All Ears

Pet Friendly Hotels?

2009-10-30T07:10:00.006-04:00

It has been a while since I have traveled with my pets, since my adult dog, Lexi, hates the car. She shakes and trembles, lies on the floor of the back seat and then throws up. It may be anxiety, since her only car trips now are to the vet or to the groomer - both not high on her list of places to go.

"Herman" / Photo: Rod Moser

Two of my Shelties loved the car. One would actually chase cars while IN the car. We had a van at that time, so she would sit on the front seat until she saw a car, and would then run all the way to back barking at it as it passed. This was annoying. Herman, my late buddy, would try and come with me all of the time; even when I was going to work. As soon as I would open the door, he would jump in. He would lie on the front seat and lick my right hand which rested on the center console. His fearlessness around cars lead to his injury a few years later when his big, bushy tail got caught under my rear tire. He was not able to recover from his injuries after extensive surgery and had to be humanly euthanized. This was one of my saddest days.

About a week ago, I had to take a few days off to put, Cali, one of Lexi's six puppies on the plane to Maryland on Pet Airways. Since the flight left from Los Angeles, about a 7-8 hour drive, my brother and I had to leave the night before. Finding a pet-friendly hotel was a bit more challenging than we anticipated.

There are dozens of hotels near the Los Angeles airport, as you might imagine, but the surrounding communities are not the safest places to stay. We did find a hotel that allows pets near the airport but the reviews were not good; scary in fact. One reviewer referred to this hotel as worse than the Bates Motel. Another advised us to lock our car and doors at all times. We figured that this pet-friendly hotel may have also been crack-friendly and prostitute-friendly, so we canceled our reservation.

There are lots of Internet sites that list pet-friendly hotels, but pet-friendly does not necessarily imply that they are wallet-friendly. Some were terribly expensive, including one pet-friendly hotel that has a one hundred dollar, non-refundable pet deposit! That is $700 in dog money! The lowest pet fee was fifty dollars. Since we were only staying there for about nine hours, we felt those fees were ridiculous.

Photo: Larry & Jeanette Moser

We finally found hotel (one of the chains) located two hours from the airport that allowed pets and did not charge an extra fee. What would this one be like? It turned out that this hotel was one of the cleanest, nicest, reasonably-priced, safest places that I have every stayed - The Hampton Inn Santa Clarita. I think they deserve a plug for being pet (and human) friendly. There were many dogs there, including some scary-looking, but well-behaved pit pulls, but not one was barking or running amok. We did sign an agreement to pay for any pet damage, which of course, there wasn't any. I would stay at this place again, even if I didn't have a pet. They even had a hot breakfast in the mornings that was darn good. I blogged about The Dozen Dirty Places in the past, listing hotels high on this list. I can truly say that this hotel is an exception. If I did the list, I would put my living room or my home office on the list instead.

Photo: Larry & Jeanette Moser

Cali made it safely to Maryland after her thirty hour journey; a longer flight than we originally anticipated. My latest report from Maryland is that she is excelling in house-training and has already been fitted with her life preserver for the boat. It is good that she is house (boat) trained quickly or you could have a whole new meaning for the area on the boat called the Poop Deck.

Photo: Larry & Jeanette Moser

Unlike most of my other dogs, Cali is the one that does not seem to mind car trips. She has already visited my elderly mother (she will be 88 next month) in the nursing home and has made many local car outings without the least bit of car-sickness or anxiety. Out of the six puppies, it seems that my brother got the "good one", although I think all of them are wonderful.

When we go out of town, we hire a house/pet-sitter. In a few years, we would love to buy a tent camper and tour our own country, hitting the best of our National Parks. I would love to take the dogs; not that they would enjoy the trip, but so we wouldn't have to leave them. My brother and sister-in-law do many car (and boat trips) so having a travel-friendly pet is essential. I am glad they got one. Since we have accumulated a menagerie of sorts - three dogs, two cats, tropical fish, and 14 non-egg laying (so far) chickens, we will need that pet/house-sitter for a long time, I am sure. We fantasize with the idea of retiring pet-free, but neither one of us can imagine a life without having a dog (or three) to love and pet.

Photo: Larry & Jeanette Moser

Are You Right-Eared or Left-Eared?

2009-10-29T08:24:00.004-04:00

Dean Shareski / CC BY-SA 2.0

What happened to in-flight entertainment? On my recent flights, there were no movies, no headphones for music, and no magazines. I long for the day when flight attendants would cruise the cabin, handing out a variety of magazines. Now, we have to buy our own magazines (at airport prices) and books, bring our own food/snacks, and supply our own entertainment.

The guy across the row from me was happily watching a video and wearing those noise-canceling headphones, periodically chuckling. As soon as the movie was over, he had one of those new electronic books, and started to read a novel. This man was prepared. I bought a TIME magazine at the news stand, but read it all waiting for my flight to leave. This is equivalent to eating all of your popcorn before the movie starts. I started leafing through those in-flight magazines (Spirit) and found an interesting article that I would like to share.

Did you know that 72% of people prefer to listen with their right ear? It is not really due to the fact that you are right-handed either. The left side of the brain specializes in language processing and is neurologically wired to the right ear. Consequently, the right side of the brain that deals with emotional cues is wired to the left ear. Two Italian researchers found that requests spoken into the right ear generates more positive responses than those uttered into left ears.

I find this very interesting, since I am one of those right-eared people. If I hear something subtle outside, I will turn my right ear to the noise. I tend to keep my wife on the right side when she is talking, too. She sits to the right of me when I am driving, and on the right when we are at the movies. When she nags me, she is usually on my right, but now that I have this information, I may turn my left ear in her direction. Of course, I do have tinnitus which is primarily in my left ear, so I suspect my right ear has more acute hearing.

We don’t have any young children in the house anymore, just dogs and puppies. We do have grandchildren, however, so I am going to try and voice those requests to pick up their stuff, or take a shower, etc. in their right ears, hoping of course, for those positive responses. I am going out on a limb here because I don’t think teenagers really respond to either ear, but I am going to try it on our 16-year-old granddaughter.

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Halloween - The Good, Bad, and the Scary

2009-10-28T06:00:00.001-04:00

Kevin Dooley / CC BY 2.0

Children love Halloween; or most likely, they love to dress up and pretend they are super heroes, rock stars, cheerleaders, or monsters. Too bad that Halloween is only once a year, and too bad that Halloween has such an evil reputation as being a day that opens the gateway to Hell. Seeing happy little children dressed as fairies or Darth Vader is not the same Halloween it was two thousand years ago.

Ancient people (and even modern people today) believe in spirits - good ones, and bad ones. When I am seeing a traditional Hmong family in the clinic, they are unusually quiet. They do not want to draw attention to themselves by the evil spirits that lurk around medical offices. Actually, I have seen them myself, cleverly disguised as inspectors renewing one of our many accreditations. The Hmong and many other people in third-world nations do not believe in germs as a cause of disease; they believe that evil spirits are responsible. Since it is becoming more and more difficult treating certain drug-resistant diseases now, I am inclined to start believing it myself.

Two thousand years ago, the Celts, a much admired group by the tattooed crowd, believed that October 31st - the last day of their year - was a day when ghosts came back for a visit, and the dead comingled with the living. The Celts would dress in masks and costumes to scare them away, and leave offerings of food (the "treats") to appease them. However, if you are already dead and just making an annual visit, I don't really understand the point. Come on...they're already dead. What can happen? I wonder if adult Celts ate the primitive Baby Ruths and Milky Ways out of their kid's stash, as is our tradition now? I heard that archeologist have found some wrappers, including one intact 2000 year old Snicker that was missed. It is still edible.

After the Romans invaded Ireland and England, Halloween begin to change. The Romans didn't really like Celts dancing around in goat pants and stuff. Then came the Christians, who put the damper on this annual holiday by making November 1st All Saints Day; thus making October 31st All Hallow's Eve, or as we know and mispronounce it, Halloween. Hallow means "Saint". All Hallow's Eve became a religious holiday. The Celts were not pleased, so they invented Irish dancing and whiskey. I made that last part up, but I love to start Internet rumors.

The good part of Halloween is the fun that children have dressing up. They love going door-to-door getting candy (for their parents). Competing neck and neck with Christmas and their birthday, Halloween is often their favorite. Why do some people hate it?

The bad part of Halloween has got to be those poor choices for costumes. Being in the medical profession and having done my time in the emergency rooms, I don't really care too much for eyeball hanging out, knives stuck in ears (worse than Q-tips!), or blood dripping down from severed limbs. I keep trying to bandage them, or at least put on some gloves to keep from getting fake blood-borne pathogens. That is the scary part for us. For the younger crowd, these costume choices are equally as terrifying. Let the teenagers wear them at parties that only have teenagers, but let's not go door to door scaring the crap out of the little ones (and their parents).

Halloween can bring out the ultimate essence of poor taste, like a transvestite Obama or a Nazi cheerleader. No one, and I repeat, no one, should be wearing costumes that are offensive or in poor taste. The medical assistant who works with my wife is from Moldova, and is offended by anything related to Halloween, even pumpkins. Since my wife loves to decorate her office for Halloween, she is slowly (very slowly) learning to tolerate this American tradition.

Spiderman, Superman, and the Transformers tend to be popular in my office for the boys. The girls still love being ballerinas, divas, or one of the Disney heroines, like Ariel or Pocahontas, although Native Americans or mermaids may be insulted. Witches and ghosts are okay; I am not particularly fond of vampires, although I did like Twilight. I can vividly remember as a child, sleeping in my hot, humid attic room with the window closed, so that Dracula would not come in. I would avoid walking through the woods at night, too. The Wolfman, if you are curious.

A local mega-church goes half-way and has a Harvest Festival. For the safety of the children, they organize an annual "Trunk and Treat." Cars are parked all around the periphery of their large lot; the children go from car to car in their costumes, getting candy and treats from the trunks of their cars. I think this is a great idea and a wonderful compromise. They are prohibited from being witches, vampires, or axe-murderers, as they should.

It is time to re-invent Halloween, not abandon it because a few inflexible people may be offended because of some issues and associations 2000 years ago. Halloween is fun if you set some reasonable perimeters and join in.

Danielle Closs / CC BY-ND 2.0

Sad Endings. New Beginnings.

2009-10-26T14:46:00.004-04:00

Sad Endings: Yesterday, our 15 year old Sheltie, Maggie, died. She is buried in our backyard under a beautiful flowering plant. She was a wonderful and gentle dog; a loyal friend, companion, and mother, and she will be greatly missed. These are always sad endings. The love a dog is something we should never take for granted, but like all life...it has an ending. The good memories will continue to live.

"Maggie" / Photo: Rod Moser

She was aided in her transition by the veterinarian who "put her to sleep." I really don't like that expression. She isn't asleep, although she was comfortably sedated and asleep before the euthanasia procedure. We have done these three times now, to three different dogs: two very elderly and terminally-ill, and one, Herman, who was tragically injured. This NEVER gets any easier. I sure wish there was a way to do this easier and more compassionately by the dog-owners. Having it done by the vet seems so cold and clinical, but at least it was painless for her. Some euthanasia experiences are not as easy and uncomplicated, so I am grateful for that.

The pain of Maggie's transition has been eased by some new lives - new healthy, active, happy puppies. We decided to keep two from a recent litter of six. As they jumped up and licked our faces, they helped wash some of the tears away.

New Beginnings: We were not sure how the puppy would handle a long car trip. Some dogs vomit due to the motion sickness or anxiety, so my brother and I were prepared. Towels were on the seats. She was in a pet carrier (open, so she could come out), and we had a ready supply of paper towels, wet-ones, and even a can of air freshener. We were prepared. What we weren't prepared for was her adaptability. Not only did she tolerate a seven-hour car trip, leaving her puppy siblings/mother, and a night in a pet-friendly motel, she thrived! Most of the time, she just slept in the back seat with her head periodically on the outside to watch us, but she would come up front to sit on our laps, kiss us, and then voluntarily go back in her carrier to sleep.

The puppy did not particularly like rest stops. They were too noisy from the trucks and I am sure, smelled scary to her. She loved the quiet grass of the pet-friendly motel where she quickly and appropriately relieved herself. She played in the room, didn't whine or pee/poop on the floor, and seemed to enjoy sleeping with us. At first, I put the puppy on the bed with me. She quickly curled up and went to sleep. When my brother woke up in the middle of the night, so did the puppy, so he put her in bed with him. At 5 AM, when I woke up, they were spooning! I took her out for her morning constitutional, fed her some breakfast, and it was off to the airport - another two- hour drive.

Photo: Rod Moser

Cali (Her name; short for California) had reservations on the 11 AM flight to Baltimore, with stopovers in Denver and Chicago. She was flying first-class on Pet Airways, a specially-configured executive plane just for pets; complete with their own pet-flight attendant. My brother paid an extra $50 for a larger pet container; equivalent to being upgraded to first-class. We briefly met some of her traveling companions: two loudly-meowing cats and their worried owners moving to Virginia (traveling coach, I am sure), a pampered poodle, and a big, goofy-looking, lab-like dog not fully-comprehending what was about to happen. I hope they don't put her next to those whinny cats. I always get the human equivalent of that when I fly.

Photo: Rod Moser

We said our goodbyes to Cali; got our face-licks, and saw her leave with the flight attendant, along with her carry-on - a one gallon plastic bag with her stuff. Her "stuff" was food for three meals (Pet Airways does not serve meals), toys, a sock full of her mother's hair, and one of my brother's t-shirts (stinky) to sleep on. She was trembling a bit, so we would feel even more-guilty than we already were. This cross-country ordeal is not cheap; about $300 for the flight alone, not including the cost of the health certificate, hotel, and airport transportation (800 miles!). When we discussed all of the options, like driving her across the country, or jamming her under a seat for eight hours on his flight, we felt that this was the least-stressful for her, even though it was going to take 30 hours! My brother had a very early AM flight the next day to meet her on the other end.

The duration of this flight - with the puppy being penned up most of the time in a pet carrier - listening to those bitchy cats that were probably pushing the call button all of the time, troubled us. We were informed that Cali "seemed nervous" during the overnight layover in Chicago. My brother said that he gets nervous when he is in Chicago, too.

Cali arrived safely in Baltimore and was very glad to see my brother. The cats weren't there; either picked up earlier by their owners; or jettisoned somewhere over the Midwest (Cats land on their feet, even from 30, 000 feet. Just kidding! I love cats, too. I have two of them, and I am sure they are happy to be off of that plane as well). After some highly-appreciated face-licking (the puppy to my brother, of course), they made the two-hour drive to Eastern Shore Maryland where she will happily live. I miss her already.

It has been a long time since my brother and sister-in-law had a dog. They have a garage cat. Don't' get me wrong, it is a nice, heated garage. It used to be a house cat until he decided that my brother's briefcase or suitcase made a convenient litter box. This decision on the cat's part resulted in his eviction a few years ago. His unfitting name is Lucky. Compared to the responsibilities of owning a dog, cats are easy. They are independent, come and go as they please, and are quite adaptable. I think Lucky likes having his own place.

Cali will be trained to be a boat-dog. My retired brother loves to sail his boat on the Chesapeake, and will no longer be jealous of all of those other boat-owners that have dogs. She will have a life-preserver and be tethered, once the sailing season begins next year. I am taking a little perverted pleasure in knowing that my brother's once-neat home will soon be converted to the puppy day-care center that we have here. I am envisioning dog toys all over the place. There is nothing like the heart-stopping thrill of stepping on a rubbery squeak toy in the middle of the night, or the even bigger thrill of having puppy poop ooze up through your toes. Still, this is a small price to pay for the love of a new puppy. It will truly be a new beginning.

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Raising Puppies - The Dark Side

2009-10-20T13:00:00.003-04:00

Anyone that has home-raised a litter of puppies knows the tremendous amount of work involved. They are just like children - they sleep during the day, but want to play at night. They get up early in the morning and want to eat. As soon as the mother dog weans them, it becomes a non-stop Poop Fest. As gross as this sounds, the mother dog does all of the clean-up for the puppies, including licking up pee and eating their droppings when they are nursing; but as soon as they start on puppy food, that all abruptly stops.

Six puppies can pee about a hundred times a day and poop about half that much. Their droppings turn from odorless, cute-little, easy-to-pick up ones to huge cow patties. They hit the papers on the floor only half the time; the rest ending up on the carpet...somewhere...like Claymore landmines waiting for innocent, human bare feet to find them. And, they stink! Malodorous puppy-poop is not necessarily a bad thing, since the odor is a good location device.

Mike McCune / CC BY 2.0

Sheltie puppies love to run. They run from one end of the house to the other. They were only a month or so old when they mastered the steps, something that I personally, have problems climbing. We have a big deck outside that has become a day-care facility, complete with hundred of toys, cardboard boxes to play in, soft beds (that they pee on), and several pairs of my socks that they have commandeered.

If two of us are home, we can take them outside to play. Think of having six pet bees. You let the bees go and then try and keep track of them, hoping they will stay in one area. It doesn't happen. Lexi, the mother dog, does her best to round them up, but they take off, either alone or in little packs to all ends of our unfenced property. We are constantly counting them, making sure we can locate them if we spot turkey vultures circling above or a crafty coyote lurking about. They like to head for the chicken enclosure and bark at them. They run in and out of our thick landscaping; happy and literally smiling, as they carry off sticks or leaves in their mouths. After about a half-hour, we round them up; one or two at a time, and carry them back to the deck enclosure. We try and exercise them at least twice a day like this. Today it is raining, and the puppies are driving me crazy.

Perhaps the most difficult part of raising puppies is sending them off to new homes. Three of them were born under the desk where I am typing this post. We can't keep 'em all, of course. Two have been adopted by a single man who lives about two miles from us. Tomorrow, Emmy goes to her new family about a half mile away. On Thursday morning, Cali will fly on Pet Airways to her new home with my brother and sister-in-law. This is going to be a stressful trip for this little puppy who is used to having the run of the house. She has never been confined to a pet carrier or really been with strangers. We will send her with some familiar toys, one of my stolen socks filled with the mother dog's hair, and some snacks. Unlike people airlines, the puppies get snacks. No booze. I plan on taping a monetary "tip" on her travel bag for the pet flight attendant for some extra loving on this 30 hour trip. I will post on this trip next week after she safely arrives in Maryland.

As soon as we are down to our two, Ellie and Zac, it will be Puppy Boot Camp. They are house trained now - they pee and poop in the house. We just have to get them yard trained. We also need to work on behaviors - coming when we call them, no biting toes, no digging in the plants, and the importance of not chewing stuff that isn't theirs.

"Maggie" / Rod Moser

Sadly, our oldest dog, Maggie, born in Michigan fifteen years ago, and the mother of my late best friend, Herman, is dying. She was diagnosed as having cancer, and is now in transition. She sleeps all of the time, isn't eating, and has started to pant. She does not seem to be in pain, but dogs do not exhibit pain like humans. Perhaps the panting is her way of coping with discomfort. She goes to the veterinarian next week and I am sure the vet will recommend euthanasia. Euthanasia for a dying pet is very humane, but a sad event nonetheless. We will pay the extra fee for the vet to come to our home - her home - so that she can be as relaxed as possible. In the hands of an experienced vet, this procedure is fast and painless. For the grieving dog owners, this experience is unbelievably painful. I am sure there is a Dog Heaven. Who would want to spend eternity without the love of a dog?

This is really a cross-section of life. There are births and there are deaths. We live and we die. It is really up to us to make the best of the precious time in between.

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Dueling Medical Studies - Who to Believe?

2009-10-16T07:48:00.009-04:00

People who primarily get their health information from the evening news, the local newspaper, or non-medical Internet sites are in big trouble. The amount of conflicting information about the risks or benefits of just about anything is staggering. I guess I am particularly troubled by television news. I use coffee as an example:

"New Study Shows that Coffee Consumption Linked to Breast Cancer"

This was a story that I heard over 30 years ago (before the Internet!). It was so shocking at the time, that women stopped drinking coffee all over the country. In one, highly-publicized study, coffee was blamed for fibrocystic breast disease and tentatively linked to breast cancer. This alarming coffee/breast cancer link was later disproven, but that news never seemed to make it to the media. This is really like having your neighbor hauled off by police as a possible child molester. The evening news shows him being put into a police car. The police quickly realize that they got the wrong man, apologize, and release him. All your neighbors really remember is that there is a child molester that lives in that house. The news that this was a mistaken identity doesn't really filter down. The accusation of being a child molester, even after being vindicated, is reason enough to move away. Capturing a child molester is a big story. The man not being a child molester is boring news.

A doctor in a nearby community was accused of fondling his patient's breasts. He was arrested in his office and put in jail. It made the evening news top story and the front page of the newspaper for weeks. After spending tens of thousands of dollars to defend his medical license and good name, he was finally exonerated after the victim admitted to lying. She had made up the entire story. What was once front-page news, complete with pictures, was now a tiny write-up on page seven. Most of his patients never saw that he had been exonerated. His practice and reputation was ruined by the news media jumping to sensationalism. People are supposed to be considered innocent until proven guilty, but the media can prematurely imply guilt.

Coffee has been vindicated, too. As a matter of fact, coffee has completely recovered from that story that it causes breast cancer. Coffee is now considered medically beneficial, assuming of course, that those recent studies were not funded by Maxwell House or Starbucks. People spend billions of dollars every year on this valuable commodity, so having a safe reputation is essential. According to WebMD there have been 19,000 studies that have examined coffee's impact on health. It appears that the benefits of coffee greatly outweigh any hazards.

Coffee contains a significant amount of caffeine, about 85 mg. - a potent stimulant. It can zip you up when you are tired, boost your concentration, but it can also raise your pulse and blood pressure, and make you a bit jittery, at least until it wears off. If you are not used to drinking strong coffee, those effects can be frightening.

When my daughter was in high school, she worked part-time at a neighborhood coffee shop. I worked for a university at the time, with a remote campus about ninety miles away. At the time, I was not a coffee drinker. I was a coffee virgin. Since I had to leave very early, I thought that I would try drinking coffee to keep me awake on the long, boring drive, so I ordered mocha. I assumed this was primarily chocolate. The guy behind the counter asked me if I wanted a "single or double". I figured this referred to the size of the cup. It was a long drive, so I said "double". I had absolutely no idea that he was referring to two shots of espresso. In about twenty minutes, the palpitations of my heart were so severe that I had to pull off of the highway. Now, my entire coffee consumption is just one cup in the morning - no double shots of anything. When driving non-stop back from Mexico, I did drink one of those new "energy drinks" heavy in caffeine. I definitely felt those effects and remained alert while driving the last six hours of an 18 hour journey.

As parents, we typically don't let children drink coffee, perhaps because we feel that kids are zippy enough without it. Believe it or not, no studies have shown that coffee is harmful to kids. Even if it is safe, I am not going to ever suggest that parents give their kids a cup of joe before heading off to school. With teenagers dozing off in math and social studies on a regular basis, perhaps coffee would not be a bad idea for them. Of course, we all worry about "complimentary behaviors" in coffee drinkers. I just can't picture a five-year sipping on a cup of coffee in one hand, a cigarette in the other, and looking for the newspaper. Okay, I know this is a bad stereotype, but you get the idea. Maybe coffee is a gateway drug? Perhaps we need a study.

Studies have now concluded the coffee is good for us; or most of us, at least. Coffee drinkers are less likely to develop Parkinsonism, decreased the risk of colon cancer, less chance of gallstones, and even less dental cavities. There is even evidence that asthmatics who are also coffee drinkers, have less asthma attacks. Coffee appears to be a good diuretic, too. There are just some of the positive health benefits that have been linked to coffee, if we are to believe those studies.

People are more likely to believe the last thing that they read in the newspaper, magazine, or on television news. We tend to quickly forget that a conflicting story may have been highlighted a few weeks prior, or even a rebuttal or disclaimer announced later. Once we glom on to a story, it becomes part of our belief system - one that we will freely share with others.

Every day in my clinic, I am defending vaccinations and dispelling junk-science about their presumed hazards. Once a parent is convinced that vaccinations may be harmful to their child, perhaps causing autism, it is very difficult for a medical provider to convince them otherwise. For some, holding on to those beliefs are like a religion - they are deep and personal.

I watched an anti-smoking documentary the other day that effectively used the Scared Straight technique. The anti-smoking lecture was given by a surgically-deformed cancer survivor who had most of his face removed. Those kids were listening. I think it would be a good idea to get a group of survivors of vaccine-preventable diseases, like polio, meningitis, or mumps, to have a talk with some of these parents.

Until I hear otherwise, from a well-designed, scientifically-controlled medical study, I am going to continue to promote vaccines, and of course, drink my one cup of coffee in the morning. Let the fools continue to smoke, avoid seat belts, drink booze, drive crazy, take drugs, have unsafe sex, and believe that vaccines are a government plot to control and harm us. Nature has some unique ways of dealing with them.

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Masks and Dark Glasses

2009-10-14T09:00:00.007-04:00

As a seasoned medical provider, I can't tell you the importance of actually "seeing" the patient. I have always had issues when people come in wearing dark glasses. Since the eyes are the window to the soul, I find it very difficult to have an effective medical encounter with someone wearing dark glasses. When you address a particular medical question, you instinctually look at the eyes for response. Is the person making direct eye contact? If your patient is a teenager, are they "rolling their eyes" at you? Are they gazing downward? Before I start any medical encounter, I ask the person to please remove their dark glasses so I can see them, and not my own reflection.

Morgan / CC BY 2.0

H1N1 flu pandemic has hit our area big time. We set up a "flu station" in the lobby where people can use hand-sanitizers and pick up a surgical mask to wear. When I enter the examining room now, it is not uncommon for everyone to be wearing masks - except me.

Just like the eyes, I also like to see a person's entire face. I want to see if they are smiling, grimacing in pain, or frowning at me. If a person had both a mask and dark glasses, I would just assume they had a big paper bag on their heads. Just like the dark glasses, I ask them to remove their masks once they are in the examination room. I don't know how Westerners can practice medicine in the Middle East. If I saw a person wearing an Islamic burqa, I am not sure how I would react. But at least, could see her eyes.

The Lone Ranger wore a mask, like no one would really recognize a well-spoken man in clean white clothes, riding a white horse along with this companion, an Indian that speaks like Tarzan. Bank robbers and train bandits wear a scarf or bandana over their mouth and nose. Spiderman wears a full face mask apparently so you won't recognize him as Peter Parker. Superman doesn't wear a mask, but uses a pair of dark-rimmed glasses when he changes into Clark Kent - another clever disguise designed to fool idiots. A guy in a ski mask coming to my front door would definitely get a rise out of me.

Josh Westbrook / CC BY-ND 2.0

If someone walked into a bank today, wearing a surgical mask and dark glasses, they would definitely get the attention of the security guards. Halloween is just around the corner, so our pediatric practice allows the staff to dress up, without masks, of course. Masks typically scare kids, even surgical masks. We don't get the Trick or Treat crowd in our rural neighborhood anymore. I sort of miss them.

The first time that I saw people in public wearing surgical masks was in Japan many years ago. Japan is a crowded, but highly-organized and respectful society. When I inquired about the masks, I assumed that people were protecting themselves from the germs of others. To my surprise, it was the people in the masks who were trying to keep their germs to themselves. They had colds or influenza and did not want to infect others. This is a very respectful hygienic practice that we rarely see in the U.S. People on the subways in the U.S. will just about sneeze in your face; or sneeze in their hands just before the grab the hand rails.

I have been exposed to so many cases of H1N1, that I expect that I have some residual immunity. I have been endured numerous sneezes and coughing in my direction. I have held contaminated hands. I have wiped noses of children. If and when the H1N1 vaccine arrives, I am not really sure I need it. I will take it for my patients, of course, but I suspect that I am either immune from prior infections, or darn lucky.

One provider was complaining this week that he had to wear to complete biohazard suit, complete with a battery-powered air filtration system and full spaceman helmet when he was examining a baby in the ICU. The baby was in protective isolation. He said it was impossible to listen to heart or lung sounds using a stethoscope while wearing a space helmet and noisy respirator.

Until this pandemic is over, we must all learn to tolerate people in surgical masks - even when they are surgeons. It could be worse. We could all be wearing those space suits.

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Salt of the Earth

2009-10-12T08:03:00.005-04:00

I recently read a New York Times article, that according to the Rand Corporation, the US could save $18 billion dollars per year in health care costs if Americans would cut their current amount of salt intake (about 3400 mg) to the recommended 2300 mg. They estimate that there would be 11 million fewer cases of hypertension. Hypertension costs about $55 billion a year to treat. Of course, there are other contributing factors to hypertension as well, including obesity, sedentary lifestyle, and a diet too low in potassium-rich vegetables and fruit. Untreated or poorly-managed, hypertension leads to heart disease, kidney failure, and strokes. Human beings are basically bags of salt water, so the "Salt of the Earth" will always be an important part of our diet, but too much of a good thing results in a lot of bad things.

Historically, salt has had a significant impact on human history. Wars have been fought over it. Salt has been actively traded as a commodity, and has been used for money. Salt has been traded ounce per ounce with gold. Roman soldiers were often partially paid with salt. The word "salary" has its derivation from salarium (salt). Gandhi lead a non-violent protest in India to assert people's right to make salt from the sea without being taxed.

TheGiantVermin / CC BY-SA 2.0

Most of the salt that we consume is not coming from the shaker, but rather in processed foods. People, especially Americans, love (and expect) the taste of salt, so it is added to most dishes and most prepared foods. Just like growing up eating chili peppers, salt is an acquired taste. You can "un-acquire" it, however.

Growing up, we always had a big salt shaker on the table, even though my mother actively salted the food during cooking. There was a significant amount of salt in processed baby food. Why? Mothers would taste the food, usually for proper temperature, before feeding the baby. If it was unsalted, it would taste terrible to the mother, who would not buy this baby food again. Babies are not born with a taste for salt. As a matter of fact, they have a very undiscriminating palate and will eat many things that we find objectionable. My kids were caught eating dried flies in the window sills, cat food, leaves, lint, dirt, and one of our kids even happily ate a dog turd! He is a successful engineer now, so it didn't seem to hurt him.

My old boss and mentor once mentioned that a person who salts their food before tasting it first is a sign that he/she is untrustworthy. When I get tempted to reach for the shaker, I always think about this. I really should trust the chef not to under-salt the food. A lot of consumer pressure got rid of a lot of salt poured over those fast-food fries.

A kid's diet is high in salt, from the more obvious potato chips, peanuts, beef jerky, and French fries to the hidden salt in ketchup and pickles. If you read the labels, you will see the word "sodium" in many forms, including preservatives and sweeteners. Sodium chloride, of course, is plain 'ol table salt.

There are literally thousands of uses for salt, not just for improving the taste of foods. My mother and grandmother used salt as some sort of cleanser. My mother brushed her teeth with salt, until she got dentures, and then used salt to clean the dentures. Salt and vinegar can be used to polish brass. We gargle with salt water when we have a sore throat, and we spray salt water into our congested noses when we have a cold. In Pennsylvania, we used tons of salt on our icy roads. You can pay big bucks at a spa for a salt rub and massage. I never had one of those, but I can imagine how it would feel if you had some open scratches on your skin.

I personally love the taste of salt, except when it is dripping down my face in the form of perspiration. When I am feverishly working outside, I tend to sweat like a sprinkler. It drips on my glasses, obscures my vision, and burns my eyes. I tend to get some painful leg cramps on those days, most likely due to electrolyte imbalances. Since I am one of those millions of Americans with hypertension, I do my best not to use the salt shaker. I must admit that this can be difficult. Old habits are very hard to break.

I recommend saline nose drops to just every patient with an upper respiratory infection, especially children. Since the FDA took away all of those cold medications for kids, saline is all that we have left to recommend. Since tears are saline, and tears drip into the nose through the naso-lacrimal duct, then spraying salt water in the nose is really just augmenting tears. When you watch a sad movie, you start to sniff as your nose runs. This is really not snot, but merely your tears (mixed with a little snot, of course). Most home and work environments are dry, so saline sprays can work for all ages. Or, you can just arrange to randomly cry.

Here are some simple steps to help break the salt habit:

Get rid of the salt shaker, on the table and near the cooking areas. You can still have salt, but don't make it so easy to grab.

Use less and less salt in your cooking, even if the recipe calls for it. Gradually, you may be able to reduce your family's salt habit.

If your food seems tasteless, then substitute other spices, like onion or garlic powder, chili flakes, or whatever your tastes dictate. Experiment with non-sodium based spices. There are even commercially-available, sodium-free spices to use.

Pay particular attention to processed meats, like ham or bologna, and canned vegetables. Ketchup and pickles are particularly high sources of sodium, so read those labels. Don't buy high-sodium snacks, like potato

Drink lots of water. One teaspoonful of salt will hold one quart of water in the body. By drinking water, you can actually flush out some of your excess sodium through your kidneys. Don't over-drink water, however, since too much water can leech excess sodium and other essential electrolytes as well. About six to eight, 8-ounce glasses of water is about right for most people. (Remember that a typical water glass is considerably more than 8 ounces).

Antibiotics for Middle Ear Infections - Love 'Em or Leave 'Em

2009-10-09T16:03:00.002-04:00

Antibiotics have only been in the medical arsenal for about 75 years, starting with sulfa drugs in the 1930s and penicillin in the 1940s. There are now dozens of different and more potent antibiotics, but very few new ones are patented. Since their discovery, antibiotics have saved umpteen millions of lives, and still do everyday. However, antibiotics have been heavily used and abused from their debut. Slowly but surely, they are become less and less effective.

As a child, our local, small town GP used to give injections of penicillin for just about any reason, it seemed. If you had a sore throat or tonsillitis, you got a shot of penicillin. If you had a fever for unknown reasons, you got a shot of penicillin. If you were uncooperative in his office, fearing that you will get a shot of penicillin, you got a shot of penicillin. He was such a shot-doctor, that kids would not even go to his door for Halloween.

In the U.S. as in many other countries, antibiotics are controlled by medical prescriptions. However, in places like Mexico, you can simply walk into a pharmacy and buy them - assuming they are "real ones" and not fake, counterfeit substitutes. With a Canadian doctor's prescription, you can easily buy large quantities in Canada. It is not uncommon for Americans to smuggle antibiotics in huge amounts across the borders, primarily for personal use, or share among friends. Some people have literally become Amoxiholics!

Antibiotics are only used to treat susceptible bacterial infections. They are completely ineffective against viruses - the main cause of most diseases. If they are self-administered indiscriminately for viral illness, not only will they be ineffective, they can make things worse. Sub-therapeutic doses of antibiotics help create resistant strains - the dreaded Superbugs. Primitive microorganisms can rapidly adapt to most antibiotics, even when given appropriately. There are bacterial strains out there that are completely resistant to EVERY known antibiotic. You really don't want an infection from these guys.

One of the major reasons antibiotics are prescribed for children is for the treatment of otitis media - the middle ear infection. Surprisingly, the vast majority of middle ear infections in children will resolve spontaneously in a few days, WITHOUT antibiotics. So, why do clinicians keep giving them and parents keep demanding them? That is the billion dollar question. Controlled, scientific studies in the U.S. and Europe have proven time and again, that antibiotics are only needed for the treatment of otitis media in very young children with immature immune systems, immunocompromised children (children with diabetes, cancer, etc.), or in children that are very toxic-appearing. These are the children who are very ill, in extreme pain, and not fighting off their infections naturally.

In Europe, children with otitis media are not routinely treated with antibiotics for at least the first week. That does not mean they are not treated in other ways for these painful afflictions. Children are routinely given pain medications - usually more than just acetaminophen or ibuprofen - to make them more comfortable while Nature orchestrates the cure. In the U.S., the typical care involves the early use of antibiotics, even in cases where the child does not even have signs of middle ear infection, and mild pain medications.

Over 90% of European children get better, on their own, with just pain medications, and tend to have fewer recurrent middle ear infections and need for surgical tubes. The U.S. kids tend to get better, too, but with potent and expensive antibiotics on board that more and more clinicians feel are unnecessary. Old treatment habits are hard to break.

I had a posting on the Ear, Nose, and Throat message board recently by a person inquiring about the proper dose of amoxicillin for her two children. She felt that the doctor's dosage was way too high, and that she would prefer to give half-doses. I really wanted to tell her that antibiotics are not really needed at all in most cases; but of course I knew nothing about her children and cannot blindly tell her not to use them. I assume that her children were properly examined, and probably treated with the appropriate dosage of amoxicillin. For most clinicians, treating otitis media is really routine stuff. However, most clinicians have not jumped on the "no antibiotic" bandwagon.

When amoxicillin first came out, maybe twenty years ago, it was dirt-cheap - only a few dollars for a standard, ten-day course. Children were treated, based on body weight, at about 20-30 mg/kg per day, in three divided doses. Amoxicillin virtually replaced ampicillin - an antibiotic that had some nasty gastrointestinal side-effects (like explosive diarrhea) and had to be given four times per day, a dosage nightmare for busy parents. The bubble-gum flavored amoxicillin even tasted better. For nearly a decade this dosage seemed to work great. Later, studies started to show that amoxicillin can be given twice a day, even more convenient for busy parents, and for as little as five days instead of ten.

My wife and I used to teach an all-day pediatric class for child care providers. I remember putting my lunch in their refrigerator, only to be shocked by the dozens and dozens of bottles of amoxicillin, all lined up for the various kids.

As the years progressed, everyone started using amoxicillin (a lot), still the drug of choice for otitis media. Unfortunately, amoxicillin started to fail as resistant strains took over. Many clinicians would abandon using it after the first-failure, until studies showed that a higher dose was more effective. Now, the standard dosage for amoxicillin (in children) is 60-80 mg /kg - more than twice the original dosage.

There are now about two dozen different antibiotics that can be used for pediatric middle ear infections. Every day in my clinic, I encounter the otitis media frequent flyers, usually on their way to the surgery center for tubes. There is a better way, but it is going to take a partnership of parent and medical provider to change the way we treat these kids. We need to trust that our immune systems have protected us long before the advent of antibiotics, and will continue to do so, IF we give them a chance.

Parents can help by not insisting on antibiotics, especially when clearly told that the child does not have a middle ear infection at the moment. Sure, they may get one tomorrow or over the weekend, or while you are at Disneyland, but that never justifies giving antibiotics prematurely.

Medical providers need to stand their ground and resist antibiotic solicitation from worried parents. Instead of medication, a healthy dose of EDUCATION needs to be administered. Parents who have children with frequent ear infections need to have a home otoscope, and learn how to use it. Medical providers have an obligation to cooperate with these novice otoscope-users, and encourage, not discourage their use. Parents should choose a medical provider that allows for this type of participatory care.

I still feel that antibiotics are miracle drugs, but the real miracle is to know when and how to use them. The bugs are getting smarter, and we need to be smart, too - always staying one step ahead.

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Puppies Off to New Homes

2009-10-05T09:25:00.001-04:00

Photo: Rod Moser

I think it was easier to send the kids off to college than it was to send two of the puppies to a new home today. My wife was sobbing, until she realized, of course, that we have reduced our puppy poop by 33% now! We still have four of them left - one will go to the neighbor's in about a week; one will go all the way to Maryland's Eastern Shore to live with my brother and sister-in-law. The other two will live with us. We are keeping Ellie, a hyper little girl who is teaching the others to bark; and Zac, a quiet little boy that has totally bonded with my wife. I guess I get Ellie....

The new owner is a retired, widowed man who lost his dog about 9 months ago. He initially wanted one puppy, but quickly jumped at the chance of getting two when another person changed her mind. He has been actively preparing for their arrival, including getting them a dedicated room in his house (I don't even have that), and has read up on caring for Shelties. Although it was sad to see him drive away with two of our puppies, they will be going to an excellent home. We know, we drove by and checked it out. My wife prepared a nice puppy pack that included the recipe for the food we are giving them now, one of my old socks filled with their mother's hair, a new collar/leash, and some of those smelly stuffed animals they have been sleeping with since they were born.

We also have an older Sheltie, soon to be fifteen. She is deaf, arthritic, and has teeth like a British methamphetamine user. She is unbelievably sweet, but sleeps about 22 hours a day now. Yesterday, when we decided to give her a bath and brush out her heavy coat, we discovered a mass. She has a walnut-sized tumor on one of her front legs. I took her immediately to the veterinarian that afternoon. The vet said it was cancer. The good news is that it is not painful for her; the bad news is that it would be too risky and painful to have it removed. Excising this malignancy will not change the inevitable, unfortunately, and surgery is a bit risky at her age. Sadly, after experiencing the utter joy of having six new little Shelties, we are going to lose our oldest one. I know that euthanasia is compassionate, but it still sucks. We hope we will not have to do this anytime soon.

Dogs have relatively short life-expectancies, unlike humans. Fortunately for many of us, we may live well into our eighties or beyond if we take care of ourselves, and are spared from life-threatening disease or accidents. Assuming dogs live about 15 years (some live longer); our life span is about six dogs, assuming you get one at a time.

My good friend drove up yesterday to see the puppies. He, too, has a very old dog. He stated that he has no intention of being without a dog, so like many people, he is looking for a back-up dog now. We have been friends for so long, that I remember at least six of his dogs. He told me that he can't imagine his life without having a dog. This time, he wants an Australian Shepherd. In the past, he has had English Bulldogs, two West Highland Terriers, a German Shepherd, and now, a pit bull (although he calls it something else less-menacing).

My brother procrastinated and pondered this decision since the puppies were born. He wanted one desperately, but did not want to sacrifice his freedom and mobility. It took repeated conversations with his friends, both pro-puppy and con-puppy, before he made the decision to get one. Logistically, this is going to be a difficult move. The puppy has reservations on Pet Airways to fly (first-class) from Los Angeles to Chicago, and then from Chicago to Baltimore. Pet Airways has a flight-attendant for the pets in transit; checking on them every 15 minutes. They fly in roomy cages in the cabin of the plane. It ain't cheap - about $250 for the one-way fare, not including the fact that we have to drive seven hours to Los Angeles to drop off the puppy. My brother is flying out for a few days prior. He will accompany the puppy to the flight, and then hop on another flight to Baltimore so he can get the puppy at the other end. Now, that is dedication. We both decided that having this little puppy in a cramped cage under the seat of the plane for eight hours was a bit cruel. This really is the best way, and a hellava lot cheaper than our other solution: having me drive the puppy to Nebraska (about three days), and him driving to Nebraska to make the switch. Of course, when you add up six days on the road, just for me, including fuel costs, hotels, meals, and wear and tear on the vehicle for 3000 or so miles, it would have cost each one of us about a thousand dollars or more!

Pets are good medicine, folks. I call it Petication! People with pets are usually less stressed (although I see a new pile of puppy poop on the floor) and happier. Pets are great listeners and relatively-good psychiatrists. They are non-judgmental, loyal, fun, and loving. Yes, you have to spend money on veterinarian bills, buy special food, and other pet necessities, but you don't have to send them to college. Pets will not steal your car, borrow money, or have parties when you are away. Pets do not smoke, drink booze, or take drugs. They will, however, chew your shoes, crap and pee on the carpet (at first), and wake you up at all hours of the night. The good things definitely outweigh the bad.

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Mentoring: Jump-Starting a Life

2009-10-01T06:00:00.006-04:00

My good friend, Robert, reminded me this weekend that "The greatest gift a man can give is to stoop down and help a child." For the last year, he has developed a relationship with a young man who lives in his neighborhood. Chad is 18 years old and will be graduating high school soon. In addition to having straight-A's for the last three years, he is also concurrently taking college classes.

Chad's drug-dependent parents are not in the picture, so he has been cared for by one of his former teachers who now has guardianship. This dynamic woman (and her mother) helped transform this endangered young man into the polite and humble scholar that he is today. Chad wants to go into the medical profession.

Robert e-mailed me a few months ago and asked me if I would be a resource for him. I quickly agreed. Robert is currently is under treatment for prostate cancer. Chad recently accompanied him on a nearly 50-mile bike ride that he wanted to do before starting before starting brachytherapy and external radiation.

Knowing that I was going to be speaking at a medical conference about an hour from his home, I invited Robert and Chad as my guests for the day. The night before, we had a wonderful Italian meal at Robert's home. I was also able to meet Chad's guardians - his "mother" and "grandmother"-the two women that have taking him under their wings.

Adolescents tend to fall in two major categories: the unmotivated group, and the academic over-achievers. Of course, there are many teens that sit on the fence between the two. Chad falls well into the second group. He was well-mannered and poised. He participated in conversations like an adult, unlike some of the teens I see in my practice that would happily text-message while pretending to listen. He wore a tie.

The next day, Robert brought Chad to the Palm Springs Convention Center. The organization provided him with a special guest pass and invitation to lunch. He attended several medical lectures, and was even allowed to cruise the exhibit floor. I introduced him to the president of the American Academy of Physician Assistants, and the author of a new book, Becoming a Physician Assistant, and acquired a signed a copy for him. Since it was about 110 degrees outside, he spent the entire day interacting with several hundred PAs.

I don't know if he will pursue the PA profession or not, but I thought we at least should try to recruit him before someone else gets him. You can teach medical skills to just about anyone, given enough time, but you cannot teach someone to be a kind and compassionate healer. Robert saw something special in this young man, and I agree. I know that he will make a wonderful clinician someday, whatever medical path he travels.

Every person who has achieved personal success has others who have paved the path before them and people that have held their hands. Some people like to think that they did it alone, but this is rarely the case. Chad has some true angels to watch over and guide him, and his journey has already started.

Is there someone out there that you can help? Can you show a little girl how to knit or make a dress? Or, teach a little boy how to fish? Can you teach a teenager how to change the oil in a car? Can you bring a young student to your office and allow them to shadow you for a day? Maybe you can help a struggling college student to pay rising tuition costs? What can you do to guide or jump-start someone else in need?

I am reading a book by one of my favorite authors, Paul Theroux, called Ghost Train to the Eastern Star. He tells of meeting an Alaskan fisherman vacationing in tropical Cambodia. The fisherman had met a young man, making a few dollars a day, operating a rented, motorcycle taxi. The man wanted to be an accountant, but since he had to rent his motorcycle, it would take him many, many years to save enough money to achieve this goal. After three days as his personal driver, the fisherman had him stop by a motorcycle dealership. The fisherman plopped down $8000 - just about all the money that he had - and bought this Cambodian stranger a motorcycle so he could earn a living and reach his goal sooner. He gave the taxi driver his e-mail and only asked that he write from time to time and let him know how things turned out.

My friend, George, has brain cancer. He and his wife allowed an immigrating Vietnamese family to live with them for nearly a year so they could get a jump-start. More recently, they paid the tuition for a Filipino woman, the sister of their daughter-in-law, so she could attend school. My friend, Randy, who now lives in Loreto, Mexico, along with other American ex-patriots, buys school uniforms and pays the Catholic school tuition for dozens of children in their little community. My own mentor, the late Dr. Robert Haskell, once wrote me a check so I could have a down payment for my first house.

It was my pleasure to be invited to help Chad - to participate in his jump-start at a career. I really didn't have to stoop down and help him. Chad was already standing tall.

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Acoustic Insults

2009-09-29T11:36:00.004-04:00

It has been a long time since I experienced "airplane ear", but this weekend reminded me that all of us are subject to sudden acoustic insults. I spent the last few days at a conference for the California Academy of Physician Assistants in Palm Springs, where I was invited as a speaker. I am proud to say that I started this organization 33 years ago in my living room; funded by $500 of my own money. The organization now has thousands of members and a $1 million budget. This literally blows my mind.

Once you have been in this profession over 25 years, you earn the title of a "Dino", short for dinosaur, of course. I have been a Dino for many years now, so a Co-Dino and I were asked to speak to a group of students. Both of us were PAs before they were born, so it really made us feel very old. Every year, we see fewer Dinos and more of the younger clinicians. This is excellent since the youth of an organization and profession are the leaders of tomorrow. Long after I am gone, this organization will continue to flourish with this new transfusion of fresh blood.

One of the entertainment venues at the conference was a PA Idol competition and dance. When I saw those refrigerator-sized speakers being put up, I made sure that I found a place far away. When the music started, the volume was unbelievable. I put tissue in my ear, but no sooner that I did this act of protection, people started to talk to me. All that I saw was mouths moving. I would usually give an affirmative nod. If they seemed pleased, the nod was appropriate. If they looked shocked, I would shake my head "No". When you think about it, I had a fifty percent chance of responding correctly, even though I had no idea what they were saying.

The bass notes made my head roar and body shake. I had to get out there. Walking outside, I was finally able to achieve some silence. As I expected, this brief acoustic insult exacerbated my tinnitus. My ringing had doubled in volume. I also had a little vertigo. Needless to say, I did not stay and watch the completion. This increased tinnitus continues, but if I stay busy, it does not interfere with my daily life.

On the flight home, I experienced barotitis - ear pain associated with atmospheric pressure change; also called "airplane ears". Periodically, my ears would clog from leaving home (2500 feet) to working in the valley (300 feet), but they would usually equalize after an hour.

This was not a typical flight: faster take-off and rise to cruising altitude, and a faster landing. I suspect all of this was done to make-up time. Our flight was delayed about 25 minutes for some reason. About fifteen minutes into the flight, my left ear felt like it was going to explode. All of my self-equalization techniques failed. My left ear was nearly deaf at this point, with my tinnitus interfering with any remaining hearing. Fortunately, this was only a one hour flight so my ear pain improved, along with my hearing as soon as we descended to a few thousand feet. When I arrived home, I used an electronic device called an EarPopper to further help equalize the middle ear pressure. It seemed to really help.

The last time that I had a barometric-related incident was about twelve years ago while landing in Detroit. For some unknown reason, the plane suddenly descended (I would sure like to know why). The drop was so rapid, I thought we were crashing. I was sitting in the worst seat of the plane - two seats in the back, under the engine, near the stinky bathroom, and with no window. I was sitting with an elderly woman, perhaps in her eighties. She must have noticed the blood draining from my face and obvious fear. I was clutching my painful ear (other people were doing this, too) with one hand, and the other sweaty hand was clutching the arm of the seat. She started to gently stroke my arm.

"Don't worry, Honey. You will be fine."

Of course, we landed safely, but it took four days to be able to hear normally again; my left ear ruptured from this incident.

After my experience this weekend, my left ear is acting up again with loud tinnitus and diminished hearing. That brief acoustic insult from the loud music, coupled by this barometric incident has taken a toll on my aging ears. Hopefully, things will quiet down in a few more days.

Acoustic incidents can happen so fast; so unexpected, that we often have little opportunity to extricate ourselves. I quickly left the blaring music, but I had no way of escape from the plane. The human body has a remarkable ability to recover from these events, so I will be happy when my pre-existing tinnitus goes back to its normal, constant whine and squeal.

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Up in the Air - Again

2009-09-25T06:35:00.013-04:00

Yuichi Kosio
/ CC BY 2.0

I am not a huge fan of flying, but you do have to tolerate this advanced form of transportation if you really need to get somewhere easily. Ever since 9/11, I have been a bit more anxious about flying. It is not that I expect a terrorist attack (although we all think about that now), it is just the whole experience of flying has lost its appeal to me. I don't like lines. I don't like hassles. I don't particularly like crowds. I would much prefer to get in my car and head out to my destination, which in many cases, is not practical or economical.

A few days ago, I fly to Southern California to attend an annual professional conference. As in years past, I am one of the speakers. I really have little difficulty with this type of crowd. I can stand in front of a microphone in an auditorium with a thousand people and feel comfortable. I meticulously write out my talk, practice it (a little bit), and then never look at my notes during the entire lecture. It takes me a few minutes to get going, but then they have to bring one of those big hooks and pull me off of the stage. I am never short on stories.

I flew down a day earlier to visit my old college buddy. He recently had brachytherapy for his prostate cancer and jokes about being radioactive now. He looked great; sort of had that "glow about him". Robert and I, along with his college roommate, sang in a three-man quartet (we couldn't ever find that 4th singer). To this day, we still know those tunes, and he can still play that piano and harmonize. I think we sound pretty-good, but then again, we had an audience of one. When old friends get together it become a laugh-fest. We begin to re-tell stories and try to re-live some of those happier times in our lives. The early 1970's was a turbulent time in the world, but tucked away in a small rural college in West Virginia, we were spared much of the Vietnam war protests, racial unrest, free love, hippies, and drugs. There was a little bit on campus, but most of the time, our lives revolved around classes, complaining about cafeteria food, and just shooting the breeze.

During school holidays, we would hitch-hike somewhere; another lost mode of transportation. We didn't seem to think very much about getting picked up be axe-murderers and crazed hillbillies. We just wanted a cheap and relatively-fast way to get from point A to point B. Our longest trip was from West Virginia to New York City. All of us, in teams of two, made it in one day. We would proudly share our ride experiences; both good and bad. Maybe we were oblivious to the risks of this practice, but teenagers tend to ignore risks.

The last time that I hitch-hiked was about twenty years ago. My wife and I had a long weekend without the kids so we decided to take a three day trip down the Eel River in Northern California on a canoe; camping out along the river. It was a nice float; a bit too many portages - a problem if you pack heavy and your canoe is aluminum - but nice nonetheless. There is nothing more relaxing than floating down a river in a canoe. We passed many, neatly-cultivated fields of marijuana, tucked in among the fields of wine grapes. They were tended by nervous-looking ex-hippies hoping that we were not Narcs. We didn't look like Narcs, but paranoid people see Narcs everywhere. We had to pick our camping spots carefully, since I had no idea we were traveling at the height of the pot harvest. Many people do not realize that marijuana is California's number one cash crop. Grapes are number two, if you want to know. Even in my college days, I was never a fan or user of marijuana, or alcohol for that matter.

Well, I got off-track again. I wanted to blog about air travel. I packed (tightly) everything that I needed for five days in one carry-on. My laptop and camera filled my briefcase. I beeped through the metal detector - my new watch and my belt buckle, but it was my bag that troubled the x-ray screener.

"Please come with me," he said politely.

The TSA officer took my bag for a physical inspection. Of course, I am in my bare feet waiting for my laptop and camera to come through before someone ripped it off.

"Do you have a Leatherman's Tool in your bag?"

"No, I don't own a Leatherman."

"Well, we see one in there..." I am thinking, "Great, I always wanted one of those."

So, he dug and he dug through my neatly packed rolls of underwear, socks, dress shoes, and assorted electronic gear that charges your laptop and cell phone. I had nothing to hide, and I had come in plenty of time.

My "Leatherman" turned out to be the buckle on my shaving kit (Yes, men with beards shave!), overlying some other junk. No Leatherman, of course, but no one will take your word.

Yuichi Kosio / CC BY 2.0

Many years ago, I was traveling with my son to fulfill a promise. We went to Cooperstown, NY, to the Baseball Hall of Fame to see Mike Schmidt be inducted. Mike Schmidt was my son's idol. On the way home, my son had bought a pewter disk about the size of a coaster with Mike's face embossed on it to add to his impressive collection of Schmidtobelia. This time, we were pushing the clock to make our flight. And, wouldn't you know it - the metal disk prompted a bag search.

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Dog Tired

2009-09-18T07:21:00.002-04:00

Our clinic has been unbelievably busy, thanks in part to the H1N1 scare. We have set up a fully-staffed flu clinic just to keep on the demand for the seasonal flu vaccine. The new H1N1 vaccine is supposed to be here in about 2-3 weeks, assuming we get our allotment. At first, we heard that two H1N1 vaccines will be required, but now the word is "just one". Our multiple-provider clinic can see about 400 patients in any given day, and we expect the demand to be high.

In practice devoted to pediatrics and adolescents, the high-season is usually Thanksgiving to the end of February, but this year is different. Our schedules are completely booked and everyone is working to capacity. If and when the H1N1 hits big-time, I hope that we will be able to accelerate this already-busy pace. All of us are dog-tired. Of course, I have even more of a reason to be dog tired. At the moment, with the new puppies, I have eight dogs; about five too many.

Photo: Rod Moser

Our dogs have the newborn baby schedule. They stay up late; wake in the middle of the night ready to eat, poop, and play, and then get up early in the morning to repeat the process. It was nice when they were able to be contained in a plastic swimming pool "whelping box", but now they have taken over the house. Since I work 12-hour shifts, it is starting to wear on this old man. I worked to 9 PM last night. I stayed late to suture a 21-month-old who split her lip and to deal with a shocked teenager who I discovered was pregnant. She came in for something else, of course. This was just the icing on the medical cake. When they have sex and don't use birth control, I am constantly at awe that they are surprised when I tell them they are pregnant. How long did they think they could play sperm roulette?

My grandson is in a year-round school, so he is off this week, staying with us. I tried to take him to see a movie this afternoon, but I fell asleep in the theater. Since we were the only two people in the theater, it wasn't an issue. Apparently, I did not snore, or at least my grandson didn't hear it over all of the shooting and explosions in GI Joe. GI Joe was the only movie in our theater that was not rated R. He liked it. I will reserve a vote until it comes out in DVD and I can see it again for the first time.

My wife and I bought a huge, metal gazebo when we were in Mexico a year ago. We had it dismantled, tied it to the top of the truck, and drove it home about a thousand miles. When my turn came at the border crossing, the customs agent asked me if I bought anything in Mexico that I was bringing home. I had this huge, jumble of metal tied to the truck, sticking out in all directions, perhaps standing four feet taller than the roof. I looked at him and said, "No, why do you ask?" He smiled and wondered why I didn't get it painted first. In retrospect, he was right. We had our oldest son finally weld it back together this weekend. It's going to take another two weekends to paint it.

It rained a bit in Northern California last week, just enough to cause a few hundred lightning fires; no big ones, fortunately. A few weeks ago, about 80 homes and businesses were lost when a wild fire raged through our foothill community. We were able to tour the devastation. Lifetimes of memories went up in minutes. Some families only got out with the clothes on their backs.

In a weakened moment, I agreed to take a medical student in my practice for the next month or so. Usually, students will slow you down, but this one is a bit more experienced, so I am hoping he will be able to help with the deluge.

I took off five days in mid-September to speak at our annual conference in Palm Springs. My topic this year should be fun. I am speaking about bizarre patient encounters. Maybe it's me, but I seem to have some sort of magnet that draws the strange and unusual to my door - the foreign bodies in the nose and ears; the people with a confusing array of symptoms, the hypochondriacs, the drug-seekers, etc. They come to my practice and they stay because I am nice to them. Over the years, I have collected quite a number of them. With the utmost respect to odd human behaviors, I will be talking about them this year. No names, of course. I will be offering suggestions on how to deal with these most-challenging patients.

Someone once said that one out of five people are absolutely crazy. I thought of my four closest friends; and they seemed "okay", so it must be me. Or I am just dog-tired.

A puppy just bit me on the toe. I will probably get rabies.

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The Pitter-Patter of Two Dozen Little Feet

2009-09-17T11:06:00.001-04:00

Photo: Rod Moser

Home-raising six active puppies is a non-stop job. My wife and I are now working opposite schedules just so someone is home with the puppies at all times. They are five weeks old now and are unbelievable active. For anyone who uses the cliché "herding cats" has never experienced herding Sheltie puppies. All of our children (five) are now adults and we have four grandchildren so far. Having puppies is hauntingly reminiscent of years raising children.

We keep them in a large laundry room at night, mostly because this room can be secured and it has tile floors. In the puppy morning (which can be anywhere from 2 AM to 6 AM), we open the door. It is a miniature version of the "Running of the Bulls" in Spain. A tiny herd of happy and energetic puppies will quickly run through the kitchen and into our living room. Although the mother has been trying to wean them, a few will usually jump up and latch on for a short ride and suckle. The rest will initiate the day-long poop and pee-fest. We are trying to paper-train them and they are doing pretty good, but still hit the carpets and hardwood floors about thirty percent of the time. It would be ludicrous to consider cleaning carpets until most are off to their adoptive homes.

We have decided to keep two puppies, instead of the one: a little boy (Zac) and a little girl (Ellie). Incidentally, we named our puppies and the mother after antidepressant drugs, since they are our living antidepressants. Lexi, short for Lexapro, is the Mom. Zac is short for Prozac; and Ellie is short for Elavil. Thinking about all of that peeing, maybe I should have named them after diuretics.

The pack will wolf down their breakfast of softened puppy chow, whole milk, and baby rice cereal and begin their antics - wrestling, yipping, pulling stuff around, and chewing on anything left at their level. In the last few days, they have learned to climb the four carpeted stairs in our bedroom. They run up and down the stairs, occasionally falling and frequently trying to jump. They weigh in about 3 to 4 pounds now, but think they are bigger...much bigger. They are making the transition from puppies to little dogs right before our eyes. I can't stop taking pictures of them, but like children, most of the photos are out of focus because they are always moving.

Shelties (Shetland sheepdogs) are a herding breed and we can already see that tendency. They will stare at each other (strong-eyed) and then leap and try to herd each other (or us). This chaos of eating, pooping, running, yipping, and playing will go on for an hour or so. Then, one by one, they will go to sleep in various places, or end up in a one big pile o' puppies.

Just like children, the work begins after they become mobile. At least in humans, we often have a few months before crawling, cruising, walking, and running begins. In puppies, they are physically active in about two weeks. The amount of work involved in home-raising puppies is difficult to explain. Only those people who have actually done it, can appreciate the time and dedication involved to do it right.

A few months ago, I witnessed a six-month-old (baby!) walking. He sat up alone from a lying position at four months, crawled at 4.5 months, and took his first step before he was six months old! If I hadn't seen it with my own eyes, I would not have believed it. There he was - walking purposefully up and down our hall, stopping periodically to look at stuff or bend down and pick up some lint or paper to eat. At this rate of development, this precocious little boy is going to be running by 7 months, and maybe driving a car by his first birthday.

Photo: Rod Moser

One puppy is going to a neighbor, so we can see her often. Another is supposed to go to my brother on the other side of the country, but he is wavering - wanting a puppy to warm his heart, but not wanting to give up some of his present freedom. I am putting an ad in the newspaper to sell the remaining two (or three) puppies. When someone answers that ad, we will be scrutinizing them like the FBI. No puppies will be sold to "unapproved" homes, I can assure you. All pet owners need to be very aware of scammers and dog-nappers. Anyone selling a puppy will need to carefully and thoroughly screen unknown potential buyers and only take cash. I am becoming so paranoid that I don't really want strangers even coming to my house anymore.

I contacted Pet Airways today, a service that will ship animals, safely and humanely, by air. I am doing this just in case my brother decides to take a puppy. We were going to drive and meet mid-way on Highway 80, somewhere in Nebraska, but decided that was not ideal. Not only would it cost us each about a thousand dollars in gas, food, and lodging, but it would be hard on a new puppy to be cooped up so long in a car. Dogs often get carsick, just like people. Lexi, the mother, is a prolific car-barfer so I suspect the puppies may inherit this tendency.

Should my brother decide that a puppy can be a part of his busy, retired life, I think the best way would be to fly the puppy, first-class, by Pet Airways. One problem: They only fly out of Los Angeles, a 7 hour drive for us, but of course, we can always tie in a trip to visit our newest grandson in San Diego. I think an 8- hour, overnight flight to Baltimore will be much easier on this little dog than six days in a car. A one-way flight isn't cheap (about $250), a bit more than it would cost for ME to fly one-way. I am bigger of course. An attendant checks the animals every 15 minutes during the flight, so the level of service is better than commercial air. I guess I could fly with the puppy under the seat (about $100 extra), but how cruel would that be?

Over thirty years ago, when I first moved to California, we shipped our Poodle-Pomeranian mix dog, Jason, by air freight. Hearing those stories of dogs dying in poorly-heated and not-well-pressurized compartments, we constantly worried. He arrived safely, but I would never do this again.

I will miss this little herd of puppies, but it will be nice to have less pee to sop up...less puppy poop to pick up...and, get a good night's sleep again.

Right now, Zac is sleeping under my desk, lying against my feet and periodically sleep-barking and sleep-running. So cute! You don't take that kind of puppy love lightly.

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Puppy Scam Alert!

2009-09-16T06:49:00.007-04:00

Our puppies are getting close to eight weeks old - the earliest time that they can be adopted. We are keeping two; a neighbor is buying one, and my procrastinating brother MAY be getting one, so we will have just two to sell. As responsible breeders, we are VERY careful about who will be getting our little dogs. When I bought my first Sheltie over 20 years ago, I was shocked that the breeder made a house inspection. Our family was required to "qualify" before he would consider selling us a dog. He wanted to meet all of the kids, see our fenced yard, and see how our children treated this test dogs - he brought four of his Shelties to play with them for a while. Obviously, we passed.

In addition to the unexpected home visit, we had to sign a five page contract that included, among other things, our agreement to spay, and that we had to return to dog to HIM should the puppy not work out. He insisted on puppy-sitting when we went on vacation, too.

Today, I received a very odd call. It was a RELAY PHONE call, a service used by people that are hearing or speech impaired. The operator stated that her client was interested in my puppies for her son. When I inquired where she (I am assuming she is a she) was located, she said that "she was in the States". I asked her where she saw the ad, she said "in the paper". When I inquired "which paper", there was no response. She wanted me to e-mail her immediately with the price and details. Interesting, since the price and the details are in the ad that she supposedly read.

I asked her a dozen questions, such as her address and where she saw my advertisement. This was another red flag, since the advertisement does not start until next Thursday. I am still wondering how she got my home phone number or knew that I had puppies. Hopefully, she is not a reader of the ALL EARS blog! I can't imaging that a scammer would read my blog, track down my phone number, and go to this much trouble. On a Google search for "puppies", there were over four MILLION hits. Of course, if you put WebMD on this search, you will find my blog posts.

We did register our puppies with the AKC and APRI, so perhaps these institutions release information to the public, just like birth announcements that used to appear in newspapers. I plan on calling them to inquire about their privacy policies.

About an hour later, I received a response. She wanted my physical address and assorted details. She wanted the final price for TWO puppies so she could send a business check or money order. When I received the check, I should cash it and wire the money to her "shipping agent" who will arrange to pick up the puppies and deliver them to her. The e-mail was filled with spelling errors and poor grammar, making me think that this person with an American-sounding name did not have English as her first language.

Good ol' Google. All that I did was type in "puppy scam" in the search engine, and viola! It was the exact, same scam - right down to the use of an untraceable relay phone, and wiring of funds to a "shipping agent". The scam alert even mentioned the poor grammar and spelling errors. A responsible puppy-buyer would (a) never buy a puppy sight unseen, and (b) never arrange for a shipping agent to pick it up. An alert consumer (me) would NEVER wire funds to a stranger, even if I received a money order or check, and even if that check seemed to "clear" the bank. Many times, the scammer will add one more zinger - they will send MORE than the asking price, apologize for the error, and ask you just to wire them the over-payment.

I guess it just doesn't happen with puppies. My brother listed his boat for sale a few years ago, and received a similar e-mail stating that they would send a check, and that he should forward the money on to the "shipper" so that arrangements can be made to pick up the boat. Yesterday, my son told of his friend that was scammed when he tried to sell a nice watch on eBay. The e-mail told of a man buying the watch for his son's birthday, so he needed it quick. He couldn't wait the week for the check to clear and asked that he be trusted. My son's friend actually dropped the box with the watch at the UPS Store, only to have second thoughts. He went back and retrieved his watch. As you might expect, the check bounced.

Traveling con-men and scammers are not uncommon in our area, or in yours. They run driveway resealing scams and roof coatings. I know, because two of them showed up at my door last summer. They just finished sealing the driveway of my neighbor "down the hill" and had a lot of material left; enough to do my entire driveway for a fraction of the cost. They couldn't remember his name. They had a spray trailer on a very nice truck with out-of-state plates, and proudly showed me a bag of their seal-coat - the "best you can buy". They gave me their business card; a very crudely-made computer generated card. While I was talking to one guy, the other was casing my place. They came up with price. They would recoat my driveway for eight thousand dollars! I laughed since it was more than I paid for the entire driveway. Of course, they negotiated on and on, dropping the price each time. Needless to say, I detected this classic scam early and sent them on their way. I reported this incident to the police, and for the next several weeks, I locked my driveway gate and put my neighbors on alert.

I even recognized the bag of seal coat. It was really special sand that is used for sand-blasting. I have a bag in my garage. The spray trailer is probably loaded with used motor oil; the same oil that they would use to spray and coat your shake roof. After they spray your driveway, they tell you it will take several days to dry (it will NEVER dry), giving them time to skip town.

I love these puppies. There is no way under the sun that I would have even sold those dogs to a legitimate person buying them without seeing them. This could have easily been a re-sale situation. They buy the puppies for a reasonable cost, and resale them for a profit to a pet store or puppy mill. Or they buy female dogs so they can set up their own puppy mill. I can't imagine a more cruel life for a dog than to be a puppy mill breeder.

I reported this scam to the ISP, but I doubt there is little that can be done. This scam may even be orchestrated as far away as Nigeria. In this case, they are not interested in the puppies, just the money wired to them via their "shipping agent".

It has been a dozen years since our last litter of puppies. They all went to good families. We even hosted a one-year Puppy Reunion, complete with a dog birthday cake (That was sort of odd, now that I think about it). Our goal was to see those puppies were loved and cared for by good families. This is our goal again.

ADDENDUM: Two days later, we received another "relay call". We refused the call this time. I suspect it was another scammer running the same scheme.

For more on this Puppy Scam: Puppy Scam Alert.

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CTAs as WEDs - Weapons of Ear Destruction

2009-09-14T07:32:00.007-04:00

willc2 / CC BY-SA 2.0

In the early days of the Iraq War, Special Forces were scouring the area around Baghdad, looking for WMDs, like poison gas, missiles, or Saddam's nuclear arsenal. Although puzzling at the time, our dedicated troops found tons of cotton-tipped applicators (Q-tips) earmarked and destined for the U.S. The goal was to flood the market and encourage Americans to clean their ears. A large number of people would be rupturing their eardrums, causing damage to their hearing, and setting themselves up for infections in the ear canal. This was a dastardly and evil plan, striking at the closed doors of our bathrooms. Had it been successful, people all over the Western World could become seriously addicted, cleaning and scratching at the inside of their ears at every opportunity. Soon, pencils, paperclips, and bobby pins would be substituted. The productivity of workers, with one hand dedicated to ear-cleaning, and the other free hand attempting to type, would drop. Eventually, our economy would suffer, the stock market would plummet, with only a few companies thriving, perhaps those companies that make these Weapons of Ear Destruction.

Little did Saddam know is that Americans and other countries are already hooked. Along with toilet paper and tissues, our medicine cabinets were well-stocked. Made of tightly-packed cotton and paper, Americans were not going to be taking any unnecessary chances should these commodities suffer.

Q-tips do not damage ears or rupture eardrums. PEOPLE damage ears and rupture eardrums. Perhaps due to social consciousness or even litigation, the makers of Q-tips have tried to warn the ear-cleaning addicted masses not to stick these things inside the ears. I am using the term "Q-tip" in the generic sense, and in no way am I pointing fingers at a particular company or their finely-made product. Anyone can make cotton-tipped applicators (CTAs) in a free-market, and there are imitations galore - imitations with wooden sticks long enough to protrude through the other ear, or tips that fall off inside your ears. A significant portion of an ENTs practice is diagnosing and repairing damage due from these CTAs - The Weapons of Ear Destruction.

Unlike the requirements for cigarette makers putting scary warning labels on the packages, CTA manufacturers can still package them like they did in the past. In some countries, smokers will see gross pictures of cancerous lungs and blackened /missing teeth on cigarette packages - perhaps aimed at those who cannot read the warning labels. I am proposing now that CTA manufactures put two pictures on their packages: One with a big circle with a line through it, showing a CTA inside an ear, and another showing the face of a puzzled person in pain, blood pouring down the side of their neck, holding a bloody CTA.

I have done my very best to discourage the use of CTAs and ear-cleaning on the WebMD Ear, Nose and Throat message board, and the All Ears Blog, but the message has apparently met deaf ears (as you might expect!). I have been anxiously waiting for some celebrity to take up the cause. When a celebrity gets a type of cancer or Parkinsonism, they become important spokespersons for the cause - raising awareness and raising money for education and research. Everyday, I watch the news hoping to hear about some ear-prominent person has been permanently injured. Prince Charles has prominent ears. So, does Ross Perot, Dumbo, and my favorite, Bugs Bunny. Now that I think about it, maybe this is why Bugs Bunny says, "What's up, Doc?" Elmer Fudd aways seems to be sneaking up on him, so maybe he doesn't hear very well? Perhaps he tried to clean out his ears with a carrot!

If Valerie Bertinelli can lose a ton of weight and thus promote Jenny Craig, maybe someone will surface for my "Ban the CTAs" campaign. I was going to write a letter to Jerry Lewis, but I think he is contractually tied up with another worthwhile project.

I could write some pseudo-science studies and publish them on the Internet. People believe what they read on the Internet, no matter how ridiculous or medically-unsupported. I suspect someone will be quoting my Saddam Hussein Q-tip Plot Revealed! When I read this story to my wife a few minutes ago, she said, "Is that true?" I rest my case.

I can try and link the use of CTAs to erectile dysfunction or obesity. For instance, "Researchers found that obese people clean their ears on a regular basis. Is there a link?" "Men with erectile dysfunction admit to regular Q-tip use." Once you get an article on the Internet, it will be quoted forever. People will then say that they lost 37 pounds in three weeks after giving up Q-tips. Actually, you CAN lose weight by using Q-tips to eat, instead of a knife, fork, or spoon. I will write a book and promote the Q-Tip Diet! Oprah, here I come.

The Federal Government is handling out a lot of cash lately, to auto companies, banks, and failed brokerages. The "Cash for Clunkers" campaign gave a few billion dollars so that people could upgrade their cars. Maybe I will write to President Obama (he has some pretty big ears that seem suspiciously clean on those close-ups) and ask for some money. As soon at this Mexican/Swine/H1N1 global influenza pandemic thing is history, maybe there will be some money left.

I already have some possible slogans and t-shirt ideas: "Skip the Tip." "Avoid the Wax Pack." "Here's to Ears!" "Don't Clean Children's Ears - They Don't Listen to You Anyway." "Don't be a Rear, Stop Cleaning Your Ear." Or my personal favorite: "Cleaning Cerumen - Not Part of Groomin'."

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Do Kids Need Pack Animals?

2009-09-11T07:29:00.007-04:00

Photo: M.Lubinski / CC BY-SA 2.0

Now that school has started again, I expect to be seeing my share of backpack-related back pain again. Obviously, the weights of those packs vary from child to child, but I have weighed many backpacks in my office and found some to top twenty pounds. That is two, ten-pound sacks of potatoes! Another observation has been - the smaller the child, the heavier the backpack. I don't really understand this.

Why are packs so heavy? First, books are heavy and kids often have to lug around ALL of their books to every class. Unlike my school days, many schools have completely eliminated lockers. Why? Apparently kids were hiding contraband in those lockers, such as illegal drugs or weapons. The only things we would find in our lockers two generations ago were ancient lunches, snacks, smelly gym clothes, and of course, the occasional Nerd. In those days, schools had the right to open our lockers anytime that they wanted without fear of the ACLU coming down on the school for violating civil rights or privacy laws. I didn't think we were entitled to any privacy in public schools.

If kids wanted to hide contraband, they can hide a lot of scary stuff into those huge backpacks they are carrying around every day.

Why don't they have wheeled backpacks? They do, but none of the kids will use them because wheeled backpacks are not cool... not cool at all. If they tried using them, they would most likely be stuffed into one of those unused, empty lockers, and permanently labeled as a nerd. It is also not cool to use both straps, like a camping backpack. Kids are expected to use just one strap, hanging on one shoulder. Backs do not like this type of imbalance.

Adolescents get injured in sports all of the time, injuring limbs and backs. Unless they are paralyzed, they want to continue to play football or do cheerleading anyway. Regardless of their injuries, they always ask for a note (see my blog post about notes) for PE. Teen rationale dictates that it is okay to play football with an injury, but not square dance in PE.

I have a solution to bring this on-going back problem to light. Since service animals, such as Seeing Eye Dogs, are protected by the Americans with Disabilities Act, I think I am going to start recommending pack animals to kids with recurrent back pain who must carry heavy loads all day long. I can just see it now; kids walking the halls with miniature donkeys, mules, llamas, or St. Bernard dogs. They can tie up outside the classrooms, or to their desks. They will be novelties at first, but soon, the schools will get used to seeing of animal poop on the floor, llama spit on the walls, and of course, the omnipresent barking and braying. I am really, really tempted to start writing prescriptions for service (pack) animals. Schools won't give our kids some lockers, so let's see if they build some stables.

Heavy backpacks are not the only things responsible for adolescent back pain. Teens tend to have the worst posture ever - the slouch in their chairs, and sit with their backs humped over like Quasimodo. The kids in sports tend to be very active, but a large percentage of teens just come home, raid the fridge, and then plop onto the couch, or more likely, slouch in a chair to play hours of computer games. Inactive, after-school, latchkey kids tend to get fat, and of course, get into mischief.

Several of my patients with back pain have bed issues. For some, there are still sleeping on swayed mattress, handed down from older siblings. Many of the six-foot plus adolescents sleep with their legs hanging over the end of their toddler beds.

I have back problems myself, but mine was not due to lugging around a back pack. I do carry a brief case that could be lighter. My briefcase weighs considerably less than my wife's purse, which incidentally, looks a lot like a backpack without the sleeping bag. I would love to dump out a woman's purse someday, just as an experiment. Once a year, I do make my wife dump out her purse so I can get the hundred or so receipts jammed in there so I can do the taxes. I once found a receipt that was four years old!

I was always told to never look inside a woman's purse. When I was older, I just assumed it was so that curious boys would not find a tampon and think it was dynamite. When my wife goes into a dressing room on those (very) rare occasions that I am with her when she shops, I usually have to sit in the man chair with the other guys and hold her purse. The men sort of nod at each other, but none of us are digging around trying to see what is so heavy in there, perhaps expecting an anvil.

Women with children get very adept at carrying heavy loads - a heavy purse and a diaper bag hanging on one shoulder, balanced out with a huge, squirming toddler on the other arm. I am often amazed in my clinic, when I lift up one of those "big ones" onto the exam table, how deceptive their weight can be. Even some of the "little ones" are dense as lead. Maybe I am just getting weaker. At the end of the day, my back is starting to hurt. I don't know how these Moms do it. I have a hidden rule: if I see a baby with more than two chins and no neck, I let the Mom pick them up.

My old college roomate, Robert, was planning a six-month long backpacking trip to Tahiti, Fiji, New Zealand, and Australia (must be nice). I had to watch him everyday, packing and unpacking his backpack, trying to make room for both summer and winter clothes and balance his load. He actually used my postage scale to actually weigh socks! After about a hundred packings and unpackings, he finally was satisfied. He was in the shower the morning of his departure; his carefully weighed and balanced backpack sat by the door. As I went out to get the morning newspaper, my evil eye spotted a loose brick sitting next to a garden wall. Smiling, I picked up the brick, and rushed into the house. I quickly unpacked his backpack, pulled out his down jacket in the bottom (for the winter in New Zealand), and carefully hid this five pound red brick. I finished repacking his bag as I heard the shower stop.

Over the next several months, I anxiously awaited those postcards from exotic places; and pictures of his lazy butt sitting on the beach in Fiji. I would smile when I would see that backpack sitting under a swaying palm tree. Then one day, my long-awaited postcard arrived.

"You SOB! I found that brick!" I had attached a note asking that he please deliver this brick to New Zealand for me.

So, somewhere in the South Island of New Zealand, perhaps along a rural road, sits a lonely, red brick. I should have put two bricks in there. Maybe next time.

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Doing Your Part

2009-09-09T11:25:00.003-04:00

Your Responsibilities as Member of a Community and of the Human Race

In the last two weeks, we are starting to administer the seasonal flu vaccine. You would be surprised how many people are refusing it because they do not think they need it. But, what about the rest of us?

We all share this small planet; a planet with limited natural resources, and a planet that is progressively becoming more polluted and damaged. Globally, steps are being made to limit greenhouse gases, preserving the protective ozone layer, finding cleaner fuel sources, and replacing some what has been exploited and raped over the centuries.

I grew up in a strip coal mining area, where beautiful topsoil was moved aside in order to get at a narrow layer of soft coal. Thanks to the efforts of environmentalists, much of that land has been restored. The air and our streams are no longer stinky and yellow. It was commonplace to run sewer lines directly into a pristine creek. A generation ago, people mindlessly dumped their trash along the side of rural roads, or simply threw out their fast-food bags from a moving car. Thanks to Lady Bird Johnson's efforts, our roadsides are no longer piles of discarded junk and rubbish. Little by little, America became more beautiful when people started caring.

A week ago, we were given evacuation orders when a wild fire threatened our neighborhood. Over eighty homes were burned to the ground. Had the wind changed directions, our home would have been lost, too. The cause of this fire is yet undetermined, but arson is a possibility. A few minutes ago, the Department of Forestry spotter plane buzzed and circled my house. There was another fire; this time only a mile away and the wind was blowing in our direction. The quick efforts of our local fire department quickly got this fire under control. According the Highway Patrol, a motorist threw a cigarette out of the window, starting a roadside brush fire. Throwing a burning cigarette out of a moving car deserves jail time, in my opinion. Of course, they will never catch the culprit.

Are we all doing our share? Do you turn out the lights in rooms that are unoccupied? Do you use energy-efficient bulbs? During the summer months, do you set that thermostat a little higher? Do you drive the speed limit and wear your seat belts? Do you recycle your aluminum cans, glass, and plastic? Are you immunized against vaccine-preventable illnesses? Do you wash your hands? Do you smoke? All of these seemingly little things help our planet and your community. As members of the human race, these are your responsibilities.

As a child, we did not have seat belts in our vehicles. Children were not restrained in infant car seats; they could freely jump from the back seat to the front if they chose. Motorcyclists were not required to wear helmets. So, how does wearing seat belts impact our role in the community or the human race? A non-seat-belted person is more likely to sustain serious head and neck injuries, assuming they are not killed. If they have health insurance, the bills could be astronomical for their care. This will raise rates for all of the other insured people who do wear seat belts. If the person does not have health insurance, the state and federal government will end up footing the bills, and of course, guess who pays the state and federal government through taxes?

Smokers feel that they have a right to smoke. Apparently, "Freedom to Smoke" is protected by our Constitution somewhere. Smokers pay the same insurance premiums as you and I, but of course, smokers tend to get more respiratory illness, such as pneumonia, asthma, or emphysema, use the emergency room more often, and have a higher rate of cancer, requiring expensive surgeries and cancer treatments. Smokers have higher absenteeism at work and lower productivity. Again, the insurance companies (and we non-smokers) foot the bill, as well as the government. When smokers flick their cigarettes out of a moving car and start a fire, someone else still has to pay for those damages. When a person chooses to smoke, they impact more than just their own lungs. They seriously impact ALL of us, directly and indirectly, in so many ways.

If people defend their right to smoke, do they also defend their right not to wash their hands? Is personal hygiene (or the lack of) protected by the Bill of Rights? Someone comes out of a public restroom and doesn't wash their hands. They put their contaminated (poopy) hands on the door handles. A little child touches that handle and becomes seriously ill. The simple act of washing your hands can have a major impact on the community.

There was a major public health effort in the 1950's. If people had the right to refuse vaccinations, no one really exercised those rights. Everyone felt that it was our community responsibility - our duty - to be vaccinated, so that people would not get polio, or measles, or whooping cough. In less than a decade, the incidence of these vaccine-preventable diseases plummeted. Everyone, by getting vaccinated, did their part. These public health efforts have saved millions of lives and billions of dollars, yet now, people feel they have the right to refuse vaccinations for personal reasons...stupid reasons. They don't care if they, or their children get the diseases, and they certainly don't care if they spread it to others in the community. You cannot achieve "herd immunity" unless all or most of the herd has been inoculated. Just like one bad apple making the others rotten, if there is an unimmunized person in a community, the disease will survive. An epidemic starts with one.

There are people in the community that count on "herd immunity". Our efforts to vaccinate ourselves and our children is their only protection. They want others to take any risks, but then expect the insurance companies and society to take care of them if they get one of these serious, preventable diseases. Medical care is God-awful expensive, not just in dollars but in emotional toll. Are their calculable risks to taking vaccines? Sure, very small ones. The risks of serious vaccine reactions are considerably less risky than the chance of getting struck by lightening, but yet people are afraid. Some of these fears are created and nurtured by the Internet, backed up by pseudo-science and charlatans.

Perhaps the real barrier is trust. Since the 1950's, Americans seem to have lost faith in their government, perhaps for good reasons. Remembering thalidomide and other recalled drugs, they do not trust the pharmaceutical companies. They do not trust the FDA that approved these drugs. Often, they do not even trust their medical providers - the people that they chose to participate in their health care. People do not trust banks, the post office, the military leaders, or our President. What happened? Right now, President Obama is trying to make a complacent and mistrusting population aware of the serious health threat that influenza can cause. Millions of Americans died in 1918 and it can happen again. Why don't people listen?

In order for people to share responsibility, we have to have trust. We have to trust that everyone will do their part and not opt out or make excuses. We have to trust our elected leaders and our scientists, and we need to come down hard on those who betray basic, human trust. It has been said that we can trust, but verify. It is perfectly normal to question recommendations, but at some point, it will come down to trust. Do you trust your government? Do you trust your medical providers? Do you trust your own judgments?

As a medical provider, I am on the front line. I had to take four nasal swabs for a pertussis test this week on a 15-month old. The mother does not "believe" in vaccines, so none of her children are immune. I can take care of her because I am immune to pertussis. I took my vaccine. Otherwise, I would be putting my own life at risk. I can take care of people with influenza and other life-threatening illness because I am vaccinated, and this is my job. Vaccines are not perfect; few things in life are perfect, but vaccines are and will remain one of our best defenses. It is much easier to prevent an illness than treat one, I can assure you.

Please do your part. Don't throw trash out of the window. Turn off unnecessary lights and use energy-efficient bulbs. Wear your seat belts or helmets, and secure your children in car seats. Don't smoke, and if you do, stop. Wash your hands. Unless you have a true contraindication, take the recommended vaccines. Be honest and learn to develop trust (again). We live in the same community; on the same planet. We are all in this together.

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Worms!

2009-09-08T13:21:00.003-04:00

We attended a birthday party for my grandson, Tynan, who turned four years old this weekend. All of the children were happily playing in the front yard, when one of the boys came in asked to use the bathroom. He said he needed to wash his worm. At first, I thought what you are probably thinking right now, but no. He actually had a dirty earthworm in his hands and wanted to rinse it off. Tynan came in next with a handful of his worms, also needing a bath apparently. By the end of the party, they had managed to dig up quite a few worms that were (happily?) living in a box of dirt.

We have six new puppies at home. Even though our puppies have never been outside, there is a very good chance they have could have intestinal worms. So, we have been giving them worm medication, even though I am skeptical that they need it. Because of these puppies, I had been thinking a lot about worms lately....all kinds of worms.

I was petting our friend's scrawny cat the other day, running my hand down his backbone. This cat, known for his bird and mouse-catching (and eating) skill, has been eating a lot, but seems to be losing weight.

"Have you thought about worming him?" I told my friend. It would not surprise me that this cat had worms.

My oldest son decided it would be a good idea to have two huge Rottweilers in his small Texas home. They were eating him out of house and home, yet had the physiques of emaciated Greyhounds. I told him to worm those two dogs, and guess what? They put on an incredible amount of weight. The next time that I saw them, their coats were shiny and healthy, and they weighed about 80 pound each. The worms, of course, were not pleased with the outcome.

In the classic movie, Christmas Story, the father was attempting to eat a piece of uncooked turkey.

"You leave that turkey alone. You'll get worms!"

I find it interesting that we dig up worms for bait in order to catch fish, but if we eat those fish, sushi-style, we could end up getting worms. Different worms, of course, but I like the irony.

You wouldn't know by looking at me now, but I was once a very skinny child. My grandmother, a doctor in her own mind with the experience of raising 13 children, was convinced that I had worms. I vividly remember being held down by my two uncles while they attempted to get me to swallow some sort of foul liquid worm medicine. I maintained my svelte shape until age 35 or so. After that time, I put on weight, hoping many times, that I would get worms.

Around the turn of the century, capsules containing live tapeworm larvae were sold as a weight control method. Apparently, you would let the tapeworms happily feast on your overindulgence until you achieve an ideal weight, and then simply take worm medicine to rid yourself of this infestation.

As a student, I was doing a pediatric rotation at the University of West Virginia. During this particular week, I had seen an unusual number of children with pinworms, a common human infestation. I have always been a dedicated hand-washer, but after seeing so many cases, I started to doubt myself. My butt started to itch and I was convinced that I had contracted pinworms. Not wanted to reveal this to my physician supervisors, I decided that I would just treat myself. Why not? I diagnosed myself. At this time, the worm medicine was a noxious, foul-tasting liquid that apparently attacked the worm's neurological system. The dosage was based on body weight, of course. Little children were given just a few milliliters. I had carefully calculated that I would need considerably more. After getting up my nerve, I downed the medicine. The taste was unbelievably bad, not unlike the stuff Grandma was trying to force down my throat nearly two decades ago. The taste seemed to evoke those repressed memories.

One of the side-effects of this medication was neurological effects, namely profound dizziness, nausea, and vomiting. Needless to say, I got them all. To this day, I really don't know if I really had pinworms or it was just my mind creating those symptoms. My butt did stop itching, so all's well that END's well, so to speak.

Perhaps because of this experience as a student, I have always had my eye out for pinworms. Anytime I would have a patient complaining of pruritis ani (the more pleasant Latin term for "itchy butt"), I would immediately consider pinworms as a potential cause. Of course, not all itchy butts are pinworms. It could be yeast, an allergic reaction, or just plain, poor hygiene.

One day, I got a call from a patient who thought her son had pinworms. He seemed to be scratching his bottom quite a bit, and this conscientious mother thought of worms.

"I am sure that my son has pinworms. How do I find out for sure?"

My sick sense of humor wanted to ask her if he was scooting around, dragging his but on the carpet, but I didn't.

"After he goes to sleep, creep into his dark room with a flashlight. Carefully, as to not waken him, pull down his underwear, spread his butt cheeks, and shine that flashlight. If he has pinworms, you will see these little, thread-like creatures moving around. If you see them, give me a call and I will prescribe the proper medication."

An uncomfortable silence ensued.

"He's 17 years old!" She replied.

I had learned an important lesson about asking the age of the child before recommending this action next time. The recommended treatment is now just one simple pill (Vermox), no matter how much you weigh. This teenager had not idea how lucky he was, although I suspect he would have spent years in therapy had he discovered his mother peering at his bare butt with a flashlight.

Once again in medicine, fate prevailed and a minor tragedy was avoided - just another case where I was able to worm out of an embarrassing situation.

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The 12 Most Annoying People at the Movies

2009-09-03T07:35:00.007-04:00

Dov Harrington / CC BY 2.0

I like going to the movies, in spite of the fact that movie tickets are over priced, and you need a home equity loan to get popcorn and sodas anymore, it is nice to see first-run movies on the big screen. I usually lie to my wife about movie start times because she is chronically late. Arriving late at a newly-released movie could be a major problem - only seats in the front, or no two seats together. Of course when you arrive early, you have to wait another 30 minutes of previews and commercials until the feature film begins. Waiting for the move to start, I have pondered as to who are the most annoying people at the movies.

1. TALKERS. Probably the most annoying of all would be the (adult) talkers. It is okay for children to talk a bit, since it is important to ask questions, but when adults are carrying on an active conversation about non-movie issues, it drives me crazy. Even with the loud speakers in the movie, it can be difficult to drown them out. It seems that the more I try not to hear them, the more I hear them. When this occurs, I try to turn around and look at them (Why do they tend to be behind you?). Sometimes, they get the idea, and sometimes you do have to turn around and ask nicely if they could not talk. It is best NOT to turn around to see what gestures they are making.

2. ROCKERS. Movie seats rock. Why? Do we really need to rock in our chairs while watching a movie? Those seats are designed to lean backwards to make you more comfortable, but I don't think the intention is for perpetual motion during the films. Rockers tend to be seated in front of you. Children like to rock in their chairs.

3. BIG and TALL. Tall people have the right to attend movies, but whenever possible, they should seat themselves in the back; certainly not in front of me or in front of one of my little grandchildren who will immediately crawl on to my lap so they can see. Now, I am not a small person by any means, but I do not hang over into the adjacent seats. The morbid obese really need to have some consideration for others and try to keep their stuff on their sides.

4. BUFFER SEAT PEOPLE. American movie theaters are filled with buffer seats - single empty seats between couples. In the days were we had ushers with flashlights walking around, there were no buffer seats. We had to sit next to anyone and everyone, including smokers in my day. Buffer seats are usually piled high with coats, purses, and those huge empty popcorn buckets. "Is this seat taken?" One member of the annoyed couple will gather up their stuff, pile it on their lap, and glare at you for the rest of the movie. I am sure they are thinking why I had to sit there and not up front in one of those empty seats under the screen.

5. ARM STEALERS. There are no hard and fast rules as to who owns the seat arm. Usually the first one that arrives claims the seat arms next to the buffer seats. When someone sits in the buffer seat, they have to tightly fold their arms against their chests, waiting anxiously for the arm-owner to scratch their nose, reach for some popcorn, or leave their seat. It is then and only then that you can quickly snatch and claim your seat arm. Your arm will eventually fall asleep since you will not move it again, no matter how uncomfortable you become. Two strangers cannot touch arms.

6. LOUD EATERS. Popcorn could be considered a quiet food, IF the eater would just chew with his mouth closed. How hard is that? If you can't chew quietly, for whatever anatomical or psychological reason, don't eat, or buy Gummy Bears. Someone cracking and snapping gum with the mouth open can drive me nuts. I once sat next to a man that whipped out a heavily-onion laden sandwich. He would literally moan as he devoured it. I quietly wished I had brought some garlic kettle chips, corn nuts, and pork rinds.

7. LEG JIGGLERS. Some people do have restless leg syndrome, but that is supposed to be a nighttime issue. There is really no reason for a responsible adult to twitch there legs like an Irish dancer. A mindless leg jiggler sitting twelve seats away can jiggle the entire row, like a seismic wave. A leg jiggler seated directly behind you can literally knock your glasses off. Granted, I may have an extra sensitive butt to this type of rhythmic torture, but sometimes, I have to move seats, becoming one of those hated buffer seat guys.

8. SNACK BAR ADDICTS. I have completely given up buying movie popcorn. I want popcorn, but I will not pay extortion. For those people who choose to buy popcorn; most will have it all eaten before the movie starts. The big bucket popcorn people will go out for their free refills, walking right in front of you. They will wait patiently until there is a good scene, and then slowly crab-walk in front of you, dragging their ample buttocks inches from your face. As soon as the movie gets good again, they will return with their stash, usually crunchy food, piled high in one of those cardboard trays.

9. STRAW USERS. We have to use straws in the movie, lest we block the person behind us chugging down a tall Coke. Straws should not be used to repeatedly slurp the last bit of moisture in a cup, even if the ice melts to provide more liquid. Straws should never be used as a musical instrument, pulling it in and out of the plastic lid, like some sort of bizarre cello.

10. CELL PHONE USERS. Do people consider themselves so important that they cannot turn off their cell phones for an hour or two? Yes, you might get a call from the babysitter informing you that she can't find your two-year-old, but that would be rare. I have sat behind someone with a bright-screen cell phone who seemed to be watching a movie, at the movie. People will actively text. Some will try and talk softly - "I can't talk now, I am in the movie. No way. She said that! Oh, she is such a bee-atch!"

11. RECLINERS. If you are lucky enough not to have someone sit in the buffer seat directly in front of you (the one next to me), it does not mean you can use the seat as an ottoman. If your legs are so long that they will not fit comfortably in front of you, then perhaps you should stay home and rent movies. Some recliners feel they are being courteous by removing their shoes first, apparently unaware of their malodorous feet.

12. PEOPLE WHO ARE INTOLERANT OF SNORERS. If a movie does not particularly appeal to me, I will quickly fall asleep, and yes, I may loudly snore. At least, I don't talk in my sleep. It annoys me to no end if they wake me up. My granddaughter woke me up during a Harry Potter film. I don't remember which one.

There are so many more that I could discuss: the silent farters, the movie critics, the experts who have seen the film before ("Watch this scene coming up; it is so cool."), the idiots who don't pay attention ("Who is that guy again?"), people who smell like cigarettes or booze, the scratchers (goodness knows why or what they are scratching), and the criers (usually, my wife).

I think that I prefer renting DVDs...less people to annoy me, cheaper popcorn, and I can sleep when I want. If I miss a scene, I can just play it back.

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Work Notes, School Notes, PE Notes - Aaaargh!

2009-09-01T07:14:00.003-04:00

When did we become a society that requires doctor's notes for everything? I spend a great deal of my precious day writing note after note to coaches, teachers, day-care providers, and bosses. Is this really necessary?

I have always felt that people are basically honest until proven otherwise. When a responsible employee is required to submit a note to his/her boss just to confirm an illness, I find this very problematic. If I have seen the patient for a particular illness, I will write the note, although I think it is ridiculous that adults have to do this. In generations past, if you were too sick to go to work, but not sick enough to pay for a medical visit, then you just stayed home. Now, people have to pay for a medical visit just to get a work note sometimes.

Yesterday, I had one of the "no show" appointments. Someone made an appointment, but didn't have the courtesy to call and cancel it. When I reviewed the records, I discovered that this person has no showed for eleven visits! I am surprised that the PCP (primary care provider) has not discharged them from our practice, since they are costing us a considerable amount of money. When someone no shows, they prevent someone else from using that appointment slot. I find this rude and inexcusable. Sure, we all forget and miss an occasional appointment. We are human. But, eleven appointments... this person has a problem. I suspect this is the same person that will call me in a few days asking for a note for her employer because she was "sick"... apparently too sick to come in, and too sick to pick up the phone and cancel her appointment.

Someone with chronic work absenteeism, someone that tends to be sick only on Mondays or Fridays, or someone who becomes too ill to work the day before a long holiday weekend, would certainly raise my eyebrows as a boss. For these yahoos, I would require a note, too, or better yet, provide them with a note - an official DCM (Don't Come Monday, you're fired).

State and federal employees always ask for notes. Teenagers who work for fast-food places ask for notes. People who are on probation for chronic absenteeism ask for notes.

This is football season for the high schools. Coaches are scrambling to get their players ready for competition, so many have practices twice per day now. If a player misses a practice, the coaches require a note to prove they were ill. A note from the parents is apparently not good enough. They want a "doctor's note". I get so tired of doing these that I have become passive-aggressive, often writing "Jim was sick today" and sign my name. I don't feel that the coach has any business knowing the nature of the illness if it does not affect the player's performance or put others at risk for a contagious illness. There are days that I would like to write, "Jim has gonorrhea and cannot play today."

Schools are probably the biggest abusers of notes. It took me a while to realize that these notes are worth big bucks to the school, since an excused absence due to illness still qualifies them for federal matching funds. For instance, a school may get $35 per student per day from the government. If just ten kids fail to show up, the school will lose $350 - perhaps the salary of one teacher (including benefits). When a hundred kids stay home during a flu epidemic; that can add up to a lot of money... and, a lot of notes for me to write.

For some reasons, teens try to get out of PE. I know, our kids were always asking us for notes. Our oldest son, Josh, wanted a note to get out of PE because of "back pain". Apparently not realizing what we do for a living, we examined him and determined that he was a malingerer - nothing wrong with his back. We gave him a note for "remedial PE" that did not include running, so he was fine. He was fine, until the PE teacher decided that if he couldn't run or play basketball, then he would be reassigned to the special needs class. For two days, our son was in a class with kids in wheelchairs, leg braces, crutches, or with mobility issues because of cerebral palsy. He quickly discovered that his bogus back pain wasn't really that significant. On day three, his disabling back pain miraculously resolved and he returned to his regular PE class. Some time later, we discovered that he had PE during first period, and it messed up his carefully styled hair!

Kids with the True Flu (medically-diagnosed Type A Influenza) MUST stay home. As a matter of fact, if they are doing okay, I would prefer that they not come in to our office, either. A doctor's office, no matter how we try to keep things clean and sanitized, is a great place to spread illness, and a great place to come in with one illness, and leave with another. Here is the Catch 22. If they need a doctor's note, I have to see them. If I have to see them, I have to have an open appointment or work them in. I often have a dozen more requests for appointments per day than I have open slots. If they can't get an appointment (to get the note), they go to urgent care or the ER, over-crowding the waiting rooms and over-exposing everyone they meet. I suspect the quest for notes costs our economy billions of dollars per year.

Daycare providers often think they are medical providers. If I had a nickel for every rash that was supposed to be measles or chicken pox, only to be hives or mosquito bites, I could have retired years ago. My wife and I used to teach a class called "Pediatrics for Child Care Providers" that was required for licensing in our county. We taught thousands of eager child care providers how to properly recognize certain infectious diseases, and how to establish reasonable exclusionary polices. When child care providers exclude your child for suspected pink eye or the plague, the parent has to leave work to pick them up, make a timely appointment for my office (usually the next day, so they miss TWO days of work), and require a doctor's note before the child can return, then I have to write TWO notes - one for the child care provider since they don't trust the parent, and one for the boss, also because they don't trust the parent.

One study showed that over 80% of all missed days for working women are for the illnesses of their children. It doesn't take very long for a responsible working parent to quickly run out of sick days just to take their kids to the doctor. If the employed parent becomes ill, they have to go to work sick, where they will expose their fellow workers, who will become sick, inadvertently infecting the kids going to day-care, thus starting an epidemic. They will then show up at my office asking for notes.

If I were the dishonest, entrepreneurial type, I would have a note vending machine in my waiting room. People could insert a five-dollar bill, type in the days they missed work or school, and out pops a signed note. That is a good idea. The Doctor Note-O-Matic! This would be a noteworthy and lucrative venture. Sorry about that...

I do have a confession to make. In my teen years, I became quite skilled at forging notes so we could go to the library instead of French class, or a teacher's signature as proof that we had completed a chemistry experiment. One of my proudest days as a forger occurred when a teacher turned down his actual signature since it did not look like the other (forged) signatures that I had done!

Actually, I attempted to write my own note in first grade when Gregory and I decided to play hooky and hide in the woods all day. In my youthful naivety, I did not know I would need a note to get back to school the next day. When mean old Miss Rider told me that I had to have a note from my mother for missing school yesterday, I truly became sick. After dozens of attempts to replicate my mother's handwriting, I knew it was not very good. Fessing up and hoping for a one-time only reprieve, my mother was not sympathetic. She actually wrote "hooky" on my note! This would not do.

I went across the street to my kindly Aunt Norine (now, 95 years old), to see if I could con a note out of her.

"Why didn't your mother write this note?" she inquired.

"She didn't know how to spell "sick", I replied.

My aunt wrote the note and I was ever so grateful. She also made me go to church the next Sunday hoping that I would confess my sins before it was too late. I found that you could pray for forgiveness. Unlike Miss Rider, God didn't require a note.

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California is Burning Again - Too Close This Time

2009-08-31T09:14:00.005-04:00

The weather has been in the low 100's. There is a breeze blowing up from the south. These are perfect conditions for a wildfire. With the budget crunch affecting the over-burdened Department of Forestry, and the fact that many of our local fire crews are fighting fires in Southern California, I always start to worry this time of year. The only good news is that my vacant lot neighbor, a moron who thought it was okay to have camp fires this time of year, has moved to North Carolina when he lost his job. God help those in North Carolina.

Yesterday was our annual "Pesto Day" - the day that I head for the farmer's market to prepare for a day of making enough pesto for the year. There were eight pounds of pine nuts, 24 pounds of Parmesan cheese, bags of fresh garlic, and I was coming home with over 40 pounds of sweet basil. My son and his fiancé were coming to help on the assembly line to pay for their share of the pesto. Some packages with be shipped to our other children; some to our friends. The rest will be in our freezer until I get a hankerin' for some pasta with pesto, a pesto pizza, or some other recipe that I find.

After hours of basil leaf-pulling, we received a call from our granddaughter to ask if we are okay because of the fire.

"What fire?"

Unknown to us, there was a wildfire raging just a few miles from us that had already burned at least thirty homes to the ground and numerous businesses. It took another half-hour before we saw live coverage on the local news.

The phone rang again. It was an automatic call with a recorded message telling us to prepare for evacuation!

"Get the pet carrier for the puppies. Don't let the dogs out. Find the cats. Get some boxes for my heirlooms. Free the chickens. Go!"

Of course, my immediate thought did not go to heirlooms, but the six gallons (not an exaggeration) of pesto in a bucket in our kitchen. So, along with irreplaceable family heirlooms, paintings, antiques, and other things, sat a big bucket of pesto ready to be loaded into the vehicles.

It was my job to hook up the trailer to the truck. It was my wife's job to decide what went in it. All I really needed was my two computer towers, my back-up drive, the tax and insurance papers, and a bag of clothes. Oh, and my camera and the video of the things inside our house that I quickly took. It should be a great video to watch someday, with my wife scurrying around loading her stuff in a box.

Several years ago, I was visiting a friend in a remote, Northern California town. As I approached, it was clear by the aerial tankers and smoke that this was not a good time to visit. When I arrived at his house, he was busily loading his station wagon with his treasures - his arrowhead collection, his Dad's chair, and of course, his two desert tortoises. A few minutes later, his wife arrived to help with the evacuation. An argument ensued when she discovered that he did not put one thing of hers in the vehicle - not one stitch of clothes. The car was filled with his man-stuff. His justification was the she could wear his clothes, but he couldn't wear hers. Good argument, but it didn't fly. Soon, my car was being loaded with stuff, too. For several hours, we watched the progress of the fire. Fortunately, it was brought under control and the evacuation order was lifted. I helped them unload the car. His wife was still miffed, muttering something about "arrowheads can't burn".

A few hours passed as we watched the live news coverage. Helicopters buzzed overhead; aerial tankers were zooming by, and then the phone rang again. Our evacuation order was lifted. The pesto was safe. The puppies slept quietly through the ordeal. The chickens were oblivious that they nearly became free-range evacuees. We never found the cats. Cats always disappear during a crisis, perhaps thinking that they may need to help.

This morning, I received phone call after phone call from worried friends. Boxes of heirlooms are stacked in the living room. The empty trailer is still hooked to my car; and in the distance; a crippled rooster crowed. A few miles away, people are mourning the loss of their beloved pets and livestock; their homes and possessions burnt to the ground. The skeletons of homes were still smoldering. A man on television was filmed staring at the burnt shell of his once-mint-condition '64 Mustang. Frightened children are clinging to an injured cat. People looked shell-shocked, stunned, and in pain. This fire came up so fast that many only had minutes to escape. Fortunately, no human lives were lost.

Several hundred miles to the south, two fire fighters lost their lives. Ten thousand homes are threatened in one of several wild fires, from the Angeles National Forest to Riverside County. Before the first rains of the season, still months away, there will be more fires...more losses of life...more personal tragedies.

I am going to drive through the burned out area this morning, if the roads are open. I will open up my home for anyone needing a place to stay, or volunteer to care for some pets. The Salvation Army will need donations. This will be a very sad time for hundreds of people in my area.

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Happiness is a Warm Puppy (Actually, Six Puppies)

2009-08-28T08:30:00.001-04:00

In the week that I was gone, the puppies doubled in weight. They are now walking around, barking a little squeaky bark, and watching us with those dark eyes. My super-tired female, Lexi, is barely able to keep up with their increasing nutritional demands. With six puppies and only five nipples on one side, one puppy has to crawl in on her back, like an automobile mechanic. They nurse like a hungry school of piranhas, about every four hours, twenty-four hours a day.

Lexi , short for Lexapro, was my canine antidepressant after the untimely death of my other dog, Herman. My whole purpose for breeding Lexi was to get one male puppy. Lexi had six puppies - five girls, and my one little boy. His name is Zac, short for Prozac. I have also decided to keep one of the little girls, too. My granddaughter wants to name her Ellie (short for Elavil?). I don’t take antidepressants; I will have four dogs instead.

Today, we brought some puppy formula to help take the pressure off of the exhausted mother. Like infant formula, this one cost about $40 a can. In another week, they will be on some moistened puppy food, however. We bought them all collars so we can tell the girls apart. The one male puppy is obvious. We have three “big ones”, now nearly three pounds each, and three little ones, a little over two pounds. Doing the math, the combined weight of those six puppies are about half the weight of the mother already. Lexi is naturally eating us out of house and home, making up for the caloric loss.

We also bought some puppy chew toys today, hoping to take the heat off of our shoes – the traditional chew toys of young dogs. They are very curious about the toys and immediately sniffed them over. Their whelping box is really a plastic swimming pool, lined with a (washable) mattress cover. There are six little stuffed animals in there with them. When the remaining puppies go to their new homes, these well-worn and familiar-smelling stuffed animals will go with them for some transitional comfort.

I spent yesterday constructing an exercise pen for the yard. In about a week or so, they will make their first outside debut. I can’t leave them outside without supervision however, since we have some circling turkey vultures. The vultures have been hanging around since I got the chickens. I have no doubt that a turkey vulture can carry off a puppy. Not on my watch, however.

For the entire eight weeks that we will have all of the puppies, we have altered our work schedules. Puppy rearing is not unlike having a new baby in the house. They poop. They pee. They whine. They eat. They sleep. They play. They require adult (human) supervision.

Our cats, on the other hand, are as independent as animals can be. They come in at night to eat, but most of the day, they are doing cat things – eating lizards and moles, sleeping in some dark, cool place, and climbing trees.

My parrot, Dorian, laid an egg on the same day the puppies were born. As a matter of fact, she laid THREE eggs, infertile, of course. Today, the eggs went away. We allow her to sit on those eggs for about two or three weeks, but then they have to go. If we take the eggs away too soon, she will lay more. Birds do not eat very much when they are sitting on eggs. Dorian is in the room with the puppies, so she has been actively imitating the puppies little squeaks and whines. I am sure I will hear those sounds long after the puppies mature. Dorian also speaks cat, microwave oven, dryer signal, telephone, and English.

Clearly, we are animal people. We give up a lot of our independence due to our pets, but we get so much more in return. Much more.

Are you a pet lover? Visit our message board, "Pet Health: The Veterinarian Is In" to chat with others and ask questions about your dog or cat.

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Brain Tumors

2009-08-26T09:41:00.002-04:00

I remember the scene in Kindergarten Cop with Arnold Schwarzenegger where a little boy tells Arnold that he probably has a tumor.

"It's NOT a Toom- A!" Well, sometimes it is.

Senator Ted Kennedy passed away yesterday from brain cancer - a glioblastoma, considered one of the most difficult tumors to treat. One of my best friends, George, was diagnosed with this same tumor about five months ago. He calls it "The Big Kahuna - The Mother of All Tumors". As you might imagine, George has been following Ted Kennedy's cancer fight closely. Kennedy seemed to be doing so good in the beginning, that his progress was an inspiration to my friend. He would tell his doctors, "I want the same treatment that Ted Kennedy is getting."

Like Senator Kennedy, he has been fighting his HMO for the best care. When he woke up one day, his only sign of his occult mass was his inability to remember words. All that came out of his mouth was a meaningless word - "Perkis". Thinking this was a sign of a stroke; his wife gave him some aspirin and called us. Obviously, we had her call 911 to get him to the hospital - STAT. A CT scan was ordered and the mass was quickly spotted. A day or so later, he had brain surgery to remove as much of the tumor as they could. Of course, this is not the full story. George had another tumor, a smaller one that was initially missed. This second tumor is the real trouble-maker right now.

It took nearly a month before he was finally started on radiation and chemotherapy. The radiation course has been completed, and he is now on this second, even stronger, round of chemotherapy. Sadly, this second tumor disqualified him for some promising experimental drugs, and more recently, the location of this second tumor, disqualified him for gamma knife treatment. His oncologists are hitting his brain cancer with round after round of potent chemotherapy agents. His most recent MRI showed that the second tumor has not increased in size - a somewhat promising sign if there really can be such a thing with this diagnosis.

When I heard the news about Senator Kennedy's death last night, my heart went out the Kennedy family, but more so, my heart went out to George and his family. Cancer victims are inspired by survivors, so I know this news will be devastating to more than just the Kennedys and our country.

George is a recently-retired university professor - a brilliant man in all respects. He can converse on just about any subject, including the medical management of glioblastomas. I am sure that he never anticipated doing research in this fringe area five months ago.

George has lost some (not all) of his Sasquatch hair. He is now wearing a hat that he found at the local hardware store that has a large crop of fake hair on the top. Like me; he has a full beard. For some reason, the chemotherapy has not affected his facial hair. The chemo is kicking his butt most of the time, so he is sleeping more, and tends to be rummy after those long naps. However, he is still the same 'ol George with a great sense of humor and a love of life. Of course, as an intellectual and realist, he knows that his life is threatened.

George is spending as much time as he can with his four (adult) children and his four grandchildren. There are get-togethers of some sort nearly every weekend - 4th of July parties, Mexican fiestas, birthday bashes, etc. You name it. George planted his annual vegetable garden with his grandson, Connor, this year. Connor eats most of the tomatoes, as soon as they are ripe.

George loves good food and fine wine. He is a member of a wine co-op and has done his share of grape-stomping over the years. His wine collection is now sitting idle. Wine is not on his "cancer diet". Also banned is red meat, with the exception of lamb (his favorite). A few weeks ago at a dinner at our house, I gave him his fill of New Zealand lamb chops, marinated and grilled to perfection, I might add.

As I write this blog post, I look out at a 12-foot high, hand-carved wooden giraffe standing in my yard. A few years ago, while we were on vacation, George drove a few hundred miles to buy it, and then installed it in my yard. We came home at night, so we didn't see it. The next morning, while I was drinking my coffee, I was startled to see a giraffe staring at me. George and his wife, Claudia, always considered our place to be "in the jungle", and you really can't have jungle without a giraffe.

If I ever have to face a serious health crisis, I hope that I do it with George's attitude and conviction. Ever since I received a letter from John F. Kennedy at age 12 (I wrote him a letter and he responded), I have been a Kennedy watcher and admirer. Our country is blessed with some extraordinary leaders, but sometimes, seemingly ordinary people do extraordinary things. George is, and will always be, my personal inspiration. Life is so precious that not one moment should be wasted. When your life is threatened by a serious health crisis, each and every day becomes even more golden.

We are but a dash in life. We are born on a certain date and some day we will all die. A little dash (-) will appear between those dates indicating the entire span of our short time on Earth. So, while we are alive, we need to do our best to make our precious dash really count.

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