HinesSight

Laurel Hines, my wife, supports changes to Oregon's Death With Dignity law

The Oregon legislature is considering a bill, SB 1003, that would make changes to our state's Death With Dignity law -- which allows people who have six months or less left to live to exercise control over the time and manner of their death by taking physician-prescribed medication.

Passed by Oregon voters in 1994, and affirmed in 1997 when it took effect after a legal challenge, the law is a good start, but it needs improving. That's why my wife, Laurel Hines, testified in favor of SB 1003 at a Senate Judiciary Committee hearing on March 3.

Laurel told the committee that it makes sense to allow physician assistants and nurse practitioners to deal with patients who want to make use of the Death With Dignity law. In many rural parts of Oregon, PAs and NPs are the primary caregivers, since physicians are lacking in those areas. 

She also approved of a proposed change that reduces the waiting period to use the law from 15 days to 2 days, telling the committee that a 15 day wait after deciding on a peaceful death could be intolerable, and it prolongs the patient's emotional agony. Further, some people lose the ability to self-administer the medication over a 15 day period (that's a requirement under the law).

My wife was quoted in a couple of news stories about the hearing. Here's an excerpt from a story in The Lund Report (an independent publication focused on health care in Oregon), "Senators hear passionate arguments over how terminally ill patients end their lives in Oregon."

How easy should it be for terminally ill people to end their lives? Debate over how Oregon should answer that question is flaring in Salem.

A group of doctors want to cut the waiting period for Oregon’s Death with Dignity law from 15 days to 48 hours and allow not just physicians but nurse practitioners and physician assistants to prescribe medication and oversee the process that allows terminally ill patients to end their lives.

Critics say the changes will remove safeguards voters were promised when they approved Oregon’s physician-assisted dying law in 1994 and affirmed in 1997. Supporters, however, say the law needs an update in response to doctor shortages and for patients who are on the brink of death.

“I believe that these changes that are being proposed are not radical at all, and extremely reasonable,” Laurel Hines, a retired Salem social worker, told lawmakers Monday.

Lawmakers considered those arguments during a hearing of Senate Bill 1003, which would make the most far-reaching revisions to Oregon’s Death with Dignity program in the history of the law.

Hines said that Oregon’s law is modest compared to what’s in place in Canada and other countries. Without reforms to Oregon’s law, she said more people would turn to “do-it-yourself options.”

“I now have traumatic memories of my sister dying the way she did, and being in the condition she was and in pain that morphine didn't control and her loss of autonomy."

The Portland Oregonian also had a story that mentioned Laurel, "Bill to ease medically assisted suicide runs into wall of opposition." 
Download Bill to ease medically assisted suicide runs into wall of opposition

The bill would loosen Oregon’s first-in-the-nation law by reducing the standard waiting period after patients ask for lethal doses of medication from 15 days to two days. Among other provisions, it would eliminate the need for two doctors to sign off on medically assisted suicide and instead allow two physician assistants or nurse practitioners to do so.

No individual lawmakers have signed on as sponsors of Senate Bill 1003, which was filed by the Senate Judiciary Committee.

Only two people spoke in favor of the bill Monday. Eight people spoke in opposition, along with 150 Oregonians who submitted written testimony objecting to the bill.

Dr. Paul Kaplan, who said he was speaking for a group of about 30 mostly retired doctors who’ve focused on end-of-life care, told the committee the bill would help reduce inequities in rural Oregon where most residents use physician assistants or nurse practitioners for their medical care.

“There are very large areas of Oregon where there is not a doctor available for hundreds of miles,” Kaplan said. “And so this service is literally not available to patients who live in those areas.”

Laurel Hines, a Salem resident, told the committee that sometimes waiting 15 days is too long. Hines said her sister deteriorated within a few days of going into hospice and would not have been able to self-administer a lethal dose — as required by Oregon law. Though Hines’ sister died in Illinois, where there is no medically assisted suicide law, Hines used her sister’s death as an example of what can happen to terminally ill patients.

“I now have traumatic memories of my sister dying the way she did and being in the condition that she was and pain that morphine didn’t control,” Hines said.

It seems that many or even most of the 150 comments in opposition to the bill likely came from an organized effort by Oregon Right to Life. Laurel read the comments and told me that there was talk about the horror of killing unborn children, though abortion obviously has nothing to do with the Death With Dignity law. Most of those opponents probably hadn't even read SB 1003, so hopefully their comments will be discounted by the committee.

Salem Health dumps Regence after each blames the other

When I went in for a teeth cleaning session at my dentist's office this week, I told the front desk person that I had different insurance now, having signed up with Providence MedAdvantage at the end of 2024 because I didn't want to run the risk of my Regence MedAdvantage plan being severely handicapped by Regence and Salem Health failing to renew their contract -- which seemed likely at the time.

I was told that many of their dental patients have done the same thing: dumped Regence. A few days ago the wisdom of that move became clear when Salem Health issued a news release whose title says it all: "Update: Negotiations fail, Salem Health can no longer accept Regence insurance." Excerpt:

For over a year, Salem Health Hospitals and Clinics has worked tirelessly to reach agreement on a fair and equitable contract with Regence BlueCross BlueShield that covers the cost of providing health care in the mid-valley. Despite daily negotiations and numerous accommodations by Salem Health, Regence has been unwilling to offer any meaningful compromise, forcing Salem Health to stop accepting BlueCross BlueShield insurance effective Feb. 24, 2025.

“It is Salem Health’s obligation and privilege to provide high quality of care for our community,” said Cheryl Wolfe, Salem Health president and CEO. “Unfortunately, that means making difficult decisions to ensure we can provide that level of care now and for the next generation. We understand this decision will be difficult for our patients who are BlueCross BlueShield members. We have worked so hard to find an alternative path with Regence and are so deeply frustrated and heartbroken that this is where we are.”

Since the contract between the two parties expired Jan. 1, Salem Health has seen a pattern of Regence denying coverage and passing the full cost of care to their members. This leaves patients with overwhelming medical bills, even as these members continue to pay their premiums to Regence.

Of course, Regence has a different perspective on this corporate pissing match, issuing its own news release, "Salem Health's leadership has walked away from negotiations." Excerpt:

We have been working for months to find a reasonable path to bring Salem Health’s providers and facilities back into our network. But today their leaders said they are not interested in continuing conversations if we won’t give them a 40% increase.

Salem chose to terminate our contract at the start of this year and appears uninterested in serving Regence members.

We’ve been transparent that our aim is to protect our members and customers from unsustainable increases in the cost of care. We hear regularly from people who are frustrated about the very real impact health care affordability has on their lives. Those frustrations extend to our regulators, who have asked us to limit care to 3.4% growth annually.

Salem Health leaders have continued to insist on reimbursement rates that far exceed that amount. We’ve regularly given them increases through the years, and we have offered them an increase in our current conversations as well. However, they continue to demand more, and we cannot do that to our members and customers, knowing any increases in the price of care will cost them more.

We understand that Salem Health’s position is that they are ready to stay out of network for a long time, asserting that they do not need Regence for their continued business and plan to prioritize patients insured by others. They’ve indicated that they can easily replace our members with other patients.

This is a most unfortunate position that prioritizes their profits and not their patients and turns a blind eye to the disruption they have caused in the community. We want to provide access to our members, but we will not ask them to shoulder the burden of lining the provider’s pockets.

I don't know who to believe. My leaning, I guess, is a bit toward Salem Health. After all, Salem Health says that they have contracts with 15 other insurance carriers, though it's unclear how many of those contracts were newly negotiated.

When I turned 65, I signed up with Regence MedAdvantage. So for over ten years I've been mostly satisfied with Regence. In 2024 I paid $72 a month for coverage, in addition to what is deducted for Medicare from my Social Security payment. Now I'm paying Providence MedAdvantage $82 a month for a roughly similar plan.

What disturbs me is the disruption caused to people in the Salem area who have Regence health insurance and either weren't able to switch to a different insurance company, or didn't want to switch, perhaps trusting that Regence and Salem Health would work out a deal. 

The number of people potentially affected is open to debate. Salem Health's news release says more than 30,000:

Salem Health requested continuity of care for all Regence members after January while the two parties negotiated toward a fair contract. Regence largely denied this request. Out of more than 30,000 local BlueCross BlueShield members, Regence has granted continuity of care for less than 400, leaving the others with almost no local access to care and large medical bills. To avoid further crippling medical debt for patients, Salem Health has made the difficult decision to stop accepting BlueCross BlueShield insurance.

Regence's press release says 30,000 is too high.

Salem Health says Regence has 30,000 affected members – not true: this number includes members from other Blue plans across the country as well as thousands of people who were no longer eligible with any Blues plan.

Regardless, it's a sad commentary on our nation's dysfunctional health care system that two giant corporations can hold hostage the physical and mental health needs of many thousands of people in our area.

I'm not expecting that the next four years of the Trump administration will see any improvement in this regard, since at the best our health care system will be fortunate to maintain the crappy status quo: way more expensive than in other comparable countries, while we have poorer health outcomes.

In Providence strike, I'm on the side of nurses and doctors

Last Friday Oregon's largest health care strike in history kicked off as about 5,000 nurses, doctors, and midwives walked off their Providence Hospitals jobs. Dissatisfaction with working conditions was a major reason for the strike, according to the Oregon Nurses Association. 

One of Oregon’s largest healthcare providers, Providence, is a system in crisis that threatens the health and well-being of all Oregonians.  

We are nurses, doctors, physician associates, nurse practitioners, and certified nurse midwives from Providence facilities across Oregon. Some of us have been bargaining with Providence for more than a year and are working without a contract.

Providence has rejected our common-sense proposals to improve patient care and safety by not committing to safe staffing and other critical patient safety issues in our contracts. That’s why we’re going on strike starting January 10.

When healthcare workers are asked to do more with less, patient lives are at stake. Providence has pushed nurses, doctors and other healthcare professionals to work under unsafe staffing conditions.  

Providence hasn’t offered any real plan to increase retention. Providence simply isn’t competitive with other healthcare systems in the areas where they operate. That means fewer workers; longer ER lines; longer surgery waits; and more medical complications, as Oregonians can’t get the care they need quickly. 

We have made the difficult decision to go on strike because Providence executives aren’t listening to us. We need Providence to put patients before profits and do everything they can to make sure healthcare professionals can work to the top of their practice and stay for the long term.  

Today Providence paid for a full page ad in the Sunday Oregonian newspaper. I'm a digital subscriber. Here's screenshots of the ad, which I found annoying and demeaning toward nurses.

Providence Health & Services claims that the Oregon Nurses Association called a strike with the intent of cancelling patient appointments and services. I doubt there's any solid evidence supporting that assertion, and it goes against the ONA statement of concern for patient well-being. 

And Providence also claims the Oregon Nurses Association is fully responsible for disruptions to patient care. Huh?

Negotiations over union contracts obviously involve two parties, the employer and the employees. Sure, often each side blames the other for being unreasonable if a strike occurs after negotiations break down, but usually this is hyperbole. Each side should shoulder some blame for the strike.

Hopefully Providence isn't operating under a fantasy that the public is more sympathetic to a giant health care corporation than to the nurses and doctors who provide care at the eight Providence hospitals around Oregon. 

I deeply doubt this is the case.

When someone needs care at a hospital, it is given by nurses and doctors, not by the management of the entity that owns and runs the hospital. I've appreciated the competency and friendliness of the doctors and nurses who handled my fairly recent hernia and eye operations at Salem Health, along with screening colonoscopies.  Administrators of the health care organization responsible for my care mean nothing to me.

After ten years of being a member of Regence Medicare Advantage, I just switched to a Providence Medicare Advantage plan after Regence and Salem Health failed to agree on a 2025 contract, which meant that I'd have to pay more for out-of-network care from Salem Health as of January 1.

So far (just twelve days), I'm satisfied with Providence Medicare Advantage. Several times I've phoned Providence with questions about my new insurance plan. The people I've talked with have been helpful and pleasant. But again, I'm thankful for the front-line staff at Providence, not management. 

The financial aspect of the offer Providence says it has made to nurses and doctors seems pretty reasonable. But it appears that working conditions and staffing levels may be the bigger concern for the nurses and doctors. I'm on their side, as I strongly suspect a majority of Oregonians are.

My wife made the healthiest main dish in the history of Christmas Eve dinners

Part of me says, "You shouldn't be bragging on Christmas Day." Another part says, "Dude, go ahead and brag -- you aren't bragging about yourself, but about your wife, Laurel."

I'm listening to that part.

For while the title of this blog post might seem to be an exaggeration, it accurately reflects the prevailing opinion among me, Laurel, and five friends we invited for a Christmas Eve dinner at our house last night 

Well, in the history of Christmas Eve dinners is an embellishment that I added for dramatic effect. But it's true that all seven of us agreed that few people were having as healthy a main dish as what Laurel served for dinner.

Here's a photo of my leftover plate that I'm having for dinner again today.

It's a vegetarian loaf with organic lentils, kale, brown rice, and carrots, with cranberry sauce as a glaze on top, plus some other minor ingredients. (It was supposed to have a celery stalk also; Laurel forgot to put it on the list when I went grocery shopping on Sunday, so celery wasn't included.)

UPDATE: Here's a link to the Ultimate Vegan Thanksgiving Load with Cranberry Sauce recipe. You have to scroll down a ways to find the recipe on this web page. 

Since I've been a vegetarian for 55 years, with no meat or fish entering my mouth during all that time, I readily admit that my taste buds are so attuned to healthy vegetarian food, there's no way I can compare this veggie loaf with turkey, ham, or any other food that once was walking around -- assuming it was raised outside of a factory farm, since in those places some animals don't have enough room to walk.

All I can say is that it tastes good to me, as it did to everybody who ate it last night. Of course, our Christmas Eve dinner included some other food: mashed potatoes, salad, green beans, chocolate cake, poppy seed cake. Our guests contributed several of the dishes. 

I'm not religious, but it was a Christmas miracle of sorts when I got on the scale this morning for my daily weigh-in and found that not only hadn't I gained any weight, I had lost some, even though I ate quite a bit last night.

That's a side benefit of eating healthy vegetarian food during the holidays, as well as throughout the year. It tends to be lower in calories.

My weight has bounced around a bit during the vegetarian phase of my life, which began when I was about 21. Currently I weigh just a bit more than I did in high school. However, my height is a few inches less (damn aging!) so my BMI, body mass index, must be greater now.

I'm not a strong proselytizer for vegetarianism.

Still, I'm not shy about pointing out that not only is giving up meat good for a person's health, it's good for our planet. Raising animals for food is a major contributor to rising greenhouse gas emissions, which makes being a vegetarian wise both personally and environmentally. 

Here's what's scientifically true about good nutrition

When it comes to what sorts of food are best for us, opinions abound. There's a never-ending avalanche of nutritional advice from many different sources: social media, news sites, television ads, books, and such.

Often this advice isn't based on scientific facts. That's why I was thrilled to see the special issue of New Scientist that arrived in the mail recently. The cover headline: How to Eat Better: The Seven Chewiest Questions About Nutrition and Your Health.

Here's the questions and a brief summary of the answers. (New Scientist is a British publication, so some spellings are different from American English.)

(1) Could when you eat matter as much as what you eat? Not really. But it's advised to "get most  of your calories earlier in the day and avoid eating altogether during your biological night, which for non-owls starts around 8pm." Owls, who wake late and go to bed late, could eat later at night. 

(2) What's the truth about hormone-balancing diets? Hormones vary a lot, so the notion of balancing doesn't make much sense. However, it's still good advice to follow hormone diets touted on social media just because they make good general nutritional sense: "eat more wholegrains, more lean proteins, plant-based fats, fruits, vegetables, high fibre foods."

(3) Is snacking really that bad for you? It depends on the quality of the snack. "If you are a grazer, as long as you're grazing on healthy food and not grazing late at night, current evidence would support that can be part of a healthy, balanced dietary pattern."

(4) What's the real supernutrient we don't get enough of? Fiber (or fibre, in British English). "Few of us appreciate just how far-reaching its health benefits go... high fibre diets lead to lower blood pressure and cholesterol levels." Good sources are vegetables, fruits, wholegrain cereals, nuts, peas and beans.

(5) Do anti-inflammatory diets work? Once again, a diet that reduces chronic inflammation, which is implicated in cardiovascular disease, cancer, arthritis, and dementia, is simply a good diet in general. "A fibre-poor diet will be more pro-inflammatory... diets that seem to offer protection are those already recognised as broadly healthy: low in processed foods, saturated fats, salt and sugars."

(6) Is personalized nutrition worth it? Probably not. "A 2023 report from the UK's Food Standards Agency concluded that the benefits of personalised nutrition 'seem somewhat marginal when compared to what is already understood about a healthy diet.'"

(7) Are fermented foods all they are cracked up to be? "The case is strongest for yogurt...[but] some of the benefits may have nothing to do with fermentation...yogurt is high in calcium, a nutrient helpful for stronger bones." Be cautious about making your own fermented food like yogurt, kombucha, sauerkraut, and kimchi. Inexpert at-home fermentation can foster harmful pathogens like salmonella. 

Constant worrying about Trump is a threat to your health

Like many millions of Americans, ever since Trump was elected president on November 5, a mere twelve days ago that seems like much longer, I've been consumed with anxiety about what this means for the United States and the world.

In short, nothing good. Or at least, very little that is good.

Naturally I'm speaking from my perspective as a Democrat who heartily supported Kamala Harris. I realize that Trump supporters feel differently. But I'm speaking to those who, like me, see Trump as a threat to democracy, the environment, equal rights, justice, the economy, Ukraine, and so much else. 

We have to resist Trump whenever and wherever possible. That's a given. However, we can't constantly worry about what Trump will do in the next four years. That way isn't good for our mental and physical health. 

And it's important that we remain strong -- to fight the good fight against Trump's malevolent authoritarianism.

Maybe you've heard of the book, Why Zebras Don't Get Ulcers. It's about stress. Humans and other animals are hard-wired by evolution to react strongly when faced with imminent danger, like a lion stalking a herd of zebras.

When the lion attacks, the zebras run like crazy. Hormones in their brain and body are instantly released to aid them in escaping from the threat to their life. But after the attack is over, the zebras return to grazing. 

That's how the sympathetic nervous system was intended to work. In his book, Mind Magic, neuroscientist and neurosurgeon James Doty says about the autonomic nervous system:

This part of the nervous system developed early in our evolution as a species and has two divisions. The first to evolve was the sympathetic nervous system (SNS), whose job it is to ensure our physical survival and the survival of our genes, and whose primary activity is to engage the fight, flight, or freeze response. 

...Because it evolved to act in life-or-death situations, it moves along very short neurons and therefore has the power to completely commandeer our physical and emotional resources in a split second, filling our body with stress hormones like cortisol and tensing our muscles for action.

Later, the human nervous system evolved further with the addition of the parasympathetic nervous system (PNS), also known as the rest-and-digest response, whose job is to return the body to a peaceful resting state, a process known as homeostasis. 

The switch to rest-and-digest is accompanied by a wide variety of physiological changes to promote balance and harmony: our muscles relax, our heart rate and blood pressure decrease, and we produce more saliva for digestion.

Nature didn't intend that we be in a constant state of anxious arousal. Our brain and body are basically unchanged from prehistoric times when early humans, like zebras, were faced with dire life-or-death threats that required a rapid fight, flight, or freeze response, soon followed by a rest-and-digest response (assuming the threat didn't end in death).

We live in a very different world now. Few of us have direct threats to our life. Instead, our modern world is filled with situations that provoke feelings of anxiety in us, such as the election of a president, Donald Trump, who is viewed by many as posing a serious threat to values they hold dear.

Instead of going back to grazing on what sustains us, as zebras do after a threat appears and disappears, often we remain in a stressful state -- because what we fear isn't a near-at-hand danger that can be dealt with, but a distant danger outside of our control.

James Doty goes on to say:

The problem is that while evolution takes millions of years to adapt to environmental change, humans have profoundly changed our environment in only a few thousand years. In fact, we lived as hunter-gatherers in groups of fifty to a hundred until only six to eight thousand years ago.

Unfortunately, today's fast-paced and anxiety-provoking world is riddled with the sorts of uncertainties and frustrations that trigger the fight, flight, or freeze response and keep it chronically activated by unreal, imagined, or insignificant threats. 

Essentially, we are responding to a passive-aggressive comment in a colleague's email through the same system that was designed to process a saber-toothed tiger attack. As we will see, the chronic activation of the fight, flight, or freeze response and its release of inflammatory proteins has damaging effects on the body, including an increase in heart disease and a weakened immune system.

I don't see Trump as an imagined or insignificant threat. He's a clear and present danger to not only the United States, but the world as a whole. Like I said, when there's an opportunity to resist him, we need to do what demands to be done. 

But we can't remain on guard against Trump all the time. He can't be a constant inhabitant of our mind. We can't react to every crazy thing he does as if it was a saber-toothed tiger attack. We need to keep informed about what he and his administration are up to, while engaging in activities that relax and rejuvenate us as much as possible.

Everybody who opposes Trump will have to find their own ways of doing this. I've meditated every day since 1969, when I started learning yoga while in college. Currently I enjoy brief guided meditations rather than the hour or two of meditation that I used to practice.

On my iPhone I switch back and forth between Sam Harris' Waking Up app and the Calm app. Today I went back to listening to the Daily Calm, which I find more relaxing than the daily guided meditation offered by Waking Up. 

Trump is going to do what he's going to do. Yes, that's a tautology. But it reminds me that by and large, it's going to be up to leading Democrats in Congress and various states to stand in Trump's way when he poses a danger. 

I can support those efforts. Yet I can't let my mental and physical health be threatened by constant worries about what Trump has done, is doing, and will do. I've got to graze on the pleasant grass in my life, not be incessantly looking around for threats from a president who isn't anywhere near me, physically.

My wife's shoulder replacement surgery is helping me be a better person

When it comes to being a caring, compassionate person, I'd say that I'm about average.

I know people who are much more caring and compassionate than I am, and I also know people who are considerably less caring and compassionate. So I've got room to grow in this regard.

However, at the age of 76, I pretty much figured that I was set in my ways and wouldn't be improving my caring and compassionate quotient any time soon.

That was before my wife, Laurel, had shoulder replacement surgery. More accurately, reverse shoulder replacement surgery.

The difference between a reverse prosthesis and a standard shoulder replacement is that in a reverse prosthesis, the ball is placed on the socket side of the joint. This is opposite of where it is located in nature, or “reverse” of what you would expect. The socket is then placed on the arm side where it is supported by a metal stem in the arm bone (the humerus).

About ten years ago, I think it was, Laurel had surgery to repair a torn rotator cuff in her right shoulder. When it got torn again, my wife had to decide whether to go through another surgery, this time a total replacement of the shoulder. 

She wasn't wild about the prospect of needing to wear a sling for around a month and go through the physical therapy needed for her to make best use of a new shoulder. But this was the wisest thing to do, so last Tuesday she had the surgery on an outpatient basis from her Salem Health doctor. 

It went well. Now we're in the post-surgery recovery mode, which has been difficult for Laurel. The first 48 hours she was icing her shoulder via a machine for 40 minutes on and 20 minutes off. That meant sitting and sleeping in a recliner chair.

She was given several prescriptions to deal with pain and inflammation, along with other medications to dealt with the side effects of the prescriptions. In short, not fun, to put it mildly. 

As with her first surgery, I'm Laurel's caregiver. She needs quite a bit of care. Basically I'm her right arm whenever she needs to do something that requires two arms. Which is a lot of stuff. Until someone has lost the use of an arm, you don't realize how difficult it is to do previously simple things.

Here's how I put my caregiving in a post on my Church of the Churchless blog, where I write more philosophically than on this blog and my Salem Political Snark blog.

Until you can't use an arm for much, it's difficult to know all the things you won't be able to do anymore. We're rediscovering those things, since Laurel had rotator cuff surgery on the same arm about ten years ago that also required her to use a sling for a month. Of course, we were a decade younger then, so everything is a bit tougher now that we're in our mid-70s rather than mid-60s.

I've been having to do a lot more around the house than I usually do.

For example, Laurel used to walk our dog in the morning and I did it most afternoons. Now I handle both walks. We shared cooking duties before her surgery. Now I have to help Laurel with her meals, unless it's a simple one that doesn't require two hands. For the first 48 hours my wife was constantly using a machine with a timer to ice her shoulder, 40 minutes on, 20 minutes off. My job was to rotate three sets of 12 frozen water bottles into the machine every eight hours, making sure a thoroughly frozen set always was available.

What I've discovered from all this extra taking care of Laurel is that the more I'm focused on her needs, the less it bothers me when something goes wrong in my life. This both surprised and pleased me. The first time it happened, it felt like I'd taken a pill that reduced the sensation of the problem I was having by about half. 

Meaning, what used to irritate me considerably now irritated me only a little. It was as if constantly putting Laurel's needs before my own, even for just a couple of days, considerably lowered the feeling of Me I normally carry around. Having less Me rattle around in my mind, and more She (my wife), left less for an irritation to latch onto. 

Also, after six days of caregiving, I've been pleased that aside from a single instance where I got a bit testy with Laurel and had to apologize to her for that, I've been able to be caring and compassionate toward my wife to a greater degree than I anticipated. 

I hadn't realized that putting a loved one's needs before my own, which I readily admit should be my habitual way of acting, but hasn't been, can become a habit. It's sort of like I hadn't exercised my caring and compassionate mental muscle before, or at least not to the extent I'm doing it now (the exception being my wife's previous shoulder surgery).

So all in all, I'm feeling good both about Laurel's prospect for getting back almost complete use of her right shoulder, and my capability for learning how to be a more consistently caring and compassionate person. Of course, only time will tell how both things go.

Regence and Salem Health are in an annoying contract dispute

Recently I got a not-so-cheery letter from Cheryl Nester Wolfe, President and CEO of Salem Health Hospitals and Clinics.

She informed me, along with many thousands of other people in Salem who get their health insurance through Regence Blue Cross Blue Shield of Oregon that Salem Health's contract with Regence expires on December 31, 2024 and "despite repeated attempts to negotiate a new contract for 2025, Regence refuses to agree to fair market terms."

Wolfe put most of another sentence in boldface to draw attention to it.

This means that as a patient, you will likely be responsible for a greater portion of the costs of your care at all Salem Health Hospitals and Clinics locations after December 31, 2024.

Yesterday the Salem Reporter had an informative story about this dispute, "Salem Health seeks 35% increase from Regence in insurance coverage dispute." Here's how the story begins:

Thousands in Salem may not be able to get in-network care at Salem Health next year due to a contract dispute between the hospital system and insurance company Regence BlueCross BlueShield.

Both sides say the disagreement, centered around how much the insurance company pays Salem Health to care for patients, may be insurmountable. 

Salem Health is seeking a 35% increase in the amount it bills Regence when members go to the emergency room or have surgery at Salem’s only hospital.

Hospital leaders said that’s necessary to keep up with inflation, while Regence said it would drastically raise premiums for members.

If a deal isn’t settled, Regence patients would pay more out-of-pocket for appointments, surgeries and care at Salem Health’s hospitals and clinics.

Federal law protects patients from paying out-of-network prices for emergency care, including airlifts.

This is really annoying. I'm on Medicare, so have the Regence MedAdvantage plan. The monthly cost is reasonable, $72 a month. I've been happy with the plan, which I've had for ten years, ever since I became eligible for Medicare.

I got a MedAdvantage plan in part because just before I turned 65, I semi-jokingly asked my Salem Health family physician if she was going to kick me out after I had Medicare, since I knew that medical providers complain about Medicare's reimbursement rates. She said that her clinic loses money on regular Medicare visits but they break even, or maybe a bit better, with MedAdvantage. 

Today I phoned Regence, being more than a little concerned about the statement in the Salem Reporter story that the disagreement between Regence and Salem Health may be insurmountable. The open enrollment period for MedAdvantage plans ends December 7, so I wanted to start looking into other options if Regence and Salem Health can't agree on a 2025 contract.

The woman I talked with at Regence was pleasant and seemingly knowledgeable. She told me that contract disputes happen all the time between insurance companies and providers, but usually they aren't as public as this one. She said that if Regence doesn't have a Salem Health contract by November 18, I think it was, they'd have to send out a letter to their Salem customers stating this.

I told her that since my deadline is December 7 to sign up for a different MedAdvantage plan, that's cutting it kind of close. She then told me that between January 1 and March 31 Medicare allows one switch of MedAdvantage plans, which often occurs because someone chooses a new plan during the fall open enrollment period, then finds they don't like that plan.

This applies even if no change has been made to a MedAdvantage plan. Meaning, I could dump Regence and enroll in a different plan between January and March. However, she added that the change doesn't take effect until the first of the next month after a change is made, which means I could have no MedAdvantage plan at all for a while if I switched from Regence early next year.

I don't want to run that risk, given the ever-present possibility of a serious accident or illness popping up. So I'm strongly leaning toward switching to a different MedAdvantage plan prior to December 7. My wife has Providence MedAdvantage through her PERS retirement health plan. She likes Providence, though no insurance plan is perfect.

Understand: I don't trust either Regence or Salem Health.

I told the woman at Regence who I talked with today that this reminds me of the disputes that regularly surface with DirecTV, which we have to use because we live in a rural area lacking cable. When, say, ESPN goes off the air due to a lack of a contract, DirecTV says it is because ESPN is being greedy, and I should complain to ESPN. Of course, ESPN says it is because DirecTV is being greedy, and I should complain to DirecTV.

My attitude is that I don't care who's at fault, I just want ESPN back so I can watch sports. Likewise, I don't care who's at fault between Regence and Salem Health, I just want health care.

It's crazy that even after joining Medicare, I still have to deal with corporate contract disputes. Our country's health care system is screwed up. Even if we had Medicare For All, so long as the profit motive dominates, patients are going to suffer from giant corporations arguing about how much money each of them is going to make. 

I benefitted from my sessions at Salem's Innerhealth Acupuncture Clinic

Today I had my eighth weekly treatment from Karen Kaufman at her Innerhealth Acupuncture Clinic here in Salem (Oregon). This was my first serious dive into the acupuncture waters, having previously only waded in the shallow pool of single sessions with a couple of acupuncturists.

Karen Kaufman, Ph.D., L.Ac

I'm convinced that Kaufman helped relieve the sciatica pain in my right leg considerably.

Naturally I can't be sure of this, since I'm not a random controlled experiment, just one person who was drawn to try acupuncture after physical therapy didn't do much to relieve the pain, over the counter medications did next to nothing, and I had to wait quite a while to get an epidural steroid injection in my back.

I had two acupuncture treatments prior to getting the epidural injection from Salem Pain and Spine Specialists on May 13. By the time of the injection, the pain in my leg was considerably reduced. I ascribe that to acupuncture, since this was the only thing I'd done differently prior to the injection.

After the injection, I continued to get acupuncture from Kaufman every week, figuring that I didn't really care about what, exactly, was making the pain lessen, so long as I was feeling better. For several months I hadn't been able to go to my Tai Chi classes, the pain was so bad. After I started the acupuncture treatments, I was able to return to Tai Chi.

At my first session, Kaufman told me that her previous three patients all had sciatica. Not surprising, since nerve pain seemingly would be one of the problems acupuncture is best suited for. I'd found a review of the literature on this that suggested acupuncture benefits people with sciatica.

I liked that Kaufman was pure acupuncture with me. No mention of herbs or other aspects of Chinese medicine. Early on I told her that I was fairly well acquainted with the notions of meridians, qi, and such, as this gets discussed in my Tai Chi classes, which I've been taking for 18 years. But I'm agnostic as to whether these things truly are scientifically valid.

Kaufman has an interesting background, according to her web site. 

Karen is excited to be returning to Innerhealth where she worked a decade ago with founder, Angela Pfaffenberger.

An Oregon native, Karen grew up in Astoria and is a graduate of U of O.  After earning a doctorate in psychology at Claremont and teaching at a university, she decided to enhance her interest in Chinese Medicine by attending the International Institute of Chinese Medicine in Santa Fe, NM.  After earning a master’s degree in Chinese Medicine, she received funding to do acupuncture research and has taught in the acupuncture doctoral program at ACTCM in San Francisco.  She has been seeing patients in private practice for 13 years.

Karen uses a gentle approach, employing every skill she has acquired along the way, often with a dose of good humor.  She effortlessly combines her east/west training and is particularly attuned to psychological aspects of pain and illness.  She considers treating stress her major area of expertise, both in terms of addressing the everyday hassles that can grind a person down and result in pain, and in treating the fallout from major life stressors and trauma that can, of course, negatively affect health.

Today we agreed that it made sense for me to take a break from acupuncture for a while and see how my leg feels without it. My insurance, Regence MedAdvantage, covers 12 acupuncture treatments a year, if I remember the number correctly. So I have four sessions left in 2024 if I want to return for an acupuncture tune-up.

I find that cold remedies can be worse than the cold

I don't get sick very often. So at first I couldn't believe that I had a cold, irrationally thinking that even though I don't have allergies, my nasal congestion was due to that, rather than a cold. 

But a week ago, I had a lot of trouble sleeping. Not being able to breathe through my nose was annoying, as was breathing via my mouth. Propping my head up on a couple of pillows didn't help. Neither did spraying saline solution in my nostrils, my usual approach to mild everyday congestion. 

So the next day I headed off to Walgreens to get some Sudafed. The real stuff with pseudoephedrine, which Oregon used to require a prescription to get since it can be used to cook up meth. Now you can get it from a pharmacist by showing ID so repeated purchases can be tracked.

I decided to get the 12 hour variety, figuring (wrongly, it turned out) that I'd take one pill at 11 am, when I bought the Walgreens generic version of Sudafed, and another pill at 11 pm, which would keep my nasal passages decongested all night.

Good plan. But based on wrong facts. 

The first pill I took at 11 am did indeed start working soon. But when I got home, my wife reminded me that pseudoephedrine is a stimulant. I'd noticed that the box said "non-drowsy," but I figured this meant it wouldn't put you to sleep, not that it'd keep you awake.

Which, it did, even after more than 12 hours had passed since I took the first dose of generic Sudafed. However, once I got to sleep, I had a pretty good night, since I'd gotten some Kroger Daytime/Nighttime  Sinus Relief after realizing that the pseudoephedrine wasn't going to work for me given how sensitive I was to its stimulating effect.

I'd also gotten some Allegra, because I wanted an antihistamine after finding that the generic Sudafed worked so well after I took it at 11 am, now I had a runny nose. That, of course, wasn't surprising, since I'd just taken a decongestant. But it became annoying to constantly be using a facial tissue to wipe my nose.

I thought (again wrongly, it turned out) that I'd found a cold remedy sweet spot with Allegra and the Kroger Sinus Relief, which is generic Mucinex Sinus-Max Day and Night. However, the Allegra soon made my nose feel too dry, so I just relied on the Nightime generic Mucinex, which had an antihistamine for runny nose along with a decongestant and other stuff.

After a few days, though, I began to worry about the warning on both the generic Sudafed (which I'd stopped taking) and the generic Mucinex (which I was taking both day and night) to ask a doctor before taking if you "have difficulty in urination due to enlargement of the prostate gland." Along with a bunch of other conditions I didn't have, like high blood pressure, diabetes, heart disease, and such. 

I'd ignored that warning, because a urologist had told me that I didn't have a prostate problem, I had a bladder problem -- the reason I need to use a urinary catheter to pee most of the time. However, after taking the generic Mucinex for about three days, while it was keeping my nose decongested, I began to find that it was more difficult to insert a catheter into the bladder.

Some Googling revealed that this can happen when taking Mucinex, Sudafed, and similar products. I'd also noticed that for the nighttime generic Mucinex, the label said to ask a doctor before use if you have glaucoma, which I do.

So my simple desire not to have my nose congested had turned into a rather complex medical puzzle because of the side effects, either actual or potential, of what I was taking. That made me realize the wisdom of something I'd read in my Googling: try to only deal with the actual cold symptom(s) you're experiencing, which may mean not using multi-symptom products like Mucinex.

A few days ago I decided to use some saline solution in my nostrils before I went to bed, propped up my head and shoulders, and slept fine without any cold remedy. Live and learn. From now on I'm only going to use the smallest amount of a decongestant or antihistamine, instead of taking this stuff all through the day, like I'd been doing. 

But at least I'm prepared for the next time I have a cold. Assuming I can remember where I stored these boxes.

Be sure to take Plenvu rather than Gavilyte for your colonoscopy prep

I've had four or five colonoscopies, can't remember exactly.

Started when I was fifty, then, because unlucky me always has benign polyps, I'm scheduled for another colonoscopy 4-5 years later, while my more fortunate wife gets away with a 10 year repeat (she can even have the test for colon cancer that doesn't require a colonoscopy).

Tomorrow I'm having another one. So today was the preparation day: no solid food, with the colon cleansing prep starting at 4 pm, with a repeat at 11 pm, a couple of hours from now. 

I'm looking forward to the colonoscopy itself tomorrow morning, since that's the easiest part. I'm a fan of propofol that I've been getting for anesthesia.

When I wake up (or regain my memory, I'm not sure which) my first reaction always is disappointment, since the propofol puts me in such a peaceful, blissful state of consciousness -- which argues for me not remembering the procedure, rather than being unconscious.

Drinking the prep stuff, not a fan. But there's better and worse colon cleansing approaches. At first I was prescribed Gavilyte by Salem Gastro, even though the Colonoscopy Preparation Instructions I was given referred to Plenvu.

I learned about the switch only after my pharmacy said that the prep was ready to be picked up. I noticed that the container was really large, but didn't think much about this until I got home and realized that I'd gotten Gavilyte, on the right in the photo below.

When I phoned Salem Gastro to find out what happened, they said that Regence MedAdvantage, my insurance company, wouldn't pay for Plenvu, which uses the much smaller bottle on the left for two split doses. 

I told them that I'd pay out of pocket for Plenvu, since Gavilyte requires drinking 4 liters, or 135 ounces, of water mixed with the prep solution, while Plenvu requires only 32 ounces of water mixed with the prep solution, 16 ounces in two split doses. You're also supposed to drink another 16 ounces of additional clear liquids of your choice after each dose.

Fortunately, my pharmacist told me that Plenvu had a discounted price for people like me whose insurance company won't cover the cost of it. So I ended up paying $50, I think it was, for the Plenvu. The cost was worth it, since I would have add to drink over four times more prep solution with Gavilyte. 

Keep this in mind if you're scheduled for a colonoscopy. The colon cleansing process isn't pleasant, given that you have to stay near a toilet after taking any prep solution. But drinking 32 ounces of the stuff is way better than drinking 135 ounces of it.

Lastly, my even more important advice is to not put off getting a colonoscopy if your doctor says it's time for one. As unfun a colonoscopy is, it's hugely preferable to dealing with colon cancer. 

The Psilocybin Center is open in Salem for psychedelic transformation

Thanks to a story in the Statesman Journal, I learned that Salem's first psilocybin service center has opened on State Street. It's aptly named The Psilocybin Center. 

Husband and wife Sammy Kahuk and Dina Odeh have opened Salem’s first psilocybin service center, and a second location is being licensed.

The Psilocybin Center at 2585 State St. offers personalized “psychedelic mushrooms” sessions to anyone over the age of 21 for behavioral or physical health conditions or for spiritual or recreational purposes.

It took me a while to find the web site for The Psilocybin Center, but once I did, I was impressed. 

So much so, this afternoon I made an appointment to talk with Sammy Kahuk next Tuesday via an online video chat that takes fifteen minutes. I'm assuming he'll ask me some questions, and I can ask some of my own. 

Like, how much the sessions cost, information that I didn't notice on their web site. My leaning is to go with the middle Moderate-High Dose option below. Microdosing seems too little for me; a Hero Dose session seems a bit too much for me at the moment.

I say "at the moment," because like many people my age (I'm 75, a baby boomer), I had quite a few psychedelic experiences during some of my college years -- 1967-68 -- with LSD, mescaline, and, yes, psilocybin. 

Some of those, most of them, really, were in the "Hero Dose" range, especially when I took LSD. Walls would melt and shimmer with color. Reality was transformed into a magical mystery tour, to not coin a phrase. 

But I'm kind of wary of jumping into a really intense psychedelic experience right off the bat, since doing this at my age could be considerably different from doing it at 19 and 20.

My primary motivation now is what Michael Pollan in his book How to Change Your Mind refers to as shaking up the snow globe. My mind has fallen into some senior citizen habits that I'd like aid in revising, which psychedelics are great at. In college, everything was fresh and new, so my psychedelic experiences just added fuel to that already flexible fire.

The Google reviews for the center are all highly positive. Here's a sampling.

 

After five months, I finally get medical treatment for my severe sciatica

If you've ever had severe sciatica pain, you'll find this blog post a heck of a lot more interesting than if you haven't. Usually that nerve pain is produced by problems with the spine, either degenerative or following an injury. 

I wrote about my current bout with sciatica back on March 23 in "If you're wondering about my absence, the answer is sciatica." An excerpt:

It can be an extremely annoying pain. My worse moments have been in the middle in the night when I need to use the bathroom, or when I get up after sleeping. A few times I was almost unable to move from my bed. When I tried, the pain was so intense I'd cry out uncontrollably, and needed help from my wife to just put my pants and shoes on.

Now I can do that on my own, though I use a single crutch to hobble into the bathroom, the pain is so bad. When I'm asked to rate the pain on a scale from 1-10, I say that at its worst, it's a 10. 

Given the occasional high intensity of that pain, which otherwise is just really annoying (though I'm doing better now, perhaps thanks to acupuncture), I've been highly motivated to get the health care system moving as quickly as possible toward treatment for the sciatica. 

However, aside from physical therapy, which I got after only a 5-week wait, and acupuncture, which I got on my own with less than a week's wait, it took me a bit over five months from when I first contacted my primary care doctor about the increased discomfort from the sciatica that I've been dealing with since 2020, until today, when I got two epidural steroid injections. 

In pain time, it felt a lot more than five months. But in health care system time, this is all too typical. Maybe even better than typical, since I have a Medicare MedAdvantage plan that is fairly generous and pretty responsive to referral requests.

Still, there are annoying hoops to jump through all along the way. For example, my wife has had three epidural injections that have helped her sciatica pain a lot. For me to get one, my primary care provider said that I needed a Lumbar Spine MRI. And in order to get the MRI, I needed six weeks of physical therapy, a Lumbar Spine X-ray, and something else that I've forgotten.

After that, of course, it took more time to be seen by several specialists. Some of them were clearly understaffed and overworked. In one case, I was shocked when I was told that it would take a week and a half to two weeks to schedule an appointment. Not to be seen at an appointment, just to schedule an appointment. That was a first for me. 

And our health care system isn't under the stress of Covid as it used to be. When I first got severe sciatica in 2020, I could understand why it wasn't possible to schedule a lumbar spine MRI, given that so many resources were going to care for Covid patients.

Now, though, the health care system seems to be under "normal" continual stress. My aging baby boomer generation must be partly to blame, given our increased medical needs. But my wife and I are both finding that now it takes much longer to get doctor appointments. Something is stressing the health care system, and i'm not sure what it is.

Here's my chronology.

December 8, 2023. I ask via MyChart for a referral from my primary care provider to Salem Health Rehabilitation Center, saying:

Dr. Gyuricska, sorry to hear that you're leaving Salem Health soon. I'll miss you. Wish you the best for your new course in life. I'm messaging you because I'd like a repeat referral to Salem Health Rehab Center for my right leg problem. The sciatica continues. What concerns me now is a different sensation in the right leg, some transitory unsteadiness/weakness after sleeping or sitting in a soft chair. Sort of weirdly, the sciatica pain is a bit less. The new problem might go away soon, but with the holidays upon us I figured that a physical therapy referral now would mean I could be seen after the first of the year. If I wait until January, naturally the wait to see a physical therapist, hopefully the same one I saw before, would be even longer.

December 11, 2023. Referred to Salem Health Rehabilitation Center for physical therapy.

January 5, 2024. Medicare wellness exam. Got advice to use BioFreeze to reduce stronger sciatica pain, which, sadly, isn't "going away soon" as I'd hoped on December 8.

January 15, 2024. Had first physical therapy session.

February 23, 2024. Primary care appointment about sciatica. Referred for Lumbar Spine X-ray which I got on same day.

March 9, 2024. Had Lumbar Spine MRI. Numerous problems found, including spinal stenosis. 

March 12, 2024. Referred to Salem Health Spine Center by primary care provider.

March 13, 2024. Had last of six physical therapy sessions.

March 14, 2024. Notified by Salem Health Spine Center to make appointment with Capital Neurosurgery Specialists neurosurgeon.

March 14, 2024. Referred to Salem Pain and Spine Specialists by primary care provider. 

March 18, 2024. Had scoliosis X-ray at request of neurosurgeon. 

March 26, 2024. Had appointment with neurosurgeon. Epidural steroid injections at two spine locations were recommended as first therapeutic step, which also would have diagnostic value.

April 8, 2024. At my request, referred by primary care provider to Portland doctor who performs MILD (Minimally Invasive Lumbar Decompression) for consultation about this possibility.

April 10, 2024. Had appointment with Physician Assistant at Salem Pain and Spine Specialists. It was agreed that I should get epidural steroid injections.

April 16, 2024. Had appointment with Portland doctor's Physician Assistant. 

April 29, 2024. Had first acupuncture treatment, which I chose to do.

May 9, 2024. Had second acupuncture treatment.

May 13, 2024. Had two epidural steroid injections at Salem Pain and Spine Specialists.

July 1, 2024. Follow-up appointment scheduled with neurosurgeon. 

A son's love and hospice supported a Salem woman during her last days

There's a lot of negativity floating around these days. I fall prey to it. I also contribute to it. So to be able to share a 100% positive story of how an old friend and hospice workers made a Salem woman's last days before she died as comfortable as possible -- that's a pleasure.

Jim Ramsey is the friend. I've known him since the early 1970s. When he was part of Ramsey Real Estate, Jim was the realtor who found a house for my wife and me in 1977, enabling us to move from Portland to Salem when I got a job with state government.

For quite a while, more years than I can recall, Jim and I have gotten together every Sunday for coffee and conversation. Part of that time, Jim's mother, Virginia (Ginger) Hager -- she got remarried after Jim's father died -- would join us at the West Salem Starbucks.

Last Wednesday Ginger died at the age of 97. She suffered from severe dementia.

That led Jim to stop sleeping in his apartment and move into his mother's West Salem home in May of 2023, about a year ago. Every week, with a few exceptions, Jim was able to continue to meet with me at the Urban Grange coffeehouse where I'd always ask, "How are things going with your mother?"

The answer always made me think, Wow, Jim is displaying such love and devotion. Because caring for anyone who is elderly with a serious health problem is difficult. When the person has dementia, which steadily worsened as the months passed, caring for them is hugely more difficult. 

I won't attempt to describe the specific problems Jim had to deal with.

All I can say is that hearing his stories of what he had to do in caring for his mother brought to mind "saintly" and "selfless." These certainly aren't qualities that I feel I possess, but I felt inspired to be a more compassionate person after each of our coffee shop conversations.

Basically, it's difficult to care for someone over a long period of time who is mentally normal but needs help with many activities of daily living: eating, getting into and out of bed, going to the bathroom, all that stuff. In Ginger's case, not only did Jim have to help with these things, he wasn't able to get much assistance from his mother. In fact, she often opposed him. And naturally Ginger wasn't capable of expressing any real appreciation for everything Jim was doing. 

Jim had support, thankfully. A caregiver who was a friend of the family was hired to come to Ginger's house for four hours almost every day, giving Jim time off to handle things at his apartment and do necessary errands like grocery shopping and coffee-house-conversation-time. She was viewed as a "grandma sitter." Jim's brother and sister-in-law lived nearby and helped out also.

But Jim was the primary support for his mother. As the months passed, I began to ask if he and his family had considered having Ginger enter a memory care home or institution.

They had, but Ginger was becoming increasingly argumentative as her dementia progressed. It was clear that she wouldn't want to leave her home, and there was no power of attorney for medical care decisions -- nor, obviously, any ability to have one signed by Ginger, given her dementia. So a court order would have been needed to admit her to an institution. 

Jim was stressed, but he persevered. Again, I found this astoundingly admirable. I'd keep telling him, "You are accumulating so much good karma for what you're doing, you should be reborn in wonderful circumstances." And I don't even believe in karma, or reincarnation. 

In January 2024,  Jim and his family had Ginger admitted to  a hospice services provider, Serenity Hospice. Great decision. This resulted in a caregiver coming two days a week for an hour each time to check blood pressure, oxygen level, temperature, and such. The hospice also provided expert advice about how to handle Ginger's declining condition, such as her reluctance to eat. 

I was much impressed with how the hospice caregivers anticipated the needs of Jim and his mother in Ginger's last days, when a caregiver came every day during the week or so before she died. Jim told me that on Monday, I think it was, several days before his mother's death, a hospice worker contacted him and said that she'd be spending the night at Ginger's house for a few days so Jim could get some much-needed sleep.

(His mother was needing almost continuous care and attention, including at night.)

Then, on Wednesday, a hospice caregiver arrived at the house at 10 am to give Ginger a bath in bed, including washing her hair, following a rough night where Jim's mother was having breathing problems that sounded like a "death rattle." 

That allowed Jim to leave the house and attend to some errands. When he returned, Jim learned that his mother had died. 

Death of a parent, or anybody, is sad for loved ones. However, given Ginger's condition and her being 97 (a few months from being 98), the sadness was mixed with relief that Ginger's suffering was over -- and that she had died relatively easily at home, after being bathed and cared for by a hospice worker. 

I've never heard anything but positive stories about hospice services. This is rare in health care, where gripes abound. Serenity Hospice was a great aid to Jim and his family, along with his mother, of course. I salute everyone who works for a hospice. It must be a difficult job, though a rewarding one.

For as the oft-heard saying goes, it isn't death that scares most people, it's the dying that precedes death. Hospices help to relieve that fear. 

Woman in wheelchair brought tears as I watched So You Think You Can Dance

There's a lot of crap on television. There's also beautiful, unforgettable, highly emotional moments. That's why I watch. A single moment of that sort makes up for all the crap.

My wife and I have watched every episode of every season of So You Think You Can Dance. The show took a hiatus during the covid years. It reappeared recently. So far this season has had a lot of memorable auditions, as the three judges select contestants for a Top Ten competition, if I recall the number correctly. (It's varied somewhat over different seasons.)

The audition that has stuck in my mind most strongly came from a 27-year old woman, Kaylee Bays, who was diagnosed with Ehlers-Danlos syndrome at the age of 21. Watch this video of her performance, which begins and ends in a wheelchair. 

It brings tears to my eyes every time I see it. 

I can't stop thinking about what she said to the judges. That last sentence, "As I lose pieces of myself, I will dance until I am dancing with my eyes," is amazingly beautiful and inspiring.

My doctors predict that I only have about five years left of mobility at this level. I feel more connected to myself as a human than I ever have. As I lose pieces of myself, I will dance until I am dancing with my eyes.

I've had painful sciatica in my right leg, hip, and butt for more than four years. In December of last year it got quite a bit worse, though initially in 2020 the pain was so bad I frequently had tears in my eyes for that reason.

I can't walk very far now. I can't go to my Tai Chi class now. I can't exercise without enduring some intense pain. I feel sorry for myself, even though I try to be as positive as possible about the prospect of finding some relief once my appointment at Salem Pain & Spine Specialists arrives in ten days.


The example of Kaylee Bays, who is much worse off than I am, yet has a much bigger smile than I'm able to manage most days, makes me feel that no matter how bad my pain is, and no matter how little I may be able to benefit from treatment, I can still fight as hard as I can to keep on doing the things I like to do and need to do.

For Bays, that is dancing. However she fares in the So You Think You Can Dance competition, she's clearly a winner. CrippleMedia describes some reasons why in "Breaking Barriers: Kaylee Bays' Triumph for Disability Representation on So You Think You Can Dance." Excerpt:

In the realm of performing arts, individuals with disabilities often encounter barriers to showcasing their talents. Kaylee Bays, a dancer hailing from Los Angeles who performs on wheels, etched her name in history as the first wheelchair user on So You Think You Can Dance. Her poignant and deeply passionate jazz solo, set to Pink’s “Never Not Gonna Not Dance Again,” embodied Bays’ journey as a disabled dancer.

The song serves as a potential anthem for disabled dancers, Highlighting that disabled dancers can still enjoy their passion, even after diagnosis or as their disability progresses, by adapting moves to what is accessible to them. At three, Bays embarked on her dance journey and pursued a professional career until her diagnosis intervened.

At 21, she received a life-altering diagnosis of Ehlers-Danlos syndrome, a connective tissue disorder, after enduring years of unexplained pain. This syndrome causes joint dislocations, stretchy and fragile skin, and hypermobility. She was informed that she had to stop dancing, a prospect that left her heartbroken.

However, Bays was determined and taught herself to dance from her wheelchair. On the show, she candidly shared her feelings of isolation and expressed a desire for a fearless role model when she first became disabled. Now, she fulfills that role for her community.

If you're wondering about my absence, the answer is: sciatica

There's lots of painful medical conditions. In my 75 years, I'm only become intimately acquainted with one of them: sciatica. 

If you're unfamiliar with the term, I'm glad for you. Because sciatica pain, which for me is in my right leg, hip, and buttock areas, can range from mild to excruciating. I'm familiar with the whole range. 

Injury or pressure on the sciatic nerve creates the pain of sciatica. So sciatica is a symptom of an underlying medical problem. However, that can be tough to figure out. Thus I tend to view sciatica as the problem, though I realize to be rid of it, whatever is causing it needs to be identified.

I've had sciatica since early 2020. It was extremely painful back then, which led to me getting physical therapy. This was at the beginning of the Covid pandemic. That prevented me from being able to get a MRI of my lower spine, which often is the culprit when it comes to sciatica.

Eventually I got better, though the pain in my right leg never went away completely. For four years, whenever I was on my feet, I felt the pain. But it didn't stop me from doing what I wanted to do and needed to do.

In December of 2023, though, it started to get worse. The pain from Sciatica 1.0 was just in my right leg. Once Sciatica 2.0 emerged, pain was added in my right hip and buttock. That made it quite a bit more painful to stand, walk, or otherwise move around.

I got more physical therapy. I do those exercises twice a day, twenty-five minutes or so in the morning, then the same in late afternoon or early evening. At first I could keep going to the Tai Chi classes that I've enjoyed since 2005. For about a month now, I've been unable to go to the classes. Too much pain.

Same with going to meetings of the Salem City Club and other gatherings. If I sit on certain chairs for too long, the pain worsens when I stand up. I'm fairly stoic about my sciatica pain, but sometimes it is difficult not to groan. So I've been avoiding gatherings where my pain could disrupt things.

That's my basic explanation of why I haven't been going to places I usually am at. I wanted to write a blog post about this in part to let people know the reason for my absences, and in part to express my sympathy/solidarity with other sciatica sufferers.

It can be an extremely annoying pain. My worse moments have been in the middle in the night when I need to use the bathroom, or when I get up after sleeping. A few times I was almost unable to move from my bed. When I tried, the pain was so intense I'd cry out uncontrollably, and needed help from my wife to just put my pants and shoes on.

Now I can do that on my own, though I use a single crutch to hobble into the bathroom, the pain is so bad. When I'm asked to rate the pain on a scale from 1-10, I say that at its worst, it's a 10. 

On the plus side, I've gotten a lumbar MRI, though I haven't learned from a doctor what it means yet. I have an appointment with a Salem neurosurgeon, Dr. Kafka, next Tuesday. Then I should learn what treatment options are open to me. 

In case you've never experienced nerve pain, it's very different from muscle pain. Much worse, in my experience. It's sort of akin to the difference between being sad, and being clinically depressed (which I was, in 2017). Nerve pain and depression simply exist on a different scale of suffering from muscle pain and sadness. 

So to those who suffer from sciatica, I feel for you. May we all find relief. I just wish I'd bought stock in whoever makes the generic Tylenol and Advil I've been using copiously. Those substances help some with the pain, but not a whole lot.

By the way, a Regence advice nurse gave me a good tip for using Tylenol and Advil. She advised alternating between Tylenol and Advil every four hours, using two 500 mg Tylenol capsules and one 200  mg Advil capsule each time. That produces 3,000 mg of Tylenol every 24 hours and 600 mg of Advil, both within the recommended daily limit.

Health care workers, it's the system that bothers me, not you

Way back when (to be more specific, the 1970s and 1980s), I was, in order of my career moves, a research associate in the Oregon Medical School Department of Family Practice, a manager with the State Health Planning and Development Agency, and the executive director of Oregon Health Decisions, a pioneering community-based bioethics effort.

As I like to say, I must have done a terrific job, because now our state's health care system is running perfectly smoothly with no problems.

Of course, that's a blatant falsehood. Oregon, along with the rest of the United States, has a disjointed health care system marked by inefficiency, inequality, and crazily high costs.

However, most people are satisfied with their health care providers. I know I am.

The dissatisfaction is mostly with the system that these providers have to work in, and under. Often this doesn't become obvious until someone has a medical problem that is causing them a lot of distress, so speedy treatment is desired, and the health care system moves with decided unspeediness.

As you probably have guessed, one of those someone's is me. After suffering from sciatica in my right leg that started off very painful in 2020, when I was a youthful 71, then got better though it never went away, the sciatica has morphed into being very painful again now that I'm 75.

So I've been seeing my primary care provider, a physical therapist, and the staff who have gotten me a lumbar X-ray and MRI. I like all of these people. It's the system that isn't working so well.

On the most basic level, there's a disconnect between a person with a medical problem, me in this case, and policies that are a buffer between what people and their providers want, and the insurance that pays for most of health care.

I don't mean to burst the bubble of those who are looking forward to becoming old enough to get Medicare, having tired of the B.S. private insurance companies engage in. I used to be in that bubble myself. I couldn't wait to rid myself of my Blue Cross/Blue Shield insurance.

However, when I became eligible for Medicare, I decided to sign up for a MedAdvantage plan, as that seemed, well, advantageous. Kind of amazingly, I chose Regence MedAdvantage -- you know, the same corporation that offered the private insurance I detested for so many years.

It seems to me that with every passing year, Regence MedAdvantage introduces more barriers to getting needed care, probably due to cost containment pressures. What particularly irritates me is how third-party contractors are used by Regence MedAdvantage to assess referrals made by my primary care provider.

This doesn't happen with every referral, but often enough. For example, today I had an appointment with my physical therapist. He'd given me exercises to do over about five visits, and offered some great advice about how to manage my sciatica. 

Since it seemed time to stop our visits, he started to suggest a plan for how to maintain an ability for me to see him again if I needed to.

Then he glanced at his computer screen and said, "Oh, but you have _______ as an intermediary. If we don't close out your case, and I see you again, they'll only approve half the visits they did this time, like from eight to four. And after that, they'll keep cutting the visits, like from four to two. But if we close your case, after 60 days they'll treat you as having a new problem and grant the original number of visits."

OK, I got what he was saying. However, it seemed strange that we weren't talking about what would be best for treating my sciatica problem; we were talking about what would be the best approach to dealing with my insurance problem.

Again, I have Medicare. I'm much better off, bureaucratic B.S. wise, than people who have private insurance.

But "much better" doesn't equate to pleasant. It bugs me when my primary care provider orders, say, a lumbar MRI to find out what is going on with my spine, then I have to wait for an approval from either Regence MedAdvantage or whoever Regence contracts with to decide if an MRI is warranted.

I realize this is a crazy idea, given how our health care system (actually a non-system) is set up, but it sure would be great if health care providers were the ones making the decisions as to what is appropriate care, with outsiders getting involved only if there's an obvious problem with what has been ordered for a patient.

Currently I'm waiting for a referral to a pain and spine clinic to be processed. I've been told that the referral has been approved. It just hasn't been processed, whatever that means. So I bug my providers, asking them what's taking so long, and they've been patient with me. I try to assure them that I'm not unhappy with what they're doing.

It's like when I hear my wife calling her MedAdvantage company when there's a problem with a prescription or care being denied. After explaining the problem, she always says, "I'm not irritated with you; you just work at ________; I'm irritated with management and your company's system."

 

Amazon Pharmacy just worked well for me

I'm a big fan of Amazon. Almost am ashamed to admit it, given how huge Amazon is and the many tales of how it screws over employees and businesses it doesn't want competing with its brand products.

But there's no doubt that Amazon is amazingly efficient.

I have Amazon Prime. My orders arrive promptly, sometimes the next day, with very few errors. It's just so damn easy to get stuff from Amazon instead of heading into town, a 20 minute drive away, and looking for something that may or may not be on a store shelf. Plus, I get a lot of benefit from reading customer reviews of products I'm contemplating buying.

So I decided to give Amazon Pharmacy a try. 

At my last primary care doctor visit I left with a prescription for daily Tadalafil, the 5 mg generic version of Cialis. In addition to its well-known use for erectile dysfunction, Tadalafil is prescribed for treatment of an enlarged prostate, which I have. 

I got a paper copy of the prescription because I wasn't sure where I wanted to get it filled. I'd asked the small local pharmacy that my wife and I use to let me know what it would cost for a 90 day supply of Tadalafil. Never got a response to the text I sent, which made me think that the cost would be a lot.

My next step was to go to our nearest Walgreens. I showed the person at the pharmacy window the prescription, and they scanned it into their system. I said that I'd filled some other prescriptions there, so they have my Regence MedAdvantage insurance information.

After some clicking away, the Walgreen's staffer said that my insurance didn't cover Tadalafil. I asked what the cost would be if I paid for it myself. Can't recall the exact amount, but it was about $840 for a 90 day supply.

Wow. For a generic. I said I'd have to think about this and took the prescription back. The cost quoted by a Canada pharmacy was about $140 for a 90 day supply, which shows how crazily expensive drugs can be in the United States.

I then remembered that Amazon had a pharmacy. It was easy to sign up for Amazon Pharmacy given that I was already a regular customer with Amazon Prime. The cost of prescription drugs is easy to find since all you have to do is type it into the usual Amazon search box. 

This is what I found for daily Tadalafil, 90 day supply.

I decided to dip my prescription feet in the Amazon waters. I sent a message to my primary care provider asking that an electronic prescription for my Tadalafil be sent to Amazon, using the phone and fax numbers provided by Amazon Pharmacy.

That just took a few days. Amazon Pharmacy then notified me that the prescription had been received. Soon after I got an email saying that, not surprisingly, my insurance wouldn't cover the prescription. I was asked if I wanted to make an order and pay out-of-pocket. 

Sure. A few clicks later I'd completed the order and almost immediately got this message from Amazon.

That message came on January 30. The next day, today, January 31, the Tadalafil was delivered to my doorstep. The cost was $29.50 rather than the quoted $26.60, but that's no big deal. The bottle had an expiration date of January 30, 2025 and said that the manufacturer was Solco Healthcare, which appears to be a reputable distributor of generics.

So my first experience with Amazon Pharmacy was very positive. I looked at some reviews of Amazon Pharmacy and many of them were negative. However, quite a few of them were from the early days of Amazon Pharmacy, so I suspect some of those initial problems have been resolved.

My other prescriptions aren't nearly as expensive, which means I'll likely stick with a local pharmacy for them, at least for now. Amazon Pharmacy can sure save people a lot of money on certain prescriptions, though, that's for sure.

Penis enhancement story in New Yorker was disturbing reading

I love The New Yorker because the magazine exposes me to great writing about important issues (I skip the fiction, preferring the non-fiction articles). But sometimes what I read is so disturbing, yet so eloquently described, I'm torn between finishing an article or putting it aside.

That was my dilemma with Ava Koffman's piece in the July 3, 2023 issue, The Perils and Promises of Penis-Enlargement Surgery: One doctor's Promethean quest to grow the male member is leaving some men desperate and disfigured.

I'll share a PDF file of the story in case that link doesn't work for non-subscribers.
Download The Perils and Promises of Penis-Enlargement Surgery | The New Yorker

I ended up reading the entire article, which was fascinating and terrifying in equal measure. Until the article came along I knew nothing about this sort of surgery. The first paragraph drew me in, making me want to learn more about why men entrust such a vital and sensitive organ to a surgeon's knife.

They wanted it because they’d just gone through a bad breakup and needed an edge in the volatile dating market; because porn had warped their sense of scale; because they’d been in a car accident, or were looking to fix a curve, or were hoping for a little “software upgrade”; because they were not having a midlife crisis; because they were, “and it was cheaper than a Bugatti Veyron”; because, after five kids, their wife couldn’t feel them anymore; because they’d been molested as a child and still remembered the laughter of the adults in the room; because they couldn’t forget a passing comment their spouse made in 1975; because, despite the objections of their couples therapist, they believed it would bring them closer to their “sex-obsessed” husband (who then had an affair that precipitated their divorce); because they’d stopped changing in locker rooms, stopped peeing in urinals, stopped having sex; because who wouldn’t want it?

Well, nine New Yorker pages later my question became, who would want it?

For while there are plenty of men who are satisfied with their penis-enhancement surgery, there's also plenty who are trapped in a doom loop of seeking help to undo the surgery, which typically isn't easy to accomplish. For the procedure is much more complicated than breast-enhancement surgery.

James Elist is a urologist who is the centerpiece of the article. He developed a silicone implant "shaped like a hot-dog bun which could be implanted just under the skin of the penis to increase its girth and flaccid length."

With the blockbuster launch of Viagra, in 1998, Elist feared that demand for surgical cures for erectile dysfunction would fall, and decided it was time to diversify. Over the years, many of his patients had asked if he could make them bigger while he was down there. Walking around the 90210 Zip Code, where the median breast size seemed to balloon by the day, Elist realized that his next move was staring him in the face.

As he toyed with an early prototype for the Penuma, other doctors were dismissive. The penis—a tentacle that shrinks and swells with an exquisite sensitivity—was nothing like the breast; it wouldn’t be possible, they told him, to put something static under its elastic skin.

Because the F.D.A. requires the pharmaceutical industry to conduct clinical studies of new drugs, it is often assumed that the same is required of medical-device manufacturers. However, a loophole known as the 510(k) process allows companies to implant untested products in patients as long as they can demonstrate that the devices are “substantially equivalent” to those already on the market.

In September, 2004, not long after Elist convinced the U.S. Patent and Trademark Office of the novelty of his invention, he informed the F.D.A. that his “silicone block” was comparable to calf and butt implants. A month later, when the agency cleared the device for the “cosmetic correction of soft-tissue deformities,” the word “penis” did not appear in its indications for use.

The article describes how many of Elist's patients were not at all happy with the penis implant they got, to put it mildly. Here's a sample of the gory details.

For dozens of Penuma patients who spoke to me, the shock of the new was the prelude to graver troubles. Some, like Mick, lost sensation. Others said they experienced stabbing pains in the shower or during sex. Seroma, or excess fluid, was not uncommon. When a defense-and-intelligence contractor’s girlfriend, a registered nurse, aspirated his seroma with a sterile needle, a cup of amber fluid oozed out. The one time they tried to have sex, she told me, the corners of his implant felt like “someone sticking a butter knife inside you.”

Some implants got infected or detached. Others buckled at the corners. Occasionally these protrusions broke through the skin, forming holes that would fester. The hole of the health-spa vice-president was so tiny that he originally mistook its fermented odor for an S.T.D. An engineer with gallows humor played me a video of the snorting crunch his penis made when air moved through a hole. He had two holes, and the skin between them eventually eroded so that a corner of the implant emerged, pearlescent.

Later, doctors unaffiliated with the Penuma would compare such penises to “a torpedo,” “a penguin,” “a pig in a blanket,” “a beer can with a mushroom sticking out on the top,” and “the tipped-down nose of the Concorde.” But the imperturbable assistants at Elist’s clinic, besieged by photographs documenting these phenomena, told patients that they were “healing as expected” and “continuing to heal well!” It was only after months had passed and the men insisted they weren’t healing well at all that Elist would sometimes suggest that an “upgrade” to a bigger size would resolve their problems.

A sad part of Kofman's article was these passages.

What surgeons continually emphasized—the implanters with pride, the explanters with dismay—was that most of the men they were seeing had been of at least average size before going under the knife. (The photographic evidence men sent to me over text and e-mail supported this contention.) “Most don’t have anything physically wrong with them at all, so what they don’t need is vultures preying on them, which is almost always a disaster,” Muir, the London urologist, said.

Along with other urologists and psychiatrists, at King’s College and the University of Turin, Muir conducted a literature review called “Surgical and Nonsurgical Interventions in Normal Men Complaining of Small Penis Size.”

The research showed that men dissatisfied with their penises respond well to educational counselling about the average size, which is 3.6 inches long when flaccid, and 5.2 inches erect. (The average girth is 3.5 inches flaccid, and 4.6 inches erect.) For men who have an excessive and distorted preoccupation with the appearance of their genitals—a form of body dysmorphic disorder—Muir said that cognitive-behavioral therapy and medications may also be necessary.

Which would be a heck of a lot wiser thing to do than get a penis implant.

How my trabeculectomy is doing 7 1/2 weeks after surgery

This is a follow-up to my initial blog post about the trabeculectomy eye surgery I had on March 6, reported on in "My eye surgery went well, though not a load of fun."

As a Johns Hopkins article about trabeculectomy says, this surgery is aimed at controlled eye pressure in people like me with glaucoma, when eye drops or laser surgery either aren't doing a good enough job at lowering eye pressure -- the only viable way of keeping glaucoma from doing more damage to the eye -- or someone can't use those other methods.

In my case, Dr. Young, a Portland glaucoma specialist, felt that I needed this surgery because I'd lost so much peripheral vision in my very nearsighted right eye, while my left eye is only very minimally affected by glaucoma. 

My eye pressure was in the low to mid 20's when I was first diagnosed with glaucoma. Prescription eye drops had lowered the pressure to 10-12 in both eyes,  but Dr. Young wanted to get the pressure in my right eye down to 6-7.

When I asked him why laser surgery wasn't an option for my right eye, Dr. Young told me that given the seriousness of my vision loss, and how slowly glaucoma usually progresses, he didn't want to wait a couple of years to learn how well laser surgery was working -- perhaps because I'm 74, and want to preserve as much vision as possible for the rest of my life.

So I had the surgery. Which then involved five follow-up appointments.

Those weren't convenient for me to get to, since Dr. Young practices in Tualatin, Oregon and I live a ways south of Salem, about a 50 minute drive from Tualatin. But mostly I didn't encounter the dreaded Portland-area freeway traffic, so the Trabeculectomy God must have been smiling upon me.

Dr. Young kept telling me that my eye looked fine, but when he pressed on the trabeculectomy site the pressure in my right eye would drop to zero, or one time 2, which isn't a good thing. In fact, it's a bad thing. 

This meant that while I could stop using an eye shield, and phase down on the post-surgery eye drops I was prescribed, Dr. Young wanted me to keep on not lifting heavy weight. At first the limit was ten pounds. Then twenty pounds. Than thirty pounds. Three weeks ago I was given the OK to lift sixty pounds.

That enabled me to use the weight machines at our athletic club, albeit some of them at a considerably lower weight than I was using before the surgery (120 pounds on four of the eleven machines).

Today, though, I got my trabeculectomy graduation notice, three weeks after my previous visit with Dr. Young where he'd said that my eye wasn't forming scar tissue very quickly. My right eye pressure was six, an excellent pressure and right on what Dr. Young had hoped for.

(Further, Young has told me that there's reason to consider that a low eye pressure following trabeculectomy is a "higher quality" pressure, since it doesn't vary much, whereas lowering pressure via periodic drops in the eye has more ups and downs during the day.)

And, yay!, Dr. Young said I could do away with any weight-lifting restriction -- though I told him that I'd gradually ramp up the weight on the machines where I was using 120 pounds. 

Time will tell whether the trabeculectomy is as successful in preserving the vision in my right eye as it seems to be doing at present.

My next appointment with Dr. Young is in four weeks. I have to wear glasses for the foreseeable future, after quite a few decades of contact lens wearing. I want to ask him when I can wear contacts again. This might relate to when I need cataract surgery, which so far I've avoided.

Ozempic shows that obesity often is a medical problem

I wish Bill Maher was a reader of this blog, because this post was stimulated by him. For Maher, who I argue has become an irritating purveyor of liberal myths, has an outdated view of people who are obese.

Here's how I put it in the above-linked post from last January.

Lastly, I can't disagree with Maher's often-stated point that obesity is a big problem in our country. He's correct that obesity is a risk factor if someone gets Covid. But it's a bit simplistic for Maher to say that all it takes for someone to lose weight is will power. 

Meaning, just eat less and you'll lose weight. I've read about numerous scientific studies that show how some people have a natural, probably genetic, propensity to obesity. Sometimes a person's metabolism is out of whack, which makes it really tough for them to lose weight. Medication and surgery may be called for in some cases of obesity.

The March 27, 2023 issue of The New Yorker has an article that indicates that I'm right and Maher is wrong about obesity. In the print edition it was called The Ozempic Era: Will new medications change how we think about being fat and being thin?

The subtitle of the online version is even more direct about what Maher gets wrong about obesity: A popular, growing class of drugs for obesity and diabetes could, in an ideal world, help us see that metabolism and appetite are biological facts, not moral choices.

If that link doesn't work for you, here's a PDF file of the article.
Download Will Ozempic Change How We Think About Being Fat and Being Thin? | The New Yorker

Some excerpts from the article by Jia Tolentino, along with the illustration that accompanied it:

The ideal female body of the past decade, born through the godless alliance of Instagram and the Kardashian family, was as juicy and uncanny as a silicone-injected peach. Young women all over the Internet copied the shape—a sculpted waist, an enormous ass, hips that spread generously underneath a high-cut bikini—and also the face atop it, a contoured hybrid of recognizably human mannequin and sexy feline. This prototype was as technologically mediated as the era that produced it; women attained the look by injecting artificial substances, removing natural ones, and altering photographic evidence.

Dana Omari, a registered dietitian and an Instagram influencer in Houston, has accumulated a quarter of a million followers by documenting the blepharoplasties, breast implants, and Brazilian butt lifts of the rich and famous. Recently, she noticed that the human weathervanes of the social-media beauty standard were spinning in a new direction.

The Kardashians were shrinking. Having previously appropriated styles created by Black women, they were now leaning into a skinnier, whiter ideal. Kim dropped twenty-one pounds before the Met Gala, where she wore a dress made famous by Marilyn Monroe; Khloé, who has spoken in the past about struggling with her weight, posted fortieth-birthday photos in which she looked as slim and blond as a Barbie. All over Instagram, the wealthy and the professionally attractive were showing newly prominent clavicles and rib cages.

Last spring, Omari shared with her followers the open secret behind such striking thinness: the Kardashians and others, she insisted, were likely taking semaglutide, the active ingredient in the medication Ozempic. “This is the ‘diabetic shot’ for weight loss everyone’s been talking about,” she wrote. “Really good sources have told me that Kim and Khloé allegedly started on their Ozempic journey last year.” Omari was about to start taking a version of the medication herself.

Ozempic, which is manufactured by Novo Nordisk, is part of an expanding class of drugs called GLP-1 receptor agonists, which have dramatically altered the treatment of diabetes and obesity. Ozempic is approved by the Food and Drug Administration only for the treatment of Type 2 diabetes—a condition that accounts for ninety per cent of all diabetes cases—and has been available since 2017. Its name is now shorthand for the entire category of weight-loss injections.

In 2021, Novo Nordisk received approval for Wegovy, which has the same active ingredient as Ozempic but comes with a higher maximum dose, as an anti-obesity drug. On a year-end earnings call in 2022, Novo Nordisk cited worldwide market growth of fifty per cent, with almost forty thousand new Wegovy prescriptions being written every week.

...A healthy body can generally signal to the brain when it has had enough food. But that signalling system can be faulty, or get injured. “One of the most important things about obesity, and something most people don’t understand, is that, in the process of gaining weight, the neural circuitry of the brain that regulates weight is damaged,” Dr. Louis Aronne, the director of the Comprehensive Weight Control Center, at Weill Cornell Medicine, told me. (Aronne, like many other prominent practitioners of obesity medicine, has consulted on trials conducted by Novo Nordisk.)

“The hypothalamus shows signs of inflammation and injury,” he went on. The prevailing theory, he explained, is that “too many calories coming in too quickly damages nerves that respond to the hormones that control body weight.” One of these hormones is leptin, which is produced in body fat, and which signals to the brain that it’s time to stop eating. But, if you gain fat, the oversupply of leptin can cause your body to be desensitized to it, making your brain erroneously believe that you are starving.

“Your body tries to rebalance the system by slowing down the metabolism and increasing appetite,” Aronne said. After a person has gained enough weight to enter this cycle of metabolic misdirection, it becomes nearly impossible to lose that weight and keep it off long-term simply through diet and exercise. (About five per cent of people manage to do it.)

A well-known study followed contestants on “The Biggest Loser,” the weight-loss-competition show, and found that the contestants’ metabolisms slowed so drastically after their weight loss that nearly all of them regained what they’d lost. One contestant, who’d dropped an astonishing two hundred and thirty-nine pounds, soon regained a hundred, and then began gaining weight whenever he ate more than eight hundred calories less than the average amount recommended for a man his size.

...Omari, the Instagram-famous dietitian, is now off her compounded semaglutide, which she’d taken to shed some pandemic pounds. She was optimistic that she’d be able to maintain her weight, as she’d generally been able to do before. But, as I kept reminding Ozempic-curious friends, these medications were designed for chronic conditions, obesity and diabetes.

For people who are dealing with those conditions, Ozempic appears to create a path toward a healthy relationship to food. For those who aren’t, it might function more like an injectable eating disorder. As the side effects make clear, it’s not a casual thing to drastically alter your body’s metabolic process, and there is no large-scale data about the safety of these drugs when taken by people who are mainly interested in treating another chronic condition, the desire to be thin.

...Kaplan, a plastic surgeon, is better known on TikTok as @RealDrBae—in his videos, he wears navy scrubs monogrammed “dr bae” and talks to the camera as though it’s his partner in an absorbing conversation at an airport bar. He believes that more people—a lot more people—are going to start taking GLP-1 drugs soon.

He didn’t have in mind thin people who want to be thinner, he added; he was thinking about fat people who had been struggling with discomfort, with inconvenience, with social pressure all their lives, who might have lately felt encouraged to try to accept their heavier weight. He predicted that the Ozempic era would put an end to all that. “They’re no longer going to accept that they should just be happy with the body they have,” he said.

My eye surgery went well, though not a load of fun

When I had surgery in 2021 to repair an inguinal hernia, my motivation was to have something wrong with me fixed so I could get back to living life as I did before the hernia popped up (literally).

But the glaucoma surgery I had today was tougher to get enthusiastic about. There's no way to fix damage that's occurred to the optic nerve. All that can be done is reduce the chance of further damage. 

However, Dr. Young, the glaucoma specialist in Portland I was referred to after some significant nerve damage was found in my very nearsighted right eye, felt that a Trabeculectomy surgery was the way to go, even though drops to reduce eye pressure (that's the main cause of glaucoma) had been working quite well for the last 18 months or thereabouts.

So despite some initial qualms -- I view all surgery as scary; eye surgery is extra scary -- after hearing Dr. Young's reasons for wanting me to have a Trabeculectomy, one was scheduled for 11:30 am today at Good Samaritan Hospital in NW Portland.

Here's why I was pleased with the surgery, though obviously it's too early to tell how successful it will be in further reducing the pressure in my right eye. (My left eye is only minimally affected by glaucoma.)

First, the Traffic Gods were with my wife and me.

I'd begged for the latest possible surgery time, because I told the scheduler that we live south of Salem and neither wanted to leave our house at a super-early time for the 75 minute or so drive to Good Samaritan, nor run the very real risk of getting stuck in morning rush-hour traffic heading into Portland.

Pleasingly, we encountered no backups at all today on either our drive to Portland or our drive home. That was a major stress reducer.

Another stress reducer was my surgery starting on time. My hernia surgery was delayed. I found it tough to be all prepped and ready to go, then be told that because a previous surgery took longer than expected, mine wouldn't start for an extra hour.

But today I was wheeled into the outpatient operating room a few minutes early.

And it was good to be awake through the eye surgery, though I'd told the anesthesiologist that I enjoy propofol when I've had it for colonoscopies. He said that he'd put a small amount in my IV tube. Don't know if that happened, though, since I felt pretty much the same during the surgery.

UPDATE: I need to change my "pretty much the same" claim after idly scratching my chest while watching TV last night and feeling a strange lump. A big lump. Checking it out, I found that it was a square of adhesive with a metal connector thingie on the top. And not just one, there were three of them on the top of my chest where they were hard to see without looking in a mirror. Must have been put there in the surgery room to monitor my heart. I have no memory of that happening, nor, as I thought more about it, of being wheeled into the recovery room. So now I believe that while I was conscious during most of the eye surgery, I wasn't for all of it, and the "pretty much the same" feeling I had while the eye was being operated on could have been a propofol effect where propofol reality feels more real than actual reality (and more pleasant). Also, I forgot to credit the anesthesiologist with a clever question. He asked me, "So what did you have for breakfast today?" Quick-witted senior citizen that I am, I replied, "Ha, trick question! I didn't have anything to eat after midnight, as I was told to do by the pre-op instructions." He must feel this gets a more honest answer than "Have you had anything to eat after midnight?"

Good Samaritan is a teaching hospital (maybe all are). A nursing student from the University of Portland accompanied the RN who did my pre-surgery workup. She asked if I was OK with the student inserting the IV tube.

I said, "Sure." I did have some qualms about this, but the student did a good job. I told him that I admired him setting out on a career in nursing, given that so many nurses retired or quit the profession during the high stress time of Covid. 

Having relaxing conversations with the nursing staff goes a long way toward making surgery as pleasant as possible, though in no way was it fun. 

It'll be interesting to see what Regence MedAdvantage is charged for my surgery. When I was wheeled into the operating room, I was surprised to see what appeared to be about a dozen people in the room. I'm sure they're all necessary. I just visualized dollar signs floating above the head of each person.

As with my hernia surgery, once again the anesthesiologist who talked with me just before the eye surgery said "You're really healthy." And once again I replied, "OK, but I'm about to be wheeled into surgery, so I'm not that healthy."

His point, he went on to say, is that I don't have diabetes, heart disease, cancer, a lung problem, an inability to walk, or other common problems that, I assume, he sees in many older patients he works with. So that conversation provided me with some perspective on my glaucoma.

Now I have to do the post-surgery thing. Three kinds of medicated drops that I have to use for several weeks four times a day. Wearing an eye shield while I sleep for a week. Not lifting more than ten pounds for a while. Going to Dr. Young's Tualatin office the next three Friday afternoons to see how the eye is healing.

Which is all fine with me. The best thing about having surgery is that it feels so good to have it over with. I'd worried about all kinds of things going wrong today. None of those things happened. 

I found that sometime last week my attitude toward the surgery changed from "Oh, no, I need to have this damn eye surgery" to "Oh, please, let's get the eye surgery done so I can stop worrying about it."

Mission accomplished. Now I can start worrying about other things that probably won't happen.

When life goes wrong, it can happen in bunches

Anticipating how some people are going to react to this blog post, I want to start off by making one thing clear:

While my wife Laurel, our dog, and I are going through a stretch of more problems in our lives than usual, we're fortunate to have a decent income, good health insurance, and a pleasant home.

Lots of people have worse problems than we do, with fewer resources available to deal with them. Like, anyone homeless.

Having hopefully defused the "privilege" objection to what I'm about to say, my main point is simple:

Life can be tough, no matter who you are, and when things go wrong, it's unfortunate that sometimes those problems occur in bunches.

Mooka is our 5-6 year old Husky mix. She came from a shelter, so we don't know her exact age. As I wrote about in January, her hip dysplasia diagnosis worried us. 

She's an active dog. We live in rural south Salem with hardly any flat areas. Our home has several sets of stairs. Long walks and trips to the Minto Brown dog park were favorite activities of Laurel and Mooka.

That was threatened by the hip dysplasia. But in February Mooka started limping badly after playing with a dog she encountered on a walk. At first she wasn't putting any weight on that paw, though now she can, at least when walking slowly.

However, today a vet told Laurel that Mooka probably has an ACL tear in her knee. There's treatments that we're pursuing. However, knee surgery would involve a lengthy recovery period, which for a dog like Mooka, who really enjoys her twice daily walks and other excursions, would be hard to take.

Laurel had to spend many hours dealing with a screw-up by Best Buy after she ordered an induction cooktop and got something else. Fortunately Kelly's came to our rescue, so that problem has been resolved.

But a few days ago Laurel had a lengthy dentist appointment to have a broken crown replaced, after getting a temporary crown about a month ago. Now she has a toothache in that tooth, which shouldn't happen after a crown replacement.

That tooth has been worked on a lot over the years, so Laurel is worried that the root is damaged, which could require an implant. Not a fun prospect.

As for me, I'm scheduled for eye surgery next Monday at Good Samaritan Hospital in Portland. This is related to the glaucoma diagnosis I got about a year and a half ago. I'm very nearsighted in my right eye, which is where almost all of the optic nerve damage has occurred to my peripheral vision, which happened surprisingly rapidly.

So even though two types of eye drops have lowered my eye pressure from the low 20s to about 10 in each eye (lowering pressure is the only way to slow down glaucoma from progressing), the Portland glaucoma specialist I was referred to wants me to get a Trabeculectomy.

I'm pleased that I can spell the procedure. Not so pleased at having eye surgery, a first for me. It'll be good to get it over with, though, since I had to cancel a February surgery appointment when I got Covid last month.

Anyway, while the health problems of my wife, dog, and myself aren't as serious as many people have to deal with, it's been stressful for us to have to cope with them all at once. But that's the way life is: unpredictable.

We just wish life could have spaced out those problems. Sadly, life isn't a conscious being that demands can be made of. Even so, we look forward to life giving us a break as spring approaches.

I get Paxlovid "rebound," but I'm OK with being Covid positive again

Six days ago I completed my 5-day course of Covid treatment with Paxlovid, which basically puts a brake on replication of the virus, giving your body a chance to deal with it before it gets up a big head of Covid steam.

I commemorated that event with a blog post, "My somewhat contrarian take on Paxlovid 'rebound.'" I said:

My symptoms (nasal congestion and a cough) have been gone for a few days. The rapid test I took this afternoon was negative. So things are looking good. 

And I'm not all that worried about Paxlovid rebound, which doesn't seem like a big deal to me.

I still feel it isn't a big deal, even though last Wednesday, four days after I finished the Paxlovid treatment, I was dismayed to find that a rapid test I took showed I was positive for Covid again. So far (this is Friday) I'm still testing positive.

That's irritating, since I enjoyed my few days of post-Covid normalcy -- having coffee with a friend, going back to exercising at my athletic club, attending my Tai Chi class. 

On the plus side, my symptoms are milder than before, and they were pretty mild the first Covid time around. I haven't had to take a decongestant at bedtime, which I did during the first bout of Covid. And I came across a recent Scientific American story about Paxlovid rebound which indicates that my "contrarian take" on this actually is scientifically mainstream. 

A tweet clued me in to the story.

If you have doubts about Paxlovid because you've heard about the rebound effect, or if you know people who qualify to get Paxlovid because they're in a higher-risk Covid category (elderly, for example) and might be reluctant to take the drug, check out the February 8, 2023 Scientific American story by Lauren Gravitz, COVID Rebound Can Happen Even without Paxlovid.

Here's a PDF file if you have difficulty accessing that web page.
Download COVID Rebound Can Happen Even without Paxlovid - Scientific American

Some excerpts from the story:

Paxlovid gets a bad rap over concerns about COVID “rebound.” That’s the primary takeaway from a series of papers showing that whether or not people take the antiviral medication, many have symptoms that wax and wane before going away completely.    

Over the past few months a number of peer-reviewed and preprint studies have looked at patients with COVID in the placebo groups of clinical trials for Paxlovid and other treatments. As part of the trials, the patients in these groups were required to fill out daily symptom trackers. Researchers consistently found that as many as 30 percent of those who did not take an antiviral experienced a rebound in coughing, fatigue, headache or other symptoms after initially feeling better. 

...Despite Paxlovid’s proved efficacy at preventing severe disease and death in people considered high-risk, Smith found increasing resistance to it. “When Paxlovid rebound started to gain traction—I’m going to be blunt—I kind of got annoyed,” he says. Perhaps more worrisome, however, is the fact that some physicians have become hesitant to prescribe it. “The drug kept people out of the hospital and kept them from dying,” Smith says. “My patients started saying they didn’t want to take it,” he adds, and “I felt guilty because I’d started it all.”

Because he knew that respiratory viral symptoms have a tendency to come and go no matter the virus or treatment, Smith set out to better characterize the course of COVID itself. As chair of the U.S.-government-sponsored ACTIV-2 trial—a series of placebo-controlled studies that aims to assess new COVID treatments—he had troves of data at his fingertips, so he dove into the trials and gave the placebo groups extra scrutiny.    

...Smith wasn’t surprised by the results. “As an infectious disease doc, [I] know that respiratory disease viruses often have this waxing and waning,” he says, adding that it also happens with colds, influenza and respiratory syncytial virus (RSV). “It’s just their nature.” This is likely because most symptoms are related to the body’s inflammatory response to the virus, not the virus itself, he says. The inflammation—which is different for everyone—generally lasts longer than the virus, and it ebbs and flows as viral remnants are cleared from the body.

Other infectious disease specialists agree. “In my view, the story of rebound was overblown,” says Ziyad Al-Aly, a clinical epidemiologist and chief of the research and education service at the Department of Veterans Affairs St. Louis Health Care System. He notes that he frequently hears of physicians who resist prescribing Paxlovid to high-risk patients for fear of rebound or the much-lamented side effect of a bitter, metallic taste. And yet, he says, “rebound never killed anyone. But COVID can put you in the hospital or, even worse, could lead to death.”    

Robert Wachter, chair of the department of medicine at the University of California, San Francisco, has heard similar reactions to Paxlovid. “I’ve heard many times from patients and from a fair number of physicians that ‘I don’t like to use it because of rebound,’” he says. “I kind of understand it viscerally, but it doesn’t make sense when looking at a dispassionate ledger sheet of the medication’s benefits and downsides.... It’s not that close a call.”    

...Until more data emerge, physicians must rely on their intuition and whatever solid information they can find. Existing data consistently point to the upside of Paxlovid. “In my world, people have looked at the data and believe the benefits of medication are quite probable,” Wachter says. “I’m certainly going to give it to high-risk people. Most of my colleagues who have gotten COVID have taken it.” And Wachter, who is 65 years old, adds that if he tests positive for COVID, he will absolutely take the drug himself.    

Physicians agree that COVID rebound after antivirals may be a nuisance, but it is far better than hospitalization or death. “Paxlovid is the best weapon we have right now for people who have COVID,” says Smith, who knows the treatment landscape better than most. “It keeps people out of the hospital, keeps them from dying and probably decreases the risk of long COVID. In short, I think it’s worth the bitter taste.” 

My somewhat contrarian take on Paxlovid "rebound"

After getting some Covid symptoms and testing positive on a rapid test last Monday, this morning I completed the 5-day Paxlovid treatment regimen. 

My symptoms (nasal congestion and a cough) have been gone for a few days. The rapid test I took this afternoon was negative. So things are looking good. 

And I'm not all that worried about Paxlovid rebound, which doesn't seem like a big deal to me.

Nobody really knows how many people who take Paxlovid either get Covid symptoms after the 5-day treatment is over, or test positive after testing first positive, then negative, then positive again. A Scientific American story says:

The Pfizer clinical trial reported between 1 and 2 percent of those who received the drug tested positive for COVID after finishing the Paxlovid course; their illness rebounded. Those rebounds were not statistically different from rebounds experienced by people with COVID who received the placebo, however.

And a Los Angeles Times story strikes a cautionary tone.

This is a story about a COVID-19 medication, a nasty trick the coronavirus sometimes plays on its victims, and how the two became a pandemic couple called “Paxlovid rebound.”

It’s also a story about how looks can be deceiving.

Americans have been quick to embrace the idea that the antiviral drug is to blame for COVID-19 relapses in people just days after they’ve seemingly recovered. President Biden was said to have experienced Paxlovid rebound this summer, after White House doctors declared him coronavirus-free. The same thing happened to Dr. Anthony Fauci and Stephen Colbert, among others.

It’s tempting to presume a cause-and-effect relationship between two things that occur in quick succession. And even when events are completely random, we tend to see the patterns we expect to find.

But researchers are not so sure Paxlovid rebound is real. Relapses have occurred in COVID-19 patients who didn’t take the drug — they just didn’t get as much attention when there wasn’t a new medicine to blame.

Doctors fear some patients who could benefit from Paxlovid are skipping it in an effort to avoid a boomerang bout of COVID-19. That’s troubling because the medication has been found to powerfully reduce the risk of hospitalization or death in the unvaccinated, older people and those with compromised immunity. Preliminary research hints it may even reduce the risk of long COVID.

Today I shared some thoughts with a friend about the subject of Paxlovid rebound. She also took Paxlovid, but is still testing positive about a week after the treatment ended. She shared an email from her doctor, which I cited in my own message. 

The way I see it, your doctor and my pharmacist are saying the same thing. Paxlovid doesn’t cause any virus lingering in the body after the 5-day treatment regimen to somehow pop back up and reinfect the person. It’s the Covid virus that caused the initial infection and it’s the Covid virus that causes any negative test result at the end of treatment to turn into a positive test result later on.

As your doctor correctly noted, Paxlovid puts a brake on replication of the virus during the 5-day treatment period. If a person’s body/immune system wasn’t able to clear all of the virus during that period, or if the person for one reason or another didn’t respond properly to the Paxlovid treatment, then any residual virus can emerge after the Paxlovid brake is turned off after the 5-days.

So if a positive test result occurs after Paxlovid, as has happened with you, this doesn’t mean Paxlovid is responsible. Paxlovid did what it should. And the Covid virus is doing what it does so well, replicate if given the chance. 

I look at the situation this way. Without Paxlovid, you or I might well have spent several weeks suffering from moderate symptoms. That was the case with a woman I know, somewhat younger than me, who got Covid and emailed me, “I hope you get over it more quickly than I did.” I recall she was sick for a couple of weeks.

So we take Paxlovid. It puts a brake on the virus replicating in our bodies. We have mild symptoms. If after the brake is released, some residual virus causes a positive test result some days after the end of Paxlovid treatment, we’re still considerably better off than if we hadn’t taken Paxlovid at all, because of the 5-day brake period, which enabled our bodies to better fight the comparatively small amount of virus that the Paxlovid brake couldn’t stop.

Like you said, it seems to come down to word choices. The word “rebound” conjures up an image of something happening that shouldn’t, whereas actually a positive test result after the 5-day course of treatment isn’t surprising, if some residual virus remained in the body after the five days. Some people seem to view “rebound” as meaning that Paxlovid caused two Covid infections rather than just one, which makes them reluctant to take Paxlovid. Of course, there was just one Covid infection.

They don’t realize that if they qualify to get Paxlovid, they should take it, since whatever happens with the course of treatment, they’ll be better off than if they just let Covid run its course in their body without Paxlovid. I took another rapid test about an hour ago: negative. So that’s good news. Of course, I’ll re-test myself every few days to see if a positive test result emerges.

I couldn’t tell from your message whether you took a rapid test after the 5-day course of treatment. If so, I’m curious if it was negative. 

I test positive for Covid. And feel positive about Paxlovid.

Well, it was a good run without ever getting Covid -- about three years since the nasty virus came to the United States in early 2020. 

After I had trouble sleeping last Saturday night, feeling on edge for no discernible reason, I took a rapid Covid test Sunday morning, which came back negative, even though my voice was a bit hoarse.

But Monday morning I had some nasal congestion and increased hoarseness, so I tested again. Yikes! A positive result. 

That kicked off a flurry of phone calls. First, I called my Salem Health family physician's office. I talked with someone who described my treatment options after I told her that I'd like to get Paxlovid given my age (74) and understandable desire to avoid a serious case of Covid.

She explained that a complication was that Paxlovid interacted with several prescription medications that I was taking. OK, I told her, no problem. I just won't take the medications while on the five-day Paxlovid course of treatment.

I then was told that they use the Salem Health pharmacy and that I'd be getting a call from a pharmacist. Probably the same day. Around 2:30 in the afternoon I got that call.

The Salem Health pharmacist was wonderfully clear.

He had me repeat what the person in my doctor's office had told me (which probably was in my chart): stop taking all of my other prescription medications for the five-day Paxlovid treatment, plus three days afterward, waiting another two days to restart the most problematic medication, Lovastatin (10 mg).

Again I said, no problem. I told the pharmacist I wasn't going to suffer much, if at all, from not taking the other medications. I'd much rather shorter the course of my Covid infection and lower the risk of getting Long Covid, which a VA study indicates is about a 25% risk reduction. 

Laurel, my wife, picked up the no-cost Paxlovid prescription for me. I took my first dose of three pills late Monday afternoon on the same day I tested positive for Covid. So I felt good that it was possible to get going with Paxlovid so soon (Paxlovid needs to be started within five days of having Covid symptoms). 

Here's how Paxlovid works.

Paxlovid is an antiviral therapy that consists of two separate medications packaged together. When you take your three-pill dose, two of those pills will be nirmatrelvir, which inhibits a key enzyme that the COVID virus requires in order to make functional virus particles. After nirmatrelvir treatment, the COVID virus that is released from the cells is no longer able to enter uninfected cells in the body, which, in turn, stops the infection. The other is ritonavir, a drug that was once used to treat HIV/AIDS but is now used to boost levels of antiviral medicines. 

As a COVID-19 treatment, ritonavir essentially shuts down nirmatrelvir’s metabolism in the liver, so that it doesn’t move out of your body as quickly, which means it can work longer—giving it a boost to help fight the infection.

At the moment I'm 3 1/2 days into the 5-day treatment. Starting today, Thursday, I'm almost symptom free.

My nasal congestion is just about gone. I cough occasionally, but way less than before. The only annoying side effect is some diarrhea, along with a bit of a metallic taste in my mouth for several hours after taking a dose.

Regarding the oft-heard Paxlovid "rebound effect," where Covid symptoms recur after going away, the Salem Health Pharmacist told me that this isn't due to Paxlovid, but to Covid. I believe he's right, after some Googling of this subject. For example, see here and here.

Not everyone with Covid is eligible to get Paxlovid. Based on my experience, I recommend that if you have Covid, ask if you can be prescribed Paxlovid.

My first counseling session: "I feel like you heard me"

I could have saved the $40 insurance co-pay by taking the advice of this cartoon and letting our dog make me feel better, instead of going to my first Salem Health counseling session.

But after seeing Wayne Halle, a MSW counselor, I'm convinced that I made the right decision to take my problems to a human, rather than a canine.

I was referred to Halle in late December after I told my family physician that I found a recent glaucoma diagnosis to be more than a little disturbing, especially when layered on top of a couple of other annoying health problems that I have.

However, early on in today's initial session I told Halle that since it took about ten weeks to get an appointment with him, now I wasn't as worried about my glaucoma. 

Of course, I quickly said that I have other concerns.

This was after I noted that like Halle, I too have a MSW (Master of Social Work) degree, as does my wife, a big difference being that soon after I got my degree, I realized that I wasn't really cut out to be a social worker, which led to me getting a job in health services research and then health planning.

My main takeaway from the 50 minutes or so I spent talking with Halle was how good it feels to be listened to attentively. That's why, when we were making plans for a second session, I told him, "I feel like you heard me."

Which isn't surprising, given that's what counseling/psychotherapy is largely about. It's also what everyday conversations should be about.  Often, though, we're guilty of paying as much attention to how we're going to respond to the other person, as to what they're saying. 

At least, I'm guilty of this. 

So it was refreshing to have Halle ask good questions about the difficulty I have in coping with a bladder that, as I like to put it, went on strike about five years ago and hasn't gotten back to working normally.

(Smooth bladder muscle, unlike regular muscle, doesn't recover when it loses its tone and becomes atonic, unable to properly push out the pee.)

I explained that one of my mental health concerns is a strong feeling of regret that I both failed to recognize warning signs that the prostate problem which I knew I had was morphing into a bladder problem, and also that when I had a urinary retention episode (unable to pee), I delayed seeking treatment, wrongly feeling that the problem would resolve itself.

Halle zeroed in on the key issue. 

"So tell me," he said, "before this happened, how many times in your life had your bladder stopped working?" "Um, none," I told him. "How then," Halle asked me, "could you have known what was going to happen, since you'd had no experience with it?"

Bingo. This interchange alone would have made the session worthwhile. My regret immediately lessened.

I'd had similar thoughts, but since the thoughts came from my own mind, they didn't have the impact  that Halle's words did. Meaning, I'm kind of immune to my own bullshit. My mind is continually churning out ideas, some of which make sense, and some don't. 

This is the problem with being your own therapist, something I alluded to in talking with Halle.

I told him that I have countless (almost) books about meditation, mindfulness, neuroscience, and such, many of which have good tips for dealing with anxiety and worries, of which regret is one manifestation. But it's difficult for me to break out of deep mentally unhealthy patterns on my own, since this is akin to me lifting myself off of the ground.

Someone else can do this, because they can use their legs and arms as leverage to raise me up. I, though, am stuck when I try to do the same thing.

This is the beauty of a skilled counselor like Wayne Halle. Within a few minutes of meeting this perfect stranger, I was telling him things about myself that I'd shared with only a couple of other close friends and relatives.

Such is the power of unconditional acceptance in a therapeutic relationship. I felt like the ideas and feelings I was sharing, though naturally familiar to me, since I was speaking them, had a special power when directed at Halle's welcoming and non-judgmental ears.

Somehow that made my concerns seem more manageable -- given that a stranger was listening to me with calm acceptance, unlike the often negative reaction I have to my own thoughts and emotions.

Which is damn strange, really, how I can be harder on myself than other people are with me. Anyway, I look forward to my next session with Halle, which won't be for about another month. (Salem, like most places, needs more mental health professionals.) 

MDMA research shows war on drugs is absurd

Sadly, I've never tried MDMA, otherwise known as Ecstasy or Molly. If I had, maybe I wouldn't have said sadly, since MDMA is a feel-good drug due to its ability to induce a massive release of serotonin, creating a feeling of well-being, love, joy.

In his book, "Waking Up: A Guide to Spirituality Without Religion," Sam Harris describes an experience he had at the age of 19, taking MDMA with a friend in 1987.

The setting of our experience bore little resemblance to the conditions of Dionysian abandon under which MDMA is now often consumed. We were alone in a house, seated across from each other on opposite ends of a couch, and engaged in quiet conversation as the chemical worked its way into our heads.

Unlike other drugs with which we were by then familiar (marijuana and alcohol), MDMA produced no feeling of distortion in our senses. Our minds seemed completely clear. 

In the midst of this ordinariness, however, I was suddenly struck by the knowledge that I loved my friend. This shouldn't have surprised me -- he was, after all, one of my best friends. However, at that age I was not in the habit of dwelling on how much I loved the men in my life. 

Now I could feel that I loved him, and this feeling had ethical implications that suddenly seemed as profound as they now sound pedestrian on this page: I wanted him to be happy.

...The interesting thing about this final shift in perspective is that it was not driven by any change in the way I felt. I was not overwhelmed by a new feeling of love. The insight had more the character of a geometric proof: It was as if, having glimpsed the properties of one set of parallel lines, I suddenly understood what must be common to them all.

...The experience was not of love growing but of its being no longer obscured. Love was -- as advertised by mystics and crackpots through the ages -- a state of being. How had we not seen this before? And how could we overlook it ever again?

Sounds great. Sign me up for some MDMA!

Oh, there's a problem. According to an article in the February 2022 issue of Scientific American, "A Psychedelic for Trauma," this happened after MDMA began to be used as part of psychotherapy with people who had distressing memories.

In 1985 the U.S. Drug Enforcement Agency (DEA) classified MDMA as a Schedule I substance, making its possession a crime punishable by up to 15 years in prison. The National Institutes of Health subsequently spent two decades funding research that suggested MDMA is neurotoxic and often lethal.

Which isn't true, as a bit of Googling easily reveals.

Most people who have a toxic reaction to MDMA got an adulterated version of the drug. This is what happens when a drug is made illegal. People still use it, but they don't get the pure drug, since it is unregulated. The Drug Policy Alliance says in relation to overdosing on MDMA:

“Overdose” refers to taking a higher than appropriate dose of a medicine or drug, which can happen with MDMA, but is extremely rare. It is much more likely that a problem would occur as a result of MDMA use with contraindicated medications (such as MAOI anti-depressants), preexisting health conditions, overexertion, or dehydration. Given the highly adulterated molly market, it’s also more likely to see an unidentified substance cause problems, rather than MDMA itself.

The Scientific American story by Jennifer Mitchell describes a key reason MDMA got such a bad reputation. 

These early studies indicated that MDMA can promote long-lasting restructuring of serotonin-containing nerve fibers, but they also suggested that such changes occurred only in high doses and were reversible over time.

Then along came George Ricaurte, a neurologist at the Johns Hopkins School of Medicine, who made a name for himself by touting the alleged neurotoxic and lethal effects of MDMA. Ricaurte claimed that "even one drop of MDMA can lead to permanent brain damage."

His findings, proclaiming that MDMA could ravage the brain and leave nothing but damaged fibers in its wake, were published in the Journal Science and used time and again by the National Institute on Drug Abuse to support the war on drugs.

These data were later retracted after it was revealed that amphetamine, not MDMA, had caused the reported neurotoxicity.

But it has taken us years to get beyond sensationalist antidrug propaganda posters in which phrases such as "This is your brain on Ecstasy" were splashed atop artificially colored brain scans, making it look as if MDMA, as one DEA official put it, "turns your brain into Swiss cheese."

Mitchell is both hopeful and appropriately cautious about the current efforts to restore MDMA as a therapeutic drug for people suffering from PTSD, depression, anxiety, and other mental problems. She writes:

At 15 study sites across three counties, working with more than 70 different therapists and with study participants with childhood trauma, depression, and a treatment-resistant subtype of PTSD, we have obtained incredibly promising results.

...And although there had been concern that administering new medication to people with suicidal ideation could worsen their problems, MDMA-assisted therapy did not increase measures of suicidal thinking or behavior. 

MDMA also did not demonstrate any measurable misuse potential (which should compel us to reconsider the reasoning behind the war on drugs and scare tactics of the 1990s).

For sure.

I'm happy that I live in Oregon, a state that has legalized marijuana, approved psilocybin (magic mushrooms) for therapeutic use, and is the first state to decriminalize possession of all drugs and greatly increase access to supportive health services.

It's time -- past time, really -- for the United States to say yes to drugs. Adults should be able to purchase legal, well-regulated drugs that they want to use either for pleasure or therapy/healing/self-improvement.

It's crazy that alcohol and nicotine can be bought everywhere, even though these substances are much more destructive than most of the drugs still under tight control by the federal government.

I have glaucoma but not worried about CBD raising eye pressure

About three months ago I was diagnosed with glaucoma. I'm very nearsighted, which is a risk factor, along with age (I'm 73). The good news is that my eye pressure has dropped from 20-21 to 11-14 via prescription eye drops.

(Lowering eye pressure is the only way of preventing further optic nerve damage from glaucoma.)

Early on, though, I had a lot of anxious moments. After all, going blind from glaucoma or "just" experiencing functional loss of vision is scary. 

My anxiety increased after my wife wondered if my use of CBD could have been a cause of the glaucoma. My first reaction was to tell her, of course not, because it's well-known that THC, another form of cannabis, lowers eye pressure.

But some Googling revealed numerous articles about how CBD raises eye pressure, so glaucoma patients should be wary of using it.

However, I've asked two optometrists and an ophthalmologist who specializes in glaucoma if I should stop using CBD. All three said "No."

Here's what one optometrist said in a reply to my question about whether I should be concerned. The small doses of CBD he refers to me using are 20 mg twice a day and 10 mg once a day, spread out during the day.

After his message I'll share additional reasons why I'm not worried about CBD raising my eye pressure.

~Brian
Hello there ~ the article from the AAO [American Academy of Ophthalmology] you cited is likely referring to this study, which was performed at Indiana University in 2018:

https://iovs.arvojournals.org/article.aspx?articleid=2718702

In that study, the researchers found that dosing mice with THC (the active ingredient in marijuana) lowered eye pressure, while CBD transiently raised eye pressure. This information has been known for a while, but has perhaps become more relevant recently as CBD products have become more available.

While it is easy to draw conclusions from the study, I would caution you from throwing away all of your CBD product. Instead, I would draw your attention to this study, completed at the University of Aberdeen in 2006:

https://pubmed.ncbi.nlm.nih.gov/16988594/

While the Indiana study was performed on mice, this study was performed with human subjects. Though the sample size was small (six individuals), it did provide some comforting information. The researchers found that while high doses of CBD (40 mg) did raise eye pressure, small doses (20 mg) had no effect. This suggests that small doses can likely be tolerated without producing eye pressure-raising effects.

Of course, much more research needs to be completed on human subjects for us to determine exactly what strength/dosage of these products is safe. But you can take heart that your small doses are unlikely to have a significant effect on your eye pressure.

My suggestion would be to continue your CBD use for now. If anything, prematurely stopping it would potentially color the results that your glaucoma medication provides. I would recommend continuing to keep your single doses at 20 mL/mg or below and spread them throughout the day.

We will be monitoring your eye pressure at each visit and should it start to creep up, we have other ways to bring it down than for you to cease your CBD treatment. At this point, I wouldn’t stress about it too much.

Good advice. I've stopped stressing about using CBD entirely, for these reasons.

First, the December 2018 IOVS Journal article described how eye pressure in mice responded to doses of THC and CBD. Mice aren't people, obviously. The article says:

Three of four studies that have tested CBD for effects on IOP [intraocular pressure] have reported no effect, but the fourth has reported an increase in IOP.

Somewhat strangely, the article doesn't give references to the three studies that showed CBD having no effect on eye pressure, just the single study that reported an increase.

But that study was the 2006 University of Aberdeen research which my optometrist referred to as showing that only a CBD dose of 40 mg raised eye pressure, while 20 mg of CBD had no effect. Since I assume the other three no-effect studies mentioned in the IOVS Journal article also were on humans, seemingly the only evidence that CBD raises eye pressure in people is the 2006 study.

Then there's the issue of CBDA, a precursor of CBD that an Oregon State University lab study found prevented cells from being infected by the coronavirus. I've been using CBDA rather than CBD for about a week, as described in my blog post, "I got some CBDA. Covid can't touch me now!"

I'm no expert on the pharmacology of CBD and CBDA. However, it seems to me that CBDA is even less likely than CBD to raise eye pressure, since CBD and CBDA work in considerably different ways. Meaning, the mechanisms by which they have effects on the human body are different.

The IOVS article says "there is no effect on IOP by CBD if GPR18 and CB1 are both blocked/deleted." In other words, eye pressure in the mice didn't increase if the receptors GPR18 and CB1 weren't functional. 

I found a lengthy study that looked at how various forms of cannabis operate. In the CBDA section, it says:

Bolognini et al. (2013) also found that, in contrast to CBD (section 7.3.1), CBDA did not display significant activity as either an agonist or an inverse agonist at cannabinoid CB1 receptors in mouse whole brain membranes, even at a concentration 100,000-fold higher than a concentration (0.1 nM) at which it potentiated 8-OH-DPAT in rat brainstem membranes.

I don't understand much of that language, but it seems clear that CBDA didn't have any significant activity at the CB1 receptor that could cause CBD to raise eye pressure at high doses. 

So I'm comfortable with using CBD even though I have glaucoma, and I'm considerably more comfortable with using CBDA. 

I got some CBDA. Covid can't touch me now!

Like I said in a recent post about an Oregon State University study that found CBDA and CBGA prevented Covid infection in a laboratory study of cells, regular CBD has very little of these acids that are  precursors to CBD, so mostly disappear when CBD is created from hemp.

But I found several online sources of CBDA. Fewer seem to exist for CBGA. This story describes the key differences between CBD, CBDA, and CBGA, with this takeaway quote.

A study published this week by researchers at Oregon State University found some hemp compounds have the ability to prevent the virus that causes COVID-19 from entering human cells.

Findings of the study led by Richard van Breemen, a researcher with Oregon State’s Global Hemp Innovation Center, College of Pharmacy and Linus Pauling Institute, were published this week in the Journal of Natural Products.

...“We identified several cannabinoid ligands and ranked them by affinity to the spike protein,” van Breemen said. “The two cannabinoids with the highest affinities for the spike protein were CBDA and CBGA, and they were confirmed to block infection.”

So I was thrilled to find this bottle in our mail today, which arrived quickly from FluxxLab, a Colorado company.

The label on the back says that half a dropper contains about 10 mg of CBDA and 6.6 mg of CBD. I've had two doses today, so it's pretty clear...

Covid can't touch me now!

Leaving aside the minor detail that there's no evidence CBDA actually prevents Covid in humans, as opposed to cells in a lab dish. But if the placebo effect is at play here, I'm even more protected, since I believe in CBD and CBDA.

I don't claim to fully understand what makes Fluxxlab products different from regular CBD, but this excerpt from the product page for their CBDA oil say those products are considerably more potent -- five times as much. 

FluxxLab™ CBDA Tinctures

Expect results that will outperform any CBD you have ever experienced. Completely natural, this pure CBDA oil tincture delivers potency many times greater than standard CBD. Carefully crafted in our own Colorado lab, we have added exactly the right natural terpenes to precisely balance the performance of what our customers tell us is “The World’s most perfect Tincture.”One ounce will provide you with a full month’s supply of the Best CBDA Rich Oil tincture you will ever find anywhere. Satisfaction always guaranteed.

Beyond all other tinctures

FluxxLab™ tinctures are precisely formulated to fit your needs and usage levels. Experience tells us that 90% of people who use CBD don’t take enough and don’t get the full benefits that they need or expect. At Fluxxlab™, we have addressed that problem with an economical and effective solution. We offer you three carefully selected CBDA tinctures. Our 500mg tincture is exactly right for those serious users who would otherwise be taking 2,500mg of regular CBD per month. We refer to this as the normal CBD dosage level. Our 1000mg CBDA oil is correct for users who would otherwise be taking 5,000mg of CBD per month, on average.

OK. I've been taking about 50 mg of CBD a day, so that comes out to 1,500 mg a month. Thus supposedly I've been well under the normal CBD dosage level of 2,500 mg.

Regardless, I'm enthused about trying out CBGA, a new thing for me. There hasn't been as much research on it as on CBD, but there's some intriguing potential benefits aside from preventing Covid.

CBDA shows promise as an effective medicine in the treatment of a variety of conditions. CBDA’s affinity for serotonin receptors helps it affect everything from mood to nausea to inflammation.

CBDA has shown to have a more intense activation of 5-HT1A serotonin receptors compared to CBD. Serotonin can affect a variety of physiological functions including mood regulation, nausea, vomiting, and intestinal motility. 

Based on the current research, CBDA’s potential as a medicine is still up in the air. 

Up until now, clinical trials have largely focused on animal models. Until trials focus on human health and how CBDA works, we will not know the full extent of CBDA’s power.

Pain relief also is a possibility (scroll down and click on benefits). 

There can be dramatic results when using CBD products. At FluxxLab™ we have first-hand experience with many hundreds of cases where our customers have experienced dramatic and amazing results using CBDA as compared to plain CBD.

The overall Endocannabinoid response to CBDA appears to be far more powerful than it is with CBD. CBDA binds with some of the same Endocannabinoid receptors in the human body as CBD, but it is also known to bind with different receptors.

Expect to find many cases where CBDA acts in similar but more powerful and effective ways than plain CBD. For example: Research indicates that CBDA acts on the human body by inhibiting COX-1, an enzyme linked to inflammation. When the human body feels there is a problem in a particular organ, it sends this enzyme to cause inflammation and stop the problem from spreading throughout the body. Inflammation is a natural body response. However, our body often creates inflammation even when there is no real problem. People suffering from such inflammation usually complain about chronic pain. CBDA appears to be as much as 100 times more effective in targeting this receptor, compared to CBD.

Not much Covid-fighting CBDA and CBGA in regular CBD

I've been using CBD oil and capsules for quite a while. So I got excited yesterday when I saw reports of an Oregon State University study that found precursors to CBD, CBDA and CBGA, prevented Covid infection in a laboratory study of cells.

Hemp

CORVALLIS, Ore. – Hemp compounds identified by Oregon State University research via a chemical screening technique invented at OSU show the ability to prevent the virus that causes COVID-19 from entering human cells.

Findings of the study led by Richard van Breemen, a researcher with Oregon State’s Global Hemp Innovation Center, College of Pharmacy and Linus Pauling Institute, were published today in the Journal of Natural Products.

Hemp, known scientifically as Cannabis sativa, is a source of fiber, food and animal feed, and multiple hemp extracts and compounds are added to cosmetics, body lotions, dietary supplements and food, van Breemen said.

Van Breemen and collaborators, including scientists at Oregon Health & Science University, found that a pair of cannabinoid acids bind to the SARS-CoV-2 spike protein, blocking a critical step in the process the virus uses to infect people.

The compounds are cannabigerolic acid, or CBGA, and cannabidiolic acid, CBDA, and the spike protein is the same drug target used in COVID-19 vaccines and antibody therapy. A drug target is any molecule critical to the process a disease follows, meaning its disruption can thwart infection or disease progression.

“These cannabinoid acids are abundant in hemp and in many hemp extracts,” van Breemen said. “They are not controlled substances like THC, the psychoactive ingredient in marijuana, and have a good safety profile in humans. And our research showed the hemp compounds were equally effective against variants of SARS-CoV-2, including variant B.1.1.7, which was first detected in the United Kingdom, and variant B.1.351, first detected in South Africa.”

Those two variants are also known the alpha and beta variant, respectively.

But since the news release spoke of CBGA and CBDA being precursors to CBD, this paragraph caused me to wonder whether the CBD drops and capsules I'd been taking were Covid fighters.

“These compounds can be taken orally and have a long history of safe use in humans,” van Breemen said. “They have the potential to prevent as well as treat infection by SARS-CoV-2. CBDA and CBGA are produced by the hemp plant as precursors to CBD and CBG, which are familiar to many consumers. However, they are different from the acids and are not contained in hemp products.”

So last night I emailed the folks at Sunsoil, a Vermont company where I've been buying CBD, asking if their products contained CBDA and CBGA. They replied promptly today, referencing a news story I'd sent them about the OSU study.

Hi Brian,

 

Thanks for sending this article along! We've had a few customers forward it to us today as well 😀 We post all of our lab reports on our website and you can find them here: https://www.sunsoil.com/pages/lab-results-1. You can match your specific bottles and batch/lot # to the reports on our website.

 

As you will see, our products do contain the full range of cannabinoids present in the hemp plant, but we definitely focus on and propagate our seeds and plants to product more CBD than other cannabinoids. Our oil does contain CBGA and CBDA but in very small quantities so that on the reports you may see either "ND" (none detected) or <LOQ (below the limit of quantification). Both of these mean that there is trace amounts of these cannabinoids in our oil, but lower amounts than the lab equipment used for results can detect.

 

Let me know if you have any other questions or need clarification! The reports can be tricky to read so I always recommend scrolling down to the Sunsoil header report as it's a bit more reader friendly. Hope this helps!

 

Have a great day,

Tia

Following the link in the email message, I checked out the lab results for the Sunsoil CBD drops I've been taking with 20 mg of CBD in a serving. Here's a table of what they contained.

The easiest way to look at this, assuming I'm reading the table correctly, which I think I am, is that the sample totaled 27.55 mg of Cannabinoids, with 22.43 mg being CBD. There was 1.83 mg of CBDA in the sample, and just a trace amount of CBGA, not enough to measure.

So, hey, almost 2 mg of CBDA is better than nothing, Covid-fighting-wise, but pretty minimal. That led me to a Google search for real CBDA or CBGA.

I focused on CBDA, since there seemed to be more sellers of this. Montkush has a detailed description of CBDA, which educated me about this CBD precursor. Excerpt:

What Is CBDA?

All cannabinoids in cannabis and hemp come from cannabigerolic acid (CBGa), the mother of all cannabinoids.

Plant enzymes then convert the CBGa into a combination of the three major cannabinoid precursor compounds: tetrahydrocannabinolic acid (THCA), cannabichromenic acid (CBCA), and cannabidiolic acid (CBDA). The combination will depend on the unique cannabis strain they are derived from.

CBDA is a non-psychoactive compound that serves as a precursor to CBD. More specifically, CBDA is decarboxylated to create CBD, meaning it is heated. This can happen instantly if smoked or vaped, or slowly if the plant material is left to dry in the sun or even at room temperature.

Cannabidiolic acid can, therefore, be thought of as raw CBD. CBDA is most often found in the live or raw hemp plants bred for high CBD levels.

Cannabidiolic acid is often consumed as CBD, but it can also be beneficial in its raw form. CBDA oil can be consumed or absorbed via tinctures, raw cannabis juice, topical creams, and raw CBDA oil.

To date, CBDA has attracted much less public attention and is seen less on the market. However, the raw juicing cannabis trend is bringing CBDA into the spotlight. People are wondering about the differences between CBD and CBDA and if CBDA is better than CBD.

So is it?

Let’s take a look.

The Differences Between CBDA & CBD

The major difference between CBDA and CBD is actually the amount of heat applied to the substance.

As we mentioned, the main difference is that CBDA is a precursor to CBD. You create CBD by heating CBDA or raw CBD.

While research in CBDA is in much earlier stages than even CBD, we know that they share some similarities.

Unfortunately, Monkush was sold out of CBDA. I signed up for an email alert for when it is expected to be available at the end of January.

I had better luck with Myriam's Hemp, which offered CBDA oil. I also got some from FluxxLab, even though their ordering process was frustrating. The box I had to check to agree to the terms of service didn't work with Safari or Chrome, but using Firefox enabled me to make an order. 

Of course, the OSU study was just laboratory research. There's no evidence, so far as I know, that CBDA prevents Covid in humans. But I figure that taking some CBDA won't hurt me, and it may have a placebo effect.

I also read that CBDA has a much stronger antidepressant effect that CBD, so if I do get Covid, hopefully I won't feel as sad about that.

Two things gym users do that really bugs me

Yeah, I know. It's almost Christmas. I'm supposed to be in a Happy Holidays cheerful mood.

But today I was reminded of two things that fellow users of Courthouse Club Fitness do that irritate me enough to warrant a complaining blog post on the eve of Christmas Eve.

One relates to sanitation.

I always carry a small "sweat towel" with me to wipe off the handles of the equipment I was on after I'm finished with it: first, the elliptical trainer in the aerobics room, then the weight machines in the circuit training room.

I also always wear a mask while exercising at the gym in these Covid times. There's a sign next to the door of the River Road Courthouse Club Fitness saying that a mask or face shield is required.

Most gym users don't wear a mask, though. I'd say three-fourths.

OK, that's an irresponsible decision that puts both them and other people at risk. But I wouldn't find those people nearly as irritating if many of them didn't also drench the machine they're using in sanitizer both before and after they use it.

That's bizarre.

The risk of getting a health problem, including Covid, by touching an unsanitized surface is hugely less than the risk of becoming seriously ill, or even dying, because of not wearing a mask in an indoor public space like a gym where many are maskless and breathing hard.

Maybe these people don't realize that Covid is almost entirely spread through the air, not by touching something someone infected with the virus has handled.

Also, I don't see them sanitizing the handles on the door they have to use to enter and leave the gym. For some reason they just have a fetish of wiping down the exercise equipment far beyond what is necessary for health and cleanliness.

My second gripe is about cell phone use by young people using the weight machines in the circuit training room.

Google images photo. 
I don't have my phone out when I'm exercising,
so I can't take a photo of the irritating people who do.

I don't do free weights, so I'm not sure if they also clog up that equipment with their obsessive need to check their phone before and after doing a few repetitions on a weight machine. Me, I've got the old-fashioned attitude that when you're at the gym, you should be exercising, not clicking away on your phone.

Yes, I do some repetitions, usually twelve, then take a short break before I do eight more repetitions. During that break I -- shock! -- simply sit on the machine, take a few deep breaths, and then resume my workout.

But almost every young person at the gym carries their phone with them while exercising. I find this to be akin to an obsessive mental health disorder. It's hard for me to believe that whatever vital information they're reading and writing about on their phone couldn't wait until they've finished their workout.

When someone sits down at a weight machine that I need to use, pulls out their phone, and proceeds to type away for several minutes, I'm tempted to go over and say to them, "Are you done using this machine as a place to play around with your phone? If so, I'd like to actually use it for the purpose it was intended."

But because I'm a polite senior citizen, I don't do this. Maybe instead I should casually drop a copy of an article at their feet, "Get off your phone at the gym, says Lou Ferrigno."

Speaking on Instagram, the New York native said:

"It's very frustrating that you go to the gym and want to have the quality of time to workout.

"I can't tell you how many times I go to the gym, I walk over to a piece of equipment, and I see some guys sitting there, holding their phone like this."

Ferrigno didn't hold back when sharing his thoughts on time-wasting gym goers.

"I'm here to train. If you don't want to work out, don't waste your time at the gym."

Although Ferrigno is best known as the original Hulk, he's also a bodybuilding icon. He hails from the Arnold Schwarzenegger heyday, and actually finished third behind the Austrian and Serge Nubret at the 1975 Mr. Olympia contest.

Not so fun day: I probably have glaucoma

I thought the day started off badly when our dog threw up three times on our living room carpet.

But it got considerably worse when I exited my visit to Retina Consultants here in Salem with a probable diagnosis of glaucoma.

Well to be exact, Dr. Justin Baynham told me that my test results were "suspicious of glaucoma." 

I'm trying to look at the bright side. Maybe it's good that my optometrist at Eye Care Physicians & Surgeons, Dr. Rebecca Chung, also wasn't completely sure that I have glaucoma.

That's why she referred me for a consultation at Retina Consultants. 

I've had an annual eye exam for most of my life, since I wear contacts. One year a while back the pressure in my eye was elevated, but it went down the next year.

In 2020 my previous optometrist, Dr. Betsy McDowell (now retired), didn't see any damage to the optic nerve, so it was a surprise when a field of vision test last Monday showed that my right eye sucks when it comes to peripheral vision.

However, Dr. Baynham told me this afternoon that 50% of people with glaucoma don't have high pressure in their eyes.

On the darker side, Chung noted some damage to my right optic nerve, and Baynham confirmed that after I had a test where some sort of dye stuff was injected into my upper arm, where it quickly found its way to my eyes, which allowed images to be taken of the optic nerves.

Not good, especially in my right eye. My left eye had considerably lesser damage.

That's irreversible, unfortunately. So the goal is to keep my possible/probable glaucoma under control to prevent further damage, which Baynham said would occur by lowering my eye pressure from 21 to 14 mm Hg. 

So I've got a prescription for Latanoprost eye drops, which hopefully will reduce my eye pressure from the high normal level of 21 to the low normal level of 14.

The big message I want to convey to others is this: Get a regular eye exam! 

Not just a vision test, but an exam that checks y0ur eye pressure and dilates your eyes so the doctor can see if any optic nerve damage in occurring. This is especially important if you're over 60, have a family history of glaucoma, or at high risk for getting this disease.

I had no vision problems other than my usual nearsightedness when I went in for my annual eye exam on October 28. Though my peripheral vision is bad in my right eye, I hadn't noticed this.

A generally positive web page about glaucoma (things can be fine if it is detected and treated early) has this to say:

People with glaucoma who manage it well can live a normal, independent life. A big problem with glaucoma is that in the early stages, people with glaucoma live their lives largely unaffected by the condition while it is all the while progressing silently.

Problems with vision can at first be subtle and many people are able to manage life well with mild to moderate visual impairment. Visual loss can even go unnoticed until it becomes severe, at which point much of the damage caused by glaucoma is irreversible.

As a doctor treating hundreds of individuals with glaucoma, my goal is to pick up on early changes and use timely and effective interventions to prevent loss of vision.  Nothing warms my heart more than to hear how my patients’ vision has become stable and that they are getting on with normal lives, being productive at work, enjoying their time with family, friends and having great experiences.

...I am grateful that we can detect glaucoma at its early stages. When my patients get a diagnosis of glaucoma at an early disease stage, I am able to keep them seeing well throughout the course of their lives.

Of course, my first reaction after hearing that I probably have glaucoma was, oh, no, I'm going to go blind! That seems unlikely, now that I've been able to have more rational reactions. 

If you have glaucoma and could share some thoughts about how you've dealt with your problem, please do so in a comment on this post. Especially if things have gone well for you. No offense, but if you've gone blind from glaucoma, I'd prefer not to know this.

My problem with the Mendi neurofeedback device

It's been a bit more than two months since I started using the Mendi neurofeedback device that I ordered via a Kickstarter campaign.

I started off enthusiastic about my Mendi, as discussed in my July 26 blog post, "I'm enjoying my Mendi neurofeedback device."

I've only been using the Mendi for a short time and need to do more exploring with it. This is my initial impression of what works best to get the ball moving upward.

My first try with the Mendi produced a pretty good score. I think this was because I simply focused on the ball and didn't try to make the ball go up.

The next few Mendi sessions didn't go so well, probably because I was trying to get a better score. From what I can tell so far -- and my experience likely is different from other Mendi users -- trying isn't the best way to train the brain.

Not trying is. 

Well, after a lot more experience with my Mendi, I'm much less enthused about the device. The main reason why was pointed to in my first blog post when I said that after I did well with the Mendi, the next few sessions didn't go so well.

For quite a while I thought the problem was with me, not the device.

But now I lean strongly to the position that the Mendi hardware, the software, or both isn't capable of reliably providing feedback on how well a user is concentrating on the single task currently available with the smart phone app: making a ball rise.

I've been meditating every day for over fifty years, often for an hour or two.

I'm a strong advocate of mindfulness, my current approach to meditation. So I'm confident that I can tell the difference between a frenzied scattered mind and a calm concentrated mind. 

Yet the scores I get with the Mendi device have little or nothing to do with my ability to focus on the ball. There's simply no evident connection between my state of mind and how much the ball moves upward, which supposedly is a reflection of oxygenated blood flow and neural activity.

The folks who designed and sell the Mendi device also seem to have a haphazard way of describing what a user is supposed to do during their sessions.

My iPhone app tells me to relax and focus on the ball. But I've also seen the advice to concentrate on trying to make the ball go upward, which is quite different from simply focusing on the ball. And other advice is to think about a mental issue you're working on, like anxiety about something.

My suspicion is that the reason there are so many different ways of describing how someone is supposed to use their Mendi device is that there's no consistent way of making the ball go up. Meaning, the device basically is giving random results, not genuine neurofeedback about someone's state of mind or ability to concentrate. 

As noted in my first blog post, I get better scores in a dark room than in the room I meditate each morning in -- which has a window facing west with a white shade that I pull down. So even though sun isn't coming through the window, even diffuse light appears to lead to a lower Mendi score.

Thus the combination of not getting results that match up with my feeling relaxed and concentrated and the sensitivity of the Mendi device to how bright a room is, possibly along with other external factors (like where on the forehead the device is worn) has caused me to stop using the device on a regular basis.

I figure that simply meditating is a better use of my time than getting scores from the device that, so far as I can tell, don't mean anything. Reportedly a software/app update is coming that might deal with my concerns, so I'll keep an open mind about the device.

I was moved to write this follow-up blog post about the Mendi device after reading a Facebook post from a user who has a similar attitude to mine. Since you have to be a member of the private Facebook group to read the posts, I'll copy in what Sami Zegnani had to say.

After several months of practice, I notice that my progress is extremely low. I have managed to make 37% increase but this is because the procedure consists of meditating during the Calibration and then I pick up the phone and inevitably my head falls and this causes an increase in blood flow in the brain. Otherwise nothing works.

 

My background is that in the middle of meditation, I reach a HRV easily exceeding 70 ms, sometimes I reach 100 ms which shows that my blood flow can be very high... On other neurofeedback devices, either on muse or on myndlift I am one of the most experienced. My scores are very good. I have thousands of hours of vipassana meditation. So I have a serious problem with this device.

 

Not only do I not progress despite regular and consistent practice, but I don't feel any well being after a session, sometimes I have a little headache! I mean I can understand that I have a low score, I started meditation 13 years ago and I had no concentration. I made 10 retreats..

 

But what I do know is that in just a few short weeks, the progress in meditation has been felt. I have no problem with having to learn. I recently started Wim Hof and I saw the benefits even though I was a novice. But with mendi, nothing, nothing nothing.

 

I wanted to wait before saying anything but now that several weeks have passed, I have a huge doubt about the device and its measurement. I'm really sorry to have to say this because I would have liked to say something good about this device. If this post can reassure people who are practicing and who think that maybe they are the problem. No, it's not necessarily you.

My hernia operation shows weirdness of hospital billing

I've been meaning to share what my May 6 hernia operation at Salem Hospital cost, because this shows how strange health care billing can be.

But I'd been putting this off -- until I was spurred into blog post action by a story in today's Statesman Journal, "Salem Hospital lacks pricing transparency, new report says."

Now, what I've shared below doesn't have anything directly to do with pricing transparency, but indirectly it does.

I'm on Medicare. My insurance company is Regence MedAdvantage.

Here's what the Medicare billing statement showed for my hernia operation. I combined the line items into categories, not that I totally understand what is included in each.

Description	Billed by Salem Health	Approved by Regence MedAdvantage	What I paid
Surgeon	378	174	40
EKG	219	80	10
Blood test	92	0	0
Covid test	160	55	0
Anesthesiologist	1,875	343	0
Operation-endoscope	1,554	667	0
Operation-Salem Health	21,972	6,413	300
Total	26,250	7,732	350

 

The main things that leapt out at me are how expensive a routine outpatient operation is, and the big difference between what Salem Health billed and what Regence MedAdvantage approved/paid.

Salem Health billed $26,250. Regence MedAdvantage paid $7,732. I paid $350.

Given this huge difference between what was billed and what my insurance paid, it's difficult for me to understand how more transparency in pricing would help people who have insurance.

Is the price what Salem Health bills insurance, what is approved by the insurance company, or something else?

Plus, when someone with good insurance, like me on Medicare, pays so little out of pocket, there's very little motivation to care about how much health care costs.

From what I've learned, the amount Medicare will pay for hospital services guarantees a decent profit for the hospital, though I'm sure Salem Health administrators would disagree. 

Intuitively, what Regence MedAdvantage approved for my hernia operation seems about right. I was at the hospital for about six hours. The operation went smoothly. Hernia repairs are common.

It doesn't seem like an outpatient hernia operation should cost $26,250. Instead, $7,732 seems about right. 

What this shows is how complicated our screwed-up health care system is. I'm a big proponent of Medicare for All, or some other form of universal health coverage for everybody in the United States.

Moving from private insurance to Medicare has been great. No regrets at all about embracing "socialized medicine," as many Republicans term Medicare, even though almost everybody on Medicare loves it.

My robotic hernia surgery goes well. Behold one incision.

At the age of 72, I'm no longer an adult surgery virgin. 

Up until today my only surgery was a tonsillectomy that was so long ago, I had to say "I don't know" when asked about the date of previous surgeries. Probably I was four or five.

All I remember about it was ether being poured on some sort of cloth, then put over my nose and mouth. 

But now I have a blog! (three, in fact) So I can go beyond the usual verbal "let me tell you about my surgery" -- a sure-fire conversation stopper, especially if an old guy is talking to a younger person.

I can write about my surgery. And share a photo of one of my three laparoscopic incisions. 

Not too gross, right? And by viewing it in a blog post, you're saved from me pulling up my shirt and making you look at it in person.

I'm a bit leery of being too enthusiastic about how little pain I feel about seven hours after the operation, since the anesthesiologist told me he puts some painkillers in the anesthetic "cocktail."

But so far I haven't even felt the need to take a Tylenol, much less one of the Hydrocod-Acetamin pills I was prescribed on an "as needed" basis.

The right side of my abdomen is sore -- which isn't surprising, since my large inguinal (groin) hernia was on that side.

My Salem Health surgeon, Dr. Hsinchen Lin, used robots to aid in the laparoscopic procedure. I've read that robot-assisted surgery has some advantages over plain old laparoscopy. Hopefully one of those benefits is less post-surgery pain.

The most stressful part of the surgery was waiting for it to start. 

My wife and I arrived right on time for the 11:30 am check-in at Salem Hospital. And it didn't take long for me to be ushered into the surgery prep room, where I got to put on the charming backless gown, get my vital signs checked, have an IV started, and chat with several friendly nurses.

Since my surgery was scheduled for 1:30 pm, I optimistically thought that I'd be home before too long.

That happy thought lasted until around 1:45 pm, when I was told that due to the previous surgery taking longer than expected, mine wouldn't start for another hour. This was the toughest part, since I already was getting tired of the decidedly non-ergonomic hospital bed I was on.

Way too soft. No back support. My sciatica-prone right leg wasn't having a good time. 

What saved me was a nurse disconnecting the IV tube in my left arm so I could use the restroom conveniently located right next door to the room I was in.

That solved a couple of problems.

I got out of the damn hospital bed and could stretch my legs. And since I have to use an intermittent catheter to pee, my bladder having gone on strike four years ago, I didn't need to worry about going through a semi-lengthy urinating process right after the surgery.

And the nurse told me that surgeons want the bladder as empty as possible prior to surgery, given the  proximity of the bladder to the hernia location.

(The anesthesiologist had pointed out what I already suspected. Just as when you go to sleep, the body's peeing and pooping functions are basically put on hold during anesthesia.)

Anyway, it feels good to have the surgery done with. It'll take six weeks to get back to 80% normalcy, Dr. Lin said.

But I'll be able to lift no more than 10 pounds between now and then, so light exercising will be possible, along with my usual two-mile hilly dog walk in the late afternoon after a few days of shorter walks.

I really appreciated how smoothly the Salem Hospital surgery process went, leaving aside the unavoidable delay in my surgery time. The nurses made me feel well-cared for. My wife and I had a very enjoyable conversation with the first RN who looked after me.

Having a surgery is stressful. Being able to chat about subjects totally unrelated to what I was about to go through helped a lot to keep my mind from obsessing about what was to come. 

Time will tell if I continue to have minimal post-surgery pain.

Regardless, I'm happy that things went as well as they did. Dr. Lin had said that I might need four incisions, given how large my hernia was, so I feel fortunate that I ended up with three, her original prognosis.

UPDATE: Forgot to mention a tip that might benefit others who need hernia surgery. About ten days before my surgery I had a rare bout of constipation, perhaps caused by stress, but maybe not. I'm a vegetarian, so constipation hasn't been a problem for me.

At any rate, I found that MiraLax, a mild stool softener, ended up working best for me. It takes several days to work, so I was glad that I'd started taking it before the surgery. Straining to have a bowel movement is a post-hernia surgery no-no, which is why a stool softener was included in my discharge instructions. (Heavy duty pain medications cause constipation.)

But since they take a while to do their thing -- softening the stool -- to me it makes sense for someone scheduled for a hernia surgery to start taking MiraLax prior to the surgery. It comes in powder form that's dissolved in liquid, so less than the recommended amount can be taken.

Yesterday I was told that if I use the Hydrocodone I was prescribed, I should increase the amount of MiraLax I'd been taking. But since I don't need that pain reliever, I'm sticking with the usual MiraLax dosage.

My hernia consultation goes well (if I ignore scary stuff)

About two weeks ago I got a hernia diagnosis, which I memorialized in "Now I can scratch 'get hernia' off my bucket list." 

The diagnosis wasn't a big surprise, given the large bulge on the right side of my groin that appeared suddenly while I was sitting in a dentist's chair a few days before I got the official diagnosis based on an ultrasound. 

I've been trying to be as positive as possible while waiting for a surgery consultation. But as today's consultation approached, my mind veered off in some decidedly negative directions.

My hernia is large; maybe it is too large for surgery. I have to use an intermittent catheter to pee; maybe this will be difficult to do after surgery. My family physician said it was OK to exercise while wearing a hernia belt; maybe the surgeon will say this made my hernia worse.

Well, as often happens it turned out that none of my fears came to pass -- though the surgeon did bring up some scary stuff when describing what could go wrong with my hernia repair.

The Salem Health surgeon I saw today, Hsinchen Lin, M.D., made a great impression. Here's a screenshot from her official You Tube video.

Personable. Caring. Good communicator. And best of all, almost, Dr. Lin used the term "OCD" about herself while describing part of the hernia procedure. 

That's exactly what I want in a surgeon -- someone nice who also is obsessively compulsive about the details of the surgery she's performing. Especially when the surgery is being performed on me.

Dr. Lin started off by saying she didn't have her usual visual aid with her, so she'd have to draw me a diagram of the hernia surgery. She offered it to me as I was leaving. I grabbed the piece of paper, saying, "I'll keep this memento in a scrapbook."

Or, blog post. 

Those are my legs down at the bottom. The dot is my belly button, and the lines above are the three laparoscopic incisions she would be making.

My private parts are in the middle of the groin, though not drawn to scale, I hasten to say. The round circle on the right side of the groin is the hole where some of what should be inside me, like part of my bowel, has crept outside. 

Dr. Lin said that men are especially vulnerable to inguinal hernias due to the way the testes descend into the testicles in a boy baby. Then the wear and tear of aging can create a hernia in that already weak spot.

Plastic mesh is used to shore up the weak areas in my groin area. I penned in the word "sew" in the area where stitches would be used to fasten down the mesh. That can't be done on the lower side, for a reason I only vaguely remember.

Something to do with blood vessels and such that have to be left clear, I believe. So scar tissue forms over the mesh to keep it in place in those areas. And natural lining from my body also covers the mesh.

Early on in the consultation Dr. Lin used the term "robot" in describing the hernia surgery. For a bit I hoped that a robot would be doing the surgery, like an internal Roomba. Lin explained, though, that she controls the four robotic arms.

The laparoscopic approach is preferred by Dr. Lin over open surgery, though she said there was a small chance she'd have to go the open route after starting with laparoscopy. 

She told me that 50% of her hernia patients don't need pain medication after the procedure, which was great news, given how some Googling yesterday revealed that sometimes the post-surgery period can be quite painful. 

My scribbling is almost illegible, but I think Lin said that I shouldn't lift more than ten pounds for six weeks. Or maybe two weeks. Guess I'll find out after the surgery. Six weeks seemed to be the usual recovery period, with a two-week follow-up to see how things are going.

I mostly blurred out in my mind the obligatory explanation of what could go wrong with the surgery. The only note I made was "Chronic pain 1-6%." I'll focus on the one percent, liking those odds.

Pleasingly, this seemed to be a rare occasion when using a catheter five times a day to empty my bladder fully (I can pee some on my own, but my bladder basically went on strike four years ago) is a plus.

Dr. Lin said that sometimes the bladder works slowly after hernia surgery, and a catheter is required. But since I'm already using a catheter, problem solved! 

I double-checked with Lin about exercising while waiting for surgery, including chores like mowing the grass on our ten rural acres with a walk-behind mower. She said that'd be fine so long as I wore a hernia belt, which I've already been doing.

Now I have to wait for Regence MedAdvantage to approve the surgery. After that I'll get a call to schedule the hernia repair. 

At the end of the consultation Dr. Lin said I should consider whether I wanted the surgery, since I'm not experiencing any pain from the hernia at the moment.

It took me about two seconds of considering to say, "Let's do it."

Now I can scratch "get hernia" off my bucket list

Trying to find some humor in the hernia diagnosis I received today, this cartoon reminded me that, hey, I only have a single hernia, so lucky me! 

(I also have taken to wearing joggers much of the time rather than regular pants, which qualify as skinny jeans. And sure, I've got a lifetime supply of bitter regrets -- which now includes getting a hernia. But it's a stretch to say I'm in midlife, since I'm 72.)

As befits my age, I don't have a great story to tell about how I ended up with a right-sided inguinal hernia.

No, I wasn't bench pressing too high of a weight. I was sitting in a dentist's chair for about 90 minutes, the first part of a lengthy session involving three fillings and a crown replacement.

During the time the new crown was being fashioned by a 3-D printer in my dentist's office, I decided to visit the restroom. When I pulled my pants down I was met by a shockingly large bulge.

Ordinarily I'd be pleased by such a bulge in the region of my groin. But this bulge was to the right of my penis, a bit less than half the size of a baseball. So impossible to miss.

I decided to ignore it for the time being, since my focus was on getting through the rest of the dental appointment. When I got home, I phoned my family physician's office.

Not surprisingly, their best guess was a hernia -- which somehow decided to manifest in a dentist's chair, since I'm certain the bulge wasn't there when I took a shower earlier that day.

I was able to see a nurse practitioner the next day. He asked if I had any pain. No, I told him.

He then stressed that if I did feel a lot of pain, that was a danger sign that should cause me to go to the ER, since a strangulated hernia where part of the colon gets deprived of blood can lead to gangrene and other nasty stuff.

I was scheduled for an ultrasound at Salem Hospital. That was done yesterday, and I got the results this morning. Not cheery findings, but pretty much what I expected.

There is a large right inguinal hernia containing fat and bowel as well as a small amount of fluid. Hernia sac measures up to 5 cm. Fascial hernia defect measures up to 3.4 cm. Hernia is partially reducible but not completely reducible.

What immediately worried me was that the nurse practitioner had said I should get a hernia belt, what used to be called a "truss." (And maybe still is, by some.) I'd ordered and gotten several belts from Amazon. 

They all said "for a reducible hernia." Meaning, the protruding stuff can be poked back into the body, thereby reducing the protrusion to nothing or almost nothing. 

So I phoned my family physician's office.

Pleasingly, I was told by a nurse to not worry and go ahead with wearing a hernia belt, which I did today. Since my hernia protrusion mostly goes away when I lie down, I put on the belt while lying prone on a bed.

The hernia belt is pretty comfortable. I went on my usual two-mile afternoon dog walk while wearing it with no problem. It gives me more confidence while I wait for a surgery consultation, which is in the works.

All in all, I'm feeling mostly OK about my new health problem. 

Hernias are much more common in men. (Thus they really should be called "Himnias.") Some Googling revealed:

Researchers estimate that about 27 percent of men and 3 percent of women will develop an inguinal hernia at some point in their lives.

OK, I've reached that point. Now I'm looking forward to getting past that point. Hopefully it won't take too long to schedule a surgery.

Reading recent Amazon reviews of hernia belts caused me to realize that many men who were diagnosed with a hernia last year around springtime had to wait quite a few months for surgery, since elective surgeries weren't being done during the first wave of Covid cases. 

I guess my hernia picked a good time to pop out for a visit. 

I'm also grateful that my family physician responded promptly to several My Chart messages I sent her with hernia questions.

Pleasingly, she said it would be fine if I kept on with my daily exercising with the Monkii 360 ball and resistance bands, as I've gotten addicted to this enjoyable wear of working out. She also told me I could continue doing physical therapy stretching exercises for my sciatica problem.

The only caveat is the same thing my physical therapist kept telling me: if it hurts after you do something, stop doing that thing. And obviously I shouldn't be lifting heavy weights.

In an attempt to be positive about having a hernia, I've discovered that when you have a couple of longstanding health problems, getting a new problem tends to shift the focus of your mind off of the old problems and onto the new problem.

Thus my sciatica isn't bothering me as much anymore. Yay! Only problem is, my hernia has become a bother.

Metabolism myths about diet, exercise, and weight loss

Science rocks. It's by far our best way of understanding reality. 

But most of us, me certainly included, often are prone to embracing folk wisdom rather than science when it comes to losing weight.

I'm six feet tall and 178 pounds at the moment -- though sadly, my long-term trend (I'm 72) has been to lose a bit of height and gain a bit of weight. 

Since I'd like to get to about 175 pounds and know how difficult it is for me to lose even a few pounds, I was eager to read the front page story in the February 27 New Scientist issue, "Metabolism Myths: Seven Things We Get Wrong About Diet and Exercise."

The author, Herman Pontzer, has impressive credentials. Here's the bio on his Amazon page.

How did the human body evolve, and how does our species' deep past shape our health and physiology today? Through lab and field research, I investigate the physiology of humans and apes to understand how ecology, lifestyle, diet, and evolutionary history affect metabolism and health.

I'm also interested in how ecology and evolution influence musculoskeletal design and physical activity. Field projects focus on small-scale societies, including hunter-gatherers and subsistence farmers, in Africa and South America. Lab research focuses on energetics and metabolism, including respirometry and doubly labeled water methods.

(He's written a recently released book, Burn: New Science Reveals How Metabolism Shapes Your Body, Health, and Longevity.)

These are the Seven Metabolism Myths in the New Scientist story, along with excerpts. Some surprised me. Some didn't. Bottom line: if you want to lose weight, likely you've got to reduce calories. There's no short cut.

Remember: the boldfaced headlines are myths. 

(1) Exercise burns through calories and boosts metabolism. It is the bedrock belief of pretty much every workout routine featured in magazines: exercise more, burn more calories. In the short term, it is correct – you burn energy while you are exercising, and if you start a new workout routine, you will burn more calories, at least in the beginning. But recent studies show just how dynamic and adaptive our metabolisms can be.

...Daily expenditures measured for participants in exercise studies routinely increase at the beginning of a new workout regimen, but those gains diminish over time. Their bodies adapt, so that within a few months, the daily energy they burn is only marginally higher, and sometimes exactly the same, as before they started working out. The boost is a bust.

(2) Exercise will make you lose weight. Even those who do manage to increase the amount of energy they burn through exercise typically still find it hard to lose weight. A recent review of 61 exercise studies, totalling more than 900 participants, lays out the grim evidence that will be familiar to many.

Weight loss often starts off well at the beginning of a new exercise regime, but it fades over time, so that a year or so later, the weight lost is a vanishing fraction of what we would expect from all the calories burned through working out.

...The reason for this is frustratingly simple: when you burn more calories, you eat more calories. You might not mean to, of course, but that is the problem. The complex systems working subconsciously to regulate your hunger and satiety do an exceptional job of matching energy intake to expenditure. 

(3) Your workout programme isn't succeeding unless you are losing weight. Not losing weight? Don’t give up! Exercise might not change the number on your bathroom scales, but that isn’t what it is for. Humans evolved as hunter-gatherers, and a heavy dose of physical activity was an inescapable part of the daily routine for more than 2 million years.

Our bodies are built to move, and there are good reasons why the Hadza avoid heart disease and diabetes, despite the fact that they burn the same amount of calories as sedentary people. Regular exercise keeps our hearts healthy, our muscles strong and our minds sharp, especially as we age.

Intriguingly, recent studies suggest that the metabolic adjustments that frustrate weight loss are a big reason why exercise is so good for us. My lab and others are working to track down the precise nature of these changes, but it seems our bodies respond to increased daily activity by reducing the energy expended on other tasks.

(4) Calories don't matter. Gaining weight is fundamentally a physics problem: when we eat more calories than we burn, those extra calories pile up as fat. Since it is futile trying to boost the energy we burn each day with exercise (or superfoods, or ice water, or the latest gimmick), the primary cause of being overweight or obese is clearly diet. We gain weight because we eat too much.

Yet counting calories has become passé. We are told it is the types of foods we eat, or the way that we eat them, that get us into trouble, and that the “calories in, calories out” view of the world is for suckers. Low-carb evangelists tout ketogenic diets – which rely heavily on fat, rather than carbohydrates – as a way to lose weight without cutting calories (some even claim you can eat more). Intermittent fasting fanatics promise much the same.

...If you are attempting to lose weight, the trick is to find a diet that you can maintain without feeling miserable. Foods high in protein and fibre tend to make us feel full. It also helps to avoid crash diets that can cause our clever, evolved metabolisms to hit the brakes and reduce daily energy expenditure.

(5) Humans evolved to eat a Paleo diet. Striving to eat the kinds of foods our ancestors ate makes intuitive sense. But emulating ancient diets, the idea behind the fashionable Paleo or “caveman” diet movement, in which people eat similarly to how our ancestors did in the Palaeolithic era, isn’t as straightforward as it might appear.

Cast your mind across the dizzying array of cultures on this planet, and consider the staggering variety of foods we eat. Clearly, there is no single human diet today, and it would be laughable to claim otherwise.

...Hunter-gatherer diets are (and were) just as diverse as diets in industrialised populations, with lots of variety among groups and through time in the proportions of meat and plants, fat and carbs. Some diets, particularly those of Indigenous people in the Arctic, are meat-heavy; others, especially in warmer climates, are plant-heavy. 

(6) A slow metabolism dooms you to obesity. Like most other biological traits, the amount of energy burned in a day varies from person to person. Daily energy expenditure in two people who are the same age and sex, and have the same lifestyle, can easily differ by 500 calories or more. Surprisingly, that variation in energy use doesn’t predict someone’s weight.

People with obesity have the same daily energy expenditure, on average, as those who are slim. That’s after accounting for body size, since a larger body tends to burn more calories per day simply by virtue of having more cells at work. If we don’t correct for size, people with obesity burn more energy. Weight gain and obesity aren’t products of a slow metabolism.

So why do some people find it easy to stay trim while others struggle? Although there is probably no single answer, a major factor seems to be the way our brains are wired. For most, weight gain comes on slowly over months and years, reflecting tiny errors in the regulation of energy intake.

The vast array of processed and engineered foods available to us overwhelms neural reward systems evolved to handle unprocessed wild foods. Our brains err on the side of overconsumption.

(7) Obesity and weight gain are a sign of personal failure. As powerful as our genes are, DNA isn’t destiny. Today’s gene pool is essentially unchanged from that of our great grandparents’ generation because genetic change is slow. They didn’t face a global obesity crisis. What’s different in much of the world is our environment, specifically our food environment – the access we have to specific foods.

In engineering our industrialised world, we have surrounded ourselves with foods that drive us to overconsume. The battle with obesity is often framed as a test of willpower, pitting the virtues of exercise and portion control against the vices of gluttony and sloth. New metabolic science says otherwise. Shops are stocked with ultra-processed foods, laden with added sugars and oils, symphonies of sweet and savoury that overwhelm our Palaeolithic brains.

...In wealthy countries, ultra-processed options often dominate the foods available in low-income neighbourhoods and those where the majority of inhabitants are from minority groups, contributing to inequities in health and nutrition. In low and middle-income countries, the growing dependence on ultra-processed foods has helped to fuel the global rise of obesity and related disease. 

I finally fill out an Advance Directive. But not a POLST.

Well, it only took me about forty years. Better late than never, as the saying goes.

Tomorrow I'm taking an Advance Directive to my family physician when I go for my annual physical exam, so it can be made part of my medical record. I've had this booklet from Oregon Health Decisions sitting at the bottom of a pile of papers in my office for a year, at least.

This booklet replaced a previous booklet that I lost or threw away.

It's kind of strange that I've been so reluctant to make my end-of-life wishes known, since I was the first executive director of Oregon Health Decisions in the 1980s, when this pioneering citizen-based bioethics organization got off the ground after a brilliant psychiatrist, Ralph Crawshaw, worked to get it going with the help of me and many other Oregonians.

In fact, I wrote the first advance directive booklet published by Oregon Health Decisions. Since back then I was in my 30s, whereas now I'm 72, it made sense that I'd put off filling out an advance directive for quite a while.

And I readily admit that as I grew older, I did my best to avoid thinking about the not-so-cheery prospect -- a certainty, actually -- of my eventual death.No longer. Yes, I'm still pretty damn healthy, though I have a couple of health problems. Most people do at my age.

I just felt it was time to do the Advance Directive thing. Probably the Covid crisis helped spur me to do this, since the prospect of being kept alive via a feeding tube, ventilator, or whatever when there is no hope of recovery isn't an appealing notion. 

What gave me the most trouble was deciding whether to complete the brightly colored POLST form that had been inserted in the booklet. That stands for Physician Orders for Life-Sustaining Treatment. My wife, Laurel, has a POLST even though she also is healthy with just a few relatively minor medical issues. 

Laurel is convinced that she doesn't want CPR, should this ever be a consideration. I believe Laurel is correct that the view of CPR in movies and TV shows, where a person recovers nicely after getting this potentially live-saving procedure, often doesn't reflect reality. For example, one CPR web site says:

Overall, all of these side effects mean that, if a person does survive CPR, their long-term health could suffer and they may be alive, but it is possible that their overall health and quality of life is significantly affected. Additionally, the psychological ramifications of a near-death experience can greatly affect a survivor, leading to anxiety, stress and depression, among other psychological conditions.

A POLST appears to be the only way to make sure that you don't get CPR, since a POLST becomes part of a registry available to medical professionals, and you can carry a POLST card with you. 

On the other hand, the POLST form says that it "is usually for persons with serious illness or frailty." And POLST.org has this FAQ about which patients should be offered a POLST form.

The POLST form is not for everyone; a POLST form is appropriate for patients who are considered to be at risk for a life-threatening clinical event because they have a serious life-limiting medical condition, which may include advanced frailty. For these patients, their current health status indicates the need for standing medical orders for emergent or future medical care.

Also, these are the patients at the greatest risk of having a medical emergency but who may not want our standard of care (standard of care currently being that everything possible to attempt to save someone's life must be done). For healthy patients, an advance directive is an appropriate tool for making future end-of-life care wishes known to loved ones.

So I decided to complete an Advance Directive, but not a POLST. I can always go the POLST route later, should this seem like a good thing for me to do. 

Monkii 360 is my favorite Covid-era home workout device

Here in Oregon health clubs have been closed for most of the pandemic. I'd been working out three days a week at Courthouse Club Fitness, so needed to find an alternative way of getting in my usual dose of aerobic exercise and weight training.

I've bought five devices that seemed promising. Three of them currently are sitting unused. I'll mention them briefly, then share what I like about the #1 and #2 favorite home workout devices.

(I walk two miles a day with our dog up and down some fairly steep hills, so my device focus has been on strength and core exercises.)

Early on I got a Gorilla Bow. I used it for a while, but it didn't appeal to me all that much. The Activ5 is a palm-sized gadget that lets you do isometric exercises via a smartphone app. At first I liked it, but eventually it came to seem too difficult to use correctly. The Nucleus Central Core Pro is a simple water-filled device that I'd still be using if I hadn't discovered...

Monkii 360. (Scroll down that web page to see a video and description of the device.)

As shown in the photo above, Monkii 360 consists of a cleverly-designed ball with hand grips that allow you to grasp it in different ways depending on the exercise you're doing, resistance bands ranging from 20 pounds to 45 pounds that afix to the ball via a carabiner in three possible locations, and optional weights that fit inside the ball to adjust the intensity of a workout.

The other end of a resistance band is easily tethered to a door in your house -- either at the top, side, or bottom. A well-designed smart phone app leads you through a variety of multi-day programs such as Cardio, Core, and Hybrid (mix of Cardio and Core).

I've been using the Monkii 360 every day for about five weeks.

I finished the 36 day Hybrid program a few days ago. It starts off with short easy workouts, then ramps up considerably by the end, where a heavier internal weight and stronger resistance bands made for a pleasingly sweaty 20 to 30 minute workout session. 

The smart phone workouts are a blend of timed exercises, short rest periods, and exercises with a set number of repetitions.

This makes for an enjoyable workout that is challenging, yet not excessively so. I still enjoy my Monkii 360 as much, or more, as when I first got it. Every day I look forward to heading to our utility room, which has the best door for attaching the device, and experiencing another workout on whatever program I'm using.

Bottom line for me: Monkii 360 is a fun way to exercise at home. It's a full body workout, for sure.

I've gotten considerably more fit after using it for the past five weeks, and I was in pretty good shape before. The wide variety of movements you can do with the device makes it a winner. It can be used by people of all ages and fitness levels. 

I feel good that at the age of 72 I was able to get through the entire Hybrid program with no problem. Here's a video that explains Monkii 360 nicely.

Lastly, I can also recommend the OYO Personal Gym. I use it every day after doing some physical therapy and yoga exercises in front of the TV. It's well designed and is a good substitute for lifting weights. I just can't call it fun, like Monkii 360 is. For me, at least. Your opinion may vary, naturally.

Getting a high dose senior flu vaccine isn't easy in 2020

Being 72 and a believer in vaccines (everybody should be, since they work), every October I've been heading off to Walgreens on south Liberty to get my annual high dose flu shot. 

(Since us old folks have weaker immune systems, a high dose flu shot offers more protection, though a regular flu shot is better than nothing, for sure.)

That's what I did last Tuesday, only to be met with a sign on the pharmacy window saying that they didn't have any high dose vaccine. Which was the same sign I saw last week.

So I decided to check with the south Commercial Walgreens. There I was told that they had high dose vaccine, but no needles/syringes. Maybe the needles would be available next week, I was told. 

Next stop was the Fred Meyer pharmacy on Commercial. The word there was they'd run out of high dose flu vaccine that day. More might come in next week.

When I got home, I did two things. I phoned my Salem Health family physician's office. They told me that they didn't have any high dose vaccine, but would put me on a waiting list. (The next day I got a call telling me I could make an appointment for October 23 to get the shot.)

I also made an online appointment for 2:45 pm today with the Costco pharmacy.

Last year, I think it was, Costco had bailed us out when my wife and I had gotten the first Shingrix shingles shot, but couldn't find any place with the second shot. Even though we hadn't gotten the first shot at the Costco pharmacy, they told us that they reserved some vaccine for people like us who'd had the first shot.

Talking with the pharmacist at Costco who gave me the high dose shot, he said they had run out several times recently, and were going to run out again today. But when someone has an appointment, they put aside the vaccine. Which was good news for my wife, since she had an appointment for 4 pm today.

Something is different this year, since I haven't had a problem getting a high dose shot since I turned 65 seven years ago.

The covid crisis must be the main reason there's more demand than usual for the high dose vaccine. Also, the Costco pharmacist said the demand for flu shots started early this year, since the wildfire smoke we were inhaling led to recommendations to get a flu shot, apparently because lungs already were being impaired somewhat by the smoke.

My theory, which I shared with the pharmacist, is that with all the debate about whether Covid is more deadly than the flu (it is, despite what Trump claims), maybe seniors are seeing the figures about how many people die from the flu each year -- 12,000 to 61,000 since 2010 -- and more fully realize now how important it is to get a flu shot.

Google News has numerous stories about shortages around the country of the high dose flu vaccine, so this is a real thing. See here, here, and here. Fortunately, any shortages likely will be temporary. 

But since it is impossible to know when the flu season will start in earnest, the wise thing to do is get a flu shot as soon as possible, especially if you're in a high risk group, such as being over 65.

How to strengthen your immune system -- advice from New Scientist

When I got the mail today and plopped the current issue of New Scientist, a British magazine, on a table, almost right away my wife started reading the cover story, "You're only as young as your immune system."

(Online version has different title, "How to fight infection by turning back your immune system's clock.")

That's the effect of the coronavirus pandemic. Suddenly almost everybody is concerned about their ability to fight off the virus, especially people over 70 like my wife and me, along with those with compromised immune systems and/or underlying health conditions. 

It's a good cover story. So good, and so timely, I'm sharing a PDF file so those without a New Scientist subscription can read it in full.
Download How to fight infection by turning back your immune system's clock | New Scientist

Below are some excerpts from the piece. I've focused on advice (in bold, for emphasis) on boosting our immune system that almost everybody can follow.

Sure, it may not be possible for someone to strengthen their resistance to infection in time for that to make a difference in how their body would respond to the coronavirus, but now is always an excellent time to start improving our immune health. Here's the excerpts:

WASH your hands religiously for 20 seconds, sneeze into your elbow, avoid touching your face, stay 1 metre away from all other people and, as a last resort, self-quarantine for a week with only your emergency rations for company. If you want to avoid getting the new coronavirus, all of these are a good idea. But ultimately, one of the most important things standing between you and a deadly bout of covid-19 is your immune system.

We know that the immune system gets weaker as we age – which is a key reason why those over the age of 70 are most at risk from the disease. But what is becoming clear is that when it comes to immune health, age is just a number. Some people have an immune system that is effectively significantly older or younger than they are.

“Some 60-year-olds have the immune system of a 40-year-old, some are more like an 80-year-old,” says Shai Shen-Orr, an immunologist at the Technion-Israel Institute of Technology. The good news is that there are some simple ways to turn back the immunological clock. Because even after the threat of this virus has passed – sooner or later another one is going to come along, and none of us is getting any younger.

...If you are younger than 60, in good health and don’t have too many bad habits, then your immune system is probably functioning well enough to keep you safe from almost any infectious disease, including coronavirus.

The bad news is that as we age, our immune systems gradually deteriorate too. This “immunosenescence” starts to affect people’s health at about 60, says Janet Lord at the University of Birmingham, UK. The older you get, the weaker your immune system becomes, and the more likely you are to get seriously ill or die because of it.

...Beyond genetics, the team found that smokers have a much older immune profile than non-smokers of the same age. It’s unknown if this is reversible. But if you don’t want to prematurely age your immune system, it would be best not to smoke.

...One key approach to keeping our immune age down relates to the fact that as we get older, some of our immune cells start to misbehave. This is especially problematic for a class of immune cells called neutrophils, the most common type of white blood cell. These form part of the innate immune system, the body’s first line of defence against infection, and are the border force of the immune system, patrolling tirelessly through the bloodstream on the lookout for harmful bacteria.

...What are these miracle drugs [that boost neutrophils]? Statins, the ordinary cholesterol-lowering drugs already taken by millions of people. Turning to real patient data from the University of Birmingham’s Queen Elizabeth hospital, Lord found that people admitted to hospital with pneumonia were much less likely to die if they were already taking statins to lower their cholesterol.

Another class of immune cells that begin to misfire as we age are T-cells. These are pivotal in the adaptive immune response – the more targeted part of the system – but are blunted in two ways by immunosenescence. As with neutrophils, their internal signalling pathways go awry, and they are also inhibited by inflammaging.

But there may be a simple way to undo this damage. According to Dayong Wu, a nutritional immunologist at Tufts University in Boston, the answer is vitamin E. ...Wu recommends people over 65 routinely take 200 international units (IUs) of vitamin E. “It may help immune function. It doesn’t hurt,” he says.

...There is also a drug-free way to rejuvenate your neutrophils: exercise. In 2016, Lord and her colleagues measured exercise levels and neutrophil migration in 211 older adults.

“Those doing 10,000 steps on average had neutrophils as good as young adults,” she says. She emphasises that neutrophils aren’t antiviral so won’t prevent you catching coronavirus or help you beat it, but they will protect you from the real danger, which is pneumonia. “Usually what carries people away with these [viral] infections is secondary infections,” she says.

...Exercise has other immune-boosting effects too. “Active skeletal muscle is anti- inflammatory and stimulates macrophages,” says Lord, who goes running every day. “Skeletal muscle is a profound immunoregulatory tissue in the body and keeping it going by physical activity really will have a lot of benefits for health. Exercise benefits all ages.”

Asked what one thing she would recommend to strengthen your immune system, she says: “Increase your step count to 10,000 per day.” In the face of the new coronavirus, it is more important than ever to find ways to stay active – even in lockdown or isolation, which isn’t going to be easy.

...Vitamin D, meanwhile, appears to do the same for the innate arm of the immune system, especially among people living at latitudes where there isn’t enough winter sunlight for their skin to synthesise the molecule. A 2017 review of the evidence for taking vitamin D supplementation concluded that it prevents upper respiratory tract infections. About 1000 to 2000 IUs should be safe and beneficial, says Wu, but people shouldn’t go higher than that because big doses actually suppress T-cell function.

...A third supplement with good evidence for immune-boosting powers is zinc. “It is very effective for viral infections,” says Wu. Though he adds, “be cautious, the effective window is narrow and an overdose will suppress your immune system”.

...What you eat will also matter to your immune system – now is the time to look after your gut flora. There is good evidence that probiotics can enhance the immune system, that poor gut health is a cause of premature ageing and even that a healthy microbiome can reduce your immune age.

...Even if a fasting diet isn’t for you, simply keeping your weight down can have immune-boosting effects. According to Bonnie Blomberg at the University of Miami in Florida, being obese suppresses the immune system to a similar extent as being immunosenesced. 

...None of these interventions is without sacrifice. But if you want to stay alive and well for as long as possible, looking after your immune system is a no-brainer – especially now the new coronavirus is being called the biggest threat to public health since the 1918 flu. “The age of your immune system is a critical component of your lifespan,” says Shen-Orr. “Think about what the system is supposed to do!”

I'm not wearing gloves because of cold, but of old (COVID-19)

With fairly warm weather coming to western Oregon next week, I want to explain why I'll be wearing gloves when I go grocery shopping, enter a coffee shop, or am in other public places.

As should be obvious, it isn't because I'm cold, but because I'm old -- and thus more susceptible to the nastier effects of COVID-19, or coronavirus. My wife, Laurel, is in the same situation, except a bit more so, since she has asthma and COVID-19 attacks the respiratory system.

Today Amazon delivered four pairs of these oh-so-trendy gloves that Laurel ordered for me. (Via Amazon I'm also getting some gray gloves with no markings, though I do like the two-tone look of these gloves.)

Laurel has been using similar gloves during her many years of walking dogs at the Willamette Humane Society.

So she's got a routine down that we'll be using until the COVID-19 epidemic in Oregon slows down markedly. Namely, have several pairs of thin plastic gloves available so the ones that have been used can be washed with a load of laundry, then reused.

The reason wearing gloves makes sense to us is that COVID-19 can linger on surfaces for hours, and we don't have a very big supply of hand sanitizer. Thus our plan is to put gloves on when we go into a store or other public place, then take them off before getting back into our car.

It'll be important to not touch the fingers of the gloves when taking them off and putting them back on, but I've been practicing how to do this.

Wearing gloves will give us some increased peace of mind when we're out and about. 

Some Googling revealed that in general, public health experts haven't been advising people to wear gloves, just as they haven't been advising the use of masks. But that advice has focused on thin disposable medical gloves.

And gloves are not recommended either: "This isn't something the general public would be wearing," said Dr. Amesh Adalja, a senior scholar at the Johns Hopkins Center for Health Security. "I don't think they're going to do anything but give people a false sense of security, waste time and create more demand for something that's unnecessary, just like masks."

While disposable gloves are frequently worn in medical settings, they won't be as effective in day-to-day life.

"Latex gloves can rip very easily," said Adajla. "They're not designed for going out, running up stairs, doing things in daily life. They're not very durable when it comes to pumping gas or anything ... They're going to get holes. They're not meant for wearing during activities and daily living. Even as a physician, I have my gloves rip all the time."

OK. But what my wife and I will be wearing are lightweight garden gloves, which, as noted above, we'll be washing and reusing. Sure, we'll look like old people worried about getting COVID-19, but here's the thing: that's exactly who we are!

And we're not alone. Today I asked the dozen or so members of our monthly Salon discussion group if they were comfortable meeting during the COVID-19 outbreak. Only one person said they were, so we're going to cancel our March meeting and see how it goes come April.

It's a risk vs. return thing.

Yes, we enjoy getting together and talking about all sorts of interesting subjects. But as I said in an email to the group, it wouldn't be worth it if someone got seriously ill from attending a meeting, as unlikely as that might be. (Plus, it's going to get more likely as the disease spreads.)

Lastly, here's a right-on post that a Facebook friend, Susann Kaltwasser, wrote today. Susann makes some excellent points.

It occurred to me last night after watching all kinds of shows with interviews of experts, mayors and governor dealing with the pandemic that here in Salem we are focusing on the wrong things!

We are worried about toilet paper and handiwipes and masks. And we worry about the crowds in the grocery stores and if school is going to be closed and how will we get to work.

But while we are worrying about the little things like staying safe and our jobs, who is worrying about the big things?

Things like ....is Salem Health (hospital) going to have enough beds to accommodate all the sick patients who have the virus and can they keep them separate from the rest of the patients in the hospital?

Do they have enough equipment to treat hundreds of people who might get ill at the same time? Respirators? ICU equipment?

What will happen to the people who are ill, but not so ill that they need to be in the hospital? People who if they stay at home will just infect the rest of the family need to be kept in isolation. Where will they stay?

What do we do about children who live with their grandparents, because they do not have parents? And then the grandparents get sick?

When will we begin testing people in Salem and then what do the rest of us do, because right now the authorities are not even telling people what city they live in?

Seattle has taken some strong measures out of necessity, but do we want to have thousands of people become ill before Salem begins to take precautions?

Our City does press releases, but where is the face of the "City"? Where is the leadership? What are they doing to help calm us now, so that when things get really bad....and we need to assume that they will...that we do not have panic (assuming that it has not already begun)?

Are we all alone and have to fend for ourselves? Do we think our president is going to save us? Is washing our hands and avoiding people all we should be doing?

This is what other cities did and it did not stop the virus...it is just placating and delaying the inevitable. But can we learn a lesson and do some more proactive things to lower our curve?

I'll bet that you have more questions. When are we going to take this situation serious and begin to actually ask the right questions?

My thoughts about the coronavirus outbreak

Yeah, there's other stuff going on in the world right now other than the coronavirus. But since my mind is filled to overflowing with thoughts about this rapidly evolving tragedy, I figure I might as well do a brain dump into this blog post. So in no particular order...

(1) Feel for us old folks, America. My wife and I are both over 70 by a year or two. So we're doomed! If we get infected. Well, maybe not mortally doomed, though this is possible, but likely we'll suffer more than younger folks. Yet the empty shelves of hand sanitizer, both in stores and online, face young and old alike.

I completely understand why a 30-something parent wants to stock up on hand sanitizer to protect their children and other family members.

But just as public health experts are saying everybody at low risk should wash their hands regularly to reduce the chance they could pass the coronavirus on to someone high risk -- like my wife and me -- maybe it makes sense to reserve some supplies of hand sanitizer for those with compromised immune systems, other serious health problems, and the elderly.

(2) Trump supporters need to wake up. Last night Trump gave a speech designed to reassure a worried nation. It had the opposite effect. Which isn't surprising, because Trump can be guaranteed to tell lies, falsehoods, and half-truths at every opportunity. His failure to mobilize the federal government in the early days of the coronavirus outbreak has made a bad situation way worse.

Other countries have tested vastly more people than the United States. Thus our country is flying blind when it comes to knowing the real extent of how many are infected with the coronavirus. The lack of testing kits is a clear case of presidential malpractice. Unfortunately, those who will become seriously ill because of our Idiot-in-Chief won't be able to sue him. We can vote him out of office this November, though.

(3) Investors are acting wisely. It's painful to see the stock market crashing. But a (small) bright spot is that investors are recognizing with great clarity that the crap Trump has been spewing about the coronavirus outbreak can't be trusted. This morning I read a great Bloomberg piece that explained why the market crashed after Trump's speech to the nation.

Basically, the reason is that Trump's ideas for bolstering the economy were feeble and made little sense, while what is needed to calm the markets is a strong, fact-based, scientifically sound approach to dealing with the coronavirus. Other countries have done this with considerable success. Until the Trump administration changes course and admits it is on the wrong track, the stock market is gong to keep saying, do something different.

(4) Life does seem a bit sweeter. Quite a few years ago I read a piece in Parade magazine by an Iraq war veteran (if I recall correctly) that contained a gripping line: "We all need something in our life that can kill us." Of course, that would be life itself. But what this guy was getting at is that life feels more lively when we know it could end at any moment.

I've been dealing with pretty severe pain in my right leg for about a month. But today was sunny here in Oregon, and it's supposed to rain tomorrow. So I got out my DR Field Mower with the lawn mowing attachment and attacked the grass in our large rural yard. As I was mowing, I kept thinking, "If I were to die from the coronavirus soon, at least I'd leave behind a good-looking lawn."

Somehow that was comforting. It got me focused on the here and now, with a dose of there and then. Namely, the prospect of my eventual death, which obviously isn't a matter of "if" but "when." Sure, it is unlikely that the coronavirus will do me in. But something will, one day, and it felt good to be reminded of how precious every moment is, given that we can't be sure how many moments remain to us -- a lesson that the coronavirus outbreak is teaching all of us.

(5) Sports... who cares? Today it was announced that March Madness, the NCAA basketball tournament, won't happen this year. Likely the rest of the NBA season is headed for the same outcome. I was looking forward to watching the Oregon teams in the tournament, but this was a wise decision by the NCAA.

Let's imagine that just one person in the whole United States contacted the coronavirus and died as a result of March Madness. Would that make the tournament worthwhile, a whole bunch of basketball entertainment in exchange for one death? I don't think so, because there isn't any way to weigh the value of a single life versus millions of satisfied fans. Sports are just a small part of life. Life, on the other hand, is life.

(6) Our health care system is teetering. What's deeply concerning about the coronavirus outbreak is how it is going to cast a spotlight on the shortcomings of our health care system. Democrats in Congress are correctly proposing ways to ensure that everyone who needs medical treatment gets it, whether or not they have insurance. But this should be a permanent given, not an add-on in a public health emergency.

Also, I'm feeling mildly guilty about my days in the 1970s and 80s when I was a health planner here in Oregon. One of our jobs was to regulate hospital and nursing home expansions and purchases of expensive medical equipment like CT scanners. The goal was a lean health care system with little excess capacity. 

But now it looks like a lot of excess capacity would be highly desirable. Likely hospitals are going to have to choose between treating seriously ill coronavirus patients, and people with equally serious other problems, such as heart attacks. Bill Gates and others have been warning that a global pandemic was coming. It's too bad that our nation's leaders didn't take those warnings seriously.

(7) Seniors, the homeless, and other vulnerable people deserve to be Job #1. Most Americans are going to get through the coronavirus crisis just fine. Yes, we might have to ration our toilet paper and hand sanitizer, along with finding other things to do than watch sports. But mostly hidden from our view will be many other people who will suffer much more.

Reports already are coming in of seniors who are afraid to go shopping because they might be infected. I hate to think of elderly people sitting at home, isolated and fearful. The homeless also are going to be affected by the outbreak. How do you "socially distance" -- keeping six feet away from other people -- when you're living on the street, or in a homeless shelter?

Then there's those with lung, heart, kidney, and other health problems. My wife has asthma. She likely would be at greater risk than I am from the coronavirus, since it attacks the lungs. And there's millions of other people in this county in a similar situation: having to deal with an immune deficiency problem, or some other serious medical condition.

I just wish we had a president right now who could speak as Joe Biden did today. Compassionately, competently, caringly. The coronavirus could be a way for our county to come together and face this problem as one people, bound together by a common enemy.

It still could happen. But not because of Donald Trump. Rather, in spite of him.

Pros and cons of being a 70-something white guy these days

Well, it was fun while it lasted... being a 71 year-old white guy. For a while recently, I was exulting in the ascendance of my 70-something peers in the Democratic primary.

Bernie Sanders: 78 years old

Joe Biden: 77 years old

Mike Bloomberg: 78 years old

Woo-hoo! The three most viable candidates left standing (albeit shakily) were white guys even older than me.

Yes, Elizabeth Warren was still in the race for a while after Bloomberg dropped out, but by that time it was clear that Sanders and Biden were going to duke it out for the Democratic nomination. It sure looked like 2020 was going to be the Year of the Septuagenarian, in my own mind at least.

I stood a little taller. My back was a little straighter. I looked in the mirror at my gray hair and beard and felt a little better about my aging visage.

Until the coronavirus panic struck. 

I was OK, though obviously not ecstatic, about the stock market going up and down like a yo-yo. Or, to really show my age, like a slinky. 

What truly grabbed my attention, though, was the frequent mentions of how old people -- often disturbingly defined as over 70 -- were at much higher risk of dying from the coronavirus. Suddenly being an old white guy didn't seem nearly as appealing.

A few days ago NPR reported that while the overall death rate was 2.3% in China, among those 70-79 the death rate was 8%. And unless my aging ears misheard the satellite radio in my car today, I recall that someone said the elderly death rate could be 10-15%.

Yikes! Those aren't great odds. Of course, having an underlying condition like a heart, lung, or whatever disease adds to the risk for us old folks, and I'm in pretty good shape, health-wise.

Still... now when I look at Sanders and Biden my thoughts are less on how great it is that they've been able to rise to the top of the Democratic presidential race at their age, as on how risky it is for them to be pressing the flesh at so many campaign events, surrounded by throngs of people that could easily include someone carrying the coronavirus. 

Oh, well. At least I can take solace in the fact that 73-year old President Donald J. Trump is in charge of keeping me safe from the coronavirus. Problem is, early on that solace took a nosedive when I heard all the lies, falsehoods, and misstatements coming out of Trump's mouth.

But all things will pass. I just hope that one of them isn't me passing away from the coronavirus before I get to see Biden (most likely) or Sanders (less likely) defeating Trump in November.

Good news is, I don't have a blood clot. Bad news is, Trump still is president.

Being an ardent progressive in election year 2020 means that I'm prone to view everything through the lens of what it means for the prospect of making Trump a one-term president this November. 

Yes, even being tested to rule out a blood clot in my right leg -- which occurred yesterday.

A bit over a week ago I had a physical therapy visit to get some advice on what to do about annoying leg pain. When Michael, the therapist, asked me what caused the pain, I gave this 30-something guy my 71-year-old perspective on health problems like this one.

"Michael, when I was your age, I could figure out why something hurt. Like, playing too much tennis with my questionable serving technique led to tennis elbow pain. But now that I'm the age I am, aching body parts happen mysteriously. I get out of bed the wrong way, or lift a bag of groceries weirdly, and -- bingo! -- pain. Except the pain doesn't occur right away, so I can never be sure what caused it."

Which is typical for us Medicare folks, based on lots of conversations I've had with people about my age regarding their bodily afflictions. 

Anyway, yesterday the pain in my right leg was so bad, I kept thinking about what a nurse at my family physician's office told me a few days ago when I talked with her about my leg pain. Her main concern was a blood clot, so she told me that if my leg is swollen and feels warm to the touch, I should seek medical care right away.

After some Googling of "blood clot leg" and measuring my calves to see if the right one was the same size as the left one (it was), and feeling that both legs were the same temperature, at first I was reassured that I didn't have a clot. Until I read one more article that said sometimes a blood clot can be present with none of the usual symptoms.

Then I got a second leg warmth opinion from my wife. She spent way more time comparing my lower legs than I did, eventually concluding, "Maybe the right one is a little bit warmer."

That tiny maybe got me to thinking that I should go to Salem Health Urgent Care to rule out a blood clot. However, that didn't turn out to be as simple as I expected, even though it was easy to make an online appointment for 2:40 pm with a Nurse Practitioner. And I was seen close to on-time.

She felt my legs, questioned me about the pain I'd been having, and did her own measurement of my calves. She also prescribed a topical NSAID that could replace the oral Advil I'd been taking, but seemingly with less risk of side effects. Somewhat surprisingly, though, she also strongly recommended that I get an ultrasound to make sure I didn't have a blood clot in my leg.

Yes, I was worried about this possibility, as low as the chance was that I had a clot. And it made sense to rule out a potentially fatal problem, like a clot breaking free and heading to my lungs, or maybe even heart. 

But having been a health planner and policy analyst in my pre-retirement life, I also was aware of how legal liability concerns can affect medical care decisions. I'm not saying that occurred in this case, but just now the Great God Google did reveal a number of law firms who have web pages along the lines of "Medical Malpractice for Failure to Diagnose Deep Vein Thrombosis."

The symptoms of DVT can be missed or misdiagnosed.  This can be extremely dangerous because a person may think that they have something simple like a leg cramp or strain when they actually are experiencing symptoms of DVT.  

I was fortunate that the Cardiac/Vascular center at Salem Hospital could perform an ultrasound on my legs later in the day, which avoided an E.R. visit. The "lower extremity venous duplex unilateral" procedure went smoothly, and I enjoyed chatting with the technician who explained what was being shown on a large screen which, pleasingly, didn't include a blood clot.

This gets me to Trump.

Health care is super-important for everybody. When you're hurting, sick, or needing medical attention for whatever reason, getting that care with a minimum of fuss and cost is Job #1 on your mind. I'm fortunate to be on Medicare, which I like vastly more than the private health insurance I had before.

Medicare For All makes a lot of sense. So does Medicare For All Who Want It. So does the Affordable Care Act. 

What makes zero sense is Trump's unceasing effort to dismantle the Affordable Care Act, or Obamacare -- undoubtedly in part because of that word "Obama," which fills Trump with irrational anger (and maybe envy, since Obama was a much more popular president than he is).

Trump has no interest in making our nation's health care system better. He simply wants to destroy the most conservative approach to providing health care to all Americans, the Affordable Care Act. Since it relies on private health insurance, Republicans like Trump should be embracing the Affordable Care Act instead of trying to demolish it.

The plain fact is that, like me, most people feel good about their doctors and other health care providers, while being indifferent (at best) about their insurance company. So if somehow Trump, or the Supreme Court, succeed in killing the Affordable Care Act, that makes Medicare for All much more likely, given that Republicans have no viable health care plan of their own.

Lastly, Trump's health care incompetence is on full display as he stumbles through a response to the coronavirus crisis. It's evident that Trump cares much more about how the stock market is doing (horribly) than overseeing a fact-based, transparent approach to dealing with the coronavirus.

One big problem that Trump faces is that his incessant lying makes people automatically believe that whatever he says isn't true. Thus his efforts to calm people down about the coronavirus are having the opposite effect, as Catherine Rampell says in a Washington Post opinion piece, "With coronavirus, Trump's lies and his reassurances backfire."

Trump clearly understands that government messaging can move markets; he blames the Centers for Disease Control and Prevention for issuing warnings that may have unnerved traders. At his news conference Wednesday, he also scolded Democrats for allegedly “trying to create a panic.” Trump seems not to realize that saying everything is fine when no one trusts you to assess the situation honestly can cause people to freak out, too.

...In this context, it’s clear how Trump-delivered reassurances might backfire — and already have. While Trump spoke Wednesday from the White House, telling Americans that the government has things under control, stock futures fell. Ordering government scientists to clear comments with Vice President Pence’s office, as has been reported, threatens to dilute the value of any soothing words such experts might offer, too.

There is a corollary to the Goolsbee rule on crisis and credibility. It’s one that Goolsbee told me he learned from the late, great former Federal Reserve chair Paul Volcker during the financial crisis a decade ago, when Goolsbee was advising President Barack Obama. Volcker said that the only asset you have in a crisis is your credibility. Hence this other rule of thumb: All normal, non-crisis time should be spent establishing the credibility you’ll need when a crisis inevitably hits.

Would that the Trump administration had done so, instead of fibbing about crowd size and so much else that followed.

How a doctor's waiting room suddenly turned pleasant

Almost always, in my experience, a doctor's waiting room has a funereal feel to it. Just about everybody sitting in the chairs is there because they've got some sort of medical issue, which isn't exactly a cause for joy.

And if people were feeling good when they entered the waiting room, generally they soon understand why it's got the word waiting in its name. 

But yesterday was different. Here's why.

My wife had gone with me to an appointment I had at a clinic here in Salem. We arrived a few minutes early for my 1:50 pm appointment.

After checking in, we sat down in a waiting area that, at first glance, worried me. Almost every chair was filled, which indicated that, per usual, my doctor was behind schedule.

There were just two empty chairs adjacent to each other, so we sat down in them. Per usual, the area was completely quiet. No one was talking. I'd brought some magazines, so I started to read one. My wife took out her iPhone and perused what it had to offer.

I'd noticed that a woman to our right was sitting with her head in her hands. After we'd been there for about ten minutes, she let out a sigh. 

My wife, who was sitting next to her, said, "Have you been waiting long?" 

Turns out, she had. "I made the mistake of getting here half an hour early," she said. Then she described how she'd been having kidney pain.

That kicked off a lively discussion about a topic dear to the heart of everybody in a waiting room: waiting. I told a story about a professor I had in graduate school who would only wait for 20 minutes to see a doctor. Then he'd walk out and bill the doctor for his wasted time.

A man sitting next to me said, "But then he'd never get medical care, right?"

I had to agree that my professor probably had embellished his story, and that I wasn't recommending billing a doctor for time spent in a waiting room, since I don't think the professor ever had gotten paid.

"Sure sounded like you were recommending this," the man said with a laugh. "OK, I guess I was," I responded.

And so it went. Once the conversational ice had been broken, the four of us, two strangers plus my wife and me, passed the time pleasantly. 

It made a huge difference to my mood.

I don't like seeing a doctor, and I especially don't like having to wait 45 minutes, like I did yesterday. But my wife's simple act of speaking to the woman, who clearly wasn't enjoying herself prior to that, changed the atmosphere in the waiting room completely.

Instead of being patients with medical problems having to passively wait for our names to be called and then ushered into an examination room, we became people with quite a bit in common.

Like a distaste for waiting. And a love of dogs, along with other subjects I've forgotten.

Just remembered another thing I said -- how another clinic I went to a few times had a whiteboard with the doctor's names on it, which, sort of like an airport waiting area, indicated whether the doctor was on time and, if not, how many minutes behind schedule the doctor was.

Great idea. Shows a lot of respect for the patients. Or rather, people, in the waiting area.

Why eating at In-N-Out Burger is morally wrong

Today an In-N-Out Burger restaurant has opened in nearby Keizer, Oregon, sending waves of feverish delight through the taste buds of people willing to spend hours in line to buy the main food offering... dead cows.

I consider this to be morally wrong, having been a vegetarian for most of my life. So my objection isn't to In-N-Out Burger itself. What bothers me is that most Americans are so uncaring about the suffering they're producing by eating meat and fish.

Understand: there's a variety of good reasons to be vegetarian or vegan. It's a healthier way to go. It's better for the planet. But my main motivation when I became a vegetarian in college (I'm 71 now) was that I didn't want to kill conscious beings that suffer for no good reason.

If you've read this far, maybe you have at least a slight openness to that argument.

Perhaps you're an animal lover, with a dog and/or cat in your home that you are confident enjoys sensations, feelings, and such just as you do, albeit in different ways. You would feel bad if someone caused the family pet to suffer.

Well, cows have sensations and feelings also. And I'm going to present a scientist's arguments for why it is immoral to cause any living being to suffer or die without a good reason. 

(Since almost everybody in the United States doesn't need meat/fish to survive, killing animals for food isn't a good reason.)

Here's quotations from the final chapter of Christof Koch's book, The Feeling of Life Itself: Why Consciousness is Widespread but Can't Be Computed. Koch is the president and chief scientist at the Allen Institute for Brain Science in Seattle, following twenty-seven years as a professor at the California Institute of Technology.

My lifelong quest is to grasp the true nature of being... I now know that I live in a universe in which the inner light of experience is far more widespread than assumed within the standard Western canon. This inner light shines in humans and in the denizens of the animal kingdom, brighter or dimmer, in proportion to the complexity of their nervous system.

Integrated information theory predicts the possibility that all cellular life feels like something. The mental and the physical are closely linked, two aspects of one underlying reality.

...I want to end this book by moving from the descriptive to the prescriptive and proscriptive, to how we should think about good and bad and to a call to action.

Most importantly, we must abandon the idea that humans are at the center of the ethical universe and that we bestow value on the rest of the natural world only insofar as it suits humanity's ends, a belief that is such a large part of Western culture and tradition. We are evolved creatures, one leaf among millions on the tree of life.

...We must cure humanity's narcissism and our deep-seated belief that animals and plants exist solely for our pleasure and benefit. We need to embrace the principle that the moral status of any subject, of any Whole, is rooted in their consciousness, not solely in their humanness.

There are three justifications for being admitted to the privileged rank of subjects. I call them the sentience, experiential, and the cognitive criteria. 

Emotionally, we most easily resonate with sentience in others. We all have a strong instinctual reaction when we see a child or a dog being abused. We feel something of its pain; we empathize with it. Hence the moral intuition that any subject capable of suffering ceases to be a means to an end and becomes an end in itself.

Any creature that has the potential to feel distress has some minimal moral standing -- foremost the desire to be and the desire not to suffer.

...The experiential justification for the idea that species other than humans ought to be considered intrinsically valuable subjects is that any entity with an inner point of view is precious. Phenomenal experience is irreplaceable in a universe devoid of extrinsic purpose.

It is the only thing that really matters. For if something does not feel, it does not exist as a subject. A corpse and a zombie both exist, but not for themselves, only for others.

A third justification for this grounding is cognitive ability, having beliefs and desires, a sense of self, a sense of the future, of being able to imagine counterfactuals ("If I hadn't lost my legs, I could still climb"), the potential to be creative. To the extent that animals have such advanced cognitive abilities, they have rights.

However, I am against justifying moral standing purely on the basis of cognitive skills. First, not all humans possess such abilities -- think of babies, anencephalic children, or patients in a vegetative state or in late-stage dementia. Should they have lesser standing and fewer rights than able adults?

...Of these three justifications, sentience is in my view the most powerful one for why creatures that can suffer deserve special status. Because I can imagine myself being left alone, starved, or beaten, I feel sympathy or empathy with the other.

...The New Testament reminds us in Matthew 25: "Truly I tell you, whatever you did for one of the least of these brothers and sisters of mine, you did for me." The Czech writer Milan Kundera in his novel The Unbearable Lightness of Being generalizes this moral stipulation to all creatures:

True human goodness, in all its purity and freedom, can come to the fore only when its recipient has no power. Mankind's true moral test, its fundamental test... consists of its attitude toward those who are at its mercy: animals.

The Buddhist attitude toward sentience mirrors this view. We should treat all animals as being conscious, as feeling what-it-is-like-to-be. This must inform how we behave toward our fellow travelers through this cosmos, who are defenseless before our fences, cages, blades, and bullets and our relentless drive for Lebensraum. [living space]

One day, humanity may well be judged for how we treated our relatives on the tree of life.

We should extend a universal ethical stance to all creatures, whether they speak, cry, bark, whine, howl, bellow, chirp, shriek, buzz, or are mute. For all experience life, book-ended between two eternities.

Not all vaping is dangerous. Vaping cannabis flower is safe.

I ingest THC and CBD by vaping every day. It's my substitute for a nightly glass of red wine, because I believe cannabis is more beneficial and safer than alcohol.

So it bothers me when reports of vaping illnesses and deaths (including two here in Oregon) make it sound like all kinds of vaping should be given up.

What appears to be dangerous is vaping e-cigarettes containing nicotine, and vaping THC cartridges that contain additives and oil.

A Vox story today, "THC vape products appear to be the main culprit in the mysterious lung illness outbreak," says: 

Investigators appear to be getting closer to uncovering one of the main causes of the outbreak of mysterious lung injuries linked with e-cigarettes: vaping products containing THC, the main psychoactive chemical in cannabis.

On Friday, Centers for Disease Control and Prevention officials said that while they haven’t figured out exactly which chemical or device is making people sick, the majority of the cases in both national and state studies to date appear to involve THC-based vaping products. Many of them are illicit products labeled with brand names such as “Dank Vape.”

Note the mention of products, chemical, and device. That's because manmade THC cartridges, not the natural loose-leaf cannabis flower, have been implicated in the vaping illnesses.

The cartridges are used with vaping devices. They contain concentrated THC that is considerably stronger than cannabis flower. I used to use THC cartridges, but now only vape ground cannabis flower in my much-beloved PAX3 vaporizer. 

I buy cannabis flower ("buds") that's been tested in accord with Oregon cannabis growing/selling regulations. I grind it into small pieces using my Santa Cruz herb grinder. Then a small amount of ground cannabis goes into the heating receptacle of the PAX3 vaporizer. 

A little goes a long way.

Vaping cannabis flower is far removed from my Cheech & Chong'ish college days in the late 60's when we'd roll joints out of whatever was available on the black market: flower, leaves, seeds... it all was rolled up and smoked.

Which meant we were inhaling, not surprisingly, smoke. Not so with vaping, where, not surprisingly, vapor is inhaled. A PAX web page explains:

A vaporizer is an electronic device that heats dry herb or concentrated cannabis to release vapor. Vaporizing does not combust the plant material, reducing odors. Vaporizing herbs has its roots in ancient history. The Greek historian Herodotus wrote about the use of hot stones to create steam vapor baths as early as 440 BC. We’ve certainly come a long way from using rocks, with many electronic options of varying sizes and capabilities on the market today.

Thus it isn't vaping that is dangerous.

What's causing illnesses and deaths is something in a product that's being vaped. Note in the quotation above that a vaporizer can heat "dry herb or concentrated cannabis." It's the concentrated cannabis that health authorities are worried about, not the dry herb (cannabis flower).

Now, I realize that experienced marijuana consumers already know what I've talked about in this blog post. My intended audience is other people who hear "you should stop vaping" and jump to the conclusion that all varieties of vaping are dangerous.

They aren't. A comment on an Oregonian story about vaping illnesses got it just right.