James Amos

Good Luck Dr. Chris Buresh

Sena was looking up the meaning of a four-leaf clover the other day. You might call it a shamrock although that’s usually reserved for the 3-leaf variety. It’s fitting for St. Patrick’s Day to say the four-leaf clover is special because it’s rare to see one. The four leaves represent faith, luck, love, and hope.

The trouble going on in Haiti is regrettable to say the least. However, it also reminded us of how lucky it was for us to have known one of my former colleagues, Dr. Christopher T. Buresh, MD. He was an emergency room physician at the University of Iowa Hospital until just a few years ago, when he and his family moved to Seattle, Washington. Dr. Buresh is now an Associate Professor in the Department of Emergency Medicine with the University of Washington. He’s also Assistant Program Director of their Emergency Medicine Residency Program.

The connection between Dr. Buresh and Haiti goes back a long way. Many Haitians were lucky he and other physicians volunteered to help provide medical care for them on an annual basis for years.

Chris is really a humble, likeable, and practical guy. He and his family were our next-door neighbors for a while and fascinating things were going on there at times. We remember they built this really cool tree house that sort of looked like it grew out of their main home. They even had an apparatus for a zip line between the two structures. I don’t think the zip line ever actually got installed, but it was intriguing.

He and I sometimes saw each other in the emergency room at University of Iowa Hospital. His energy, compassion, and dedication to patient care were an inspiration to colleagues and learners at all levels. Sena saw one of his presentations about his volunteer work in Haiti. He never mentioned the difficult politics of the situation. He emphasized the work of caring for the Haitians most of all and gave credit to members of the team doing everything they could in that challenging and, I’m sure, sometimes horrifying environment.

It would be easy to just sit and wonder why he left Iowa, and to be sorry about that. On the other hand, when you thing about the 4-leaf clover, you really have to wonder about something else. Maybe he had one in his pocket with all four of what we all want: faith, luck, love, and hope.

Please Return to Sender

We get a lot of mail meant for somebody else. What’s up with the United States Postal Service (USPS)? It has been happening for years. What we do is identify that the mail is not for us and put it back in the mailbox for the postal delivery person to pick up. We write “Person does not live here” on the envelope.

We’re going to write “Return to Sender” on them. Maybe that’ll work.

Remember The Calling

I recommend Dr. George Dawson’s recent posts on seeing the practice of medicine as a calling and his passing a big milestone with 2 million reads on his blog.

I wrote a post entitled “Remembering Our Calling: MLK Day 2015.” It was republished in a local newspaper, the Iowa City Press-Citizen on January 19, 2015. And I reposted it in 2019 on this blog.

The trainees I taught also taught each other about psychiatry and medicine when they rotated on the consultation-liaison service at the hospital. We put them into the format of short presentations. I called mine the Dirty Dozen. The trainees and I also presented the Clinical Problems in Clinical Psychiatry (CPCP).

There were many of those meetings, which were necessarily short and to the point because the service was busy. We got called from all over the hospital. We answered those calls and learned something new every time.

I posted a lot of the trainees’ presentations in my previous blog, The Practical C-L Psychiatrist, which was replaced by this present blog. I haven’t posted the presentations partly because I wanted to give the younger teachers their due by naming them as they did on their title slides. But I would want to ask their permission first. They are long gone and far flung. Many are leaders now and have been for many years. I still have their slides. I’m very proud of their work. When they were called, they always showed up.

So, you’ll just have to put up with my work and my cornball jokes.

The Svengoolie Phenomenon

I wrote about Svengoolie a couple of years ago and just for old times’ sake, I watched the 1960 horror film 13 Ghosts on the Svengoolie broadcast by MeTV a few days ago. It had been a while since I watched Svengoolie and I thought I would have the usual experience of being able to sit through the opening credits and then being unable to watch more than 5 minutes of one of the cheesy movies for which Svengoolie is well known.

In fact, I watched and even enjoyed 13 Ghosts which I suppose makes me a hopeless case. The movie is about a family down on their luck and about to become homeless but a rich uncle leaves them a haunted house. It turns out to be haunted by a dozen ghosts, and the surprise ending reveals who the 13^th ghost turns out to be.

Back in the day, William Castle, the maker of the film, had a knack for coming up with neat gimmicks for his films. The gimmick for this one was a set of special glasses for the audience, which allowed them to see the ghosts or not, depending on which part of the glasses you looked through.

I recognized a couple of the actors in the movie. One of them was really well known to me and thousands of others. It was Margaret Hamilton as the housekeeper, who played the Wicked Witch of the West in the Wizard of Oz (1939). The other was Martin Milner, who was in the TV crime drama, Adam-12, which ran from the late 1960s to the mid-1970s. Hamilton obviously teased viewers by holding up a broom and smiling broadly in one scene.

I really didn’t get a lot of nostalgia from watching 13 Ghosts since I was too young to see it when it first opened. But I watched it from start to finish, something I could never do in the past when watching Svengoolie. Don’t get me wrong; I actually got more of a kick out of Svengoolie’s cornball jokes and gags complete with rubber chicken firing squads.

One thing I am still amazed about is the popularity of the Svengoolie show. There were over 3500 comments about 13 Ghosts the last time I looked, which was days after the movie. There were over 2,000 just during the show!

Another thought about Svengoolie and his rubber chickens. I looked all over the web for a free picture of a rubber chicken. I found only one. Why is that?

Mouse in Your Engine Not the Same as Tiger in Your Tank

The other day, Sena was out at the auto dealership getting our lease car serviced and had an interesting conversation with the service guy and another customer.

The other customer was discussing his vehicles issues with the service guy and mentioned that rodents were probably snacking on his engine wires and hoses. The bill for a partial repair just to get his car back on the road temporarily was several hundred dollars. Sena overheard him mention “mice” and asked him about it.

The other customer and the service guy both endorsed the idea that mice and other rodents were eating the edible tubes and belts of the engine because nowadays they more often are made of plant-based materials. It’s a phenomenon connected with the economy going green, and making products that are generally more environmentally friendly. They said that, while rodents generally have always nibbled on engine parts, it’s gotten worse with the auto industry adoption of things like soy-based hoses and whatnot.

We were curious about this and looked it up on the internet. It turns out that the soy-based auto parts are not just a shenanigan supported by soybean intensive states like Iowa—so you can’t blame us.

We noticed that the idea that rodents chew auto parts because they smell like vanilla is controversial. Sometimes it seems like what side you’re on depends on how you make your living. Auto makers tend to deny that the soy-based materials attract mice—for obvious reasons if they use them in the manufacture of their products. On the other hand, some (but not all) pest control experts tend to endorse the notion, often in an obvious effort to get your business.

One auto expert said this whole idea about rodents getting addicted to soy-based alternator belts and the like was debunked by a study. The problem is the author didn’t give a link or a citation for the study.

One of the pest control experts testified, I mean reported, that the rodents are actually chewing through the compressed super beets radiator hoses because they’re seeking a healthier way to keep their teeth from growing too long. They need to gnaw things partly because if they didn’t their teeth would grow through their lower jaws.

Yet another den of bald-faced liars, I mean stakeholders, say that the critters might be addicted to certain substances other than soybeans. There is a story about mice eating their way through a half ton of marijuana in a police break room, I mean evidence room, in police headquarters. That was just because of the munchies.

That’s a little hard to believe until you have a look at the study of laughing rats. It turns out if you tickle them on the back or the belly, they laugh so hard you can actually hear them if you use special audio equipment and smoke a bong of weed.

Alternatively, the auto industry could make radiator hoses with little fingers on them which is similar to the hand chasing game in rat tickling experiments. As the rat crawls on them, the little hands tickle it on the belly. They would laugh so hard they fall off the hose. On the other “hand,” if the auto industry made auto fan belts of marijuana, that could get the rats (the rodents, not the auto makers) so stoned they might just forget what they’re doing.

Seriously, the most intelligent and even- “handed,” well-documented summary of the problem with rodents eating timing belts made of Iowa ditch weed was written by Erin Gobler, an auto insurance staff writer, updated August 22, 2023. It’s entitled “Does Car Insurance Cover Rodents Chewing Wires?”

Ready for Another Step Counting Recommendation?

Remember my post about the step counter and my workout update pointing out the possibly bogus 10,000 step recommendation?

Well, get ready for another recommendation which lowers the bar somewhat, based on your sedentary index.

There’s a new study which says, essentially:

“Conclusions: Any amount of daily steps above the referent 2200 steps/day was associated with lower mortality and incident CVD risk, for low and high sedentary time. Accruing 9000–10 500 steps/day was associated with the lowest mortality risk independent of sedentary time. For a roughly equivalent number of steps/day, the risk of incident CVD was lower for low sedentary time compared with high sedentary time.”

Reference:

Ahmadi MN, Rezende LFM, Ferrari G, et al. Do the associations of daily steps with mortality and incident cardiovascular disease differ by sedentary time levels? A device-based cohort study. British Journal of Sports Medicine 2024;58:261-268.

I figure I’m in the low sedentary category. This is somewhat reassuring to me because so far, my step counter averages (over 3 days) about 2500 steps during my usual daily exercise periods. Of course, this doesn’t count trips to the bathroom. I guess I can relax now.

Thoughts on Journalist Sydney J. Harris

I just have a few things to say about Sydney J. Harris, who was a journalist whose columns were syndicated to over 200 newspapers. I remember reading them in the Des Moines Register years ago.

I ran across one of his books for sale on Amazon. I’ve never read any of them, but I found one of them, “Winners and Losers” on sale “new” for $111 and change. I was astonished. I admire his diction and learning, but I would never pay that much money for one of his books. You can buy them for less than $5, even on Amazon. You can read “Winners and Losers” for free on the Internet Archive.

You can also find a lot of quotes from Sydney J. Harris on the web. I found a collection which I thought were admirable. Funny thing is, the more I read, the more I thought he was a product of his times. I thought I could detect a little male chauvinism (maybe more than a little). The more quotes I read, the more I noticed he almost always used the word “men” or “man” and rarely mentioned women, unless you count:

“The commonest fallacy among women is that simply having children makes them a mother—which is as absurd as believing that having a piano makes one a musician.”

Nobody’s perfect.

New Compound MM-120 Related to LSD Gets FDA Nod

I saw the story in Psychiatric Times about the compound MM-120, which the FDA recently granted breakthrough designation. MM-120 is related to LSD. Breakthrough designation is defined by the FDA as, “…a process designed to expedite the development and review of drugs that are intended to treat a serious condition and preliminary clinical evidence indicates that the drug may demonstrate substantial improvement over available therapy on a clinically significant endpoint(s).”

The compound is made by the company MindMed. This is not to be confused with mind meld, a Star Trek thing related to Vulcans like Spock who can do this telepathic touch thing. The MindMed organization made MM-120 to help treat people who suffer from Generalized Anxiety Disorder. Their study shows the drug could be used as a standalone treatment for the disorder.

According to one story about it published in the December issue of Drug Discovery and Development, it’s not likely MM-120 will be stocked in pharmacies next to the antihistamines and decongestants. The authors believe it would be more likely included in a Risk Evaluation and Mitigation Strategies (REMS) program.

This brings back nightmares about the Clozapine REMS program, which many psychiatrists found almost impossible to enroll in several years ago because of glitches in the web-based application. In fact, the FDA was still not happy with it a couple of years ago, to the extent they had to “temporarily exercise enforcement discretion” over aspects of the program.

Anway, the article goes on to say that the drug has a pretty good safety profile, although concede that the study found the higher dose of MM-120 led to “…perhaps some more challenging experiences….” There were no incidents of suicidal or self-injurious behavior.

I wonder what the “challenging experiences” were, exactly. After all, MM-120 is basically LSD, which was invented in 1938 by the Swiss chemist, Albert Hofmann. He was doing research into crop fungus. He thought it could be used to treat mental illness, even after he accidentally ingested some of it and hallucinated a future in which a guy named Timothy Leary would advise everyone to “turn on, tune in, drop out.”

That whole fungus research issue reminds me of the still unsettled question of how a whole town in France got higher than a kite (leading to some deaths) back in 1951. Ergot poisoning was the initial theory, although later somebody believed it might have been perpetrated as a secret LSD experiment by the CIA. I think the mystery is still unsolved.

However, there is also the history of MK-Ultra, which apparently actually was a classified CIA project running during the Cold War which involved giving LSD to certain unlucky subjects, some of whom didn’t know they were getting it—with disastrous results in some cases.

Just to let you know, I don’t suspect there is some conspiracy between extraterrestrials and the pentagon to get the world population so confused on LSD that we start believing all those crop circles are being created by two guys using a board and a rope. Forget what Agent Mulder says.

Do You Really Need to Walk 10,000 Steps a Day?

Since we got this little step counter, I’ve been paying more attention to how I exercise. The step counter will even track steps when I juggle—probably because I drop balls often enough to chase after them a lot.

And then I ran across the 10,000 steps as a benchmark for walking to keep healthy. I get about 3,000 steps during a typical 30-minute exercise session, which I do at least 5 days a week. Most people probably know that the CDC recommends that older adults spend 150 minutes as week (5 days a week for about 30 minutes a day) of moderate-intensity exercise.

That includes walking, jogging, wrestling Bigfoot, things like that. Muscle strengthening and balance are also important.

The 10,000-step thing (or 4,000-6,000 steps for older adults) puzzled me a little. The 10,000-step goal has an interesting story behind it. It turns out that around the time of the 1964 Tokyo Olympic games, that 10,000 steps goal had no scientific basis and was a marketing gimmick for selling the early pedometers.

In fact, if you really use your imagination, you might see how the Japanese character for 10,000 looks a little like a man walking—a stick man. The meter was called a Manpo-kei which literally translates to 10,000 steps.

Just walking 10,000 steps a day as a health goal probably doesn’t have a lot of scientific support. But you can increase the intensity of walking to get more benefit, such as walking up stairs or using a step platform, which I use nowadays. As a consultation-liaison psychiatrist, I walked all over an 8-floor hospital. I would usually use the stairs, often well over 20 flights pretty much every day.

I think the other way to make walking a more vigorous exercise is to develop and practice the well-known technique of silly walking, documented in the Ministry of Silly Walks documentary.

Monty Python

Jim Updates His Workout and Adds a Step Counter!

Since we added the step platform, I’ve been wondering how to count steps when I use it because for some reason my smartphone step counter won’t count steps when I try to use it on the platform.

Sena got a handy step counter and it works! It works if you have it in your pocket or wear it on neck with a lanyard.

I usually practice juggling patterns as a warm up to exercising. I’m still working on the shower pattern. Progress is slow.

My exercise routine takes a half hour. Following that I sit for mindfulness meditation for 30 minutes. We are still using our anti-Peloton exercise bike. I do one leg stands for a minute on each leg. I still do floor yoga, body weight squats, planks, and dumbbells. I still count my own steps on the platform: 50 steps alternating right and left leg four times (200 steps). The counter number varies between 170-200 or so.

As a review, a recently published study found that climbing 5 flights of stairs (approximately 50 steps) was associated with a lower risk of ASCVD types independent of disease susceptibility (Song et al, see reference below). There was a threshold effect of stair climbing in the study, meaning the benefit was lost if you went over a certain number of “floors.” Going over 15 or 20 didn’t gain much for subjects. A flight was 10 stair steps.

Step up!

Reference:

Song Z, Wan L, Wang W, Li Y, Zhao Y, Zhuang Z, Dong X, Xiao W, Huang N, Xu M, Clarke R, Qi L, Huang T, Daily stair climbing, disease susceptibility, and risk of atherosclerotic cardiovascular disease: A prospective cohort study, Atherosclerosis (2023)