The Dark Ages of pain management : Australia, 2012

The Question

I asked a well-regarded pain management specialist recently a simple (if loaded) question. I asked : Do you agree that Australian pain management is a decade behind the US and other first-order countries? His answer shocked me to my core.

The Answer

He said “No.”.

Now this is where I must beg to differ from a conservative medical opinion. There’s a huge difference between considering yourself to be on the cutting edge of medical science, and actually being there. Unfortunately, for most (if not all) medical practitioners in general, and pain management specialists in particular, this is poorly understood. Let me explain.

Mmm, shellfish…

In 1998, an omega conotoxin (part of a shellfish’s poison defense) was synthesised in the US, and was almost immediately approved for use in patients via intrathecal delivery. This marvellous stuff is known as Ziconotide. While it has a number of significant and deleterious side-effects in some patients, it offers an enormous improvement in pain management, from both an efficacy and from a tolerance perspective. It’s much more powerful than morphine, and unlike morphine, it has NO (that’s zero!) measured tolerance increase. That means you need to use less of the stuff to mask pain, and you generally don’t have to increase the dose as your body becomes accustomed to the stuff. How cool is that?, I ask chronic pain sufferers.

The bits that show I’m fully qualified to discuss pain.

So, being the well-read and stupidly naïve patient that I am, I asked my pain specialist about Ziconotide as an alternative to my own constantly failing pain management regime. His initial response was, “It’s not approved for use in your intrathecal pump.”. This was surprising, since the documentation from 1999 and 2001 stated quite clearly that Ziconotide was approved, specifically and singularly, for the exact pump model I have implanted (a Medtronic Synchromed II-40 – Model 8637). To his credit, he did contact the Australian Medtronic people, and after a couple of weeks I was able to extract a “confirmation” through him, that it was, according to them, not approved for use in any Medtronic pumps, period.

WTF?

I was starting to get cognitive dissonance headaches, and I guess this is where most patients would give up : after all, who wants to argue with one of Australia’s leading pain specialists AND the company who made the equipment? Me, that’s who.

So I sent my specialist a copy of all the Ziconotide documentation, including the specific FDA approval document details, the followup documentation from other US medical specialists detailing the issues with management of the stuff, and so on, and requested that he forward the written information to Medtronic, and get back to me with an answer.

After another few weeks of the usual thing (you know, 24/7 pain, getting all the side-effects and none of the benefits of what was in the pump, apart from massive increase in tolerance and pain), and hearing nothing, I asked during my next appointment-slash-pump dose increase if there had been any news from Medtronic Australia. Oh yes, he said, there was.

Oh yeah…No.

Medtronic Australia’s stated position was that since Ziconotide was not approved by Australia’s regulatory authority (the Therapeutic Goods Administration) for use in patients, the approval of the FDA for the use of Ziconotide in Medtronic equipment was a moot point. When I pushed a bit harder, I found that no-one in Australia’s medical echelons is even considering Ziconotide (or any of the related conotoxins) for use in treatment of patients with chronic pain – despite the fact that the drug has been used for more than 12 years in the US, and is still classed as a first-tier analgaesic in that country!

I was really starting to see double standards everywhere I looked. So I asked what it would take to get the damn drug into a trial in Australia. I was informed that if I wanted to set up a trial of Ziconotide, I would have to front up a minimum of AUD$400,000 before anyone would show any interest in looking at its use in patients with chronic pain in Australia. No-one in the pain managment specialties were interested at this time in trialling Ziconotide, or any other conotoxin, for use as a chronic pain management option for Australian patients. (Aside : I would love to be proven wrong about this, so please feel free to comment if you are aware of any program evaluating Ziconotide or any other similar conotoxin for use in chronic pain management!)

[Additional Info]

My previous pain management specialist (perhaps one of THE most highly regarded pain specialists in Australia) talked quite a bit about conotoxins, but wasn’t prepared to discuss or explain much beyond the risks, and nothing about the benefits. Of course, this was the medical individual who harangued and insulted my wife and I in a special consultation, because I refused to allow his mentor, a real butcher of a medico, to continue treating me after failing to perform basic medical precautions during the last pump implant – a situation that I now have to have further surgery to correct.

So I’m not entirely satisfied with the willingness or compassion of the pain management people here in Australia, which is actually what prompted me to write this article in the first place. I had to redact so much it almost wasn’t worth including, but I’m feeling a bit saner now.

[End of Additional Info]

I should state here, for the record, that I would probably disqualify myself from any possible study using Ziconotide. I have too many mental health issues with depression and mild bipolar disorder for Ziconotide to be an appropriate treatment option, even given that I’m unlikely to be one of the 10% who do suffer from those particular side-effects. So it’s not really helping me, not in the long run, but I can’t imagine why so many people who should know better won’t put their money where their bank accounts are and get with the rest of the world (or at least, with the rest of the world as it was thirteen years ago).

The Bottom Line

So where does this leave us? Well, it leaves me frustrated as hell, and it leaves Australians with chronic pain problems fairly and squarely out in the cold. Unless we can get a petition or some other means of attracting attention to this dereliction of compassionate duty, we’re stuck with the same old same old – pethidine, bupivicaine, morphine, hydromorphone, fentanyl, or if you’re really lucky (like me) maybe sufentanil or remifentanil. But don’t hold your breath for anything modern, that costs money and we’re apparently not worth it.

I’d be interested to hear if anyone would consider joining me in setting up an online donation site to help fund, if nothing else, then at least Ziconotide testing here in Australia. The way I figure it, is if we have the money, we then have some control over getting a trial started, and managed properly, perhaps an ongoing cause to bring Australian medicine out of the dark ages.

The Intermetaphor

The Internet (aphorism and metaphor)

We float on an estuary, with a river below. It flows fast as light beneath, but on top, the long stories and the bold drift, accreting and learning and losing; entropy.

The bold stories, like news headlines and the latest “celebrity” pawn, can distract and entertain, but seem to teach only those who truly look. Why do they appear so quickly, only to disappear just as fast? Well, the traditional answer is to divide the approximate number of people interested solely in such information, by their average IQ (gauged from the comments threads, fair and square); multiply that by the cosmological constant (20 or so as of this writing, give or take a couple of terms I can’t remember), and divide by pie. Mmmmm, pie……… Yeah. So. Where was I? Yes. Now take that number, and bake for 25 minutes or until the crust is golden…mmmm….. pie crust……. You get the drift.

The problem with all the traditional answers (crowd reactions, attention spans, ‘virality’, and so on) treats the items of interest (ephemeral ephemera) as though they had the same information value as the long, slow stories they appear next to. That’s the problem. They don’t.

You don’t have to take my word for it. (But it helps grease the wheels, so go with me on this, OK? OK.) I’m sure there’s a study or two, peer-reviewed to within an inch of its life, retracted, redacted, resubmitted (no, this doesn’t end up with the beaureaucrats [why can I never spell buereau beareua bureaucrat that word?] of Vogon, though you can often detect their thumbprints) and published without fuss in some scholarly journal somewhere, that will confirm these gut feelings of mine. And if there isn’t, I’ll just dig around until I find one that does – that’s the beauty of the internet!

So. From my perspective, I see the same behaviour patterns repeated over and over again. The watchers of the television programmes whose presenters use words like ‘fave’, ‘have your say’, and ‘facebook us’ tend to be the watchers of the bad news, and bad news sells product, and product makers pay… huh? Where did that come from? No, no, no, no, no – it’s not that at all. That only ever worked on the telly.

What really happens is the watchers are the bearers of bad news, and that creates enthalpy, ownership, and competition. Who can bring the worst news to the largest audience the quickest? It’s not Rupert “Run from the Light” Murdoch, it’s not Reuters AAP, it’s not even slashdot or Dugg or whatever those cut-and-paste publishing things are called. It’s everyone with a mobile phone and a 3G (or better) connection and a paid-up phone plan. It’s the people who can’t distinguish between a megabyte and a microchip, or a call cap and a phone cover. (And don’t get me started on KiB and MiB! Witless marketing morons, die!).

In other words, it’s your daft uncle, your tone-deaf neighbour, your sister, your husband, your kids. And let’s face it, they can’t really be trusted to remember their mobile number, let alone who did what to whom – unless they also have crappy 120×177 iPhone “footage” of the event, and even then they can’t be relied on as eyewitnesses with a cheat sheet. These are the forces driving the glitter on the internet now. They can’t spell, they punctuate like Touretters (my apologiesFUCKto sufferers of Tourette’s SyndromeSHITeverywhere), and most often they can’t complete a sentence, let alone a coherent account of whatever news it was that happened to catch their eye and dazzle them for long enough to get their thumbs twitching. Twitter Twats, I’m looking at you.

What about the boring stuff? The *real* internet? Ah, that will have to wait for another time. It’s there, I just have to go and whip up another baby recipe to post on the Evil Atheist World Domination Headquarters…

Luckily for humankind the nerds still rule.

Drifting on the (zicono)tide

I was going to launch into a full-fledged discussion about one of the newer synthetic drugs, ziconotide (also called Prialt), but I realised I haven’t really explained about pain. Specially chronic pain. So I’m going to go into yabber mode, and explain what (very little) I know about pain, and why ziconotide is important.

Unfortunately, that means a long lecture. Probably boring too. Incredibly boring. So to minimise the possibility of your gut trying to strangle your brain to stop the insanity, I’ll try and break it down as much as possible into small, easily digested lumps of technical babble. You can then choose to chuck it back up, or learn summink. It’s entirely up to you.

Writing about this also helps me get things straight in my own mind – to make sure I really do understand about pain, and (more importantly) when pain goes wrong. So let’s get started!

Oh, the Pain!

We all kinda know nowadays that pain is transmitted by nerves to the brain, where some very fast thinking is done, and the brain then sends signals back down the nerves to take our hand off the burning kettle (or whatever it is that we’ve accidentally touched or fallen on).

That’s actually quite amazing, when you think about it. Forty or fifty years ago, people like you and I didn’t know even that much about pain (though we all become experts at trying to avoid it). I suppose unless you’re especially clumsy (like me), you don’t really experience pain often enough to want to know what the hell makes it work. And I agree knowing about it doesn’t help us avoid it all that much, and it sure as shit doesn’t make the pain less! Still.

So this kind of pain/response is called “acute pain”. It’s a stimulation of a particular nerve receptor (heat or pressure) that causes (hopefully) an instant reaction to stop the pain from continuing. As far as it goes, that’s a great adaptation of our bodies to stop bad things from getting worse.

In the late 17th and early 18th centuries, it was believed that only Man could feel pain, and that animals somehow were mechanically motivated to emulate the display of pain, but they didn’t actually “feel” pain the way we do. So some scientists performed all sorts of experiments on living animals. I won’t go into these experiments, except to say if you don’t think nailing a puppy’s paws to a wooden board and then disembowelling it and skinning it to see what made it scream in agony was a good idea, I’m with you. That neither benefited the cause of science, nor did it prove anything apart from a shocking cruelty reflected in the rest of that backward society.

On that subject : this view of “Man” as the “ultimate being” on Earth, was just one more example of what religious thinking does to normally sane and rational people. I can’t think of any good reason to conduct such an experiment, on any animal, let alone to try and prove that your disgusting religious idiocy was somehow real or true. But that’s food for another post altogether…

What about when things go wrong?

So acute pain and it’s reaction helps us avoid or minimise damage to ourselves. But there are two really interesting instances of what can go wrong with such a mechanism. One is caused by bacteria, the other – well, we just don’t know what causes that. But I’m trying like hell to find out!

When we feel no pain : Hansen’s Disease.

How many times have you wished that you couldn’t feel physical pain? I’ve lost count, personally, but it turns out that not feeling pain is far, far worse than putting up with it!

Perhaps the most extreme form of failure in the pain response system is caused by two types of tiny little bacteria, Mycobacterium leprae and Mycobacterium lepromatosis. You can kinda tell from the names what I’m going to talk about.

Now, the bacteria doesn’t directly cause the horrific and life-changing features of Hansen’s Disease (otherwise known, wrongly, as leprosy). In fact, the bacteria seem to cause nothing more than the absence of pain, which you’d think would be a pretty good deal! I won’t go into detail about how the bacteria actually do what they do, you can find excellent articles about the mechanisms for Hansen’s Disease on Wikipedia.

The problem with this disease is that it stops people from feeling pain, particularly in the extremities, like your feet and hands. Now, if all that’s happened is that you’ve barked your shin on a coffee table without breaking the skin, there’s no major cause for concern.

But if you have Hansen’s Disease and you’ve accidentally stood on a rusty nail, or cut yourself, you just won’t feel anything! Then chances are good that you’re going to not treat the wound, and that’s when infection sets in. That’s what the problem is with leprosy – it’s not the bacterial disease per se, it’s the result of not noticing that you’ve cut/stabbed/broken/torn yourself, and not taking action to fix the problem, allowing all kinds of other bacteria to get under your skin and in your bloodstream. That’s why leprosy is almost always fatal.

Of course, with the advent of modern antibiotics, Hansen’s Disease could be kept in check almost indefinitely, allowing the sufferers to at least live a reasonable life. But the penalty, even with the antibiotics, is that as sufferer has to continually scan their body for the slightest sign of cuts or abrasions, or worse. This used to be called VSE (visual self examination), and it was a huge drain on your energy and intellect. Imagine having to stop and scan your hands (front, back, in between the fingers, under the fingernails) and feet (top, sole, ankles, shins) – every 20 seconds or so!

So there’s an unfortunate example of what the pain response can help us avoid, by alerting us to the potential for infection or worse, blood loss, bone damage, and so on.

When the Pain Won’t Go Away

On the other side of the scale is what is now called chronic or neuropathic pain.

This seems to be triggered by a major (or minor!) injury, that the nerves for some reason can’t stop sending pain signals for. At the time of injury, the pain was useful for telling your brain that something was wrong somewhere. But, whether you were unable to get treatment for the injury, or if you got treatment, the pain receptors just keep on firing, telling your brain the injury is still there. It’s similar to amputees’ reports of “phantom limbs”. Some amputees can still “feel” their missing arms or legs, or feel itching, or tingling, in fingers or toes that don’t exist any more.

Chronic or neuropathic pain, however, involves much more than just the peripheral pain receptors. It’s now known beyond doubt that long-term receptor firing can cause the whole chain of pain transmission to go “askew”, from the receptors in the skin or muscle, to the pain fibres themselves, to the inter-synaptic gaps and the chemicals that take part in pain signalling, right up past the spinal cord and into the brain.

Worse, as the constant receptor signalling “ratchets up” the amount of pain signalling, the body responds by activating more and more pain transmission channels, and even lowers the threshold of pain, in an awful and unstoppable spiral.

That’s what I’m going to talk about next. That’s what’s happened to me, and that’s why I want to find a way to stop and/or reverse the problem. I know it’s possible to stop the spiral, because every now and then it happens, for a minute, or an hour, or sometimes even a whole day, so there’s something involved that all the so-called “pain specialists” on the planet are missing. Probably because none of them ever felt such pain, but that could just be my bitter take on their inadequacy.

How Pain Works

This is going to get technical. Enjoy the ride!

No Place to Hide?

So here’s my question for tonight : Where does your subconscious go to play when your dreams become logical?

It seems that a certain ennui has slid in on a silent tide. While I wasn’t watching, focusing on keeping sane and civil to people who only just barely deserve that respect (they sure as shit haven’t earned it yet!), it would appear that my mind has made up it’s mind on the matter.

Today was another tiny pebble in the gelid avalanche of self-centred mistakes that’s been rolling down the hill in SuperSloMotion™. Maybe that’s what’s set off the klaxon in there – I know it pissed me off no end to find that the pain management specialist I was relying on to update the intrathecal analgaesic “forgot” to remember to order the sufentanil, as we discussed mano-a-mano six weeks ago. So instead, he switched to not-thinking-mode and ordered a big ol’ batch of pethedine, a substance that’s not only 8,000 times less potent than the sufenta, but that I’ve told him repeatedly (and nicely – is that my problem?) does. not. work. for. my. pain. management. Period.

It didn’t help that, when I mentioned waiting for six weeks to get this appointment (the six week figure was what his secretary informed me her pet specialist was taking – as a break to “refresh and revitalise” – when I made this appointment six weeks ago to the day), the specialist looked surprised and informed us that he’d only taken just over 2 weeks off, and never intended to have six weeks! So there I was, looking stupid and whiny. After all, if I could wait 4 weeks after he returned from his six-week (oops, sorry, two-week) break, I couldn’t possibly have a medical condition worthy of his time, could I?

There’s four weeks of hell and more that I really could have done without. Thanks, secretary, for making sure your pet pain specialist didn’t have nasty needy patients interfering with his day job. I guess that’s another two pebbles in the landslide, huh?

Not that it bothered Jan or Barry. They don’t have a clue what their patients are going through. At least, not in a way that makes a difference to the aforesaid patients.

Is it wrong for me to wish my pain on their spines, for a day, a week, a month, a year? No, but it’s wishful thinking. Ah well.

No, I’m not making this shit up.

I know my Wingless Angel is frustrated for and by me… She’s frustrated for me because she knows I’m not making this shit up, and she can see the self-centred “I couldn’t give a Sprague-Dawley rat’s arse” attitude on people we trust NOT to have that perspective, and I don’t blame her for that. I should have shouted and made a “scene”, which would have got an answer much quicker, I suppose.

And she’s frustrated by me, because she doesn’t truly understand that if I let that particular genie out of the bottle, I’d have a lot of trouble getting it back in. Suppressing? You betcha. It’s the only tool I have left to deal with these people.

See, the problem is, the avalanche metaphor is understated if anything. So if I rage and spit and scream at these two nincompoops, I’d have to rage and spit and scream at everyone who make our lives that much more difficult. e.g.

• The Pharmacist who closes up shop an hour early every now and then, so customers have to wait another day to pick up their prescriptions, and who never works Saturdays or Sundays because he doesn’t make enough money.
• Or The Other Secretary, who sends out “thank you for paying” notes instead of receipts, so patients can’t claim the incredibly high fees billed by Messrs. Muir and Courtney (yeah, The Butcher), and who then refuses to answer the phone, and then deletes all her messages at the end of the day, whether she’s answered them or not.
• Or both New and Old Secretaries, who can’t get their acts together to send patient histories to the referred specialist, because the Old One can’t be bothered to do the legal thing, and the New One just can’t be bothered to remember to call the Old One because she’s a nasty, bitter old lady.
• Or the Old Friend who can’t be fagged responding to emails, because he’s promised something he’d rather not keep – after all, he does live more than 40 minutes away by supercar.
• Or the Morally Upright Eldest Daughter, who stridently demanded (and cunningly sought) to attend family functions, after her ex-husband’s sexual predations (and her tacit knowledge of those predations) were outed by his victims, all related to her. Unfortunately, while those victims are free to attend those fun-filled family get-togethers, that’s not likely to happen, because the  Eldest Daughter now lives “in sin” with, and insists on bringing along to those family functions, her current sex partner – who is her ex-husband’s  identical twin brother. Creepy or what?
• Or the Confused Grandmother, who much prefers to sit down and chat and laugh with the Eldest Daughter and the paedophile’s identical twin brother, instead of with her psychologically devastated grandchildren. That really makes it difficult to keep the genie in the bottle, doesn’t it?

I did tell you I wasn’t making this stuff up.

No, I’d just have to yell at all of these morons. And you know, with the monkey on my back, the tinnitus that’s now past the point where I can’t hear the rain any more – or cicadas (which is actually a bonus), the non-working intrathecal pump that The Butcher misplaced so it’s now sliding down into my armpit, the incredibly useful neural stimulator that’s unbelievably painful to recharge, the customer work that I can’t begin to start until my pain management improves (and that I can’t give to anyone else because no-one else wants to do that kind of work any more), I just can’t raise the energy.

Perhaps that’s why my dreams are losing their oomph. Or – and this is just a guess – it could be because I’m once again coming off an opiate that doesn’t really work. Mind you, I’ll start taking it again, because it’s better than a poke in the eye with a burnt stick. And then I’ll stop again, because the world crashes in on me when I get those Opioid Blues…

So later today (it’s quarter to five am again) I’ll snatch a couple of hours’ exhausted sleep, then with a cup of coffee and four or five dextropropoxyphene tabs and a couple of hydromorphone slow release nuggets easing the physical pain, and the duloxetine and my own constitution masking the mental fry-up, I’ll try rewinding my Gauss gun coil and see if I can get my kilojoule of energy into the projectile so I can flog the damn thing to the army.

Should be a good day! Better than the last few, anyway! Onward and upwards!

Keep your head above water – and don’t forget to breathe. – Rob Thomas

On the Shoulders of Giants…

… You can see forever!

Let’s talk about fusion, not metaphorically, but as a detailed look at exactly what made us and how it happened!

Look! A new Star!

On the 24th of August, 2011, the team at the Palomar Transient Factory discovered a brand-new supernova : PTF11kly, in the M101 galaxy, around 22 million light-years from Earth.

Here’s an animated GIF image, created by Thunderf00t, who photographed the before and after with his own equipment. You can see a beautiful rendition of what he saw and what it means on YouTube.

It’s now been confirmed that before the supernova (SN), at the same point in space there was a very, very difficult to see binary system – a white dwarf (much like what our sun – Sol – will turn into in a few billion years) orbiting a darker, colder companion star.

It seems that the white dwarf was ‘sucking’ ionised gases from its companion star, and probably has done for a few million years. All this extra ‘fuel’ finally allowed the white dwarf to begin converting the new fuel into carbon isotopes, before finally collapsing and expanding in a cataclysmic event.

How cool is that?

What’s a supernova?

OK, let’s go back to basics.

Most main sequence stars (like Sol) fuse (or ‘burn’ as it’s inaccurately known) hydrogen to form helium.

The fusion happens because all those trillions of tonnes of hydrogen gas gets squeezed together under the weight of it’s own gravity, until hydrogen nuclei (one proton plus one electron) get squished together so hard that they form helium – 2 protons and 2 electrons. This releases more energy than it takes to do the fusing – and the star starts to shine.

If you’d like details, see the end of this post, where I show the actual reactions taking place. For those of us more visually inclined, here’s a diagram of the first stage of the fusion process :

It can happen in a few seconds, literally – before there was a huge gob of hydrogen in a massive ball, getting smaller and smaller and smaller (this can take billions of years). Then all of a sudden, two nuclei are fused, which releases energy so that another two nuclei are fused, then another  pair, and another and another and another and voilá : you gotta sun!

Now, all that extra energy can’t just sit there, it has to go somewhere, so it eventually finds its way out to the surface of the newly-formed star – as light. And solar particles, and neutrinos, and a bunch of other weird and wonderful little strange things. But mainly energy, which emerges and is seen by us as light.

This light exerts an outwards pressure on all the nuclei between the fusion in the centre and the outside – which is why the big ball of gas doesn’t just explode instantaneously, fusing all the hydrogen in one vast destructive bang. So the fusion pressure balances the gravitational squeezing pressure just so – and this can last from a few million years (for really big motherfucker stars, like Betelgeuse started out as) to a few billion years (like Sol).

The Bigger They Are…

Most “typical” stars fuse hydrogen into helium for a few billion years, until the hydrogen is all used up. Then, since the energy output drops, the star begins to compress again under its own gravity, until the pressure and temperature rise enough to initiate helium fusion. This is stage two.

The helium fusion begins to create some heavier elements (Lithium, Beryllium, Boron, Carbon, Nitrogen, and our favourite, Oxygen).

But you can’t fuse these metals to make energy… can you?

Well, it turns out that you can. But it takes a LOT more effort than just fusing hydrogen!

Little Bang

For stars like Sol, hydrogen fusion is pretty much the only thing it can do really well. It’s just not big enough or badass enough to fuse metals, at least not in a useful way. So eventually, the Sun will start to bloat – expand – enlarge – giganticise, until the force of the internal reactions (by this stage, all the hydrogen’s used up and so is most of the helium)  suddenly stops dead – and the huge, bloated outer perimeter of the Sun (which will end up somewhere between us and Mars) will suddenly realise there’s no more pressure forcing them outwards, and will collapse suddenly (taking maybe a few minutes tops!), and rebound outwards in a massive explosion, called a nova.

After the nova, the guts of the Sun will be a tiny, white dwarf, hundreds of times smaller than it is now, burning helium to sustain itself, until the helium runs out and the star finally dies down to a banked ember of what it formerly was – a brown dwarf. Then, a few more billion years later, the light will go out forever.

Ohhhhhh. Isn’t that sad – the death of a star? What an opera could be made of this!

But for bigger, badder stars – stars more than about 30 times the mass of the Sun – there’s a much, much more spectacular end in store.

Big Badda Boom!

So you’re a massive star, let’s say. You were originally composed of hydrogen, helium, and the metals created by smaller stars; but you’re so big, and so bad, that even when you run out of hydrogen, and then helium,  even the ashes you’ve created – the lithium, beryllium, boron, and so on – will start to fall towards the centre, compressing and heating up as they go.

In fact, the gravity is now so strong (remember, we’re now talking about quite large nuclei, much bigger than hydrogen and helium, squishing into roughly the same amount of space as before) that these new metallic elements begin to fuse together, again releasing energy!

It would be like running out of petrol in your car, and being able to fill the tank with sand and still run the engine – although the exhaust would be much worse than carbon monoxide and water vapour – it would be metal particles and more.

So the process continues, fusing heavier and heavier elements, running out of the lighter elements, expanding then recompressing under gravity, until finally, the temperatures and pressures are high enough to create iron. And this is the end of the road for you, because after iron, creating heavier elements requires monumentally more energy (instead of releasing energy, as fusion has done up until now).

Now you’ve got the ingredients for some of the biggest explosions in the modern universe : a SUPERnova!

A supernova is to a nova, what an atomic bomb is to a firecracker. We’re talking major destruction here. But even in the destruction of these massive stars, something fantastic happens…

Not only are all the remnants of the elements created as fusion’s by-product scattered out into space (where they can form clouds and eventually planets!), but the force of the explosion itself creates heavier elements – gold, lead, tin, copper, all the stuff we take for granted.

In fact, you can even see the process happening – right in the middle of the Eagle nebula. You may have seen these images before, but hopefully now they make more sense…

So that’s how all the elements you see around you – rocks, trees, bumblebees, your moronic brother-in-law, the oceans’ water, your wedding ring, your teeth – are created from the simplest thing of all – hydrogen atoms.

I use the word cool a lot, but to me, that’s the coolest thing of all.

And there’s no need to talk about Gods, or invisible creators, or intelligent design, or any of that bronze-age mumbo jumbo. It just happened this way, and we’ve been smart enough to figure it out without outside help. Now THAT’s cool!

I hope you enjoyed this little explanation.

The Equations :

The equations aren’t really that frightening, and we’ll break them down step-by-step. If you remember any chemistry at all from high school, it will be a piece of cake!

Stage One : Hydrogen to Helium

First, two hydrogen nuclei (which are really just a proton with an electron) fuse together to form deuterium (H2), with a positron (e⁺) and an electron neutrino (ν) released :

H¹ + H¹→H² + e⁺ + ν

So far, so good – we have deuterium (which is still hydrogen!) plus some “bits” ejected. There’s not a lot of energy made, as the positron hasn’t reacted with anything yet, and the neutrino doesn’t really react with anything at all!

Now, the deuterium nucleus that was just formed fuses with a single hydrogen nucleus to form Helium3, and emits a gamma ray (γ). Now, a gamma ray is (as you may have heard) a pretty nasty little doohickey. It’s basically a proton with a LOT of energy – enough to pass through lead! So there’s the first bit of real energy available.

H² + H¹→He³ + γ

Finally, as the last part of this stage of fusion, two He3 nuclei fuse to create a helium nucleus, plus two hydrogen nuclei :

He³ + He³→He⁴ + 2 H¹

The hydrogen nuclei then become available for further reactions, sustaining the fusion process and emitting gamma rays, positrons, and electron neutrinos like there was no tomorrow.

But that’s not the end of things. Not by a long shot!

Stage Two : Helium to Lithium and Beryllium

Stage Three : Li and Be to Boron

Phase Two : Making Us

Now the star is creating an enormous amount of energy and heavier nuclei. This allows the creation of even more useful things, like Carbon, Oxygen, and Nitrogen

Fusion = Beauty!

Bearded Sky Faeries and the real world

Sitting again on the balcony the other morning, I realised that Carl Sagan and Brian Cox were absolutely right. Fusion is everything.

Here’s an example of what I mean :

Hydrogen fusion, seen from about 149,597,870.691 kilometres away

And here’s what can happen when hydrogen fusion is allowed to continue for a few billion years undisturbed :

Acorn in the sun - fusion at its best

Ok, it’s cheesy, but at least it’s true – and there’s not a bearded sky faery in sight. (There never is!)

So what’s the point of all this rambling?

Morons, Retards, and Nitwits, Oh My!

Well, I’ve recently come away from a banal (and heartbreakingly pointless) “discussion” on Thunderf00t’s latest YouTube posting – you can see it here – with a number of religious chumps. ‘Canon Fodder’, I call ’em… heh heh heh.

For an achingly beautiful video soliloquy on just how bloody marvellous the universe is and how lucky we all are (by a hard-nosed, dyed-in-the-wool experimental physicist, no less!) the most common complaint was that he “forgot” to mention god.

He forgot to mention god? I mean, how moronically retarded do you have to be to ignore the wonder and beauty and strangeness around and within us, and need to posit a vague, invisible, impossible “being” who must have “created” all of this – and you and I and yes, even the morons who believe in this mentally-defective rubbish?

If it's good enough for the goose...

And from there, the “discussion” degenerated into one ineffable chap bashing the scientist for not keeping his emotions in check! What the…?

I Believe In… Reality!

'Nuff said...

The final straw was laid by some sad, unlearned cab driver, who stated that “It must have been god”… not because there was any evidence for that assertion (there never is and never will be), but because he (the cab driver, not the unknowable invisible friend of his) “didn’t believe in evolution”!

I tried (with utterly zero success, which I guess I knew at the start) to get the point across that it wasn’t actually necessary for him to believe in evolution, any more than it was necessary to believe in breathing – if it hadn’t happened, he’d still be a cloud of foul-smelling steam hovering over a wasted, barren planet!

But it’s no use arguing with these sad and pathetic people, because a) they’re intellectually incapable of understanding how the universe truly works, and b) they can’t be taught – by anyone.

Well, they can quite obviously be “taught” something – by a priest. (And we all know what priests teach, don’t we?) But they can’t actually be taught by someone who’s actually qualified to teach them things (you and I call these rare people teachers!). I mean, that’s like going to a hairdresser to learn how to drive a truck! (OK, it might be cheaper than getting driving lessons, and it’s probably way less difficult than actually climbing into the cab of a training rig, but you ain’t gonna actually know how to drive an 18-wheeler on a public highway!)

So – why is it OK to do the same thing with your mind – your only tool for understanding the universe? Answer : It’s not OK!

Oh, God, Please Don’t Kill Me!

It’s just so heartbreaking to think that there are human beings who refuse to accept reality, and instead substitute some type of bizarre and fantastical (and usually homophobic) “all powerful” entity – with no actual proof of existence, power, or any other attribute, by the way – who they vainly and sadly hope will one day cause them, personally, to magically avoid the reality of entropy, and somehow live forever!

It would be funny if they knew what they were wishing for. But they don’t – they haven’t got a damn clue. And they seem to be (but aren’t ever) happy about their ignorance! So they cling vainly to made-up invisible sky faeries in the hope that… what?

So the atoms they’re only borrowing for a short while won’t go on to become a new star system? So the energy that the universe has lent them – at enormous cost per individual, by the way – doesn’t become part of a new galaxy, or a new race of beings, or a new pulsar?

Why on earth would you wish to not be part of the astonishing future of the universe? How closed, how self-centred, how selfish, how stupid, how mean, how unbalanced do you have to be to want to not be part of what you’re inevitably going to become?

I mean, you can want to fly until you’re blue in the face; but unless you’re in some kind of aerodynamic craft, the only flying you’re going to do is between the top of the cliff and the top of the rocks at the bottom of the cliff! Gravity rules! It’s the law!

Gravity - more than a theory!

What sort of hearts and minds do religious people have, that they’re so greedy for life they’ll abuse, ignore, pity, or even kill someone else simply because they don’t agree with their bizarre fantasy?

These kinds of folks are not religious “fanatics”. They’re not even “moderates”.

They’re childish, selfish, pathetically sad reality deniers.

And praise the lord I’m not one of them! (I love playing with their tiny minds!)

Imaginary Friends - who needs 'em?

Hindsight (New version)

“Hindsight” was originally written in late 1995, in a horrid little hotel in Seoul. It’s been redrafted three or four times, to polish out most of the shit. While it started out quite dark, it turned out to be a positive expression, which surprised the hell out of me!

I was about three-quarters of the way through an important training trip, but it was becoming horribly obvious that my selection of trainer, subject, and material had backfired badly. Audience feedback was shockingly bad, particularly because I hadn’t verified the freelance trainer knew her subject – so she was just wasting everyone’s time. And that meant that I was wasting everyone’s time too.

I was also getting in trouble at every airport due to the metal construct in my back, and I had to carry with me all my painkillers – 36 boxes of morphine ampoules and tablets that had to be explained, in detail, to customs. Even with medical letters of support, travelling wasn’t particularly easy for me. It was also less than 4 years since the fusion, and I was in incredible difficulty managing to keep to schedule and meet and greet in each country – schmoozing was mandatory in the business, and I wasn’t yet anything like a good schmoozer!

On top of that, it was winter (which I usually enjoy to the max) – but instead of going out to the countryside in each location, our schedule was so tight, all I could see was what was between the airports and the hotels! And if you know anything about urban planning, they don’t tend to make the landscape between the airport and the cities particularly interesting. It was sad-looking ice and dirty snowdrifts everywhere. For those who love The Lord Of The Rings, it was much like what Frodo and Sam saw in the Gladden Fields. Except for the bodies… (Well, I didn’t actually see any bodies…)

Speaking of which, it never even occurred to me that the metre and rhythm of this poem is identical to J.R.R. Tolkien’s wonderful poem, “The Chant of Ëarendil”, from LTR. You know, the one that starts off…. Ëarendil was a mariner/ that tarried in Avernien/ and built a boat of timber felled/ in Nimbrethil to journey in…. Seems John did get into my DNA after all!

The hotel (like most of the mid- to lower-end hotels my employer chose for me) was a-clutter with chintzy, garish gilded lamps and ever-so-slightly-frayed curtains and wallpaper. Although I’ve never been to one, I imagine a Collingwood whorehouse would look a lot like these hotels!

At the same time, there was a huge amount of political bullshit going on on the international stage, and that’s what I absorbed each night before crashing into a “fitful, haunted sleep”…

And on top of it all, this was the very first time I’d been away from my Angel. Homesick? You betcha! But as you’ll see, I did manage to keep a sense of perspective.

I hope you enjoy this as much as I enjoyed getting it out!

Naturally, this material is copyright (C) Me. No part of this material may be copied, reproduced, or used in any manner whatsoever without my express written permission. I know it’s a wank, but I have to say it…

Hindsight

What bends and twists and torturous loops we push our tired bodies through!
We grasp and grab at visions which (while not quite strictly true)
at least feed the daemons we release – but time and time again we fall
through plastic phrases, instant feelings, someone else’s beck and call.A star is lost! A guiding star has fallen from the firmament!
Until we see it wasn’t what we thought we said we felt we meant.
A painted dot, an icon (gilded) burnished in the dark –
and, vanished from our dimming eyes, we see the frame – skeletal; stark.

A fleshy face, a rosy glow is all we need to drape what’s not
really there; yet still we grieve for innocence. A dream of what
we dreamed in youth is hued with passion’s marvelous red.
But still remains this day; this life; this dawn, this unmade bed.

A passion play, where actors’ bones must bend and break
in synchrony with heartbeat’s ceaseless count of days. We try to make
the story real, while life whisks past (a carousel of neon light)
as lies and lessons learn themselves – and feed our souls with dark and light.

The wind rakes leaves from Autumn’s arms; the ghostly branches, naked, stand
against the whitewash of the moon, against the limning of the land.
Silhouettes of sparkling flame in tarnished mirrors redly burn;
but give no warmth. My love, projected in the dark, does not return.

I dared to dream, and dreaming, found a new perception of the maze
in which we run our ratty lives. And, though the days
of wine and roses (fake, of course) are all but gone, their truth is smoke:
at least the magic stayed with me, and having magic, my blood spoke.

A gritty lesson’s buried there – perceived as truth, the point is taught
that, while our hopes and dreams survive, the fire never burned for naught.
For while I dreamed, a glittering star arose, and showered silver bright;
and though the ashes fall to earth as cold, grey dust – my heart is light.

Never Give Up – Never Surrender!

Musing…

So I’m sitting in the warm afternoon sunlight, watching the world go by from my perch on the balcony, knocking back a couple of milligrams of dextropropoxyphene and caffeine, and almost starting to feel good about things! Why?

I dunno… Could it be the opiate receptor response? Probably!

Maybe it’s because the Mounties finally decided to catch their man (after more than two decades of doing nothing).

Or, perhaps it’s because I’ve found an outlet (however limited) for some of my physics knowledge, helping to answer questions on Professor Brian Cox’s Facebook page (and asking some of my own, since there are so many wonderful physics specialists there, even if they need pushing to answer the tough [i.e. extremely simple] questions!). I love to do that because in answering someone else’s question, it really makes you think about the exact details and how to explain it so that someone else will understand a little bit better, and that’s always a great workout for the mind!

Or it could be just that my Angel said the nicest thing anyone’s ever said to me. She was burrowing through the piles of paperwork still unsorted (it’s only a year since we moved, give us a break!), and she found – and read – some of my poems. Not the one I won the punch bowl for, that was done and dusted and finished when Heather (another patient I met with opiate tolerance problems) died.

No, she found “The Craftsman”, “Songs of War”, “Hindsight” (the new version), and “If I Could Take the Sky” (which was always about Fran), and she read them again for the first time in years.

I didn’t even know she’d found them. All I heard was her saying quietly as she kissed my (infinitely small) bald spot, “You should write poetry professionally”…

Instantly, the tiny traitor in my mind started showering me with excuses and refutations, but I kept them to myself and thanked her, but she was already gone to finish the paperwork…

After sleeping on it, I figure, what the hell… I can’t finish the customer recording repairs I’ve got until I replace the blown-up computer system, and I’m not going to be able to even think about the possibility of allowing the thought to even cross my mind (let alone actually fix the issue) while I’m on the disability pension, and I’m not working at the moment while the various ‘borg bits get healed over. So why the hell not update and start writing again in the meantime?

Since I only have paper copies in my archives (thanks so much, 3Ware, for your shitty RAID controllers), I’ll post what I’ve got later this week.

Meanwhile, I need to work on a score for “The Craftsman”, probably using David McWilliams’ “The Days Of Pearly Spence” as a jumping-off point. After all, it’s his bloody fault I wrote the damn thing in the same metre and rhythm as his epic song! He owes me big time. How dare he write a song that enters my DNA when I’m just 12?

To the Keyboard! Prontissimo!