month, can be as close as 222,000 miles.

There are a great many gravitational forces acting on both the earth and the moon, so the moon’s orbit is anything but exact. It hasn’t come this close to earth since 1948, and won’t come this close again until 2034.

Sunday and Monday evenings the nearness of the moon made it appear to be about 14 percent larger than average, and it cast about 33 percent more light than average.

I hope you had the opportunity to d a bit of moon gazing. It was beautiful.