Obviously Clever

The fact that we can put fluids into people via IV saves more lives than I can actually communicate. There are so, so many more ways to die when we can't do that. You can go from literally at death's door from an illness you have no other cure for, to Basically Fine, You'll Feel Icky A Bit Longer But You're Otherwise Fine and Your Own Immune System Will Work Now, from sterile saline into a vein.

Or even fucking subcutaneous, under your skin. It still gets into your system faster and bypasses any fuckery going on in your gi-tract.

But you want the other end?

I recently got the answer to a crapload of symptoms of mine and it turned out to be Crohn's. Ileal crohn's.

For most of human history there was literally nothing to do about this but hope and pray that your immune system didn't decide to rip ulcers and lesions in your digestive tract to the point where you bled out, or the point where parts of it died and killed you with sepsis, or enough to build up stricture bands of scar tissue sufficiently to cause impactions or any other really gnarly and unpleasant ways you can die because for some reason your body decides the walls of your digestive tract are the enemy and need to be dismantled cell by cell. (Including a fuckload of cancers caused by the constant damage to the cell wall.)

Even as recently as when most of the younger people reading this were small children, mostly all you could do about it was take corticosteroids when you were in a flare. And that was better than Nothing. But at the same time, corticosteroids have a potential laundry list of side effects and you want to take them as little as possible and for as brief a period as possible. And there wasn't a lot else.

I am on a medication with the proprietary name "Skyrizi" and the generic name risankizumab. It's made from taking antibodies from a non-human source and then modifying their protein sequences to be more similar to human antibodies, after which they modify them further in order to make it so that the literal only thing they do is go into my body and bind to something called "tumour necrosis factor" so that this will stop flagging my own goddamn digestive system walls for destruction by the rest of the immune system.

Please feel free to read that paragraph over again.

There used to be a common, horrific illness that sailors would get, which was mysteriously cured by limes. People know about this one, it's scurvy. But there are other horrible ways to be sick from vitamin deficiency that weren't considered curable at all, and people had no idea what caused them.

Rickets is a disease caused by vitamin D deficiency where your bones get bendy and grow in the wrong shape (it is most apparent in children). It causes permanent deformity and very easy fractures, along with debilitating pain and persistent dental issues. Historically, it was known that milk, and later, cod liver oil, would improve or prevent it, but the reason was not understood until the vitamin was discovered.

Wernicke-Korsakoff syndrome is a complication of alcoholism that leads to psychosis, dementia, and death if left untreated. Severe alcoholics used to just go completely mad before dying, basically. It ultimately results in permanent memory loss (retrograde amnesia), as well as the inability to form new memories (anterograde amnesia). It is caused by the fact that alcohol prevents the absorption of vitamin B1 (thiamine). It is treatable and preventable by giving the patient thiamine shots - if caught early, before permanent brain damage has occurred, it is fully reversible, although the underlying substance abuse issue still needs to be addressed to prevent recurrence.

Pernicious anemia is caused by vitamin B12 deficiency (in turn ultimately caused by an autoimmune issue causing poor absorption). It causes blood cells to be the wrong size and too few in number, resulting in dizziness and fatigue. It also causes neurological symptoms like tingling in the extremities, poor coordination, confusion, and, in late stages, dementia. There was no cure for pernicious anemia in the past. People would simply become anemic and die from it. That's why it's called "pernicious" - that's an old-fashioned way to say "insidious and deadly," named for its slow onset and then-incurable course. Now it is curable with vitamin tablets or periodic injections.

Cretinism, or, less stigmatizingly, congenital hypothyroidism due to iodine deficiency, is a developmental disorder caused by the inability of the thyroid gland to function properly without sufficient iodine. it causes short stature, intellectual disability, infertility, hair loss, and a large lump in the neck known as a goiter (i.e. a hypertrophic thyroid gland). It was historically associated with poor inland populations living far from the ocean (due to the protective effect of consuming seafood, which is naturally high in iodine). We now simply put iodine in table salt, and this disorder is virtually unheard of in regions where this is the case.

Neural tube defects are a leading cause of birth defects, infant mortality, and stillbirth. The most common nonlethal forms of neural tube defects include spina bifida, hydranencephaly, and encephalocele. These defects are caused by a failure of the embryonic structure that becomes the spinal canal to close properly during development, leading the central nervous system to have a distorted shape that may impair cerebrospinal fluid drainage and put pressure on the brain. In severe cases, e.g. anencephaly, the brain/spine essentially develop outside of the body, which is not compatible with life (anencephalic and iniencephalic babies typically die within hours or days; fetuses with more severe forms are usually stillborn if they are not terminated). The risk of these defects is drastically reduced by taking supplemental folic acid (vitamin B9).

Vitamin K is perhaps the most amazing one on this list. Newborns often have very low vitamin K levels due to the fact that it does not cross the placental barrier easily and is not found in high levels in breast milk. It is only produced by gut bacteria, which babies do not have when they are born, and it takes time for them to acquire the right flora from their environment. Deficiency impairs blood clotting, and in infants, can lead to brain bleeds and sudden, unexplained death. Tiny babies would simply die of brain hemorrhaging for no good reason at all. But if they're given a quick shot of vitamin K at birth, that doesn't happen.

band portraits, 2004. art by Gerard.

I'm autistic and just texted my overnight carer that I couldn't sleep anymore and would like to get up. I was led into the bathroom by her and she helped me there. I was then led into the kitchen, she made me tea and now, while I'm drinking from my dysphagia cup, she watches every sip in case I choke. I can't drink unsupervised.

After that she'll help me go to the bathroom again and help me shower, brush my teeth, etc.

I needed help with this all my life and what I can and can't do is really good and a lot of progress, actually. There was a time when I couldn't hold the shower head and needed someone to fully shower me, for example. Now I at least can wash myself in the shower with prompts.