Vairas Vīķes-Freibergas kandidatūra nu ir oficiāli izvirzīta Eiropas Savienības Padomes prezidenta amatam, sākta atbalsta parakstu vākšana un tiek aktīvi spriests,  kādas vispār var būt izredzes kandidātei no Latvijas. Tāpat Latvijas publiskajā informācijas telpā izskan gan “Par”, gan “Pret”, gan neitrāli viedokļi. Es uzskatu, ka pat tad, ja VVF kandidatūra neizrādītos vēl viens “meteorīts” un cīņā par augsto amatu viņa izcīnītu sensacionālu uzvaru, Latvijai no tā būtu maz labuma.

Nav šaubu, ka bijušajai Latvijas prezidentei ES vadītāja amats nozīmētu jaunu karjeras virsotni un nav arī jābažījas, ka viņa ar jaunajiem izaicinājumiem nespētu tikt galā. Freibergai ir gan nepieciešamās personiskās īpašības, gan pieredze, gan valodu un pārējās prasmes, lai godam pildītu Eiropas līderes lomu nākamos divarpus gadus. Taču savā amatā viņa pārstāvētu ES un domātu par ES, no kuras Latvija ir tikai niecīga daļiņa, ja ņem vērā mūsu ekonomikas lielumu vai iemaksas ES budžetā. Turklāt pamatots ir aizrādījums, ka reti kurš ne-ganietis zina, no kuras valsts nāk bijušais ANO ģenerālsekretārs Kofi Anans un pat ka ne-portugāļiem varētu būt grūtības pateikt EK vadītāja Žozē Manuela Barrozu tautību.

Patiesībā VVF daudz vairāk Latvijai šodien varētu palīdzēt, iesaistoties tās iekšpolitikā un kandidējot 10.Saeimas vēlēšanās vai nu jaunas partijas, vai SCP/JL/PS apvienības saraksta priekšgalā. Par spīti dažiem nesmukumiem VVF pagātnē, viņai izdotos piesaistīt vairākus “nesasmērējušos” domubiedrus, kuri līdz šim nav politikā darbojušies. Tas savukārt varētu likt doties pie urnām daudziem vēlētājiem, kas citādi paliks mājās un vēlreiz pārdomāt savu izvēli tiem, kas grasās atdot savu balsi par sīkpartijām vai kādu no “zagļiem-bet-kārtīgajiem-saimniekiem”. VVF vadīts saraksts būtu visnopietnākais oligarhu bieds.

Kāpēc tad bijusī prezidente ir gatava vadīt Eiropu, taču ne Latviju? Freiberga 8 gadu prezidentūras laikā pievērsa daudz uzmanības ārpolitikai, viņa jutās lieliski uz starptautiskās skatuves. Taču iekšpolitika viņu nekad nav īpaši interesējusi un arī tajā izcīnītie panākumi lielākoties ir bijuši saistīti ar Latvijas starptautisko tēlu. Skarbi runājot, VVF uzskata Latvijas politiku par pārāk prastu, lai būtu vērts ar to smērēties. Pat nestabilais Latvijas premjera krēsls nav nekas tāds, kura dēļ dabūt liekas galvassāpes un sacūkot savu reputāciju.

Lai arī Valdis Zatlers ir sevi labi parādījis Latvijas prezidenta amatā, viņam diezin vai kādreiz izdosies panākt tādu tautas atbalstu un politiķu respektu, kā to spēja VVF un kura, par spīti tam, ka viņai līdz šim nav bijuši skaidri definētas ekonomiskās nostādnes, noteikti būtu labāka Latvijas premjere par Šķēli, Šleseru, Lembergu, Urbanoviču, Zīli un pat Dombrovski. Kā to ir konstatējis viens no eksprezidentes politiskās biogrāfijas autoriem Pauls Raudseps, Freiberga kā politiķe ir īpaša ar to, ka viņu vada idejiska pārliecība, nevis personiskas intereses un ka viņa ar šo pārliecību spēj aizraut tūkstošus latviešu.

VVF nav pienākuma kļūt par valsts glābēju, tomēr, ja jau bez laimes lāča iztikt nevaram, tad labāk būtu, ja nāktu tāds, kas bez medus zagšanas pieprot arī smalkākas un godājamākas lietas.

At one of the follow-ups after the diagnosis of my post-hysterectomy vesico vaginal fistula (VVF) I asked my gynecologist if he thought the effects of testosterone on vaginal tissue could have played a role in my complication. He thought for a moment, then replied that he didn’t think so.

I was certainly not the first trans man that my surgeon had performed a hysterectomy for, but I don’t know just how much recent experience he has with trans men. There’s also very little data out there about the effects of testosterone on vaginal tissue. (Trans men are a very understudied population.) However, I have come across references that state the following:

• Testosterone makes vaginal tissues weaker, thinner, drier, more brittle.
• Testosterone changes the pH of vaginal tissue to be more alkaline.

If vaginal tissues in a trans man are weaker and thinner, wouldn’t that call for a surgeon performing hysterectomy to be more cautious with the pressure used in suturing?

Isn’t is plausible that my androgenized vaginal tissues were weaker and thinner and thus more susceptible to the pressure of that slipped stitch that went through the vaginal wall and into my bladder?

When I was asked to facilitate the Hysto Stories discussion group at the 2009 Gender Odyssey Conference in Seattle, I knew this would be an opportunity for me to share my story about VVF and also consult with some of the leading minds in FTM surgery to get their thoughts about my theory of increased risk.

Dr. Toby Meltzer’s presentation, FTM: GRS, was particularly eye opening. He stated:

• Atypical bacteria is found in the androgenized vagina.
• Androgenized vaginal tissues are not preferred for urethroplasty because they are weakened.

While not referencing hysterectomy and VVF specifically, this information seems like supporting evidence for my theory.

I attended Dr. Burt Webb’s presentation on hysterectomy the next day. Dr. Webb is the OB/GYN who works with Dr. Meltzer in Scottsdale, AZ. Dr. Webb performs vaginectomy (colopocleisis) and hysterectomy for FTM patients. I asked Dr. Webb if he thought testosterone had negative effects on vaginal tissues that could weaken them and put trans men at higher risk of complications. He didn’t think so. I cited Dr. Meltzer’s comments from the day before and he seemed surprised, then said he didn’t know. (Which I think is a fine answer. It’s better than bull.) Hoping I wasn’t dominating the Q&A, I went on to briefly tell him about my VVF. It then seemed obvious that Dr. Webb didn’t have much clinical experience with VVF. I don’t mean that disrespectfully, it’s just that he said a few things that are not true:

• VVF’s often heal spontaneously.
  FALSE: The chances of spontaneous healing of VVF with conservative treatment (catheterization) is less than 5%. With no treatment, that drops to less than 1%.
• VVF’s aren’t caused by a stitch.
  FALSE: Biopsies performed on excised fistula tracts have shown them to be caused by sutures. The presentation of my VVF indicated quite clearly that it was the result of a single misplaced stitch—not a scalpel nick.

Like my own gynecologist, I can’t expect Dr. Webb to be an expert on VVF if he hasn’t seen them in his own practice. They just aren’t that common.

But wouldn’t you know it… Shortly after leaving Dr. Webb’s presentation, I got an email on my Blackberry from another trans man who recently suffered a post-hysto VVF, had two repair surgeries, and is still experiencing related pain and discomfort. Similar stories have been trickling into my inbox since I first published information about my own VVF. I think it’s quite possible that trans men are at higher risk of VVF due to the androgenization of vaginal tissues, and I’ll keep looking for more facts that might support this. I don’t need to be right about this—in fact, I’d prefer to be wrong—but if the theory holds true, trans men and gynecologists need to be aware of this heightened risk.

UPDATE, 09/21/09: Dr. Kate O’Hanlan is a Gynecologic Oncologist based at Sequoia Hospital in Redwood City, CA. Dr. O’Hanlan has significant experience with trans men, and is the lead author of a 2007 study that I have referenced here before, Total Laparoscopic Hysterectomy for Female-to-Male Transsexuals (PDF.) In Dr. O’Hanlan’s pre-op info handout for trans men (PDF), it states:

At your physical exam, Dr. O’Hanlan may have prescribed low-dose Estradiol suppository tablets… these tablets help maintain mucosal tissues and will play an important role in your internal healing…  Once we are sure the internal scar line is cleanly healed, you will no longer need the tablets. In any case, the hormone dose is local and so low that it will not interfere with your testosterone treatment.

This is the first time I’ve come across a recommendation for Estriadol pre-hysterectomy to “maintain” vaginal tissues and help with healing. This isn’t clear cut support for my theory of androgenized vaginal tissue and higher hysto risk factors for trans men, but I’d love to get Dr. O’Hanlan’s thoughts about it.

Hat tip to Nico for sending me this reference! Thank you for contributing!!

UPDATE #2, 10/18/09: Estrogen suppository tablets are also prescribed to trans men who experience bleeding with penetration, restoring integrity to weakened, androgenized vaginal tissues.

www.stendardoimpianti.it

Sito web con diverse gallery dei lavori effettuati. Sito di qualità per la massima interoperabilità: XHTML 1.0 e CSS 2.0 validati by W3C 

Committente:  FRANCO STENDARDO IMPIANTI Installatore impianti idrici termici clima gas – Presicce (LE)

Prodotto: Installatore di impianti idrici, termici, fognanti, gas, clima, vigili del fuoco; progettazione impianti ingegneri collaboratori. 

Realizzato:  Aprile-Maggio 2009 

Software: Illustrator, Photoshop, Fireworks

Dr Richard writes…

Grace, a lady in her late thirties, went into labour with fourth child. Went to health centre and diagnosed obstructed labour (baby could not get out). Went to hospital and had caesarian section but too late (happens commonly) and baby was stillborn and there was much damage to her pelvic organs. Went to Mulago hospital…in for two weeks …no treatment. Went to another hospital diagnosed fistulae (new passages between bowel and vagina) and bowel and abdominal scar. In other words bowel contents coming out from the wrong places… This hospital kept her for two weeks but no surgery.

A VSO colleague brought her to Hope Ward 6 weeks after birth. She was discharged yesterday in full working order thanks to Hope Ward and Dr Moses after another 4 weeks in hospital. We were able to get her really fit with blood transfusions and feeding for long and complex surgery.

The picture is of her and her sister just before discharge.

There are 100,000 women with this complication of obstructed labour in Uganda…often known as VVF…Vesico vaginal fistula…damage to bowel causes connection to bladder and vagina. What an awful condition and so easily preventable.

For some reason of all the patients we have treated on Hope Ward this lady’s outcome pleased me more than any!

This post is a copy of a Press Release wired on the November 12th and it concerns to Branding. I will not cut any part of it as also I will not give my opinion what so ever. This is merely informative.

–

Tom Hardy, one of the world’s most recognized independent design strategists, has introduced VVF(SM) the latest version of Verbal-Visual Framework(SM), a powerful, proven, reliable and relevant research tool that accurately informs and directs brand-design decision-making.

A quantitative research instrument incorporating proven semiotic algorithms and predictive analytics, VVF(SM) delivers relevant, objective and actionable insights on how specific brand intent resonates emotionally through design. Coherent strategy across a company’s brand portfolio is a primary outcome of applying the VVF(SM) process.

“VVF(SM) was developed to identify, clarify and structure associative, multi-dimensional factors used by customers to choose a specific brand, product or service as well as to define the most appropriate design expression of brand intent,” said Mr. Hardy. “The tool is invaluable to both the design team and brand manager.”

VVF(SM) provides dynamic modeling that clearly defines personality. The process clarifies and visualizes how brand attribute meaning is perceived and powerfully transformed through specific multi-dimensional associations, such as shape, color, image, composition and sound. Results focus creativity to ensure more effective messaging and expression across products, services, packaging, retail, websites, advertising and other communications.

The method reduces risk and determines a direction more relevant to customers, as well as reliable insights for measuring return on brand investment (ROBI). VVF(SM) is definable, repeatable, measurable, scalable and actionable.

In closing, Mr. Hardy states, “VVF(SM) methodology can accurately predict customer choices, reduce risk and visualize brand-design context in a simple, yet compelling and strategic manner.”

Tom Hardy website: http://verbal-visual.com

Vesicovaginal fistula

I recently got a question via the contact form concerning the recording of a transvaginal procedure. As this may be interesting to others I post the question and my answer here. If you got any further advise or ideas for solutions to this difficult problem, please don’t hesitate to comment.

The question

I’m working with a company to develop multimedia-based training software for surgeons learning to repair vesicovaginal fistulas (VVF) in Africa and other developing countries. VVF is an obstetric complication resulting from obstructed labor and ischemia to pelvic soft tissue. As the body heals the soft tissue necrosis of the pelvis a hole can develop between the bladder and vagina rendering the women incontinent of urine for life (image credit). The problem is nearly exclusive to communities without emergency obstetrical care. Many, many women are in need of repair!

Now the video problem. Most surgeries are done transvaginally! We need good footage of an area the surgeon will have trouble seeing. The surgeon is closely involved with the project and would be willing to step out of the way for the camera. As a note and an added challenge, the procedure could be filmed in rural Africa.

My answer

First of all – this sounds like a very important project. I’ve read a few stories on the large amount of women with VVFs in Africa. Training surgeons for this procedure is a very important task indeed.

On to the video-problem. I have filmed a few transvaginal procedures, but never with a standard camcorder.

Colposcope
If possible, the best solution will be to get video through a colposcope, which will both provide an enlarged view of the area and sufficient light. The colposcope will have to be fitted with a camera that you can hook a recorder to. Here is a video of a cervical conization I’ve recorded through a colposcope. The magnification can be adjusted so you’ll see more of the vagina than in the video.

A colposcope used to examine the cervix

I’ve recently come across a colposcope with a built-in camera, that could be very interesting for your project.

It’s a Welch Allyn video colposcope with an integrated light source and camera, with a simple vertical stand included (photo credit). The unit has an s-video output, so all you need in addition to the scope is some kind of recording unit that can handle s-video. It’s quite expensive though.

Welch Allyn video colposcope

As for the recording unit, I’ve got some good experience with a hard disc recorder from nNovia, which has analogue inputs (composite, s-video) and records to Quicktime- or AVI-files. Compact (book size) and not too expensive. You’ll need a monitor to view the picture from the scope. You can loop the signal to the monitor via the recorder, so you’re monitoring the recorded signal.

But this is also the catch with the Welch Allyn colposcope. It’s video only. There’s no viewfinder for the surgeon to look through. So if she’s going to operate using the colposcope, she’ll have to watch the monitor while operating. But it will of course be ideal for the video recording even if it’s not used during the entire procedure.

If your budget allows it, getting a colposcope like this would definitely be worth considering. It could easily be brought along to a rural location, as long as there is a power outlet.

Laparoscope
Another possibility is to use a standard laparoscope to film the procedure. I’ve filmed a vaginal trachelectomy using this method. It was impossible to get any footage while the surgeon was working, but I got some good pictures when I had the surgeon stop at important steps in the procedure and expose the area for me. Like the colposcope, the laparoscope also has its own highly focused light source. The only problem with this method is keeping the laparoscope still, as it has no stand, and you’ll have to hold it with your hands. This method is of course only available in a well-equipped hospital.

The video still below is captured through a laparoscope. You see the cervix and specula in the vagina.

Video still from a vaginal trachelectomy

Camcorder with light
If neither of these methods is an option, you’ll have to use a standard video camera. I that case I think the best solution would be to bring a separate light source with a high output, and a focusable beam. Small camera lights can be quite powerful these days, and would hopefully provide enough light. I have some experience with lights from PAG. They can be fitted with a 100 W halogen lamp and the beam can be focused to increase the light density. They also come with their own battery packs, so they don’t have to be fitted on the camera.

Separate light is important, as you will need to place the camera and light in different places or angles to the operating area. I would place the camera (fixed on a camera stand) pointing directly at the axis of the vagina. You can then use the camera light hand held and move it around until you get the best lighting of the operating area.

Except for a colposcope with a viewfinder (which the surgeon can see through while operating) the surgeon will need to step out of the way for the video footage. This means you will not be able to record what she’s doing while she’s doing it, but only before and after shots.

Vakar Dziesmu Svētku noslēguma koncertā izskanējusī dziesma Trīs zvaigznes manī atvēra sentimenta un dzejas čakru. Gribas lasīt pantiņus par mīlestību, saskatīt tajos sevi un paraudāt – diezgan garlaicīgs un saldsērīgs meitenes garastāvoklis. Rīt mēģināšu atvērt kādu blogam interesantāku čakru.

Vainīgā dziesma atrodama šeit – Marijas un Renāra izpildījumā feat. VVF

Mēs gribam ēst!

Tur, pa labi vai te, pa kreisi:

VVF- Mēs gribam ēst!

Video klips:
LETA Video

Mēs esam stipri,
Mēs esam diženi,
Mēs esam raženi,
Mēs esam skaisti,

Mēs zinam, ko mēs gribam..
.. ēst, ēst, ēst … ēst, ēst, ēst… ēst, ēst, ēst… ēst!

Avots: grupas VVF (Visu varu frīkiem) diesma – Mēs gribam ēst

Bonuss:
Lejupielādēt VVF (Visu varu frīkiem) – Mēs gribam ēst

Personal care products and oleo-chemicals maker VVF today announced the acquisition of Canada-based antiperspirant and deodorant maker, Teo Corp. This is the company’s second acquisition in North America after picking up Colgate’s manufacturing facility in Kansas in November Teo Corp had declared bankruptcy in late 2006 and the company will now operate as a wholly owned subsidiary of VVF.

The Colgate plant would be used to produce bar soaps and liquid home and personal care products. Through this acquisition, VVF will now have the capability to produce a range of underarm, deodorant and antiperspirant sticks as well as pain relief sticks. VVF would use the plant to expand its product line offering in North America and to further build its position in the growing private label market for personal care products.

VVF is largely into contract manufacturing for brands like Nivea in addition to having its own soap brands such as Doy, Doycare Aloe Vera, Shiff and Jo. Exports constitute over 50% of the Rs. 675 crores company’s turnover. The company aims to cross the Rs. 1000 crore-mark by 2008. In addition to the yet to be started North America operations, VVF also has operations in Dubai through which it taps the European and African markets.

Read the Business Standard article for more details.