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Christmas for Children

For the Ragtag Daily Prompt: shop.

The main thing I am going to shop for today is a little tag that I got at my Sunrise Rotary yesterday. This is a gift request for a child, part of Christmas for Children, run by our local Kiwanis. Here: Port Townsend Kiwanis.

Applications for gifts for children are here: https://www.christmas4children.com/.

This year, Christmas for Children is not only handling Port Townsend requests, but Chimacum and Port Hadlock and Quilcene.

A friend just remarried and he says that they are comparing stuff. They have two of many many things! Kitchen items, house items. Maybe as a wedding gift we should all offer to go choose between two of the things and take one away to donate to someone in need! All those decisions!

 

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The Extroverted Feeler and the Terminator

For the Ragtag Daily Prompt: grateful. I have a series of stories about my son and daughter. My son is the extroverted feeler….

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The Extroverted Feeler and the Terminator

From the time the extroverted feeler is 3.5 until he turns 7, we live in Colorado, in Alamosa.

Alamosa is isolated high desert, in the San Luis Valley, at 7500 feet. We are surrounded by mountain passes, the lowest over 9000 feet, to the south. The San Luis Valley is named “Land of Cool Sunshine”. We have over 300 days of sun a year, but the temperature drops in this high desert valley every night, about 30 degrees. One day a fellow doctor announces that we’ve had a record high at night in the summer: 56 degrees. The locals complain about a heat wave when the day time temperature gets to 80.

My husband will talk to anyone, anyone and is interested in everyone. We get to know a German man, younger than us, I think through the gym.

He flies back to Germany to see family. Alamosa has a one gate airport and is really expensive to fly out of. He drives 250 miles, to Denver, to save money. Over a pass that is 10,000 feet plus.

He returns and is driving home.

He wakes up in a hospital. When the ventilator tube is removed.

We are visiting and he tells us about it. “When I woke up, they asked me what my insurance was.”

I said, “It’s in my wallet.”

“Where is your wallet?”

“In the glovebox. My truck.”

And then they show him a photograph of his truck.

He fell asleep and rolled his truck. Multiple times. There was no glovebox. Really there was not much left except bits of frame and wheels. And he’d rolled it about 17 miles from home. He almost made it the 250 miles. It was awful. Horrifying.

We are talking to him at his house a couple of months after the accident, when he is finally home. He was lifeflighted back to Denver after the accident. He’d broken an arm and his leg in multiple places and rib fractures and at home still has metal rods going into his arm. External fixation, holding bits of bone together.

My son is six. He keeps looking at our German friend and looking up above him.

Our friend notices. He is sitting in an armchair. Right behind him on the wall is a poster of the Terminator. Our friend is big and blond and has a Terminator build.

Our friend grins at my son when he realizes what the extroverted feeler is looking at. “Yes, that’s me. I am the Terminator. Part metal and part human.”

We laugh with him, glad that his sense of humor has survived….

…and had my son seen the Terminator? I suspect that he had, when I was off at work. His main sitter was a family across the street from us, a couple with teenagers. He loved hanging out with the teens. I think he got to watch a lot of movies that I didn’t know about….Our friend still had a bit of a German accent which would make it all the more compelling….

The photograph is my sister dancing with the invisible spirits… no, really we are on a road trip in the 1980s and stop for a hackysak break. She is gone from cancer.

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doctor’s orders

For the Ragtag Daily Prompt: recommend.

doctor’s orders

I recommend a daily walk

no earbuds
no headphones

listen to the wind
to the trees
to the birds
to the traffic
to the city
or the country

feel the ground
the pebbles
the sidewalk
the dirt
the grass
the wind
the sun
the rain
the cold
the crunch
of snow or ice

look at trees
weeds
birds
dogs
people
sidewalks
cracks
water
snow

smell cold
snow
rain
sun
sand
sidewalks
grass

taste the wind
a snowflake
a leaf
ice

touch the earth

and let the rest go

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broadcast

For the Ragtag Daily Prompt: broadcast.

“Were you, like me, brought up on listening the the radio? Or do you prefer more modern ways of communication? How do you broadcast your news? And how do others broadcast to you?”

I was not brought up on radio. More record player. No television until I was nine, and I think my parents mostly got their information from newspapers. And they discussed articles and ideas…

But the deeper answer to this question is that mostly I don’t.

I am introverted and shy. I also failed small talk in school very early and learned to shut up. I was comfortable talking in my family and would talk to friends after I’d known them for years. We moved every 2-5 years while I was in school so my peer friends were really my sister and cousins. When we moved, I pretty much would only talk to teachers for the first year. After a year, I might try to make a friend, having studied everyone. After a year, they might or might not be interested.

I got to know one woman from high school after we’d graduated. After a while she said, “I thought you were shy in high school.” I laughed and said, “No, I just didn’t talk.” This is really about opinions: I was way more opinionated than she realized and when I got comfortable enough to talk, I could talk a lot.

I also found that smart women are not admired, so I hid it. There are different ways of hiding it: mine was to be multi talented. I played instruments, scored equally well on the math and english part of the SAT, read voraciously, and mostly talked to adults. My parents’ house had a wild array of interesting and unconventional adults. Artists, trumpet players, singers, world travelers, university professors, rich women, poor women, beggerwoman, thieves, doctors, lawyers, native chiefs. I didn’t discover sports until college, other than hiking, skiing and swimming. My high school had no swim team.

My daughter complained about small talk in preschool. Why were kids she didn’t know talking to her? And why did they talk to each other when the teacher was talking? If everyone would just shut up and listen, they could move on to more interesting topics. I sympathize but also think that we all have to live with and care about each other. So how do we do that when we are so different?

In clinic all of my patients are smart. I treat them all as smart and the result is they ARE all smart. Now, that doesn’t mean that they immediately do smart things like quit smoking or quit drinking a 6 pack of coke a day or quit eating too many donuts….But change is incremental. It is hard to change.

Also, all of my patients ARE smart, about something. It could be car engines or church organs or comic books or Russian. I have an elderly woman who is fluent in Russian and feeling rather lonely. Another turns out to be a silversmith, though her lungs won’t tolerate it now.

I had a new patient recently who said that she didn’t understand what I was on about. I slowed down, explained the meaning of some of the words, and I think she understood. At least some of it. I am very happy that she felt comfortable saying, “I don’t know what that word means.” I was talking about a pathology report and needed to back off and define the words. I feel the same way when I talk to my accountant: wait, what does that word mean? I don’t know the language. I need bookkeeping for dummies…

I wish that we all broadcast that everyone is smart. Imagine what it will be like when we all assume that everyone has secret talents and genius.

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Mundane Monday #185: balance

For Mundane Monday #185, my theme is balance.

I took this yesterday, hiking the beach with my daughter.

How would you photograph balance? Or what photograph does it make you think of?

Send your links and I will post them next week.

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Last weeks theme was rats.

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USPSTF

USPSTF is the United States Preventative Services Task Force.

Here: https://www.uspreventiveservicestaskforce.org/.

This is a site I often use and frequently show to patients. For further reading….that is, if they want to know more about a topic. There is a nice two minute video about the Task Force right now, saying that it’s a volunteer organization that started 30 years ago, to review research about preventative care, agree on a recommendation and publish that recommendation.

Before they publish or update a recommendation, they ask for public comments and expert comments.

I have great respect for the USPSTF. Let’s take breast cancer screening. The current recommendation is here: https://www.uspreventiveservicestaskforce.org/Page/Document/RecommendationStatementFinal/breast-cancer-screening1. There was a big furor when this came out, because the recommendation is for biennial mammograms. Every other year, not every year. The USPSTF went through reams of data and papers and said that they could discern no difference between yearly and every other year screens in normal risk patients. The screening recommendations are different for people with abnormal BRCA1 and BRCA2 genes.

So who yelled about that recommendation? Radiologists for one. Now, there is a financial incentive on their part to have women get the mammograms yearly. The American Cancer Society was annoyed and the Susan B. Komen Foundation too. But the USPSTF stand their ground. The guidelines get updated in a 5-10 year cycle.

Reasons that I like the guidelines:

1. They are online. My patients can look at them too.
2. They make recommendations for screening by age groups.
3. They rate their recommendation: A, B or C level evidence or I for Insufficient Evidence.
4. You can read the fine print. They put the article with all the detail and all the references on the website. The weight of evidence is apparent.
5. They say “We don’t know.” when there is insufficient evidence.
6. The site is pretty easy to use.

I have to weigh evidence in medicine. A functional medicine “study” that is not a randomized double blind clinical trial and that only has 20 patients is really more of a case report. Hey, we tried this supplement and they liked it. The recent study about alcohol from Europe with 599,912 patients has a lot more weight. The Women’s Health Initiative had 28,000 women in the estrogen/progesterone arm, and 21,000 in the estrogen only/had a hysterectomy arm. Length of study, design, all of these are important.

There is a recent headline about a study saying that coronary calcium scores have now had one study where they were useful. That is a study. The guideline from the USPSTF is here: https://www.uspreventiveservicestaskforce.org/Page/Document/UpdateSummaryFinal/cardiovascular-disease-screening-using-nontraditional-risk-assessment. The guideline says “insufficient evidence” and that’s what I tell patients who ask for it. I offer referral to a cardiologist to discuss it, but I am reluctant to do a test where I really don’t know what to do with the results. I pay very close attention to the guidelines and they are always changing. They have the strongest and least biased (by money and greed) evidence that I can find. And patients can read them too, which is wonderful.

Even though the USPSTF says that there is insufficient evidence for mammograms after age 75, we can still do them. That is, medicare will keep covering them. Some people keep doing them, some don’t. I discuss guidelines, but I will support the person continuing the care if that is what they want and they are informed. People are infinitely variable in their choices and logic.