What a mess!

What the hell were we/they thinking? Maximize profits at what expense?

The assembly line model for patient care will lead to medical errors and missed diagnoses, not to mention terrible patient satisfaction.

Observations in Training

"Learning how to practice medicine is not easy. There is a tremendous amount of information thrown at us. I am constantly balancing medical school coursework, exciting extracurricular experiences that enrich my learning and prepare me for residency applications, and personal relationships that keep me grounded. At times, though, it feels like I'm running out of energy and that too much is being asked of me. This feeling is not unique to medical trainees. Anyone developing a skill or portfolio at the beginning of their career works exceedingly hard to develop mastery of their craft, and that often takes a toll." - Nihar Rama

Reflecting on the reflection I recognize the toll that medicine and medical education took on my and my colleagues. We have become fried by the system, unable to stay grounded, tossed by the ocean of change and stresses upon us through many unnecessary discomforts.

Dr. Lisa Rosenbaum, in the New England Journal of Medicine, writes of the tensions between the rigor of medical training and how many trainees are pushing back against the demands of the profession. She writes, 

"…Maintaining our commitment to excellence while remedying our failures requires distinguishing unnecessary harms from necessary discomforts."

My generation of clinicians has been unnecessarily harmed, in irreversible ways. I've always hoped that the new generation can reverse this phenomenon in order to help recreate the system that has become sick-care in the United States and beyond. 

 

There needs to be much less "unnecessary harms" to save the system from completely drowning in and upon itself.

Think Blue!

Want to live long and prosper? Think Blue.

Blue Zones, regions of the world where people live exceptionally long lives, ten times more likely to live to 100 - Barbagia region of Sardinia, Italy, Okinawa, Japan, Nicoya Peninsula, Costa Rica; and Icaria, Greece

1. Move naturally

• "soleus push-ups" (calf raises) in a sitting position
• opt for walking or biking for short distancesleg lifts or seated stretches
• take the stairs

2. Say yes to happy hour

• moderate alcohol consumption often occurs in a social context, emphasizing the role of community and celebration

3. Take time to down shift

• take a deep breath, hold for a few seconds, and slowly breathe out through your nose

4. Give your diet a plant slant

• plant-based sources of protein, like beans, including black, soy, fava, and lentils, over meat
• 3- to 4-ounce serving of pork

5. Find your crew

• love and positive social interactions have been shown to release oxytocin, reducing stress w/ long-term improvements in emotional state and physical health

6. Abide by the 80% rule

• stop eating when stomach is 80% full

7. Put your loved-ones first

• investing time in your family 
• keep aging parents (or grandparents) nearby
• commit to a life partner
• children, make an effort to spend time with them

8. Find a place you belong

• attending a faith-based service four times per month could add four to 14 years to your life expectancy
• seek out a squad that makes you feel accepted and seen

9. Know your "why"

• purpose in your day-to-day life
•     What do I love? (Passion)
•     What am I good at? (Profession)
•     What does the world need? (Mission)
•     What can I be compensated for? (Vocation)

Time to take account and seek the "blue" proven ways to age strongly and gracefully.

Ugh

As I write this, I have been sitting in an emergency department with a family member for almost 14 hours, suffering from up charges for a simple procedure in the morning.

I can't tell you how broken the system is because the disrepair is beyond repair. The rooms in the hospital are filled up and patients line the walls on gurneys with the beep beep sound of EKG alarms blaring. Every 10 minutes or so some employee comes over to the cabinet across the hall from our gurney and looks for equipment that is not there. Wasted time and effort. Frustration beyond belief. 

Nobody looks happy.

It's no wonder people get sicker when they come to the hospital. The staff is overworked. The equipment is absent. The system is overwhelmed, broken and without hope as populations grow and resources become more scarce in relation to the strain of perceived community needs. 

We are screwed!

But in a pure irony of need, a new building is being built on the property to accommodate the growing need for sick care. A building that will likely be filled with patients, not enough staff searching for inadequate equipment.

STOP Vaping NOW!

Vaping-induced #pneumonitis, also known as electronic cigarette or #vaping-associated lung injury (EVALI), is a condition characterized by inflammation and damage to the lungs caused by the use of electronic #cigarettes or vaping devices. This condition emerged as a significant health concern in recent years.

#EVALI typically presents with symptoms such as cough, shortness of breath, chest pain, fever, and fatigue. In severe cases, it can lead to respiratory failure, requiring hospitalization and intensive medical intervention. The condition can resemble other lung diseases, such as pneumonia or acute respiratory distress syndrome (ARDS), making it challenging to diagnose accurately.

The exact cause of vaping-induced pneumonitis is not yet fully understood, but it is believed to be a result of chemical exposure from the inhaled aerosols produced by vaping devices. These aerosols contain various substances, including nicotine, flavorings, and other chemicals. It is thought that the heating and aerosolization process can cause chemical reactions and the production of toxic compounds, which can irritate and damage the lungs.

Furthermore, some cases of EVALI have been linked to the use of vaping devices containing tetrahydrocannabinol (THC), the psychoactive component of cannabis. Certain THC-containing e-liquids or cartridges may be adulterated with harmful substances, such as vitamin E acetate or other oils, which can cause severe lung injury when inhaled.

The treatment for EVALI typically involves supportive care, such as supplemental oxygen, bronchodilators, and anti-inflammatory medications. In severe cases, hospitalization may be necessary, and patients may require mechanical ventilation to support their breathing. Most important...STOP VAPING!!

Prevention is essential in addressing vaping-induced pneumonitis. Individuals, especially young adults and adolescents, should be educated about the potential risks associated with vaping and the importance of avoiding the use of unregulated or illicit vaping products. Regulatory measures, such as stricter quality control standards and ingredient disclosure requirements, are also crucial in minimizing the risks associated with vaping.

It is important to note that the understanding of vaping-induced pneumonitis is an evolving field of research, and healthcare providers and public health officials continue to investigate and monitor this condition to develop better strategies for prevention, diagnosis, and treatment. If you have any concerns or experience respiratory symptoms related to vaping, it is essential to seek medical attention promptly.

Trauma

A violent assault. 

A rocky childhood.

A car accident. 

If these are in your past, they could be affecting your present health.

These are all examples of traumatic events — which, in psychological terms, are incidents that make you believe you are in danger of being seriously injured or losing your life.

Research shows that these events can trigger emotional and even physical reactions that can make you more prone to a number of different health conditions, including heart attack, stroke, obesity, diabetes, and cancer.

Harvard T.H. Chan School of Public Health

Age Argument Doesn't Work

"18 year olds can fight in war should be able to buy an assault weapon..."

Ok...then we should license (enlistment), train (basic training) and supervise all 18 y/o with any such weapon.

Then argument doesn't work. It's not the same.

It's not a different standard as long as we license, train and supervise said person.

As one NRA member attendee said, "Raise the age limit to 25...that's a start"

Attack

One of the foundational building blocks of a healthier world is consistently under attack: sexual and reproductive health and rights.

Sexual and reproductive health and rights are central to the health and well-being of patients and communities.
It reflects not only the ability to exercise rights related to sexuality and reproduction, but also the ability to make informed decisions and have full access to sexual and reproductive health services.
This includes access to safe abortion.

Each year, nearly 25 million unsafe abortions take place, representing just under half of all abortions worldwide.
As many as 25% of women and girls who undergo unsafe abortion are likely to develop temporary or lifelong physical and emotional health problems.

Lack of access to abortion does not lead to a decrease in abortion, it only increases the danger to people's health and lives.
Evidence suggests that whether or not it is legal, patients will seek ways to induce an abortion if necessary.
And in countries with highly restrictive abortion laws, the proportion of unsafe abortions is significantly higher, with profoundly harmful effects for its citizens.

What kind of world are we becoming when access to healthcare choices is restricted by a single viewpoint of non-medical voices?
We deserve "progress", not regression.

Tragedy In Front of Us

From Mariupol…

"I told the brothers that it's good for her to sleep." Ukrainian gymnast Liliya Podkopaeva, from her basement in Mariupol, where her mother died."

"We went to the toilet, slept, or ate leftovers in the basement. Mother was hanging on until the end, 3 days before our evacuation, she died. I told the brothers that it's good to sleep and don't wake her up."

"The corpses stink so much."

"I hate Russia."

"My dear uncle is there. Do you know what I heard him saying over the phone today? "Kotya? What is Katya?, I don't know you. What war, what Katya? And then writing from a burner phone: "Katenko, don't write to me. For me, my motherland is not safe." 

"I hate them! Who would have thought for a moment that such a thing would happen again. And who would think for a moment that Russia is acting like that, that it has turned into the Horde."

The pain, the suffering, the determination of the Ukrainian people is stunning. We can't survive as a planet if there are forces in the world willing and able to cause such destruction, death, and pain. 

Healthcare, like Education

You have heard the news. Education is under attack.
Teachers are burned out.

And so are healthcare clinicians.

We have lost faith in the system.
We are disillusioned with leadership.
We are sick of the constant pandering to agencies, administrations, politicians and others.

We are no longer willing to heal a system beyond repair at their own expense.
Many of us technicians, nurses, physicians, PAs and others are done.

We are expected to fix the ills of society, but when we aren't treated like the experts and professionals we no longer see any reason to stay.

The highs of medicine, as in education, are no longer worth the many lows.
For many, a time for healing, a time for change.

Nutrition Assessment

Amazing what 30 minutes with an education individual will do for you. I had a nutrition consultation. Just when I thought I knew it all. It was enlightening on many levels, but the core concepts validated what I know I need for health and wellness.

Turns out as I descend into "elderly" class, full of dings, flaws and faux pas...my body needs stuff that my earlier version did not. Clearly, in addition, the food sources that are big box stores have become deficient in vital nutrients to sustain an active lifestyle and promote wellness.

So in an effort to balance "needs" and "sales", any nutrition discussion is often based in science, peppered with theory and promoted on supplement evidence, no matter how slim. Yet, somewhere in the discussion comes to the surface elements of reality that are hard to ignore. And the conclusion that we may not be able to get all we need from food (although we should be able to come pretty close) in the category of vital vitamins, minerals, and other nutrients is hard to ignore.

So what does a relatively healthy 60 something need?

1. A good multivitamin with quality ingredients and absorption. The flavor of the week? Fermented.

2. Vitamin B (complex), methylated for maximal absorption. Most nutrients need to be methylated in order to be used by the body.

3. Vitamin C, in a form that is maximally absorbed and used.

4. Vitamin D, in addition to getting some healthy sun for a time each day, outdoors (go bathe in nature). So much value in being sure the D is "topped off" for multiple systems including immune functions.

5. A probiotic (and perhaps a prebiotic). The pre? A good variety, volume of organic fruits and vegetables daily. A simple, perhaps fermented, probiotic to provide depleted microbiome characters to the mix to assist with digestion and absorption of nutrients.

6. Collagen, supplement or healthy bone broths, for healthy bones, ligament, tendons, cartilage and joint fluids. Powders (collagen, protein, green drink products etc) appear to have less challenge being digested and absorbed.

7. EPA Fish Oil, omega 3 predominant, for heart and vascular health, to counteract the ill effects of the unhealthy Omega 6 in so, so many food sources.

8. Digestive enzymes for acute (chewable papaya for example) and long term (encapsulated) digestive assistance to breakdown food sources to absorbable forms and assist with stomach functions.

9. CoQ10 for production of cellular energy, mitochondria health and its antioxidant capacity. Your cells will thank you.

10. Need help with stabilizing mood? (apparently all elderly get depressed...and why not?) 5 HTP (small dose of 50 at first), and ashwaganda (to help lower high cortisol) might be helpful.

I know these things are healthy for me. But are they so as supplements and not part of the complex structure that is food. When using food as medicine, each elements (listed above) is part of a complex "dance" of constituents that may affect the value of that substance. Example, is a probiotic supplement as good as eating probiotic, fermented and similar foods?

I appreciate the excellent information and time spent with a highly qualified nutrition specialist. But... We are clearly entering an era, with global warming, population explosion, water/nutrient depleted soils and other forces that the foods we have access to in the mega food stores (where most of us get our Western stuff) is less than nutritious. Certainly suspect.

The growth of organic direct from farm to table markets and the explosion of personal sustainable backyard/deck/window sill farming is encouraging and clearly a trend to follow. In the end these solutions may be better pursued for our needs than walking down the aisles of the whole fresh food market big boxes for supplementation to what we aren't getting in our food.

State of the Union

Today, around the world, demagogues appeal to our worst instincts.

Conspiracy theories once confined to the fringe are going mainstream.

It's as if the age of reason, the era of evidential argument is ending,

and now knowledge is increasingly delegitimatized and scientific consensus is dismissed.

Democracy, which depends on shared truths, is in retreat,

and autocracy, which depends on shared lies, is on the march.

- Sacha Baron Cohen

Whatever

"Whatever hip new thing you're promoting, I'm probably uninterested. Whatever buzzword you might be enamored of, I probably hate it. And whatever bureaucratic activity you want me to engage in, I almost certainly think it's pointless. But despite my lack of buy-in for whatever you're into, I'm also willing to work hard."

https://www.chronicle.com/article/tips-for-managing-curmudgeons/

Patron Saint

Experience

 

A ship engine failed, NO ONE could fix it.

Then they brought in a man with 40 yrs. on the job.

He inspected the engine carefully.
Then reached into his bag & pulled out a small hammer.

He gently tapped a spot.

Immediately, the engine rocked into life. It was fixed!

7 Days later, the owners got his bill for $10,000.

'What?!' the owners exclaimed.
'He scarcely did anything.'

They asked for an itemized bill.

His response:
"Tapping with a hammer = $2
Knowing where to tap = $9,998"

Lesson: Don't Ever Underestimate Experience!

Relief

My fellow Americans, the people of this nation have spoken.

They have delivered us a clear victory. A convincing victory. A victory for "We the People."

We have won with the most votes ever cast for a presidential ticket in the history of this nation -- 74 million.

I am humbled by the trust and confidence you have placed in me.

I pledge to be a President who seeks not to divide, but to unify. Who doesn't see Red and Blue states, but a United States. And who will work with all my heart to win the confidence of the whole people.

For that is what America is about: The people. And that is what our Administration will be about.

I sought this office to restore the soul of America. To rebuild the backbone of the nation -- the middle class. To make America respected around the world again and to unite us here at home.

It is the honor of my lifetime that so many millions of Americans have voted for this vision. And now the work of making this vision real is the task of our time.

As I said many times before, I'm Jill's husband. I would not be here without the love and tireless support of my wife, Jill, Hunter, Ashley, all of our grandchildren and their spouses, and all our family. They are my heart.

Jill's a mom -- a military mom -- and an educator. She has dedicated her life to education, but teaching isn't just what she does -- it's who she is. For America's educators, this is a great day: You're going to have one of your own in the White House, and Jill is going to make a great First Lady.

And I will be honored to be serving with a fantastic vice president -- Kamala Harris -- who will make history as the first woman, first Black woman, first woman of South Asian descent, and first daughter of immigrants ever elected to national office in this country.

It's long overdue, and we're reminded tonight of all those who fought so hard for so many years to make this happen. But once again, America has bent the arc of the moral universe towards justice.

Kamala, Doug -- like it or not -- you're family. You've become honorary Bidens.

To all those who volunteered, worked the polls, local election officials -- you deserve a special thanks from this nation. To my campaign team, to all the volunteers, to all those who gave so much of themselves to make this moment possible, I thank you for everything. And to all those who supported us: I am proud of the campaign we built and ran. I am proud of the coalition we built, the broadest and most diverse in history.

Democrats and Republicans and Independents. Progressives, moderates and conservatives. Young and old. Urban, suburban and rural. Gay, straight, transgender. White. Latino. Asian. Native American.

And especially for those moments when this campaign was at its lowest -- the African American community.

I said from the outset I wanted a campaign that represented America, and I think we did that.

And to those who voted for President Trump, I understand your disappointment tonight. I've lost a couple of elections myself.

But now, let's give each other a chance. It's time to put away the harsh rhetoric. To lower the temperature. To see each other again. To listen to each other again. To make progress, we must stop treating our opponents as our enemy. We are not enemies. We are Americans.

The Bible tells us that to everything there is a season -- a time to build, a time to reap, a time to sow. And a time to heal.

This is that time for America. A time to heal.

Now that the campaign is over -- what is the people's will? What is our mandate?

I believe it is this: Americans have called on us to marshal the forces of decency and the forces of fairness. To marshal the forces of science and the forces of hope in the great battles of our time.

The battle to control the virus. The battle to build prosperity. The battle to secure your family's health care. The battle to achieve racial justice and root out systemic racism in this country. The battle to save the climate. The battle to restore decency, defend democracy, and give everybody in this country a fair shot.

Our work begins with getting COVID under control.

We cannot repair our economy, restore our vitality, or relish life's most precious moments -- hugging a grandchild, birthdays, weddings, graduations, all the moments that matter most to us -- until we get this virus under control.

On Monday, I will name a group of leading scientists and experts as Transition Advisors to help take the Biden-Harris COVID plan and convert it into an action blueprint that starts on January 20th, 2021.

That plan will be built on a bedrock of science. It will be constructed out of compassion, empathy, and concern. I will spare no effort -- or commitment -- to turn this pandemic around.

I ran as a proud Democrat. I will now be an American president. I will work as hard for those who didn't vote for me -- as I will for those who did.

Let this grim era of demonization in America begin to end -- here and now.

The refusal of Democrats and Republicans to cooperate with one another is not due to some mysterious force beyond our control. It's a decision. It's a choice we make.

And if we can decide not to cooperate, then we can decide to cooperate. And I believe that is part of the mandate from the American people. They want us to cooperate.

That's the choice I'll make. And I call on the Congress -- Democrats and Republicans alike -- to make that choice with me.

America's story is about the slow, yet steady widening of opportunity. Make no mistake: Too many dreams have been deferred for too long. We must make the promise of the country real for everybody -- no matter their race, their identity, their ethnicity, their faith.

America has always been shaped by inflection points -- by moments in time where we've made hard decisions about who we are and what we want to be.

Lincoln in 1860 -- coming to save the Union. FDR in 1932 -- promising a beleaguered country a New Deal. JFK in 1960 -- pledging a New Frontier.

And twelve years ago -- when Barack Obama made history -- and told us, "Yes, we can."

We stand again at an inflection point. We have the opportunity to defeat despair and to build a nation of prosperity and purpose. We can do it. I know we can.

I've long talked about the battle for the soul of America. Now we must restore the soul of America.

Our nation is shaped by the constant battle between our better angels and our darkest impulses. It is time for our better angels to prevail.

Tonight, the whole world is watching. I believe at our best America is a beacon for the globe. And we lead not by the example of our power, but by the power of our example.

I've always believed we can define America in one word: Possibilities.

That in America everyone should be given the opportunity to go as far as their dreams and God-given ability will take them.

You see, I believe in the possibility of this country. We're always looking ahead. Ahead to an America that's freer and more just. Ahead to an America that creates jobs with dignity and respect. Ahead to an America that cures disease -- like cancer and Alzheimers. Ahead to an America that never leaves anyone behind. Ahead to an America that never gives up.

This is a great nation. And we are a good people. This is the United States of America. And there has never been anything we haven't been able to do when we've done it together.

In the last days of the campaign, I've been thinking about a hymn that means a lot to me and to my family. It captures the faith that sustains me and which I believe sustains America.

And I hope it can provide some comfort and solace to the more than 230,000 families who have lost a loved one to this terrible virus this year. My heart goes out to each and every one of you.

"And He will raise you up on eagle's wings,
Bear you on the breath of dawn,
Make you to shine like the sun,
And hold you in the palm of His Hand."

And now, together -- on eagle's wings -- we embark on the work that God and history have called upon us to do.

With full hearts and steady hands, with faith in America and in each other, with a love of country -- and a thirst for justice -- let us be the nation that we know we can be.

A nation united. A nation strengthened. A nation healed.

God bless you. And may God protect our troops.

Joe Biden

Vote

If you vote your conscience, there is no real choice.

Fed Up, And Not Being Fed

Truth is...

I work in a disease management system with absolutely no concern for or interest in health.
We are being fed by a system that doesn't know jack about nutrition.

Medical education is lacking in quality nutrition knowledge dissemination and it makes no sense.
The GI tract ("gut") and it's microbiome are key to our immune system and produce a multitude of health promoting benefits and substances. There is a GI/brain axis of communication that we neglect as a cause/effect of ill health. We can't event begin to prevent disease without gut/food focus.

I'm fed up and formally ill fed.

Do the Right Thing

Sometimes... You just have to do what it right.

Life

... could be healthier