We are a commune of inquiring, skeptical, politically centrist, capitalist, anglophile, traditionalist New England Yankee humans, humanoids, and animals with many interests beyond and above politics. Each of us has had a high-school education (or GED), but all had ADD so didn't pay attention very well, especially the dogs. Each one of us does "try my best to be just like I am," and none of us enjoys working for others, including for Maggie, from whom we receive neither a nickel nor a dime. Freedom from nags, cranks, government, do-gooders, control-freaks and idiots is all that we ask for.
Our Recent Essays Behind the Front Page
Tuesday, November 26. 2013
As a native Cape Codder and cranberry fan, it's a delight to report that they may have a powerful anti-atheroscletotic effect. Maybe this news might have a beneficial effect on a specialized family farming that has been bedeviled by low prices.
The big producers are Wisconsin, Massachusetts, New Jersey, Washington, Oregon and Michigan.
The sentence in Science Daily I don't understand is the following: "The researchers said that the next step is to determine which compounds in cranberries contribute to the benefits and then figure out how to incorporate them into the diet in a form palatable to humans." How about in cranberry juice, cranberry muffins, cranberry pancakes, 25 kinds of cranberry sauce, cranberry cobbler, and dried cranberry "raisins,"....for starters? You can buy unsweetened, undiluted cranberry juice now in most supermarkets.
We keep bags of them in the freezer, and they seem to last a year.
Cranberry sauce: it's not just for Thanksgiving turkey. It's good for chicken and almost any kind of game meat. Never use the junk from the can, though. Even if you think you like it, you will find you like the home-made better.
More on this native North American bog plant here.
Thursday, November 14. 2013
I recall my first deaths in medical school, in the ER. Two ambulances, family of four after a parking lot accident. The cool efficiency of the ER senior resident doing five-second triage: the 7 year -old - "Dead." The ten year-old - "Dead." The Mom - "Dead." The dad, blue but not grey like the others - "Breathing. Get him in a room and let's work on him. Tube here now, chest tube, EKG, crash cart, IV. Get a surgeon down here. Let's go, team."
In just a couple of minutes the unconscious Dad was intubated, had an emergency chest tube, IV, monitor, etc., survived.
Monday, November 4. 2013
Good grief. I suppose that will ensure steady work for the public health people forever.
In a related piece, The Radical Case for Bloomberg's 'Nanny' State
Thursday, October 24. 2013
If $300,000 buys you a statistical chance of living a few more days with a terminal cancer, would you take it? Would you take it even if Medicare paid for it - which it probably would?
Cancer chemotherapy is a big business: The Cancer Drug Racket:
Monday, October 21. 2013
When government gets involved in things, those things become politicized. Same thing goes for medical care. The death panels are meant to be a buffer against popular clamorings, but they won't work.
When it comes to medical care, nutrition, vitamins, exercise, etc, the loudest quacks and cranks tend to prevail: The Quackish Cult of Alternative Medicine - Dr. Paul Offit's battle against charlatanism
Is there quackery in non-alternative medicine? Sure, but it is mostly unintentional quackery. Docs tend to cling to the most recent information they have read, but most of it proves, in time, to be in error: Trouble at the lab - Scientists like to think of science as self-correcting. To an alarming degree, it is no.
Best to go with a conservative physician who has a good dose of skepticism and common sense.
Monday, September 16. 2013
Three years ago, I was playing tennis during the final weekend of summer. The previous two weeks, I'd had some calf pain, nothing significant, I just kept stretching to keep it loose. Suddenly, while chasing a shot down the line, I collapsed with a sharp pain in my calf. At first, it felt like a hot stone had hit my calf. This feeling matched the description my brother had given me of tearing his Achilles, so naturally I was concerned. However, I was able to stand and walk, although stiff and in pain.
This past Friday, while on a golf outing with a client, I was walking down from the first tee when I was hit by the same 'stone' in my other leg. Luckily, this time I knew what the issue was and completed the round, though I used my clubs for support at times.
I suffered, both times, from a tear or strain of the Plantaris tendon. The Plantaris is a vestigial muscle in the calf, often harvested for repair work because it has a tendon which runs from the heel almost up to the knee, attaching a very small muscle. It's length and relatively low capacity makes it attractive for harvest when the need arises. The tricky part is that about 7-10% of all people don't even have this tendon.
Tennis players often suffer strains and tears of the Plantaris. My guess is this is due to less attention being paid to the calves by most workouts. At the gym I rarely see people stretching or even working out their calves. But the calves require more attention than they typically get. I'm resting it now and avoiding my usual leg workout at the gym.
Friday, September 13. 2013
Here's what I have learned, over time:
- Abusers of precribed narcotics are a trivial social problem
What are you views?
Sunday, August 25. 2013
It is not only true in medicine, it applies to all statistical research. Here's Why Most Published Research Findings are False.
1 Boring Old Man has been devoting himself to uncovering the Pharma-Psychiatric research cabal, but nobody is really listening. My rule of thumb is to take everything I read with a a few grains of salt.
Saturday, August 24. 2013
This is part of why my high-meat, zero carb weight loss program (fixed) works: all calories are not handled the same way (and bacon and eggs are a good, healthy diet breakfast). More here:
Miley Cyrus Gluten Free Diet is a Hoax, and 3 Other Weight Loss Scams
Like I said, if you want to lose weight, cut out the carbs and eat meat. Calory-counting does not work because it's the insulin that stores the carbs.
Thursday, July 11. 2013
Emergency help on the street did work for Gerard, but the one time I did a sidewalk CPR the 45 year-old ended up with brain damage, but alive. Of course, the most difficult part for amateurs is to diagnose the need for it. People who turn pale and faint do not need CPR.
From the article:
Wednesday, June 26. 2013
Lyme Disease (Borreliosis) is endemic in the Northeast US, and probably always has been. That complicates diagnosis because so many people in the area have been exposed to the germ, and thus show some degree of antibodies to it. Many if not most cases of Lyme are subclinical and never diagnosed.
The spirochete-like bug is transmitted by the bite of a mostly-mouse-born tick called a Black-Legged Tick or Deer Tick. The Tick is much smaller than the common dog tick, and much harder to find on your body. Ordinary dog ticks are harmless, if annoying, and can not be confused with the Deer Tick.
Lyme Disease is readily treated with antibiotics, but about ten years ago one of those disease fads came along, so appealing to hypochondriacs and hysterics, called "Chronic Lyme."
As with other fake disease fads like Chronic Fatigue and, in my opinion, Fibromyalgia, Chronic Lyme believers often made themselves into invalids with vague aches and pains.
I thought the Chronic Lyme fad had passed into the history of medical faddism, but I see this odd and credulous article in The New Yorker: The Lyme Wars. The Lyme-disease infection rate is growing. So is the battle over how to treat it.
There are two serious errors right in the title. The infection rate is not growing: the diagnosis is growing and probably many people with aches and pains are being unnecessarily treated for Lyme just because they have been exposed to it at some point in their life. Second, I have never heard of any credible Infectious Disease doc in New England who had any question about how to treat real Lyme.
Thursday, June 20. 2013
Came home from a busy and exertional family day last weekend to notice some of Mrs. BD's Digitalis in glorious bloom.
Whenever I see Digitalis - Foxglove - in bloom I remember "the Shropshire Crone," renowned in medical history for promoting the use of it for "dropsy" - congestive heart failure. The astute and open-minded Dr. William Withering took notice and got all of the credit - hence the continued use of Digitalis for heart failure. Many people we see walking around would be either dead or bed-ridden without this herbal treatment. Digitalis increases the contractility of the failing heart, but in higher doses it kills you.
Digitalis is a biennial, and self-sows generously when in a happy spot - half-day sun, rich soil. That is Nepeta in bloom in the foreground, and the low-growing Little Lamb's Ear Hydrangea on the left, which will bloom white in late summer.
Up here in the land of snow, we treasure our gardens especially because our growing season is so darn short. Our plants have to know how to carpe diem even if we do not. We try to learn from them. Winter is coming.
Friday, June 14. 2013
I think everybody's ideal is to have an internist or family practice doc who knows you well personally as well as medically, and where you can call or come in anytime if you have a concern. For various reasons this has become elusive.
Based on what I have seen, three trends are growing. The first is the Doc-in-a-Box or, more likely, a PA in a pharmacy.
The second is concierge medicine in which, for a modest annual fee, you have unlimited contact - 24/7 - with your generalist.
The third is generalist docs who will not accept insurance but who charge modest fees and will offer a bill that you can send for your own reimbursement, if any. They can charge modest fees because they do not need to hire a large back office staff for coding and billing.
It's a good idea to have a generalist who knows you and your family. With ObamaCare, I think all three of these modes will grow in popularity, especially the last one. They are all working mostly outside the system. They are not likely to want to make time to see you, however, unless they have met you (except for the PA in a box trend).
Generalist physicians, whether Family Practice, Internal Medicine, or whatever, are the ultimate docs. They see everything, major and minor, and know when to refer. People who want to use their Medicare and Medicaid are going to have a tough time with office visits in the future.
I had always aspired to be a country doc, a generalist, in the New Hampshire countryside, but became too fascinated with what I now do. I had dreams of fixing broken arms, stitching up nasty cuts, treating poison ivy, delivering babies, consoling the terminal, sending appendicitis patients to a surgeon friend, etc. It's kind of funny, but my generalist friends tell me that half of their work is Psychiatry anyway.
With the training I had, I suspect that I could still do those country doc things pretty well, but my malpractice insurance does not cover it. In my training, I caught 42 babies. Some were dangerous and complicated. As I have admitted here in the past, I refused to participate in abortions not because I am so religious but because I did not want it in my memory.
Primum non nocere.
Saturday, May 25. 2013
I had the same experience as Insty did. I refused an MRI because I had zero interest in shoulder surgery and there is no point in paying for a medical test if you have no intention of doing anything about it. (Yes, I pay for my medical care.)
I did not bother with physical therapy, rested it from tennis and weights for a year, and it's pretty good now except that I have had to replace my fast serve with a spin serve - which is probably more effective anyway. It gets sore after four hours juggling a chain saw, but that's ok with me.
Sunday, May 19. 2013
We discussed salt last week. Here's The Bogus Public Health Attack on Sugar
Sugar in soda pop is no more fattening than any other carb, eg fruit, bread, milk, fruit juices like apple juice and orange juice. Nevertheless, it's not a "public health" issue, it's an individual choice issue. I like that light brown granulated sugar in my coffee.
It's brown, so it must be healthier, right?
Tuesday, May 14. 2013
Salt is one of those things that drive dietary cranks, control-freaks, and ignorant do-gooders nuts.
There really is no reason for that. Most of us docs have been saying this for years and I have made this point here in the past. Salt is an absolutely necessary nutrient for all animals, and very low levels of sodium chloride can make you sick or dead.
The average, normal human body contains around 50 quarts of salt water.
The reason people used to advise "low-salt" diet is because excess dietary sodium is a bad idea for people with kidney failure and congestive heart failure, and people with uncontrolled high blood pressure (with its associated higher risks of heart attack and stroke).
However, salt does not cause those things.
Significantly-high blood pressure is easily dealt with these days. Heart failure will likely kill you in time regardless of what you do (barring a heart transplant), but it is treatable with medicines and some salt restriction.
The new study from the CDC: No Benefit in Salt Restriction.
The American Heart Association is not up to date on the topic: Sodium is Your enemy.
If you have high blood pressure, get it under reasonable control with your doctor. If you have organ failure (eg kidney or heart failure), or have some other ailment, do whatever your doc says. If you're healthy, enjoy your salt. It makes food taste better.
One recipe tip: I always season a salad with salt and pepper. It makes rabbit food taste almost good. Don't get me on the topic of whether green salad is "healthy." (It's neither healthy nor unhealthy. It's just filler.)
Monday, April 29. 2013
I never have done so even though stretching makes you look like a serious athlete. Reasons Not to Stretch
Jumping Jacks or Jump Rope are excellent warm-ups, if one wants it.
Tuesday, April 16. 2013
Every four years I let my Dermatologist buddy scope out my skin with his special lights and magic glasses. He doesn't miss a single square centimeter of it, scalp to anus to the bottoms of my graceful feet. I'd like to avoid death by melanoma, if possible. Not sure what I want to die from, but I just want it to not be right now.
$175, cash for 1/2 hr. consult (he won't do insurance), including the good conversation and comraderie, plus a pile of samples for my spot of eczema and a little nitrogen zapping of some ancient sun damage to my face.
He knows that I have spent all of the time I could in my life outdoors, usually without hat and never with disgusting sunblock (except maybe on the nose when the Mrs. makes me). When I was at prep school, we termed sunshine "catching bennies," ie the beneficial rays of the sun. Studying Latin or dozing on the lawns.
I have happily spent all the time I can on boats, soccer fields, lacrosse fields, golf courses, tennis courts, tractors, trout streams, skiing, beaches, gardens, and hunting fields since I was a kid.
As he scrutinized my beautiful, well-fed, pasty-white-skinned body, he told me that one problem he has is people with sun phobia. He said people require an hour or two daily of exposure to unblocked sunshine (not sunburn), and that sun phobia (especially with kids covered with hats and sunblock) is a more important health hazard than benign sun-related skin cancers (which are pretty much all easily-curable when found in a timely way).
Our skin produces instantly-bioavailable and natural Vit D, necessary for normal bone growth, vitality, and disease-avoidance (cancer, heart disease, depression, osteoporosis, etc.). In the US, they add Vit D to milk (but only enough to prevent rickets in little kids) and it's far from enough to substitute for wholesome playing in the sunshine.
Sunburn bad (possibly but not definitely associated with melanoma, but definitely associated with wrinkles), but wholesome sunshine (even through clouds) is good for us. Not to mention the reality that a little tan makes us crackers look more attractive.
My dermatologist claims that we evolved to live in the nude, outdoors. Sheesh. I'd try it, but I would get arrested because I do not live in San Francisco - and I would have to fight off the women.
Friday, March 22. 2013
Over the transom, with info from the Mayo Clinic cardiologists -
I knew you need your minimum water to help flush the toxins out of your body, but this was news to me.
Subject: Mayo clinic aspirin
Tuesday, January 29. 2013
I posted about epigenetics a few weeks ago: Epigenetics in Metazoans.
Here's a good example from pigs: Why Cloned Animals Aren't Identical.
Friday, December 28. 2012
I've been preaching this since long before Gary Taubes' books came out. That's because I have a colleague who studies the physiology of insulin. From what I know, Taubes is right. A quote re Dietary Incorrectness at Powerline:
Taubes is a serious science reporter, not a crank. As I say here ad nauseum, and as Taubes explains, if you want to get trim, quit the carbs. None. That includes fruit, which isn't any good for you anyway. It's just sugar. As the man says, after 14 days off all carbs they will not appeal to you so much anymore. (There is an addiction-like quality to carbs.) And if you want to be fit, youthful, sexy, intelligent, and vigorous, then exercise or do physical work too. If you want to lower your triglycerides, get better genes or take Lipitor.
It's not complicated. It's a free country, food is cheap and exercise is free. Do what you want to achieve the goals you desire. Don't tell me it's hard to do, because everything in life is hard to do except eating, surfing the net, and watching TV.
Tuesday, December 11. 2012
A simple jump rope is possibly the best cardio exercise device one can own. It is also the cheapest and most portable.
Jumping rope will burn also 11 calories per minute (more than anything else) while offering almost total body fitness. If you have the fitness and endurance to jump rope for half an hour, you can burn off one candy bar or one donut but few people could go that long even if they wanted to. At a very fast pace, maybe a donut in less than half an hour. However, nobody I've seen can go that long.
At my gym, it's mainly men who jump. Amazon has all sorts of jump ropes. Many people like the beaded ones and the weighted ones.
Done properly on the toes, it's a low-impact exercise. Most people seem to jump in 30-second to three- or six- minute stints. It is demanding for people over 25.
If you google jump rope exercise you will find hundreds of articles about technique and the benefits.
Thursday, November 8. 2012
In The New Yorker, a Boston physician studies The Cheesecake Factory in an effort to decide whether Big Medicine can be more efficient and effective than the usual: Big Med. It begins:
I'm no fan of Big Med - I practice Cottage Med and I prefer to do it my own way. However, it's a fascinating article and actually makes me want to try a meal at The Cheesecake Factory too. I had thought of it as a kind of cheesy place, but I love wasabi-crusted tuna as long as it is just seared.
Thursday, October 11. 2012
Keller seems to have written his glowing essay about the Liverpool Protocol,
If he had spoken with American doctors, he would know that most American internists do something very similar with patients whose condition is hopeless, and do so routinely. Daily. Everybody dies. American hospitals have plenty of patients with "DNR" (Do Not Resusitate) orders on their charts, and hospice units and hospice centers are common in the US.
I see two exceptions, occasionally. One is when the family or patient is adamant about "Do anything and everything." These tend to be people who don't know much. The second is with some terminal cancer patients. I have seen terminal cancer patients, with widespead metastatic disease in the ICU, dying while the latest cancer chemotherapy is still being pumped into their veins. It's pitiful.
Generally, doctors know when to give up and do not view death as an enemy. Unfortunately, Bill Keller seems to be addressing a straw man.
Keller should read this: Why Doctors Die Differently - Careers in medicine have taught them the limits of treatment and the need to plan for the end. Doctors know when they're a goner, and when their patients are too. Most docs do not offer false hope, and do wrong when they do.
Tuesday, July 24. 2012
Apropos of (is it necessary to use "of" after "apropos"?) our post a while ago about scientific research, here is Dr. Ionnadis's famous essay: Why Most Published Research Findings Are False.
It's a classic, and a good antidote to "the experts say..." and "studies show." Thanks for the reminder, reader.
Interesting to note that, the hotter the topic, the less reliable the findings. In the social sciences, it's far worse. Mostly garbage, I think.
I am science-trained, and it made me a skeptic about everything I read.
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