Ten Good Reason I Donated Blood–Which One Works For You?

Give Blood…

…But don’t expect to ever see reward.

Pete Townsend-1986

I dropped a pint Tuesday afternoon. 500 ml of rich red A Positive, ready to be tested, packaged, and split off into a variety of components–red blood cells, plasma, platelets. I will barely notice it is gone, but a few strangers will benefit. To paraphrase an old Doritos ad “Take all you want, I’ll make more.”

What are my reasons for getting out to donate blood a few times a year? Here are 10:

Blood Centers don’t pay for volunteer donations, but sometimes there is a surprise inside. This time I received a coupon for a pint of Baskin-Robbins Ice Cream. A pint of red cells for a pint of Jamoca® Almond Fudge is the deal of the week.
Sometimes the donation can open a whole new world. My donation on the 10th anniversary of 9/11 earned free admission to the Baseball Hall of Fame in Cooperstown, NY. My friend who decided at the last minute he wasn’t eligible to donate was gifted with free admission too, just for thinking about it. Rest assured he has paid for that free admission with half a decade of verbal abuse.
My first boss, Dr. Earl Suckow, was a founder of North Suburban Blood Center, a progenitor of what has become Lifesource. Old Earl had a rough edge to him, and he has been gone for many years, but I never donate without thinking of him.
I have a fantasy that Ed McMahon will suddenly appear and hand me a $20,000,000 check for being the 10,000th donor of the year. The chances of this fantasy coming true are in no way diminished by the fact Mr. McMahon has been dead since 2009.
Donating a unit of whole blood is a snap. I have donated some other components in the past, and that can be a bit rough, but a simple unit of Raff Red, Vintage 2016? Easy.
At the donor center you are shown a list of exotic countries that have exotic blood borne diseases. These are places the CDC probably doesn’t want you to visit. Good to know when planning your next vacation.
A pound of body weight flows right out your arm.
Little Debbie Snack Cakes on the post donation refreshment table! So much for #7.
That one pint is enough blood for Theranos Lab and its CEO Elizabeth Holmes to run approximately 3 quintillion lab tests using the revolutionary Edison Technology. Of course all the results will be wrong.
I feel great, knowing you have helped someone, somewhere recover from surgery or battle a chronic illness. I can wear the “I Gave Blood Today” sticker with pride.

If any of my reasons strike a chord, sign up the next time a Blood Center road show comes to town. And feel free to comment below on the reasons why YOU donate.

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How to Become a Baa-Baa: A Grandpa’s Tale

What’s in a name? I blogged a while ago that I have never had a nickname. It is as glaring deficit in my personal history as not having a tattoo would be for today’s millennials. Somehow, I have learned to live as “Les”. And my full name,”Lester”, has taken on a bit of a cache since Leicester City, F.C. won its remarkable 5000-1 championship in the British Premier League Football. Yes, “Leicester” is pronounced “Lester” (and “British Premier League Football” is pronounced “Soccer.”)

But now I have a special name! I have had it for a several months, and like most special names it is one that no one could predict. What makes it super-special is that it came from my granddaughter Hannah. I am proud to be Baa-Baa.

It is always fun to guess what children will call their grandparents. When Hannah was a newborn, Barb and I played that game. Barb was hoping for “GlamMa”, defined by Urban Dictionary as “the new Grandma, a woman with a sense of self and style. ” Yes, that would fit Barb. I had no special preference, but we both agreed that we did want to be Bubbie and Zaydie, names we still feel are a little too old school.

So how did I become Baa-Baa? Every Friday morning while Barb is baby-sitting for Hannah the three of us spend a few minutes Face Timing. On one of those morning calls I gave Hannah an iPhone tour of my office, including the row of bobble heads on a high shelf above my microscope. There was a one-armed Robin Ventura, a stern Carlton Fisk, Detroit Tiger star Miguel Cabrera, and even White Sox groundskeeper Roger Bossard. Hannah was fascinated as I bounced their heads up and down. Soon all our Friday calls started with Hannah calling out for the bobble heads. “Baa-Baa, Baa-Baa” was her greeting to me. And that’s what I became. Not Robin, or Carlton, or Miggie–but I will take Baa-Baa any time.

As for Barb, both of Hannah’s grandmas became Na-Na. But now that Hannah is a little older and wants to differentiate between her two wonderful grandmothers, Barb has become Na-Na-Baa-Baa. It works!

While on family matters, just a reminder that I will be making my annual run for prostate cancer awareness and support, in honor of my late father, in the SEABlue Prostate Cancer Run/Walk. I ask all my family, friends and casual readers to support this cause. You can sponsor my run by clicking here: Support Les’s Run. I already have a great start at reaching my goal, but there is still a long way to go. Thanks for any contributions, and please mention on the link that you heard about the Run/Walk here.

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How Your Doctor Will Get Paid–Should You Care?

Meeska Mooska Mouseketeer…

…Mouse Cartoon Time Now is Here.

The Original Mickey Mouse Club

Yes, I had a crush on Annette. What baby boomer guy didn’t? That Meeska-Mooska chant was burned into my brain at an early age. And singing our adaptation of the Mickey Mouse Closing Theme (now it’s time, to say good night) at baby bedtime has been a family tradition for a couple of generations. So it’s no surprise that I felt like putting on my Mickey Mouse ears and going back to a simpler time after attending a dinner meeting of my medical group Tuesday night. The main topic on the agenda, right alongside the filet and tiramisu, was Medicare’s new payment plan, the “Medicare Access and CHIP Reauthorization Act of 2015”, affectionately known as MACRA.

What is MACRA? It describes the new system that will slowly change the way physicians and other health care providers are paid for services to Medicare patients. In simpler days, your doctor examined you, operated on you, followed you in the hospital. A bill was sent and either you, or your insurance company, or Medicare, paid it. Do a service, send a bill, get paid. Pretty straight forward, right? But over the past decade Medicare has inserted one word into the formula. Do a service WELL, send a bill, get paid.

I have no quibble with that change in philosophy. However, the difficulties include:

Who defines “well”.
What criteria do they use?
How do you measure what “they” define?
How do finances fit in?
What impact does the above have on the relationship between doctor and patient?

There are no easy answers to any of the above questions, and the process has been evolving. Results have included “expert” panels that really weren’t so expert making medical care recommendations (more on that in a future blog), the almost universal presence of Electronic Health Records replacing paper medical files (great in concept, very clunky in execution, great at allowing regulators easier access to data), and the growth of medical systems such as the Chicagoland behemoths Advocate Health Care and Northshore University Health Systems. It has also lead to a series of ever changing programs that help define how Medicare pays your doctor. We have struggled through an alphabet soup of SGR, PQRS, MU, ACO, and now MACRA, with its evil step-children, MIPS and APMs (don’t ask).

What parts of this matter to you? Should you care if your favorite doc earns a little bit more or less income every month? Probably not. Should you care if all this leads to better health for you and a smaller health care bill for the nation? Yes and yes. But if all this leads to your doctor typing into your medical record rather than talking to you, you should care about that too. And if smaller physician’s groups are driven out of business by the need to keep up with the changing rules, or if they all sell out to the “big boy” hospital systems you should definitely care about that, as it can impact your access to care.

There are no easy answers, and no crystal balls telling us how this will work out. I hope for the best from both sides of the equation, as my practice winds down and as Barb and I age and become bigger consumers of health care.

There is only one thing I can say for sure…in American medicine, every day has become “Anything Can Happen Day!”

Virtual Prizes for Virtual Contests-White Sox, WXRT and Donald Trump

Feelin’ Groovy!

59th St. Bridge Song

Simon and Garfunkle-1966

Remember Sarah Palin’s “Bridge to Nowhere”? It was a convoluted tale that garnered a lot of attention when the Alaska Governor was selected as John McCain’s running mate in the 2008 Presidential election. Since than Madame Palin has had the career to nowhere, but that is a story for another day. But do bridges to nowhere lead to “contests to nothing?” Two of my favorite local media outlets have gone that route.

Even though I grew up on the North Side (Rogers Park to be precise), I have spent my life a diehard White Sox fan. And like many White Sox fans, the past few years have been dreary, dreary, dreary. Whether the fault has been lackadaisical players, a too laid back manager, or too many Ken Harrelson “Hawkisms”, watching the beloved Pale Hose on the tube has been a type of torture specifically outlawed by the Geneva Convention. This year has been a breath of fresh air as new players Todd Frazier and Brett Lawrie have had a spring in their step, Robin Ventura has suddenly remembered to manage, and most importantly, there has been a new voice in the White Sox TV booth. Jason Benetti is now the Sox play-by-play man for home games. Paired with color announcer Steve Stone, Benetti has brought a lively new spirit to the broadcast. They have also brought a new contest, the aptly named “White Sox Math”. It’s a daily contest with problems such as “Multiply Jose Abreu’s uniform number by Jimmy Rollin’ s strikeouts in 2005 and then add Chris Sales career saves.” If you are a total stats geek or happen to have the Baseball Almanac handy, you will of course quickly arrive at the answer of 5621. And your prize for having all that information rattling around in your brain? A trip to the “Virtual Prize Shelf”. That’s virtually–nothing!

Not to be outdone, or perhaps underdone, my favorite radio station WXRT has a contest of its own. Every morning at about 6:40 Lin Brehmer and Mary Dixon host “Three for Free.” Tweet in the correct answer to their audio quiz about the celebrity of the day and you can win exactly…nothing!

Yet somehow there I am watching the White Sox with my calculator in hand, or intently listening to Lin and Mary’s musical clues. And since there is a winner every day, I suppose I am not the only one willing to put out all that effort for nothing. So I suggest a few more contests with prizes of questionable value:

Volkswagen will give a new diesel car to the first correct answer in their “Predict Our Next Estimated Mileage Report” challenge.
Elon Musk will present a hyperloop ride from Wrigley Field to the Cell to the winner of the “Who Can Predict How Long the Tesla Model 3 Will Be Delayed” contest.
The Department of Transportation will give a TSA job to the first person who–well, basically to anyone. No contest entry needed.
The Republican National Committee wants to award the Vice Presidential nomination to the first voter to provide Donald Trump with a foreign policy. Send the RNC your plan, single spaced, with a self addresses, stamped envelope and prepare to go to Cleveland.

And of course, just by reading this, you are entered into my contest to win–nada. Happy trails!

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photo credit: Footbridge via photopin (license)

Inspired by Budweiser, I Rechristen our New House

By now, everyone with a TV or Internet connection has heard about Budweiser’s new summer marketing plan. Instead of being labelled Budweiser, cans and bottles of brew will have the familiar Bud script replaced with “America”. The labels will also be festooned with patriotic slogans. “E Pluribus Unum” on the package instead of “Profits Sent to the European Multi-National Company We Really Are”. Not a bad sleight of hand! By the way, did you know that Clydesdale horses are Scottish?

Since we are intent on making America great again, and since “American” branding is a super idea for the 25th most valuable brand name in the world, I realized we could get some mileage branding our future home as well. From now on, instead of continuing to call our soon-to-be residence the “new house in the last vacant lot in that nice development by the Tristate”, I am dubbing it the Midwest White House. No, we haven’t switched the exterior stone to alabaster, I just want to make sure you know we are an American Brand.

And things are ramping up at the MWH. On Saturday morning, First Lady Barb and I had a lengthy onsite meeting with our architect, Alexander Hamilton, and General Contractor Thomas Jefferson. We climbed up the American Oak construction stairway to the loft, and in the bitter May cold finalized the design of what is now known as the Lincoln Bedroom. We shaved a closet here, expanded the attic there, and closed off a wall so that future generations of Americans won’t fall backward down the stairs. The space is now perfect, and can even be used for hosting foreign dignitaries. Or we may auction off the privilege to spend nights in there. That is a strategy that raised plenty of campaign cash for Bill and Hillary when they auctioned off nights in their Lincoln Bedroom.

Once the loft was settled, we returned to the main floor. The library, heretofore to be known as the Oval Office, still presents some challenges. We are not quite sure how to place two desks in such a way as to give us both a view of the TV for watching important press conferences. We are hoping our designer, Betsy Ross, will come up with an improved layout. If she does well, we may toss her an extra star to sew onto her flag. We have finally settled on a design for the Presidential Bedroom Suite, although Ham and Jeff are concerned that our plan deprives us of a view of the Rose Garden. It just proves that even when building a national treasure, some sacrifices must be made.

The basement still seems enormous to me. Tricky Dicky Nixon put a bowling alley in his White House basement, we will settle for an exercise room and wet bar in ours. I do have my eye on a nice American Eagle area rug that will keep the American brand going throughout the house though. I’ll run it up the flag pole and see if Barb salutes.

So that’s my plan. And to the Anheiser Busch-InBev Company of Leuven, Belgium, I salute you for the great Americans you are. And remember–this Bud’s for you!

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Walgreens and Mental Health–Better Luck This Time?

Chicago locals take pride in Walgreens, the big ole pharmacy chain that got started way back in 1901. There actually was a Mr. Walgreen back then, and the chain slowly expanded through the Chicago area. Walgreens’ international headquarters are still close by–I drive past them in Deerfield just about every day. But Walgreens is a lot more than the corner pharmacy these days.

You may remember the Theranos nightmare; I have written about it a few times. Theranos was the clinical laboratory started by Elizabeth Holmes, the clone formed by a pseudo mating of Steve Jobs and Bill Gates. Her concept, to perform a wide range of blood testing from a finger prick, was going to revolutionize the laboratory world, and Walgreens was going to be her partner! Somehow Walgreens, a multi-billion dollar firm, fell for the hype of an unproven, untested methodology. I imagine the embarrassment that must have been felt by the Walgreen’s Board and CEO when Theranos started failing quality and accreditation inspections left and right. Neither Walgreens nor Silicon Valley did a very good vetting job before turning Theranos into a unicorn.

But Walgreens is marching on. In a press release yesterday the company announced its commitment to mental health. Through a series of new links in a section on its website,

“Walgreens can help connect people to free, scientifically based online screenings for a number of conditions, including depression, anxiety, bipolar disorder, PTSD and others.”

Thank heavens this time Walgreens is going for “scientifically based” processes! I admit I don’t know as much about mental health issues as I do about laboratory science. But I have seen family members and friends stricken with crippling depression and bipolar disorder. I also have friends and relatives who are mental health professionals. I hope that those professionals, and the mental health community as a whole, will examine the Walgreens’ web site and determine if the tools that are presented really do help in self-identification of patients with mental health disorders, and that the site is also useful in getting those people the help they need. I’m crossing my fingers that this time the results are positive. Walgreens doesn’t need another failure (Laury has a few shares of their stock) and neither do the people they are trying to help.

In another health related matter, I have tabulated the results to my non-scientific (there, I admit it) insurance poll from a few weeks ago. Most of my readers pay significantly more for health care coverage than they did previously and have also seen cut backs in their coverage. That mirrors our own family. I still believe in many facets of the Affordable Care Act, but I know that “affordable” may not have been the most appropriate moniker.
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Standard Operating Procedures.

If the rule your followed brought you to this…

…what use was the rule?

No Country for Old Men — 2007

Standard operating procedures (SOPs) are the life blood of the laboratory. They tell us what we are doing and how to do it. The best ones even tell us why we are doing it. I would never suggest changing an SOP without validating any new process, verifying that any changes produce results at least as accurate, timely and cost effective of what came before. But rigid procedures can lead to monotony and lack of attention. And lack of attention can lead to errors. Sometimes just a tiny tweak, not in the procedure itself, but how you go about following it, can freshen up an otherwise mundane task.

In my work as a urologic anatomic pathologist, I spend several hours each day examining prostate biopsies. Now, I cannot vary that I have to look at each slide carefully, need to make decisions about presence or absence of malignancy, grade the tumors I observe, and record my findings. Those steps are immutable. And after 11 years, they could easily be cemented in stone. But I have discovered that making small changes in the way I go about each step gives me elasticity and prevents mind freeze.

What kind of changes am I talking about? First, I have to admit that there was one big one. For years I had been using the same microscope, actually one I brought with me from my old hospital position, an older ‘scope the hospital sold to me for a song. Last year my colleagues convinced me that an ergonomic microscope with a tilting head and eyepieces would go a long way toward preventing back and eye strain. And that’s important as I enter my fourth decade of peering down the ‘scope — something both my Lab Safety Officer and more importantly my Occupational Therapist wife, agree with.

So that was a pretty big variation, but most of the others have been small, simple and inexpensive. I changed the location of my microscope, putting it just a quarter rotation of my chair away from my desktop computer. As we have become integrated with an electronic medical record, I find myself more and more frequently logging into the computer to get some patient information from the EMR, so the proximity is a real time saver. And the change in “locale” made the work seem fresh again.

My latest initiative changes the way I dictate my cases. I have traditionally used dictation equipment using a foot pedal so that I can dictate in real time as I look through the ‘scope. We progressed from tape to digital a few years ago, but that didn’t change my style. However, I recently decided to record my findings in writing and then dictate at the end of each case. I developed a worksheet that makes it simple to record Gleason Score and extent of tumor in my prostate cancer cases. It’s a snap to read my findings off the worksheet after each case. Now I have a written record in case the dictation gets disrupted. And no complaints from the transcribers so far.

Even outside the lab, “SOPs”, can be useful, but find a way to keep things fresh! It may be adding nutmeg to a recipe (easy), finding a new route to the job (moderately challenging), or building a new house (insane). It will keep you rocking.

(Note: To my colleagues on the various lab listserves, feel free to distribute)

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George Lucas-I’ve Got Your Museum Right Here!

If you build it…

…he will come.

Field of Dreams-1989

April showers have hopefully faded away. The Cubs and Sox are both in first place. Cinco De Mayo is here. And we are making progress on the house! With carpenters working overtime (but not violating the neighborhood construction restrictions!) the framing and roof construction are near completion. Barb took a climb on a rickety ladder yesterday and tells me the view from the second floor is magnificent. Of course, when all the wallboard is up some of those sight lines will disappear, but we will always be able to look out at our tranquil pond and its occupant swans, Harvey and Sheila (Alan Sherman, anyone?) We have also finalized selection of the exterior stone; a little of this color, a little of that color, then a little more of both. Preliminary sketches for cabinet designs are done. Barb has raised her sights and begun assaying light fixtures.

All this leads me to believe we WILL eventually be moving into our new home. And I have a convenient solution to the problem that has been plaguing Chicago and George Lucas. Where the heck to put that museum? The Lucas Museum of Narrative Art has been ejected from San Francisco, evicted from its first potential Chicago site, and now the McCormick Place locale is also being challenged. Mellody Hobson, George’s wife, has pronounced they may look elsewhere, prompting Waukegan to get in on the action.

Waukegan? That’s half way to Wisconsin. And don’t they have something nuclear up that way? A Jack Benny Museum I could understand, but Lucas? I have a much better suggestion. When we move out of our Long Grove home, the Lucas Museum can move in! It’s a revolutionary suggestion, but the pros outweigh the cons.

Pros-

Long Grove is used to crowds-the Apple and Chocolate Fests really pack ’em in. And this could be a bigger deal than Strawberry Fest.
The kitchen is perfectly designed for dishing out American Graffiti Burgers. Just be kind to the marble countertops.
Now that we sold the exercise equipment from the bonus room ((Thanks Wallapop!) there is plenty of room up there for a Millennium Falcon exhibit.
Six bathrooms and no North Carolina type laws restricting their use.
Pretty good cell phone reception, as long as you stick to Verizon.
Long Grove isn’t that far from Harrison Fords hometown of Park Ridge.
Empty lot behind the house is perfect for parking.

Cons-

The Home Owner’s Association Renovation Committee might be picky about exterior signage. No wait, Barb is ON that committee. No problem as Lucas gets it approved before we move.
Long Grove is not known for its public transportation. However, I am sure we can work out a deal with all the landscapers to use their trucks to move folks in and out.
We think Adam Driver is better on “Girls” than he was in “Star Wars: The Force Awakens.” But maybe he will bring Allison Williams to the Grand Opening, so all is good.

All in all, its a win-win. Mr. Lucas, let’s do this!

Live Long and Prosper!

I’m gonna live forever…

…I’m gonna learn how to fly

Fame-1980

Barb and I have been lying. To ourselves and to each other. To friends and family too. Ever since we turned the big “LX” along with some of our buddies, we have been telling the world that 60 is the new 40. It turns out we were wrong. According to an article in the New York Times, 60 is still 60. Our bodies have changed, our brains have changed and we are in the “anteroom of the aged.” How’s that for a spring awakening?

The Times article, written by Gerald Marzorati, suggests that all the workouts, all the dieting, all the brain games we play won’t really do a thing to keep us from aging, gracefully or otherwise. The author’s prescription for possibly adding a few years of life, and keeping memory intact, is to choose and master a new task. And not to go about it casually, but to find a coach in whatever it is you want to master, and strive for the 10,000 hour mark that makes an expert. Talk about digging in!

The task Mr. Marzorati has undertaken is to become a decent tennis player. He has trained in at a tennis academy and improved his game. Now Barb and I have been playing tennis for the last 10 or 15 years, sometimes with coaches, sometimes without. I regret to say that if becoming a good tennis player is what it will take for either of us to add a decade or so, we might as well have the Grim Reaper as the line judge.

So what are the new tasks we can choose to master? Who knew that Barb would become a juggler? She is currently juggling building a house and selling one, doing hand therapy here and hand therapy there, planning a wedding for one of our kids and baby sitting for the other, and oh yeah tennis. She may not have coaching for most of it, but I see no problem with her getting in her 10,000 hours of juggling. She must be lengthening her lifeline with every faucet she chooses and diaper she changes.

As for me, to master a sport, any sport, is a non-starter. I have given up golf, frequently feel like giving up tennis, and haven’t bowled in years. I do a bit of running, but my time for last weeks 5K race indicated I won’t be winning any trophies, even in my senior(ish) age group. I guess short form writing, such as this blog, has become my new passion. 10,000 hours = 10,000 posts? I don’t think anyone would want to sit through that! Now a novel on the other hand…that would add years to my life!

Any suggestions for new skills to master, comment below, or send ’em along to les.raff@post.com.

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