Obama’s legacy.

July 28th, 2015

Iranian Foreign Minister Zarif stands on the balcony of Palais Coburg, the venue for nuclear talks, in Vienna

Why is this man laughing ?

A good column today by David Gerlenter makes a strong case that Obama will be remembered for what he is doing with Iran.

Obama will be remembered ultimately for the Iran treaty, as Johnson is remembered for Vietnam. Like Johnson, Obama is wrapped in a warm blanket of advisers who flatter his earnest, high-school views of world politics. Like Johnson, he lives in his own delusional world in which he’s commander-in-chief not merely of the military but of the whole blessed nation. Like Johnson, he has been destroyed by the arrogance of power; and his blindness has endangered America. Unlike Johnson, he was never big enough for the job in the first place.

His comparison with Lyndon Johnson is excellent. I read HR McMaster’s “Dereliction of Duty,” and the resemblance to Obama’s policies is astonishing. I recently read another book that points out the consequences of Obama’s decision to abandon Iraq. It is written by a young British woman named Emma Sky and is called “The Unraveling.”

The future is still to be written but we see a few hints. The Iranians are already celebrating and by “Iranians” I do not mean the oppressed citizens of that sad country. They are passengers on a runaway train driven by lunatics. We have now given those lunatics the keys to the atomic bomb.

The other Obama legacy in the middle east may be his agreement with Turkey to attack the Kurds who are now building a Kurdistan, anathema to Turkey. Of course, the Obama administration denies that it is allowing Turkey to attack the Kurds.

Turkey has finally entered in force into the U.S.-led fight against the Islamic State group, but the move also has exposed the contradictions and confusion at the heart of U.S. policy, with the Obama administration struggling Monday to balance its promises to warring allies in the region and to prevent a deeper U.S. ground force engagement in the fight.

As NATO ambassadors prepared to gather Tuesday for only the fifth emergency session in the alliance’s 66-year history to discuss the crisis, the Pentagon denied that it was setting up a no-fly zone over war-torn Syria while the State Department faced sharp questions over the extent to which President Obama was abandoning America’s Kurdish allies in its haste to enlist Ankara in the fight against the Islamic State.

On one hand, U.S. officials praised the expanding Turkish military role against the extremist group, also known as ISIS and ISIL, which is based in neighboring Syria and Iraq. But on the other, they acknowledged how complicated the development is amid concerns that Turkey is using its campaign as a pretext to crush Kurdish militants whom Washington has relied upon as the go-to ground forces in northern Syria and Iraq.

Such concerns were highlighted Monday as reports swirled about Turkish fighter jets targeting not just Islamic State-controlled territory in Syria, but also positions held by the Kurdish Kurdistan Workers’ Party, or PKK — an ultra-leftist, Kurdish nationalist outfit that has waged an insurgency for decades in Turkey and maintains bases in remote parts of northern Iraq.

Obama’s black thumb in foreign policy, in which every initiative results in defeat, is still in evidence. There is another good column today by Leon Wieseltier who is a former editor of The New Republic. He doesn’t like the deal.

Rhodes has, perhaps inadvertently, exposed the president’s premises more clearly than the president likes to do. The rut of history: It is a phrase worth pondering. It expresses a deep scorn for the past, a zeal for newness and rupture, an arrogance about old struggles and old accomplishments, a hastiness with inherited precedents and circumstances, a superstition about the magical powers of the present. It expresses also a generational view of history, which, like the view of history in terms of decades and centuries, is one of the shallowest views of all.

Predictably, the Atlantic readers don’t agree and accuse him, of course, of being an Israel loving Jew.

The annoying thing for me is when certain pro-Israel commentators pretend they know better than the US government, or try to prescribe or influence US foreign policy by labelling the current administrations as “naive.”

Does the fact that every US ally in the Middle East, Arab and Jew, opposes this deal mean anything ? No. Of course not to the brilliant left.

Civil wars everywhere.

July 24th, 2015

Tia Oso

At the “Netroots Nation Conference, while an illegal alien was interviewing Martin O’Malley, a Democrat candidate for president, the stage was invaded by a black convicted felon who protested when O;’Malley said “All lives matter.”

Chanting, “What side are you on, my people, what side are you on?” and “Black lives matter,” the demonstrators moved to the front of the ballroom about 20 minutes into the event as Mr. O’Malley discussed proposed changes to Social Security. They remained there, heckling the candidates and posing questions, until organizers shut down the event, one of the centerpieces of the annual Netroots Nation conference.

The Democrats are going to have serious problems with the black activist movement.

The black radicals even plan to dig up the remains of General Nathan Bedford Forrest and his wife, law or no law. This sort of lunatic behavior is going to discredit this stuff pretty soon.

Of course The Connecticut Legislature voted to remove the names Jefferson and Jackson from their annual celebration, so the black radicals not that much more crazy.

Connecticut state Democrats voted Wednesday to remove the names of former presidents Thomas Jefferson and Andrew Jackson from their annual fundraising dinner, reportedly because of their ties to slavery.

According to the Hartford Courant, it only took two minutes for the Connecticut Democrat State Central Committee to unanimously pass a resolution stripping both names from the title of the Jefferson-Jackson-Bailey Dinner.

Party Chairman Nick Balletto proposed the change. He told the Daily Caller the decision, which apparently came under pressure from the NAACP, was about party identity.

Yup, the lunacy continues.

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Metabolic Syndrome and Obesity.

July 20th, 2015

I spent an interesting day last Saturday at a USC post-graduate course on “premalignant lesions of the GI react.”

Part of the session discussed the question of obesity and diet. “Fatty liver” is a condition related to obesity and metabolic syndrome.

The Wikipedia definition includes.
1. abdominal (central) obesity,
2. elevated blood pressure,
3. elevated fasting plasma glucose,
4. high serum triglycerides, and
5. low high-density lipoprotein (HDL) levels

Central obesity is not the same as subcutaneous obesity, which is what we all think of. Titters out there is a racial factor with blacks more likely to have subcutaneous obesity without the central obesity involving the liver and internal organs.

Metabolic syndrome and prediabetes appear to be the same disorder, with insulin resistance as a major factor.

Other signs of metabolic syndrome include high blood pressure, decreased fasting serum HDL cholesterol, elevated fasting serum triglyceride level (VLDL triglyceride), impaired fasting glucose, insulin resistance, or prediabetes.

Associated conditions include:
1. hyperuricemia,
2. fatty liver (especially in concurrent obesity) progressing to
3. nonalcoholic fatty liver disease,a.so called NAFL
4. polycystic ovarian syndrome (in women),
5. erectile dysfunction (in men), and
6. acanthosis nigricans.

It is generally accepted that the current food environment contributes to the development of metabolic syndrome: our diet is mismatched with our biochemistry. Weight gain is associated with metabolic syndrome. Rather than total adiposity, the core clinical component of the syndrome is visceral and/or ectopic fat (i.e., fat in organs not designed for fat storage) whereas the principal metabolic abnormality is insulin resistance.

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Growing up in South Shore.

July 16th, 2015

I grew up in a section of Chicago called “South Shore.” It was a beautiful part of the city now ravaged by crime and economic collapse. I have previously posted an article on my childhood. Here is more.

I was born in 1938 when my parents lived in this building at 77th and Marquette Avenue, near mother’s sister Marguerite and her husband Art.

Apartment 77th and Marqurette

That street was a quiet street and my aunt and uncle had lived there for many years. I think it was the only house they ever owned. Sadly, it is gone having been torn down after being damaged by vandals. My mother had lived with them since she was a girl and her mother had lived there until she died in 1926. By the time I was three and my sister was born, we had moved to a rented house on Clyde Avenue.

Peg and Art and me

Here they are holding me in their yard on Marquette. My uncle Art’s parents had lived right behind them on the next street.

St Brides

That is St Brides, the church in which I was Christened in 1938. Many years later (1967), my daughter Kate was Christened in that same church. In the days when I lived in Chicago, that church was so busy that it held two simultaneous masses on Sunday every hour. One was in the main church and the other in a smaller chapel in the basement. That door is seen to the left of the steps.

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The Suicide of the West

July 14th, 2015

AUSTRIA-IRAN-EU-US-CHINA-NUCLEAR-POLITICSThe Iran negotiator waving goodbye to western civilization.

Obama has gotten his Iran deal. He announced the deal with great fanfare.

In each case, the country’s top official decided to reverse a long-standing policy, taking significant risk to open space for negotiations. In gambling that the time had come to seek a deal, President Obama and Ayatollah Ali Khamenei broke a stalemate that had made the years of on-and-off negotiations an exercise in frustration.

Yes, Iran has agreed to all our concessions.

It begins when Obama came to office in 2009 and signaled his interest in reviving negotiations, sending a letter to Iran’s supreme leader, Khamenei, and Nowruz holiday greetings to the Iranian public. Although Obama insisted that he did not trust Iran’s mullahs, the first principle of his foreign policy was that contact — “engagement,” as he refers to it — was better than past administrations’ efforts to isolate adversary governments.

That might have been because they considered them adversaries. “Death to America” is not exactly the expression of friendship.

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Are the Republicans following the corporate wing of the party to disaster ?

July 11th, 2015

SF killing

There are a number of national stories recently that seem to resonate with voters. A big one is the killing of a San Francisco woman by an illegal alien with seven felony arrests who was deported five times.

The fatal shooting of a woman in San Francisco last week, allegedly by an illegal immigrant man convicted of seven felonies and previously deported to Mexico, has sparked a debate about the extent to which local law enforcement and federal immigration authorities should cooperate.

At issue is the Department of Homeland Security’s practice of seeking to identify potentially deportable individuals in jails or prisons nationwide by issuing a “detainer,” a request rather than an order to extend the individual’s detention.

San Francisco is a “Sanctuary City” which has pledged to resist efforts by the Immigration and Customs Enforcement agency to deport illegal aliens.

On March 26, Mr. Sanchez was booked into the San Francisco County Jail on a local drug-related warrant after serving a federal prison term, the city’s sheriff’s office said. The next day, Mr. Sanchez appeared in San Francisco Superior Court and the drug charges were dismissed.

After San Francisco officials confirmed that Mr. Sanchez’s federal prison term had been completed and that he had no active warrants, he was released from jail on April 15. He was freed despite a request from Immigration and Customs Enforcement, a division of DHS, to the city’s sheriff’s department that would have enabled the federal agency to take him into custody.

This is routine, plus of course, the fact that the Obama Administration has chosen to facilitate illegal immigration and resist deportation.

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Greece is going glimmering.

July 5th, 2015

Greeks

I’ve been planning trip to Greece for months. Back in January, I decided to wait until the Greek monetary crisis was closer to resolution. Finally in May, I made reservations for September. I even posted my plans here.

Well, today it may be all going glimmering. The Greeks have apparently voted NO to the EU deal.

Greece has overwhelmingly rejected Europe’s latest bailout package, plunging the country’s future in the Eurozone into jeopardy.

With most of the votes counted in a referendum that will shape the future of the continent, the ‘No’ campaign has a staggering 61 per cent of the vote - 22 points ahead.
German Chancellor Angela Merkel and French President Francois Hollande called for an EU crisis summit to find a ‘solution’ for Greece, with leaders set to meet in Brussels on Tuesday.
Thousands of anti-austerity voters took to the streets in celebration as the leader of the pro-EU ‘Yes’ campaign resigned, with an official announcement of the final result imminent.
But German politicians warned of ‘disaster’ as they accused Greek Prime Minister Alexis Tsipras of ‘tearing down bridges’ between Greece and Europe.

Now what ?

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Expensive babies.

July 5th, 2015

Mila

There is a post on Instapundit today about expensive babies.

It references a new book about a premature baby and is named “Girl in Glass.”

That baby was referred to by the CEO of AOL in a speech to employees explaining why he was cutting benefits for all employees. Her care cost 1 million dollars. The Guardian article goes on to complain about US healthcare (of course) and the cost of premature baby care.

I have a somewhat similar story in my own new book, War Stories. My story is not about a premature baby, although I have one of those too, but a little boy who was born with a heart defect that caused an 18 month hospital stay at Childrens’ Hospital in Los Angeles.

Here it is:

Following my general surgical residency training, I spent an additional year training in pediatric heart surgery at Children’s Hospital. During this time I learned more about the amazing resiliency of children and their recovery from terrible illness. I was also reminded of the constant possibility of catastrophic error in medicine. One young patient named Chris was the best example of the tremendous recuperative powers of children. He was coming in for open-heart surgery to repair a large ventricular septal defect. The ventricles are separated by a muscular wall called the septum, which forms during early fetal development of the heart. The heart has four chambers, two atria and two ventricles, which are separated by walls called “septa,” plural of septum. There are a number of major cardiac anomalies associated with the development of the atrial and ventricular septa and also with the rotation of the heart and the connection of the great arteries to the ventricles from which they arise. Chris was born with a very large defect in the septum between the right and left ventricle. In this situation, the newborn goes into congestive heart failure very shortly after birth. The defect causes no trouble before birth because the lungs are not inflated and the blood flow through the lungs is very small. The cardiac circulation in utero consists of oxygenated blood returning from the placenta through the umbilical veins, passing in a shunt through the liver and then entering the right atrium, which also receives the non-oxygenated venous blood from the body. The oxygenated blood returning from the placenta enters the right atrium and passes through a normal atrial septal opening called “the foramen ovale,” which shunts it directly to the left atrium and left ventricle for circulation out to the body. This bypasses the lungs. The venous blood, and the umbilical vein oxygenated blood that does not go through the foramen ovale, enters the right ventricle where it is pumped into the pulmonary artery. There, because of the high pulmonary resistance it goes through another shunt, the ductus arteriosus, a connection between the pulmonary artery and the aorta, to bypass the lungs and circulate to the body. Minimal flow goes beyond the ductus into the pulmonary arteries until birth. During fetal life, the presence of a ventricular septal defect merely eases the task of shunting the oxygenated blood from the right side of the heart to the left and then out to the general circulation.

When the infant is delivered into the world from its mother’s uterus, it inflates its lungs and very rapidly major circulatory changes occur in the heart and lungs. The pulmonary arteries to the lungs, which during intrauterine life carry almost no blood because of a very high resistance to flow in the collapsed lungs, suddenly become a low resistance circuit with the inflation. The foramen ovale, which has a flap valve as a part of its normal structure, begins to close very quickly and the ductus arteriosus, connecting the pulmonary artery and the aorta, also closes within a matter of several hours. These two shunt closures are accomplished by hormonal changes associated with the changing physiology of the newborn. In very low birth weight preemies, that have low blood oxygen concentration due to immature lungs, the ductus often does not close. In the child with a ventricular septal defect, the sudden drop in resistance to flow in the pulmonary circulation together with the closing of the ductus arteriosus causes the shunt, which was directed from the right to the left heart in utero, to switch to a left to right shunt after birth. The pulmonary circulation is now the low resistance circuit and the systemic circulation; that is, the aorta going out to the arms, legs, and organs is now a relatively high resistance circuit. The flow in the pulmonary circuit goes up tremendously, a short circuit in effect, taxing the ability of the right ventricle to handle the load. At the same time circulation to the organs, the brain and the extremities, drops because of the shunt. This combination of circumstances produces acute congestive heart failure in a newborn. Cardiac output is huge but the flow is going around in a circle through the lungs and then back to the lungs.

Chris had a huge ventricular septal defect and as soon as his lungs inflated and the pulmonary circulation began to assume the normal low resistance of the newborn, he developed an enormous left to right shunt and went into heart failure. The venous return from the body entered his right atrium, passed into the right ventricle and on into the pulmonary artery to circulate through the lungs. Once the oxygenated blood returned to the left atrium on its way to the body, it was shunted back to the lungs because the pressure in the aorta and left ventricle was much higher than that in the right ventricle and pulmonary artery. The short circuit in the heart diverted almost all blood flow to the lungs and little went to the body. The right ventricle, which is thin walled and flat like a wallet, cannot handle the load and quickly fails. The treatment of an infant with a large ventricular septal defect and heart failure is to perform a temporary correction by placing a band around the pulmonary artery above the heart. This accomplishes two purposes. One, it artificially creates a high resistance and equalizes the pressure in the right and left ventricles so that the flow across the ventricular septal defect is minimized. The right ventricular pressure is as high as the left ventricular pressure and little or no shunt occurs. This stops the huge shunt and, with the smaller flow, the ventricle can handle the pressure. It also protects the lungs from high blood flow that damages the pulmonary circulation.

In a related anomaly called “Tetralogy of Fallot” a partial shunt occurs but it is the other way, right to left, since the pulmonary artery is severely narrowed at its origin as part of the anomaly. These children do not go into heart failure, but they are blue because of the mixture of venous blood from the right side and arterial blood from the left. Some patients with ventricular septal defect (VSD) do not go into heart failure because the shunt is not that large but if treatment is delayed and a continued high flow through the lungs persists, in later life they develop irreversible changes in the lungs from the damage to the pulmonary circulation by high flow rates. They become blue later as the increasing pulmonary resistance in the lungs reverses the shunt from left to right to right to left as in Tetrology of Fallot. This condition is called “Eisenmenger’s Complex” and, once it occurs, cannot be corrected. Once this reversal occurs they do not benefit from correction and require heart and lung transplantation. Some VSDs are small and do not produce enough flow to cause trouble, at least in childhood.

Chris had a pulmonary artery banding procedure at about two or three days of life and an extremely stormy course for a very long time postop. He was in the Intensive Care Unit at Children’s Hospital for over a year. He had a tracheostomy for much of that time as he was unable to breathe without a respirator for a year. He had intravenous feeding for well over a year. During this time he had several cardiac arrests and the staff became convinced that he would be brain damaged if he survived. Finally, after 18 months in Children’s Hospital, he went home. This had all occurred before my time. Now, 3 years later, he was being admitted for the definitive repair of his heart defect. The pulmonary band is Teflon tape and does not grow so the pulmonary stenosis, which had saved his life, was now a threat, as it did not permit adequate flow to his growing lungs. He was five years old and was joyously normal. His intellectual development, in spite of everything, was normal and he was a very calm and self-confident little kid. He was not afraid of the hospital or of us, the white coat brigade. Most nurses and staff in children’s hospitals and pediatric clinics avoid white coats preferring colorful smocks to reassure kids that we are all regular folks. The kids are not fooled but it does seem to defuse the tension, especially at first. When we would make rounds on the ward for the few days Chris was in the hospital for pre-op checks, he would go around with us. He wore his little bathrobe and sometimes carried charts for us. He was completely unafraid. I don’t know if it was because he remembered his previous experience; I didn’t think that memory would be very reassuring.

Anyway, the day of surgery came. His mother was a nervous wreck because she had come so close to losing him and here they were risking him again. I did not see much of the family on the day of surgery. His grandfather was a famous movie star, one of the biggest box office leaders of all time, and the hospital had thrown a big luncheon bash for the family as they waited. We heard about it and grumbled that they could have spent the money on a better blood bank (we were having trouble getting blood for elective cases), but no doubt they hoped for a big donation. The surgery, itself, was almost an anticlimax. The data from the original heart cath, when he was a newborn, suggested that he had almost no interventricular septum and we anticipated trouble reconstructing a new septum. As it turned out, his heart, in its growth during the past five years, had developed a good septum with a modest sized defect in the usual place. It was easy to patch and the surgery went well. The other worry with VSDs is the conduction system, the Bundle of His, which carries the electrical stimulation to the ventricles, and runs right along the edge of the defect but this was not a problem. There was no sign of heart block after the sutures were placed and tied. Postop we always took the kids straight to the Heart Room, a combination recovery room and ICU. The nurses there knew more about cardiology than I did and probably more than anyone else at Children’s below the rank of associate professor. His mother came in and stood at his bedside for a while just thankful to have him. I never saw the rest of the family although I did meet his father before he went home. He recovered quickly and completely. I had one more encounter with him about a year later.

After his recovery from the heart surgery he had another operation, this time on his leg. He had been in the hospital for so long as a baby with an IV line in his groin that his hip would not straighten out completely. A few months after the heart surgery he had another operation to release that contracture, the scar that had formed limiting his hip movement. It also went well but had been postponed until his heart was fixed. A couple of months after that procedure he was well enough to climb trees. I know that because he fell out of one of them and cut his forehead requiring several stitches. I removed the stitches in the office a couple of months after I started practice in Burbank. He recovered completely and is now an executive in the entertainment business. I have not seen him since 1972.

I don’t know what Chris’s care cost but I think it was worth it. AOL was foolish to self-insure and not buy reinsurance for catastrophic cases like Chris and Mila’s. There are ways to reform health care and to cut costs but they are not what AOL did or what Obamacare did.

The fate of babies in medieval Italy.

July 4th, 2015

Sienna babies ladder

This painting is on the wall of a medieval hospital in Sienna, Italy which depicts babies climbing a ladder to heaven. This probably represents the fate of many babies in those times. A figure, probably the Blessed Virgin, is seen helping them once they reach to top.

This photo was taken on a trip to Italy with a medical history group in 2003.

Annie and the other kids.

July 3rd, 2015

I have a beautiful daughter who has accompanied me around the world since she was a teenager. She has a beautiful sister, as well.

Annie in Athens

There she is in Athens.

Her sister Claire is also beautiful.

ClaireRosetta

This is Claire in London at the British Museum and the Rosetta Stone.

My oldest daughter is Kate.

Kate, Mike and Joe

There she is with her brothers, Mike and Joe, at the USC graduation of both her and Mike.

Annie graduation

Annie’s graduation. I don’t seem to have one of Claire’s.