Category Archives: Healthcare

The Story

I’ve been working on a story for a while, but writing it keeps getting in the way.

I’ve always admired Sir Arthur Conan Doyle’s “Sherlock Holmes,” which was published as a serial in the Strand magazine, a monthly publication. My story–“The Story”–has been under development for a while. Like most writers, I d-r-a-g things out far too long as I write them. It’s a case of “Wait! It was a small dog, not a puppy!.”

As George Lucas supposedly said, “Movies are never completed, only abandoned.” The same is probably true of stories, so I’m going to publish–on this blog–at least a chapter a month. I make no promise that a particular chapter (including one that I may publish) will not be removed or eliminated.

Welcome to the wonderful??? world of writing. You may have the chance to experience my dreams, frustrations, pain, and stupidity, as I try to write a story.

I’ve already changed at least five chapters, but, interestingly, all of the characters remain, although their experiences might be different. If I share, I’ll try not to be too confusing (I’m not responsible for confusing myself).

If it’s worthwhile–I hope you enjoy.

Chapter One is coming soon.

Show Me the Data!

Too many decisions are made with questionable–or worse, self-serving–data. Even worse, they are made for us rather than by us.

In Washington, DC there is a five cent charge for each plastic bag you use at the store. I, like almost everyone else, am tired of seeing those bags stuck in trees, fences, etc. My family recycles about 95 percent of the plastic bags we receive, including the ones in which the newspaper is delivered. The other five percent are repurposed as litter bags, to wrap shoes before they go into the luggage, and for many years, to separate one string of Christmas lights from the others when the season was done.

The idea, I guess, is to use reusable bags, which require energy and raw materials (look–there goes the carbon dioxide into the atmosphere) and reusable bags have microbes delivered  by the fresh fruit and vegetables. The microbes that remain in the bag have nothing better to do that to wait for the next shopping trip. Drop in an orange or two, a banana, and some grapes and the microbes are off on a reproductive orgy.

So, the answer, apparently, is to wash the reusable bags, but water is also a precious commodity in short supply. Is washing reusable grocery bags more ecologically sound than single-use bags that can be recycled?

I’ve yet to see definitive data on any of this to guide me in my decision. However, I do believe that there is a segment of the population who will discard the plastic bag, along with the various wrappers, skins, or bones of the initial contents inappropriately (i.e. on the ground somewhere outside the store).

They say you can’t legislate morality. Likewise you can’t make stupidity or callousness punishable acts. The people who care, will continue to care. The people who don’t, won’t.

In the meantime, can someone show me the data thata will tell me the magic combination for carrying groceries home?

The Brain? Abby Normal

foot

Aaron Hernandez (the late football star) is in the news because he committed suicide while in prison after he was sentenced for murder. His dead body provided shocking information that medical science was not able to discern; his autopsy showed chronic traumatic encephalopathy.

Now, let me get this straight—it’s the twenty-first century, and instead of having flying cars (dammit!) we are just beginning to realize that if you hit someone in the head, over and over, it affects them. It impairs their judgement, causes mood swings, and inappropriate behavior.

Well, we’d better stop that—unless getting hit in the head is part of a professional sport that generates millions of dollars in revenue.

Sounds curiously like the justification for the gladiators fighting to the death in the Roman Coliseum. That, of course, pleased the crowds, but was barbaric.

We’d never stoop so low today, but, if it has major network coverage, instant replays with everything coordinated to accommodate commercial breaks, and attractive cheerleaders, it’s okay. Hell, we’ll have a dedicated section of the newspaper every day!

Hmm.

Being surprised that repeated head trauma causes problems is kind of like the medical logic that “if you shove an ice-pick up somebody’s nose far enough so that it reaches the brain and you wiggle it back and forth, they act differently afterward.”

Is it just me, or are we missing the blazingly obvious?

Maybe I should just shut up and bang my head against the wall repeatedly, until it makes sense.

Football In the Future

Football Hall of Fame Re-opens

Newly remodeled Football Hall of Remembrance opens to celebrate Traumatic Brain Injury.

SATIRE AFFILIATED PRESS
CANTON, OHIO 11 September 2035

Although American style football has been banned, the Football Hall of Remembrance—formerly the Football Hall of Fame—is still a popular tourist attraction. It’s remodeling was recently completed and the familiar football roof is now surmounted by an artist’s conception of traumatic brain injury. Over the front door, the entryway features a bronze relief of a player being carted off the field after, as they used to say, “Having his bell rung.”

While the exhibits still include trophies, helmets, jerseys, and other game paraphernalia, it’s the preserved brain tissue and MRI scans that are today’s favorite. Visitors can view the pathology, then try to guess to which famous player the brain once belonged. Pressing a touch screen, the player’s name, teams, scores, and number of concussions is displayed. Original plans included videos of interviews with former players, but many could no longer communicate, being content to babble incoherently, or stop mid-sentence with, “What did you just ask me?”

Taking a page from big tobacco’s playbook, the industry insisted for years that football was not dangerous; eventually there were too many injuries at the high school, university, and professional levels to ignore. Professional teams found that medical insurance costs exceeded revenues—even if the revenue from sale of team products like hats and jerseys are included. With the profits gone, most owners took their investments elsewhere. Unfortunately, this left many cities with substantial debt for stadiums they built. Many are crumbling and have been condemned because of the degree of deterioration; there’s reason to repair them and no money to tear them down. Universities initially expected a huge financial crisis, but found that the sport had actually not been a money maker, in terms of real cash, but a huge annual loss. Without football many universities were able to improve facilities and pay teachers better.

Football, is gone, but not forgotten—except by those who played the game and had their bells rung too many times.

Fixing Healthcare – Part Three

Physician’s Assistants (PAs) and Advanced Registered Nurse  (ARNPs) are helping lower costs and increase access. While some nurse practitioners, can operate relatively independently; other nurse practitioners and most physicians’ assistants, cannot. Why?

Physicians are adamant that they maintain a high degree of control over these and other healthcare workers. This is a throwback to the nineteenth century—which is kind of interesting in a weird sort of way. The story, and I cannot vouch for its accuracy, although all my research seems to support it, is that the country was besotted with traveling medicine shows hawking patent medicines (You’ve seen it in the movies—“One for a man, two for a horse”). The physician industry supposedly promised to get things under control if they were put in charge of medical practitioners, i.e., physicians and surgeons (MD). It, at best, minimized, if not blackballed, osteopathic physicians (DO), chiropractors (DC) and chiropodists, now known as podiatrists (DPM).

A physician, at the time, could authorize any hireling under his license to perform any duty under the concept that the doctor was “the captain of the ship” and was responsible for everything. Therefore, he had authority to authorize any employee to do anything—hopefully, but not necessarily, after some training.

Today, many non-physician healthcare workers are licensed in their own right; in most states this includes nurses (of all levels), therapists (of all varieties), and technologists (ditto). These people are trained and possess technical skills that physicians do not. Generally speaking, only television doctors leave their practice in order to operating high technology devices. It’s good theater but bad economics.

Many of the other healthcare careers such as nurse practitioners, physicians’ assistants, etc., have made significant advances Unfortunately, old attitudes die hard, and there are too many physicians who try to maintain an inordinate control over everything, including these other professionals. Nurse anesthetists and physicians’ assistance must be “supervised” by a physician, although such supervision does not require actual observation or even the presence of the supervising physician.

Efforts to keep others under control have led to some bizarre arrangements. In radiology, for example I’m told that the technologists are now required to periodically retake the examination that initially proved their competence even though there has been continuing education requirements for 40 years. If true, I believe this is a unique requirement, but a warning to all others. Of all the physicians’ assistants, only those specializing in radiology are not permitted to interpret x-ray or other diagnostic images.

Why?

Some blame the American Medical Association, a very powerful organization with effective lobbyists. However, it apparently speaks for a self-selected group of physicians. Out of 923,308 practicing physicians, the most recent numbers available indicates that only 228,000 belonged to the AMA. If you don’t round, that’s just less than 25 percent.

Nobel Laureate Milton Friedman and his wife, who wrote the book Free to Choose, asserted that the AMA functions more like a guild with the goal of increasing physicians’ wages and fees by limiting both the supply of physicians and the competition from non-physician groups.

This is yet another issue that must be addressed if we are truly interested in fixing healthcare.

Fixing Healthcare in America

First in a series

To correct healthcare and get costs under control, we must first acknowledge, then change the healthcare industry’s unique and outrageously dysfunctional business model.

  1. Physicians and other practitioners who decide which resources will be used in a hospital are often neither the direct provider, the one who pays, nor the beneficiary of the service. Basic economic rules, therefore do not apply. Medical tests, which are intended to provide information that will in some way impact the patient’s course of treatment, don’t. Many test and other procedures are ordered even when the outcome of the test will in no way affect the treatment of the patient or its results.
  2. Medical products and services are priced without any rationale. Often, prices are set artificially high in order to allow large discounts to insurance companies. This means that patients without insurance can be charged list price; eighty dollars for an aspirin or $100 for a BandAid®. Hospitals, which were once a ministry, stewardship, or public service have changed their priority to the bottom line. Some hospitals now own and operate their own collection agencies augmented by a small army of lawyers to guarantee that they collect what they have billed. This is why it is not uncommon for a small-town hospital to have millions of dollars in the bank—and still retain their not-for-profit status.
  3. And the insurance companies that get those big discounts? The hospital needs a staff of trained bureaucrats to generate the paperwork that is sent to the insurance company in order to receive payment. Payments may not be received for several months (for the MBAs out there—remember the first rule of finance—a bird [dollar] in the hand is worth two in the bush [accounts receivable]). When payment does arrive, administrative staff must reconcile the payments and file additional paperwork as necessary. All this adds to the hospital’s costs without adding any value. The insurance companies, on the other hand, are usually quite profitable, even after spending a lot of money on lobbyists. But just like Don Corleone said, “It’s nothing personal, it’s strictly business.”

So, what do we do?

First, it would be valuable to have the physicians evaluate how tests really affect the outcome for their patients and develop appropriate protocols. Malcolm Gladwell relates an excellent example in his book, Blink. The cardiology staff at Cook County Hospital was able to reduce tests while simultaneously improving patient outcomes.

[Gladwell, Malcolm (2005). Blink: The Power of Thinking Without Thinking. New York: Little, Brown.  ISBN 0-316-17232-4 (Especially the chapter on Cook County Hospital Cardiologists)]

Second, revise medical pricing so that it reflects reality—and that must include adequate margin to offset costs for necessary but expensive services. Emergency rooms are expensive to operate while an intensive care unit for patients suffering from burns is actually cost prohibitive. However, hospitals have an obligation to the community to provide necessary services—either directly or by affiliation—to the community. The community, in turn, must ensure the hospital is resourced to provide a wide range of services. If hospital prices reflected cost plus a reasonable margin to offset other costs, and everyone paid the same price—patient or insurance company, it might lead to more rational decisions—outcomes first, but economics as a consideration. If Grandpa—God love him—is a 96-year-old heavy smoker with high cholesterol and other morbidity factors who was hospitalized because of a stroke, a battery of tests that will not affect his quality of life or his longevity are not appropriate, and the insurer should not be expected to provide carte blanche payments. However, if the prices are realistic, the family may decide that they would be willing to pay for those additional procedures on their own.

Third, emphasize cooperation over competition. Is there any other business, other than hospitals, that would allow someone to work in their facility AND directly compete with it? Radiologists have their competing imaging centers, surgeons may have their private surgery centers, etc. Should specialty practitioners be entitled to benefit from the hospital’s patients and compete with the hospital for those same patients? It should be the practitioners’ choice—one or the other, but not both.

Two excellent resources for these issues are:

Brill, Steven (2015), America’s Bitter Pill: Money, Politics, Back-Room Deals, and the Fight to Fix Our Broken Healthcare System. New York. Random House. ISBN 978-0812996951

Rosenthal, Dr. Elisabeth (2017). An American Sickness, New York: Penguin Press. ISBN 9781594206757

If you want to fix American healthcare, pass this along to your friends, neighbors, doctor, etc. I’ll get a lot of hate mail, but we need to have the discussion.

More to follow.

Mayonnaise

As promised, in order to be completely politically correct, this blog is devoted to mayonnaise. Perhaps devoted is too strong a word, but it will be about mayonnaise—I don’t want anyone thinking I have some kind of mayonnaise fetish.

Wikipedia says that mayonnaise is, “a thick, creamy dressing often used as a condiment. It is a stable emulsion of oil, egg yolk, and either vinegar or lemon juice, with many options for embellishment with other herbs and spices.”

I say that mayonnaise is politically correct, non-controversial and slightly bland.

Many of us grew up being told that the most dangerous thing at a picnic was not the poison ivy, the fire ants, or even hungry bears. We were warned to avoid any potato salad that had been out of the refrigerator for more than ten seconds because it would spoil, cause food poisoning,  and we’d die a slow, painful death. Some years later I heard on the radio that because mayonnaise contains vinegar and/or lemon juice—both acting as preservatives—this was unlikely. Of course the guy on the radio might have actually intended to be a mass murderer and slaughter thousands of gullible listeners,wielding spoiled potato salad like a deadly weapon.

There’s phony mayo, labeled either “Salad Dressing” or “Phony Mayo.” Considering that a dab gets added to a sandwich filled with several kinds of meat, cheese, lettuce, tomato, pickles, and jalapenos, I’m sure most people couldn’t tell which dab had been added to  the sandwich they were eating.

Spices are often added because mayonnaise is slightly bland. You must be careful, though since adding things to mayonnaise, changes it. Add mustard to mayo and you have remoulade. Add chopped cooked potatoes, eggs and celery and you have deadly potato salad.

I hope you have enjoyed today’s politically correct, non-controversial, and slightly bland blog. Please do not leave this blog outside in the summer sun as it may spoil and kill you.

Medical Abbreviation$

When I sleep, I use a CPAP, which is an abbreviation for, “I’m buying some doctor a Jaguar to drive.” There are several sound medical reasons for the CPAP:

  • First, I suffer, from chronic healthcare insurance. As long as I have insurance that pays for treatment, the medical industry will find things wrong with me.
  • Second, I have sleep apnea. This mainly means that when I sleep, I snore. Technically it means that I stop breathing while snoring, but I’ve never noticed this. Perhaps it’s because I’m always asleep when this happens.
  • Third, I’m gullible. I actually believe it when someone says, “Here, wear this facemask every night and you’ll sleep better, lose weight, and have a better sex life.” (The preceding is actually true; those were the words of the sleep specialist).

I realize I’m older, and to paraphrase Indiana Jones, “It’s not just the age, it’s the mileage,” but it’s amazing how every trip to the doctor leads to a battery of expensive tests, followed by an expensive prescription. Once, when the doctor couldn’t find anything specific wrong, he wrote me a prescription for a drug specifically formulated to treat a patient with a lack of symptoms.

And so it goes as we get older, yet there’s nothing we want more than to get even more olderer.

We Are Oh, So Smart!

Blood_letting.1

We twenty-first century humans are the pinnacle of humanity in so many ways. We can kill one another with great efficiency AND effectiveness. We can blather to the entire world about absolutely nothing, thanks to smart phones and social media (excuse me while I shoot a selfie).

No one in history was as great, and wonderful (and, might I add, humble) as us. We are the undisputed technological winners.

Well, mostly.

There is that thing about Damascus Steel that the ancients could do with sword blades that we have never duplicated. Imagine what amazing Ginsu knives could be made of that! Or weapons for Seals and Delta Force! Or surgical scalpels and medical implants!

We’re proud about our computers and claim them as our own, but then there’s that mechanical computer from the first century found in a shipwreck by Greek sponge divers. Some say that if it had not been lost, civilization would have advanced so that space exploration would have begun centuries earlier.

And now we find that the bacteria that can whup our best antibiotics (with one pseudopod tied behind its back), Methicillin-resistant Staphylococcus aureus (MRSA) can be controlled by a concoction from the tenth century. An eye salve, found in Bald’s Leechbook, made from fermented, garlic, cow bile, and wine appears to be effective against the disease in several trials. “Leechbook” because the barabarian healers still believed in bloodletting—yet the barbarians got this one figured out better than we did. (Oddly, my insurance provider doesn’t have it in their pharmaceutical formulary, so if I need it, I have to pay for it out of pocket.)

If we truly are smart, we’ll honor those who came before, and figured out some things that demand our respect.

Why My Mechanic Is More Trusted Than My Doctor

I swear that this is not associated with yesterday’s Jobsxtaposition topic.

I love science. I love thinking, questioning and learning. I love Edison’s I didn’t fail, I found a thousand ways NOT to make a lightbulb. Think. Hypothesize. Experiment. Compare results to expectations. Think some more. Question why things turned out the way they did.

I love logic. I love the steps to prove that something is true; I’m challenged by, but accept that you cannot prove something is false.

However, the practice of science today is be very different than my expectations of science. Today, at least according to the media and the politicians, we rely on consensus rather than experimentation, opr God forbid, fact.

How did this happen? Maybe it started with global warming. If we cannot prove that man did not cause it (because you cannot prove a negative) therefore, it is a manmade problem. Why? Because we have a consensus!

There was once another proud science – medicine. While I was doing some research I came across an interesting issue; doctors are expected to treat patients according to universal standards. If the majority of doctors prescribes medicine A or surgery B, and your doctor prescribes therapy C he or she can find themselves in big trouble if they don’t follow the consensus. They could be censured or lose their license. A handful of states have written laws to protect doctors who dare to think, but in most states the medical profession has the clout to keep the state legislature in line.

So, after four years of college; medical school; internship/residency; and several years of fellowship, doctors are expected not to question or think. They are expected to follow the consensus; order the consensus driven tests, prescribe the consensus driven treatment and not vary from the consensus.

Hmm.

My doctor is a wonderful guy. He orders various tests and based on the outcome of the tests he prescribes certain treatments and medication. There are guidelines he is expected to follow. If he varies from the universally accepted (i.e. consensus) he faces consequences.

My auto mechanic is a wonderful guy. He connects my car to the diagnostic computer and based on what the computer says, he makes certain repairs. There is a book that tells him what to do and what to charge. He’s a smart guy, but doesn’t have the education of my doctor.

The difference is, that if my mechanic wants to try something out of the ordinary, he can, and does, and it often fixes the problem, thank you.

 

Murphy’s Law and Aging

Bob came into work the other morning, looking more unhappy than I’d ever seen him before; naturally I asked him why he looked so glum.

“I’ve worked hard all my life,” he began. “You know that as well as anyone. We cut corners and pinched pennies. We managed to raise three kids, giving them whatever support we believed to be important. They all graduated from college and their careers are all off to a good start—a real good start, if I do say so myself.

“For years, it was Burger-Helper, buying used cars that we then kept for ten or twelve years, and foregoing vacations. Neither my wife nor I minded; it was for the family. But after the kids had grown, we sold the house and moved into a brand new home. We designed it ourselves; it was a smaller place ideally suited to a couple. It had a beautiful master bedroom suite. The kitchen was equipped with professional level appliances—larger cooking area, smaller eating area.

“We enjoy cooking gourmet meals together—it gives us a great chance to just chat, so after slicing, dicing, and sautéing together, we’d sit together in the smaller dining area which seemed, well, romantic. Outdoor cooking is just as fantastic. The patio is built around a grilling system complete with mini-refrigerator, wine cooler, and a sink with hot and cold running water. All the things we had given up for so many years, we could now plan on enjoying: a beautifully aged, well-marbled steak accompanied by a lobster, gourmet cheese, a stuffed baked potato, freshly home-baked bread, fine wine, exquisite desserts and for me, with the political climate changing, perhaps even an after dinner Cuban cigar.”

“That all sounds wonderful,” I offered, “so why so sad?”

Bob took a deep breath. “I went in for a ‘routine’ medical visit—the ones I had often tended to skip for financial reasons in the past. The doctor ran all the fancy lab work and such, and then called asked me to stop back in for the results. That worried me of course. Fortunately it wasn’t to tell me I had cancer or whatever.”

“Then what was it?” I asked. At this, Bob sobbed.

“He told me all the years of eating cheap food had taken its toll. Forget the steak and shellfish—too high in cholesterol. The French advise ‘either cheese or dessert.’ My doctor says ‘neither cheese nor dessert.’ Bread and potatoes have too many carbohydrates, and I don’t have to tell you about the lecture I received about starting to smoke at my age.”

“Wow!” I replied. “You must have been devastated!”

“That’s not the worst of it,” Bob replied. “He said, ‘Guys your age all think they should be able to enjoy wine, women, and song. Go easy on the wine. You have a wonderful wife, so it’s woman
not
women, and, by the way, if you want to keep her—since I’ve heard you sing—I’d suggest you limit your singing to church.”

CDC and Ebola

Spanish flu treatment center Smithsonianmag.com

Spanish flu treatment center
Smithsonianmag.com

My congressman ran a poll asking his constituents if they were confident in the Center for Disease Control’s (CDC’s) ability to combat Ebola. He’s probably sorry he asked, because this is how I responded. Obviously these are my own opinions (aren’t they always?), although I did try to check basic facts (number of dead in World War I, etc.)

I spent 30 years in the healthcare industry, starting off in a technical clinical discipline, and later, after completing my graduate degree I moved into management and was a Fellow in the American College of Healthcare Administrators. My current position includes support for emergency management.

CDC is very good at doing certain things, but their best work has involved basic research, which doesn’t mean “simple” but getting to the root issues behind a scientific question. Basic research is often the most result oriented because instead of jumping to a search for the solution, it instead focuses on learning about the problem without preconceived notions. The classic example was when Dr. Fleming noticed that something was affecting the other bacteria in his experiment. By studying this “something” he discovered penicillin.

It appears that in recent that the attention of the leadership of the CDC has been drawn away from basic scientific research and become more focused on political issues, which well may have impacted their effectiveness. For example, there are reliable reports that CDC has spent significant effort to shut down doctors who believe in treating chronic Lyme disease. Some physicians believe that the organisms that causes Lyme disease, and an associated disease, babesiosis can become dormant in a patient, but when triggered by trauma, or other events, the symptoms become active again. Although not scientifically proven, patients have reported improvement when treated with a regimen of certain antibiotics and anti-parasitic drugs.

The CDC has not proven these conditions do not exist, which is understandable given that it is impossible to prove a negative. However, they have taken this issue on as a crusade and allegedly gone so far as to classify this as a Homeland Security issue in order to justify the use of legal authorities and law enforcement techniques.

Unfortunately, they have not been quite as enthusiastic at adhering to basic, proven infection control techniques they haven’t exerted the same amount of effort to adhere to basic protocols resulting in the exposure of CDC personnel to anthrax and the loss of at least one container of viable small pox. Incidentally, small pox was the first chemical weapon when the blankets of small pox victims were given to Native Americans, thereby intentionally introducing the disease to the indigenous population of North America.

I’ll give the CDC the benefit of the doubt. I think they can handle this IF the politically appointed and wanna-be-police types get out of the way. Should we cut off contact with western Africa and deprive them of essential expertise, medicine and equipment? I think not. While it may be politically unpopular, until effective treatments or vaccines are perfected, quarantine may be the most logical step. The health professionals actively working with Ebola patients at the handful of designated hospitals are the best trained and equipped. However, mistakes are made, equipment fails, and while the doctors, nurses, therapists and technologists may follow the protocols correctly, is it possible for a housekeeper or a maintenance person to become infected? I think so.

It may be wise to quarantine people who have been exposed to Ebola. The Ebola hospital staffs may just have to live and work within the confines of the facility for the duration. It’s an inconvenience but our military men and women have been living with such inconveniences for the past eleven years, all the while being shot at, rocketed, mortared and the target of suicide bombers and IEDs.

If the USNS Comfort and USNS Mercy – the Navy’s 1200 bed hospital ships are not being deployed elsewhere, they could provide medical care as well as quarantine. Those exposed and being monitored would not have to live in military austerity, but instead could be housed in nicer accommodations to make the experience less painful; a hotel leased by the government, or perhaps a cruise ship. Nice accommodations, but safely out of circulation until everyone is sure that the individual is not infected

If everyone exposed to Ebola were quarantined for 28 days, it just might prove to be significantly cheaper to pay for lost wages and accommodations for these people than to let the disease spread. If the CDC puts the science and safety first, they’ll succeed. If the politics and power struggles take precedence, stand by. Those who do not study history are doomed to repeat it. The “Spanish” flu of 1918 is estimated to have killed between 50 million and 100 million; by comparison, the total death toll of the Great War (World War I)— all military and civilians—is estimated at 43 million.

Bottom line—let the scientists do their job.

It’s Kind of Like Denny’s – Only Different

eggsSeveral high tech companies have now adopted policies to enhance the ability of women to compete in the workplace. Science has now made it possible for a woman to have her ova (eggs) harvested when she’s young so that she can delay having a family. The advantage is that a 40-ish year old woman can have the eggs harvested at age 28 fertilized and implanted so that the risks normally associated with a later-in-life pregnancy won’t be a problem.

It’s the female answer to sperm banks.

Of course, if you’re now a fortyish female who has risen to the top at a high tech company, will you really want to take time out to hatch those should-now-be-a-teenager eggs?

I suspect this is the first step of a whole new process for talented people of both sexes. (I initially meant one of each, but actually, any combination works.)

If someone is ubersuccessful in their chosen field, if they deferred having children in their early corporate years, what is the chance of them leaving that coveted corner office unprotected once they’ve hit the big time? Personally I think not so much.

I figure it will go something like the sex scene between Harold Ramis and Diane Keaton in the movie Baby Boom – only less intimate.

The husband and wife (or other combination) go to a romantic setting, and after ordering cocktails or a bottle of wine the maître de hotel introduces the twenty-first century version of the wine steward (and for you traditionalists, no tasting cup on a chain around his neck – PLEASE!).

“Good evening, madam; sir. I am Francois,” (actually it’s Ralph, but Francois gets him better tips). “Now I understand, Ms. Cheri that you are thinking of your ovum from 2000, although you also have ova frozen in 1998 and 2005. Am I correct?”

“Yes, Francois. I like the millennial aura, you know. The changeover from mainframes to servers, the whole Y2K thing.”

“An excellent choice, madam, but, just in case, we also have a wonderful selection of ova ranging from exotic dark haired beauties from Tahiti to our honored Native Americans.”

“Thank you, Francois, but I’ve given this a lot of thought, and I am sure that I will be using my ovum from 2000.”

“But of course, madam. Then of course, we must consider the gentlemen.”

“Oh, I have, Francois, I have. Bob here is a wonderful husband and provider, but long ago we realized that his DNA would never be put out for stud. I’m looking more for a Steven Hawking type, but disease free, of course.”

“Absolutely, madam. Fine arts, Law, Science?”

“Science, please, and I’m partial to electrical engineers.” Francois leaned in.

“I have one and only one Nobel Laureate in physics, but it’s outrageously expensive.”

“Not a problem.”

“And would madam like to schedule her appointment for implanting the fertilized embryo? I have next Tuesday available due to a cancellation.”

“Francois, would you be a doll and line up a surrogate? We’re finishing up our new line of cell phones with the product release in a month.”

“Yes, madam, I understand. Do you wish us to arrange for a surrogate who will also act as nanny?”

“Francois, you’re wonderful! Make sure she reminds me of birthdays and holidays. I promise I’ll try to stop by and see my child for all those occasions.”

“Of course, madam. And may I be the first to congratulate you on the wonderful news!”

My New Patient, the Terrorist

As a psychiatrist, I see all kinds of people; couples trying to communicate, Woody-Allenish-neurotics, and the occasional psychotic with delusions of grandeur. Some of my patients are folks for whom La-La Land is Home Sweet Home.

One of my newest patients has occasionally been in the news. Operating under the code name of “The Fruit Fly,” Whoopee bin Yowhzah was apprehended for an attempted act of terrorism on a flight. Although he did not, in fact, have a bomb, he nevertheless set his (rather soiled) underwear on fire. When the smell of his own scorched skivvies did not achieve the desired effect, he then attempted to set fire to the underwear of the other passengers.

When the plane landed in Cheyenne, Wyoming, he was arrested. He proudly announced to anyone who would listen that he was sure he would sent to Guantanamo, but was instead held in the Laramie County Jail. He demanded to be water boarded, which was ignored by the staff, so he stuck his head in the cell toilet and repeatedly flushed it until deputies restrained him.

It was decided that instead of communing a military tribunal, he would be tried before a judge and jury in New York. He was, quite understandably, found “Not guilty by reason of insanity” and committed to a psychiatric hospital.

I first met him as he sat on the edge of his bed. We started out with some small talk, and I asked him to tell me about himself.

“Me? I am a terrorist!” he replied enthusiastically.

“I see,” I replied, “and why did you become a terrorist?” He looked at me as though I was clueless.

“Being a terrorist is a religious calling!” he explained. “God, Himself, called me to be a holy warrior!”

The patient in the next bed sat bolt upright and glared at both of us. “I most certainly did not!” he replied.

 

Calculating Retreat

Monty Python and the Holy Grail

Monty Python and the Holy Grail

There are times when the best thing to do is, to quote Monty Python, “Run away! Run away!”

Imagine how history would have unfolded if George Armstrong Custer had decided that maybe this wasn’t the day to make a stand at the Little Bighorn. He might have lived out his days in his household rather than becoming a household name.

Here are some signs that a retreat is in order.

Your boss says, “The company is doing great! We’re financially sound. By the way, does everyone understand the benefits of public transportation and the healthcare exchanges?”

Your daughter walks out of the bathroom with a deer-in-the-headlight expression holding a small plastic wand and says, “Guess what?”

You stop by the auto shop to get the estimate for repairs on your car and hear the mechanic on the phone, saying, “Don’t worry, I figured out how we can send Junior to college without a student loan.”

Your mother calls you by your complete first, middle and last name, followed by a pause.

What’s Really Important?

Reading the headlines – the war in Crimea, political buffoonery in Washington, global warming, Snowmageddon, etc. can be intimidating.

What’s really important? What really matters?

I’ve given it much thought and I decided.

Of all the laundry, I like the towels best.

Brotex.com

Brotex.com

They’re easy to fold, AND you can fold a whole dryer load in a matter of minutes.

They’re easy to match than socks.

None of them need to go on hangers.

And nothing beats a warm towel after a shower on a winter’s day.

Designer Babies

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The news says we can now modify genes in babies to eliminate certain possible diseases. This is done by adding genetic material from a woman to the existing DNA that originated with the father and the mother. Some say that the next step is “designer babies” with DNA adjusted to be exactly what the parents’ desire.

1. I can certainly see some fights between parents as to what should or should not be included. Picking a name is often contentious enough.

2. If the baby doesn’t turn out exactly as planned, whom do you sue?

3. Does the “other woman” have any childcare obligations in the event of divorce? Can she say she’s been “put out for stud?”

4. Remember that cute kitten you had that grew up to be a cat? The baby might be “up to specs” but that doesn’t guarantee that it will be perfect as a teenager.

I tell my kids that God made each of them exactly the way He wanted them for whatever role He expects them to play. I prefer to leave such decisions up to Him.

However, I wouldn’t mind if the “clean your room” gene suddenly clicked on.

One Day

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In John Scalzi’s Old Man’s War, the protagonist, John Perry, talks about how when you reach a certain age it isn’t “one thing after another,” but instead, “everything all at once.”

That’s what my father is dealing with, and us along with him.

Both my father and mother – and myself for that matter – have told others that if medical science can return us to a reasonable functional level, go ahead and do what is necessary. However, if life is going to be severely limited, such as being bedridden and connected to a ventilator, please don’t take such extraordinary measures.

My father hasn’t been able to eat much over the past week or so. Today the discussion among the staff was the need for a feeding tube. There’s a temporary nasogastric tube that’s effective but uncomfortable. There’s a surgical gastrostomy tube that’s permanent. Where’s the line between supportive and extraordinary? What should we do?

His doctor arrived at about 9:00 pm and discussed the situation with us.

Were we going to face a heart rending decision?

She brought us up to date on everything. When it got to the issue of nutrition, my father protested that even the sight of food bothered him. His taste was altered by the treatments and everything was sickly sweet.

“What about toast?” the doctor asked. “Say toasted rye bread?”

“I think I could do that,” my father replied. “I also want something to drink that’s not sweet – like lemonade.”

The doctor pointed out that lemons have too much potassium. We threw out various suggestions and lo and behold someone mentioned a particular grapefruit based soda that none of us had thought about in ages.

My brother ran out and got the soda. My father decided that toast and the soda was good.

The Lord gave us at least one more day, but I know there was a reason. Perhaps it was to bring us closer. Perhaps it was to teach us not to let the high tech overshadow the simple solutions. It could even be because He rewards families that love one another.

For whatever reason, it was a day that began with concern and ended more sweetly.

Thank you God.

The Lyme Disease Conundrum

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Lyme disease is back in the news. The Center for Disease Control (CDC) estimates 300,000 Americans are infected each year. This is ten times as many as the various reports have suggested in the past.

Lyme disease is an illness in which a spiral shaped bacteria – Borrelia burgdoferi is transmitted by the bite of the Blacklegged Tick. The basic test for Lyme disease (Enzyme-linked immunosorbent assay [ELISA]) is viewed as unreliable. There is a more reliable test called the Western Blot but its use is not automatic.

The signs and symptoms of acute Lyme disease are nonspecific and are often flu-like, including fever, chills, fatigue, body aches and/or headache. The most unique sign of Lyme disease is a red lesion at the site of the tick bite, surrounded by a clear area which in turn is surrounded by a red rash resulting in a bulls-eye pattern. Unfortunately this is not universally experienced, or may occur on the scalp or some other area that is not apparent.

The real controversy is in the discussion of chronic Lyme disease. The symptoms described by those who believe they are suffering from chronic Lyme disease include extensive fatigue, aching joints and/or headaches as well as vision problems, heat intolerance and adrenal insufficiency.

There are people in the medical and insurance industries who claim chronic Lyme does not exist. These include the Infectious Diseases Society of America and the American Academy of Neurology. Their position is essentially “We don’t know what it is, but it ain’t Lyme,” and refer to this medical condition as “Post-treatment Lyme Disease Syndrome.” I really have to wonder about medical professionals who don’t know what it is and are satisfied with that.

Are there opportunistic microbes like the parasite Babesia that take advantage of a patient’s compromised condition during acute Lyme, resulting in a long term disorder? Does the Lyme spirochete leave the bloodstream and settle in tissues where it is more difficult to find or medically treat? We don’t know and we need to find out.

So where does that bring us? Here’s the condensed version with additional facts inserted as appropriate.

We have a disease that was discovered in 1982. The primary test for this disease is not accurate. There is a more reliable test, but the medical establishment does not recommend its use when the first test is negative, but only when the first test is positive.

We now believe that we are understating the number of patients with acute Lyme by 90%.

Some who are infected have the condition have the condition relieved by prompt medical treatment including antibiotics. Others continue to describe pain and significant fatigue for years after treatment for acute Lyme disease. Medical science does not know what the chronic condition that follows is, or how to treat it.

Some practitioners have utilized long term antibiotics to treat chronic Lyme / Post-treatment Lyme Disease Syndrome, with the patients reporting relief of the symptoms. Other practitioners claim that the long term use of antibiotics is no more effective than placebos, and may be harmful. In my opinion, the research has not been comprehensive.

Incidentally, you can have your dog vaccinated to prevent Lyme disease, but not your children.

My recommendations?

1. Our understanding of disease is not absolute. There are things we don’t know.

2. Medicine has had to change its position on a number of issues. We no longer practice bloodletting and trepanning. Even in my lifetime, medical opinions have changed with regard to Multiple Sclerosis, Fibromyalgia, Agent Orange, and Gulf War Syndrome. We regret the lobotomies and involuntary sterilizations that once were common in dealing with the mentally ill.

3. Many medical conditions are handled by treating the symptoms rather than the disease. If a patient presents with sneezing and a runny nose during pollen season, practitioners prescribe Zyrtec (R), Flonase (R), Allegra (R), etc. without needing to know which flora or fauna is responsible.

4. We have the scientific tools available to investigate how to solve this question and alleviate patient suffering.

5. Should we reinstate human vaccination for Lyme?

Unfortunately, we will probably have to begin this research from scratch. Practitioners who have focused on the management of chronic Lyme disease / Post-treatment Lyme Disease Syndrome, have been driven from the field or tried to maintain a low profile to avoid criticism or censure by various professional societies and organizations.

In Virginia, there recently was legislation requiring doctors to tell Lyme patients that the ELISA test was not infallible and that the Western Blot test was available. It did not require any action on the part of the practitioner – only that the patient be informed. This was firmly opposed by the Medical Society of Virginia.

However, I have faith that practitioners and scientists out there will conduct the research that will lead to an effective method for alleviating these symptoms in patients.

Note: If you want to read a great book on how numerical and statistical data that seem to point incontrovertibly to a conclusion really doesn’t , read Proofiness, by Charles Seife.

Quickstart Guide for New Parents

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Congratulations on starting your family. As a new parent you may be concerned about properly raising your child. There’s no need to worry, all of the documentation required is included with your new baby.

This Quickstart Guide will give you key information on raising your family until you have time to read the entire manual.

Your oldest child will act as a practice model. It is expected that you will be more attentive, more restrictive and generally more paranoid about this child. It is normal to check on a first baby every few minutes when sleeping to make sure he/she’s breathing. You can expect to favor healthy, possibly organic-locally grown and home pureed foods. You may decide to restrict television to educational channels or prohibit it entirely. Every bump and minor bruise will cause you to rush to the emergency room.

However, subsequent children will require less attention. For your second or later child you will permit them to eat whatever they want, watch television 23 hours a day, and only missing limbs or arterial blood spurts will capture your attention. In addition, these younger children come equipped with the highly developed ability to irritate your oldest child and cause him/her to misbehave badly. This sibling interaction will keep the entire family involved for hours.

It’s normal that you and your spouse will each have very specific ideas as to how the child should be raised. Each of you will expect the other to adapt on issues from cultural mores, manners, education, and hobbies right down to details, such as the correct way to fold clothes. Don’t worry, because you’re both wrong.

You may have received the optional “advice” feature for your child. Ideally this is provided through a maiden aunt who will be happy to provide unsolicited advice on how children should be raised and direction on all manner of parenting issues.

Again, this is only a Quickstart Guide. Remember to read the entire Child Rearing Handbook, which will save you much time and anguish. The Child Rearing Handbook is contained in the same envelope as your child’s warranty card, and receipt in case you decide to return or exchange the child. These items can be found conveniently located fg hu6th heiemn ded.

If you have any questions or problems, please contact us 1-8hg-stf-xd#@ or at http://www.&^hsg463nbgm.com/hasythr

Once again, congratulations on starting your family.