Ever have surgery? If you have, and if any part of you has been removed or biopsied and “sent to the lab,” or if you have even had a Pap smear, you are the proud owner of a pathology report.

I have written a few times about being a pathologist, describing how bits and pieces of the human body are examined and a diagnosis rendered. But what happens next? The reports my colleagues and I generate, filled with descriptions, diagnoses and technical mumbo-jumbo, find their way to your doctor, either in a paper form, or more likely these days, as a digital report in your electronic medical record. Your doctor reads it and acts upon it, or mentally files it away for future reference. And perhaps he or she reviews it with you.

Yes, you certainly have a right to that path report. Your provider may give it to you, or in many instances it is available through an electronic patient portal. If you read the report you may come across a straight forward diagnosis, but you may also run into unfamiliar measurements (is a millimeter a lot or a little?), weasel words of uncertainty (is “consistent with” the same as “suggestive of”?), lengthy protocols (is “cold ischemia time” the same as “cold brewed”?), and double negatives (is it good or bad that residual tumor is “not unlikely”?) Ideally your doctor will review the report with you in enough detail to answer any questions you might have and explain how it will influence your future health care. But that can be time consuming for all involved, and unless you are taking notes, you may not recall everything that you have been told.

Is there a better solution to help you parse your pathology report? You can always send a copy to your friend if he or she happens to be a pathologist. I get a few of those a month and am happy to do a favor for a buddy and give them a “curbstone consultation,” explaining in general terms what their report means and what the implications are. But I rarely tear into the report and explain every word.

Of course you can look things up on the Internet. But to take your report and do a Google search on every medical/technical word is a frustrating endeavor. When you add everything up you would probably have something as unintelligible as instructions on a made in China alarm clock.

One nationally known pathologist has come up with another solution. His reports include a link to an online FAQ page. It can answer some common questions that might relate to your report–or it may not.

Is it really important how well you understand your report? Isn’t enough that your doctor is in the know?  Of course that’s up to you. But knowledge IS power, and when it comes to your health, don’t you want all the power you can get?

I am interested in discovering how many people actually have seen their path/biopsy report and how beneficial it was for them. If you would like to provide that information, please click this link to fill out a very short questionnaire. You will be transferred to SurveyMonkey to complete the survey. Thanks for your participation, and please pass this blog on to friends and family and ask them to fill out the survey too. I would like to gather as much data as possible.

PLEASE PASS THIS BLOG AND THE SURVEY LINK ON!

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The post election Democratic Party is a mess, its coalition in tatters now that the white male center has fled.

The Republican Party is in no better shape, unable to take advantage of its unexpected win. The transition team has fumbled as badly as Jay Cutler on a strip sack; the blown hand-off from Chris Christie to Mike Pence revealing poor signal calling from the start. “Draining the swamps” will have to wait until someone figures out how do do a public works project that works for the public. And some of the rhetoric is very, very scary.

So let’s say we muddle through the next four years. By 2020 I assume Trump will have had enough of the scrutiny and the in-fighting with a party he foisted himself upon.  He will want to enjoy the fortune that multiplied exponentially during his presidential tenure. Call him One-Term-Trump. Mike Pence will be available as a candidate, but can he survive four Trumpean years without being tainted? So Republicans may need a new man at the head of the ticket. And as for the Democrats? The bench is EMPTY.

What will the parties be looking for? Someone young and fresh, but with a little bit of experience, maybe 4 or 5 years in the Senate. Someone who understands wealth and is comfortable dealing with big business, but also has a family tradition of having a heart and caring for the poor and downtrodden. Someone who has been tested in war and can be a hero to those who want a strong military. Someone who has the courage to face Moscow down, but won’t be too quick to pull the nuclear trigger. A natural debater, and a eloquent speaker whose words can inspire. Perhaps in a religious minority, with understanding of what being a minority means. Someone with style and elegance, because when you are a world leader, those things DO matter.

Someone like that might have some baggage. So attractive, so well-groomed, many would be attracted sexually or romantically and not all would get turned down. Maybe family ties would be a little too strong at times, with that being the first test of loyalty. Maybe chronic war time injuries would be swept under the rug. And it might take some back room politics to get elected.

But it would be laid on the line, our service to the country would come before the country’s service to us. And whether this candidate is a man or a woman, black, white, yellow or brown would not matter.

The saddest truth is that we had that person He was assassinated 53 years ago today. I look at our leaders now, and I weep.

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Ice skating makes some people happy. How do I know? First I saw an overwhelmed sitcom mom having fun on an ice rink. Then I listened as an audiobook protagonist, grieving at his mother’s funeral, cheered up when he remembered skating on a frozen pond as a boy.

Now my experiences at the long gone Rainbo Arena Ice Rink in Chicago were mostly spent laying prone on the ice rather than speed skating across it, so I can’t consider ice skating a joyous activity. But the coalescence did make me stop and think about things that had made me smile over the last week or so. After all, it hasn’t been all Trump Tremors.

1. The Supermoon. We had a beautiful view of it rising above our construction site. And I got a laugh reading the article in the New York Times that dissed all the attention as being not particularly scientific. Come on–sometimes you have to think with your heart, not your head.
2. International Pathology Day. Yes, to my surprise, yesterday was a special day for my field. Of course it was totally ignored. I would have been the easy winner if it had been the topic for ‘XRT’s “3 for Free” but unfortunately the contest is off the air with Lin Brehmer in Italy. Oh well, maybe next year.
3. Our anniversary. Barb and I had the opportunity to celebrate our 38th attending a downtown wedding. We danced to “Shout,” sang along to “Don’t Stop Believing,” and of course took notes in preparation for next year’s Laury-Alex extravaganza.
4. Our anniversary, part 2. A video of our granddaughter singing “Happy Anniversary” to Nana and Baba. I won’t post a link here, but if you are a Facebook friend of Barb or me you can find it there.
5. Our anniversary, part 3. A gift book from Barb, “Hamilton: The Revolution” by Lin-Manuel Miranda and Jeremy McCarter. All the lyrics, with annotations by Lin explaining all the musical and historical references, as well as the back story of how the musical was created. A great way to indulge my Broadway passion, and prepare me for the next time we see the show (yes, there must be a next time.)
6. Some progress on the house. What is completed looks great, there just seems to be so much more to go. My smile comes when I drive to the site and see a row of tradespeople’s trucks lined up in front. I don’t get as much of a thrill when all I see is an empty house begging to be finished.
7. A surprise visit. I learned that Barb’s cousin from California will make the trip to Chicago to attend a dinner I am being honored at for Israel Bonds. Very sweet of her to come in for the event. And maybe a chance for her to spend some time with her son and his family who live here too. A definite win-win. Oh, and if anyone wants more information about the dinner or Israel Bonds, email me at les.raff@post.com.  All inquiries appreciated.
8. Buddy Ball. A great Sunday spent with good friends. Lox, chili, Password, and tears of joy (this means you, Gary) over the Cubs. Oh yeah, we watched the Bears-Buccaneers game. I promise not to spend any more Sundays this year with that.
9. Kate McKinnon on Saturday Night Live. Her rendition of Hallelujah brought a smile and then some tears of my own.
10. A Patrick Kane goal. Since we started talking skates, let’s finish the list that way too. Patrick Kane demonstrated his award winning skill against the Canadians Sunday night with an incredible falling down goal. Here’s hoping that Kane’s future is all highlight reels without any more news about predatory “locker room” activity.

So ten smiles in a week isn’t too bad! How about you–what has been making you smile? Add a comment, share the blog, let’s ind out what makes people happy!

To subscribe to downsize,m maybe! just enter your name in the box on the right margin. Or drop me a line at les.raff@post.com

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The ice caps will melt, the oceans will rise. The storms will be violent, the droughts will be endless. Yes, I fear it is all coming. But what all the meteorologists and climate scientists and other doom-sayers have missed is all the bizarre things already taking place in the world. I don’t think it is related to the amount of carbon in the atmosphere, but in the last year or so we have seen:

• Leicester City beat 5000-1 odds to win their first English Premier League title, 132 years after the club was founded. Since this is soccer, the truly odd part is not that Leicester won, but that any Americans even heard about it.
• Keeping our sights on the UK, we have Brexit, in which the Brits stunned forecasters when they decided they don’t like the rest of Europe. Maybe not so odd in retrospect.
• Much to educators surprise, Americans are learning American History–at least as much as can be learned in 2 1/2 hours of the hip-hop musical “Hamilton.” And who should steal the show but that hilarious old mad man King George III. Again, in the world of the weird, “Rule, Britannia!”
• The Cubs World Series Championship. Who predicted that as a prelude to global warming hell would freeze over?
• Trump Trump Trump. No one foresaw him wiping out the Republican challengers and then mopping the floor with Hillary. On the other hand, the Secretary’s downfall was envisioned in the Book of Revelations where it is written “From Ilarkyork will arise a mighty wind, only to falter in its quest for world domination on the altar of baggage and emails.”

Are other odd things in store? Gazing at the Super Moon, I made the following prognostications:

• Angelina and Brad will bury the hatchet, and not in each others skulls. Professing undying love and devotion, they will retreat to an uncharted island in the Pacific and never be heard from again. The truly unusual part of the story will be that People Magazine will not ask Jennifer Aniston to comment on the reunion.
• The Ricketts’ family will buy every professional sports team in Chicago galvanizing White Sox, Bulls and Blackhawk fans. The Bears will continue to lose.
• The number one box office hit over the holidays will be a lovely romantic comedy without a superhero or spaceship. The producers will admit the CGI guys were busy the day they were supposed to add in the meteor crash.
• The cure to breast cancer will be discovered, but under TrumpCare will only be available to angry white men. Other cancer victims will be given a “Make America Great Again” baseball cap.
• Paul McCartney, Ringo Starr, Keith Richards and Mick Jagger will go on a Rolling Beatles World Tour. Their contract rider will insist on dinner for the performers at 4 pm, and the soup “shouldn’t be too hot.”
• Canada will build a wall to keep out stampeding US citizens. Those Americans who make it through will have one serving of poutine, change their mind about Trump,  and head back for home.

It will be a mad, mad, mad mad world.

If I missed anything, or to subscribe to Downsize-Maybe, drop me a line at les.raff@post.com

Dear Mr. Trump,

Congratulations. Over 59 million people chose you to be this nation’s leader for the next four years. A virtually equal number cast their ballot for Secretary Clinton but it was your vision that spoke more loudly across the country, and the presidency is yours. That’s President of the United States. You will be the 12th President in my life time, but the first one that I have been moved to write to personally.

Your supporters will expect a lot from you. Your slogan “Make America Great Again” struck a responsive chord. My life has been pretty great so far without you, but I have no problem with the slogan if we can just tweak it a bit to read “Make American Great Again for Everybody.”

You have made some pretty big promises,. You have spoken of walls and mass deportations. I don’t know if you really believe in those things, but many of your supporters do. Maybe you can convince your constituency that the wall was a symbol, a bit of election rhetoric, and that there are reasonable ways to accomplish your goals of lawful immigration and secure borders.

You have stirred people to your side with a promise to bring back jobs. That is a noble goal, and I hope you are successful. But it is not a simple goal, you cannot wave a magic wand and bring back steel mills, bring back factories. Convince your followers that the nation’s  investment in education and training is the long term solution, and that we can provide support for them in the interim. Don’t let them find scapegoats. Don’t let the brutish minority of your supporters take prominence, don’t become an administration of haters.

You will have a lasting legacy via your Supreme Court nominations. I know that your choices will have a conservative bent, but I pray you see fit to name those who will not trample on the hard fought for rights of our women, our minorities, our LGBT family and friends. We are a better nation when all of our people are established as  full citizens, entitled to “life, liberty and the pursuit of happiness.”

Your biggest challenge may be setting how the country interacts with world. Where to support our allies, where to intervene, where to turn away. We live in a very inter-related time; when a butterfly flaps its wings in China we truly do feel it here. It is not an “I win-You lose” world.  If there is an element of Radical Islam that wants to destroy us it must be corralled and defeated, but the entire world of Islam is not our enemy. Other aggressors must also be contained, no matter  who their rulers are friends with.

I am both a producer and user of healthcare. I know the ACA and MACRA have many failings. But make sure what you replace them with makes our nation healthier. There are wonderful therapeutics being developed, but they are extremely expensive. Let’s look at what we can save with some emphasis on preventive care too.

The issue that the entire election ignored was climate change. It is not a hoax. There is no point in pretending it is. Barring a nuclear war (you won’t do that, will you?) it is the greatest threat to our civilization. Use your business man’s ingenuity to connect with the industries that can develop the energy of the future. Make America an exporter of that technology. Don’t just make America great, make it create–create the ideas of the rest of this century. Future generations will celebrate you for it.

I didn’t vote for you, but on January 2017 you will become my President. Please do these things for me, and for 300 million other Americans.

Lester J. Raff, MD
Son of Immigrants
Father and Grandfather to the Future

It is a Monday morning ritual. Every week at about 10 a.m. a head pops into my office saying “We’re here.” The head belongs to one of our Human Resource professionals, leading a group of dazed people, mostly young, predominantly female. These are the new recruits, the medical assistants, the billers, the nurse professionals, that are joining the UroPartners team. They are spending the day in our business office next door, being oriented, filling out forms and taking online courses on safety, HIPAA and other snooze inducing topics. The march across the parking lot to the lab is their only glimpse of sunshine for the day.

Why do we bring them over? With rare exception, these people are not future employees of the lab. They are hired to work in one of the 15 or 20 UroPartners offices spread across the metro Chicago area. But there are things I want them to know about the lab, about how we work, and I think the best way to get our point across is with some real face time and a lab tour.

Sometimes we start with a little history of the UroPartners; what we are, where we are, how the group functions.  Then we move on to lab specifics, beginning with how lab tests are ordered in the doctors’ offices and transmitted to us via our shared electronic medical record. It is at this point that I begin harping on my main theme, the proper identification of all specimens. My mantra, repeated at each stop on the tour, “each specimen label needs two identifiers, label the container, NOT the lid.” Barb swears I repeat this in my sleep.

I explain that the patients’ blood, urine and biopsy specimens are picked up from the various doctors’ offices every evening by our courier company.  I always see some eyes roll when I explain that the lab day starts at 5:15 a.m. when the specimens get to our door. Yes, we are an early morning bunch, but that is what it takes to get results out to the office in a timely fashion. By 6 in the morning, the place is really buzzing.

We walk through the lab, and I point out our various testing areas:

• Histology, where biopsy specimens are converted to thin tissue sections on glass slides awaiting our pathologists’ diagnoses.
• Microbiology, the olfactory challenging area where we look for bacteria causing urinary tract infections and also do bacterial cultures that help limit the risk of infection in prostate biopsy patients.
• Hematology and Chemistry, the home of blood counts, PSA measurement (you know how strongly I feel about that) and other important blood tests.
• Cytology/FISH, studying urine specimens in simple and more complex ways for the lurking cells of bladder cancer.

In each area, I give an idea of our turn-around time–the length of time from when we receive a specimen to when a report goes into the medical record. I explain how an abnormal result on one test can “reflex” to another. And I am always reminding about proper specimen labeling. We end the tour with introductions to our laboratory administrative team, the people who make the phone calls and ask the questions when something we receive doesn’t seem quite right.

How much of this information soaks in? Sometimes our newbies ask questions, their eyes shine, and I know they are listening. With other groups there is more of a blank, this doesn’t relate to my new job, look on their faces. My goal on orientation day is to convince everyone that sometime in there UroPartners career they will interact with the lab, and working together we can do what we need for our patients and providers. No magic about it!

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