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All Ears

General health problems such as ear infections, pink eye and influenza affect nearly every person eventually. Rod Moser, PA, PhD, shares information and advice here on the most common general health disorders, their symptoms, treatments, and prevention.

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Wednesday, April 30, 2008

Baja - The Adventure Continues
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I was pleased that the place we were staying had high-speed, wireless Internet so I could post on the ENT board. After a few hours (or more), I caught up on all of those messages. I stopped when my wife reminded me that I was on vacation.

A few hours after we arrived in Baja, and after a nice shower and change of traveling clothes, we were heading off to dinner with our friends. In less than a block, we spotted what appeared to be a man lying in his driveway. "Old Man Down!"

One my friend's elderly American neighbors - a man not known to be in the best of health - was lying motionless in his driveway in a pool of blood. He had also urinated himself - not a good sign. We thought he was dead. He failed to respond to our yelling.

His compound was locked, so we could not get to him. He was lying about three or four feet from the 15 foot, spike-topped gate. We yelled for his wife, who was about three sheets to the wind (intoxicated). She eventually heard our calls and came out (slowly) to open the gate. It seemed like forever before she could fumble with the lock. By this time, Tony (the guy on the ground) was twitching a bit, so we knew he wasn't dead (yet) . She finally opened the gate and we got to him. He was still unresponsive and bleeding from a huge gash in his head. I unbuttoned his shirt, felt for his heartbeat (it was there), checked his pupils, and tried to get him to respond. My wife went to call 911 (nueva - uno - uno?). They had a difficult time finding the phone. Ten minutes later, while holding a wad of Kleenex on the big gash in Tony's head, he responded with the classic, "Where am I...and who are you?"

During my quick exam of Tony, looking for other injuries, I found a piece of popcorn lodged in his hairy belly-button.

"Tony, Do you know that you have a piece of popcorn in your belly-button? Want to eat it?"

He smiled, then laughed and, of course, declined. The sense of humor is really the last thing that goes. When he laughed, I knew he would be fine. The Mexican paramedics hauled him off to the local hospital. I washed off a great deal of Tony's blood from my hands and had to go back and change my shirt. We got back in the car and headed for the restaurant (again).

I had shrimp (camarones). They were good.

UPDATE: Tony insisted on going home after getting about a hundred or so (estimate) sutures on his face and forehead. In the States, he would have been CT scanned and admitted for post-concussion observation. Tony apparently is doing fine; perhaps finishing the rest of his popcorn.

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Posted by: Rod Moser_PA_PhD at 12:40 PM

Friday, April 25, 2008

News from Baja
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If you plan to visit a remote area or a Third World country, you have to expect and tolerate some inconveniences along the way. If you cannot, you should really stay home.

My wife and I made it to Loreto yesterday afternoon...2-1/2 days and 1500 or so miles of military check points, cursory inspections (none, actually), and some very interesting stories.

We made it to Ensenada the first day. We were going to go three more hours south to El Rosario, but we were tired. We sort of zipped through the border crossing; didn't give the Federales any eye contact so we don't know if they want to inspect us or not...we just merged in with the busy Tijuana traffic and headed south.

We stayed at the Joker Motel. That was our first mistake. It just seemed less-tacky than some of the other ones and it had a high, prison-like gate around it so no one would steal our truck. As we pulled on to their property, there were machine gun-welding guards. Hummm...maybe this WAS a prison.

Later that night, we knew why there were police at the hotel. Hundreds of party-goers (mostly drunk teenagers) arrived and went crazy. They were jumping in the pool, drinking, fighting, playing the loudest music you can ever imagine, and cheering on people doing things unimaginable. All night long, the Federales were hauling them into the room next to us. Apparently, this was the "jail"! Occasionally, we would hear them beating the hell out of someone. We left as soon as it was light. We did not get much sleep, but the entertainment was interesting.

Day 2 we made it to San Ignacio, a little Mexican village and oasis in the desert. The entire place is covered with date palms planted by the Jesuits in 1732. The Jesuits were forced out several years later, but the palm trees have stayed. The locals now make some sort of booze from the dates. I did not drink any.

Photo Credit: Rod Moser
We stayed at a unique bed and breakfast. It was a Mongolian yurt, purchased in Oregon by a Canadian couple who owned this unique "Yurt and Breakfast", in the middle of Mexico. This was quieter than the Joker, with the exception of the love-sick bull frogs who called for each other from one end of the yurt to another. A yurt is not your typical tent. It has a bathroom, tiled floors, shower, flush toilet, tiled bedroom, kitchenette with microwave and fridge, a huge skylight to see the full moon, and a hot tub outside. After the Joker, we wanted an upgrade. We went in to town to get dinner; some of the best and most garlicky scallops I have ever had. We wanted some date pie, but they were out of it. We bought a date pie from an elderly woman who lived next door to the restaurant.

While I was eating my scallops, a Mexican man walked by and gave me a friendly nod. He was carrying a pot with four pigs feet in them. He sat the pot down on the table beside us. The then went back to the truck and brought in the rest of the pig (minus those four feet) on his shoulders. He flopped it on the table and begin butchering it. You don't see that in often in the U.S. I don't know if you are supposed to tip the pig-butcherer or not. I asked him if he was making carnitas. "Maybe tomorrow," he replied in Spanish.

We basically had an uneventful trip down Baja. No one even looked in the back of the truck were we stashed our "smuggled" children's clothing (about a hundred outfits). We also brought our kayak and a gasoline power washer I was bringing down for my friend. We like to travel light. We originally had intended to bring about a thousand pounds of children's clothing, but were reluctant to do so because of a ban on used clothing. Millions of illegal Mexicans make it across the border each year. The drug cartels bring in tons of marijuana and cocaine. For some reason they weren't going to tolerate two Americans bringing in kid clothes for the orphans. Where is the logic here?

After milling it around for weeks, we gave the bulk of the clothing to a local church for their community fair clothing give-a-way. The rest we stuffed in three big suitcases for the trip to Baja. No one even searched our bags, so we didn't have to make up any stories to explain those clothes. We won't be so lucky on the way home next week. Northern bound cars are scrutinized a great deal. I will wear my clean shorts for the full body search.

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Posted by: Rod Moser_PA_PhD at 4:06 PM

Wednesday, April 23, 2008

Travel Woes
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It seems that every time that I decide to go on a trip, like a vacation, something happens. We are leaving for a long drive to Mexico tomorrow. Last week, my dreaded irrigation system went on the brink (again), so I am in the process of putting in a new one at considerable expense (Have you priced copper wire lately? I need about 3000 feet.), and with considerable headaches. Right now, I am watering all of my beloved plants, trees, flowers, and landscaping with precious well water. Because I have a deep and relatively-low flow well, the pressure is like watering with a squirt gun. The irrigation system went out two years ago, too, when we were at our youngest son's wedding. We planned on staying a week in a rented beach house, but I had to come home and deal with the water problem; the rest of the family enjoyed the seashore.

When the late Pope visited Australia, there was a major terrorist plot uncovered to cause him harm and to down some airplanes. Guess who was on vacation in Australia? For those of you who complain about the hassles at the airport now, you should have experienced the security measures on our flight. They wouldn't say, but maybe the Pope or some other dignitaries were on our flight. We had to arrive at the airport four hours before flight time. We were not permitted ANY carry on bags; women were not even allowed to have a purse. No toothpaste (that was a mystery to me at that time, but not now); no bottles of water; nothing. We were able to hold our passports, until they collected them, of course. There were cameras everywhere and uniformed guards walked among us. One by one, we went behind a private, curtained area and had a nice body search by a same sex examiner who wore latex gloves. That was the most terrifying part - the gloves. Fortunately, my quick eye did not see any KY jelly, so I relaxed a bit.

After a while, half of the people were moved to another room; and the other half remained. Some people traveling together were separated. We did not know why. Eventually, we all boarded the plane bound for Los Angeles.

My son and I were singled out in New Jersey several years ago (before 9/11), returning from a pilgrimage to the Baseball Hall of Fame. We attended the Induction Ceremony for his idol, Mike Schmidt. To add to his collection of "Schmidt", he bought a 4 inch diameter pewter disk - sort of like a drink coaster. Of course, this caused some commotion at the metal detector as we were rushing to catch our flight.

"Gonna need da look in yo bags", I was informed. (This person did not speak well)

After dumping out all of our dirty underwear on a big table in front of other fellow passengers and digging around with a stick, she found the innocent coin-like object. Apparently, there are a lot of dangerous weapons that look like coins, like some sort of Ninja thing or land mine. I didn't ask. We were late.

"OK...you can go now." She left all of our scattered laundry for us to repack again.

This was not an easy task since we decided to pack tight so we could get everything in one bag. Speaking to my son in a final moment of frustration, I said, "What a hassle." (It really was.) Apparently, the Transportation Safety Agent overheard this private comment. As we were running to catch our plane, we were stopped again, this time by a giant security guard.

"Why you call Gladys a hass-ole?" (Please forgive the profanity. I am just quoting)

After several minutes of denial and puzzlement, I realized that not only did Gladys not speak well, she apparently had a hearing problem, too.

When I said, "What a hassle", she heard, "What an Hass - ole". When I explained this to the guard, he understood how this could have happened, so he let us go and ran off to his next emergency. Perhaps someone was being arrested for yelling "Hi" to a friend named Jack.

Of course, airline safety is no joke and we all need to be patient and respectful travelers. Gladys was just doing her job. Even if I encounter a hassle again, I definitely will keep it to myself.

We are leaving for Mexico tomorrow. This morning, I read an alert by the State Department regarding escalating violence at the border towns, such as Tijuana. Granted, we are zipping right through Tijuana and heading south, but there have been kidnappings of Americans, car-jacking, and even a few murders. There are reports of thugs that will follow your car dressed as policeman. Yes, a major travel alert just in time for our trip.

We have had an incredibly long and stressful winter in our clinic, requiring me to work long hours. My 12-hour shifts are usually 15 hours. I really, really need a vacation. I do not need to be robbed or hassled. If I wanted that, I would have stayed home...or flown to New Jersey.

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Posted by: Rod Moser_PA_PhD at 7:05 AM

Tuesday, April 22, 2008

Traveling Baja
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This week, my wife and I are driving (yes, driving) to Loreto, Mexico from Northern California - about 1500 miles one way. While that distance may not be impressive for salespeople and long-distance truckers, when you are driving in Baja, it can be challenging. With the exception of dodging cows on the narrow highway or rock slides, it is really a very pleasant trip. The weather may be a bit hotter than last year.

Why drive? Our original intention was to transport a huge load of donated children's clothes to some of the orphanages that we passed last year. I should have done my homework first, since used clothing is actually BANNED from Mexico. Why, you ask? According to the State Department, clothing has been used to smuggle guns and drug money across the boarder; and used clothing devalues the textile industry in Mexico. If you try to bring clothes (and many people, church groups, etc. do this) the Mexican officials can heavily fine you and confiscate the clothes. So, not wanting to be arrested for smuggling thing IN to Mexico, we have found another local church to accept these clothes for distribution in our local community. However, if several dozen cute little dresses and other children's clothes somehow get mixed in with our many suitcases, what are we to do? I guess we will just have to give them away. Oh, well.

If we would have known that the price of gas was going to hit $4.00 a gallon (it is probably a bit less expensive across the border), and that the clothes were not going to be filling the truck, we would have flown less expensively. Of course, now that the airlines are canceling flights right and left, maybe we are still better off taking a chance of hitting that random cow or donkey on the road.

We have the house/pet-sitter all lined up. The plants have been watered; the mail held at the post office. The tires have been inspected and rotated; oil changed. I hate to share this but I practically have the car packed five days ahead of time. Am I anxious to go or what?

I always keep five gallons of spare gas in the back of truck; just in case. Just because there is a gas station along the highway does not mean they have gas. We didn't have to break into the spare can last year, however. Gasoline prices in Mexico are controlled by the federal government, so in most cases, you do not have to shop around for the best price. Between towns, you will see flat bed pickup trucks with a barrel of gas on the back. The owner of this traveling gas station will gladly charge you two to three times the going rate, estimate the number of gallons they give you, and you have to trust that it is really gasoline. It is always best to fill up every chance you get and at nearly every gas station.

People do judge Mexico by what they see at the border - a big mistake. Once you get beyond the sleaziness of the border, you will find a beautiful country with beautiful (and honest) people. We feel safer driving through remote areas of Baja than in downtown LA or Oakland. Sure, there are bad guys everywhere, but we didn't really see any in Baja.

We have one, mid-way stay in the little town of San Ignacio where we will actually be staying in a Mongolian yurt for the night. I have been thinking about buying a yurt for the grandkids, but I thought it would be good to stay in one first. Since we will not have the truck filled with kid clothes, we are bringing the kayak. San Ignacio is an oasis, and of course, everything in Baja is close to the ocean or Sea of Cortez. Rather than just take pictures like we did last year, we are going to jump in the kayak and explore those beautiful lagoons and coves; maybe snag a fish or two.

Our final destination will be the formerly-sleepy town of Loreto. We want to spend as much time as we can here before it becomes spoiled. A few cruise lines have now found it, and there is a huge resort just south of town with luxury condos and trendy shops. We plan on spending most of our vacation exploring the desert and sea kayaking. We are staying in a rental owned by one of my former patients. His children were also my patients, and now, I take care of his children's children. These are more of my grand-patients. The thought really makes a guy feel old.

I will be celebrating (sort of) my 57th birthday while in Mexico. I wonder if the Mexican waiters will put an American hat on my head and sing "Happy Birthday" with an English accent. Being on the Sea of Cortez, the seafood in Baja is wonderful and relatively inexpensive. This is usually all that we eat while we are on vacation. The beef in Mexico could be road kill; you see enough dead cattle along the highway. Some of the meat hanging in the butcher shop looks like it was cut with a chain saw. We are packing our own steaks from Costco; frozen in a thick, Styrofoam cooler used to store vaccinations.

We bring our own water, but Loreto has a very clean water treatment plant where you can buy five gallon bottles for about a dollar. The only time that I got diarrhea was from bottled water that I bought in Mexico. Someone probably refilled an empty bottle with a hose, re-sealed it, and sold it to me. Diarrhea and kayaking are really incompatible activities. Actually, diarrhea and ANYTHING is incompatible.

I will blog and post on the Ear Disorders board about every other day or so while on vacation. Actually, the Internet service in remote Mexico is better than what I have at home.


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Posted by: Rod Moser_PA_PhD at 1:09 PM

Monday, April 14, 2008

The Bare Went Over the Mountain: A Shy Person's Guide to Public Nudity
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There is nothing more precious than seeing the unbridled freedom of a child when they are naked. They will run and laugh without a care in the world. They don't really care if they have a big tummies or chubby butts; they are just happy to be free of those diapers - at least until they are captured and re-clothed. Nude children romp around in sprinklers and freely skinny-dip. They love to bathe together. In our clinic, we weigh infants and toddlers in the buff so that we can get an accurate weight, devoid of a heavy-laden diaper. Because of this policy, I see dozens of little butts streaking by my office nearly every hour.

In high school, we were required to group-shower after physical education. Often, this was the first time that many of us experienced post-puberty nudity. In a small town, these were often the guys we skinny-dipped with anyway, so it was not a big deal.

As a hormonally-charged pre-teen, my friend, Jim and I were once given a picture of a naked woman by our local barber/sex educator, Nolan. We were so excited, that we actually created a shrine of sorts to house this treasure. This treasure was eventually lost in the stacks of Playboy magazines that somehow made their way into our secret hiding spots in the years that followed.

In the 70's, I was once held up in traffic for hours while thousands of streakers ran across San Francisco's Golden Gate Bridge. We still hear crowds cheering when a lone streaker runs across a football field. Masked (of course) streakers still run through high school or college graduation ceremonies. People really seem to love nudity, but only a select few will actually shed their clothes in public.

Marin County, California, just north of the Golden Gate, was a hippie enclave in the 70's. I live there. I was not a hippie. Most of the beaches were nude beaches (many of them still are). Once, while walking (clothed) down a beach in Bolinas, CA, my dog happily ran over to a group of naked girls. He refused to come when I called him. Of course, I had to go get him. I walked my dog more often in those days.

The North Beach area of San Francisco is still famous for their nude shows, for those who choose to pay to see nudity. While traveling with my 9 year old grandson last summer, he turned and asked, "Grandpa, what is a NUD?" (He pronounced this word like it rhymed with "mud".) Don't you just love what kids come up with sometimes?

One of my strangest experiences in 1975 was a nude graduate school interview! I applied for a master's program at UC Davis. In order to save me the travel time, three of the faculty members offered to interview me at their home in Sonoma County. I arrived promptly, clad in my interview suit and tie. There was no answer at the door, but I heard them call me from the back yard. As I entered through the gate, I couldn't help but notice that I was a bit over-dressed for the occasion. I don't really know, but I think I am the only person ever to be interviewed for graduate school by three nude faculty members. I remained clothed for the interview and was accepted anyway. Six years later, I joined that same faculty and eventually shared in those nude experiences many times at our annual retreats. But many things have changed over the last thirty years. We all wear clothes now for some reason. Apparently, as a person ages and their bodies change, they are a bit more selective when it comes to public nudity. We are not even comfortable looking at ourselves while walking past a mirror.

In the 80's, my wife and I kayaked down the Green River in Utah, naked most of the time. The high canyon walls protected my white skin from becoming seriously-red skin. My wife and I also visited several California "clothing-optional" spas, soaked in sulfur-smelling water, and plopped into mud baths. (Yes, we were "nud.") It was a real Zen experience. Once, while cooking in some very, very hot water at Wilbur Hot Springs, some idiot broke the meditative silence by belly-flopping into the hot tub, thrashing around like two-year old with ADD. As we stared at this unexpected exhibition, we suddenly realized that he did not dive into the tub; he had fainted and fallen in. What we were witnessing was him drowning! We pulled him out of the tub, flipped him on his side, and he started breathing and coughing. A few minutes later, he recovered and walked away; naked and embarrassed, of course.

My older brother, Larry, was born wearing a suit and tie. The idea of going nude was unimaginable...until he tried it. In an effort to shock him out of his back East conservativism, I made reservations at a wonderful facility near Big Sur, CA, called The Esalen Institute. I had taken a few classes there in the past and really enjoyed zoning out in their big hot tub perched on a cliff over the Pacific. Initially, my brother absolutely refused to go "au naturale". However, after less than an hour, he was happily romping toward the hot tubs like the rest of us. Needless to say, he had a wonderful experience and has visited Esalen a few times since then. Being able to shed your clothes, soak in a hot tub, eat organic food, and have a relaxing massage is truly a mental catharsis during times of stress and indecision.

Take a long look at my picture posted on this Blog. You may see me as a conservative, mature, grandfatherly, medical professional. In reality, I am a reformed nudist. That's right! I admit it. Now that I live on top of a rural mountain with no close neighbors, I am starting to revert. I have my own hot tub and sauna. I have a big tummy and a chubby butt (again), not unlike those little toddlers that run by my office door. And, like those children, I don't really care if anyone sees me naked. Because I care about the health of my readers, I will not post any pictures, but rest assured that I am naked under my clothes right now.

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Posted by: Rod Moser_PA_PhD at 8:39 PM

Friday, April 11, 2008

Larry the Seasick Sailor
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My older brother and I grew up in land-locked, rural Appalachia. The only source of recreational water for our use was a shallow, contaminated creek and a stagnant pond called the Canoe Canal. Our town had just one canoe and it was rarely seen on this tiny inland sea. Maybe it was this obvious lack of water recreational resources that created an interest in water sports.

I selected the kayak. It was smaller, cheaper, and more portable. My wife and I like to explore in our Klepper. For those of you that are not familiar with this classic kayak, allow me to share. The Klepper is a hundred year old German-designed sea kayak that is collapsable into two bags. It has a frame of wood that you have to assemble like a big Tinker Toy and a skin of very durable fabric. It has a rudder, two comfortable seats, and room for gear. This is a very serious, seaworthy craft. As a matter of fact, a German physician by the name of Hannes Lindermann actually paddled (and sailed) an identical kayak across the Atlantic Ocean in 1956 in 72 days! Of course, I was five years old at the time, chucking rocks into the Canoe Canal. Since my heritage is German as well, I wonder if I have some of that craziness myself.

Since I am a careful and cautious explorer, I wanted a kayak that was stable - I do not want any unintentional Eskimo rolls. So, years ago, I bought a used Klepper. Since that time, my wife and I have paddled in Mexico, Australia's Great Barrier Reef, New Zealand, British Columbia, and Jamaica. We also had it in the Puget Sound and around the San Juan Islands. It is already packed for another trip to the Sea of Cortez in April. On our first trip, we did get into a little storm of sorts. I can still hear her cussing me out over the howl of the wind and the breaking of the waves over the bow. Incidentally, my wife will be 62 and I will soon be 57. We don't do storms anymore and you sure as hell will not see me trying to cross an ocean in a kayak!

FYI: The picture is of me in the Klepper. I am in the stern; my friend, George (not my brother...or my wife!) is in the bow seat. We are off of the coast of Santa Cruz, California.

My brother selected a sailboat. He bought his first sailboat about twenty years ago - a racing trimaran. They often say that the two happiest days of a man's life are the day he buys a boat and the day he sells it. A few years ago, my brother saw his beloved trimaran leaving with its new owner. No longer would he be able to sail the challenging waters of the Chesapeake. He only remained boatless for about a year. In January, he retired. Apparently, when you retire, you are obligated to buy another boat. I did not know that.

My brother (soon to be 65) bought another boat - a really big one this time. He will be upset since I don't remember what kind it is or how long it is, but just know that it is big. I have not personally inspected this ship, but I have seen many photographs. It is a white with a green bottom (not unlike me right now!)

This morning, I received an email that my brother (retired) is flying to Florida to help a friend bring a 40 foot plus sailboat up from Florida to the Chesapeake. The voyage is going to take a month; averaging 60 miles a day (on a good day). This will be my brother's longest sea voyage. Although they will most likely stick to the calmer waters in the sea channel close to shore, he is a bit anxious about getting seasick. Yes, Larry the Sailor gets seasick.

When Dramamine or Bonine do not work, he does use Transderm-Scop - little scopolamine patches that go behind your ears. I suspect Transderm will be all that he will need to hold down his breakfast, lunch, and dinner. If that doesn't do the trick, I told him about promethazine (Phenergan). This prescription medication is very effective in settling the seasick stomach, but at a price. Phenergan can make you very sleepy. Most people would rather be sleeping than feeding the fish over the railing. Assuming the seasick person can hold down the pills, this will likely solve the profound nausea caused by the motion of the ocean. For those unfortunate vomiters that cannot even hold down the medicine, promethazine is available as a rectal suppository. My brother did not want them. Hopefully, I will not get an email or cell call from some Atlantic port with a change of mind. I really should have sent him a couple promethazine suppositories anyway; perhaps encased in glass so he could "Break in Case of Emergency".

Since my big brother has wireless Internet, I will publicly wish him smooth sailing on his venture north:

May the wind be at your back, the sun in your face, and your tuna sandwich remain in your stomach.

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Posted by: Rod Moser_PA_PhD at 12:23 PM

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