Really?

Just a few very puzzling things that require some response.

While I am not a huge fan of Senator Lindsey Graham, I did call to thank him for being on the side of the Angels. I try to call to thank legislators to balance out when I call to ask them to change a position. What did the Senator do? He stood up in front of a Republican gathering in his state of South Carolina and recommended that folks consider getting vaccinated for COVID. And, he was booed. He tried to water down his recommendation and was still booed. He tried a third time and was still booed. Really?

This followed on similar recommendations by Reverend Franklin Graham, another person I am not a huge fan of due to his bigotry, but who nonetheless has done some good things in the world. Graham wrote about getting the vaccine online and he was promptly vilified by his primary audience for so recommending. The retorts were less than Golden-rule like from this religious audience. Really?

Now, I have read that teachers are getting death threats for being worried about teaching when their is no vaccine requirement for the school. Death threats. Teachers. Really?

I recognize that people have been led to tap their innermost feelings for something which should be so simple. I also realize that only a small group of people would actually be troll-like enough to offer death threats – these folks being hateful. But, it is the folks booing people for having the temerity to try to save their lives by suggesting getting the vaccines which stymies me. Booing. Really? Why?

A brief thought – err on the side of caution

I am off to a doctor’s appointment in a few minutes, but wanted to capture a brief thought. I am reading several school boards in Florida will be ignoring Governor DeSantis’ rule that there will be no mask or vaccine mandates. In response, the governor has said he will hold back pay of superintendents who violate his rules.

The lesson that continues to be failed to learn by governors like DeSantis and Abbott over in Texas among others, is with respect to community health, we must err on the side of caution. With respect to children’s health, we must err on the side of caution.

Of course, they took their lead from the former president who put people in danger after he knew of COVID-19 danger inviting them to events, calling it a hoax, and naysaying its severity. And, these were his biggest fans.

Now, we have a rising COVID Delta variant that is plaguing the unvaccinated, primarily. The risk of exposure exists now as much as ever. We must be mindful of these risks.

The military is mandating vaccines, but over 1 million military members have already been vaccinated, which us a huge start. Speaking of military, I have quoted my veteran US Air Force brother-in-law who simply said, “You are not being asked to storm the beach at Normandy. Wear a mask. Get a vaccine.”

This is not a civil liberties issue, this is a public health issue. We must err on the side of caution. It is only your health and that of your family.

A Tuesday tale

I met with an old friend last week for lunch. He was visiting his daughter and we decided to get together, masked appropriately. He shared a wonderful story that I hope will warm your heart, as it did mine and my wife’s when I told her.

He said his daughter is a specialized nurse. He and his wife had adopted both of their children in their first week. For medical history reasons, his daughter wanted to find out about her birth parents. He gave a nice piece of advice to be prepared for the consequences which may not turn out like you want.

He went on to say she was adopted when they lived in Ohio, who changed their laws to allow for open records, provided the birth parents did not specifically say no during the transition form sealed records.

After much legwork given a common name, they found the birth mother and father. It turns out the birth mother was also a nurse and her father was the doctor her mother worked for. It was the mother who turned down the doctor’s proposal to be married, so they put the child up for adoption.

So, if that does not give you enough tingles that people she never met were also in the medical field, the next item might. We live in North Carolina, not Ohio. And, the daughter does not live in her home town having moved within the state. It turns out the birth mother lives nine miles away from the daughter.

The rest of the story remains to be told. I will add the mother who raised her is in medical research, so her daughter’s interest is most likely due to her influence and example, but DNA to help others might have also been a factor.

The story is not intended to judge anyone’s motives or reasons for placing a child in adoption. We do not know the circumstances or history of those involved. I would only surmise decisions like this must be difficult.

Franklin was on the side of the Angels and got chastised

I have written before when Franklin Graham has used his pulpit to denigrate groups of people who do not worship, love or gender present like he does. I have added it detracts from the many good things his Samaritan’s Purse organization does, when he demonizes groups. Yet, this time he is getting flak from his own followers for suggesting that people get the COVID vaccine.

Here are excerpts from an article called “Franklin Graham believes Jesus would take COVID vaccine. He’s still catching grief”.by Joe Marusak of The Charlotte Observer. A link to the article is below.

“Evangelist Franklin Graham is still catching grief from some of his Facebook followers weeks after saying Jesus would have supported getting a COVID-19 vaccine.

Based on the parable of the Good Samaritan, Graham said he concluded that Jesus would have supported getting all types of vaccines.

He said nobody should have to endure what some of his staff and their family did after contracting the coronavirus…

‘My wife and I have both had the vaccine; and at 68 years old, I want to get as many more miles out of these old bones as possible!’

Some of his followers, however, are still fuming about his COVID vaccine recommendation.

‘You my friend Franklin Graham are leading your sheep to slaughter,’ a woman posted Friday.

‘Satanic sell out,’ another woman posted.

‘STOP,’ said another last week. ‘It is NOT your job as a pastor to try and talk people into taking a vaccine that is considered experimental.’

Other comments were along these same lines. Just in the selection of these three, only one-half of one them raised an actual issue that gave him or her pause referencing “experimental.” The vaccines were rushed, but we have had the benefit of seeing the results of such along with the stops and starts. The J&J vaccine has some issues they are looking into, but for the vast most part the vaccines have been safe.

What amuses and concerns me is the vitriol used to share their opinions with the reverend, who is just trying to offer encouragement. He did exactly what I did after getting my vaccine and that is to share a positive experience. “Satanic” is a little harsh as a retort and offers no counter argument.

That is a bigger problem where people are replacing arguments with bullying and name calling. The latter does not improve anyone’s argument, even when they are a current or former politician. Being smug does not make one right, it just makes one smug.

Franklin Graham says Jesus would get COVID shot | Charlotte Observer

Time to get shot – vaccine shot that is (an update)

It is my time to get the first of the COVID-19 vaccines. I went Saturday to an event sponsored by Atrium Health at Bank of America stadium on Saturday. It was actually well organized and very quick, but more on that later. And, the only side effect is a tender arm where I was shot.

When I signed up through my hospital system, it was like buying tickets online for a concert. I had several locations to choose from, but when I hesitated to actually read something they wanted me to, my choice locations vanished. And, I had to start again. That is how I ended up at the football stadium. I promise I did not spike the football after getting shot. The other locations are drive-throughs at various hospital locations.

Nonetheless, I am glad to have started the vaccine train with its two stops. Three weeks from now, I will get number two and be done. These have been scary times the past fifteen months. I did see there is an uptick of COVID-19 in more places. Cavalier attitude toward socializing is the likely culprit along with politicians saying more political than prudent things.

Those not interested in the vaccine are an enigma to me. I cannot understand why something that is so needed is avoided. I cannot understand why something that is relatively easy to do is avoided. If people are so doing because they have an anti-vax attitude, I understand it more, but still don’t understand it enough. If people are avoiding it because of the pace of the development, I understand that a little more, but the stories of side effects get more air time than the countless no problems. Yet, if people are doing so for a political statement, that is just inane. Politicians now campaign all of the time rather than govern, so we must take what many say with a grain of salt.

The event was smooth sailing. The only waiting was for parking as it was bottle necked to one lot. I eventually bailed and went to another lot. I walked right on in and two check points later got my shot. I was out in thirty minutes counting the fifteen minute observation wait at the end.  I was encouraged when they sent me a text to NOT show up earlier than fifteen minutes before my appointment time. 

By the way, I am old enough to remember some shot we all got when I was in elementary school. I don’t remember what it was, but we all lined up for our poke in the arm. I do remember the kids behind me asking “did it hurt?” which everyone one was asked. By the way, this did not hurt. I exercised the next morning and today am without any tenderness.

Sidebar: A funny story happened, which my wife chuckled at when I told her later. The person giving me my shot was a pediatrician who was my age as she commented when I told her my birthday. When I asked her if I needed to roll up a sleeve, she said if we just unbutton the top button on your pull over shirt, we can roll it down enough to give me the shot. To my surprise, then she started doing it. And, I said don’t you need to know my first name to start undressing me. She laughed and said I am a pediatrician so I am used to just doing things. Everyone needs a chuckle, especially those doing repetitive things.

Time to get shot – vaccine shot that is

It is my time to get the first of the COVID-19 vaccines today. While I am an old fart, I am only now qualifying by age and one other condition, that hypertension thing. So, I will be participating in a hopefully, well organized cattle call at the football stadium downtown.

When I signed up through my hospital system, it was like buying tickets online for a concert. I had several locations to choose from, but when I hesitated to actually read something they wanted me to, my choice locations vanished. And, I had to start again. That is how I ended up at the football stadium. I promise not to spike the football after getting shot.

Nonetheless, I am glad to start the vaccine train with its two stops. Three weeks from now, I will get number two and be done. These have been scary times the past fifteen months. I did see there is an uptick of COVID-19 in more places. Cavalier attitude toward socializing is the likely culprit along with politicians saying more political than prudent things.

Those not interested in the vaccine are an enigma to me. I cannot understand why something that is so needed is avoided. I cannot understand why something that is relatively easy to do is avoided. If people are so doing because they have an anti-vax attitude, I understand it more, but still don’t understand it enough. If people are doing so for a political statement, that is just inane. Politicians now campaign all of the time rather than govern, so we must take what many say with a grain of salt.

So, hopefully it will be smooth sailing. My guess it will require a lot of waiting. But, I was encouraged when they sent me a text to NOT show up earlier than fifteen minutes before my appointment time. By the way, I am old enough to remember some shot we all got when I was in elementary school. I don’t remember what it was, but we all lined up for our poke in the arm. I do remember the kids behind me asking “did it hurt?” which everyone one was asked.

Internal Bleeding – Be your own Health Care Advocate

The following post was written about nine years ago. Since that time, some of the changes noted below have taken shape, but the message remains important. Be your own health care advocate.

A few years ago, two doctors looking to improve the quality of health care in the US, wrote a book called “Internal Bleeding: The Truth Behind America’s Terrifying Epidemic of Medical Mistakes.” Since Drs. Robert Wachter and Kaveh Shojania wrote their book, improvements have and continue to be made, but with the concern over the US’ 38th position in health care quality, while being the most expensive system in the world (according to the World Health Organization), I think it is appropriate to belabor a few of their key points, in particular, being your own health care advocate.

In today’s world, we must be the navigators of any customer service we receive whether it is at a bank, the driver’s license office or in a retail store. We must be diplomatically relentless in trying to gain the service we expect and need to resolve an issue. Service providers, in particular those in a Call Center, need to stay on script as much as possible. When your problems get them off script, then your navigation diplomacy skills are needed the most.  I mention this as context for what we also must do in gleaning good health care service.

A few years back there was a study conducted by a combined group called the “Leapfrog Group” to improve the quality of health care in hospitals. Leapfrog came up with three major ideas – (1) Electronic orders were a must (poorly written prescription orders were killing people), (2) Intensive Care units need to always have a doctor on site and (3) Medical procedures of import need to be done in centers of excellence, not where a hospital may have done only a handful of surgeries in this area. “Internal Bleeding” echoes many of these same issues, especially the one on electronic order taking. Yet, they also go beyond these Leapfrog issues.

They noted that often times in hospitals, fewer critical questions are asked closer to the time of the procedure. Sometimes, the critical mistake may have occurred very early in the process. They used the analogy of all of the holes in Swiss cheese aligning to allow a mistake to pass all the way through. They used the example at Duke University where a famous heart transplant for a minor child occurred. The doctors at this very fine medical center, one of the best, were so excited when a heart of a young deceased donor became available, that they assumed others had checked that the type of blood of the donor matched the patient. It did not and the patient died. Similar examples occurred when doctors operated on the wrong leg, arm, kidney, lung, etc. The doctors failed to ask the very basic of questions and assumed these issues had been resolved.

In addition to the above and related to the Rx orders, the authors advocate the patient understand fully what is being done to them in the hospital or before they get there. They recommend you introduce yourself to every care giver who comes into the room, ask questions of them relative to medications you are being given and make them fully aware of other medications you are taking. They recommend if you cannot speak for yourself or are uncomfortable in so-doing, to delegate this important role to someone you trust. In other words, they are recommending being your own health care advocate. This will help minimize mistakes.

Health care is both a science and an art. It also is a trial and error business, so the doctors may not know for certain what is wrong with you and have to figure it out. They will do their best, but they do not know you very well or at all. So, you have to play the role of information provider and advocate.  Using the authors’ recommendation supplemented by other sources of information and experience, you must be your own health care advocate and do the following to get the care you expect and need.

– Write as good a summary of your and your family medical history as possible. Make it available to others you trust who may need to speak on your behalf.

– Before you see the doctor, write down your symptoms and questions as you may get stage fright when you see the doctor’s white coat.

– Do not be scared to ask questions, especially if you do not understand the diagnosis or remedy – he or she is there to serve you. I tell my kids you show your intelligence by asking questions, not by failing to ask.

– Get a second opinion on major diagnoses. For example, it takes a lot of practice to read a mammogram correctly and a non-inconsequential percentage of misdiagnoses occur. Using this example, computers cannot take the place of human fingers in doing a self-test. If you feel a lump and the first mammogram shows negative, get a second opinion.

– Make sure you inform your doctors and pharmacists what drugs you are taking. There are a number of drugs that contraempt the drug you need (make its use less effective) and some which are toxic when taken together. I ask my pharmacist questions all the time about some over counter drugs that may be harmful when taken with the prescriptions my family is taking, including me.

– Take your medications as prescribed and through the dosage. Many people stop taking their meds when they start feeling better.

– Be truthful with the doctor about your drinking and extra-curricular drug use. Doctors tend to believe patients understate their drinking, so help them out and tell them the truth. You drink more than you say you do.

– Make sure you get treatment for a major problem at a place that does a lot of what you need – a center of excellence. This is especially true with back or spinal surgeries and surgeries on any major organs. If you are having heart surgery, do you want it done where they have done 25 in the past year or 250, e.g? I have two friends who are having major back complications after spinal surgeries were done poorly.

– Get all the information you can around procedures to make informed decisions. In some cases, living with a mild discomfort with medication may be better than invasive surgery. Ask the doctor what are the options, what are the chances for success and what are the risks. If he/ she doesn’t know, ask him/ her with whom you can speak.

– Be diplomatically relentless with Call Center personnel at insurance companies. Mistakes do occur and sometimes you may be allergic to a substituted generic prescription. So, you can appeal a claim if you feel under-served.

– This one comes courtesy of Dr. Sandra Steingraber, an ecologist, biologist and cancer survivor. Family history needs to recognize your environment as well. She was adopted, but her bladder cancer at the age of 21, also occurred in other family members who lived nearby (as well as other cancers). Bladder cancer is a bell-weather cancer. It is largely caused by environmental toxins. If your family, neighbors or community has some longevity in an area and more than one or two bladder cancers have occurred, start doing some fact-finding. It may be more than a coincidence. Since people move around, showing environmental causes is difficult as the exposure may have occurred years before.

– Finally, take care of yourself in a sustainable way. Walk more. Reduce portions. Eat more slowly and ingest more calories earlier in the day. These measures can be sustained whereas diets cannot.

These are just a few ideas, but the key message is be your own health care advocate as you are the only constant in any equation about your health. If you feel you cannot serve this role well, please take a trusted friend or family member with you. Doctors and nurses are marvelous care givers, but they are not perfect. You have to improve their service by being present in the conversations. It is only your or your children’s lives.

Workouts need not be long to add value

Having spent more than fifty years working out in some fashion, I have learned that workouts need not be elongated affairs to add value to your body and mind. The key is to do something that is sustainable, something you can do with regularity. And, the amount of time needed can vary based on age, body style, health, etc.

I would also encourage you to start slow and build up to the routine that makes the most sense, listening to your body. Don’t do things that will cause harm – backs, knees and hips are very dear, eg. I am very careful with my back as I am tall.

For several years now, I have gravitated to a routine that makes sense for me. I workout for fifteen minutes AFTER I shower in the morning, so it is not too intense. The shower loosens the muscles and my back. I vary the daily routine between three workouts based on Yoga, Pilates, isometrics, calisthenics and light weigh-lifting using two 20 pound dumb bells as a maximum, but the weight can vary and be effective for you.

But, a key to each of these workouts is breathing. Since these exercises are not heavy duty, I breath in and out through my nose. If you feel the need for more oxygen, try breathing in through your nose and out through your mouth. I used to do more of the latter, but have learned I snore less at night when breathing more naturally during exercise. On repetition exercises, breath in on the lesser portion of the exercise and out on when you exert.

The first set of exercises are standing stretches, a series of about a dozen exercises, but for those who cannot stand well, several can be done while seated. I will highlight two of the more productive exercises.

  • The Yoga warrior pose is one of the best exercises, which is a stretch and hold routine to twelve nice breaths. varying my arms three times for a total of 36 counted breaths. One leg is out front with foot pointed, the other leg being behind with foot slightly perpendicular to your body as you bend into the front leg. I start with my arms over each leg with palms down, then arms over my head and ending with arms out palms up. Then, I switch sides and do 36 more. It is one you can start with a count of three and build.
  • The other is a calisthenics exercise. Standing up put both arms over your head straight up from your shoulder. Then bring one leg up bending at the knee as you lower your arms. Then raise your arms again as you lower your leg. Then do the same with the other leg. You breath out when you raise your leg and in when you lower it. I do 24 of these.

The second set of exercises for the following day is a floor routine of about a dozen exercises, as well. These focus more on the legs and core areas. Let me focus on two exercises.

  • On your back, bend your legs so that your knees are are up and feet on the floor. Now, gradually swing both legs toward the right, not touching the ground with your knees and then swing them to the other side. Breath out when your knees approach the ground and breath in when you move them up. I do a count of 24 of these. Try to be smooth with your movements.
  • Again on your back, do stomach crunches which is an easier way to do sit-ups and not hurt your back. While bending your legs at the knee with your feet on the ground, put your hands behind your neck and lift your chin up and part of your upper torso off the ground. The key is to make your stomach muscles feel the exertion. Then, return your torso to the ground. Breath out when you exert and in when you let you head back down. I do 24 of these, but like the above start with a few and build up.

The third set for the next day is light-weight lifting exercises.

These are simple exercises, again about a dozen of them. I warm up with an 8 pound medicine ball, then move to one dumb bell then two, each weighing 20 pounds. But, use weight that is comfortable to you. The key is the technique and repetition more than the weight. Just picking two:

  • Take a small medicine ball and while standing hold it in front of your waist in both hands. Rotate the ball to each side with a small twist breathing out as you do. Swing it to the other side, breathing in, then breathing out. This works on your love handles. I do fifty of these, 25 on each side. If you don’t have a medicine ball, you can use a small dumb bell or just interlock your wrists and twist.
  • Using one of your dumb bells, kneel down with your left knee and place you left hand on the floor. Using your right hand, lift the dumb bell up like you are slowly pulling a lawn mower cord. Breath out when you pull up the weight, breathing down when you lower it – don’t drop the weight, lower it. Build up to fifteen of these. Then switch legs and arms and do fifteen more. Start slow and with a light weight. This is the best way to work your back lateral muscles without harming your back.

Remember to start slow with fewer reps and lesser weight. The key is to use smooth movements and get your breathing right. Also, please check with your doctor or a trainer if you need to get counsel. Even five minutes will help each day, but whatever you do keep it sustainable. I have had many routines in the past that would wane after a few months. I have been doing a variation of these for more than five years.

Predicted and predictable

Nate Silver is the genius behind 538, one of the most accurate predictors of election results. 538 weights various polls based on their relative veracity. What his polls showed in 2016, after the late Comey announcement, that while the median favored Clinton winning, Trump could win within acceptable standard deviation. People focus too much on the median and not the range.

With this background, Silver said something of import recently, that many of us have said less succinctly. He said the COVID-19 contagions that are cropping in schools and colleges are both “predicted and predictable.”

When people get together without strict adherence to social distancing and mask wearing, exposure to COVID-19 will occur. And, the virus spreads exponentially, not arithmetically. This means when ten people get it, they infect ten more, who infect ten more…This is why the president was forewarned of the pandemic risk in January by US intelligence and why his misinformation and mishandling is so problematic.

Let me go further. If all people don’t wear masks, socially distance, wash hands and act with some common sense, COVID-19 will be with us much longer. I know we want to get back to normal, but managers, owners, deans, school executives, and elected officials must understand that corralling the virus cannot occur unless we all do our part. Even if a vaccine is created, a recent survey said only about 70% of Americans would take it.

This is why telling people the truth is so critical. Only then, will people follow instruction. And, sadly in the absence of truth tellers who must be supported not demeaned, conspiracy sources get listened to. As an example, measles had been eradicated in the US, until the anti-vaxxers spread their conspiracy information and now it is back.

Further, unless we have a president who tells the truth, we will not solve many problems. And, as an epidemiologist and historian said, telling the truth is mission one in dealing with a pandemic.

The pandemic risk is exponential, not arithmetic

I read today in The Charlotte Observer the president called the North Carolina governor asking for full opening of the Republican National Convention (RNC) with no social distancing or masks required. Think about this. He has the nomination. He just needs the delegates to vote on it. Yet, he is advocating the gathering of Republicans which heighten the risk by people who believe him when he says these protocols are not needed.

Pandemics work exponentially, not arithmetically. Let’s just say 0.5% of the people at the RNC get infected. That is 250 people who expose people serving food, ushering, securing, guiding them around Charlotte. That is 250 people who take the risk back to their communities to expose their families, friends and communities. On February 28, a night the president still called the Coronavirus a hoax, we had the first recorded American death due to COVID-19. We now are passed 105,000 on May 31, three months later. The question to ask is it worth 250 people infected in late August, that will cause a much large number of deaths come the day of the election?

I want Trump supporters to realize the risk the president is placing on the Republican party and others just so he can hear applause at the RNC. Yet, many citizens are smarter than this president and other politicians. While masks being worn by Democrats and Independents exceed 80%, 58% of Republicans are wearing masks, which means more are than are not. So, if this convention occurs without limits, will they come? If they do have the RNC, just maybe only the delegates and a few supporters actually show up; that would help the exposure immensely, but not rid ourselves of it.

Let me update a few ratios in closing. As of today, the US has 5% of the global population and 28% of the COVID-19 deaths. Thinking we solved this problem is a huge mistake in overconfidence and is yet more evidence of misinformation to gloss over the problem. Those US deaths tally 105,000 and counting as of May 31. Remember, we just crossed 100,000 last week. The summer weather will help, but we must keep our social distancing, keep good hand washing hygiene, wear masks in stores, in spite of what some influencers may tell you. It is only your and your family’s health we are talking about.