Archive for September, 2016

Jim Kilroy died today at 94.

Friday, September 30th, 2016

kialoa-v-by-ingrid-abery

Jim Kilroy spent 40 years sailing his maxi-boats and setting records.

At 66, Kilroy’s wavy hair is snow white, but he is tall, lean, energetic and well established in style through 32 years of campaigning the Kialoas. At Long Beach, an onlooker was startled to see the 79-foot aluminum sloop leave the dock without him.

Later, on the 45-foot tender, Kilroy explained: “I never take over the boat until the sails are up. Allan takes the boat out and Allan takes the boat in.”

Allan is Allan Pryor, a New Zealander whose job it is to take care of Kilroy’s boat, wherever in the world it is.

“It’s Allan’s boat when we’re not racing,” Kilroy said.

His New Zealand crews were famous in ocean racing for many years. I was in a bar in Mazatlan in 1976, the first time I heard the Kilroy crew chant for good competitors. No, it wasn’t for me but I was there and heard it.

I knew him casually in sailing. Once, when he was building one of his yachts, he sailed in the Ensenada Race with Alan Puckett, who was the president of Hughes Aircraft Company and who owned Blackbird, an Ericson 46.

The Ericson 46 was not an easy boat to sail, especially if the wind was up, but Kilroy would rather crew for someone else than stay on the beach. Puckett, himself, was a well known sailor in an era when none of us were professionals.

Allen was an avid yacht racer and cruising sailor. Over the years, he raced on 4 boats of his own, including a Lapworth 36 “Alsuna,” a Cal 40 “Alsuna 2,” an Ericson 46 “Blackbird” and finally a Farr 55 “Amazing Grace.” When he was not skippering his own boats, he was also a highly sought-after master navigator, in the days when a sextant, compass, wristwatch, and paper charts were primary, and sometimes only, equipment used. When the first portable personal computers became available, Puckett was one of the first to develop software to assist in navigation and sailing performance analysis.

Vale, Jim Kilroy and Alan Puckett. Smooth seas and fair winds.

Does Hillary Clinton have Parkinson’s Disease?

Sunday, September 18th, 2016

The Hillary collpase last Sunday has prompted a lot of speculation on her condition. Early on I was inclined to blame her neurological condition on her history of concussion and cerebral vein thrombosis.

That seemed logical, given her history. However, it does not explain her quick recovery. It also has nothing to do with pneumonia.

This video has now convinced me that she has Parkinson’s Disease, and it is fairly advanced. In the video, the physician mentions Apomorphine, which is not morphine but an alpha adrenergic drug used in Parkinson’s Disease.

Currently, apomorphine is used in the treatment of Parkinson’s disease.

What use does it have in Parkinson’s? It is used for “Non-motor symptoms.”

What does that mean ? Parkinson’s Disease is characterized by a serious of motor disabilities.

The cardinal symptoms of Parkinson’s disease are resting tremor, slowness of movement (bradykinesia) and rigidity. Many people also experience balance problems (postural instability). These symptoms, which often appear gradually and with increasing severity over time, are usually what first bring patients to a neurologist for help. Typically, symptoms begin on one side of the body and migrate over time to the other side.

These symptoms are typically controlled with Dopamine like drugs, such as L-Dopa. There are other symptoms less easily controlled.

For example, in advanced cases, difficulty swallowing can cause Parkinson’s patients to aspirate food into the lungs, leading to pneumonia or other pulmonary conditions. Loss of balance can cause falls that result in serious injuries or death. The seriousness of these incidents depends greatly on the patient’s age, overall health and disease stage.

Hmmmm.

There are also side effects of L Dopa.

L-DOPA therapy is further complicated by the development of movement disorders called dyskinesias after 5 – 10 years of use in most cases.

Dyskinesias are movement disorders in which neurological discoordination results in uncontrollable, involuntary movements. This discoordination can also affect the autonomic nervous system, resulting in, for example, respiratory irregularities (Rice 2002). Dyskinesia is the result of L-DOPA-induced synaptic dysfunction and inappropriate signaling between areas of the brain that normally coordinate movement, namely the motor cortex and the striatum (Jenner 2008).

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Alaska in September.

Saturday, September 17th, 2016

We spent ten days in Alaska this month. The weather was almost perfect with only one rainy day which coincided with an 8 hour train trip.

anchorage-hotel-2

We stayed at the Hilton, where I stayed when I was there 23 years ago. We had dinner the first night at Simon and Seaforts, which I considered the best sea food restaurant I had ever visited. For some reason the food was not as good as I remembered but it was still full on Thursday night.

The next morning, we got up early and caught a bus at the Convention Center, called the Eagan Convention Center. There followed a six hour bus ride, broken by a short stop at McKinley Wilderness Lodge, about opposite Mount McKinley (Denali now).

denali-jill

The view from the Lodge is terrific. We were still a long way from our destination, however.

The bus finally dropped us off at The Denali Cabins, which are right outside the park on The Parks Highway.

There we were picked up by another bus, this one to take us to the The Denali Backcountry Lodge, another 92 miles into the park.

The Backcountry Lodge is a private company that occupies (with some passive resistance by the Park Service) some old gold mining claims. It was not there when I visited the Park 23 years ago although the gold claims go back to before the park existed. There is another lodge back there called The Kantishna Roadhouse, and the whole area is a community called Kantishna, although some old prints show that the name was originally Kantshitna. You can’t find a link to the old name but it was there on a photo of an ancient poster.

We left the Denali Cabins at 1 PM and arrived at the Backcountry Lodge at 7:45 PM, a trip of seven hours. Part of that is the 92 miles, of which the last 72 are gravel. Part of the time was spent looking at animals we encountered in the park.

denali-bear1

This was the first bear we saw on the way. We also saw caribou.

Caribou single

Here are two about 100 yards away. When I was there before, 23 years ago, we saw caribous cross the road just ahead of us but not this time.

Finally, we arrived at the lodge just in time for dinner, which they had delayed about 45 minutes for us. There were about 30 people staying there and our table mates remained as such the next few days.

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The video guy.

Wednesday, September 14th, 2016

hillary-video-guy

Now there is a guy I would not sell life insurance to.

Hillary Clinton and cavernous sinus thrombosis.

Tuesday, September 13th, 2016

The episode of Hillary Clinton’s collapse at the 9/11 Memorial Sunday has raised some interesting questions. Several years ago, she had a series of neurological events.

Getting a true picture of the events requires that we go to British newspaper sites, as the US media has shielded her for ten years.

1998 Blood Clot
Clinton’s first known blood clot occurred in 1998, while she was still first lady.
Clinton experienced symptoms while attending a fundraiser for Sen. Charles Schumer of New York, who would soon become her Senate home-state colleague. Her right foot swelled up to the point where she couldn’t put on her shoe.
Clinton got quietly taken to the National Naval Medical Center in Bethesda for treatment at the time. She was found to have ‘a big clot’ blood clot behind her knee, Clinton wrote in her memoir, ‘Living History.’
She called it ‘the most significant health scare I’ve ever had,’ the Washington Post noted.
According to her physician, Mt. Kisco physician, Lisa Bardack, Clinton was advised at the time to take Lovenox, described as a short-acting blood thinner, when she took flights. The meds were discontinued when she went on Coumadin.

That history has not been discussed, to my knowledge in light of her recent problems.

2009 Blood Clot
Clinton had a second blood clot incident in 2009. The episode was described by her doctor in a 2015 letter.
The doctor didn’t provide a detailed description of the event. Rather, she wrote that Clinton’s ‘past medical history is notable for a deep vein thrombosis in 1998, 2009 and a concussion in 2012.

Her extensive air travel might be a factor in the DVT episodes. This has been referred to as Economy Class Syndrome, and was first described by physicians at London’s Heathrow Airport. There are other factors involved.

In recent years, the association between air travel and the incidence of deep-vein thrombosis or pulmonary embolism has become clearer. Epidemiologic studies reveal an increased relative risk of thromboembolism after flights of more than 8 hours and especially in subjects at higher risk for this disease, due, for example, to congenital thrombophilia or the use of oral contraceptives. However, the absolute risk of deep-vein thrombosis or pulmonary embolism after prolonged air travel is very small. Studies have shown that a combination of factors present during prolonged air travel may account for increased activation of coagulation. There is no definitive proof that elastic stockings are effective in reducing the incidence of clinically relevant thromboembolism during air travel. Acetylsalicylic acid is not effective in the prevention of thrombosis during air travel and may be dangerous.

Hillary Clinton certainly does not travel “coach class.” What about the concussion?

2012 Blood Clot and Concussion
Clinton got a bad stomach bug and fainted at her home in Washington in 2012, an event that led her to get a concussion. Information about what exactly had happened emerged only slowly over time.
As her doctor put it, ‘In December 2012, Mrs. Clinton suffered a stomach virus after traveling, became dehydrated, fainted and sustained a concussion.’
The then-secretary of state wasn’t seen in public between Dec. 7th and when she left the hospital in New York January 2, 2013.
Clinton experienced ‘double vision for a period of time and benefited from wearing glasses with a Fresnel Prism,’ a special corrective lens, her doctor wrote in a letter voluntarily released to the media in 2015 as part of Clinton’s presidential campaign. Her concussion ‘resolved within two months,’ Bardack wrote.

That is a very severe concussion and would disqualify anyone with that history from the US military. The whole story is suspicious.

Clinton was diagnosed with a blood clot in the brain, transverse sinus venous thrombosis, and began anticoagulation therapy, her doctor wrote.
Clinton had to work from home and postpone planned testimony before a House Benghazi committee.

That is NOT part of a concussion and suggests a much more severe condition.

Cerebral venous and sinus thrombosis (CVST) can present with a variety of clinical symptoms ranging from isolated headache to deep coma. Prognosis is better than previously thought and prospective studies have reported an independent survival of more than 80% of patients. Although it may be difficult to predict recovery in an individual patient, clinical presentation on hospital admission and the results of neuroimaging investigations are–apart from the underlying condition–the most important prognostic factors. Comatose patients with intracranial haemorrhage (ICH) on admission brain scan carry the highest risk of a fatal outcome. Available treatment data from controlled trials favour the use of anticoagulation (AC) as the first-line therapy of CVST because it may reduce the risk of a fatal outcome and severe disability and does not promote ICH. A few patients deteriorate despise adequate AC which may warrant the use of more aggressive treatment modalities such as local thrombolysis. The risk of recurrence is low (< 10%) and most relapses occur within the first 12 months. Analogous to patients with extracerebral venous thrombosis, oral AC is usually continued for 3 months after idiopathic CVST and for 6-12 months in patients with inherited or acquired thrombophilia but controlled data proving the benefit of long-term AC in patients with CVST are not available.

What are the possible consequences of CVST ? A comment in the Wall Street Journal today suggests one.

“The clot does not dissolve or disappear as Clinton camp has inferred. About 1/2 of patients will continue to have a blocked vein, & half will have partial reopening of the vein, but either way, there will always be some insufficiency in drainage…. It is not a question of whether the intracranial pressure increases. It is a question of how severe and how bad are the symptoms that follow…I have treated numerous patients for this very issue—the consequences can lead to significant disability. It deeply concerns me that one of the 2 leading presidential candidates may have such serious health issues…Hillary [must release] her full & unaltered medical records.”

I have seen epidural and subdural hematomas from trauma, sometimes rather trivial trauma, but I have no experience with cavernous sinus thrombosis from trauma. That is usually a consequence of local infection, such as sinus or ear infection.

The next subject is her blue sunglasses, which are often prescribed for seizures. They can be used to treat Photosensitive Epilepsy.

Hmmm… Could those blue sunglasses be cross polarized lenses ?

One of our patients had clinical seizures that were inadequately suppressed with moderate doses of valproate (VPA) but completely suppressed with blue cross-polarized lenses. The second patient’s photoparoxysmal response was suppressed by both parallel-polarized and blue cross-polarized glasses, whereas the third patient’s photoparoxysmal response was not suppressed by either.
CONCLUSIONS:
These preliminary data suggest that blue cross-polarized lenses may be useful in the treatment of photosensitive epilepsies and that their efficacy can be predicted in the EEG laboratory.

Maybe Hillary needs to release her EEG results.

My brief review of the medical literature shows that cerebral venous thrombosis is rare and I can find no reports of association with trauma or concussion. Something else is going on.

Reading the tea leaves.

Monday, September 5th, 2016

Once again, Richard Fernandez finds the essential point.

Russia isn’t governed well. But people don’t rise to power in Russia according to their skill at solving public policy issues. They climb a ladder by how well they can grip the rungs of guns, bribery and deceit. Putin’s “political socialization took place as vice mayor of St. Petersburg in the 1990s, where … one of his key roles was acting as a liaison between the political and criminal authorities. It was the Wild Wild East, a world where duplicity was the norm, rules are for sissies, and only might makes right. It was a world where informal networks ruled and you controlled people by corrupting them.”

Such jungles tend to evolve very capable predators.

Putin, in my opinion, has done a fairly good job with Russia given the serious problems they have as a nation.

Madison tried to warn us about the risk of corruption, or as he called it, “Faction.”

Complaints are everywhere heard from our most considerate and virtuous citizens, equally the friends of public and private faith, and of public and personal liberty, that our governments are too unstable, that the public good is disregarded in the conflicts of rival parties, and that measures are too often decided, not according to the rules of justice and the rights of the minor party, but by the superior force of an interested and overbearing majority.

We now are at serious risk of electing the corrupt member of a cabal of self interested manipulators of the public interest for private gain.

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