We just found out there’s going to be a total solar eclipse on April 8, 2024. We hope to get some solar eclipse glasses before then if they don’t run out of stock everywhere. They’re selling fast.
We’ve seen a couple of lunar eclipses and those were fun. The most recent one was during cold weather in November 2022. I had to wear a winter coat.
In Iowa City, it starts at about 1:00 PM on April 8, 2024 and runs until a little after 3:00 PM. We missed the last one in 2017. The next one visible in the U.S. won’t be until 2044. We think we better see the one next month.
Just in case you missed it, the FDA posted an announcement about Kratom in February this year. According to the FDA:
“Kratom is a tropical tree (Mitragyna speciosa) that is native to Southeast Asia. Products prepared from kratom leaves are available in the U.S. through sales on the Internet and at brick-and-mortar stores. Kratom is often used to self-treat conditions such as pain, coughing, diarrhea, anxiety and depression, opioid use disorder, and opioid withdrawal.”
The other day as we were driving home on Highway 1 through Iowa City, I saw a sign advertising Kratom on a small store. I thought that might be illegal, but when I checked the Iowa Office of Drug Control and Policy, I found out it’s currently legal in the state.
Opinions vary about risks of using Kratom. The DEA tried to place in on the Schedule I, but the American Kratom Association and other supporters apparently prevented that simply by protesting it. The pharmacist who wrote the article (link above) raised a note of irony by questioning why marijuana is still regulated as a Schedule I drug.
The legality of Kratom also varies across the country. There is a very detailed review article about it that attempts to examine the use of Kratom from both the medical practitioner and patient points of view.
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.
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 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?”
In keeping with Iowa History Month 2024, you can have a look at the Iowa State University website “African and African American Studies Research Guide.”
Iowa State University happens to be my alma mater, or in a way, one of them. I took my Bachelor’s degree there and later graduated from The University of Iowa College of Medicine.
There is a wealth of information worth browsing on the ISU website devoted to the history of black people in Iowa. In fact, I found out a few of those connections were to Huston-Tillotson University (HT-U, an HBCU) in Austin, Texas, where I spent several semesters in the 1970s before later transferring to ISU.
The connections between HT-U and Iowa go way back into the history of that school. It started as Tillotson College in 1875, which is where some of the ISU black students also later worked as faculty. The list includes notable scholars:
Ada M. Deblanc-Yerwood: After graduation from ISU, she became head of Home Economics at Tillotson College. She was also co-founder of the George Washington Carver Museum in Austin, Texas. She also had an interesting perspective on retirement. She didn’t, and pursued other positions. Her answer to why she didn’t retire: “Old is a state of mind. When you do nothing, you become nothing. The need to be productive—give life to something—doesn’t automatically stop at age 65 or 70.”
Dr. Samuel P. Massie, Jr.: Dr. Massie went to ISU in 1941 to pursue a Ph.D. in Chemistry. He had to hitchhike to campus because there was no housing for Black students within 3 miles. Dr. Henry Gilman at ISU assigned him to work full time as a research assistant on a special assignment connected to the Manhattan Project (the top-secret effort to build an atomic bomb). President Lyndon B. Johnson appointed him to a Chemistry professorship at the U.S. Naval Academy. He distinguished himself as a scientist in many HBCUs (Fisk, Howard University, North Carolina College, and others) and elsewhere despite the racism that tried to hinder him. In 1981, ISU gave him the highest award—the Distinguished Achievement Citation.
Dr. Frederick Douglass Patterson: He was a brilliant student and he attended Samuel Huston College (see history of Huston-Tillotson College at link above). He also attended ISU, graduating with a DVM in 1923. In his book, Chronicles of Faith, he wrote: “In the veterinary program, I did not feel odd being a part of the group of students working in the veterinary clinic although I was the only black person there. The absence of animosity encouraged me to see veterinary medicine as a field in which I could practice without being hampered by the racial stereotypes and obstacles that would confront me as a medical doctor, for example. I found the teachers of Iowa State helpful whenever I approached them. Educationally, it was a fine experience.” He received the Presidential Medal of Freedom from President Ronald Reagan in 1987. He was President of Tuskegee Institute and transformed it into a university. He also founded the United Negro College Fund.
The United Negro College Fund was part of the reason I was able to attend Huston-Tillotson University. And it’s connected to the history of Iowa.
Sometimes I write “depressing” blog posts. On the other hand, I have both good and bad news today.
I found out that, according to the Treatment Advocacy Center, Iowa’s state psychiatric hospital bed availability is dismal according to 2023 figures. That’s actually not new. Although we rate last in the nation for this, we still get a Grade B overall. I’ll have more to say later about it. You can check your own state’s grade on the web site’s map graphic.
And a recently published article about antidepressant prescribing for young people is sort of depressing, there are ways to address the likelihood that adolescent females are being prescribed antidepressants more often than adolescent males.
I tend to agree with the author of another article on adopting a more nuanced perspective on what is often called “depression” in young people. Not everybody who is distressed is depressed.
Even if we are depressed, there are healthy activities we can engage in to heal. We don’t all necessarily need antidepressants. That’s the point of a recent systematic review and meta-analysis on the role of exercise for managing depression. Exercise is effective either by itself or in addition to psychotherapy and antidepressant.
Iowa actually seems to be putting a lot of hard work in mental health outreach, such as Your Life Iowa. It’s funded by the Iowa Dept of Health and Human Services under the Division of Behavioral Health.
I saw this interesting article on a study about the effect of chair placement on physicians’ behavior when in a patient’s room, specifically whether it altered the length of time a doctor spends with a patient or the level of satisfaction patients had with the interaction. In this study, it didn’t lengthen the time, but seemed to strengthen patient satisfaction with interaction with the physician. It’s a concept I recognize because I took this one level up—I carried my chair with me on hospital rounds in my role as a consultation-liaison psychiatrist.
I got a gift of a 3-legged camp stool from a colleague who ran the palliative care service at University of Iowa hospital. Other members of the palliative team had been using them as well.
Patients got a big kick out of a doctor who carried his chair around with him and actually sat down to talk with them. The way the camp stool folds up apparently made it look like nunchucks to some patients, so I got jokes about that occasionally. It really helped build rapport.
The only drawback with the camp stool was that my one of my legs would go numb the longer I sat on it, and could lead to a challenge getting up from it gracefully because it was partly a balancing act. Even so, I often spent much more than 10-15 minutes with patients.
Once, the stool actually broke and I dropped unceremoniously on my butt while evaluating a patient for catatonia—who proved not to be catatonic by the apparent facial expression of mirth as I fell on the floor. In that sense, the chair actually became a part of the evaluation—accidentally.
Thomas Hackett knew all about this. He was a famous consultation-liaison psychiatrist and a past president of the Academy of Consultation-Liaison Psychiatry (ACLP). One of his quotes from an early edition of the Massachusetts General Hospital Handbook of General Hospital Psychiatry fits perfectly in this context:
“As a matter of courtesy, I sit down when interviewing or visiting patients. Long accustomed to the ritual of making rounds, many physicians remain standing as a matter of course. Standing, physicians remind me of missiles about to be launched, poised to depart. Even if that is not necessarily true, they look the part. Patients sense this and it limits conversation. In addition, when standing, the physician necessarily looks down on the patient. This disparity in height is apt to encourage the attribution of arrogance. Looking down at a patient who is prone emphasizes the dependency of the position. Sitting at the bedside equalizes station. Sitting with a patient need not take longer than standing with him.”— Hackett, T. P., MD (1978). Beginnings: liaison psychiatry in a general hospital. Massachusetts General Hospital: Handbook of general hospital psychiatry. T. P. Hackett, MD and N. H. Cassem, MD. St. Louis, Missouri, The C.V. Mosby Company: 1-14.
Reference: Effect of chair placement on physicians’ behavior and patients’ satisfaction: randomized deception trial BMJ 2023; 383 doi: https://doi.org/10.1136/bmj-2023-076309 (Published 15 December 2023)
In light of March being Women in History Month (as well as Iowa History Month), I’d like to share some history stories about an African American librarian from Mason City, Iowa named Esther J. Walls. In 2020 during the Covid-19 pandemic, there was an essay about her, “Esther J. Walls: The Role of a Black Leader.” Her life story as a librarian, traveler, and educator is fascinating.
I looked through the list of women elected to the Iowa Women’s Hall of Fame and couldn’t find her name. However, I recognized Deborah Ann Turner’s name on the list. She was the first African American woman to be certified by the American Board of Obstetrics and Gynecology in gynecologic oncology. She was also from Mason City, Iowa. Her life story and list of accomplishments is also impressive.
I identify with both of them because they were born and raised in my hometown, Mason City, Iowa. Esther J. Walls was employed at the Mason City Public Library, my favorite haunt because my love of reading and writing began in early childhood.
An archived news item about Esther J. Walls entitled “A Mason City woman’s globe-trotting career” highlights her travels and her sense of humor.
We watched the section of the CDC ACIP meeting about RSV vaccines on February 29, 2024. There was a lot of discussion on the safety of the vaccine. It looks like it will still have a requirement that you have a shared clinical decision-making meeting with your physician. I think that still implies you’d need a prescription. However, there are only a handful of states which would require a prescription from your doctor. Iowa is one of them.
That made the comment by one of the committee participants thought provoking. I believe she got the RSV vaccine from a pharmacist, who asked no questions. There was no shared clinical decision-making discussion with that pharmacist.
But there was a discussion during the meeting with a pharmacist who was in the room. She made it clear that pharmacists had plenty of training (“20 hours” along with additional learning) and could handle the shared clinical decision-making piece with patients.
Sena and I have had all of our vaccines including the Covid-19 shots administered by pharmacy techs. I hardly know what the pharmacists look like because they are a blur, managing the drive-up window and all other customers. It’s clear that a large proportion of vaccines are available at most pharmacies and the techs give the shots. They are pleasant and happy to apply the Band-Aid.
You can’t even telephone the pharmacy and talk to a live person. Sometimes you’ll get a recording which replies to most of your questions with “Sorry, I didn’t get that. Did you say you want a vaccine or a cheeseburger with fries?” Scheduling vaccine appointments are generally done on line. Scheduling a visit with the pharmacist is probably not easier than scheduling one with your doctor, who might confuse you with “the colonoscopy” in room 5.
I’ve looked at the health care professional section on the CDC website pertaining to the age and medical conditions necessary to qualify for getting the RSV vaccine. I’m pretty sure I’m in the right age category, although I stopped keeping track after the evolution of asparagus. I don’t have any chronic medical conditions, unless you count dad jokes. I exercise, juggle, take only a multivitamin a day, meditate, and regularly leap tall buildings in a single bound. I’m pretty sure I don’t need the RSV vaccine, but what do I know? I’m a retired psychiatrist.
It looks like the risk of getting Guillain-Barre Syndrome (pronounced “GBS”) is not zero and may or may not be associated with the RSV vaccine. It’s pretty clear that 2 of the 3 major manufacturers of the vaccine who attended the meeting were pretty sensitive to any hints their product might have anything to do with GBS and might challenge you to a no holds barred thumb wrestling match if you say otherwise.
We think there’s a long way to go before everybody’s clear on who gets the RSV vaccine and when, and also where. But you can’t get it at the pharmacy drive up window.
Go Retire Psychiatrist 