Year 2007 - State Of Oklahoma: Fill & Download for Free

That we don't have a written constitution, but one that's based on precedent. When a tricky constitutional question comes up, no one really knows the answer.We don't get excited about freedom of speech. It's a bit of a non-issue. (And things seem to run smoothly - I'm pretty sure that any group like the Westboro Baptist Church would be banned/arrested fairly quickly. And no one would worry about whether their rights had been violated.) (And someone was recently sent to prison for what they wrote on Twitter. Update: It's happened again: Man jailed for antisemitic tweet to Labour MP).There is no right to bear arms, and no movement (worth mentioning) for a relaxation in very strict gun laws.There is not a big fuss made about the way that the British flag is treated. There is no flag code, and no pledging allegiance. You can set fire to a flag if you like - no one will take any more (or less) notice than if you set fire to any other piece of cloth or paper. You can buy Union Flag toilet paper.It's very, very rare to see a police officer carrying a gun. Most British police never carry a gun.Police in Britain fired their guns three times (that's three gunshots, i.e. three bullets) in 2013. No one was killed by those shots. (In 2012, one person was killed by being shot by the British police - I haven't seen information about how many shots were fired.)The last time a British police officer was shot and killed was 2012 (when two officers were shot). The time before that was 2007.Carrying a knife can get you arrested if the blade is more than 3 inches long and you don't have a good explanation of why you have it. You may not buy a knife if you are under 18 - even a butter knife. There is no movement for a right to bear knives either. Knives: the laws on buying and carryingIn 2011 there were 177,185 people born in the US living in the UK. (I didn't find a source of the opposite - British citizenship is not as clear as US citizenship.) That's approximately 1 person in 300, and includes Boris Johnson, the mayor of London.If you're born in the UK, you are not automatically a UK citizen.There is no separation of church and state. In fact, it's the opposite. The Queen, as head of state is nominally the head of the Church of England. She defers to the prime minister who appoints the person who actually runs it (the Archbishop of Canterbury). The Church of England bishops have a role in the goverment - there are 26 bishops in the House of Lords (imagine that 26 pastors of super-churches automatically sit in congress, and that these people led prayers at the start of each day. )Many state (public) schools are influenced by the church. I went to three Church of England (Controlled) schools - which is very common. In such a school, the local Church of England vicar chairs the board of governors. (I don't know if that's still the case - there was nothing special about it, this was a regular local school).Related to that, the monarch, and the heir to the throne may not marry a Catholic. (This is being debated [Jan, 2013] and astonishingly some people are objecting to changing this rule: Hark what discord follows when you meddle with the monarchy - Telegraph).The education system allows you to specialize early. I did not study history, geography, art, Spanish after age 14. At 16 I dropped French, English, math(s), chemistry, English. (I think you have to do some science up to age 16 now). At 16 you choose three subjects to study.Accents vary within a very small region. I grew up 35 miles North of Birmingham, and 40 miles south of Manchester. My accent would never be mistaken for one of them. (In a murder case, known as the Yorkshire Ripper, police received a tape which they believed was from the murderer. They believed that they had narrowed the accent down to one small town.) Here's a nice video on accents -None of these people have an accent like mine. The closest I could find was:Petrol (gas) costs US$8.60/gallon in London (today's price, today's exchange rate: http://www.guardian.co.uk/money/2012/mar/23/petrol-prices-rise ).Unless there is some sort of crossing, you should not cross the street at a corner. (Drivers will not be expecting you there). Crossings tend to be few yards down the road away from a corner.Most people teaching and working in universities are not professors. When I was an undergraduate there was one professor in the psychology department. I then went on to work in another psychology department of a university which had no professors (for several years).There's only one private university in the country. (There are a few very, very small places - but only one that you would really consider to be a university). It's the University of Buckingham.British people have very different ideas about how long a drive is. A 100 mile drive would be a long way. I told my mother I was driving to a ski resort almost 100 miles away. She asked where we were staying, because there's no way that anyone would drive 100 miles in a day, and then just drive home the same day.Related to this, the UK is small. The area of the UK is about the same size as Michigan. England is about the size of Louisiana.But the UK is densely populated. The population of the UK is about that of Michigan plus Louisiana plus Kentucky, Oregon, Oklahoma, Puerto Rico, Connecticut, Iowa, Mississippi, Arkansas, Utah, Kansas, Nevada, New Mexico, Nebraska, West Virginia, Idaho, Hawaii, Maine, New Hampshire, Rhode Island, Montana, Delaware, South Dakota, Alaska, North Dakota, District of Columbia, Vermont and Wyoming,England, Great Britain, the United Kingdom and the British Isles are all different things. If you call someone English, when they're not, they might be insulted. (But it's OK to call them British, or that they're a citizen of the United Kingdom.)Cricket matches can last 5 days. And if it rains, it's a draw.No party ever gets a majority of the popular vote in parliamentary elections. In the 1997 election (the first Tony Blair won) the Labour Party won more seats than they had ever won before in a historic landslide victory . They got 43.7% of the popular vote (and 63% of the seats in Parliament). George W Bush squeaked a controversial victory in 2000 with 47.9% of the popular vote.British people are said to have bad teeth, until (relatively) recently, having bad teeth was a sign that they were your own teeth, not false teeth. A reason for pride.British plumbing is quite different from American plumbing. In the UK, for example, there tends to be a gap between where the drain pipe ends, and where the drain begins. The drain from the bathroom (not toilet) and kitchen sink might look like this (it's usually got a cover). It's somewhat unsightly (less so with a cover) but much easier to access when it's blocked.If you ever see a very long, very straight road, it's likely it was built by the Romans originally, and it's been updated since then. Watling Street is the most famous example: http://en.wikipedia.org/wiki/Watling_StreetTown / city names that end in -cester or -chester (Worcester, Leicester, Chichester, Winchester) were founded, or named, by the Romans and tend to the in the South. Towns that end -by (Derby, Corby, Whitby) were named or founded by the Vikings and tend to be further North.Most people drive manual (stick shift) cars. If you pass your driving test in an automatic car, you will get a licence that only allows you to drive automatics. This is very rare. If you rent a car, it's likely it will be manual, unless you specify that you want automatic.Postcodes are much more specific than zipcodes. A postcode only refers to a few houses, and some businesses will have their own postcode. If you put someone's name and their postcode on a letter, it will probably reach them. If you put their house number and postcode, it will definitely reach them. (E.g. I use to live at number 49, YO31 1BP. There's only one house with that number in that postcode.)The best selling newspaper (The Sun) in the country prints a large, color picture of a topless woman (just to be clear, with breasts exposed), on page 3. Labour party politicians (equivalent of Democrats) are much more likely to want to do something about this than Conservative politicians (equivalent of Republicans).Sometimes you'll see older houses with what appears to be a window which has been filled in with bricks. This is because houses were taxed according to the number of windows - the window tax. http://en.wikipedia.org/wiki/Window_taxThe first time it reached 100F anywhere in England was in Kent (South East) in 2003. (I'm not sure if it's happened again.)'Squash' is a drink. Lemonade is clear and fizzy (like 7-Up).Diet Coke outsells regular Coke.Healthcare is free (at point of use - it's paid for by taxes). I know that most Americans know this, but they don't really understand it until they experience it. If you are injured, you can go to a hospital or doctor or walk in center and they will treat you. You will pay no money. You will provide no ID. (They'll ask your name, for the record, but they won't know if you're lying). If you're in the hospital, it's free. If you're an inpatient in the hospital, food is free. Lab tests are free. Home visits are free. It's all free. (And the UK spends less on healthcare per person than the US).Scotland and Wales have separate parliaments, a little like a state. But they are still part of the UK. England does not have a separate parliament. But the Scottish parliament has more power than the Welsh parliament.If you need medication of any kind, it's a flat fee of around $12 per prescription, regardless of what it is (even if it costs less than that). If you're over 60, under 16, pregnant or poor, it's free. If you need a lot of prescriptions, you can buy a pre-payment certificate - (about) $50 buys all your medication for 3 months, $150 buys them all for a year. (This is different in Scotland, I believe).The exception to the prescription charge is for contraception. That's always free. This is not controversial.Dental treatment is free for children.In June 2012, it was reported that the prime minister was having lunch in a pub and went home, forgetting his 8 year old daughter. http://www.guardian.co.uk/politics/2012/jun/11/david-cameron-daughter-behind-pub. This was generally reported as "Ho ho, shows he's human. I've done that too." Imagine if the president had gone for lunch with his daughter to a bar, and forgotten her there. The reaction might be different.An MP doesn't have to live in the area they represent. They don't even need to have any connection to it. Boris Johnson (current mayor of London) stood for election in Henley without any prior connection to it. The reason being that Henley was a seat that the Conservatives (his party) were virtually certain to win. People can stand for election in multiple constituencies (not at the same time though). One way of proving you are a good campaigner is to stand in a seat that your party is very unlikely to win (and hence is not competitive to get the position), and then to do better than expected. Having shown you are a good campaigner, this means you are more likely to be selected to stand in a seat which is marginal.In 1971, the UK changed to decimal money. Before that, the money system was based on that introduced by the Romans and was extremely convoluted. There were four farthings (until 1960) or two halfpennies to a penny. 12 pence in a shilling and 20 shilling (240 pence) in a pound. A guinea was 21 shillings. There was a 10 shilling note, and a sixpenny bit. A crown was 5 shillings. A half crown was 2 shillings and 6 pence. A threepence coin was three pennies. After the changeover, people would ask "What's that in old money?", the phrase "Old money" came to mean the old way of doing something. If you said something was two metres, and I asked "What's that in old money?", I'd be asking how many feet and inches it is. After the conversion, a shilling was worth 5 pence (1/20th of a pound), and was still called a shilling or a bob. A ten bob bit is a 50 pence piece. (A friend of my father's had moved to the UK and was buying something in a second hand store. He asked how much something was, and the shopkeeper said "10 bob". He had no idea what that meant, so he said "How much?" The shopkeeper thought he was haggling, and said "All right, what about 4op?" More here: £sdBanknotes (bills) are different sizes, to help partially sighted and blind people tell them apart. Coins are also designed (thickness, diameter, shape, edge) to be able to be distinguished by touch for the same reason.NOTE: This one isn't really true. See : Is Muhammad the most popular boy's name in Britain? and Martin Beer's comment below. The most common first name for boys would be Mohammed, if there weren't so many different ways to spell it (e.g. Mohammed, Muhammad, Mohammad).There are strict rules about what can be called a city. Towns are sometimes granted city status on special occasions, in 2000, for the millenium, Brighton and Hove became a city, as did Wolverhampton. More here: City status in the United KingdomSales tax is set nationally, and its called Value Added Tax (often, but not always, pronounced 'vat'). It's currently set at 20%. It applies to goods and services (unlike sales tax in the US). It originally applied to 'luxury' goods, but that definition has increased. For example, adult clothes have VAT, children's clothes don't. Hot takeaway food has VAT, cold food doesn't (so if a store microwaves something for you, they should charge VAT, if you eat it cold, they don't). Frozen peas have VAT, canned peas don't. It's very rare for anything in shops selling to the public, rather than business, to have the price before VAT, so most consumers don't know what it applies to and what it doesn't.Children are allowed in many bars and pubs in the UK. Heck, they're encouraged. Many pubs have outdoor or indoor playgrounds to keep children amused while their parents can drink a beer (or whatever).Many cities have a football (soccer) team, or more than one named for them (Manchester City, Manchester United). London doesn't. (Although London has many teams, they don't have London in their names.)Counties are the (another, very rough) approximation of states in the US. But counties get shuffled about more often. Rutland ceased to exist (as a political entity) in 1974, but it was reinstated in 1994.The vast majority of households in the UK will have an electric kettle, for heating water to make tea and coffee.Lots of surnames are named after places. But these don't tend to be large places - there are very few people with the surname "London". Something like your occupation, or your city of origin, would be used to identify you - you were "Jack from London", but if it were a big place (like London) that might not be useful, because there could be more than one Jack from London (so your occupation might be used). The most common surname based on a place in the UK is Burton (which is known for its beer).Grilled cheese sandwiches don't exist. The closest thing would be a 'toastie' or a toasted sandwich (made in a sandwich toaster).Arugula is called 'rocket'.You can drink alcohol in a bar from the age of 18. You can drink beer, wine and cider if you are eating a meal and with an adult at 16. You can drink alcohol at home at 5.Cider always has alcohol in it.Chips (which an American would call 'fries') are typically served with salt and vinegar - ideally malt vinegar. Some pubs which are very finickety about their beer will not have vinegar, in case it contaminates the beer.Marmite is delicious.

Chris Paul was drafted in 2004 by the New Orleans Hornets and began playing for that franchise the following season. After Hurricane Katrina flooded three fourths of New Orleans in 2005, the Hornets moved play to Oklahoma City for two seasons. However, during that time they were referred to as the NOK Hornets. I have never found an explanation of what "NOK" stood for, but it was presumably an amalgamation of NO (for New Orleans) and OK (for Oklahoma). While in Oklahoma City, Paul publicly lobbied to have the team remain in OK, but the Oklahoma City had made a very public commitment to the citizens of New Orleans that they were not trying to take their team from them (as a New Orleanian I say thank you OKC. I have so much respect for you). They were, however, using the situation to show the NBA that their market was a viable one since the NBA had stated that they did not feel that OKC was a viable site for a team. The idea served them well because shortly after the Hornets went back to NO, OK was awarded a team in the Sonics moving from Seattle to there and becoming the Thunder. After the two years in OK, Paul and the Hornets returned to New Orleans to start the 2007-8 season. In 2011 he was traded to the Los Angeles Clippers where he currently plays. Before he was traded to the Clippers he made a speech (at a wedding) about wanting to play for the New York Knicks with a few other superstars (but that didn't pan out). He then tried to get traded to the LA Lakers. He was so close to getting the job with the Lakers, the there is a report that Kobe Bryant was driving to the airport to pick him up in Los Angeles but returned empty handed as the deal fell apart while Paul was in the air en route to accept the Lakers job. It was shortly after this deal not going down that he signed with the Clippers.So to answer your question he has played for two franchises, but one of which was in two different locations due to the disaster. So he has played for: The New Orleans Hornets, The NOK Hornets, and the Los Angeles Clippers.

What do you live for?The short version is that I live for the opportunity to do more because there is way too much that I am curious about….….too many things that I haven't tried….….so many ideas that I have had to push to the bottom of the stack, just waiting to pop up when the time is right.And then there is the long version:Despite my ambitions I had several opportunities to "shuffle off this mortal coil" in recent years and so far I have managed to hang on by willpower and fair amount of luck.I made the decision to join the US Air Force in 2009; funny enough despite having two children (2005 and 2007) I was in the best health of my life.At the time I was working an office job that I hated so much, I took a split shift schedule and ran the 1.7 mile trip from my house to work four times daily (physical exhaustion was the only way I could stay calm cool and collected sitting at a desk the rest of the day).Making it through MEPS was a challenge only because I had too many tattoos (I removed two of them, myself, but that is a story for another day) but everything else was easy.I entered the delayed entry program for precision measurement equipment lab but there weren't enough potential candidates so I was delayed again and ended up taking an open electrical spot just so I could get to basic training.I entered basic training 8 days before my 28th birthday and again, had no problems.I got assigned to work aircraft avionics and went to tech school.Electronic principles was tremendous fun; I got to take over teaching a block and taught principles of electromagnetism by modeling a tattoo machine (having built quite a few of them from scratch it was easy to throw together).I got assigned to work C130 aircraft and went to my follow on training. I graduated, got orders and joined my unit as permanent party.Six months later I was tapped to deploy to Kandahar Airfield in Afghanistan and I ran through all my pre deployment requirements, including vaccines.It is important to clarify some things here before I continue.I am NOT anti vaccine.Herd immunity is IMPORTANT and there is a lot of really good research to support the safety profiles for individual vaccines. BUT like anything in life there are risk factors and especially with certain vaccines there are contraindications that must be accounted for.My great grandmother was an epidemiologist who worked for Dr. Adams at UCLA (primarily on multiple myeloma) well into the 70s.She drilled it into our heads, so much that it has become family ‘ism' NEVER GET THE SMALLPOX VACCINE.Why?There is a population of people who seem to have a genetic predisposition that increases the risk of adverse reaction to that vaccine (this is per the manufacturer of the vaccine).Genetic research was still fairly new when my great grandmother was researching but the event that took her from living as a housewife and raising two children in Muskogee OK to studying Biology at U of Ohio Kent State was mandatory smallpox inoculation.My great grandmother was half Chahta (Gardner on her Dad's side, mom was an Irish immigrant), my great grandfather was also half Chahta (his mom was a Wilson and Dad was an Irish immigrant) they went to indian school and lived in Muskogee.My great grandmother got married young (14 or so) and had my grandfather and great aunt fairly young as well.When the indian agents came around it was prudent to hide the young children because sometimes they would take them. Somehow my grandfather and great aunt were kept out of sight and they didn't get the mandatory smallpox vaccine.Over the course of the month following the vaccine many of the kids who got it grew sick and suddenly died.This so perplexed and worried my great grandmother that she got her sister to take in my grandfather and great aunt, left her husband and put herself through college. She had a burning desire to figure out exactly why those children got sick and died after having the vaccine.I found some of her old notes when I was a child, they are sadly long since gone, but I remember that she was thinking there was a genetic component long before there was any way to prove it.Fast forward back to 2011 and me getting my immunizations.I am educated, I went out of my way to research ACAM2000 (and it's predecessors just to be thorough), according to the *manufacturer* I shouldn’t have received the vaccine.I have dyshidrotic eczema, which was noted and determined to not be a disqualifying factor when I enlisted, however it is a contraindication for ACAM2000, and despite being light skinned I am sufficiently Native American (I am a registered citizen of the Choctaw Nation of Oklahoma through my paternal grandfather, but my paternal grandmother and my maternal grandmother are also native, mixed).I self identified to the NCOIC on duty and was told get the vaccine or get an article 15, end of story. It is mandatory for deployment, no exception, and if you can't get it you can't deploy and if you can't deploy the Air Force doesn't want you.I had a lot invested in this, I was supporting my family, with a spotless service record and I *wanted* to deploy, I wanted to do my job!I said fuck it and cast my lot to chance.Of course it didn't help that they nailed me with the smallpox vaccine, hep B, Anthrax, live flu mist and a tetanus shot all in one go.Holy hell.Four weeks later I was still averaging about 103.5 F and despite presenting as *ill* I was cleared to go.I was told, that's normal, everybody gets the “crud". Once you get in country your body will adjust and it will be fine.I got in country but my body didn't adjust and I certainly wasn't fine.I worked the midnight to noon shift so I would come on duty while it wasn't insanely hot, if possible get all the work done before the sun came up and spend the rest of the shift odd jobbing. Because of that I generally wouldn't stop to eat until around 9 or 10 in the AM.I started to have trouble staying awake through the late morning/ early afternoon, which is understandable.With constant rocket attacks, densely populated shared living space and 24-7 activity it was hard to sleep.They gave out ambien like candy there, which led to some really odd encounters with personnel at times. Ambien zombies were a real thing, one of my roomates was well known for wandering outside in her bra and panties.The problem is that it went beyond tired, I was blacking out (without ambien or any other medication) having dizzy spells and episodes of confusion.My supervision wasn't sure how to handle me; my work was top notch, I jobbed my ass off but by the end of the day I was delirious.They decided I wasn't drinking enough water, so my water intake was monitored. It wasn't dehydration or overhydration, I was doing well with water.So they decided it was heat susceptibility so they confined me to our morale tent (it had an ac unit) during peak heat but it didn't seem to make a difference.It continued to be a mystery (and a bone of contention) until I was eating an apple cinnamon muffin and passed out *in front of our flight surgeon * who immediately began treating me for anaphylactic shock.I almost died, on top of a picnic table in Afghanistan, because of a muffin.Holy crap, what an ignoble way to go!All the times I “blacked out" or “fell asleep” I was unconscious, in shock, but because no one knew what they were looking at (and I sure as hell didn't know what was going on) they just shrugged and made sure I was cool and my feet were elevated.Our flight surgeon was *pissed* at me, he didn't believe me when I explained to him that I had never been allergic to anything in my life, not even wasp venom (I got stung like 22 times when I was 7, it hurt but a baking soda bath took the swelling down and I was fine afterwards. Later on my aunt reminded me that I had a bad reaction to an antibiotic when I was a baby but that was it, I was always a healthy kid).He then combed my medical records and made some phone calls. He decided I was telling the truth and immediately put me on an elimination diet and started the process to get me sent home early as a medevac.By this point I had already been in country 4 1/2 months out of a six month deployment.We found out that I was reacting to nearly everything I ate. I could tolerate small amounts of rice and fresh or cooked pureed fruits (applesauce), soy milk and peanut butter. Anything dried, preserved with benzoate salts or acids, food coloring, any kind of animal product at all, wheat or similar (probably cross contaminated grain) was guaranteed 100% to knock me out. I was also reacting to cleaning agents, degreasers, fragrances, soaps, lotions, hand sanitizer, engine oil, gasoline, JP8, etc. It was hellacious.I lost a lot of weight even before the elimination diet because everything was making me sick. I lost more weight afterwards because it was a challenge to source an adequate amount of food.I was ecstatic to at least know, vaguely what was happening to me.Sometime around the beginning of month five I developed a subcutaneous growth in my low back. It increased rapidly from the size of a pea to about a silver dollar over 3 days.Our flight surgeon was concerned, with all the other weird medical crap going on he thought there was a good chance it was malignant and wanted to take it out ASAP. So he informed my supervision that he was performing surgery that afternoon.The role 3 was booked solid with trauma patients so we drove over to the role 1 clinic, which is where you go for general stuff like head colds and vaccinations. He commandeered an exam room and found a nurse with surgical experience.I have to say, tumor excision under local was a particularly bizarre, hilarious and painful experience.Especially memorable, “nurse, you have tiny fingers, stick one in there and hold this”, oh man, she did have tiny fingers but boy they felt like ten inch wide flaming hot pokers in that moment.He stitched me up, gave me some truly excellent painkillers and told me that I was to report to work because he wanted me under supervision in case there were complications (I was the only female on my deployment so there was no one that could keep an eye on me back at my MOD/living quarters, my roomates were all in an entirely different squadron).He told me that I was *not* cleared for duty and I was to tell anyone who gave me crap that I was too high to work and to fuck off.In retrospect I am sure he was joking to make a point but lo and behold that is exactly what I did the next morning.Somehow the news that I had surgery didn't get passed on and when my production supervisor, who was a senior master sergeant, told me to rally up and get on the truck I told him to fuck off, that I was too high to work.Oh man.The shit storm that caused, but I was actually really high on painkillers (I'm a lightweight) so while he was screaming in my face I suddenly found everything hilarious and couldn't stop laughing.Mind you I was the low guy on the totem pole on this deployment, the only A1C and the FNG.A tech sergeant I worked with regularly had to intervene and get our lieutenant, who did know about the surgery, to save my bacon.I am pretty sure I was seconds away from getting my ass dragged out onto the flight line, literally.I spent the next two weeks being monitored in recovery and by the time my medevac got approved I was able to hop one of our planes on early rotation home a week early so after discussing the situation with his colleague at Ramstein Air Base, our flight surgeon decided it would be better to just send me home the regular route.He was of the opinion that the turn around to get me in to see an allergist would be better at home station.Boy was he wrong.The first thing I did during medical for redeploy was ask for a referral to allergy and to have my stitches out. My doctor on base *did not believe me when I told him I had surgery *.I pulled up my shirt and showed him my healing incision and stitches. He refused to touch the stitches until he figured out “what I had done myself".I ended up getting a co worker to pull the stitches and made follow up appointment. I don't know why but it took four months, several incidents where I passed out on aircraft while working (the last of which I almost took a swan dive off a B5 stand) and my squadron commander calling the medical group commander to get me a referral to an allergist.The allergist was strangely excited despite the fact that the only allergy my blood work came back positive for was dust mite (high but not dangerous) and I reacted to the entire skin prick panel with delayed onset of anaphylaxis.He told me “I think I know what this is! I have seen this before, it is a rare disease called mastocytosis, so I am referring you to hematology/ oncology.”My oncologist was less excited, “I have never seen a case of mastocytosis with such severe presentation of spontaneous anaphylaxis. Unfortunately, I think you may have mast cell leukemia.”My spleen was huge, I was crazy symptomatic (at this point I was reacting to soy, peanuts and most fruits in addition to all the other previously eliminated stuff. I was literally living on rice and beans), I had hives and wheals, rashes, flushing, purple fingers and toes, nausea, pretty constant vomiting and GI upset……I was really ill.So we did a left iliac crest bone marrow biopsy……on my 30th birthday.We waited with baited breath for my lab results to come back……normal.WTF!?Don't get me wrong, I was insanely happy to find out that I didn't have an acute, fatal cancer.But the strange thing is according to the PCR analysis I didn't have mastocytosis either.Getting good news didn't make me any less sick, so what the hell was going on? My oncologist was confused, so he sent me out for further biopsy and ran every test he could think of.The results were inconclusive; I had slightly higher population density of mast cells, but not enough to be clinically significant on their own.My serum tryptase (generally used as a biomarker for mast cell activity because it is one of the few mast cell metabolites that is somewhat stable enough to test easily) was barely detectable but my urine methylhistamine levels were consistently elevated way above normal.My oncologist was at a loss and considering sending me to rheumatology simply because he didn't know what to do with me.I admit it, I flipped out. I yelled, I got nasty, I threw papers, kicked a chair across the room, accused him of giving up on me and punting me to someone else.I walked out of that appointment thinking he was going to call security and I was going to be labeled as a psycho patient.Instead he called me and apologized, he said I was right. I begged him to give me a week to put together some research and if he thought it was implausible then I would let it go and we would part ways amicably.He agreed and I got cracking.Early on when I was dealing with the allergist I had been pulled off of flight line duty and given a desk job as a Unit Deployment Manager.I had institutional access to Elsevier and the first thing I did was read biomedical journals. Allergy/immunology, hematology/ oncology, molecular biology, translational research, cell biology, biochemistry, so on so forth.I already had a few ideas to fall back on once the labs came up unremarkable. I had been looking at the research of Dr. Molderings at the University of Bonn, Germany and ran into some papers that he co authored with Dr. Afrin about Mast Cell Activation Disorder that covered the weird grey zone I seemed to be occupying.I literally wrote a summarized, annotated report for my doctor, contacted Dr. Afrin (who is by far one of the kindest people I have ever had the privilege of interacting with) who offered his contact information and said he was more than happy to chat with my doctor.My oncologist looked over the report I gave him and was intrigued by the literature. He contacted Dr. Afrin and they worked out a game plan.They trialed me on hydroxyurea, an RNA inhibitor, and fantastically my spontaneous anaphylaxis stopped.I was on hydroxyurea for two weeks before I was started on Gleevec which is a targeted tyrosine kinase inhibitor.With the Gleevec I was still doing well, no anaphylaxis, for over six months but for whatever reason (there are a couple of theories) my symptoms began to escalate again.Fearing the worst, a total relapse, I began researching imatinib (Gleevec) method of action and I remembered a few curious case reports from earlier in my research.One was a case report of a Chinese man with vitiligo who was diagnosed with a gastrointestinal stromal tumor (GIST) and treated with imatinib. During his treatment his vitiligo reversed as a side effect of the imatinib. Melanocytes are the cells that produce melanin in the skin and are affected by the presence or lack of mast cell stem cell growth factor signaling (c-KIT).A paper discussing identified c-KIT mutations in several cases of piebaldism and the possibility of those mutation being representative of a "dominant negative" expression as opposed to a recessive loss of function helped to elucidate the seemingly paradoxical response of the Chinese GIST patient with vitiligoThe other case report was a patient who had been treated with sunitinib (Sutent) and experienced a pattern of follicular depigmentation that mimicked a distinctive pattern of piebaldism (right side white forelock and eyebrow pigmentation seen with KIT mutation F584L) as opposed to the more commonly seen global depigmentation.I also found a lovely paper that predicted the effectiveness of sunitinib and imatinib for certain individual mutational conformations of c-KIT by comparing the structure of the receptor before and after exposure to the drug to wild type c-KIT with calculated degrees of deviation.I wasn't sure why the imatinib was losing efficacy but as I said before, I had some theories.I didn't have an identified c-KIT mutation but I had a clear picture of what mutations I didn't have through a combination of PCR analysis, 23andme testing (which I coincidentally joined as part of a study on malignant neoplasms) and simple process of elimination (some c-KIT mutations are fatal, carry lifetime health consequences and/or have obvious physical symptoms and there are several places where a mutation would not confer a clinical expression of disease).What happened next is a little fuzzy.Disclaimer, I was on a *LOT* of liquid diphenhydramine, which, as some of you know is an anticholinergic and can have some interesting effects on perception and memory.It was the only "antihistamine" that I didn't react conversely to with anaphylaxis or in the case of the leukotriene antagonist Singulair, third spacing directly into my lungs resulting in sterile pneumonia (the radiology tech said it literally looked like I had suffered a drowning).With the imatinib doing less and less, I was having to take more and more diphenhydramine to control my symptoms (I got it from the pharmacy in a gallon jug and went through it like water).I'm sure most of you are familiar with the phenomenon of "drunk brain" or the technical term "alcohol-induced fragmentary blackout".While on diphenhydramine (at work) I was busy bending my mind to trying to find a reasonable explanation for why the imatinib was no longer working, invent a fall back therapy for when it inevitably failed and still you know......do my job which involved a crap ton of coordination and paperwork.My life was being lived via sticky note because once the diphenhydramine wore off *I couldn't remember what I was doing earlier in the day*, and vice versa.It was maddening.I was spending a good part of my day leaving notes for myself, trying to communicate across the divide.All while running a Bayesian Statistical analysis on my genetic data.......omg.My coworkers occasionally expressed concern but chalked it up to my weird coping mechanisms and my leadership decided that as long as I was still performing well at work they would ignore the mad science vibe my desk gave off (I had notes and printouts taped *everywhere*, I had de-evolved into color coding and time stamping, it was insane).It made sense for sunitinib to be a second line therapy in the case of imatinib failure, just like in GIST (which is generally driven by c-KIT mutations) but it wasn't developed to treat my particular flavor of mast cell whatever the fuck and I had to work hard to make sure it was a logical choice.I had to justify the use of the drug and predict the possible efficacy before I could give myself permission to even think about pitching it to my oncologist.It was a matter of trust and pride (possibly a little bit of overzealous behavior shining through) but I thought to myself, yes! For science!So things continued to deteriorate until I slid into a multi-day series of reactions that eventually culminated in anaphylaxis.The worst had happened, I had relapsed.I found myself sitting in a tiny closet of an exam room at an unfamiliar clinic, as my oncologist had managed to squeeze some time out of his day doing rounds at the hospital to see me."Not good, not good" he clucked and hissed at my chart and looked at me."What do you want to do?"I nodded tiredly and handed him my research.“It's not perfect but I think I have narrowed down the possible locus of any potential KIT mutation, I don't think it is a single SNP. I think there are a number of intronic alterations that are affecting the function of the ATP binding pocket. The effect may be inversely analogous to the known pathogenic mutant F584L and based on the probable location it should be a good candidate for sunitinib."He looked over my research and tapped the pages thoughtfully."Sutent is a nasty, nasty drug, it's broadly effective. I try to not prescribe it because the side effects are very bad."I nodded in agreement. "Yes, but in a dose dependent manner. By my calculations I could potentially have a positive response to a little as 6mg daily."He flipped back though my notes. "The smallest it comes in is 12.5mg."He paused and we looked at each other for a few minutes.He then told me a story, I will do my best to give it justice here but I can only tell it they way I remember it."I had a colleague, who was a very good friend early on in my practice. His wife was diagnosed with a cancer and I became her physician. We didn't think it would be too difficult to treat, it wasn't a particularly fast moving or aggressive cancer but for some reason she was not responding well to the usual treatments. It became apparent to me that we needed to try something different and so I wanted to trial a fairly new drug that looked promising. Her insurance wouldn't authorize this new drug because they said it was too dangerous, they rationalized that the type of cancer she had usually had a good prognosis and didn't merit the risk of the, in their opinion, more dangerous drug."He took a deep breath."She died. I don't know if the drug would have saved her or not, I didn't get the chance to find out and I know I did the best I could, but just the same....what if.""So look. We are going to try this. You have a good idea here and if you can't tolerate the Sutent we take you off it, simple. I am bringing patient advocacy in and we are going to fight for this."I left his office feeling sad and hopeful, proud and humble, afraid but optimistic, resigned but ready to fight!Two days later, to my complete and total surprise, I received a package via courier delivery from a specialty pharmacy.It contained three months worth of 12.5 mg Sutent.I immediately called my oncologist and told him I had the drug in hand, no questions asked, my insurance came through miraculously. We both laughed a bit about the randomness of the universe and he had me start the drug immediately.It worked as I predicted. I was able to recover all the foods I had been previously reacting to with anaphylaxis as well as get completely off diphenhydramine.Sunitinib isn't without side effects, but they are manageable (for me at least) and it opened up a new line of therapy for people struggling with Mast Cell Activation Disorder who were previously out of options (and possibly mastocytosis as it seems to be cytoreductive without an upswing in tumor necrosis factor).I have been on it since April of 2014 and have had zero episodes of anaphylaxis, which is a tremendous improvement!Other symptoms have been up and down; I had to have two back to back Achilles tendon reconstructions to fix a total rupture with 7cm of separation. It seems that any immune insult is like turning back the clock, symptoms flare up dramatically and it can take months for things to calm down.Unfortunately I did have some very bad asthma attacks and episodes of bronchospasm earlier this year but the good news is that I have been tolerating Xolair (in addition to the Sutent) well for about three months now and it has significantly improved my daily life.I'm under no delusions, I am not holding out for a cure or a fix but it is tremendous to be able to leave the house occasionally.My goals and aspirations have shifted in accordance with my physical condition.It's been a hell of a learning curve and there are days where I struggle more than others (today is one of those days where I am essentially stuck in bed wrapped in cold packs) but on the grand scale of things it could be so much worse.I'm still above ground despite it all, and at least there is potential in being alive even if it isn't always nice to experience.As far my drug addled brain's adventure in Bayesian probability, I had a colleague tell me "genetics don't work that way" which is fine, I'm not a geneticist and I have no interest in becoming one so I will simply defer to his judgement.*but*This is a picture of me while I was deployed. You can see by the tremendous amount of regrowth that I am a natural blond (I prefer to dye my hair red, apologies for the slightly out of focus picture, it was taken with a crappy cell phone).This is a picture of me while on Gleevec; I had to cut my hair short because I was losing it (side effect of the drug) and my hair turned a really dark brown.This is a more recent picture from about four months ago.I'm back to dying it red (I use henna) but as you can see I have the right side white forelock now because of the sunitinib (As I predicted would happen, LMAO. I don't dye the white because it turns a ridiculous brassy yellow color and why not keep it white? I earned it!).My eyebrows are also striped with white but I find that people get weird if they can't clearly see my eyebrows (as I often wear a mask in public) so I dye them for the sake of nonverbal communication.So was I right, or was it Serendipity….does it even matter?Eh, sometimes I contemplate trying to recreate the calculations that my coworkers say I chucked through the shredder (I don't have any memory of this, they said I came in one day, took down all my notes and destroyed them)….but then I think about how crazy that couple of months was and I realize I don't really want to take the trip down that particular rabbit hole again.::shudder::Anyway, just for fun this is the fortune cookie message from the first “real" meal I had in three years, when I started sunitinib.#TRUTH