HCV–WHEN DOES SVR ACTUALLY EQUAL “CURED”?

Posted on July 24, 2014 by asknod

downloadToday “almost” viral-free Randy from the mile-high stoner city of Denver sends us this important “Well, not exactly.” article that we are coming to associate with the VA medical community. Hepatologists from our favorite AO laboratory at the National Institutes of Health (NIH) are beginning to retreat from earlier ebullient claims and throw out decoy flares to distract us from the fact that SVR-even SVR after six months or a year- does not mean “true” SVR. It merely means the HCV is lying dormant again as it usually does-hiding in this or that organ. Or, it is a reinfection. Or….”‘It’s Baaaaaaaack!” and no one knows why but make sure you notify your local Health Department so they can publish your name (again) in the ‘recently diagnosed with STDs’ BOLO newspaper release. 

Randy and I discussed this yesterday afternoon. He’s using the VA pharmacy and they disburse their Sovaldi in 14-pill, two-week increments so you won’t go out and resell it on the black market. Same for the Ribavirin. No, fellow Veterans. We won’t descend into an orgy of laughter and guffaws over this. Their logic is already well into the Twilight Zone. I merely mention this because they (VA) seem to also have trouble counting. Again, hold the Captain Obvious award. I’m not referring to scheduling practices in Phoenix. I’m referring to much smaller numbers emanating from their laboratory sleuthing.

sesame-street1Randy called to announce his recent reduction in perceived bugs per-square-inch of blood. Seems the stoned folks down at the lab need the services of the Sesame Street Count as they are unable to venture past the number of fingers and toes born with. Their initial number two humans and one extra hand (forty five) but after a quicky do-over, they discovered it was actually two guys  and seven fingers (twenty seven). 45-27= 18. 18 is not a rounding error. 18 is not close as in horseshoes, M-26s and Claymores. In science land, 18 is a gaping chasm. Apparently at the VA, it’s no big deal. Au contraire, ma cher. To us hoping for the Holy Grail of SVR, being off by 18 bugs is the difference of getting stung again inside a supposedly screened-in environment after a heapin’ helpin’ of OFF bug repellent.

Randy and I, being HCV rocket scientists with big long strings of impressive-looking capitalized letters after our names, opined that it may be impossible to scare all them critters out in such short order. Have you ever gone grouse hunting and flushed a covey out off the edge of a forest? There’s always that one bird who hesitates and the dogs almost run over him after you’ve flushed them and shot. Only then does he make his presence known.  And much like the reemergence of HCV, it scares the living shit out of you. We theorized that these rogue grouse viral cells can hide out in your organs. Hell, we know they love our livers. They’re like little PACMAN critters running around munching it up. Endemic evidence over time has revealed their presence in our brains and even the thyroid gland. Considering the x rays of my kidneys look like the Shenandoah Caves’ stalactites, I’d say they hang around there on spring break as well.

When the Practitioners of Medicine read the blood results from the lab, they are looking at the number floating in free liquid (your blood). If you’re running around with a Franchi SPAS  12 gauge and a 20-round drum magazine full of Sovaldi buckshot hosing these viruses, it stands to reason a few could hole up in the recesses of the body to avoid the slaughter. They’re smart enough to mutate ever so slightly to disguise themselves from your white blood cells so it is plausible. After 44 years with HBV, then HCV and now AIH, nothing would surprise me. One thing is certain. It’s freaking out the scientists enough that they’re actually thinking about trying to get to the bottom of it. As usual, the immediate panacea is: Take protein pill. Put helmet on; use protection when having sex, do not share toothbrushes/razors/coke straws and avoid intravenous drug use.  Yo, Gendarmes. Round up the usual suspects tout de suite.

I feel like I’m in the right place at the right time for once in my life. Mark went down from one million to 15 BSI (bugs per square inch) after four weeks and then bingo at six. Randy went from 2 million copies to 27, assuming we trust that latest VA estimate for the last four weeks. Next week I find out my initial number as well. I was starting from a lower number of 448,000 BSI. My autoimmune disorder manufactures a lot of white blood cells (WBC) which ‘hunt’ for viruses. Unfortunately, their aim is less than perfect and they incur collateral damage when they miss and hit the liver.  I’m glad I’m using a civilian lab. They rarely call back and say the bugcounter doomoflotchie wasn’t calibrated correctly.

Medical science re HCV is in such flux now that the Grand Poohbahs of the Art cannot even present a unified front on how to attack it. I hear several schools of thought  coming from different sources that queers me to the idea any of them even knows what they are about. One school of thought from the pharmacy who supplies me is “Do they still have you on the Ribavirin?” Remember, this is the beginning of the second month-not three or four later. If the pill salesman is amazed you’re still on it, it implies some of us are not. It also means they’re partially amazed you made it to the phone and answered it coherently before it went onto the answering machine.

HouseNext, I am becoming anemic. Not just a little anemic but a lot. The monogram on Ribavirin says “May cause anemia”. My Sovaldi minder (Mariah) at the doctor’s office called last Friday and said “Hmmmmm. Seems your getting a leettle anemic. I wonder what’s causing that? Let’s try something here. I want you to take one less Ribavirin a day henceforth. That would be four tablets instead of five a day. Can you remember that or should I send you a letter?” Wowser. Where did you park the ambulance, Dr. House?

Add in that they are perfectly aware, or should I couch it in VA terms and say “They are in constructive possession”, of the knowledge I get a phlebotomy of 800 ml (one pint) every month which, the last time I checked, is the speediest way short of slitting your wrists to attain perfect anemia. No one has suggested I refrain so I didn’t. I almost can’t wait to see the horrified looks next week over the realization that my Red Blood Cells (RBC) are going to be in the subbasement. Screw it. I want the BSI in the cellar. We have the technology to increase the RBC. That’s the very least of my worries right now. Besides, it gives me a bodacious buzz when I tie my shoelaces and stand up. It’s like a 30-second LSD trip where everything takes on that paisley look with a pink tint. Relax. It’s an anemia thing. You wouldn’t understand.

Today’s blog is brought to you by the numbers 2 and 7. In VAspeak, that’s all your fingers and toes, your four appendages and your ears and nose. Do not employ the bilateral factor when adding or this won’t work. Do not round up or down, either.

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Posted in HCV Health, HCV Risks (documented), VA statistics | Tagged , , , , , , , , , , , , , , , , , , | 5 Comments

NEW VASEC

Posted on July 23, 2014 by asknod

US_Navy_050901-N-0780F-003_The_dock_landing_ship_USS_Ashland_(LSD_48)_and_embarked_elements_of_26th_Marine_Expeditionary_Unit_(MEU),_arrive_in_Souda_HarborThis morning I heard Ronald McDonald had been formally crowned the new VA Secretary. This is an interesting development and one that has direct, if not dire, implications for Vetkind. How he approaches some of the old, intractable warlords in upper management and how hard a hand of poker he plays will tell us all we need to know soon. There’s no time to learn the ropes and start sanding off the peeling varnish of the USS Vermont Ave. (VBA-810). His new motto should be ” We jump from 8,000 at dawn.” Of course, an equally apt one would be “Boldly going somewhere finally “.

Make no mistake about it. Reforms are going to have to come hard and fast. New revelations about retribution to whistleblowers at Palo Alto is all over the news. VA is making no pretense or even trying to disguise their actions. It’s like the Red Queen running amok at the afternoon garden tea party screaming “Off with their heads!” In fact, the sugar baby responsible for trying to hang the VA whistleblowers in the pharmacy there was transferred to Phoenix as Sharon Helman’s replacement.  TA-DA! Yeppers, Elizabeth (Lisa) Joyce Freeman, who served as director of the Palo Alto VA Health Care System until she left this month to become interim director of the VA’s Southwest Health Care Network in Arizona was the Red Queen. imagesThey just really don’t get it. Witness Lucy Filipov having to Chieu Hoi last week up in Philadelphia and Diana Reubens taking a demotion to replace her. You eventually realize this musical chairs game is nothing more than a desperate rearrangement of the same old furniture on the aft deck of the Titanic.

This one has to change. The idea of creating a new file on the VA claims  ”desktop” (read in basket), filling it full of partially completed claims and then walking away from them without finishing them does not reduce the backlog. You can take them off the official “roles” of claims awaiting action, but you have not done anymore than make another mess that will eventually have to be cleaned up. Whether our new VA Clown will even scratch the surface of all this or go the protein pill/ helmet route is of burning interest. Does he have the cojones? Another Hispanican standoff is not going to pass muster with Uncle Jeff and the crew in HVAC.

downloadHow it plays out with the Col. Sanders show up in the Senate is still fuzzy in my magic eight ball. If they can’t even agree on how to fix our medical care without a fire hose of billions and billions, why bother? Perhaps integrating us into the new ACA would work. Not. The private medical system is now slowing down (as predicted) to dial-up internet speed with the massive influx of new Medicaid enrollees. Adding Vets in equally mass quantities will produce more and more of the same tortuous gridlock.

The Senate cares not if they overburden the budget. What the hey? Here, take another Elevendybillion for VHA. Just make sure you build some of them new hospitals in my state. Hear? The House, desperate to triage our public debt, is demanding offsets in all the public welfare programs to balance this added expense. Guess who gets the short straw? Legislative impasse once again paralyzes our system and nothing happens.

Coming soon to a VAMC or VARO near you soon.

Coming soon to a VAMC or VARO near you.

The new Bozo could have all the best intentions in the world but if Congress does nothing, the McDonaldmeister and his new, improved management team is going to be pissing into the wind to fix anything. Based on all organizations ever a part of government, you can expect a waste/fraud/redundancy factor of 37%. If Old Ronnie could squeeze this out of existing union/management and hire more Native Americans instead of Chiefs, he might make headway in spite of a recalcitrant, balky Congress. It would certainly be a good head start to begin paying  entry-level bedpan changers $15 an hour rather than $45.  Throw in some of that much-touted VA medical care, too. That ought to increase the “shareholder” mentality of VA employees.

As a postscript, it’s quite telling when the Big Six VSOs want to keep the same old VAMC model and touch up the paint. Of course, them fellers don’t have to use it. They have the new ACA or their own gold-plated plans.

Posted in VAMC Scheduling Coverup | Tagged , , , , , , , , , , | 2 Comments

FORT FACEPLACE–THE NEVERENDING BATTLE

Posted on July 22, 2014 by asknod

282863_10151187753006314_1575312628_nOnce again, in an attempt at weak weekly humor, we venture afield in the vast wasteland of that social interface network where we learn who did what when and with which new profile picture. Somewhere in between, in order to grab our attention, a keeper pops up that bears sharing with a much wider audience of appreciative Veteran. I think I speak for many of us that more humor is better than less. The VA is like wet firewood on a campfire- smokey and obscuring what’s afoot. Humor, like sunshine, is good for the soul. At Camp HepC, every day is a rotten day. This makes it ever-so-slightly more palatable.

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Posted in FACE HUMOR | Tagged , , , , , , , , , , , , | 1 Comment

CAVC–JEFFREY V GIBSON-SHOW ME THE LEAD TEST

Posted on July 21, 2014 by asknod

thumb_d10d7a64-04ab-4462-9561-19cb885ef6d9You’ve probably noticed by now that a decision with the word “reversed” in the ruling verbiage is a magnet to my senses. Glen R. Bergmann bags a good one here. The BVA and the RO were just not going to do a simple lead test on Buddy here. Even after a remand to do so, they reneged and started looking at the wallpaper and the clock when it came back without one.  The OGC then stood behind this indefensible bulljive instead of quietly trying to email Glen to reach an amicable JMR where everything was finally done according to Hoyle. This is a classic example of VA’s out-of-control VBA on parade. In a nonadversarial environment, an olive branch can often go a long way and preserve scarce judicial resources for others in line. When Gunn testosterone and Eskinazi estrogen mix with Veterans claims, you can guarantee some interesting, wasted judicial escapades and a lot of time spent hindering the process rather than helping it.

openingtable1152Just imagine a Perry Mason scenario where Hamilton Burger, with Lt. Tragg in tow, dropped by Perry’s office and they all went out for a two-martini lunch. Burger could agree to drop the murder charges to involuntary manslaughter and they could reach a modus vivendi to a sentence that was equitable and just. Perry would agree and even pick up the lunch tab because the client was paying for it anyway.  In that same vein, could you imagine Laura Eskinazi or one of her munchkins calling up Glen and Co. and proposing a top-drawer lead test to get to the bottom of it? Mr. Jeffrey was in the Navy. Ships had lead paint in copious quantities back then inside and out. If it still showed up in the blood, what the hey? He wins. No skin off Laura’s butt. It’s America’s money and if Buddy has gray blood, then it probably happened in the Navy. Everyone wins and another Vet gets his claim heard sooner rather than later. Yes, Virginia. In a more perfect world, perhaps.

Instead, VA decided to ignore his and his counsel Mr. Bergmann’s impeccable logic, fight tooth and nail over whether it was apropos to have one ( a blood test) and then try to drag out an old 2001 knee x ray in lieu of it and say “Nope. Don’t say that the technician identified any lead streaking in there”.

Jeffrey v. Gibson reversal

This is classic VA “I did it my Way” logic. Rather than comply, they sail the boat around the world backwards to avoid the Panama Canal transit fee. Ignored is the theory that the 2001 technician was looking for evidence of lead poisoning. He wasn’t. He was looking for a knee injury. Duh? You could have a tumor the size of Rhode Island and the VA technician is going to opine on the meniscus-not the cancer. VA’s attempt to repurpose the 2001 knee x ray as a valuable negative diagnostic tool to rate a disease runs up against the introspective capabilities of Judge Greenberg. Had Greg Block assigned this to Kasold, I wouldn’t be writing this. Jeffrey might or might not have been in transit to the Fed. Circus in hopes of a more nuanced reading of justice had that happened.

vlcsnap-492640b

VA Texas-style Necktie party

The reversal of the finding that the BVA Board “substantially” complied with the remand order is the bitchslap. Greenberg has, as does any judge, the right to summons the proper amount of umbrage to take with a VA adjudication failure. Hence the more egregious the omission of basic justice, the stiffer the rebuke. Considering they have several options that can preserve a Veteran’s right to another day in court, the tenor of the remand often expresses just how fed up Judge X is with VA’s Texas Necktie Party held in your honor.

Judge Greenberg is a sassy old fart. He retired as an O-7 and came up through the leagle beagle ranks. I doubt anyone expected him to be as pro-Vet as Bartley but he is a piece of work. Reversing the finding of substantial compliance informs the Veterans Law Judge (VLJ) below that he got his law degree whistle out of a Crackerjack Box.  Reversals bite like a cat-o-nine tails. It brings to the fore the question of just how able VLJ John J. Crowley actually is if he cannot master the concept of this basic judicial tenet in thirty three pages of BVAspeak.

Obviously, the real bitchslap is the one where it becomes patently obvious that this whole thing is part and parcel of the much broader BVA denial system. When a microcosm of Vets (5,000) who appeal and come to the CAVC annually out of the 50 thousand who appeal and lose, keep coming away with a static 65% remand, vacate or reversal of their adjudications, it speaks volumes about the quality of the decisions below. As the number of claims appealed continues to rise, the percentage stubbornly remains at 65%. Why is that?

VA’s Under Secretary for Apologies, Allison Hickey, assures us that the new VBMS, due to go online any decade now, is so perfect that it regularly clocks in at 89% accuracy and does it in just months. Months, of course, can be defined in Jupiter or Saturn months legally at VA without question. 89% can be defined as all the requests for burial flags being substantially correct and timely dispersed to the intended recipients.

Considering that Congress’ temper is getting shorter and shorter with VA’s intransigence, it follows that there will be some spillover into the judicial arena. Coming up to 625 Wagonburner Lane NW again and again with the same defective interpretation of what constitutes “substantive”, “marginal”or outright gerrymandering of the meaning of “lead test”  is guaranteed to get Judge Greenberg’s goatee.  His scathing dissent in the en banc Pacheco decision was all the ammo Paul Schoenhard needed to get a remand from the Fed. Circus. It’s like Greenberg ( and Bartley, too) researched Westlaw and squeezed all the juice out for him. Jeffrey is no different. It’s poor BVA law as usual with all the warts and missing parts in technicolor and 3D.

070206-F-4335C-004Mr. Bergmann gets to notch his six shooter,. VLJ Crowley will take a remedial course in the Presumption of Regularity as it applies to VA examiners.  Mr Gibson could give a flying donut because he’s going to be down the road in short order. Former 0-7 Hickey is similarly situated. I predict she’ll soon be pulling the curtain handle over her head and punching out. Maybe she can get her old job back at Accenture. Or become the director of cheerleaders back at her alma mater. Woe betide the cadets.

 

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ZUKES AND FOOD BANKS-A MATCH MADE IN HEAVEN

Posted on July 19, 2014 by asknod

sunsetI just wonder how long I’m gonna get away with this. I started all the squash/pumpkins in the greenhouse in March and the zukes are pooping out about 15 a day. None of our local food banks have any yet. Saw the new location and beat feet to home to make a “deposit” at the “bank”. Check out the sunset from the back porch. 

zukesfood bank

first pumpkins

first pumpkins

Crazy blueberry cherry tomatoes

Crazy blueberry cherry tomatoes

Head fertilizer technician Kona and his sidekick Wally

Head fertilizer technician Kona and his sidekick Wally

Posted in Food for the soul, Independent Living Program | Tagged , , , , , , , | 1 Comment

VAMC PHOENIX–VA ADMIN. THREATENS SUICIDE

Posted on July 18, 2014 by asknod
Brad 'the 'stache' Curry.

Brad ‘the ‘stache’ Curry.

Yeppers. This just in from Maple syrup Frank. Seems the Administrators are starting to realize their days of employment at VAMC Phoenix are numbered. No more can they depend on a VAOIG whitewash. Sharon Helman will probably be next threatening to take an overdose of aspirin if not given her job back.

What’s next? Brad and Sharon file for PTSD saying they were “stressored out”? I’m sorry. Until they see fit to remunerate the VA for stealing those VA bonuses all these years, there’s a nice, cozy spot near the fireplace in Hell just for folks like them. Warm beer with cigarette butts in it is on tap for them as well.

Posted in VA Bonuses, VAMC Scheduling Coverup | Tagged , , , , , , , , , , | 4 Comments

Proof that HCV Sustained Virological Response (SVR) is a myth?

Posted on July 18, 2014 by Laura
nih-imagebank-1481-150

Scanning electron micrograph of a human T lymphocyte (also called a T cell) from the immune system of a healthy donor.

The HCV monster-machines are apparently craftier than we have been led to believe.  Even after IFN/R therapy, and non-reactive (not detectable) standard clinical testing, more sensitive tests prove that HCV RNA still resides in the human body in reservoirs.  The researchers of the small “first” study, Persistence of Hepatitis C Virus during and after Otherwise Clinically Successful Treatment of Chronic Hepatitis C with Standard Pegylated Interferon α-2b and Ribavirin  Therapy (published November 2013) are very confident in their experimental methods, results and conclusions. There is no waffling.  

The study is highly technical but I’ve pulled out some sentences, the gist of which, can be understood by this layperson (with footnotes removed). My remarks are in red.

New terms: occult HCV infection (OCI) which was discovered in 2004 but “rarely investigated.” peripheral blood mononuclear cells  (PBMC). Lymphoid cells

  1. HCV is infectious even in trace amounts, with approximately 10 virions or 20 copies of viral RNA capable of transmitting infection in chimpanzees and with 20 to 50 virions able to establish productive infection in human T cells in vitro. (How many zillions of virions can fit on the nozzle of a jet injection gun?)
  2. The long-term consequences of this essentially asymptomatic infection, termed as occult HCV infection (OCI), remains uncertain; however, OCI coincides with histologically evident protracted low grade liver inflammation and fibrosis in some patients for at least 10 years after completion of antiviral treatment. (My spouse was told he was completely cured.”)
  3. Also, clinically diagnosed sustained virological response (SVR) achieved due to IFN or PegIFN/R does not universally prevent progression to HCC, which develops in up to 3.9% of these individuals. (This is not a good number and how many primary doctors are even looking for HCC in SVR patients?)
  4. Contrary to prevailing opinion based on the currently available clinical testing for HCV RNA, clinical diagnosis of SVR does not reflect molecular eradication of HCV…(They drive this point home throughout the paper.)
  5. In addition to persistence of HCV in plasma during OCI, virus and its replicating genomes were uncovered in PBMC and liver biopsies in individuals for many years after having been considered to be clinically cured of hepatitis C. (Yes, they are still replicating..)
  6. …the accumulated data showed that HCV residing in immune cells fully retains biological competence, including infectivity…(No identity confusion in these monsters.)
  7.  …to fully recognize the sterilizing potency of new DAAs in the context of the extremely high mutagenic capacity of HCV and the virus’ resulting ability to generate drug resistant mutants, the DAA effects on virus replication at extrahepatic sites, particularly in immune cells, should be routinely assessed since these cells also are the site of virus active propagation.  (The expect some to relapse after DAAs who may then be offered INF/R.  Ugh.)
  8. These and other findings prove that immune cells, including T lymphocytes, are targets of naturally occurring virus, they are reservoirs of replicating HCV regardless of symptomatic or occult appearance of infection.  (Is this why HCV is linked to lymphomas?)
  9. Therefore, HCV is not completely cleared during ongoing administration of PegIFN/R otherwise capable of ceasing progression of CHC and virus commonly persists at levels not detectable by the current clinical testing. The findings suggest the need for continued evaluation even after patients achieve undetectable HCV RNA post-treatment. (The VA won’t test my spouse for HCV anymore…but they should.)

The authors are affiliated with the following institutions: Virology and Hepatology Research Group, Memorial University, Can. Center for the Study of Hepatitis C/Div. of Gastroenterology and Hepatology, Weill Cornell Medical College, New York City; Div. of Gastroenterology, Hepatology and Nutrition, Dept. of Medicine, SUNY-Buffalo.  The study has only been downloaded 212 times so far and cited only twice even though it has greatly added to the knowledge base on HCV.

A preview of the book, HCV Infection and Cryoglobulinemia by Franco Dammacco, is available in Google books.  It’s a good resource. Using the keywords, “occult HCV infection (OCI)” I was able to read a discussion about this issue. 

So the upshot for SVRers is to take care of your whole biological system as best you can. 

Editor’s note: To all of you who VA says are SVR, this is the smoking gun you need to rebut with. When they say you are pure as the driven snow, wave this one in their face. Take note Malcolm!

Posted in Guest authors, HCV Health, HCV Risks (documented), Jetgun Claims evidence | Tagged , , , , , , , , , , , , , , , , , , | 8 Comments

VBA-PLEASE KEEP EXIT AISLES CLEAR

Posted on July 18, 2014 by asknod
Willy Gunn says 'We be gone'.

Willy Gunn says ‘We be gone’.

As I predicted several months ago, the stampede to the exits is in full swing. Following  Petzel’s lead were Joan Moody and Willy Gunn who didn’t even wait for the jumpmaster or a green light. Dr. Brown, Under Secretary of VHA Health (acting) is certainly not the last. The USS Vermin Ave. is alive with the sound of resumé music.

Joan Moody: " I need more time with my kids. At fifty, I feel my mission at VA is done''.

Joan Moody: ” I need more time with my kids. At fifty, I feel my mission at VA is done”.

We’ll never know why Moody took the poison pill. At 50, she’s not ready for retirement. This isn’t going to have a smiley face on her resumé but I’m sure she can get some of her former bosses at Vermin Ave. to write glowing endorsements on her ability to advocate for bonus awards and her exquisite grasp of Congressional and legislative affairs. After all, that was her strong suite at VA. I see a glowing future as the Veterans Service Center Manager in Manila, Philippines after a suitable hiatus as a talking head on the  VA’s problems with CNN.

What will be interesting to see is how the VA, and it’s possible new Secretary, Ronald McDonald, reorganize the personnel roster. If this merely results in a Punxsutawney Phil approach with no visible shadow, involving the same employees with no new ones chosen from without, then we are doomed to six more decades of winter at 810 Vermin Ave. NW. punxsutawney-philThat is the crux of our dilemma. Given VA’s propensity to ignore public sentiment and common sense, it appears we’ll merely see a new cast of characters with similar sounding names. Expect to see Laura Eskinazi move to Willy Gunn’s slot. Prepare for Hickey’s exodus and fresh meat like Lucy Filipov to replace her.

Musical chair affairs at VA’s Central Office are amusing and oh-so-predictable. Much like the military, having time in rank determines promotion. Intelligence, sadly, is not a prerequisite. When the music stops, there will be no body slams for the last vacant chair. Musical chairs at the VA do not obey the childhood game. There’s always a seat for you. Everyone politely acquiesces to the one most senior to inhabit the one with a corner-office view of Lafayette Square. The reason is simple. For decades, you were virtually guaranteed a seat at this dance. You simply had to wait your turn. If someone stepped on his necktie and just could not be rehabilitated or repurposed to Fort Harrison, Montana as the VSCM, you got an early Christmas present and a parking spot in the basement sooner that you expected. Merely being able to fog the mirror with the air escaping your nose was sufficient to maintain your seniority and guarantee the next step in pay.

With the new paradigm, those days would appear to be over. The operable word here is “appear’. VA has been intransigent in the past and had the chutzpah to fly in the face of adversity- indifferent to public opprobrium. While the recent resignations might imply this is no longer the case, I suspect the majority are still waiting for the SS Carpathia’s lifeboats to arrive and begin transferring the senior managers to their new digs. The majority of them are too obtuse to absorb the concept.

Hickey’s abysmal performance and abject self-degradation up on the Hill the other day was belied by the press release the following day announcing the ‘All Clear’ siren and the raising of the SOSDD  flag out on Vermont Ave. That’s the endemic problem we have to contend with. Mea culpas at the HVAC have to be accompanied by the gomers going through the motions to appease public and congressional disfavor. Sackcloth and ashes are the uniform of the day but VA hasn’t gotten that email yet. Moreover, they can’t conceive of that apparel nor will they ever.

VA’s hierarchy has been indifferent to public opinion for over twenty five years. Following the inception of the New World Order of the Court of Veterans Appeals (COVA) in 1989, the VA paid lip service and proceeded merrily on their way just as they had for the prior seventy years. BVA judges continued to write medical opinions in violation of the Colvin decision as if it had never been decided. Ratings were denied with no C&Ps. Due process was a hollow phrase that made a nice matching bookend to Benefit of the Doubt.

We have reached a crossroads-a perfect storm- where fourteen years of continuous war have finally brought our wounded chickens home to roost. No longer can we look the other way and try to ignore the plethora of warriors missing large parts of their anatomy. The profusion of aftermarket arms and legs is becoming a de facto totem of the Afstan conflicts. How we did this after Vietnam was disingenuous-we popped smoke and corralled them at Walter Reed out of sight. Afterwards, we  quietly salted them away in their hometowns with fat VA SMC ratings-again-out of sight. Well, fat if you think like the gomers at the Central Office. Compared to their wages, we now know that it was pretty skinny largesse-and still is.

The ‘knickknack, paddywhack, give the Vet a bone’/ this paraplegic went rolling home’ metric isn’t going to fly anymore. No amount of wool-pulling is going to hide the problems at VA. Were the egregious actions of VA’s hierarchy truly just a recent, maladroit error or minor misfeasance by a few, the media and Congress might have been more forgiving. That they rise far above that to endemic, long-term malfeasance by all involved (collusion) cannot be swept under the rug. So, too, can Congress’ turning a blind eye again and again to these shortcomings of the VA no longer be ignored.

imagesThe Piper awaits-nay-demands his pay and will not accept payment for hamburgers today come Thursday next. Americans demand our Vets get a fair shake now. Unfortunately. VA cannot produce the golden egg as promised all these years. Asking for another ‘one time’ infusion of twenty or thirty billion dollars on the heels of the same, similar requests in years past seems to be falling on deaf ears up on the Hill. It’s not that the request is ill-timed or untoward. It’s because the request is as tired and predictable as thunder following lightning. Were the VA to retrieve all those illegitimate bonuses for the last decade or two, they would have the funds needed. Had they been paying wages commensurate with job requirements, they would have the funds. Had they not engaged in an orgy of Human Resources cheese and wine tastings with General Patton look alikes and ice sculptures, they wouldn’t be so funds-challenged.

Could have, would have and should have seem to populate the problem list at VA today. Seeing that Congress is loathe to apply the salve of ‘mo’ money, honey’ again, it’s no wonder the resumé template on VA’s antiquated Central Office Adobe 2 programs is running so slowly. Everyone is packing his/her parachutes and checking that of his/her fellow employees’ against the inevitable upcoming massacre. While I admire Sen. Bernie Sanders’ recent epiphany that Vets are getting the sharp, brown end of the punji stick, I have to disagree with how we can fix it. As long as we continue to shoot the messengers and reward the bank robbers, there can be no change. No amount of money can fix stupid and greedy.

Merely promoting from within without purging the pollution of longevity serves no logical purpose. Unfortunately, being a governmental organization does not permit a wholesale Saturday night massacre and infusion of new personnel. Nothing can change due to the built-in resistance to change. Removing bonuses won’t drive out intelligent, competent dedicated employees. Those are oxymora. There simply are none to be found at the VA.

Posted in VAMC Scheduling Coverup | Tagged , , , , , , , , , , , , , | 2 Comments

DAY 25–SOVALDI

Posted on July 17, 2014 by asknod

download (1)Day 25 dawns with a nagging headache. This is # 7 since beginning the new prophylaxis. Additional noted complaints include itching (yes Leigh, me too) in odd places never mentioned in public, anemia, idiopathic thrombocytopenic purpura on exposed arms, pruritus, dizziness, and RUQP. Mind you, I am not complaining. These represent minor inconveniences on the way to a longer life without the dragon breathing over my shoulder.

In other news, Diane C. remains SVR after a year. Mark (Hepsick) is SVR after 6 weeks and will be coming up on another SVR assessment soon,. My own first checkie-checkie for less bugs per square inch of blood will be next Tuesday. That will mark the one month milestone we all look forward to and dread simultaneously.

 

The reason I am such a prolific author today is because I had a phlebotomy yesterday. The check engine light has been on ever since. Seems when you’re anemic, removing another pint of blood has consequences. Mine is a push. Allow the contaminated AO blood to fester or pump it out. Either way, my Sovaldi minder is going to be in for a rush when she sees next week’s results. They do have a laissez faire attitude about all this and didn’t exactly tell me not to keep getting phlebotomies. What I find interesting is the poster on the wall at the blood bank. It clearly points out that you cannot donate any more frequently that every 57 days. How is it I can do a phlebotomy every 30 days-and have been since November 1992? The little black spots in the corner of my eyes are my constant companions now like my dogs. They follow me everywhere. And for those who wonder, that’s thirty one gallons of blood down the tubes. Well, they claim they’re throwing it away but you know how that works…

My heart goes out to all of you who were subjected to the triple-drug cocktail VA was pushing (VERTEX) when they knew full well that Sovaldi was on the horizon and active trials were in progress. Perhaps it was part of that VA scheduling snafu that’s in the news these days. Damn Vets refused to keep calling back in to keep their desires for treatment current. What’s a VA scheduler to do? Roger that. Create a ‘secret list’ so they don’t lose track of these lazy sons of guns. Some day they’ll want that appointment and it pays to have proof you were just doing your duty trying to keep up with their desires.

P.S. If anyone finds that ten lbs. I lost or misplaced, please send it back. I guarantee the postage.

 

Posted in Medical News, Sofosbuvir | Tagged , , , , , , , , , , , , , , , , , , | 10 Comments

BVA–NEW 2ND QUARTER DECISIONS POSTED

Posted on July 17, 2014 by asknod

scThe second batch of 2014 decisions were put up today and the increase of cases being won via jetguns is finally getting some traction. Here’s the very first one I looked at and the turn around in VHA “expert” opinions shows 30 pieces of silver aren’t enough to hush their mouths.

With regard to receiving injections from air gun jet injectors, the expert found that such exposure is as least as likely as not to have led to the Veteran’s current hepatitis C exposure. In support, the expert provided that currently, multi-use jet gun injections and injectors are no longer medically recommended due to the risk of transmission of blood-borne diseases. Further, because there is a lack of showing of any other possible means of transmission through other identifiable risk factors, to include sexual transmission, as there is no medical evidence establishing any such risk factors, the only plausible means that remains at least as likely as not is the air gun injectors.

Finally, after 22 years, they are willing to admit (and grant service connection) that there is a link between the jetguns and the bug. I’m sure Gary Lupole is smiling down from somewhere above and saying “No duh.”

Gentlemen, start your keyboards.

Posted in BvA HCV decisions, HCV Risks (documented), Vietnam War history | Tagged , , , , , , , , , , , , , , | 4 Comments