Hanukkah Is Almost Here!

In this time of incredible global turmoil, what we need is more LIGHT. Bring it down!

A Deadly Drug Cocktail Shines a Light on an AstraZeneca Blockbuster – Bloomberg

https://www.bloomberg.com/news/features/2017-12-06/a-deadly-drug-cocktail-shines-a-light-on-an-astrazeneca-blockbuster

HEADS UP–Seroquel (quetiapine)+methadone= DEATH

Please read and share this widely in your networks.  You may save a life!

Bullshit Generator

http://www.bullshitgenerator.com/

This link brought to you as a public service. I deny everything.

Cooking For Two

Last week I had to make a trip to Phoenix to see the cardiologist. Phoenix being the smouldering Valley of the Desert Smog that it is, I knew I’d have to be running the air conditioning non-stop, because this fancy sardine can that I live in concentrates heat like the dickens. I booked two nights in an RV park as close to downtown as I could get, figuring I’d leave Atina the Wonder Dog at “home” safely plugged into 30 amps (RVs can plug into electricity to run all their systems) while I caught a ride to the medical center. She’d stay nice and cool.

Quick recap: Atina, my 3 year old Belgian Malinois, was born without kidneys. OK, she had the physical organs, but only about 10% functioning tissue. And as she’s grown, her body has outgrown her functioning kidney tissue. Dogs, for some reason, do not do well with kidney transplants, and only movie stars can afford doggie dialysis, so Atina’s lifespan will be drastically shortened.

One of the things that is bad for kidneys is heat stress. It’s something that’s seen in humans, notably in agricultural workers, say, in California, where migrant workers are frequently affected by acute kidney failure from working in extreme heat without sufficient water. Turns out dogs are extremely susceptible to kidney heat stress. Every episode, even those that pass unnoticed by observers, kills a little more kidney tissue. And for Atina, who doesn’t have much to go on, a bad episode could mean the end.

With all of my good intentions, there was one thing I couldn’t control: potty breaks. We had to go outside. For pee breaks, not such a big deal, since Atina knows what “Go pee, quick!” means. But poop has its own timing….very few of us can conjure up a poop on command, especially on short notice (well, there are those of us who poop, like, every five minutes, but that doesn’t count.) So in spite of my best efforts to plan for minimal heat exposure, there were several ten minute treks around the impeccable white-paved park, its fields of white gravel radiating 100+ degrees in spite of the relatively chilly 95 degree day. It turns out that even these brief exposures took their toll.

By the end of the first day I started smelling old pee. I checked myself. Nope, hadn’t had any accidental leakage, so where the hell was the infernal stench coming from? Atina jumped up on the bed. Yeccch! I whiffed her fur. Oh goddess, please no. It was urea crystals forming on her skin because her kidneys have stopped excreting it in her urine. Now she is peeing pure water, and sweating pee. Soon the entire interior of my van reeked.

I quickly hooked her up to the IV bag that hangs from a hook in the van.

I put 350 ml under the skin, to slowly absorb into her bloodstream and help wash the toxins out.

The next crisis came at supper time. She flat out refused to have anything to do with her prescription kidney-diet dog food that she’s been gobbling for two and a half years. She refused breakfast too. This is no joke, as she’s already lost 15 pounds over the past year.

After two missed meals I pulled out the “sick food:” rice with chicken broth. She sucked it down and asked for more. I let her have as much as I dared to give her. Then I sat and thought about how to proceed.

The object here is twofold: keep Atina feeling as good as possible for as long as possible, and…keep Atina by my side because she keeps me alive.

That’s an old joke between me and my psychologist. When business owners ask me what trained task my Service Dog performs, I can tell them honestly: “She keeps me alive.” And it’s actually not a joke. How can I kill myself at this moment, when my Doggess has tucked my foot under her neck as if it were her sleeping puppy? She guards my life from moment to moment. In fact, hearing me sniffling a bit just now, she’s gathered up my entire lower body and is wrapped around my legs peering anxiously into my face.

So you see I must take the best care of her that I possibly can.

I thought first about getting the hell out of hot Phoenix. To tell you the truth, I thought I was going to be hauling a dead dog to my vet in Flagstaff, or maybe a dog who would need to be euthanized as soon as I got there. I thought of calling ahead, but there was no possibility of speaking without breaking out into sobs, so I put the pedal to the metal and blasted up the 80 miles and 7,000 feet of elevation to my second home town on the edge of the Coconino Plateau (my first home town is, of course, Jerusalem.)

There’s a place on I-17 coming into Flagstaff where you power up the steep grade of the Mogollon Rim, and just before it levels off, a breathtaking view of the four Kachina Peaks fills the sky. These peaks are where the Kachinas, the Holy People of the Hopi (and Navajo, under a different name), came out of the Earth to serve the People. They stand like 14,000 foot guardians over the land between the Mogollon Rim and the Grand Canyon. White people call them the San Francisco Peaks.

As soon as the Peaks came into view, Atina was all attention at my elbow, peering out the windshield. Not dead. Not a bit!

So I kept on driving, stopping to get groceries and top off the diesel tank before setting out into the Coconino National Forest to find a good spot to camp….and cook.

She loves potatoes, and yams, and rice, and cooked veggies. For protein, I add pretty much whatever I’m eating. I searched the veterinary Merck Manual and found critical information on nutrients in kidney failure, which I now use as a guide in my home hospice nutrition program. I did make an appointment with her vet to talk about nutrients and what to do when…..

We’re doing daily subcutaneous fluids now, and this has had the strange effect of taking away her sense of thirst. It frightens me that she doesn’t drink. The vet says the subcu fluids do her more good than what she actually drinks, and of course my medical brain knows that but it makes no sense to my human brain.

The temperature is a balmy 63 degrees in the daytime and in the 20’s at night. If you hadn’t seen my girl when she had a bit of kidney function, you’d never know she was sick. She’s hell on squirrels. If a squirrel comes into her perimeter, she’s off like a shot, hell-bent for the Ponderosa pine she knows that squirrel is making for.

Today she treed a bigger trophy: a lost hiker! Poor fellow, he had got himself turned around in the woods because he was trying to navigate with a dim photocopy of an outdated map and got on the wrong trail. Atina found him, though, and scared him witless by leaping up and staring into his face again and again. In the K-9 business this is known as a “silent hold-and-guard.” In the lost hiker business, it’s known as “out-of-body, where’s-the-toilet-paper!” I pointed the poor chap on his proper path and took Atina home for a few Milk Bones. I never gave her Milk Bones before (“doggie junk food”), but now that she is on hospice I don’t care. She can have whatever makes her happy, as long as it fits the ratios of protein, calcium, and phosphorus that rule her diet now.

She is the best Doggess.

Hugh and #MeToo

For me, innocence ended with my favorite uncle.

He was my favorite because he was funny. Always cracking jokes. And he had a big fancy car, and he owned a music store and a giant color TV with a wooden console, and he let me play pool on his pool table that cost a zillion dollars and even ride the Vespa scooter around the neighborhood.

One day the bubble burst. It was one of those Jewish holidays that lasts a week, and my parents had actually taken me out of school to join the extended family in the New York suburb where Uncle Funny lived. He was married to my mother’s sister. The family was very close-knit.

Suddenly on this particular holiday, Funny Unc just could not keep his hands off my growing butt. Every time I walked past him with the hors d’oeuvres tray, zap! He made it a point to show me I could not avoid his pinching fingers.

To not carry the trays, or serve drinks, was not an option. Never mind that my cousins were all outside playing. My mother made sure I played “little hostess” and made sure everyone got some. But until this one year, my buns had not been up for grabs.

Telling anyone was just not an option. There were jokes about this or that uncle, how you had to watch out for him. But it was considered a kind of cat-and-mouse situation: cat is a cat, and mouse is a mouse, and you play the game.

That night the adults went out for dinner and left us cousins with TV dinners and the TV itself, but we didn’t watch it. Instead we let ourselves into the aunt and uncle’s bedroom.

After a warm-up snoop around my aunt’s dressing table, where we marveled at her collection of false eyelashes and the accompanying paraphernalia, we got down to the real business.

Under the bed were a number of cardboard boxes. In the boxes were the Playboy magazines, also Hustler and Penthouse, which we considered to be way too dirty for even us to look at. I thought maybe my cousins looked at them when I wasn’t there, but when I picked up one with a real pussy shot on the cover, they made me put it away. I had never seen such a thing. They had.

We contented ourselves with flipping through the Playboy numbers, giggling at the ridiculous appearance of full-grown women sporting ears and tails, serving cocktails to cool-looking men in evening dress. I wondered whether the women in their leotards and fishnet stockings were cold, because they certainly would never let the men in suits be too warm. I wondered if they got headaches from the rabbit ears, like I did when my mother made me wear a headband to keep my hair out of my face.

We scurried to put all the magazines back properly before the Cadillac tires crunched in the driveway. When the adults got home, we were downstairs playing pool like usual. I did not know what to do with this new information, the fact that there existed such a thing as dirty magazines and that there were boxes of them under my uncle’s bed. The thought of broaching the subject with my parents took my breath away. So until this very moment, only the actors involved shared my secret.

That night, my uncle came into the room I shared with my girl cousin, to say goodnight.

“Let me give you an earlobe,” he said through breath smelling of Manhattans.

“A what?” I asked.

“An earlobe. Here, let me show you.” My cousin tittered from her twin bed. She most certainly knew what an “earlobe” was.

Well, I found out. Funny Unc took my ear in his mouth, breathed into it, and stuck his tongue in it…and that was enough! I pulled away, feeling mortified and not knowing why. I felt very confused. According to my cousin, this was something pleasurable. According to my feelings, it was invasive, inappropriate, and wrong.

After that I flatly refused to do anything that put me in range of pinching fingers and probing tongues. I never told a soul, but I much preferred my mother’s wrath for not “serving” to my uncle’s abuses.

Years later I learned, through judicious listening to aunts who didn’t know I was eavesdropping, that Uncle Funny had sexual problems. He couldn’t get an erection without his porn. Lights went on in my head, especially later on when I became an expert in child sexual abuse: there is a pattern there, a certain profile, where the male factor has difficulty achieving sexual satisfaction with real grown women, so he seeks out porn and children. My uncle was one of those.

So among the other infuriating distractions of the past month, I’ve had to somehow contain my rage at the fact that in the face of the wave of “casting couch” accusations, confessions, denials, “mee-too-isms,” and mea culpas, glossy tributes to Hugh Hefner, the Big Bunny Boffer, father of modern pornography, Objectifier In Chief, are all over the virtual newsstands I frequent. I have no fondness for the man who built an empire on the vulnerability of women, on the ritualistic subjugation of those with the “right” measurements and the implied or outright denigration of those who measured otherwise.

To Hugh Hefner I say: good riddance…I truly wish you had never existed.

To my Funny Uncle I say: you destroyed the lives of your children, but you couldn’t get me. Rot in hell.

And to the at least two generations of women who have obsessed about their measurements and shoe size, who thought that ass pinching was simply something you had to put up with, and probably meant you had found favor with your power brokers: no more! We don’t have to do this anymore.

In fact, we never did. We bought a lie, but it’s time to return it. It doesn’t fit.

Cartoon For Today

“This person we’re trying to poison, does he have any dietary restrictions?”

—The New Yorker

Depression Comics Halloween

https://wp.me/s2dNEa-366

Owner of a Loner Heart

It strikes me, the irony, that I should finally, at last, be free of the loneliness that has followed me like a black dog through my years–that it’s not permitted for me to simply enjoy the profound pleasure of being alone without being lonely. No, other things must rise to the surface and break the spell.

I’ve not been well, the last few years. And I’ve had my share of grief and loss, and chronic pain to boot, with a couple of injurious falls thrown in. Trips to medical practitioners were not particularly productive of substantive reasons for my general malaise, exhaustion, swelling of the ankles, heart palpitations, and occasional crushing chest pain.

I chalked it up to stress and anxiety and grief and depression. That’s plenty, don’t you think?

I slogged on, in the belief that all of my symptoms could be attributed to aging, plus piss-poor protoplasm. Then I ran low on my blood pressure pills. In the olden days, I might have simply ordered myself some, since they’re not controlled substances. Nowadays I am not comfortable doing that. I made an appointment at a retail medical clinic. Doc-in-a-box.

The place turned out to do real medicine, to a point. There’s a young Nurse Practitioner (NP) in designer scrubs, assisted by two even younger medical assistants. They weighed and measured and took notes. The NP came in and asked the screening questions and briefly examined. He ordered an EKG. I was impressed.

A young male assistant came in wheeling the EKG machine. We joked until it was time to push the button. Then I breathed quietly while the machine read my heart’s electrical messages.

“Wait here, please. Armando will speak to you about your EKG.”

Eh? Armando? Oh, the cute little NP. My EKG? Why, what’s the matter with it?

“When did you have your heart attack?” Inquires Armando, not without an accusing aspect. (Trying to get one over, eh? Concealing heart attacks, or so you thought?)

Hmm…hem….errr, so I guess that’s what it was? Because I went to the Duke University ER one of the times I had chest pain, but they didn’t find anything. And I followed up with a cardiologist, who did a nuclear stress test because I was too exhausted to complete the regular treadmill stress test. I thought it was odd that he didn’t stop to think about why I should be so exhausted. I thought maybe I was being too concerned about trifles, so after being told my heart was normal, I decided to behave as if it actually felt normal.

In fact, my heart did not then and does not now feel normal. It hurts and squeezes and flops around like some airless fish inside my chest. It is downright disconcerting, but I can ignore almost anything, especially in the service of denial.

So let’s see that EKG. Oh dear, it’s telling us there’s some scarring on the south pole of the heart, where it rests up against the diaphragm. Sonofabitch, just where it was hurting so badly, a couple of months back.

Sigh. I had a heart attack.

Such very strange words to say, or to read: I had a heart attack.

And now what? Do I start behaving like someone who has heart attacks (40% of women who have a heart attack will have another within 12 months)? What would that look like? Maybe I’ve already had another one. I have no way of knowing, since I have chest pain on and off all the time. Should I worry? Do I care?

What’s the responsible thing to do? Get a referral to a cardiologist, I suppose. But I don’t want a catheterization! I don’t have family, friends, or any support whatsoever. Invasive procedures….nah.

Oh, and my heart rate was 47. Normal is anything over 60. Why would my heart rate be 47? Well, I do suspect my thyroid gland of being sluggish, which could certainly cause a slow heart rate. Or, damage to the heart’s electrical system. I’ll vote for the thyroid…can be fixed with pills.

So I told my son that I had a heart attack. Telling him felt surreal. Listening to him react felt surreal. I imagine that in a few weeks my brain will have readjusted to this new state of being. Right now I’m just kind of wishing the whole thing would go away.

I guess I’ll need to start taking some anti-platelet drug or other. I’m deathly allergic to aspirin. Oh, how tedious. I’ve just recently become comfortable with the chronic illnesses I’d been given up to now. Perhaps that was my mistake! Being comfortable, after a fashion.

What You See Is What You Get

Abortion After 20 Weeks

A few days ago, I received an email from one of the many pro-choice organizations I follow. The email was in panic mode:

“URGENT! Your signature needed! Our reproductive rights are being threatened again!”

Two days ago, Congress passed a bill banning elective abortion after 20 weeks gestation. “Elective,” meaning not due to conditions dangerous to the mother (such as preeclampsia or eclampsia), or fetal demise, or fetal malformations that are incompatible with life. Those are still possible. Just not, “I don’t want to have this baby.” I haven’t read the full text of the bill, so I don’t know what other exceptions there are. Stay tuned.

I took a deep breath and wrote a letter, but not the kind they wanted or were expecting.

You see, I have a lot of personal history surrounding both abortion and fetuses, and from where I stand, it’s not so simple. Truth be told, it’s never simple to curtail any life, no matter how tiny or how tenuous.

When I was a 16 year old virgin, in 1970, I was drugged, dragged into a dark basement, and raped so violently that after two reconstructive surgeries my nether parts are still not normal. I ran away, partially because the much older man who did the rapes was then sharing me with his friends and as a young person with Asperger Syndrome I didn’t know what to do, and partially because my mother’s abuse escalated around that time, probably due to my increased vulnerability. I fled from Massachusetts to California, where instead of peace and love I found more rape.

I missed a couple of periods. My breasts were swollen. I had no idea what was going on, since there was no such thing as sex education in the schools at that time, and my parents were phobic about anything having to do with sex. I went to a mobile street clinic and discovered I was pregnant.

Being California, there were choices. I could have the baby and keep it; I could have the baby and give it away; or I could have an abortion. I couldn’t fathom either of the first, so I settled upon the latter.

My pregnancy was past 11 weeks by the time I discovered it. California law required that pregnancies over 12 weeks be terminated in the hospital rather than the clinic because of the different technique necessary and the increased danger of perforation of the uterus. The soonest they could schedule me was in two weeks, at almost 14 weeks of pregnancy.

I’m glad they did it in the hospital, because they knocked me out. All I remember is the OB resident coming to see me afterward in tears, ranting at me about “people thinking they can use abortion as birth control.” I had no idea what he was talking about, or why he was so upset.

Fast forward to 1988.

I was a second year resident in Pediatrics at a big city hospital. My Neonatology rotation included participation on the Perinatal Ethics Committee, which deliberated on matters concerning difficult pregnancies and how to handle them.

There was a woman in her fifth month of pregnancy on the inpatient Obstetrics ward. She was 38 years old and had been pregnant already many times, and had miscarried every time. Her underlying problem was high blood pressure, which prevented proper blood flow to the placenta. She routinely miscarried between 18 and 24 weeks. At that time, and mostly until this day, for specific reasons, 24 weeks was considered the lower limit of fetal viability. Efforts to work around those limits are ongoing, but for the most part not practicable.

But she desperately wanted her baby. The perinatal team knew her well and liked her in spite of her challenges. They felt that if it were technically possible to save her baby, then we had a mandate to do all we could to deliver her a living child.

Now, this lady was no married, upper class, healthy white person. She was black, intellectually disabled, and chronically ill with severe hypertension due to lupus. She was unmarried, lived in a rough part of town, and had a criminal record for theft. In other words, a high-risk prospective parent under any circumstances, and especially for a very premature delivery. What was the prognosis, really, for her to safely and effectively parent a tiny preemie who would, if she survived, need intensive care in the hospital for months and intense home care for years afterward? Not so good. We debated the issue for hours and hours. The lady really desperately wanted her baby, but we were literally not certain we could deliver a viable baby for her, and certainly not a healthy one.

What should we do?

One thing in favor was stress. Normally we think of all kinds of stress as undesirable. We’re always thinking up new ways to combat stress in our lives. But stress is the premature baby’s friend. Stress in utero leads to increased stress hormone production by both mother and fetus, and this speeds the maturation of the fetal lungs. That was one good thing. After the lungs, the greatest challenges are the kidneys, and the skin. In utero, the placenta takes care of fetal waste, but undeveloped kidneys are something we have not learned to adequately deal with on the outside. Likewise, no need for skin inside, but here in the big world, without skin we quickly dehydrate and without its protective barrier, bacteria get in and wreak havoc.

These things don’t finish their development until the middle of the 23rd week. Our job was to keep this lady pregnant until the end of that week, if possible.

The plan was to do thrice-daily ultrasounds of the maternal-fetal circulation. Her problem had historically been that because of her hypertension, her placenta would become calcified, leading to a net reversal of blood flow so that instead of her blood going to the fetus, the blood flow became reversed, so the fetus became starved of oxygen and died. We put her on complete bed rest with high levels of supplemental oxygen, to keep the pregnancy going until that precious 24th week, at least.

In our cutting-edge neonatal ICU we boasted well over 90% survival at 26 weeks, unheard of at that time. That’s because our hospital pioneered the use of pig surfactant, a substance that, when blown into the stiff lungs of a tiny preemie, caused those lungs to become suddenly functional. It was nothing less than miraculous.

(Part of that miracle is that it was discovered by an Orthodox Jewish postdoctoral fellow, who would come into the hospital at all hours to blow a tube of pig lung secretions down a baby’s tube.)

This almost entirely eliminated the biggest barrier to survival of premature babies, the lungs, unmasking the next big challenges, which were and still remain, skin and kidneys. (We don’t have artificial substitutes for either kidneys or skin, but believe me, they’re working on it.) So we knew that if we could get this little girl past that 23rd week, between the stress and the surfactant we’d stand a pretty good chance for having her grow up.

The neonatal team was on call for the moment the blood flow in her placenta reversed. If she made it to 24 weeks, we’d deliver by Cesarian section and then, if she breathed spontaneously or with minimal intervention, we’d go all out. If she did not breathe, we would not intubate her. That was the compromise we worked out.

As it turns out, she never made it to 24 weeks. At 23 1/2, placental blood flow reversed. We had a quick conference and reconvened in the delivery room, where the fetus was removed by Cesarian section and handed off to the attending neonatologist, who happened to be me.

Squirming in the surgical towel they handed me was the tiniest human I have ever seen. I placed her on the scale: 325 grams, about a third of a pound. I’ve had burgers bigger than that! Her eyes were open, and she had all her fingers and toes. She was perfect.

As I laid her very carefully on the cold scale, a hole opened in her tiny face and a huge wail came out! She cried lustily, and I shrugged as I handed her to the NICU nurse.

“She wants to live,” I observed.

“Damn right she does,” said the nurse protectively, placing her in the warm incubator. “Let’s roll!” And they took her to the NICU, where she endured many challenges but never gave up.

I followed her until she was nearly 3 years old, then lost track. She didn’t have it easy. Her mother predictably dropped out of the picture, but her aunt took over and did a great job with her. She never had any of the really disastrous preemie problems (brain bleeds, oxygen toxicity, gut problems, sepsis.) We figured the stress she endured prenatally might have helped. Or maybe, as in the Jewish way of thinking, her soul really, really needed this particular vehicle in order to accomplish its mission.

No matter. After holding that little tiny life in my hand, watching her hang onto that life for all she was worth and actually grow up, there’s no way I’m going to say that a 20+ week fetus does not feel, or is not alive.