Hepatitis C Testing and Treatment Update from a Retired Psychiatrist

There is a very informative CDC media briefing transcript about why so few Americans are getting tested and treated for Hepatitis C.

I’m a retired consultation-liaison psychiatrist and I used to be the go-to consultant to the hepatology clinic back when the only treatment was interferon-alpha. Because interferon-alpha was associated with neuropsychiatric side effects, notably treatment-emergent depression, I was frequently called to help assess potential treatment candidates and on-going follow-up for some.

A significant number of patients could not tolerate the psychiatric side effects.

Back in the day, interferon-alpha was really the only treatment. Now there are many treatments available and Hepatitis C is a curable disease.

Yet, few Americans are taking advantage of the new curative treatment. There are several reasons why, including the barrier of the high cost of treatment and insurance restrictions. The patients with the highest prevalence tend to be younger than age 40 and struggle with injection drug use, commonly opioids.

A large number of those at risk for Hepatitis C don’t know they have the disease. It’s vital to know where free Hepatitis C testing is available, which can be found at the CDC web site.

Why Do We Want to Believe?

I heard a song called “Marfa Lights” on the KCCK 88.3 FM radio program, the Friday Night Blues Show with John Heim aka Big Mo. The lyrics mention the Marfa Lights, describing them as UFOs or flying saucers. It was the first time I ever heard a blues song mentioning UFOs.

I looked it up later on the web. It turns out there’s a town called Marfa in Texas where people see strange lights. Years ago (and maybe even nowadays) a lot of them think they might be UFOs or some other paranormal phenomenon, like ghosts. A couple of studies in 2004 and 2008 pretty much debunked them as automobile lights triggered by atmospheric changes like temperature inversions. Still, some people want to believe they’re something weird or cosmic.

On the same evening I heard the song, I watched an episode of Ancient Aliens which is one of those shows which has a paranormal theme, mostly involving aliens. They talked about a blind seer named Baba Vanga, whose predictions about the future are thought to be 80% accurate. The speculation by the hosts of the show is that Baba Vanga might have been tapping into a phenomenon called the Akashic Record.

Encyclopedia Britannica on the web says the Akashic Record is said to be a “…compendium of pictorial records, or ‘memories,’ of all events, actions, thoughts, and feelings that have occurred since the beginning of time.” (Britannica, The Editors of Encyclopaedia. “Akashic record”. Encyclopedia Britannica, 29 Jan. 2015, https://www.britannica.com/topic/Akashic-record. Accessed 13 August 2022.)

It’s not a physical thing, but it sounds like an ethereal public library. The Ancient Alien enthusiasts suggest that anyone can access it, even aliens (of course!)—if you have a current, valid library card and don’t have any overdue books or have at least paid up all the fines you owe.

In fact, there are a lot of entries on the web claiming you can access the Akashic Record just by formulating a clear question, like “What does Kellogg really put in those so-called all natural Kashi Granola Bars—and what exactly is Pyridoxine Hydrochloride anyway?”

Then you have to get into a pretty deep meditative state, which is nothing like mindfulness meditation. You need to ask really specific questions and insist on talking to the head librarian if you start to get the run around about certain resources being on reserve only for high-level professional mediums who charge outrageously high fees to search the record for you.

People want to believe. That’s why you can even find a WikiHow with detailed instructions for tapping into the Akashi Record to check out any of the episodes from the first season of the X-Files.

The Akashic Record might even have the Cliff Notes on what is going to happen to humans in the remote future. Ancient Aliens guys seem to spin this a couple of different ways.

One is a version of the matrix theory, which means that we’re living in some kind of computer simulation run by aliens who set this up with a special code or script that absolutely must be followed—meaning that the future is strictly determined. That would be bad because it sounds like it ends with a tremendous nuclear explosion on Mars, which humans eventually colonize but then can’t get along with each other because there are not enough rib joints for both humans and aliens.

The other future scenario is that humans evolve into beings who can tolerate indefinitely prolonged deep space exploration and go planet-hopping for the rest of eternity looking for Douglas Adams’ restaurant at the end of the universe. Forget getting in if you don’t have a reservation.

Maybe the question for the Akashic Record keepers should be pretty basic.

Why do we want so hard to believe?

What About the Deer?

I saw a very thoroughly researched article the other day about the issue of deer population management in Little Village, a monthly news and culture magazine. You get an idea of the conflict between deer and people when you read the title of the article, which contains the gentle term, “Rats with hooves.”

I was reminded of it when Sena yanked the tall grasses out of her garden recently. Later, I could hear her tapping on the windows and yelling at the deer who could now see the garden is actually a salad bar.

I have lost count of the number of deer who ask me to light their cigarettes for them after they breed on our front lawn.

And I made a video in which they cavort and chew their way across our back yard on their way to parties. For some reason, it’s gotten over 1,280 views as of this writing (8/11/2022), and got about a 1,000 in one day.

I’m not clear on exactly why deer management by bow-hunting is such a failure. Iowa City has contracted with an outside company which can cull the population by the hundreds using sharp shooters who apparently do this for a living. I guess bow hunters see this as a form of recreation.

I’m ambivalent about people killing deer. On the other hand, a deer did run into Sena while she was driving the car a few years ago. They can leave a pretty good dent and can even kill motorists.

The Little Village article quotes somebody who said that neighbors call deer “1,200-pound rats with hooves.”

That sounded pretty heavy to me. I looked it up on the web and the average deer weighs a little over 100 pounds. If they’re seeing something that big in their yards, they might be confusing a moose for a deer. And that means we’ve got an even bigger problem.

There are other ways to control the population besides shooting them. I learned that you can surgically sterilize them. It costs about $1,000 per animal. Would these be veterinarians who might call their clinic, Pay to Spay?

The other way might be to introduce natural predators, such as wolves, into the areas where deer are making themselves a nuisance. Collateral damage could become an issue during backyard cookouts. And has anybody considered the risk of werewolf contamination?

Mmmm, venison!

Could we round up the deer and relocate them to a wilderness where wolves and other natural predators could control their population? I won’t mention the name of such a place, but it starts with the letter A-L-A-S-K-A.

Could Bigfoot get involved somehow? Maybe, if scientists could come up with a way to alter the deer genetic code to make them smell like beef jerky.

According to the article, the application for participating in the bow-hunt season runs through October 21, 2022. Property owners can fill out an application to allow them on their land. Anybody up for shish kabob at their cookout?

Improve Your Sleep!

Listen to the IPR River to River Podcast episode from June 7, 2022 as host Ben Kieffer interviews University of Iowa Hospitals & Clinics neurologist and sleep disorders expert Dr. Eric Dyken who explains sleep disorders and how to get a better night’s sleep.

Should We Smudge the Attic?

We never did figure out what was making the knocking noise in our attic.  I guess we’ll have to find out what to do about it. We did get the ladder and check out the attic, though.

As a general rule, animals don’t knock. They usually lack good manners, especially the Chupacabra and its cousins. And I can’t figure out what a wild creature would eat up there, unless it likes insulation.

I tossed an old fruitcake through the hatch to distract the werewolf, demon or zombie or whatever might be haunting the place. I figured that would probably kill it or at least the candied fruit would gum up his fangs so bad his jaws would stick closed.

It was pretty dark up there. We didn’t hear any knocking, but we did notice a disconnected duct. We’ve scheduled a fix with a local HVAC company.

We might have to Smudge the attic. I looked this up on the web. It’s a way to spiritually cleanse a house. You can use burnt sage or other substances which you have to light with a match or a lighter (which you could accidentally drop)—something I’m not sure I want to do in an attic when it’s hot and dry and there’s a lot of insulation and wood all over the place.

You end up with a lot of smudges that way—from a fire.

Anyway, you’re supposed to work your way around the attic from right of the entrance all the way around counterclockwise until you get the left side of the entrance.

We have attic hatch that is about 22’’ x 30.’’ It’s a long way around the attic. It’s pretty big and some things can hide under the abundant insulation—like giant pythons, which can go a long time between meals.

Snakes don’t knock; they lunge, strike, and coil. And if they’re possessed by a demon, they’re not usually impressed by how hot it can get in an attic.

This is why the HVAC repair person is waiting a while before coming out to our house. They try to avoid doing work in attics in the summer heat—not because they’re afraid of pythons. Python wrestling is just part of the job.

This gives us a little time to work out a smudge technique that doesn’t involve adding things like heat and smoke to the attic. That reminds me. You’re supposed to open up windows to let the smoke out. There aren’t any windows in our attic. Come to think of it, do any attics have windows?

It turns out there are smokeless cleansing methods—that don’t involve sprinkling Copenhagen all over the joint.

You can bang on pots and pans or ring bells. This can wake up the neighbors, who might call the police.

You can dust and vacuum and mop, but I’m not keen on cleaning up the attic. Attics are just the right places for large piles of insulation, dirt, and shadows—which can hide werewolves.

 You can make a spray out of stovetop potpourri, which might be a mistake because it could draw people from miles around who think you’re throwing a cheese and wine party.

You could open some windows to let in light but not in our attic, unless we knock out a few walls. Vampires don’t care for bright lights and might take offense.

Magical sweeping with an ordinary broom might work, but it would just make a cloud of insulation particles and make you sneeze—which could startle the werewolf, who would then rip your lungs out.

I think we’ll just stay out of the attic for now.

Holes in Our Heads

I remember getting a trephination of my fingernail a long time ago when I was working as a surveyor’s assistant. We were out taking elevation shots with a level and a rod measuring the depth of sewer pipes.

This required us to remove the manhole covers, which are very heavy. I got one of my fingers pinched and man that hurt. My crew drove me to the emergency room where an ER doctor drilled a tiny hole in my fingernail. The immediate pain relief resulting from the release of the subungual hematoma pressure felt miraculous.

That was trephination of the fingernail. I’ll bet some of you thought of my skull when you read the word in my first sentence, though.

Trephination is just the word for the medical procedure of making a hole in the body for some reason. In order to relieve pressure and severe pain from getting your finger mashed, a doctor can make a hole in your fingernail.

Trephination can also mean making a hole in your skull to treat brain injuries or to let the evil spirits out. That was done thousands of years ago, but making burr holes in the skull for other medical reasons is still being performed, including to relieve pressure.

It’s the origin of the old saying, “Well, I’ll be bored for the simples,” where the term “simples” means feeble-mindedness and “bored” refers to the obvious treatment.

Anyway, boring holes in either your mashed finger or your head can relieve certain kinds of pressure and pain.

Figuratively speaking, we can feel under pressure in our heads for all kinds of reasons. In fact, we’re born with several kinds of holes in our heads that can lead to the pressures of anger, anxiety, sorrow and fear.

Our eyes can fool us, even to the point of making us believe we see Bigfoot when all we’re really seeing are pictures or videos that are very blurred and pixelated. I didn’t say nobody ever sees Bigfoot. I’m saying that there’s a term for some forms of visual misperception, one of them being pareidolia—the tendency to perceive meaningful images in random or ambiguous visual patterns.

Our ears can also fool us. Mondegreens are misperceived song lyrics. One of the most common mondegreens is a line I was very embarrassed by for years, “Wrapped up like a douche, another runner in the night” from the song Blinded by the Light by Manfred Mann’s Earth Band. It’s actually “Revved up like a deuce, another runner in the night.” A deuce is a kind of automobile that was often converted into a hotrod in the 1930s, usually a Ford.

Those are just a couple of examples of how holes in our heads can sometimes lead to trouble getting along with each other. All you have to do to prove this is to look at news headlines. Everybody’s slamming each other.

There’s no magic cure for interpersonal conflict, although there have been plenty of efforts to help us understand how it may arise from misperceptions and misunderstandings, often arising from missteps in communication. I doubt making more holes in our heads would be helpful.

For example, I could have chosen to show you a picture of which one of my fingers got pinched in a manhole cover. How I might have done that could have been unnecessarily provocative and even offensive—even if I only meant it as a joke. A prominent scientist recently published a picture on social media of what he called a new star he said was taken by the Webb telescope. It later came out it was actually a picture of a slice of chorizo, which is a sausage. Many people didn’t think it was funny, but that was his explanation for the post.

I don’t have to say anything more to convey the message that being mindful of what and how we are communicating is vital to making ourselves understood while remaining respectful and kind.

Practicing mindfulness is one way to facilitate clear communication that can help solve problems without hurting the feelings of others and triggering vengeful counterattacks. We’ve all been there.

Not everybody gets the idea about mindfulness. I think the blogger thegoodenoughpsychiatrist does a great job discussing it in the post “Reflecting on DBT and Mindfulness.”

As the blogger says, “Sometimes, you just need to be brought back down to earth.”

And if that doesn’t work, we can always try trephination.