Cannabis-based medicine: a personal (UK) perspective

On July 17, 2021, something very wonderful and special arrived at our address in England: cannabis-based medicine prescribed by an English doctor. 

I published an article about what this delivery meant to us, over on Medium: Prescription cannabis and quality of life: a case study from the UK. 

Based on Medium's statistics, this could be the most widely-read article that I have written since I retired in 2019. Here's a quote:

"after four days of taking the capsules my wife was better in nine out of 14 ways, meaning there were improvements in, or reduction of, nine of the 14 symptoms...after seven days of cannabis-based medication, Chey is now enjoying improvement in 13 out of 14 areas."

What's so special about this UK cannabis? 

Friends and family will know that our household is no stranger to medical cannabis; Chey began exploring its potential to ease her pain and suffering even before we moved to California in 2011 and she received her medical marijuana card.

After considerable trial and error with different cannabis formulations—some of which she made herself—Chey found what worked for her: capsules containing a mix of the two main cannabis compounds, THC and CBD.

And when I say "worked for her," I mean: did such a great job of addressing her chronic musko-skeletal pain that she went from taking 140mg of morphine a day to zero, nought, none. She used cannabis to end years of heavy opioid use. Cannabis also put an end to years of nasty and unpleasant opioid side effects, not to mention recurrent medical harassment by doctors who accused her of being a drug addict.

When we decided to move from California to England in 2019 to be near my mum, who is now in her nineties, we knew that the Conservative government had changed the legal status of cannabis medications in 2018 to make them more accessible. What we didn't know until we got here is that the government's actions were in reality far less helpful than they sounded (a hallmark of Britain's Conservative governments for the last decade or so).

Three years on, this is still the case, with only a handful of Brits actually getting cannabis prescribed by the National Health Service. The result is that an estimated 1.4 million people in the UK are still using cannabis illegally for medical reasons. 

At the same time, a few thousand people in the UK have managed to navigate "the private option" in which you pay a special doctor at a special clinic to examine your case and legally write you a prescription. (I have described the process in this Medium article: Getting prescription cannabis meds in the UK legally: a beginner’s guide.)

When Chey's supply of California-sourced cannabis meds ran out, and her health got worse and worse, we decided to try the UK's pricey private option. This required many phone calls and emails, took many stressful weeks, and of course involved paying consultation fees and product costs. Not ideal for someone who is suffering multiple symptoms that are seriously eroding their quality of life.

Eventually, and very thankfully, we achieved the transformative delivery that happened in July. Since then Chey has been able to get her dose adjusted and her prescription renewed. Yet this is bad news as well as good news; it's good news for Chey, but bad news for millions of Brits who cannot afford to get cannabis through this process. This is clearly wrong.

Frankly, I fail to see how the UK's convoluted and deeply unethical three-tier approach to cannabis medication can continue in the face of mounting protests and outrage. Most Brits are repulsed by the current a situation in which "the rich get high quality cannabis meds, the poor do not, unless they take their chances breaking their law."

Fortunately, there are plenty of groups working to change this. I have included some here, along with some relevant articles:
Clearly, the absurdity of the current status of cannabis-based medicine in the UK is well understood in some circles. What is needed now is to spread that understanding and ensure that it reaches all corners of power and governance in the country. An enlightened approach to cannabis, led from the top, would enable huge improvements in quality of life for millions of people as well as generate jobs and wealth. Consider the manifold benefits of a blended model in which:

a. recreational use of cannabis becomes a revenue stream for UK companies (growers processors, dispensaries), employees of those companies, and of course the UK treasury, much akin to the alcoholic beverage industry today, and

b. the national health system provides affordable medicinal cannabis prescriptions to people in the UK who need them and thereby: reduces use of addictive opioids, treats conditions such as depression, anxiety, ME/CFS and Long Covid; potentially eliminates some conditions, such as childhood epilepsy; and generally improves quality of life for millions. 

There are no legitimate barriers to the UK adopting this model and becoming a world leader in responsible cannabis production, research, and medicine. I would certainly vote for this, and I have no interest in consuming cannabis myself. 

[Disclaimer: future changes to my health may create a personal interest in taking cannabis for medical purposes, but in the past I tried recreational use of cannabis and did not enjoy it.]

Finally...

If you are writing about cannabis-based medicines, I have a request and a free offer. The request is that you use the more accurate terms "cannabis-based medicine" or "medicinal cannabis," and avoid using "medical marijuana." The latter is now widely considered to be inaccurate, confusing, and potentially inflammatory or prejudicial.

The free offer is a high resolution version of the public domain image below, created by me for anyone who is illustrating articles, brochures, blog posts, etc. about cannabis-based medicine. This image makes a welcome change from overused and grossly misleading graphics using smoke-shrouded foliage. Free to download from UnSplash using this URL: https://unsplash.com/photos/qzD_H7-Jcj4.


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Missing links and images

Like their creators, websites age over time, and sometimes they forget things, like where a particular image or document is located. This page is an attempt to provided some of the things that have gone missing on the various Cobb websites, starting with a link to my master's dissertation:.

*Getting to know CISOs: Challenging assumptions about closing the cybersecurity skills gap, a Security and Risk Management master's degree dissertation (pdf).

*The Rock Throwing GIF: I made this to make a point and you are free to use it as well.

With many thanks to readers who have taken the time to use my Contact page to let me know of missing links and pages.

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Classic Glass Photography: pursuing a hobby during lockdown

I'm into classic glass photography. That's using lenses from old 35mm film cameras to take pictures with modern digital cameras (for example, the Minolta lens on my Olympus camera shown here). 

I will write more about my hobby here on this blog. Here are some articles on classic glass:

BTW, if you have old 35mm SLR camera lenses around you might want to use them like this, or sell them on eBay. I get the impression that some old lenses are now fetching decent prices if they are in good condition.
 
(Just FYI, this blog post is being used as a test. I want to see if the image of my camera—shown above—appears automatically when I tweet the page.)

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Can you tell us a bit about how you grew up? The power of your story, in a time of change

This month I took part in a slightly unusual interview. The interviewer was from a publication called Authority and the interview was carried out entirely via email, but that's not the unusual bit. The title of this interview was: 5 Things You Need To Know To Optimize Your Company’s Approach to Data Privacy and Cybersecurity. Again, nothing unusual there—I have spent several decades studying how companies approach data privacy and cybersecurity. But consider the very first question of the interview: Can you tell us a bit about how you grew up?

Six year-old me, with my father,
an engineer, in Canada, 1959

That may not be an unusual question if you were being profiled by a lifestyle magazine, but as a prelude to professional opinions on cybersecurity? To me, that was unusual.

However, as I thought about my response—words that would truthfully answer the question while remaining relevant to the context—I not only enjoyed the process, I realized that this was a question I'd been discussing with myself for decades. 

Furthermore, across those decades, the answer has changed, many times. Indeed, the answer to "how I grew up" was often a story of both origins and change, a way to make sense of how my life started out and then turned out. And of course I have told that story many times, in job applications and interviews, at business dinners and networking events, and on the Internet via websites and social media profiles. 

I don't know how you feel about making sense of your life, but I have found that having a coherent personal narrative of my life has helped me to cope with some of the tough times that I've had to live through, mercifully few though those have been. (I am well aware that I have enjoyed exceptional good fortune in life and, as a white male, a massive amount of privilege; however, I have had to face grief and loss, prejudice and enmity, and I know from personal experience what it is like to be unemployed and homeless.) 

Your story of change

Speaking of tougher times, 2020 seems to be determined to bring more of these to more people in more places than any other year since the 1940s. During the ongoing Covid-19 upheaval I have found myself advising several people whose lives and careers are now—for a variety of reasons—in a period of involuntary transition.

However, because I am not a professional career counsellor or life coach, I felt obliged to bolster my own advice with that of experts. Fortunately, I found this very relevant perspective:

When you’re in the midst of a major career change, telling stories about your professional self can inspire others’ belief in your character and in your capacity to take a leap and land on your feet. 

This appears in an article titled What’s Your Story? by Herminia Ibarra and Kent Lineback that was originally published in the Harvard Business Review magazine. While the article was written over 15 years ago, it remains 100% relevant to 2020. Both authors are considered experts in their field with books to prove it. 

According to Lineback's profile on Amazon: "he helps companies and executives tell their stories, so others can learn from their experiences." Ibarra is an organisational behaviour professor at London Business School and offers lots of organizational and personal development resources on her website; she is also active on Twitter as @HerminiaIbarra. 

The authors begin their discussion of "Why You Need a Story" with this observation:

"All of us tell stories about ourselves. Stories define us. To know someone well is to know her story..."

However, and to the point of this blog post, they continue: 

"Seldom is a good story so needed, though, as when a major change of professional direction is under way...In a time of such unsettling transition, telling a compelling story to coworkers, bosses, friends, or family—or strangers in a conference room—inspires belief in our motives, character, and capacity to reach the goals we’ve set."

If you are dealing with an unsettling transition right now, I strongly urge you to read What's Your Story. And if you are hesitant about the idea of "telling stories," the authors make it clear that: 

"In urging the use of effective narrative, we’re not opening the door to tall tales. By "story" we don’t mean "something made up to make a bad situation look good." We’re talking about accounts that are deeply true and so engaging that listeners feel they have a stake in our success."

Personally, I have been very fortunate to have a lot of time to think about my life this year, and I now see that in the past my career benefited greatly from discussing—with myself and others—factual accounts of my life that are both "deeply true" and "engaging." 

In a 2018 TEDx talk, Ibarra refers to her work as teaching and researching people who come to those points in life that she calls: "what got you here won't get you there moments." I think most of us have experienced moments like that, even before 2020. I hope her article, and the other resources that I have pointed to in this blog post, prove helpful to you in getting through such moments now and in the future.

My story of change

Allow me to close with my version of "a bit about how you grew up" that appeared in Authority, the online publication which uses this tag line: Top Lessons. Top Authorities. Authority is published on the Medium platform, which I have used a few times myself—like this story about lack of trust in tech companies—but Authority uses Medium at scale. I think at least a dozen other people were interviewed with the same set of questions. You can read the full interview here, but the following is the bit about how I grew up:

I have spent much of my adult life in the US but was born and raised in Coventry, England, a city synonymous with innovations in industrial technology, like the pedal chain bicycle and the turbojet engine, and manufacturers like Jaguar, Land Rover, and Triumph. My father was an engineer, as were my grandfathers. As a teenager in the 60s I aspired to be a celebrated poet and songwriter, but the oil crisis of 1973 crushed funding for the arts and I pivoted into petroleum accounting, tax auditing, and from there to computing; that’s how I became enthralled by the clash of technology and ethics that is at the heart of cybersecurity.

I hope that gives you a sense of who I am, how I got to be who I am, and some of the changes I went through to make a career of studying how humans create and confront technology risks.

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Just time for a quick update


You may recognize the phrase "Just time for a quick update" from John Oliver's show "Last Week Tonight With John Oliver." Like me, John is a dual national (UK/US) who was born in the UK, in the part that is called The Midlands.

John was born in the city of Birmingham. I was born in the city of Coventry. These two cities are close together but have remained separated by about seven miles of protected green space thanks to some sensible planning here in the Midlands. (Note, it is not called the Midlands because it is in the middle of the UK, it's not, it's in the middle of England, which is one of the four "regions" that make up the United Kingdom—it's complicated.)

A year ago today, I arrived here in the Midlands from America, with my partner, Chey, to explore a possible future in which we could be closer to my mum—who turned 90 in 2019—and my brother and his wife. Mum was born and raised and still lives in the Midlands. My brother and his wife now live in Spain. 

Less than six months into this experiment, the parameters changed: Coronavirus created a whole new set of variables, including restrictions on our ability to go to Spain or back to America or pretty much anywhere. 

Obviously, no "quick update" can capture the many and varied implications of all this, but fortunately I can point you to some of the things I have been doing during this time, namely research and writing on malware, cybercrime, cybersecurity, and a worrying lack of trust in tech firms. 

I will try to share some of the details of our ongoing experiment as time permits, mainly in the hope of helping others who may been dealing with some of the same challenges we have faced, but also some of the joys we have encountered, like the view at the top of this post. That's what the way to my mum's house looks like on a sunny day in late summer, early autumn.


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Brexit: 11 p.m. GMT on 31 January 2020

[UPDATE: 00.01 on 1 January, 2021 — The UK completed it's departure from the EU. A bad idea has now become a bad reality, IMHO.]


I always thought that joining the ECC/EU was good for the UK.

I always thought that leaving the ECC/EU would be bad for the UK.

I am not happy that Brexit is happening. Period. Full stop.

No, seriously, that is the whole article. Nothing more to read. Too sad and angry to write any more.
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What Am I Thankful For? A diagnosis of congenital amusia

In November of 2008 I wrote: "we’ve arrived at the time of the year when it’s traditional to speak of things for which we’re thankful, I figured I would put it like this: I am thankful for a diagnosis, even though that diagnosis is hemochromatosis." Now I'm back with thanks for another diagnosis, one that thankfully does not involve physical pain and suffering, although it has had quite an impact on my life.

The difference a name makes

It was my partner, Chey Cobb, who received that diagnosis of hemochromatosis. The thankfulness we felt at getting this diagnosis came from having a name for the constellation of symptoms that had forced her to quit working and turned her daily life into a daily struggle (one that, sadly, has continued to this day). We were both surprised by what a difference it makes to have a name for the suffering you've been going through.

As inveterate researchers, we saw Chey's diagnosis as a starting point for exploring treatment options, finding support groups, and lobbying policy-makers. I started a Facebook page and website to raise awareness of hemochromatosis, which is widely under-diagnosed and not well understood by many doctors. We personally validated a CDC study that found the average time to get one's hemochromatosis correctly diagnosed was nine years, enough time for the condition to cause irreversible damage to joints, liver, heart, brain, kidneys, and other organs.

Sadly, we saw a replay of this diagnosis phenomenon three years ago when doctors confirmed our daughter's suspicions that she had Multiple Sclerosis (MS). The day she got that confirmation she called us in state akin to elation, tinged with validation, even though she knew all too well that the road ahead was going to be a very tough one. But we understood how much it meant to have a name for what you've got.

Now hear this

When you get a medical diagnosis, particularly one that's taken many years to obtain, there are two phrases that are likely to come to mind right away: "that explains a lot" and "I knew I wasn't imagining things." (The latter is likely to be familiar to female readers - numerous studies show that the tradition of doctors telling women their symptoms are "all in your head" is still a thing.)

The diagnosis that I am thankful for today "ticks all the boxes" as they say in England: it explains a lot, and it validates a whole bunch of thoughts and feelings I've had since December, 1959. That's when, during rehearsals for the school Christmas concert, I first learned of the problem for which I now have a diagnosis: congenital amusia.

Technically, "a deficit in fine-grained pitch discrimination," what I have is sometimes called "tin ear." Indeed, what the teacher said to seven year-old me was: "Stephen Cobb, stop singing, you have a tin ear." What Mrs. Ashby did not know, and I have only just learned, is that I was born that way. In other words, congenital amusia means that I have always been, from birth, somewhat tone deaf.

(I don't want to go into detail about the congenital amusia in this article - I put together the 4amusia website for more information - but studies show that 4% of people have this disorder. My particular form of amusia is not severe, it doesn't mean I don't enjoy music, and I don't lack a sense of rhythm; but, regardless of how hard I try, I can't sing or learn a musical instrument - my brain lacks something in the pitch processing and retention department.)

What I am so thankful for today is the knowledge that my inability to carry a tune or learn a musical instrument is not due to laziness, sloth, or weakness of character - qualities of which I, and many other people with my condition, are routinely accused. I am so grateful that I can now say, with scientific certainty, that those accusations were inappropriate.

Lingering effects

I'm sure I could write a whole chapter about how much it hurt to suffer those accusations, the self-recrimination and doubt that it induced. I know I could have done without the castigation of teachers who were sure I could learn to play the recorder - a rite of passage in English schools of the 1950s and 60s - if only I would apply myself.

Then there's the chapter on how frustrating it was to grow up in the sixties with a strong poetic streak but no ability to voice the songs I composed, not to mention fruitless hours failing to learn guitar. Sure, I could pose for the album cover, but I was never going to be on the album.

But today I'd much rather give thanks for the unexpected gift of this diagnosis: the empathy it has given me for this thing called neurodiversity, the growing realization that human beings are not all wired the same way.

While I realized long ago that organizational aversion to people who are "different" is bad for organizations, and bad for "differently-abled" people who can bring great insight and real value to any mission, I have to admit that I didn't truly 'get' neurodiversity until I learned that my own brain had a wiring issue.

And as I look at what is happening today in terms of research, it strikes me that there is great potential for humans to learn more about the many different ways in which we are wired. These days a decent school is going to recognize something like dyslexia at an early age and respond appropriately. Hopefully, schools will soon be recognizing that some children don't hear pitch the same way most people do.

While I sometimes get quite emotional about this topic, let me be clear that knowing more about neurodiversity isn't just about people feeling better about themselves, it has seriously practical implications. Knowing the ways in which you are different makes you better able to be the way you are, and it sometimes happens that there are benefits to being wired differently. Society is better off as a whole if we can see that, and go with it.

*With a huge thanks to those scientists who believed people when they said "my failure to learn an instrument was not for lack of effort."
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It's official! I'm making some big changes

I have retired from my corporate position and we're moving to England!

After many enjoyable years with ESET—the organization I've worked for longer than any other—I began to think it was time to change things up a little, or down a notch, depending on your perspective.

And I knew that—owing to several factors on which I will elaborate later—the change would involve a move. So we began to look at living somewhere other than San Diego.

When Chey and I went to the UK earlier this year—for my mum's 90th birthday—we arrived at the conclusion that we would like to move closer to her. We now plan to complete our relocation by early September, to a cozy place just a short walk from mum's flat in Coventry, the thousand year old city in which I was born. And when we've unpacked and the dust settles, I expect to be sitting in a comfy chair in small study with a big internet pipe, conducting independent research into the darker aspects of humans and technology.

I will probably reemerge as Stephen Cobb, Independent Researcher. Down the road it could be Stephen Cobb, Public-Interest Technologist. (And I wouldn't rule out Prof. Cobb since Coventry has two thriving universities and there are several more nearby, including my alma mater, the University of Leicester).

What? When?

Timing is not always everything, but it did play a big role in this set of changes. By the end of 2018 I had reached a point in time that is referred to in America as "full retirement age." This is when Americans can start receiving the full amount of their pension (if you were born in 1952, that age is currently 66). What I mean by "pension" is Social Security retirement benefit, but we decided to use the term pension because in England "social security" means something quite different.

As 2018 unfolded I began see this pension as a "social retainer," a way for me to finance a different approach to my life's work, a chance to labor at my own speed, in my own way. I will write more about that work in a different place, but suffice to say it involves - among other things - helping the world to "enjoy safer technology." As you may know, that phrase is how ESET - my former employer - frames its mission, and it's one reason that I worked there so long.

I realized that a pension potentially means being able to choose my own strategy - like writing a book to give substance to the points I want to make, or making those points as an independent voice, not someone employed by a corporate entity (to be clear, ESET had an admirable commitment to objective research and required me to stay "vendor-neutral" in my public speaking - but one ethical company cannot save the reputation of an industry that needs redeeming).

But why did I say: "a pension potentially means being able"? Well, the enabling power of a pension is dependent on the size of that monthly check from the government relative to the cost of living where you live. Exactly how dependent will vary based on your circumstances. All of which turns out to be quite relevant to our decision to move to Coventry in England, as I will now explain.

How much?

The "Too Long, Didn't Read" version is that the pension checks which Chey and I started to receive this year are not enough to live on in San Diego given that we don't own a home here. We are members of a fairly large group of people whose assets were wiped out by the Great Recession, so we entered this decade with no savings and no home of our own.

Since 2011, we have lived in rented property in San Diego, where the average rent is now over $2,000 a month. When we moved here we decided to live near the ESET building in Little Italy so that I could walk to work (which costs a lot less than driving, with way less stress). You pay a premium for this location but sadly, Little Italy has become less of a community in recent years, and more of an entertainment district. We have felt it grow less livable even as it has become less affordable, providing additional incentive to move from our current location. (After dozens of moves in the nearly five decades since I left home, I've come to see moving across the country or over the ocean to be no more of a pain than moving across town.)

Last year, rents in San Diego as a whole rose 7%, and the average monthly rent in Little Italy is now over $2,400, and still rising. We pay slightly more than that, for a decidedly smaller place than the one we rented for $1,750 when we first moved here in 2011. So, unless you already own property in San Diego, or have managed to accumulate and retain a large nest egg, the prospect of retirement here, however appealing it might seem, is economically infeasible.

Being researchers, we analyzed numerous "more affordable" places after our nest egg was cracked by the Big Bank Fraud (then smashed by the Great Recession and mopped up by the for-profit healthcare industry). Turns out we can live in a nice house in Coventry for less than half what we currently pay in Little Italy. True, Coventry has less than half the number of sunshine hours you get in San Diego, and twice as much rain, but our pensions should be enough to pay the bills plus occasional flights to see my brother in Spain, while keeping us in wax jackets and wellies to boot.

The changes we are making this year have already taught us a lot and as our journey continues I will endeavor to share what we discover along the way. In the meantime, I will be tweeting as @zcobb if you'd like to follow me there.

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23andMe and Hemochromatosis


This blog post is a place holder related to a conversation that started back in 2016 when someone wrote to me, as follows:
I read your blog regarding Hemochromatosis and decided to look further into the 23andMe test. They tell me that their test results do not report on HFE. Do you know if this is a recent change with their testing or am I missing something? Below is the email correspondence I had with 23andMe [not reproduced here]. Do current 23andMe test results show C282Y, H63D and S65C mutations? If so, where do I find this information in the reports?
The question was addressed to me because I had been researching hereditary hemochromatosis due to my partner's condition: hereditary hemochromatosis. This is due to a genetic mutation (HFE) which can cause the body to mishandle iron intake. This can lead to excess iron in your joints and soft tissue, an affliction known as iron overload. If not treated and managed, iron overload can cause permanent damage and may prove fatal. 

We had both been early customers of the 23andMe genetic testing service. Back then it was possible to get information about one's HFE status (known by codes like C282Y, H63D and S65C). However, in 2013 the FDA took issue with 23andMe and censored access to this data. (Some of the background to this, from 23andMe's perspective, is here.)

In response the FDA restrictions, people found a way to extract the HFE data from the raw 23andMe genetic data (to which the FDA did not bar access). That was the situation in 2016 when I received the inquiry cited at the top of this article. However, in 2017, the FDA allowed 23andMe to resume the provision of HFE results (as described here).

The bottom line is that the set of instructions that I wrote up in 2014, documenting the workaround to determine HFE status from the raw data, is no longer needed.


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High blood pressure cure? For some, this treatment is not a conn

Short Version/TLDR: 

I used to have persistent high blood pressure (HBP) that was referred to as "essential hypertension," but now I don't. 
  • If you have HBP and low potassium, check out Conn's syndrome, also known as Primary Aldosteronism or PA. 
  • If you have PA/Conn's syndrome, an operation can fix it. 
  • I had the op in 2013 when my BP was 150/100 while on HBP meds. 
  • At the end of 2013 my blood pressure was 120/70 w/out meds, and it still is.

Why am I re-sharing this information?

I wrote about my experience with Conn's syndrome back in 2013. This blog post is simply a re-sharing of what I wrote back then (with one new piece of data at the end).

Why am I doing this? Every time I hear a person say "I have high blood pressure" or HBP, my thoughts go like this:
  • I know what HBP is like.
  • HBP is not very nice.
  • HBP can shorten your life.
  • I am extremely fortunate that I don't have HBP any more.
  • Should I tell this person about Conn's syndrome?
Of course, the answer to the "should I tell" question depends on a range of variables: who is the person saying they have high blood pressure? Where is this being said? Do I know this person? I try to weigh these variables before speaking, but as people who know me will tell you, I tend to err on the side of speaking up, sometimes to strangers. I also have a tendency to speak up about some things that other people might prefer to keep private.

However, a fair number of people have thanked me for sharing the story of my battle with high blood pressure because they found it helpful. And that is why I wrote about my experience, so people could "read all about it" if they wanted to, rather than listen to me talk about it.

So here are the relevant blog posts in historical order (as in earliest first - I am not suggesting that these articles are 'historic'):

What now?

I always intended to write one more blog post on this topic, documenting the long-term prognosis and perhaps adding some references. I guess this is that 'one more' blog post. Sadly, I don't have time to do a full reference list but this article on Conn's syndrome is quite helpful, as is this more technical paper). Also check out the Primary Aldosteronism Foundation website.

My sense from reading the literature is that there will be many more cases like mine: people cured of their HBP, often after years of being told that their HBP had no known cause and they just weren't eating and living right. These people will be identified by: [a] continual improvements in ultrasonography (US), computed tomography (CT), and magnetic resonance imaging (MRI); and hopefully [b] greater awareness of Conn's / Primary Aldosteronism.

The summer of 2018 marked the five year anniversary of the operation that returned my blood pressure to 'normal' without drugs. It has been a busy five years. I started a masters degree in late 2014 and graduated in 2016, all while carrying a very full workload (from an employer wise enough to subsidize graduate school tuition).

For the most part I have felt pretty healthy. There have been some issues with my digestive system and I sometimes wonder if they are a lingering side effect, not of the adrenalectomy itself, but the infection I got during my hospital stay. 

Nevertheless, that operation was well worth it and I feel very fortunate that—thanks again to a wise employer—my health insurance covered it. I am reminded that it is in the national interest for everyone to have access to affordable healthcare, so that the negative economic impact of conditions like HBP can be reduced by more efficient diagnosis and treatment.

The sting in the tale

An update from late 2019: my adrenalectomy did not cure my atrial fibrillation, which was probably caused by the excess aldosterone in my body during all those years in which my primary aldosteronism went undiagnosed. 

Sadly, "the current diagnosis of primary aldosteronism is suboptimal–its delayed diagnosis results in end-organ damage that requires complex management...an increased awareness of primary aldosteronism is required in both primary and tertiary care so that an earlier diagnosis can be made for optimal patient outcomes." That's from a 2018 article in the Australian Journal of General Practice published by the Royal Australian College of General Practitioners (here's a link to the article).

All the more reason to let more people with high blood pressure know about Conn's syndrome / Primary Aldosteronism, so they can ask their doctors to investigate, before excess aldosterone has a chance to do lasting damage.

One of these days I will write about how many doctors and cardiologists missed the classic symptoms of my primary aldosteronism, and how I feel about that. In the meantime, I will keep telling people that there may be a cure for their "essential hypertension."
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