October 31, 2011

What A Difference A Day Makes . . .

. . .  24 Little Hours

My backyard at 4 p.m. Saturday October 29:

My backyard at 4 p.m. Sunday October 30, 2011;

I was going to finish this post with some philosophical crap about how I need to remember when I'm having a bad day tomorrow will be better. (I know, YUCK!). Actually I like both photos and enjoyed both days. Maybe there's a philosophical maxim there, but I'll leave that to you.

October 28, 2011

TGIF: A Light Touch for an Important Issue

We've talked about some heady issues these past few days. Today's post addresses another important issue -- breast cancer -- but in an unexpected "Chippendales" sort of way. Hey, if this approach can help women remember their self-examinations, so much the better! And I know a few men who will enjoy this as well.

October 27, 2011

Part 1: When Making Health Care Decisions, Should We Switch the Default from "Just Do It!" to "Watchful Waiting"?

On Monday, we reviewed the federal task force recommendation against routine PSA screening for men, regardless of age, since the test tended to lead to other treatments that didn't prolong life and even impaired quality of life.

In Tuesday's post, we considered other common tests and procedures that researchers have challenged for similar reasons.

This research made me think about how I've tended to make my own health care decisions. My decision on how to deal with the finding in 1994 that I had prostate cancer is a good example. As I said, consultation with my urologist, and my own research, narrowed the options for me:
  • Surgical removal of the cancerous prostate, with the known risks of erectile dysfunction and/or incontinence.
  • "Watchful waiting" -- we take no immediate action, but carefully monitor developments.
It was an easy decision for me, given my tendency to favor doing something when the options are "act" and "do not act." I had the surgery.

Looking back on that 1994 decision, and on what's happened since, I wonder if the quality of my life might have been better if I'd opted for watchful waiting instead of surgery.

Part 2: Even With Good Info and the Best of Intentions, Doctors, Patients, and Families Will Still Opt for Useless -- Maybe Harmful -- Tests and Procedures

If patients become better informed and play more active roles with their doctors to manage their health care, some reduction in overtreatment might result, but it wouldn't have a major impact because of the way doctors, patients, and family members interact in today's health care system.

Role of Doctors
In a recent survey reported in the Archives of Internal Medicine, nearly half of the more than 600 primary care doctors who responded believed that their patients received too much care. Almost a third of them acknowledged that they were partly responsible for this surfeit of care.

The doctors surveyed attributed the pressure to overtreat patients primarily to three factors:
  • Almost half believed that inadequate time allotted to patients led doctors to order more tests or refer them to specialists.
  • More than three quarters believed that the fear of malpractice suits or of being perceived as not doing enough put undue pressure on them to order more treatment.
  • More than half believed that the quality measures and clinical guidelines endorsed by health care experts and insurers as a way of reining in health care costs were in fact having the opposite effect. Ironically, most of these guidelines -- which insurers increasing link to reimbursement -- are based on more testing and treatments.
  • Some accuse doctors of prescribing unnecessary care for financial gain. But only 4 percent of the doctors surveyed believed that was a factor. (A brave 4%!)

October 26, 2011

A Walk in Roscoe Village, Ohio and into the Surrounding Woods

It's a great Halloween house, although the 30-40 steps up to the door might discourage sugar-addled trick-or-treaters from making the ascent. Come to think of it, does this beautiful old house resemble -- just a little -- the Bates Motel from Psycho? I love the multi-colored leaf-strewn lawn.

Before my friends enjoyed their sunny day at the Coshocton-Ohio County fair two weeks ago, they had a few rambles through surrounding parks and small towns on a cloudy day. Here are just a few of the photographs they took.

October 25, 2011

Other Healthcare Tests and Procedures Under Scrutiny. What Should YOU Do?

Yesterday, I discussed the uproar over -- and my own uncertainty about -- the federal task force recommendation that men not get the PSA test for prostate cancer. I had my cancerous prostate removed in 1995, and have been having PSA tests twice a year since then.

Should this new recommendation simply serve as the start of a conversation between doctor and patient, leaving the decision for action -- if any -- up to them? Or should Medicare and private insurance companies just stop reimbursing for the test?

I'm similarly unsure what to think about other tests and procedures now being challenged. Do they help? Do they save lives? Do they cause harm? Do they add unbearable cost to our health care system? Do we check "all of the above"?

October 24, 2011

Uproar Over PSA Testing: Would I Have Been Better Served If I'd NOT Had the Test OR the Operation?

I've been following with interest the fallout from a federal task force conclusion that most men should not routinely get the PSA blood test for evidence of prostate cancer. I got the test back in 1994 and had my prostate surgically removed in 1995. A post-operative PSA test showed that cancer cells remained, and I've had the test every six months since then.

Now, the U.S. Preventive Services Task Force has concluded that the exam does not save lives and may even lead to harm for 20-30% of men. (These PSA recommendations are proposed and still have to go through a comment and review procedure.)

The task force stirred up similar controversy in 2009 when it recommended against routine mammograms for women under 50, and suggested screening at two-year intervals after that age. When a firestorm of protest erupted, the recommendation was withdrawn.

The 16-member task force -- which reports to the Department of Health and Human Services -- was established to perform an evidence-based assessment of preventive medical care. Its recommendations could affect what services Medicare and private insurers will cover. And under last year's health care reform law, their findings carry additional weight.

The PSA issue is part of a bigger, growing debate about our overuse of tests, drugs and procedures. Does this trend toward excess (which seems part of our culture) needlessly drive up health care costs and expose patients to risks? Does it help explain why U.S. healthcare is the world's most expensive, but hardly the best?

October 21, 2011

Stem Cells: Two Updates

It seems every time I review the latest medical developments online, there's something new about stem cells. Here are two of the most recent items; each carries its own surprise. Did the Vatican really fund stem cell research?

October 20, 2011

Jefferson and Monticello: A Bit of History

Last Saturday's visit to Monticello (see the photo post below) re-ignited my fascination with Thomas Jefferson, no doubt the most brilliant and multi-talented of our Founding Fathers (who all stood head-and-shoulders above our current crop of politicians!). I remember Jack Kennedy's quip at a dinner for Nobel Prize winners:
I think this is the most extraordinary collection of talent, of human knowledge, that has ever been gathered together at the White House, with the possible exception of when Thomas Jefferson dined alone.
Jefferson As Statesman
Here's the chronology:

October 19, 2011

Monticello Glistens on a Glorious Fall Afternoon

Last Saturday I woke to a beautiful fall day. For the first time since the car crash two months ago, I felt like getting out and doing something. We decided to check out Charlottesville and the University of Virginia campus, designed by Thomas Jefferson.

A few miles out of Washington in bumper-to-bumper traffic, we wondered if we'd made a good decision. Then I remembered that the road to Charlottesville was also a route to the Skyline Drive in Virginia's Blue Ridge Mountains, where the fall foliage was approaching its colorful peak. So we took a different, longer route.

When we finally arrived in Charlottesville, we discovered another unfortunate coincidence: it was homecoming weekend at UVA, featuring a football game with Georgia Tech. Lots of traffic. An army of pedestrians. But -- as these pictures show -- what a beautiful day!

October 18, 2011

Tony Bennett's Duet with Lady Gaga: Love It!

The power of music! The power of unexpected friendship. The power of keeping your mind open to All Things New. Oh, by the way, Tony Bennett is EIGHTY FIVE years old. Talk about "young at heart"!

Click, watch, enjoy, feel your blood pressure go down, and your spirits soar. Go, Tony! Go, Gaga!

Now, check out the kudosTony gives Gaga. WOW!

The Legend giving major props ("bigger than Elvis"!) to a fellow performer who is SIXTY years younger than he is. Fabulous!

October 17, 2011

Family Get-Together and Cookout at Son Todd's House

I've often mentioned the role luck has played in my life. Here's an especially happy example: my two children, three grandchildren and two great granddaughters all live in the Baltimore-Washington area. Yesterday (Sunday, October 16), son Todd invited all of us for a cook-out at his house in the hills near Thurmont, Maryland.

It was a perfect day (except for the Redskins' sabotaging their previous good showings with an interception-plagued loss to the Philadelphia Eagles).

Here's our host and cook Todd:

Todd prefers to live either in the heart of the city or way outside the suburban developments. I wouldn't want the troublesome commute, but Todd loves living here, and these pictures show why:

October 14, 2011

A Farewell Tribute to Employee-Owned BNA

Let me make it clear from the outset: with its sale to Bloomberg, BNA will not just survive; it will thrive. BNA's employees will have more security and opportunity with Bloomberg... surely more that they would have enjoyed had one of BNA’s existing competitors purchased the company instead. Hats off to BNA's top management and board of directors for pulling off this result!

Nonetheless, I'm still a little sad to see BNA's tenure as the nation's oldest 100% employee-owned organization come to an end. So, in a fond farewell, here’s a brief recap of the company’s early years.

October 13, 2011

Connecting the Dots That Led to My 40-Year Career at BNA, the Nation's Oldest 100% Employee-Owned Company... But No More

In my October 7 post (see below), I reviewed the three stories Steve Jobs told in his 2005 commencement address at Stanford University. First, he “connected the dots” that led him to his work at Apple. “You have to trust in something -- your gut, destiny, life, karma, whatever. This approach has never let me down, and it has made all the difference in my life,” he said.

While I hesitate to compare myself in any way with such a visionary pioneer, I've had similar thoughts about my own unplanned path toward a career that was damn near perfect for me. I’ve always just called it serendipity. Here’s how I connect my own dots:

October 12, 2011

"To Autumn" by John Keats

I've written recently about my fondness for October. I've written, too, about the power of music, and the effect it has on our health. I have friends who'd say that poetry has powers similar to those of music. The short work below offers poetry, music, and a beautiful appreciation for this magical time of year.

John Keats was only 23 years old when he wrote this poem. About 17 months later, he died. I wonder what he might have created if he'd lived a longer life.

The sketch above of the handsome young poet was completed by Charles Brown in August, 1819 -- just a month before Keats wrote the glorious ode that follows.

October 11, 2011

The Coshocton-Ohio County Fair. Memories of MY Tompkins-New York County Fair Many Moons Ago

Ah, October! There's so much to like about this month: a happy goodbye to the summer heat and humidity of Washington, DC... those amazing, rich colors of the fall... the cool, snappy mornings and the warm, sunny afternoons.... It's a favorite time of the year for me. I feel the same way about April, six months away on the other side of the calendar.

I was reminded of my fondness for October this past weekend, when a friend emailed me some pictures he took on a recent trip with a friend to Coshocton, Ohio. Their visit there with Steve's wonderful, active, 94-year-old, piano-playing mother happily coincided with the run of this year's Coshocton County Fair. It's a big event in this east central Ohio county, and this year it celebrated its 160th anniversary. And what's not to love about the merry-go-round, above? The very first painted pony I ever rode -- at the Tompkins County Fair in upstate New York -- looked pretty much like these.

The pictures that follow below brought back memories of my own happy childhood experiences at the Tompkins County Fair. I'll bet you a roast beef sundae that something here looks very familiar to YOU.

October 7, 2011

Reflections on Steve Jobs and His 2005 Commencement Address at Stanford

Learning of Steve Jobs' death, I went back to his 2005 commencement address at Stanford University, which is mentioned in many "appreciations" and obits. I'd seen the address video several times in the past. But this time I printed it out. (I'm of the older generation that gets more out of reading an address than viewing it.)

He begins by noting: "I never graduated from college. Truth be told, this is the closest I've ever gotten to a college graduation." He introduces his address by saying he has just three stories to tell.

October 5, 2011

Bettye LaVette Proves What Recent Research Only Suggests -- Music Is Therapeutic!

In my last post (just below this one), I reviewed a report on recent studies suggesting that music can be good for both your physical and mental health. I now have proof positive.

After the September doldrums that resulted from my totaling a new car in late August, October got off to a great start by accepting an invitation from my son and his girlfriend to join them at a Bettye LaVette concert this past Saturday night.

I had probably read about her in connection with her appearances at Obama's pre-inaugural concert and the 2008 Kennedy Center Honors (the annual event honoring five leaders in the performing arts). Otherwise I knew nothing about her, and had never seen her perform. Was I in for a surprise!

October 4, 2011

The Healing Powers of Music Confirmed in Recent Studies

Take a music bath once or twice a week for a few seasons. You will find it is to the soul what a water bath is to the body.   --Oliver Wendell Holmes

Without music, life would be a mistake.  --Friedrich Wilhelm Nietzsche
Few of us would disagree with these sentiments. But now recent studies show that music also has major positive effects on many aspects of health -- ranging from memory and mood to cardiovascular function and athletic performance. These studies were reviewed in the July issue of Harvard Men's Health Watch. Here are some of the studies and findings:

October 3, 2011

Reflections on My September Setback

Back in January on this blog, I explained why 2010 had been -- in many ways -- the best year of my life. This year was in the running for at least a silver medal, and may even have challenged 2010 for the gold.....

Until I totaled my new Honda Fit in late August (right after a three-week tour of the Pacific Northwest, probably my best-ever trip in a life full of travels). As a result, September may have been one of my worst months ever.

There will be other difficult times down the road as I get older. But, reflecting on this past month, I've learned some lessons that will surely help me weather future set-backs.

First, a brief recap of what happened: