Category: Iowa

Look at Us Back on the Scott Blvd Trek!

The weather was pretty good for a walk on Scot Blvd the other day. Right away I got a video clip of an Indigo Bunting, a bird I haven’t seen in over 20 years! It was sitting on a thin grass stem which couldn’t hold its weight. It looked like it was sinking lower and lower on a slow elevator.

The people we passed along the way were friendly. Just looking at the landscape while sitting next to the Sitting Man was relaxing.

The video of the song “Then You Look At Me” by Celine Dion also fits, depending on your mood. Looking at nature puts you in the mood. Try not to think of robots.

Watch Out for Spaghettification on Skinwalker Ranch!

I’m not up to speed on the math of black hole portal wormhole vortices and whatnot, but I think the actors on The Secret of Skinwalker Ranch need to be careful what kind of incendiary devices they’re tossing into the Triangle Area.

I barely got through the general physics introductory course at Iowa State University. I remember the momentum lab experiments—barely. My lab partner showed up late because he was really hung over. I think he asked me if I ever partied and I said I had pretty much outgrown that kind of thing. He looked at me like he was shocked and exclaimed, “You mean this crap ends?”

On the other hand, despite his hangover he grasped the momentum math better than I did.

I’m still trying to figure out why one of the actors said “A black hole?” when somebody posed the question “What does that thing look like?” referring to what looked like a black hole at ground level following a LiDAR imaging test in the Triangle Area. I didn’t know you could find black holes with LiDAR.

There was also the suggestion of funnels in the air above the black hole, leading to the team wondering if it was a portal leading to a wormhole. Everybody got excited about it, and wondered if it might explain all the weird stuff happening on the ranch. Could there be monsters, extraterrestrials, orbs, and Braunschweiger with Miracle Whip sandwiches zipping in and out of these things?

It got me looking around on the internet to find out whether black holes and wormholes could be the same thing. It turns out some scientists think there could be black hole portals on one end and white hole portals on the other end of wormholes, which I think means you get spaghettified on one end and reassembled on the other.

However, this could mean you have to be wary of spaghettification if you try to travel to another dimension through a wormhole. You don’t have to take my word for it (and you shouldn’t!). Just ask physics professors Leo and Shanshan Rodriguez at Grinnell College in Iowa. Black holes swallow up everything that comes within spitting distance from them, stretch them way out so they resemble noodles and eventually destroy you.

The only thing you can do then is call Chuck Norris, who routinely eats black holes with Braunschweiger and Miracle Whip for lunch (they taste like chicken) and farts them into another galaxy far, far away. Chuck’s side hustle is to work part time at the Large Hadron Collider (LHC) where he is a part time janitor, sweeping up the little black holes it sometimes generates. That black hole the LHC created in 2012 which swallowed reality didn’t stand a chance against Chuck, who gargled it and spat reality back out.

This goes back to Einstein’s theory of general relativity of course, which proves by advanced, hyper galactic step over toe hold jujitsu level mathematical formulas that the stitches in the fabric of spacetime get all warped leading to a crazy strong gravitational pull involving stirrup pants that stretch you enough to motivate some men to spend any amount of money to increase their penis size including subjecting themselves to black holes such that they would need a carryon bag to haul it through Chicago O’Hare and believe spaghettification is just the trick although airport security has yet to devise how they can get it through the screening machine in order to avoid pat down searches which can not only tickle but also delay passenger boarding and lead to mass hallucinations of a big UFO similar to the O’Hare event in 2006, which was actually caused by a weather event according to men in black suits posing as FAA agents at the airport.

Does anybody else have a sudden craving for pasta?

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.

Braunschweiger and Miracle Whip Nostalgia Sandwich

Sena bought two items at the grocery store that brought back memories: Braunschweiger and Miracle Whip.

You may recall the Miracle Whip vs Mayonnaise challenge blog posts last August-September. Miracle Whip took a beating and it’s partly because I suspect the makers changed the recipe for it.

I can’t change that. On the other hand, I used to make sandwiches using slices of plain white bread and Braunschweiger. There are dozens of brands of Braunschweiger. I’ve never heard of Field, but it hardly matters. I think they’re all pretty much the same.

On the other hand, try telling that to the food science experts at Iowa State University. We found a YouTube video of a guy explaining what they look for when judging Braunschweiger. He went on about how it has to be a certain color (reddish is better), it can’t be spreadable, and it has to be flown in from a distant galaxy and so on.

But we also found a couple of videos that show the spread of opinion on what people think of the taste of Braunschweiger. One of them showed a guy in Texas who tried it for the first time. He toasted the bread (something I’ve never done), sliced the meat, placed it between the bread slices without any kind of condiment—took a while to roll it around his mouth and finally praised it highly.

That contrasted with a video of a father and son who made a hilarious and overdone spectacle of themselves gagging their way through a taste test.

There are a lot of recipes out there using Braunschweiger. Many of them look really tasty. Nostalgia is the word for my version. I don’t do anything fancy with it. I slap Miracle Whip on the bread, slap Braunschweiger slices on them and have lunch.

I ate a lot of lunch meat sandwiches when I was growing up. I didn’t know about nitrates and nitrites back then and didn’t worry about carcinogens from them. I still don’t. If you want the lowdown on nitrates and nitrites in your diet and the relationship to diseases like cancer as well as their benefits, you can read a very thorough and recent review of it (Karwowska M, Kononiuk A. Nitrates/Nitrites in Food-Risk for Nitrosative Stress and Benefits. Antioxidants (Basel). 2020 Mar 16;9(3):241. doi: 10.3390/antiox9030241. PMID: 32188080; PMCID: PMC7139399.). There is no slam dunk decision on whether it’s totally evil or not—note the word “benefits” in the title.

I recommend you not watch any overly dramatic YouTubes or read any scary science articles about it. Keep it simple. Just enjoy your Braunschweiger and Miracle Whip sandwich. You can also enjoy it with mayonnaise, if you’re so inclined. Sena and I did a taste test and this time the Miracle Whip tasted just like it did when I was a kid! Sena actually liked Braunschweiger. She ruined it with mayo, but that’s just her.

Pineapple Pizza Redo!

Well, we tried pineapple pizza a couple of months ago and the other day we tried it again. This time, as promised, we tried the Lotzza Motzza version. We didn’t doc it up. We thought it would be the best.

Neither of us were impressed. Sena says she wouldn’t try it again.

Neither of us could even taste the pineapple, although it seemed like there was enough of it on there.

Sena mentioned that somebody she used to work with got takeout pineapple pizza at Pagliai’s here in Iowa City. The place is legendary for great pizza here and the friend swore it was delicious. We’ve always been impressed with Pagliai’s Pizza.

However, I think we’ve had enough pineapple pizza.

Thoughts on the Passing of Dr. Russell Noyes Jr.

I recently found the obituary of my mentor, Dr. Russell Noyes, Jr. MD. He died on June 21, 2023. This is the first time I’ve ever said that he was my mentor. I probably just didn’t realize it until I found out he passed.

Dr. Noyes was my teacher during the time I was learning consultation-liaison psychiatry back in the 1990s at The University of Iowa Hospitals & Clinics. His knowledge was vast. He contributed greatly to the scientific literature on anxiety disorders. He also wrote about near death experiences.

Dr. Noyes retired in 2002. As his students, we chipped in to get him a retirement gift. It was a large bookstand. We were just a little uncertain about whether a bookstand was the right gift for someone who was a tireless researcher and teacher. He was also an avid gardener and musician. He soon returned to work in the department, staffing the outpatient clinic. He also continued to regularly attend grand rounds and research rounds. Years later at a grand rounds meeting, someone asked him about his retirement. Dr. Noyes retorted, “I don’t believe in retirement.”

I remember I could hardly wait to retire. Since then, I’ve been ambivalent about retirement, but not so much that I ever seriously considered returning to work. I sometimes have dreams about being late for college lectures because I can’t find my way to them. A couple of times lately, I’ve had dreams about not being able to find my way through a hospital to conduct a consultation evaluation. I don’t know what that means.

I was an avid student of consultation-liaison psychiatry but I was not a scientist. That was part of the reason I left the university in 2005 for a position in a private practice psychiatry clinic. He cried at the going away party my students and co-workers held for me. I still have a little book in which well-wishers wrote kind messages. Dr. Noyes’ note was:

“Jim

We’re going to miss you. You are the consummate consultation-liaison psychiatrist and your leaving is a great loss to the Department. We wish you the best and hope to see you at the Academy meetings.

Russ”

His sentiment was one of the main reasons I soon returned to the department, only to leave again a few years later—and return again after a very short time. I came back because he was a consummate teacher and I wanted to learn more from this beacon of wisdom.

Many who knew him, including me, often saw him riding a bicycle on Melrose Avenue to and from work at the hospital. We wondered why he didn’t drive instead. His son James wrote a beautiful remembrance of him and posted it on the web in 2006. It’s entitled “My Dad (Russell Noyes, Jr).”

James says his dad was a terrible driver. This triggered a memory of how it was Russ’s wife, Martie, who drove the rental car when we rode with them from the airport to the hotel where an Academy of Consultation-Liaison Psychiatry meeting was to be held. I remember gripping the armrest and wishing we’d hired a taxi as Martie steered erratically through heavy traffic.

Dr. Noyes knew how to guide his learners through their careers. He also knew how to write and was a stern editor. Even as I wrote this remembrance, I could see how he might have critiqued it. I tried to do it on my own, and of course I failed. It will have to do.

Costa Rica Tarrazu Coffee Notes

Sena bought a bag of ground Costa Rica Tarrazu coffee the other day. It brings back memories. We savored it along with some piano music from George Winston, may he rest in peace.

You can gas about coffees a lot. You can call Tarrazu a thing which has a certain complexity of notes, a balanced flavor, a spicy character and whatnot. I guess appraising coffee can be similar to judging wines. I don’t like wine and know nothing about it. I don’t know much about coffee, either.

But there’s a coffee connoisseur who made a YouTube video evaluating the Tarrazu we have. He said it has “coffee notes.” I should hope so. He gave it a so-so rating, 6.1. I guess there’s a 10-point rating scale. I think he takes subtle sarcasm to a new level. He had some kind of fancy coffee filter I’ve never seen before. He compared Tarrazu to coffee you get from Denny’s restaurant—as though Denny’s is a highbrow establishment. He also said it has chocolate notes. I actually noticed that years ago.

We first tasted Tarrazu at the World Market in Madison, Wisconsin many years ago. The drive from Iowa City to Madison was a pleasure. We took the more scenic route, which was Highway 151. Just in case you read this and make the trip yourself, I’ll say this: what is scenic to one is boring to another.

I remember we sampled Tarrazu from those little white Styrofoam cups in the World Market store. It was the smoothest coffee we ever tasted. We were hooked and bought a bag.

There’s a lot to do in Madison, which is not to say there’s not much to do in Iowa City. There’s just more of everything in Madison. Every day there was some new attraction to explore. Tarrazu was also a new experience.

We had a lot of fun in Madison. We went up to Wisconsin Dells and darn near froze to death on an open boat ride in the early fall. Part of the “fun” of the ride was mainly for the driver, I think. He would rev the boat at rocket speed and splash us with water, which could have had a thin skin of ice notes over it, judging from the shock. We saw the House on the Rock in Spring Green. We relaxed at the Sundara spa. We rode the horse-drawn wagon on the Lost Canyon tour and still have a deck of playing cards from the gift shop.

We’ve bought Tarrazu a couple of times since our adventure in Madison and found that, somehow, the flavor wasn’t quite as bright, not as smooth. On one bag, the name was spelled “Terrazu” rather than “Tarrazu. Sure, it had “coffee notes,” but not the chocolate notes. And it didn’t evoke memories of Wisconsin.

Finally, getting back to the Tarrazu we have now. The taste is miraculous, just like it was so many years ago. It takes me back to the Styrofoam cups at World Market, the speedboat in the frigid water, the Sundara bedsheets stained by previous guests with mud notes from the spa, the Infinity Room in Spring Green, cheese curds and chili.

Those are my Tarrazu notes.

I Just Heard the Song “Florida Man” on the Big Mo Blues Show

I heard the song “Florida Man” by Selwyn Birchwood on the Big Mo Blues Show on KCCK radio tonight. I updated my post “Gators OMG” by adding the YouTube video to it.

Squirrel Feasting on Mulberries!

The other day we saw a squirrel racing all over a tree in our back yard. At first, we didn’t know what kind of tree it was, but it was obvious the squirrel knew it could get a tasty meal from it.

The tree was full of fruit and, after a web search, we think it’s a mulberry tree. Lots of creatures eat mulberries including squirrels. That probably also explains why we see so many bird species flying in and out of that tree.

My Two Cents on the Involuntary Treatment of Tuberculosis and Psychiatric Illness

By now many of us have seen the news headline about the person in Washington state who was arrested and sent to jail for noncompliance with a court order for treatment of tuberculosis. This led to my searching the literature about the connection between court-ordered treatment for psychiatric illness and court-ordered treatment for tuberculosis in Iowa. I’m not assuming that the person who is the subject of the news story has psychiatric illness.

I’m a retired consultation-liaison psychiatrist and the issue of how to respond to patients who refuse treatment for tuberculosis arose maybe once in my career. When the Covid-19 pandemic began a few years ago, I thought of the Iowa code regarding involuntary quarantine of patients infected with Covid-19 infection. I thought it was a situation similar to that of persons infected with tuberculosis. That was an issue for the hospital critical incident management team to deal with.

I found an article relevant to both internal medicine and psychiatry. It is entitled “Can Psychiatry Learn from Tuberculosis Treatment?” It was written by E. Fuller Torrey, MD and Judy Miller, BA and published in Psychiatric Services in 1999. The authors point to the directly observed therapy (DOT) programs in place in several states, including Iowa. Such programs can include positive reinforcement incentives such as fast-food vouchers and food supplements, movie passes and more. They credit the New York experience using DOT with reducing the tuberculosis rate by 55%.

Torrey and Miller point out that many psychiatric treatment programs didn’t offer as many incentives as DOT programs for treatment of tuberculosis. They also say that a “credible threat of involuntary treatment, essential for the success of DOT” often is absent from psychiatric programs.

I was puzzled by their view because of what I saw from our own integrated multidisciplinary program of assertive community treatment (IMPACT) at The University of Iowa Hospitals & Clinics, which started well before they wrote the article. My impression is that it has been very successful. The Iowa Code covers the role of involuntary psychiatric hospitalization in the event of noncompliance as a result of uncontrolled psychiatric symptoms leading to danger to self or others or inability to provide for basic self-care needs.

On the other hand, because of my background in consultation-liaison psychiatry, I wondered about how we might treat someone with both tuberculosis and severe psychiatric illness, the latter of which could make treatment of the former difficult or even impossible.

We can use long-acting injectable antipsychotics to treat those with chronic schizophrenia. They’re not uniformly effective, but they play an important role in acute and maintenance therapy.

But I also forgot about how tuberculosis treatment could be administered to those unwilling to take it voluntarily. I rediscovered that tuberculosis treatment can be given by injection, if necessary, although it’s usually intended for treatment-resistant disease. On the other hand, scientists created a long-acting injectable drug for tuberculosis which was effective in animal studies and which could be a delivery system for non-adherent patients.

And I thought about who would be the responsible authority for administering tuberculosis medications on an involuntary basis. It’s not psychiatrists. It turns out that in most states, including Iowa, the local public health officer is in charge. The CDC has a web page outlining suggested provisions for state tuberculosis prevention and treatment.

Patients with tuberculosis who refuse treatment can be confined to a facility, although it’s not always clear what that facility ought to be. Certainly, I would be concerned about whether a jail would be the best choice.

I don’t have a clear answer for an alternative to incarceration. Would a hospital be better? General hospitals are not secure and there would not be an ideal way to prevent the patient from simply walking away from a general hospital ward. If the patient has a comorbid severe psychiatric illness that interferes with the ability to cooperate with tuberculosis treatment, then maybe a locked combined medical-psychiatric unit (MPU) would be the better choice. Arguably, while an MPU might not be the best use of this scare resource, it’s probably more likely to have a negative pressure isolation room for a patient with both tuberculosis and psychiatric illness. I co-attended with internal medicine staff on The University of Iowa Hospital’s MPU for many years. There are rigorous criteria for establishing such units. The best expert in integrated health care systems I know of would be a former teacher and colleague of mine, Roger Kathol, MD. He is currently the head of Cartesian Solutions.

I’m aware that just because someone refuses treatment for tuberculosis doesn’t necessarily mean a psychiatric illness is present. The critical issue then could become whether or not the patient has the decisional capacity to refuse medical treatment. The usual procedure for checking that would include assessing understanding, appreciation, reasoning, and the ability to make a choice. You don’t necessarily need a psychiatrist to do that. Further, there are nuances and recent changes in the decisional capacity assessment that can make the process more complicated. The New York Times article published in early May of this year, entitled, “A Story of Dementia: The Mother Who Changed,” makes that point based on a real-life case in Iowa, involving psychiatrists at The University of Iowa.

It occurs to me, though, that just because a person is able to pass a decisional capacity assessment doesn’t necessarily make a decision to refuse tuberculosis treatment OK. Letting someone expose others to infection when effective treatment is available doesn’t sound reasonable or safe.

That’s my two cents.

Quenard F, Fournier PE, Drancourt M, Brouqui P. Role of second-line injectable antituberculosis drugs in the treatment of MDR/XDR tuberculosis. Int J Antimicrob Agents. 2017 Aug;50(2):252-254. doi: 10.1016/j.ijantimicag.2017.01.042. Epub 2017 Jun 5. PMID: 28595939.