Of US politics…from West Africa

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08 août 2012

Of US politics…from West Africa

Health update: as of yesterday, my status for the next ten (10) days will be the same – in Dakar, on medical hold and under observation, while the doctors wait to see what (if any) effect the anti-seizure medications will have. If they work as hoped, I will be sent home to the US next week. Whether I will still be medically separated or on medical hold at that point remains to be seen.

I should note, however, according to my doctor, it’s no longer a question of if I will be separated, so much as when: will I just be sent home, with no ongoing care or per diem, or will I receive the 30 days’ med hold and accompanying per diem first? Time will tell. This will likely be the last update this week, look for more information around the 14th.

Do you live in Ohio, Pennsylvania, Florida, or Iowa? Are you used to being a battleground state each and every Presidential election? Are you resigned to endless quadrennial panoplies of third-party attack ads, quasi-truthful billboards, and pandering candidates?

Well I’m not.

In fact, I hate Presidential elections. Not ‘hate’ as in ‘I hate the way my groin gets cold when I put on sopping wet underwear’, but ‘hate’ as in ‘I hate the way my mouth feels after I go to the dentist, and he tells me I have to get 25 fillings, 4 root canals, and 2 crowns…and his drill is broken, so he’s going to have to use a chisel…and he’s drunk…and he was just diagnosed with advanced Parkinson’s…and he’s out of anesthesia.’ In short, I hate them to the core of my being, and I would do almost anything to get out of having to deal with them.

Hell, I might even join the Peace Corps.

Oh, wait…

All hyperbole aside, I can truthfully say that missing out on the 2012 election season has been one of the biggest  perqs[1] of my service. This is especially true since my home state of North Carolina[2] has decided to get all wacky this year and morph into a battleground state. I’m not quite sure what motivated them to volunteer for such a masochistic status, but I’m quite sure that I’m glad to be missing out on the downstream results. According to horror stories from friends back home, yard signs are already copious, billboards are going up aplenty, and you see attack ads 24/7 on every channel – even on the highly coveted Cartoon Network/3am timeslot[3]. I can smell the desperation from here.

Here in Africa, however, the viewpoint on the election is far more casual. It goes something like this:

Random Person In The Street: “I like Obama, because he is African. You should vote for Obama.”

Me: “Do you even know who he is running against?”

RPITS: “Is he African?”

Me: “What if it’s a she?”

RPITS: “Is SHE African?”

Me: “Does it matter?”

RPITS: “Yes!”

Me: “Then point in fact…no, he’s not.”

RPITS: “Wait…you just said it was a woman!”

Me: “No…I said it could be a woman.”

RPITS: “Have you ever had a woman President? I know I am just a villager in Africa, and I am not an expert on US politics, but I feel like I would have heard about that.”

Me: “Um…no.”

RPITS: “Then why would you say it could be! It never has been…oh, nevermind. You should vote for Obama, because he’s African, and that means he’s awesome!”

Nor, to be fair to that random person in the street, are the PCVs or other expats really any better:

Random PCV/Expat: “WOOOO!!!!! SUCK IT WINGNUTS!!!! OBAMA RAWKS!!!!!!![4]

Me: “Is there even the slightest possibility that you would one day remotely think about thinking about considering the idea of debating the thought of pondering the potentiality of voting for someone else?”

Random PCV/Expat: “Well…now that you mention it, he is awfully right of center. If we don’t care about realistic election chances, I really like Stewart Alexander or Jill Stein.”

Me: “Excuse me…who??”

Random PCV/Expat: (sighing) “Southerners are so conservative.”

As you might expect, the insulation of being in West Africa is both a blessing and a curse. It’s a blessing in that you get just enough information to know what’s going on, but not so much that you feel like taking a shotgun to your TV just to get some peace and quiet. On the other hand, it’s a curse in that, if you are an undecided voter (not much of an issue in this election), you are genuinely going to have trouble getting the information that you need to make your decision.

For example, right now we know that Romney is the GOP contender, he hasn’t yet chosen a VP candidate, he’s a little behind in the polls, and he just did a trip to Europe. It’s an admirable précis of the situation, and when you think about it, that’s all we really need 3 months out. Yes, things should pick up after the conventions, but that’s to be expected. What wasn’t necessary was the eleven months of hype leading up to today. However, if all you knew was that you weren’t too thrilled with the current state of things and you maybe wanted a change, you could genuinely have trouble making an informed decision. The internet is slow or non-existent, the satellite TV channels are all in French (and subject to French political interpretation), and there are no print media to speak of. It could be rough.

At any rate, if nothing else it has been interesting to see how the developing world views our domestic political theater. They definitely pay attention, and it is definitely discussed in the streets in Burkina Faso and Senegal to an extent that would surprise many Americans[5].

I know it surprised me.

 

 


[1] No, I didn’t misspell that. ‘Perq’ is short for ‘perquisite’; ‘perk’ is a thing coffee does. I don’t care if Word doesn’t like my spelling. It’s my blog and my grammar rules, and everyone else can deal.

[2] NC is normally a very odd political blend: a state whose government is traditionally dominated by the Democrats, but which is reliably red when it comes to Presidential elections. This time around, we have our first Republican legislature since Reconstruction, but we voted for Obama in 08 and we very well may do so again in November.

[3] Which, when you think about it, really tells you just as much about the poor sleeping habits of my friends as it does about the candidates’ determination to carry the state.

[4] In fairness to PCVs, there are conservatives in the Peace Corps. I’ve even met one or two. But if there are currently, say, 10,000 PCVs serving, I would estimate that 9,500 of them are liberal, 420 of them could care less about politics, and the other 80 (about 2 per country) are some species or another of conservative. Yes, those numbers are wildly unscientific, but sadly they’re also more accurate than you might think. Suffice to say, there is a skew.

[5] But don’t feel too flattered; they do the same thing for France. Also, point in fact, many villageois think France and the US are somehow part of the same country, and that you can drive to both from West Africa; it’s an interesting phenomenon to hear them discussing French or US politics in detail, when you know their geographic knowledge is so spotty.

More photos from Dakar

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05 août 2012

More photos from Dakar

Health update: I have started my anti-seizure medication, and if I don’t have any adverse reactions, they’re going to send me home in 10 days or so. After that, it will be up to my neurosurgeon in the States to figure out what is wrong with me and to get me working again. In the meantime, I have naught to do but sit, wait, and go tour Dakar.

Since my previous photo post seemed to be a huge hit,  here’s a follow-up. Some of you complained that the previous photos weren’t labeled or organized very well, so I’ll try to do better this time.

Enjoy!

It’s all about confidence

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03 août 2012

It’s all about confidence

If you went to a restaurant and ordered a sandwich and then asked the server what was in it and they replied ‘Oh…I can’t tell you that, because if I did, you would never eat it. But trust me – it’s really good’, would you eat it?

Or if you bought a car, and you asked the guy selling it what sort of condition it was in, and he replied ‘Oh…I can’t tell you that, because if I did, you would never get in it, much less drive it. But trust me – it’s safe’, would you buy it[1]?

Yeah, I didn’t think so.

Yesterday, I went to see the neurologist to see what he thinks of my MRI and other test results. As I predicted, they were 100% normal. Which left the neurologist with the following information:

  1. I’m having episodes of some sort
  2. My CT scan and MRI are totally normal
  3. My EEG is only very slightly abnormal – and the existing abnormality is exactly to the degree you would expect to see in someone who had once had a brain surgery like I did

For me, this means that my problem isn’t neurological, and we should try something else[2].  However, for him, this just means that we need a longer observational period and more testing. I don’t blame him for this mindset – it’s only natural that a neurologist would see a problem as being neurological – but I find myself being…less than convinced by some of his approaches.

Case in point: during the meeting yesterday, he mentioned that he wants to put me on an anti-convulsant for at least a couple of weeks, to observe and see what happens. Basically, it’s a fishing expedition; he doesn’t have a clear idea of what’s wrong with me, but he wants to give me the medicine anyway, because hey – it might make my seizures go away. Normally, I wouldn’t fault him for this mindset – I like my physicians to be proactive, and at least he’s trying something – but then we had the following conversation:

Him: So…your tests aren’t strongly indicative of anything, but I want to start on you on the medicine anyway, to see if it helps with the seizures.

Me: Ok. That seems reasonable enough. What medicine, and for how long?

Him: (some French brand name that I instantly forgot – why I even bothered asking is beyond me). It’s the worldwide standard for situations like this. Basically, we’ll ease you into it over a couple of weeks, to see how you respond. And if the side effects are too bad, we’ll switch you to another.

Me: Um…what kind of side effects are we talking here?

Him: (laughing) Oh…if I tell you the side effects, you will never take this medication. But you do not need to worry. It is safe.

Me: (hoping the expression on my face mirrors my feeling of ‘that response did not imbue me with confidence)

Him: Normally, the major side effect is a feeling of tiredness during your first few days, and maybe some headaches and weight gain. There are other side effects too, but they are very, very rare.

Me: (nodding and making furious mental notes to Google that shit the instant I get out of his office)

Him: So…you probably will not feel well for the first day or two after you take this, so maybe you should not start until the weekend, hm?

Me: Uh…sure.

As you can imagine, this conversation left me feeling, shall we say, less than enthused. I don’t mind taking medication in the hopes that it might help, but I object mightily to taking a drug that can cause (among other things): motor coordination impairment, cardiac arrhythmia, blurry or double vision, aplastic anemia, and thyroid problems. And I REALLY object to taking a drug that can cause me to hear notes a semi-tone lower, develop serious adverse cognitive anomalies, develop potentially fatal skin reactions, and even give me lupus[3].

But Abraham, you ask…what is this wonder drug that could potentially kill you while doing absolutely zero good?

Well, friend, let me tell you: it’s called carbamazepine, and it’s a great drug – IF you have epilepsy. It’s been around since the 50’s, it has been in use for epilepsy since the 1970’s, and its chemical mechanisms are actually understood[4]. If you have epilepsy, it helps suppress your seizures, it offers minimal side effects, and it absolutely helps you get your life back.

There’s only one problem: I don’t think I have epilepsy. All of my tests were negative or inconclusive, none of my ‘episodes’ really resemble true seizures[5], and my neurologist flatly admitted that he’s just kind of fishing around at this point. Nor, to be honest, do I have a huge amount of confidence in my neurologist; yes, he is truly an excellent doctor – one of the finest in Africa, and absolutely up to US or European standards – but he just isn’t that familiar with my case. We’ve met exactly twice, his English is about on a par with my French, and there’s just enough of a cultural divide that I feel less than fully relaxed around him. I don’t doubt his competence, I just feel that a physician who comes from a cultural setting where ‘take this because I say so, and don’t worry about the potentially harmful side effects’ is appropriate may not be exactly the person I want rummaging around in my brain[6].

Consequently, it should come as no surprise that, when Peace Corps says that it’s starting to look like the best solution might be to send me home to my neurosurgeon, I tend to agree with them. No, I don’t want my service to end, and no, I don’t think my problem is neurological (I definitely want to talk with an endocrinologist as soon as I can), but if Peace Corps insists on me being cleared by a neurologist before I can  return, I know who I want doing the clearing and he isn’t in Dakar.

So here’s where I currently stand: right now, my neurologist wants to start me on this medication, then observe me for 10 – 14 days for adverse reactions, then release me to fly to the US. However, the Peace Corps doctor here didn’t actually start me on the medication yet (she said to give me time to see Dakar, but I think she wants to consult DC first), so I’m not actually certain that this will happen. And if/when the time comes, I’m not actually sure I’ll be willing to take it. We shall see.

I still don’t have any firm answers right now, but in short it would appear to no longer be a question of if I’m being sent to the US, but rather when and for how long. I don’t know if I’m going to be sent to my home of record for a consult, but still on per diem, or if I’m just going to be medically separated, or even if something else entirely will occur. All I know is that what can be done in Dakar has been done, and now I’m just waiting to see what DC says about my future.

And that’s likely all I’ll know until the weekend is over.

Look for lots of photos tomorrow!


[1] Although, in fairness, it occurs to me that this is basically what happens every time I get in a Ouaga taxi. The unspoken rule is, you don’t ask about the dents and broken glass and weird noise coming from under your seat, and they won’t tell you about it. This helps everyone sleep better at night.

[2] Like seeing an endocrinologist

[3] But at least my stumbling, blurry vision having, cognitively impaired, auto-immune compromised, skin-destroyed self will be free from phantom limb syndrome and intermittent explosive disorder…it actually helps cure those problems.

[4] A BIG deal for me. You know all those antidepressant commercials that say real fast ‘Zoloft is thought to work by…’ yeah, no. Not for me, thanks. You either know what it does, or you don’t put it in me.

[5] Although in fairness, there are many kinds of seizures, and it IS absolutely possible that my fit the bill. They just don’t have the corresponding EEG evidence to back it up.

[6] This is ironic, because I’m a big opponent of prescription drug advertising, and I honestly feel that you should never, ever say to your doctor ‘what? You’re giving me that? Could I maybe ask you about (insert drug name you saw on TV) instead?’ It smacks of self-diagnosis and is idiotic. Normally, I take what my doctor tells me, when he tells me, for as long as he tells me, and then I toss the bottle. That I would want a different doctor because of a disagreement over a prescription is definitely a new experience for me.

Photos from Dakar

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1 août 2012

Photos from Dakar

Today, for almost the first time since I left the US, I find myself having the magical combination of a computer, photos, a fast internet connection, and the actual inclination to spend an hour uploading a large number of photos. I’ll also do this for Burkina Faso when I get home, but in the meantime, enjoy.

I have no idea what I want

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29 juillet 2012

I have no idea what I want

It’s a common theme of this blog (and more or less every other PCV blog) that Peace Corps service is a constant roller coaster of positive and negative emotions. One week, you love your job, you love your site, and you love your life; the next week, your job is idiotic, your site is a miserable hellhole, and your life is a pit of despair and loneliness.

Nor do the hills and valleys really flatten out with time. My first week in country, I loved and hated everything about this place, and this week I feel the same way.

But unlike my first week in country, this week I’m leaving, and I don’t know if I’ll be returning. Yes, I could be in Dakar for just 3 or 4 days before I’m diagnosed, fixed, and sent right back, but it’s equally possible that they could run two weeks’ worth of scans, find nothing, and decide that it’s in my best interest to medically separate me. There’s just no way to reason in advance of some badly-need data, and so I’m left trying to plan and mentally prepare for all eventualities.

The problem is, I have no idea what I really want to happen. Some days, I think ‘gee…if I got offered interrupted service right now, I would take it and never look back’, but other days, I’m solidly in the ‘there is NO WAY that I’m voluntarily leaving this place before my two years is up!’ camp. It changes rapidly and without any clear reason, and my mindset is sufficiently mercurial that even *I* don’t know what’s up with me.

Part of that is obviously because it’s my brain – ie, the part that does the evaluating and decision making – that’s broken right now. You can’t really make good decisions under stress anyway, but youdamn sure can’t make good decisions when you’re under stress *and* your brain is being physically damaged (or at least adversely affected).

You can see my dilemma: when I’m feeling down, how much of that is me, how much of that is the ‘normal’ stress of PC service, and how much of that is whatever the heck it is that is happening to my brain? Similarly, when I’m feeling very up, am I really feeling positive about what I’m doing, or am I just riding a temporary serotonin high, courtesy of the latest whatever-the-hell-is-wrong up there in the ol’ grey matter? You can go crazy trying to sort these sorts of things out, so I’m letting them rest right now, in anticipation of further information in Senegal.

I do have one consolation though: I’m not the only one who feels this way. Yesterday, I was talking to a friend while we lounged by the pool, and she was recounting her memories of her first 6 months at site. Apparently, she was miserable, and she remembered specifically writing in her journal that she wouldn’t be upset at all if something were to happen to her program just after her one year mark. And then it did (she originally served in Mali, and came here after that program was evacuated and closed follow a coup d’etat in March). But did she take the previously anticipated (and even coveted) interrupted service[1] and go home? No, of course not. She came to Burkina instead.

Which just goes to show: you never quite know what you want, until the time comes to make a decision. Then, you make what seems like the best choice at the time, and you go with it.

I’m curious to see how I’ll choose.


[1] There are five ways for a PCVs service to end: administrative separation (you get fired), medical separation (you’re sent home for medical reasons), early termination (ET)(you resign), close of service (COS)(you finish your term and go home), and interrupted service (your service is ended due to factors beyond your control, for example a revolution in your country of service requires all US personnel to be evacuated). Normally, you only get full benefits if you have A) served at least a year, and B) get medically separated, COS, or get interrupted service. However, with interrupted service, it’s possible to get full benefits anyway, so this can be an especially appealing option to some PCVs.

Throw away your mirror

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27 juillet 2012

Throw away your mirror

Yesterday, after putting it for weeks, I finally broke down and did one of the most uncomfortable things that you can ever do in an alien land: I got a haircut.

I know it doesn’t sound like much, but getting a haircut is a big deal! Sure, most haircuts are more or less non-events, but we’ve all had the experience of getting an absolutely awful haircut, and it truly is traumatic. A bad haircut can affect your self-image, your happiness, and even your productivity at work – it’s one of those subtle little things that helps to make up our weltanschauung, and we would be wise to never underestimate the relative importance of such small details in our lives. This is especially true here in Burkina Faso, where getting a haircut entails conveying your wants and needs in a different language, your hair is physically very different from what the hairdressers are used to working with, and the training and experience of your hairdresser may or may not be zero[1].

Point in fact: yesterday, I went to a hairdresser whom I know to be good and to be experienced with PCV hair, and I said in perfectly acceptable French, ‘clip my whole head (he only has clippers), and take off maybe a centimeter from the top, and make it a little shorter on the sides’. Then I asked, ‘do you understand?’, and he replied ‘yeah! You want me to just trim it a little, more on the sides and back, but almost as long on top as it is now’. This seemed perfectly clear, so I sat down and waited…

…and the very first swipe of the clippers left a buzzed strip on the back of my head barely more than 1/8 of an inch long.

Damn.

My first instinct was to yell in outrage, but since the one thing he can’t do is put it back on, there was nothing for it: I was committed. So, I closed my eyes, and waited, and when he was done I had a very nice, neat, high and tight that any Marine Corps recruiter would approve of heartily. It is, in fact, almost the exact opposite of what I asked him to do.

But you know what? I don’t really care.

See, one of the reasons we really hate a bad haircut in the US is that we are surrounded by mirrors. We have mirrors in the bathroom, in the bedroom, in the car, at work, in restaurants, everywhere. I’m willing to bet that if you’re reading this from work, you’ve checked yourself in the mirror at least 5 times this morning. Maybe I’m wrong, but I bet if I am, I’m only off by one or two times.

And since you’ve checked yourself in the mirror so much, you’re probably very concerned to one degree or another about your appearance. Maybe you’re having a bad hair day. Or maybe that zit that no one else can see is driving you nuts. Or you’re wondering if those are wrinkles beginning to form at the corners of your eyes. Or one of ten thousand other little peculiarities. You’re not a bad person for worrying about these things, you’re just a human with a mirror – we’re social creatures, and when you can see yourself as others do, you automatically begin to judge yourself as you judge them. And it sucks.

That’s why I love Burkina Faso: there are more or less no mirrors here. Sure, I know my hair is short, but you know what? I don’t care. Because I can’t see it, I’m much more focused on how much fun it is to run my hand back and forth over the stubble, as well as being more than a little bemused by the fact that all of my surgical scars are currently visible in their entirety. In place of the visual anxiety imparted by the mirror, I’m instead delighted by the tactile pleasure of it all. And I think that’s a good thing.

It’s also an important lesson to take home with me: throw away your mirror. It may be a wrench at first, but in not too terribly long at all, you’ll be much, much happier.

Trust me.

 


[1] There’s no such thing as a license for that sort of thing here. If you own a pair of scissors and some clippers, you put a sign outside of your home and viola! – a salon!

What’s actually wrong with me?

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25 juillet 2012

What’s actually wrong with me?

So…

Over the course of the past two months, I have become increasingly ill, to the point that my service has been at least temporarily suspended. At the moment, I’m on medical hold in Ouagadouogu, awaiting further tests and information.

To date, I’ve feeling somewhat tentative about talking about this, mostly due to PC’s determined approach to preserving medical confidentiality. However, upon reflection, I’ve decided that it’s my health, my life, and my decision, so I want to talk about it in more detail.

Note: I hate typing the same thing twice. I already had to do a written report of my symptoms for the consulting neurologist in DC, so I’m going to save time and just copy and paste it below. You will be reading exactly what my doctor read. Sorry for the rather pompous tone.

My current problems began with a seemingly innocuous incident in March of this year. During IST, a chair I was sitting in collapsed, dropping me backwards so that I hit my head on the ground. Although the blow was quite gentle – the skin wasn’t even red afterwards – it nonetheless left me unconscious for about 2 minutes, and feeling somewhat woozy and hung over afterwards.

At the time, I didn’t think anything of it. I had experienced mild spells of unconsciousness after my surgery, but my surgeon was aware of them and was of the opinion that they would dissipate with time. This event felt very similar in character, especially since my prior spells had all been triggered by rapid positional changes of the head and this had almost entirely consisted of a rapid positional change of my head (ie, tumbling head over heels). Consequently, I was inclined to dismiss it as an unfortunate accident and nothing more.

However, since then I have begun to experience a gradually accelerating series of unfortunate events. These episodes are hard to describe in detail, but they are certainly neurological in nature. They seem to take the form of a mild fainting spell or seizure: for 10 or 15 minutes beforehand, I feel very strange. Faint, and weak, like one might with low blood sugar, but with an accompanying tightness in the area of my surgical scar and at the temples. After awhile, I feel almost entirely overcome by the desire to lie  down, and then I have no clear memories of what happens.

I’m told I appear to fall deeply asleep for perhaps five minutes, followed by a period of semi-consciousness that gradually expands into full returned capacity. Afterwards, I’m light-sensitive, weak, and generally feel hung over. Eating sugar or drinking sugared drinks helps. After a couple of hours, I’m back to normal, save that I have no real memories of the episode itself or the first 5 -10 minutes after waking up.

At first, these episodes didn’t unduly concern me. They’re not especially burdensome or serious in effect – for example, I can feel them coming well in advance, so I’m not afraid to ride a bike or drive a car – and they’re similar enough in feeling to dehydration or overexertion that for awhile I thought they were just an effect of insufficient hydration or of the heat of the Burkina Faso hot season (120+ for days on end). However, hot season has now ended, and they’re coming more frequently, rather than less: I had 1 or 2 in April, 2 – 4 in May, 4 – 6 in June, and 9 so far in July. Also, they don’t seem to have any immediate environmental cause: I’ve had them immediately after taking Doxy & 14 hours after, in the morning and at night, in heat and cold, before exercise and without. There doesn’t seem to be any common thread between them, save that they happen, and they’re happening more frequently.

Nor do they incapacitate me in any way for work. I can still ride a bike, meet with local officials, write grants, carry water, shovel dirt, chop wood, and do all of the many other things a PCV does in the field. I just sometimes have to stop and lie down for a bit. Insofar as my daily life is concerned, these events are an annoyance rather than a real problem; it’s what they might presage in terms of a graver underlying condition that concerns me. Why are they happening? Are they just isolated, or do they indicate something more? I’m in no way concerned because of the events themselves, but I am deeply concerned as to what they might mean.

There are also accompanying side effects that may or may not be directly related to these episodes. I feel as though I’m far more emotional a few days before one happens. I’m also more prone to anger,
I generally feel more stressed, and my mood is far more down that it normally is in the US. Furthermore, I frequently experience an odd feeling of tightness at the base of my skull. It’s hard to describe, but it’s definitely internal rather than muscular in sensation; to a certain extent, it almost feels as though I can feel one of these episodes coming, and that I can fight it off in a way, if I try.

It’s very hard to describe the feeling and effect of these events. From the outside, it looks like a sort of limp seizure. From the inside, I go from fine to feeling a bit weird to wanting to lie down to waking up and being foggily uncertain of what happened. Before and after, I’m fine; my blood pressure doesn’t spike at either time (I borrowed a cuff to check), I don’t feel like my blood sugar is off (but I did not check), I don’t see lights or visual effects, and I don’t get especially strong headaches. Nor can I predict when an episode will happen. I just have them, and then I wait.

Here endeth the report.

So what does this all mean?

To put it bluntly, I have no idea. And right now, my doctors don’t either. They haven’t seen one, my scans are all normal, and with little more than a description to go on it’s hard to say what’s up. Happily, I can say it doesn’t seem like I’m experiencing another tumor, but that’s about it. I suppose it will be up to the very bright boys and girls in the US to figure out anything more than that.

Let’s hope they can.

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