Archive for the ‘personal’ Category

Here We Go !

Monday, August 24th, 2015


UPDATE: Here is a good description of what I think is coming.

The US stock market is being buoyed upward by technology shares that are pure luxury items, a bit like the China Ghost Cities.

America’s technology darlings aren’t exactly making good on Silicon Valley’s legacy. Microsoft, Cisco, IBM and a few other businesses of the old guard have a reasonable claim to being the companies that run the world, but Twitter and Facebook? Not so much – whatever their crazy valuations.

You see, as much as global financial concerns are going to hit tech companies harder than other sorts of enterprise, so too will their own lack of ambition. The ugly truth is that Silicon Valley has largely given up trying to fix big problems and has retreated into photo-sharing apps and productivity tools. That may sound harsh, but just look at some of the absurd and pointless startups that are getting vast checks written and tell me that founders don’t need a kick up the ass and a reminder that no one has solved batteries yet.

I have been pessimistic for several years. That may be just my own psychological makeup but I am not the only one.

California is getting a bit agitated about what is happening in China.

Gyrations in the stock market have taken California’s fragile finances for a ride before — when the dot-com bubble burst, when the Wall Street crash sank the national economy less than a decade ago.

So when the market continued its dive Monday, state officials began glancing around for their seat belts.

More than most states, California depends heavily on taxes from the wealthy, pulling about half of its income tax revenue from just 1% of residents in recent years.

California is a top down society because it depends on income tax. Texas doesn’t and its state government is funded by sales tax, which everyone pays, even illegals.

The Obama Administration has been playing a Ponzi Scheme for years.

A Ponzi scheme is a fraudulent investment operation where the operator, an individual or organization, pays returns to its investors from new capital paid to the operators by new investors, rather than from profit earned by the operator.


The Coming Shortage of Doctors.

Monday, August 3rd, 2015

33 - Lister

This Brietbart article discusses the looming doctor shortage.

Lieb notes, that the U.S. is only seeing 350 new general surgeons a year. That is not even a replacement rate, she observed.

A few years ago, I was talking to a woman general surgeon in San Francisco who told me that she did not know a general surgeon under 50 years old. The “reformers” who designed Obamacare and the other new developments in medicine are, if they are MDs, not in practice and they are almost all in primary care specialties in academic settings. They know nothing about surgical specialties.

They assume that primary care will be delivered by nurse practitioners and physician assistants. They are probably correct as we see with the new Wal Mart primary care clinics.

The company has opened five primary care locations in South Carolina and Texas, and plans to open a sixth clinic in Palestine, Tex., on Friday and another six by the end of the year. The clinics, it says, can offer a broader range of services, like chronic disease management, than the 100 or so acute care clinics leased by hospital operators at Walmarts across the country. Unlike CVS or Walgreens, which also offer some similar services, or Costco, which offers eye care, Walmart is marketing itself as a primary medical provider.

This is all well and good. What happens when a patient comes in with a serious condition ?


Metabolic Syndrome and Obesity.

Monday, 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, 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.


Growing up in South Shore.

Thursday, 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 after they left. 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 to the chapel is seen to the left of the steps.


Greece is going glimmering.

Sunday, July 5th, 2015


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 ?


Expensive babies.

Sunday, July 5th, 2015


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.

Annie and the other kids.

Friday, 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.


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.

White Privilege.

Thursday, July 2nd, 2015


The subject of “white privilege” is very much in the news there days.

Administration officials at the John F. Kennedy School of Government at Harvard University have reached an agreement with student activists to force “mandatory power and privilege training” on incoming students during orientation.

The group, which calls itself “HKS Speaks Out,” will have a meeting this week with the dean of the Kennedy School, David T. Ellwood, to discuss the funding for the compulsory training and to “make sure this training is institutionalized” throughout the school, reports Campus Reform.

Who is this group behind the “white privilege” training session ? Well, they are disgruntled students.

The movement, called HKS Speaks Out, began in October after students expressed having “really negative classroom experiences,” according to Reetu D. Mody, a first year Master in Public Policy student and an organizer of the movement. She said the group has amassed about 300 student signatures, or about a fourth of the school’s student population, on a petition that calls for mandatory privilege and power training.


She can’t breathe. She is a Congressional staffer but I can’t find out whose staff. Democrat if not Bernie Sanders.

Steve Sailor is not impressed.

Harvard U. is full of people who clawed their way into Harvard, so it’s not surprising that they often can’t stand each other. Fortunately, 21st Century Harvard students have a vocabulary of whom to blame for any and all frustrations they feel. From the Harvard Crimson:

Kennedy School Students Call for Training To Combat Privilege in Classroom

Whiteness !


I wonder if that Confederate flag will become a symbol of freedom.

Saturday, June 27th, 2015


The hysteria is in high gear over the Confederate battle flag. The controversy began with the the shooting of nine people in the Emmanuel AME Church in Charleston, SC by a schizophrenic young man. South Carolina is, of course, the first state to secede from the union after Lincoln’s election in 1860. Since the Civil War, South Carolina has been ruled by the Democratic Party until the past few years when Republicans have elected the governor and legislature. In 1962, in an act of defiance, Governor Fritz Hollings (D) presided over the placing to the Confederate flag on the capital building. The flag was subsequently moved to a Confederate memorial on the capital grounds by a Republican governor.

Meanwhile, Fox News’s Special Report noted this fact during one of the show’s “All-Star Panel” segments with host Bret Baier alluding to it as well as how a Republican was in office when the flag was taken down from the dome and moved to the Capitol’s grounds as a compromise in 1998.

The shooter appears to me to be a paranoid schizophrenic who lived in appalling conditions with a weird father who seemed to care little about his welfare.

The hysteria about the Confederate flag seems to be a planned assault on southern states and on conservative politics. The fact that the South was ruled by Democrats until very recently is also an issue for these people who resent the recent appeal of the Republican Party. The cry of “Racism” seems a bit exaggerated when there is a trend recognized even by the leftist New York Times of black families moving back to the southern states.

The percentage of the nation’s black population living in the South has hit its highest point in half a century, according to census data released Thursday, as younger and more educated black residents move out of declining cities in the Northeast and Midwest in search of better opportunities.

The share of black population growth that has occurred in the South over the past decade — the highest since 1910, before the Great Migration of blacks to the North — has upended some long-held assumptions.

Both Michigan and Illinois, whose cities have rich black cultural traditions, showed an overall loss of blacks for the first time, said William Frey, the chief demographer at the Brookings Institution.


Planning a trip to Greece

Saturday, June 20th, 2015

I have been a student of Greek history for many years. When I was a medical student and later a surgery resident, I kept a copy of J.B.Bury’s “History of Greece to the Death of Alexander on my bedside table as reading material for relaxation. I have read it several times.

Another source of pleasure has been the novels of Mary Renault, the pen name of Eileen Mary Challans. Sh wrote a series of historical novels which won awards and which provided a more intimate view of Greek society in the classical era. Some of her novels provide a more sympathetic view of homosexuality than I have found anywhere else but that is not the attraction. Her history sounded like something written by one who lived it.

Another favorite novelist is Helen MacInnes who wrote novels of adventure set in and after World War II. Two of them were about places in Greece and one of those, Mykonos, is a favorite spot.

Mykonos harbor

Her novel describes this harbor and, while a new cruise ship terminal has replaced some of her story, the harbor looks just as she described it.

Mykonos square

The story, titled “The Double Image” describes a tiny square in the town that sounds exactly like this one looks.

We are looking forward to this trip with some trepidation, however. Why ? Because Greece may be heading into serious trouble.

Since December, Greeks have been preparing for a weekend such as this, pulling more than 30 billion euros out of banks. Week after week, the Bank of Greece borrowed banknotes from the rest of the continent to replenish this hoarding of the one asset Greeks still trust — cold, hard cash. Its liabilities to the rest of the euro area for the excess physical cash it has to put into circulation quadrupled between December and April, the last month for which there’s available data.

In November of 2012, there was rioting in Athens and it was about proposed austerity.

On the same day that Greece’s parliament passed harsh new austerity measures as part of a multi-billion euro rescue package, workers cleared wreckage from burned-out buildings damaged during a round of intense riots the day before.

The unpopular bailout deal requires dramatic cuts in wages, pensions and jobs, according to Reuters, and Sunday’s protests saw the worst violence in Athens in years.

Since those riots, a new radical leftist government has been elected that has vowed to defy the EU and austerity.

Greece’s new leftist government opened talks on its bailout with European partners on Friday by flatly refusing to extend the program or to cooperate with the international inspectors overseeing it.

Prime Minister Alexis Tsipras’ government also sacked the heads of the state privatization agency after halting a series of state asset sales.

The politically unpopular policy of privatization to help cut debt is one of the conditions of Greece’s 240-billion-euro bailout that has imposed years of harsh austerity on Greece.

Now, the moment of truth approaches and what will happen ?

Everything comes together on Monday [Monday June 22 !]. Greek Prime Minister Alexis Tsipras, back from a visit with Vladimir Putin in St. Petersburg, will spend his weekend coming up with a proposal to take to a Monday showdown with euro-area leaders.
A deal there is key. The bailout agreement that’s kept Greece from defaulting expires June 30. That’s the day Greece owes about 1.5 billion euros to the International Monetary Fund.
In an interview published Saturday in Brussels-based l’Echo newspaper, Greek Finance Minister Yanis Varoufakis warned that the ruling Syriza party could be replaced by neo-Nazis if Greece ends up defaulting and leaving the euro.

This may be standard leftist scare tactics but what will happen ? We have planned the trip to anticipate potential trouble in Athens. I have been to Athens before and have been to the Acropolis and the Parthenon.

Annie in Athens

Annie much more photogenic than I am and this was taken when she was 14 and standing on the Acropolis.

The plan is to fly to Athens and then spend only two nights there. I have planned a side trip to another place described in one of Helen MacInnes’ novels, Decision at Delphi, which is set soon after World War II and describes Sicily as well as Athens and Delphi. Delphi is quite high in the mountains north of Athens and involves some climbing so we will spend most of that time in the Delphi Museum.

Important finds included sculptures from the Temple of Zeus, the Nike of Paeonius, the Hermes of Praxiteles and many bronzes. In total 14,000 objects were recorded. The finds were displayed in a museum on the site.

Today, the Museum contains treasures from those excavations.


The museum itself.


And the interior with the exhibits. The trip can be made in a day and I have made arrangements.


On the way to Delphi, I want to make a short side trip to see the Lion of Chaeronea. This statue was erected over the common grave of the Sacred Band of Thebes. This was a unit of sworn lovers, probably all homosexual but in the fashion of classical Greece in which women were closely held in harem-like seclusion and men tended to adopt a pattern of an older man with a younger boy which might be merely sexual or it might be a sort of apprenticeship in arms. The Sacred Band had never been defeated in battle until that day, August 2, 338 BC. On that day, the Sacred Band was annihilated by the army of Philip II of Macedon, the father of Alexander the Great. The Band was buried in common grave and the lion statue erected over their grave. It was found by British tourists around 1900 and excavated and restored. Beneath the site were found the skeletons of nearly 300 men.


The battle,according to accounts which survived, was won when the Macedonians’ right flank conducted a sudden retreat, drawing the Athenians out of line. The Sacred Band was destroyed holding the line. I want to see their grave.

After that day trip, we plan to fly to Thessaloniki, a city east and north of Athens to visit the tomb of Philip II, the father of Alexander and winner of the battle of Chaeronea.


The remains in the tomb have recently been confirmed as those of Philip II

The tomb, itself, is well preserved and restored. The town of Vergina is near Thessaloniki and too far from Athens to drive in a day.

From Thessaloniki, we will fly to Crete and spend a few days near the Palace of Knossos and its museum.


The museum and the palace ruins should keep us busy for five days, then we fly back to Athens for one night and catch our flight to London and home the next day.

Or so the plan goes.