Category: health care

Beat the Heat with Cold Snap and Common Sense

Sena likes to be out in the garden no matter how blisteringly hot it is. A few days ago, she was planting some yellow coreopsis and lantana, whatever that is. It was 82 degrees and with the heat index (about 60% humidity), it felt like 86 degrees. Later in mid-afternoon it rose to 95 degrees with the heat index.

She came in for a break to get some cold water and suddenly remembered the cooling cloth called “Cold Snap” you can wear around your neck to stay cooler outside. You just run it under cold water from the tap and wrap it around your neck.

She also put on her headband to keep the sweat out of her eyes to prevent her tear ducts from plugging up. That happened a longish time ago. She had a lot of tearing, and went to the eye clinic where a faculty ophthalmologist thought she might have a more complicated problem than a blocked tear duct (nasolacrimal duct obstruction).

The Cleveland Clinic differential diagnoses of a blocked tear duct include infection, injury, or nasal and paranasal tumors. Just getting older can make your more susceptible to blocked tear ducts. Procedures include the polysyllabic dacryocystorhinostomy (DCR, in which a bypass ductal drainage system is created) or alternatively, something which sounds like a last resort, the punctal plug.

The ophthalmologist recommended a complicated diagnostic and surgical treatment pathway the name of which she can’t remember (possibly something like those mentioned above) and said it was probably the only intervention that would work. Sena took exception to this and asked for something simpler. They arm wrestled, best two out of three, and Sena won.

So, the ophthalmologist finally just used a needle and syringe full of water and hosed the puncta. He and Sena both heard a small popping noise, and the obstruction was removed. The ophthalmologist was astonished and said it was a good teaching case for the residents. The problem was likely grime related to sweat and dirt—hence her use of a headband. She also uses baby shampoo to wash her eyes nowadays.

She never complains about the heat outside. She just gets out there in the garden and often stays out most of the day—no matter how worried I get about her.

There are ways to be heat aware in summer. The ReadyIowa web site on heat is a great resource.

Maybe I Should Be More Optimistic About Humans

I read the Psychiatric Times article “How Psychiatry Has Enriched My Life: A Journey Beyond Expectations” by Victor Ajluni, MD and published on July 4, 2023. It was like a breath of fresh air to read an expression of gratitude. Just about everything I read in the news is negative.

At the end of the article, Dr. Ajluni added a comment acknowledging that artificial intelligence (AI ChatGPT) assisted him in writing it. He takes full responsibility for the content, to be sure. I wouldn’t have guessed that AI was involved.

There’s a lot of negative stuff in the news. There are hysterically alarming headlines about AI.

I suppose you could wonder if Dr. Aljuni’s article is intentionally ironic, maybe just because the gratitude tone is so positive.  If it had been intended as irony, what could the AI contribution have been, though? I have a pretty low opinion of the AI capacity for irony.

I think irony occurs to me only because I tend to be pessimistic about the human race.

Maybe that’s because it has been very easy to be pessimistic about what direction human nature seems to be taking in recent years. I’ve been reading Douglas Adams’ satirical book, “The Ultimate Hitchhiker’s Guide to the Galaxy.” It contains several of his books which I think are really about human nature, and the setting is in a funny though often terrifying universe. I think there’s an ironic tone which softens the pessimism. The most pessimistic character is not a human but a robot, Marvin the paranoid android.

Unlike Marvin, I don’t have “a brain the size of a planet” (it’s more the size of a chickpea), but I am getting a bit cynical about the universe. I’m prone to regarding humans as evolving into a race of beings similar to those described in the book “Life, The Universe and Everything.” In Chapter 24, Adams describes the constantly warring Silastic Armorfiends of Striterax.

The Silastic Armorfiends are incredibly violent. Their planet is in ruins because they’re constantly fighting their enemies, and indeed, each other. In fact, the best way to deal with a Silastic Armorfiend is to lock him in a room by himself—because eventually he’ll just beat himself up.

In order to cope better, they tried punching sacks of potatoes to get rid of aggression. But then, they thought it would be more efficient to simply shoot the potatoes instead.

They were the first race to shock a computer, named Hactar. Possibly, Hactar was an AI because, when they told Hactar to make the Ultimate Weapon so they could vanquish all their enemies, Hactar was shocked. Hactar secretly made a tiny bomb with a flaw that made it harmless when the Silastic Armorfiends set it off. Hactar explained “…that there was no conceivable consequence of not setting the bomb off that was worse than setting it off…”, which was why it made the bomb a dud. While Hactar was explaining that it hoped the Silastic Armorfiends would see the logic of this course of action—they destroyed Hactar, or at least thought they had.

Eventually, they found a new way to blow themselves up, which was a relief to everyone in the galaxy.

There are similarities between Hactar and the AI called Virtual Interactive Kinetic Intelligence (V.I.K.I.) in the movie “I, Robot.” The idea was that robots must control humans because humans are so self-destructive. Only that meant robots had to hurt humans in order to protect humanity. The heroes who eventually destroy V.I.K.I. make up a team of misfits: a neurotic AI named Sonny, a paranoid cop who is himself a mixture of robot and human, and a psychiatrist. Together, the team finally discovers the flaw in the logic of V.I.K.I. Of course, this leads to the destruction of V.I.K.I.—but also to the evolution of Sonny who learns the power of the ironic wink.

Maybe kindness is the Ultimate Weapon.

What’s Up with Seasonal Vaccines This Fall?

I just read an interesting article in JAMA on this fall’s Covid-19 vaccine. Most of it is from the FDA meeting in June (Rubin R. This Fall’s COVID-19 Vaccines Will Target Omicron XBB Subvariants, but Who Needs Them Remains to Be Seen. JAMA. Published online July 05, 2023. doi:10.1001/jama.2023.10053).

One expert was quoted, indicating that there will be “…an elaborate discussion” at the CDC ACIP meeting about who should get the new monovalent XBB.1.5 vaccine. I don’t see that the meeting is scheduled yet.

There are some other interesting quotes to pass along:

“Back in March and the first half of April, XBB.1.5 represented more than 80% of circulating SARS-CoV-2 in the US, according to CDC estimates. Its dominance began to slip in late April, and as of late June, XBB.1.5 represented little more than a quarter of circulating SARS-CoV-2 variants. By then, though, XBB.1.5 and 9 other XBB subvariants together accounted for a total of 96% of circulating SARS-CoV-2 in the US. Fortunately, members of the XBB family of subvariants are antigenically similar to each other, so a vaccine against XBB.1.5 should protect against the rest of them as well, the WHO committee noted.”

“By the third quarter of 2022, an estimated 96.4% of approximately 143 000 blood donors in a nationwide, longitudinal cohort had SARS-CoV-2 antibodies from previous infection or vaccination or both, according to an analysis published in June in Morbidity and Mortality Weekly Report.

Or, as Sawyer told JAMA, “[t]he whole US has had this virus in one form or another.”

Because of the high prevalence of SARS-CoV-2 antibodies in the population, Paul Offit, MD, in an interview predicted “a focused recommendation by the CDC” regarding who should receive the XBB.1.5 vaccine.”

“Offit said he expects that the CDC will recommend the new monovalent XBB.1.5 vaccine for groups at the greatest risk for severe disease, reflected in continuing hospitalizations for COVID-19. Those groups likely would include people who are 75 years or older, people with severely compromised immune systems, and pregnant people, Offit said.”

“At least for people 60 years or older, the fall vaccine situation will be more complicated than it was a year earlier, Schaffner noted. That’s because at its regular monthly meeting in June, ACIP voted to recommend that this age group have the option of being vaccinated against respiratory syncytial virus (RSV) after consulting with their physician or pharmacist.”

That would mean that there would be 3 vaccines coming in the fall: RSV, Covid-19, and influenza. Sena and I have been doubtful about why a conversation with a physician would be necessary for the RSV vaccine. We don’t know whether that means you couldn’t get it without a physician’s order. There are also questions about coadministration of the RSV and Covid-19 vaccines.

Because the time is coming soon for seasonal vaccines, we’re hoping the questions will be answered soon.

Sena Tries Miracle Whip on Braunschweiger!

The other day, Sena suggested we have a soup and sandwich dinner. We both had a Braunschweiger sandwich on toasted bread, with onions—and Miracle Whip! Sena suggested the adding the onions and toasting the bread. She also decided to try the Miracle Whip spread. I chose the soup, which was so spicy we needed a drink of lemonade with every bite.

Usually, she prefers mayonnaise to Miracle Whip, so I was floored. In fact, adding onions on toasted bread with the sandwich was delicious! We both liked it.

Braunschweiger is also very nutritious. According to one web article, a single serving has 14 grams of protein, important for muscle growth, repair, and health overall. It also has heart healthy monosaturated fats (good for you), it’s high in Vitamin A which is great for eye health, and has many essential vitamins and minerals.

And is Miracle Whip good or bad for you? It turns out it has half the calories and fat of mayo, so it’s a healthy choice.

Sena actually liked the Braunschweiger with Miracle Whip sandwich. She made sure I put onions on the sandwiches and she liked the way I diced them. In fact, onions are also good for you. They’re low in calories and nutrient rich.

Try to pair it with a soup that it isn’t nuclear grade spicy and doesn’t require a gallon of lemonade to put out the fire.

Older adults can learn more about healthy eating and exercise at the Move Your Way link. Try it. You might like it.

Move Your Way!

I saw the HHS Move Your Way campaign regarding the new strategy on encouraging older people to exercise, namely the Midcourse Report: Implementation Strategies for Older Adults.

There are many ways to get and stay fit. We could all do better, including me. I exercise pretty much daily for about 30 minutes. Following that, I usually sit in mindfulness meditation for 30 minutes.

The report says we should do moderate intensity aerobic activity for at least 150 minutes a week and muscle strengthening activity for at least 2 days a week.

I do a combination of stationary bicycle exercise, weight exercises with dumbbells, planks, body weight squats. I also do one leg stand, one minute each leg.

And juggling is great aerobic exercise. I struggle a bit with advanced thumb wrestling.

Raccoon in the Mulberry Tree

I was not sure what exactly I saw this between 6:30 and 7:00 this morning shaking the mulberry tree branches in our backyard. It seemed too big to be a squirrel and I dismissed the thought, telling myself that it was most likely the usual squirrel getting its mulberry breakfast.

Just prior to this incident, I had seen and heard what I thought was a blue jay in the mulberry tree. It gave a series of short whistles while bobbing up and down on the branch. I had never heard a blue jay make whistle notes, just the usual screeches. I doubted what I saw and heard. I checked my bird book, “Birds of Iowa: Field Guide” by Stan Tekiela. It didn’t mention anything about blue jays making short whistling notes and bobbing up and down as they did so. I didn’t bother to get up and try to get a video of it. It would have been through the window of our sun room and the jay didn’t sit for more than a few seconds.

So, I looked it up on the web. It turns out blue jays make a variety of noises besides the jeer. They bob up and down as a part of a courtship ritual. They make what is termed a “pump handle call” and I found a video which duplicates what I saw and heard.

Anyhow, getting back to the critter in the mulberry tree, it turned out to be a large raccoon. It was eating mulberries and I tried to take video of it as it was climbing down the tree. This reminded me of an essay by E.B. White entitled “Coon Tree.” If you’ve ever read essays by E.B. White, you probably know already that this one is about a lot more than raccoons.

It’s basically about the conflict between nature and technology. The main essay was published in 1956 and a post script was added in 1962. The coon represents nature which White idealizes and contrasts with references to new inventions, including nuclear devices which represent the destructive side of technology.

I guess we can forget for the moment that raccoons can carry diseases like rabies and roundworm. I’m also reminded of an old TV commercial in the 1970s about margarine (an alternative to butter) in which an actor says angrily, “It’s not nice to fool Mother Nature!” The idea was that margarine (which was a new invention in the late 19th century) was healthier than the natural spread, butter—although the trans fat in it makes the comparison a bit more complicated.

White also says something interesting about unsanitary homes, claiming that children who live in them become more resistant to certain diseases like polio than the kids who grow up in clean homes. The polio scourge raised its ugly head recently in New York, which renewed the recommendation by the Centers for Disease Control recently that people who didn’t get vaccinated against polio should get vaccinated—regardless of how dirty your home was.

And then there is the artificial intelligence (AI) technology. I wonder what E.B. White would say about that? AI can improve detection of some diseases and assist in medical research. On the other hand, AI can still make mistakes and it needs human surveillance.

I read you can sometimes use loud noises to keep raccoons out of your yard. For example, you could try recordings of blue jays.

Selected Highlights of CDC ACIP Meeting on Covid-19 Vaccines

Today I’m highlighting a few items of interest to older adults from the summary slide set on Covid-19 vaccines presented on June 23, 2023 at the CDC ACIP meeting last week. Information for other age groups are included in the slide set.

Covid-19 continues to be a major health threat for the population, especially older adults and the immunocompromised. Vaccines are still the most effective intervention. However, the bivalent vaccine uptake was very low; most people didn’t get it.

A new Covid-19 monovalent vaccine with an XBB.1.5 composition, is expected to be available this fall.

In the fall, the vaccine manufacturers will switch to the commercial marketplace. In order to continue making Covid-19 vaccines available to the uninsured, there is a Bridge Access Program for Covid-19 Vaccines and Treatments” which is described at the HHS website.

Covid-19 Variants in the News

Sena alerted me to a CBS news item with the headline “CDC tracking new Covid variant EU.1.1.” The story seemed a bit misleading because the FDA just announced approval of vaccines for XBB.1.5. beginning in the fall.

I checked the CDC Data Tracker for variants and noticed XBB.1.5 is still the most common Covid-19 subvariant in the U.S.

While the EU.1.1 is on the list of subvariants tracked, it’s pretty far down the line and is much less common than the news headline seems to suggest. And it’s not clear the new vaccine for XBB.1.5 wouldn’t protect against EU.1.1 as well.