The Novavax Covid-19 vaccine was approved by the CDC a few days ago. University of Iowa Health Care was one of the sites in the multi-site Phase 3 trial.
The vaccine is not based on mRNA technology; it uses a more traditional method similar to the flu vaccine, which is familiar to more people.
Heard this tonight on ‘da Friday Blues KCCK with John Heim AKA Big Mo. It’s a little rock and roll from Boz Scaggs.
We have a new water heater today! What a relief. We spent a whole week on pins and needles waiting for the hot water to stop flowing again (maybe abruptly), and put us back on the cold shower regimen.
But the plumber was in and out in 2 hours flat. He was personable, knowledgeable, efficient, fast, and neat. He even put down drop cloths to keep the floors clean as he carted the old tank out and the new one in.
He gave us a quick rundown on the controls. They look easier to read and adjusting the temperature is simple—just turn a dial. The old one had a confusing light array. If you didn’t press them in just the right order, you could end up like a lobster being prepared for dinner.
There is an LED light on the control box and there are more than a dozen System Status Code sequences and they all mean something different. One is called “Heartbeat” (alternates bright and dim) and the control status description is “Call for Heat (no fault conditions).” I guess that means I call the plumber whenever I want hot water, which sounds a little inconvenient, but that’s how these newfangled gadgets are.
He was good with a joke, too. When we were discussing the controls and the LED indicator light, I asked him how we would know if something is wrong. On cue, he quipped, “You won’t have hot water.” I think he’s told that one about a million times. I’ll give him a call when the Heartbeat LED blinks.
Of course, we got an owner’s manual. It clearly states that the manual “must remain with water heater.” There was no manual with the old water heater when we moved in a couple of years ago.
It’s a pretty big deal to get a new water heater. If you have a young family, you generally have to give up your first born as collateral to cover the cost. That’s why you want to check your insurance coverage. In general, it’s a bad idea to try robbing banks to boost your finances.
The water heater is energy efficient, with an Energy Star label on the tank. It also has an ECO (Energy Cut Off) system that will shut off the water heater if the water temperature is too high.
There is a thorough Troubleshooting Guidelines section which includes Corrective Actions. A couple of them sound kind of Scary: “Combustion Odors,” and “Sizzling, Rumbling Noises.” Funny, I would think the Corrective Action would be to head for a hotel on the other side of town and don’t pack any bags. But it doesn’t mention that.
Anyway, we’re very pleased to be in hot water.
University of Iowa research shows that exercise could help for protecting us against Alzheimer’s disease. After age 65, our risk for this category of dementia doubles every 5 years.
Even if scientists develop effective and safe senolytic compounds that could allow us to live to be 200 years old, that won’t be happening in the near future. There’s another way to help prevent Alzheimer’s disease.
Exercise can lower the risk for Alzheimer’s disease, especially some form of aerobic exercise.
When it comes to exercise, any exercise is better than none.
Sena found that leaked Kentucky Fried Chicken (KFC) 11 herbs and spices recipe on the web. It was published in the August 19, 2016 on line edition of the Chicago Tribune story, “KFC recipe revealed? Tribune shown family scrapbook with 11 herbs and spices,” by Jay Jones. It was said to have come from the Sanders’ family scrapbook.
It calls for white pepper which we’ve never tried. The recipe has been a top secret for years, but every so often there’s a news item will pop up saying that it has been leaked to the public.
You’ll also see “copycat” recipes on the web which claim to replicate the KFC taste. It’s important that the Chicago Tribune story clearly stated that the recipe was not written in the Colonel’s handwriting. Nobody knows who wrote it. There has been more than one anecdote about the recipe being found or revealed accidentally on purpose.
We don’t have a pressure cooker. Sena prepared it, following the recipe to the letter and fried it in a tabletop cooker.
It was delicious. But we both agreed that it didn’t have that KFC taste. We think the occasional stories about leaked recipes from the Colonel are entertaining and mainly a clever publicity stunt.
I don’t really notice much of a taste to the white pepper, but then my palate is not as refined as Sena’s. She could even detect the oregano.
Maybe it’s the 11 herbs and spices that make KFC chicken so special. Maybe it’s the pressure cooker.
I think KFC uses alien chickens.
I read an excellent article in Clinical Psychiatry News recently in the Hard Talk section. The title is “A prescription for de-diagnosing” by psychiatrists Nicholas Badre, MD and David Lehman, MD in the July 2022 issue (Vol 50, No. 7).
The bottom line is that too many psychiatric patients have too many psychiatric diagnoses. A lot of patients have conflicting diagnoses (both unipolar and bipolar affective disorder for example) and take many psychotropic medications which may be unnecessary and lead to side effects.
It takes time to get to know patients in order to ensure you’re not dropping diagnoses too quickly. Discussing them thoroughly in clinic or in the hospital is an excellent idea. And after getting to know patients as people, it makes sense to discuss reduction in polypharmacy, which can be quite a burden.
This reminds me of the Single Question in Delirium (SQiD), a test to diagnose delirium by simply asking a friend or family member of a patient whether their loved one seems to be more confused lately. It’s a pretty accurate test as it turns out.
This also reminds me of the difficulty in making an accurate diagnosis of bipolar disorder. I and a Chief Resident wrote an article for The Carlat Report in 2012 (TCPR, July / August 2012, Vol 10, Issue 8, “Is Bipolar Disorder Over-Diagnosed?”) which warned against overdiagnosis of bipolar disorder. Excerpts below:
Some argue that bipolar disorder is actually under-diagnosed. They have support from abundant literature showing that bipolar disorder tends to present more often with depression than mania or hypomania (Judd LL et al, Arch Gen Psychiatry 2002:59(6):530–537). As many as 10% of patients with unipolar depression ultimately are shown to have bipolar illness instead, according to some experts (Goodwin GM et al, Eur Neuropsychopharm 2008:18(7):535–549). (See this month’s Q&A with Claudia Baldassano for more on this.) In addition, a new emphasis on subthreshold mood symptoms and more rapid mood shifts has led some psychiatrists to promote the concept of a “bipolar spectrum disorder” (Youngstrom EA et al, Curr Psychiatry Rep 2010;12(6):479–489).
While it’s important to remain vigilant about a history of manic and hypomanic symptoms, we think the problem of over-diagnosis is probably greater. For instance, in a 2008 study, Zimmerman and colleagues performed a comprehensive diagnostic interview on 700 patients, nearly 21% of who self-reported a history of “bipolar disorder.” However, when using the gold-standard SCID (structured clinical interview), only 13% had the diagnosis; they also had more first-degree relatives with bipolar disorder than the others (Zimmerman M, Ruggero CJ et al, J Clin Psychiatry 2008:69(6):935–940). The authors hypothesized that over-diagnosis of bipolar disorder might be a consequence of efforts to improve recognition of it and avoid under-detection. In fact, the same authors studied 40 depressed patients previously diagnosed with bipolar disorder and found that, by the SCID, they had specific phobia, PTSD, drug abuse/dependence, or a personality disorder instead (Zimmerman M et al, Compr Psychiatry 2010;51(2):99–105).
Over-diagnosis can also occur when apparent mood episodes are defined as psychiatric when in fact, they have a different etiology altogether. Decreased need for sleep, disorganized or racing thoughts, increased activity and agitation, and delusional thinking, even when they occur together, can represent a sort of “final common pathway” for medical conditions and other syndromes. The manic phenotype can occur in patients with agitated delirium, brain tumors, corticosteroid treatment, and of course substance intoxication (Bunevicius A et al, CNS Spectr 2008;13(11):950–958; Brooks JO and Hoblyn JC, Am J Psychiatry 2005;162(11):2033–2038). These other phenotypes can be distinguished by recognition of key features such as the fluctuating nature of consciousness in delirium, neuroimaging findings, and positive urine drug screens.
Unfortunately, physicians may also be susceptible to diagnostic shortcuts. When faced with limited time for diagnostic interviews and the pressure to prescribe by patients and their families, well-meaning clinicians may give the diagnosis after a single brief interview. Not uncommonly, we find that it was diagnosed on the basis of mood fluctuation over minutes, temper tantrums, and fleeting insomnia. The rapidly expanding repertoire of medications approved for bipolar disorder, and their relative ease of use, may also contribute to over-diagnosis. Unfortunately, in some cases the treatment may be worse than the symptoms themselves (Iordache I and Low NC, J Psychiatry Neurosci 2010;35(3): E3–4).
I was accustomed to asking what I called the Single Question in Bipolar (SQiB). I frequently saw patients who said their psychiatrists had diagnosed them with bipolar disorder. I would ask them, “Can you tell me about your manic episodes?”
Often, they looked puzzled and replied, “What’s a manic episode?” I would describe the typical symptoms and they would deny ever having them.
The article by Drs. Badre and Lehman is a bit disappointing in that it doesn’t look as though we’ve improved our diagnostic acumen much in the last decade.
We need to try harder.
I think it was last week that I got this thought about getting attention compared to paying attention. At first, I thought it was original. Hey, did I really just come up with that idea? The see-saw nature of it appealed to me. I write this blog partly to get attention. But I notice that when I pay attention and focus on what I’m writing, it’s more fun.
I quickly gave up the thought that I came up with the idea. I think the context was a little discouragement about the really low traffic to my blog. Now, I’m not just saying that to get more attention—although it does sound like that. And I really appreciate the visits I get from readers!
I searched the web for more about the get attention vs pay attention thing because I was pretty sure I didn’t come up with it but just forgot where I first heard about it.
The funny thing is that what first came to mind was the Men in Black (MIB) scene in which Agent J’s elementary schoolteacher Mrs. Edelson is displayed on the big monitor at MIB headquarters. It turns out she’s actually an alien and she’s crabbing at the class, “…Be quiet and pay attention!” I’ve searched for the YouTube clip but all I found were two: one deleted scene in which her rage at the class went up like a bomb and was way overdone and the other which was blurry and the audio was terrible.
Anyway, you get the idea. Of course, I also found the TED Talk by actor Joseph Gordon-Levitt about paying attention vs getting attention, “How craving attention makes you less creative.”
I think his point is spot on about social media being a big part of the push for many of us to crave attention. I used to have accounts on Twitter, Facebook, and LinkedIn but dropped them years ago because I got almost no traffic. I’m still on YouTube, which has low traffic but which I have fun with because I like making funny little videos. I also made teaching videos back when I was a consulting psychiatrist at University of Iowa Hospitals & Clinics.
I get hardly any traffic on my current blog (which I’ve had for about 3 years) and I get a little frustrated with that. However, I like to write so I’m probably going to hang on to it for a while. I had a previous blog that lasted for about 7 years. It also never got more than a modest number of followers.
When I’m paying attention to what I’m writing about, it may not get any views but I get more satisfaction from writing them. I do my best writing when I’m just having fun doing it. I get a kick out of writing. But then I wonder why I’m not getting any views.
I think the see-saw aspect of paying vs getting attention is normal. So, I should pay more attention to Mrs. Edelson.
Well, even though our hot water heater was temporarily fixed, there is no guarantee that it won’t fail again between now and later this week. That’s when we’re scheduled to have the new water heater installed
That will cost approximately 10 billion dollars. This item will be the major selling point for our house because we’ll have to sell it immediately in order to move to the poor house.
We have insurance of course. We know what our deductible will be, although we’re not exactly sure how much the insurance company will pay. Maybe they’ll want to know whether we tried to “fix” the water heater first.
Technically, we did that although it could go out again during a shower. That could mean a trip to the emergency room for treatment of rapid hypothermia including surgical removal of icicles from various bodily orifices.
There may be an upside to that. Flash freezing could mean we could preserve ourselves for the future when scientists figure out how to slow down or even stop the aging process.
In fact, that reminds me; Sena saw a news item indicating that there may be a class of medications called “senolytics” that could allow humans to live up to 200 years.
The article doesn’t say what kind of shape you’d be in around that age. What are the implications for retirement age? Would that have to be postponed until you’re over a century old? What would it be like to be that old? Maybe we could ask certain entertainers who are making a living in Branson, Missouri.
How much would senolytics cost at the pharmacy? Probably about 10 billion dollars per pill.
How about extending the working life of water heaters?
This is just a quick shout-out to the Iowa City Fire Department (Iowa City Fire Engine 4 and Engine 1) and the Johnson County ambulance service for their outstanding rescue of a person who suffered a cardiac arrest recently. It was reported in the news and the city of Iowa City wrote a great story about it as well.
We visited with a firefighter at Fire Engine 4 when we were out for a walk a while back.
Every day I see news stories about people acting up just to get attention. I pay attention to the stories about people who exemplify courage and kindness.
The new 988 Suicide and Crisis Lifeline number is available starting today. Iowa is with the program and you can read more about it at the Iowa State University Extension and Outreach website.
You can also learn more at the 988 Lifeline web page.
Go Retire Psychiatrist 