Category: Iowa

Moderate Respiratory Illness Activity in Iowa

The CDC tracks respiratory illness and there is moderate activity in Iowa according the data tracker.

The weekly snapshot as of December 1, 2023 shows highlights including:

  • “COVID-19 test positivity (percentage of tests conducted that were positive), emergency department visits, and hospitalizations have increased nationally. A group of Omicron variants (XBB and its sublineages) are the predominant lineages detected in the U.S., with HV.1 being most common. The prevalence of another lineage, BA.2.86, is projected to account for 5-15% of currently circulating variants. CDC continues to monitor HV.1, BA.2.86, and all other lineages.
  • National test positivity, emergency department visits, and hospitalizations for influenza continue to increase.
  • RSV emergency department visits and hospitalizations continue to increase across the country. RSV-associated hospitalization rates remain elevated among young children and are increasing among older adults; of note, only 14.8% of adults 60+ report having received an RSV vaccine.
  • National vaccination coverage for COVID-19, influenza, and RSV vaccines increased less than one percentage point for children and adults, where indicated, compared to the previous week and remains low for both groups.
  • CDC has been monitoring increases in respiratory illness reported recently among children, including potential elevated rates of pediatric pneumonia in parts of the United States. These reported increases do not appear to be due to a new virus or other pathogen but to several viral or bacterial causes that we expect to see during the respiratory illness season. CDC will continue to work closely with our state and local public health partners to maintain strong situational awareness and will provide updates, as needed.”

Update on CDC Recommendation for Adult RSV Vaccination

I just checked to see if the Iowa Board of Pharmacy rules had changed about the recommendation that a physician and patient shared decision-making discussion should help clarify whether and why a prescription would be necessary to enable a patient over the age of 60 years to get the Respiratory Syncytial Virus (RSV) vaccine.

I found out that nothing has changed the position of the Iowa Board of Pharmacy on this issue, despite the CDC published list which now includes the RSV vaccine (which seemed to be the main issue against allowing pharmacists to administer the vaccine independently). I finally found the CDC Adult Immunization Schedule by Age web page. The section shows a table of vaccines recommendations broken down by age. Below the table is a list of the CDC recommended vaccines. Under the RSV category there is a Special Situation section with guidance for those over the age of 60 regarding those most likely to benefit from the RSV vaccine:

  • “Age 60 years or older: Based on shared clinical decision-making, 1 dose RSV vaccine (Arexvy® or Abrysvo™). Persons most likely to benefit from vaccination are those considered to be at increased risk for severe RSV disease.** For additional information on shared clinical decision-making for RSV in older adults, see www.cdc.gov/vaccines/vpd/rsv/downloads/provider-job-aid-for-older-adults-508.pdf.

For further guidance, see www.cdc.gov/mmwr/volumes/72/wr/mm7229a4.htm

**Note: Adults age 60 years or older who are at increased risk for severe RSV disease include those with chronic medical conditions such as lung diseases (e.g., chronic obstructive pulmonary disease, asthma), cardiovascular diseases (e.g., congestive heart failure, coronary artery disease), neurologic or neuromuscular conditions, kidney disorders, liver disorders, hematologic disorders, diabetes mellitus, and moderate or severe immune compromise (either attributable to a medical condition or receipt of immunosuppressive medications or treatment); those who are considered to be frail; those of advanced age; those who reside in nursing homes or other long-term care facilities; and those with other underlying medical conditions or factors that a health care provider determines might increase the risk of severe respiratory disease.”

While the rationale for the recommendation is clear, it’s interesting that Iowa is one of only 4 states in which pharmacists cannot administer the RSV vaccine independently (meaning a physician prescription is necessary). The RSV vaccine is in the CDC published vaccination schedule, which looks like it would satisfy the Iowa Code Section 155A.46 according to the Iowa Board of Pharmacy.

I still wonder whether it’s the shared decision-making discussion or the Iowa Code that’s the main reason a physician prescription is necessary to get the RSV vaccine.

It isn’t that I want the RSV vaccine. In fact, based on what I’ve read on the CDC Immunization Schedule, I don’t think I need it because I’m pretty healthy for a geezer. I just don’t understand why only 4 states require a physician prescription. Does that mean the pharmacists in the rest of the country are confident they can have a shared decision-making discussion with patients about the indication for the RSV vaccine?

Early Snowbird Gets the Berry

We got our first snowfall that stuck around yesterday. We didn’t have to shovel because it melted off our sidewalk and driveway shortly past noon.

On the other hand, the snow drew the birds out for the berries in the trees. Cedar Waxwings and other small birds feasted in the early morning. Whether they got the winterberries low to the ground or the ones high up in the trees—they got them.

It snowed the better part of the morning. It caught some Iowa drivers off guard. There were pictures in the news of cars rolled over on their roofs in the ditches.

But the birds made out like bandits.

Music Credit for YouTube Video:

Eternal Hope by Kevin MacLeod is licensed under a Creative Commons Attribution 4.0 license. https://creativecommons.org/licenses/by/4.0/

Source: http://incompetech.com/music/royalty-free/index.html?isrc=USUAN1100238

Artist: http://incompetech.com/

Bucks Throw Down But Does Decide

I caught sight of some buck deer contending for some does out in the clearing behind our house. This is probably what you might call the rut for white tail deer. The bucks do a lot of jousting for access to the does. But clearly, the does decide.

We have never caught them mating on film. In fact, the does never display any interest in the bucks as they trot around and fight each other. The only way we know mating eventually happens is when the spotted, frail-looking fawns appear in the spring.

The Geezer Remarks on Superfoods

Sena is big on eating healthy, which is a good thing. On the other hand, we don’t necessarily always like the same foods. And there’s the whole issue of what people call superfoods nowadays.

Funny, when I was a kid, I used to just refer to superfoods as “yuck!” There are variant spellings.

I read the Wikipedia entry on superfoods and it essentially says there is officially no such thing.

Take beets—please!

Sena’s big on Beets and Leeks. I’m not a big fan. I’ll eat them, of course. There’s nothing wrong with them that intravenous ipecac and a stomach transplant won’t fix. The drawback is the medical bill.

I don’t think we’ve ever had kale. Does that make the superfood list? I think it’s the same thing as mustard greens, okra, and other building materials similar to shingles.

I tried okra when I was a student at Huston-Tillotson University (then Huston-Tillotson College). I was offered this slightly slimy substance as part of a dinner at the home of my Religion and Philosophy professor and his family. It’s slimy because it contains mucilage, which is (correct me if I’m wrong but I’ll naturally ignore you) also the name of the glue we used in grade school to make valentine cards.

In fact, think of any food you dislike as intensely as any medication or tonic you had to take when you were a kid. That would be classified as a superfood. I had to take a tablespoon of mineral oil a day, which is a substance very much like mucilage.

I found out that millet is marketed as a superfood. That’s funny, because it’s also used as a filling for juggling balls. When you work up an appetite juggling, you can just bust open one of the balls and snack on a handful of bird seed, which is what millet really is.

Actually, superfoods come in handy in case you’re abducted by extraterrestrials. Whenever they look like they’re getting ready to jam some kind of implant up your nose, offer them a juggling ball. Just tell them to keep chewing through the leather shell until they get to that tasty millet center. This will give you time to write down the driving directions to the nearest barbecue joint for them (Jimmy Jack’s Rib Shack in Iowa City for example).

Anytime you need any more expert advice on superfoods, just let me know. I’m not available.

Happy 46th Wedding Anniversary!

It was 46 years ago today Sena and I were married at the Little Brown Church in the Vale in Nashua, Iowa. I was a skinny guy with a big afro. She was and is a beautiful bride.

We cut the wedding cake together. We fed each other big bites. It was the biggest event of our lives.

There were other big events. The trip to Vegas and marveled at the Bellagio fountains. The helicopter ride over the Niagara Falls. The view over New York City from the Empire State Building. That was my first senior discount ticket. Sena holding a little alligator in Miami. The Lincoln Book Tower in Washington, D.C. Festooned with the birds of Hawaii.

Wherever we went, whatever we did, we were always together. She’s always fearless. She’s gone with me wherever I went, even when I was wrong. I am often wrong—but I was right about marrying her.

Food for Thought

I’m giving a shout-out to a couple of child psychiatrists, one I know only from a blog, The Good Enough Psychiatrist. The other is an assistant professor in the University of Iowa Child Psychiatry Dept. I’ve never met her.

Since Jenna gives her name in the About Me section of her blog, I’m going to call her that because it’s easier. Jenna writes many thought-provoking posts, but I really admire the one titled “Amae.”

Dr. Ashmita Banerjee, MD wrote an essay titled “The Power of Reflection and Self-Awareness.” It’s published on line in the Mental Health at Iowa section of The University of Iowa web site.

As a relatively recently retired consultation-liaison psychiatrist who is also a writer, I feel a strong connection to them. In addition to being very glad that extremely talented persons are filling the ranks of a specialty which suffers from a serious manpower shortage, I get a big kick out of reading what really smart people write.

Here’s where a geezer retired psychiatrist starts kidding around. Jenna, a fellow blogger, is used to my habit of deploying humor, admittedly often as a defense. Dr. Banerjee doesn’t know me.

What is it about these essays that reminds me of the X-Files episode “Hungry”? It’s a Monster of the Week episode from the monster’s perspective. This monster looks like a human but sucks brains out of people’s skulls. He’s conflicted about it and even sees a therapist. But in the end his dying words were, as Agent Mulder shoots him down, “I can’t be something I’m not.”

If you read Dr. Banerjee’s essay and followed one of the links, you would have caught the clue that I actually read it because I consciously substituted the word “What” for “Why” in the previous paragraph. I could have as easily asked why instead of what—but it’s less helpful in gaining self-awareness.

And I haven’t sucked anybody’s brains out of their skulls in, what, over two weeks now! Upon reflection, I’m very aware of being incorrigible. Food for thought.

Jenna’s description of the Japanese concept of the word “amae” and Dr. Banerjee’s examination of the Japanese word “kintsukuroi” fascinated me. What made both writers consider human emotions using a language which captures the nuances so deftly?

I was a first-generation college student. There was a time in my life that a path to medical school seemed impossible. At times I probably thought I was trying to be something I’m not.

I’m just grateful for the new generation.

Falling Leaves

The leaves are falling everywhere, including our back yard. Just watching them drop like a snowfall is mesmerizing. It feels like it’s going to snow. Temperatures have been low enough for frost and freeze warnings around here. The mowers were bundled up, wearing stocking caps and gloves yesterday.

Fall is Sena’s favorite season. Temperatures are cooler and the changing colors of the leaves makes us wonder how the trees know when it’s time to drop them.

When I was a kid, I and a lot of neighborhood kids jumped off a small cliff at a park into a huge pile of leaves. It was a big deal to take the leap. We felt like we were flying. The bits of dry, brown leaves got in your hair and down your back under your shirt, making you itch.

I remember raking leaves in an old guy’s yard once. I got blisters on my hands and he didn’t pay me much. I didn’t like that part of fall and still don’t.

That’s why spring is my favorite season.