Tag Archives: screen

by

Sexually active

At a clinic visit this week the Medical Assistant screens me. “Are you sexually active?”

I say, “Um, what do you mean?”

“Are you sexually active?”

“Um, I do not have a partner.” By now, I really want to laugh.

She still looks confused. “You are not sexually active.”

“Ok.” I try not to giggle. Apparently her question series does not cover um, solo sexual activity and I resist telling her about the downtown sexual health and toy store. The new multispeed, multipattern suction toys are, well, enlightening and INSPIRING and EXPLOSIVE.. Or, um, something. Snort.

Let’s just study the dome. This is from Venice and tells the story of Adam and Eve.

I have sent a message to my physician saying that they may want to rephrase the questions. “Do you have any sexual partners?” would be more enlightening as far as sexually transmitted disease risk. Heh. The whole thing cracked me up. My blood pressure was still 108 over 70. Ha, so there, heart disease. My English/Scots father’s family is adapted to tobacco and alcohol and my father ran a low blood pressure even with 55 years of unfiltered Camels in his lungs.

Heh.

For the Ragtag Daily Prompt: dome. This is the Basilica San Marcos, which has multiple domes. This one tells the story of Adam and Eve. I now want to paint one of my ceilings. The bathrooms have too much moisture. I suspect this will not enthuse future realtors.

Alone and lonely are not the same thing.

Fantasy is good.

by

Dating Scream

Happy Halloween, darlings, and let’s make you scream.

I am the Witch of Fourteenth Street, at least, I take a woman over on Fourteenth Street on Halloween. I can’t control her year round, but once a year at midnight, she is mine. Mine, mine, mine.

There is only so much evil one can do from midnight to one am once a year, but THIS year. Oh, darlings, this is so much FUN. She already identifies as a feminist. I can’t make many changes, but I can get away with one. A dating screen. Or a dating scream, if you prefer. While I am in her brain, I tweak a neuron here and a neuron there: just a little. If you mess with too much, they go all schizophrenic on you and some witches have been trapped in brains. I’ve been delicately tweaking this brain for years. Just a touch and then out and wait for the results.

Delightful.

So she wakes on November 1, and does she notice? No. I have to tweak lightly, so my touch doesn’t even go into effect right away. In fact it takes months. She is just having the result now.

“I have a new dating screen,” she says to a male friend. “Have you ever read a trashy romance?”

“No. Why would I?” says her friend.

“That’s my new screen. All these guys I know say “I don’t understand women.” If I ask them if they’ve read a romance, they act all insulted. They say why would I do that? The conservative ones act like it is beneath them.”

“Um.” says her friend.

“But if these guys are interested in women, why aren’t they interested enough to study women’s culture? Romances show exactly what our culture is packaging for sale to women. Bodice rippers. Harlequin Romances. And so forth.”

“Well, I’ve read two articles in Cosmopolitan about women.”

“The truth is that most men think women’s culture is beneath them. It is unimportant. They scorn Harlequin Romances, knitting, women’s work, women’s culture. And guess what? I don’t want to date some jerk who thinks he’s superior to me. Men expect women to respect male culture, but they have no respect for women at all.”

“Hey, not all men.”

“Yeah? Will you read a romance?”

“I have a long list of important reading.”

“Oh. I am disappointed. I would like to discuss a romance with an intelligent male. Never mind.”

“Uh, well… Um, maybe you could pick one that would get your point across.”

Oh, darlings, aren’t I the greatest witch in the world? I primed my victim with quotations. “Women’s virtue is man’s greatest invention.” Cornelia Otis Skinner (1901 – 1979). “In passing, also, I would like to say that the first time Adam had a chance he laid the blame on woman.” Nancy Astor (1879-1964). “I thought that the chief thing to be done in order to equal boys was to be learned and courageous. So I decided to study Greek and learn to manage a horse.” Elizabeth Cady Stanton (1815-1902). My victim has been thinking about the quotations and has reached a conclusion.

And darling, do you think she will find anyone to date?

Shall we start a pool?

(Evil laughter.)

by

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.

by

screen door

For Thursday doors. This is one of the cabins that my family owns at Lake Matinenda. I don’t think anyone has stayed in it since my sister died in 2012. That summer my daughter and I went and tried to clean some. There were too many things that were out where the mice could get them. We bought plastic containers and crated things up. We took all the beer bottles in the boat to the car and 17 miles to town to recycle them. We took loads of mouse nested clothes and shoes to the dump. We took a guitar that belonged to my sister home to my niece.

We were too raw to make decisions, to take the clothes and wash them and give them to a charity. It is time to do that.

A door into memory and how much my daughter helped, with no complaint.