Random Connections

Today, I read Dr. George Dawson’s blog post, “How I ended up in a high-risk pancreatic cancer risk screening clinic.” As usual I was impressed with his erudition, scientific literacy, and rigorous objectivity, even as it pertained to a deadly disease which runs in his family genetic history. I couldn’t help admiring his courage.

And, whether this is a random connection or not, this somehow led to my remembering Dr. George Winokur, a giant in the scientific study (including genetics) of psychiatric diseases, especially mood disorders. He died of pancreatic cancer shortly after he was diagnosed with it in the spring of 1996.

Dr. Winokur was chair of the University of Iowa Department of Psychiatry from 1971 to 1990. He remained on faculty, actively involved in research and teaching up until the day of his death in October of 1996.

I was a resident in psychiatry at University of Iowa from 1992-1996 and I have a clear recollection of meeting with Dr. Winokur in his office during my last year, when I was preparing for job interviews. I knew he had been diagnosed with pancreatic cancer.

He had been actively recruiting me to accept a position in the department and did so even as we spoke briefly. I remember noticing that he gripped an electrical conduit on the wall next to his desk so tightly that I wondered if he were in pain.

He was the main reason I stayed in Iowa. He had a great sense of humor. All of us residents loved him. There was even a list of his “commandments” all new residents received when they began their residencies at Iowa.

Winokur’s 10 Commandments

  1. Thou shalt not sleep with any UI Psychiatry Hospital patient unless it be thy spouse.
  2. Thou shalt not accept recompense for patient care in this center outside thy salary.
  3. Thou shalt be on time for conferences and meetings.
  4. Thou shalt act toward the staff attending with courtesy.
  5. Thou shalt write progress notes even if no progress has been made.
  6. Thou shalt be prompt and on time with thy letters, admissions and discharge notes.
  7. Thou shalt not moonlight without permission under threat of excommunication.
  8. Data is thy God. No graven images will be accepted in its place.
  9. Thou shalt speak thy mind.
  10. Thou shalt comport thyself with modesty, not omniscience.

I never got the impression that George Winokur recruited me because I was black, although it was pretty obvious to me that I would be the first black University of Iowa psychiatry department faculty member. He had too much class to make that an issue.

I’ve known a few classy psychiatrists. Maybe the connection is not so random.

Catatonia Education Resources

I noticed what is, for me at least, a new educational resource for catatonia. There’s an aricle about it in the March 2023 issue (Vol.51, No. 3) of Clinical Psychiatry News. The resource is available at University of Rochester Medical Center website. They include pdf files and training videos for assessment of catatonia.

There are also links for information about catatonia:

Catatonia Information Center

University College London

The University of Rochester presentation has has demo videos using a standardized patient (a physician, Dr. Joshua Wortzel) and a teacher, Dr. Mark Oldham.

I saw cases of catatonia while I was a consultation-liaison psychiatrist at The University of Iowa Hospitals & Clinics and they often had medical causes. My YouTube video lecture on Catatonia, Neuroleptic Malignant Syndrome, and Serotonin Syndrome is still getting views after 4 years.

Behind the Mask Policy

Tomorrow I’ll get to see how the new Covid-19 face mask policy works at the University of Iowa Hospital & Clinics. It goes into effect today. I’m going to see the dentist, as I have periodically for years, even during the Covid-19 pandemic. Of course, the idea of masked dental patients is ironic.

The rule change about masks being sort of optional is a little confusing.

It’s sort of optional because it looks like it’s not optional for unvaccinated health care employees. They still have to wear masks.

I wrote about this back in May of 2021, “Unmasked Means Fully Vaccinated?” That was back when bandanas were acceptable as face coverings.

So does being masked mean “not vaccinated?” It’s confusing because if masking is optional for patients and visitors, why are health care workers the exception? I’m not sure how anyone would enforce the policy.

If you can wear a mask just because you want to do that, how does that separate you from the unvaccinated person?

If masks are optional, then why are the entrance and exit policies not changing, including screening of patients, visitors, and staff? I didn’t see the guidance about what to do if anyone says they are symptomatic or unvaccinated and prefers not to wear a mask, other than to offer a mask (which is free!).

If it’s disrespectful to ask a patient or visitor to put on a face mask, why is it not disrespectful to require an unvaccinated health care worker to do so? There is one bullet point in the question-and-answer section about whether you can ask anyone to wear a face mask which says you can’t ask anyone, including “employee, colleague, patient, visitor, etc.” In the same section is the statement: “Whether or not to wear a mask is a personal decision that each person must make for themselves and for their own reasons.” Does that apply to getting a Covid-19 vaccine as well?

That said, I’m a staunch supporter of everyone getting a Covid-19 vaccine, if they don’t have medical or other exemptions. They don’t make you magnetic!

And I don’t think the recent Cochrane Review results on face masks really means they’re useless, which some news stories tend to convey. I think the Cochrane review does what most such reviews do, which is point out the problems with some controlled studies. And the reviews themselves may have unintended biases.

What’s the most important part of all this? Well, maybe the predicted snowstorm coming to Iowa tomorrow will prevent my dentist from getting to the clinic. And if that doesn’t work, maybe I could just exercise my right and privilege to wear my mask as a barrier to any nefarious procedures.

Face Masks Optional at University of Iowa Hospitals & Clinics Starting March 8, 2023

As of March 8, 2023, face masks will be optional for visitors, patients, and employees at University of Iowa Hospitals & Clinics.

Xylazine More About Death Than the Walking Dead

The recent news stories about xylazine-adulterated fentanyl (also known as Tranq) describe it as turning users into zombies because it causes skin necrosis. This can lead to abscesses which may require amputations.

Even more important, it can kill users. Xylazine, which is an animal tranquilizer (hence the name “Tranq”) is said to be available for free in some locations. It has been reported in the eastern states, including Pennsylvania and the availability has been moving steadily westward across the country. The Iowa Office of Drug Control website has posted information about it.

Connecting xylazine to zombies may be a way to get people to pay closer attention to this dangerous substance. That’s ironic because it doesn’t make users just look like the walking dead—it causes death. Xylazine-laced fentanyl overdoses can’t be completely reversed by naloxone because xylazine is not an opioid.

Dr. George Dawson wrote an excellent blog post describing the scientific details about xylazine and its deadly effects in April of 2022.

Those who make this drug know exactly what they’re doing. It’s one thing to sell it on the street, which itself is a terrible thing to do. But if it’s true that it is available for free in some places, then something other than the profit motive is at work.

I Got The Greatest Shout Out Today

I just got the greatest shout out from one of my heroes, Dr. H. Steven Moffic, MD. The link to one of his regular Psychiatric Times web (PT) articles, mainly on what’s in the daily news that impacts psychiatry or vice versa, is on the menu of my home page.

The title of the PT article in which I get a shout out  is “A Tale of 3 Retirements: Football Star Tom Brady, Black Psychiatrist James Amos, and Me.” He got my retirement date wrong by 20 years, but what the heck; no big deal. He did his homework otherwise just fine.

In fact, I didn’t know that Dr. Moffic even noticed that I had a blog. I have written articles for PT in the past. You can still find them by searching my name on the web site. One was on stress and the psychiatrist and another was on how consulting psychiatrists can be helpful in recognizing and managing delirium.

And today, Psychiatric Times (PT) contacted me to make a video about my juggling hobby. I gather it’s a regular series about what psychiatrists do outside of their work/practice. Imagine that; PT wants to see ugly juggling! How did PT know about that? Dr. Moffic mentioned my name.

In return, I’d like to give a big shout out right back to Dr. Moffic and also to other psychiatrists. One is Dr. George Dawson, who writes the blog Real Psychiatry. Another is TheGoodEnough Psychiatrist. These are featured on the main menu on my blog. I can name another who also writes for PT and this is Dr. Ronald Pies.

Dare to Discover at University of Iowa!

There’s been enough bad news. How about some good news? Have a look at the Dare to Discover campaign at The University of Iowa. It shines a light on young researchers who dream big. And that’s great for all of us!

FDA VRBPAC Discussion Topics Today

The FDA VRBPAC 178th annual meeting on future Covid-19 vaccine regimens includes two main discussion topics:

“Future periodic vaccination campaigns:
Simplification of COVID-19 vaccine use:

  • Immunization schedule: Please discuss and provide input on simplifying
    the immunization schedule to authorize or approve a two-dose series in
    certain young children, and in older adults and persons with compromised
    immunity, and only one dose in all other individuals.
    Periodic update to COVID-19 vaccines:
  • Vaccine composition: Please discuss and provide input on the
    consideration of periodic updates to COVID-19 vaccine composition,
    including to the currently authorized or approved vaccines to be available
    for use in the U.S. in the fall of 2023.”

Among the members attending the web conference is University of Iowa Professor Stanley Perlman, MD, PhD, Departments of Microbiology and
Immunology, Professor of Pediatrics, Mark Stinski Chair in Virology.

The meeting is today from 8:30 AM to 5:30 PM ET.

Update: Dr. Stanley Perlman MD, PhD from the University of Iowa will be the acting voting chairman of today’s meeting.

Update: Dr. Jerry Weir gave a clarifying and practical bird’s eye view of the issue at hand which began at 2:30 PM on the live play today (the meeting is being recorded). The questions and comments for Dr. Weir by Offit, Levy, and Chatterjee were also helpful to hear.

Update: Voting Question is:

“VRBPAC Voting question
Simplification of current COVID-19 vaccine use:

  • Vaccine composition: Does the committee recommend harmonizing the
    vaccine strain composition of primary series and booster doses in the U.S.
    to a single composition, e.g., the composition for all vaccines administered
    currently would be a bivalent vaccine (Original plus Omicron BA.4/BA.5)?”

Voting Result: Unanimously upvoted.

Reminder: FDA Advisory Committee Meeting Thursday January 26, 2023 on Future of Covid-19 Vaccination Regimens

Remember, the 178th Annual Meeting of the FDA Advisory Committee on the future of Covid-19 Vaccination Regimens is this Thursday from 8:30 AM-5:30 ET.

The details so far include the voting question:

“Simplification of current COVID-19 vaccine use:

  • Vaccine composition: Does the committee recommend harmonizing the
    vaccine strain composition of primary series and booster doses in the U.S.
    to a single composition, e.g., the composition for all vaccines administered
    currently would be a bivalent vaccine (Original plus Omicron BA.4/BA.5)?”

More Crazy Announcements!

Here are crucial announcements.

Sena bought me Bigfoot pajamas. They clearly show Bigfoot doing the Patty walk, which refers to the historic sighting of Bigfoot caught on video decades ago in the Patterson-Gimlin film.

The Amaryllis leaves have grown to about 11 inches! There is no flower.

Cattle ranchers are now putting diapers and masks on their cows to reduce methane emissions. Soon there will be statutes requiring humans who fart and belch in public to take Beano gummies several times daily. You know who you are.