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!

You never know what you will find here. To subscribe, type your email address in the box and click the “Create Subscription” button. It is completely spam free, and you can opt out at any time.

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.
_________________________

You never know what you will find here. To subscribe, type your email address in the box and click the “create subscription” button. It is completely spam free, and you can opt out at any time.

________________________

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)

———-

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.

———————————–

Running Mates and Other Mates: Fighting Trump, Fighting Cancer

Girl, I heard you’re getting married,

Heard your getting married,

This time you’re really sure.

Brooklyn Bridge-1969

Ted Cruz keeps looking for a partner. First we have the sort of/maybe/not really deal with John Kasich, trying to not cut each others throats in the remaining primaries. Quickly followed by yesterday’s announcement of Carly Fiorina as his Vice Presidential running mate, and vocal coach as well. All of this, of course, in an effort to stymie Donald Trump in his march to the Republican Presidential nomination. It appears that Cruz’s philosophy is that if you can’t win on your own, grab your partner or partners and do-si-do.

I don’t know how well the pairing technique is going to work in politics, but a new study reported in the journal Cancer and summarized in the Chicago Tribune suggests that married patients do better in their fight against cancer than comparable single people. The advantage is greater for men than women, and is not associated with socio-economic status. It seems that hand holding, cooking, chaffeuring and all around loving can help survival. No surprises there, right? But it brings to mind a former colleague of mine, one of the most talented men that I have had the pleasure to have known and work with. Let’s call him John, and his wife Mary About 18 months ago John was given the diagnosis of advanced lung cancer. He has undergone surgery, traditional chemotherapy, and novel treatments as a patient in advanced clinical trials. During all this John has maintained his active lifestyle and achieved new professional goals and accomplishments. He has documented his battle in a wonderful blog (the blog is not public, I cannot share a link) that both faces the difficult realities and celebrates all the wonderful triumphs. And as he freely admits, it is the love, care and support of the magnificent Mary, now aptly nicknamed Chemo-sa-babe, that makes it all possible. I know that as I experience John’s life on his blog, Mary is there holding his hand for every battle won and for every set-back. And as the study in Cancer suggests, that hand holding may be the reason the wins so greatly outnumber the backslides.

Cancer has also visited our family; fortunately it did not stay. I hope I did enough to support Barb four years ago, though I think it may have been the prospect of Michael and Becca’s wedding that hastened her recovery. I hope neither one of us becomes the supporter or the supportee in the future.

And as for Ted Cruz, does it matter how many partners he takes? He will continue to be Ted Cruz, and that doesn’t seem to be the man the rest of America wants to marry!

Type your email address in the box and click the “create subscription” button. My list is completely spam free, and you can opt out at any time.

Doctor, Doctor, Give Me the News

Affordable Care Act or Obamacare, no matter which one you call it, it has probably had some effect on you or your family. As a “bleeding heart liberal,” I applaud the expansion of some sort of insurance coverage to millions of Americans. As a physician, employer and provider of health care insurance for the two of us, I have my reservations about the cost-benefit ratio. I have been hit by higher premiums, higher deductibles, changing provider networks and complex pharmacy rules. I understand that even without the ACA, health insurance premiums would rise pretty steadily every year, but some of the other perturbations in the health care system seem to be a direct result of the Act. And don’t ask Barb about the phone calls she gets from our insurance carrier offering to make her primary care appointments for her, probably as a result of the carrier trying to meet some new quality regulation. As she points out to the caller regularly, she is quite able to make an appointment, and money spent on calling her is money wasted.

When I look for data about the effectiveness of the Act, I can find statistics about the number of new insurance enrollees and Medicaid enrollees, but nothing much telling me if the health of the nation has improved and if people are satisfied with their coverage. So I am taking an informal poll. Its just a few questions, and won’t be scientifically significant, but if you have a few moments, click on the link below. If we have enough results, I will publish them at a later time. To that end, please feel free to pass this post around!

Click here to take the poll.
—————————————
You never know what you will find here. To subscribe, type your email address in the box and click the “create subscription” button. It is completely spam free, and you can opt out at any time.

photo credit: <a href=”http://www.flickr.com/photos/127934495@N07/25141039242″>160225-D-DB155-007</a> via <a href=”http://photopin.com”>photopin</a> <a href=”https://creativecommons.org/licenses/by/2.0/”>(license)</a>

When Cancer is no Longer Cancer

Things change. A recently published study discusses re-evaluation of a certain type of thyroid lesion–Encapsulated Follicular Variant of Papillary Carcinoma of the Thyroid (EFVPTC). Follow up on over 100 patients who had the lesion surgically removed showed no evidence of spread or recurrence. The findings imply that EFPVTC is benign, with no need for further treatment, and tumors with this particular microscopic appearance will henceforth be given a rather lengthy name, shortened to NIFTP . Don’t call it cancer! The appearance of the tumor hasn’t changed, just our understanding of its behavior*. This is big and important news for patients with a lump in their throat. Similar re-evaluations have arisen or may arise in dealing with lesions in the bladder, prostate and breast.

I learned about the study in an article in the New York Times. The article is interesting reading, but what I spent more of my time examining was the Reader Comments section of the Times. I am amazed at the varying opinions, observations and hostility that this article provoked. A major thread is that Cancer-Industrial Complex (CIC) of physicians, hospitals, and Big Pharma are in the business of over-diagnosing and over-treating cancer in the interest of increasing revenue. These readers are amazed that the CIC would ever allow a study to be published that would decrease the number of cancer patients. After all, fewer cancer patients equals fewer dollars in the hands of greedy docs, hospital administrators and pharma execs. Then there are the readers who believe a study such as this one must be supported by the government and insurance industry. Medicare, Blue Cross, Humana and others stand to save millions of dollars if there are fewer thyroid cancer patients making claims.

My view? Designations change. One way is through the use of long term follow up studies such as the one on EFVPTC. Molecular studies on the genes in tumor cells may soon do an even better job at differentiating benign tumors from malignant ones. In the meantime, I report what I see under my microscope, the “names” I use based on our current knowledge and agreed upon terminology. My goal is neither to enrich our “industry” or save the insurance company some bucks. The people whose biopsies I look at may not know my name or where my office is, but they are still my patients, and I want only the best for them.

*A reinforcement. The findings in the published article refer to only one very specific type of thyroid cancer.

—————————————-

Kitten Power Can Get Things Done

And I’ll be takin’ care of business, every day…

…takin’ care of business, every way.

Bachman-Turner Overdrive-1973

The mighty Colorado River carved the Grand Canyon over millions of years. The immense pressure of the earth’s mantle creates the environment for the creation of diamonds. Small aquatic plants and animals crushed under the weight of sea beds leads to petroleum. So eons and eons and tons and tons can lead to massive changes. But what can the weight of a seven pound cat accomplish in the span of just a few years?

We have talked about our kitten and my problems with her before. The two of us are on improved terms these days, though her objections to visiting the veterinarian did lead to several scratches, puncture wounds and a cancelled appointment. She remains tiny, even more apparent now that she has lost her warm winter coat. But this skinny, demure creature has made an indelible impression on our house (for sale! for sale!) , or at least on our furniture.

Note chair “A”. See the nice straight line of the back cushion. That’s what our bedroom chairs looked like before Princess Kitten came along. Now lets take a look at Chair “B”, the cat’s favorite perch. On this chair, that back cushion is a deep “v”, a permanent, unreversable groove. I don’t have to tell you which chair has been the kitty’s favorite sunning spot for the last four years, do I?

So it doesn’t take a lot of weight, or even a lot of time, to make a dent in things. Look what this welterweight has done in just four years, the length of one Presidential term, or the length of time it might take to build our house. Is there a lesson to be learned? I guess you don’t have to have the power of the Colorado, or the weight of the earth’s crust to make a difference. Sometimes a little steady, gentle, pressure can get the job done. Sort of fits with my preferred management style. Of course, unlike our kitten, I try not to shed my fur as I go!

——————————-

What’s in Your Wallet? There’s a Little Aluminum Foil Package In Mine.

You can’t always get what you want

but if you try sometime you find

you get what you need.

The Rolling Stones-1969

I don’t leave it to chance anymore. There is always one in my wallet, sealed in its aluminum pouch. It was Barb’s idea. “You’re out and about and wish you had one, and then you get irritated when you try to buy one and can’t get the type you like.” After almost forty years of marriage, I have learned to listen to my wife on matters of such importance.

It wasn’t always a necessity. I used to be able to get them with ease. Every store had one of my favorites. Barb could buy them for me anywhere. We could share one, or I could grab one even if Barb wasn’t around.

It is a lot tougher to find what I want now. Last month we were headed for what promised to be an interesting evening at the home of friends. From past experience, I knew our hosts wouldn’t have any and it would be prudent to bring my own. Maybe I was distracted when we left our house, but I forgot to grab one or two from my stash. Realizing my slip-up, we stopped at a convenience store and I searched the shelves. I found plenty of exotic varieties. But where were my favorites? I unearthed a pile of them in the back of the store, unwrapped, unappealing, and not for sale. But I convinced the clerk I absolutely had to have one, and we negotiated a price. We closed the deal and the night was saved…I had my Lipton Tea Bag.

Yes, when it comes to my tea, I am a demanding purist. Give it to me black, without bergamot or orange rind. Load it with caffeine and make the water hot enough for a full, rich brew. No fancy blend is needed. Plain old English Breakfast will do nicely. But the supermarkets are crowded with frou-frou flavors, and restaurants are even worse. When I ask for tea at the trendy neighborhood trattoria, the waitress will flip open the polished rosewood box and tell me they “have Herbal Raspberry Zapper and Decaffeinated Green and of course Chamomile with Rose Hips.” Or the snooty waiter at the four star joint will tell turn up his nose and say “we have first blush, the finest tea in the world,” for a mere $25.00 a cup. I beg for Lipton. And if my favorites cannot be found? I whip the aluminum pouch from my wallet, rip it open, and ask for a pot of boiling water. Let them charge me a corkage fee, I am brewing my own! I was never a Boy Scout, but now I know. When it comes to my favorite drink, just like everything else in life, it pays to be prepared.

——————————