There’s a new podcast in town from The University of Iowa Health Care and the title is “When to Suspect Atypical Recreational Substances.”
88: Modifiable Risk Factors for Breast Cancer –
Rounding@IOWA
In this episode of Rounding@IOWA, Dr. Gerry Clancy sits down with breast cancer experts Dr. Katherine Huber‑Keener and Dr. Nicole Fleege for a discussion of modifiable and non‑modifiable risk factors, modern screening tools, and practical strategies clinicians can use to guide prevention and early detection. CME Credit Available: https://uiowa.cloud-cme.com/course/courseoverview?P=0&EID=82146 Host: Gerard Clancy, MD Senior Associate Dean for External Affairs Professor of Psychiatry and Emergency Medicine University of Iowa Carver College of Medicine Guests: Nicole Fleege, MD Clinical Assistant Professor of Internal Medicine-Hematology, Oncology, and Blood and Marrow Transplantation University of Iowa Carver College of Medicine Kathryn Huber-Keener, MD PhD Clinical Associate Professor of Obstetrics and Gynecology – General Obstetrics and Gynecology University of Iowa Carver College of Medicine Financial Disclosures: Dr. Gerard Clancy, his guests, and Rounding@IOWA planning committee members have disclosed no relevant financial relationships. Nurse: The University of Iowa Roy J. and Lucille A. Carver College of Medicine designates this activity for a maximum of 0.75 ANCC contact hour. Pharmacist and Pharmacy Tech: The University of Iowa Roy J. and Lucille A. Carver College of Medicine designates this knowledge-based activity for a maximum of 0.75 ACPE contact hours. Credit will be uploaded to the NABP CPE Monitor within 60 days after the activity completion. Pharmacists must provide their NABP ID and DOB (MMDD) to receive credit. JA0000310-0000-26-035-H99 Physician: The University of Iowa Roy J. and Lucille A. Carver College of Medicine designates this enduring material for a maximum of 0.75 AMA PRA Category 1 CreditTM. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Other Health Care Providers: A certificate of completion will be available after successful completion of the course. (It is the responsibility of licensees to determine if this continuing education activity meets the requirements of their professional licensure board.)
This is a fascinating topic and the discussion ran for close to an hour, which is longer than usual because there’s a lot to say about it. The substances include a lot of chemicals that are not illegal and, in some cases, easily available in convenience stores and gas stations. In fact, the name for one of them is gas station heroin, which is tianeptine, approved in other countries as an antidepressant.
The discussion also included substantial information (or maybe better said, lack of enough information) about bath salts (usually cathinones), kratom, and something I’ve never even heard of: diamond shruumz (chocolate bars which can contain various substances not limited to psilocin). Remember that guy who chewed the face off of somebody in Miami in 2012? That was attributed to intoxication with bath salts.
This is way beyond the 1970s stuff like window pane or blotter (LSD) and pot. Many people end up in emergency rooms for evaluation of what looks like poisoning from multiple drugs. The stickler is the possibility that they got poisoned from something bought at a convenience store. Often it’s difficult to tell what the person ingested.
One of the takeaways from this podcast is that, whenever possible, try to get a history from the patient. They might just tell you what you need to know.
I made this YouTube video of a full six deal game of cribbage solitaire—and missed a 3-card run which would have won the game!
What the heck, I probably made other mistakes too that others will notice.
The rules:
Cribbage solitaire has six hands and six cribs and you peg your six hands.
Start by dealing two cards down to form part of your hand, then one down to form part of the crib. Deal two more to your hand, one more to the crib, and finally two more to your hand (which now has six cards and the crib has two.
Discard two of the six cards to form a four-card crib. Then flip the top card of the deck for the starter card.
Then peg your hand for maximum count, which would not always be the way you’d peg in a game with an opponent. Colbert’s example paraphrased: if you hold 5-10-10-jack. Play the 5 first, then a 10 for “15-2,” then the other 10 for “25, a pair for two and a go.” The remaining jack also scores a “go” for one point. Your peg is six points total.
After scoring the peg, count your hand, then your crib.
Then start the second deal by using the first-hand starter card, which becomes one of the first six cards for your hand. Again, deal the crib two cards. Repeat this process until you complete the game with the sixth deal (the deck will have four cards after six deals). (Colvert, 2015)
Reference
Colvert, D. (2015). Play Winning Cribbage 5th ed. Missoula, Montana: Starr Studios.
Svengoolie Show Intro: “Calling all stations, clear the air lanes, clear all air lanes for the big broadcast!”
This coming Saturday’s (September 13th) Svengoolie movie will be the 1956 Warner Bros. production of “The Bad Seed,” which is about a little psychopathic girl who dares another kid to knock a stick off her shoulder and when he does, he finds out with a shock it’s not a stick but a venomous snake which bites him on the nose, sending him to the hospital in an ambulance which careens off a bridge into a raging river full of giant piranha which—OK, so that’s not exactly how the movie goes and I’ve never seen it before.
The show is coming on at 6:00 p.m. central time instead of 7:00 p.m., just to let you know.
I think I found a pair of articles from the mid-1970s in the Huston-Tillotson College Ramshorn Journal that might have a connection to each other, even though the authors didn’t know it at the time.
One of them was written by yours truly and published in December of 1975, entitled “H-TC Sponsors Education Seminar.”
The other is a New York Times editorial from January 1976 which was reprinted in the May 1976 volume of the Ramshorn Journal and was written by Christopher F. Edley, a very successful lawyer and, at the time, the Executive Director of the United Negro College Fund.
Both were written about the same time, in the era of the civil rights struggles. I’m not comparing myself to the brilliant and accomplished Mr. Edley. And I’m just going to admit that I really don’t remember much about the trip to Houston for the Education Seminar about which I wrote my article, despite my being a participant. But I think it’s hard not to notice the language I used in my description of the importance of what the education seminar was all about. While much of the text is rather dry, when I discuss what was emphasized, I sound a little more intense. I may not remember much of what we specifically did and said but I caught the tone.
When I say the trip was not a guided tour, I mean that both faculty and students were serious about what the main message was for us—as black people. We had to measure up in a way that implied that we had to be better than best. That whole section starting with “Throughout the program, our people were reminded that any person who aspires to a position with any company must fulfill particular criteria.” It was as if I were saying we had to be perfect to make up for being black. We had to be the exemplars.
The individual must exhibit creativity, aggressiveness, ambition, self-confidence, initiative, dedication, maturity, and an ability and willingness to cooperate and effectively communicate with other people. The individual must punctual and reliable. Industry demands nothing less than high-gear performance. But they pay handsomely for that high-gear performance.
As I read this now, I get caught up on all the exhortations to be scrupulous, alert, and so on because, after all, we’re in a corporate jungle which is all about survival. I could have recast the last sentence above as “But they pay dearly for that high-gear performance”—which refers to the candidate, not the one doing the hiring.
I admit that how I wrote the story may reflect my reaction to rather than the reality of the emphasis of speakers at the seminar. But I did get the impression that I, as a black person, would be held to a higher standard than a white person. And I was uncomfortable about that.
When I turn to the New York Times article by Mr. Edley, I again am impressed with the struggle for fairness and justice, which didn’t seem forthcoming. He expressed the same sense of unfairness that I felt in Houston. The tone is almost one of outrage. He described the black people who were going to college in those days as most likely being the first ones in their families to go to college.
That’s what I was.
Mr. Edley was expressing frustration about blacks and browns just being able to get to the door of opportunity. I got the message that the struggle would go on forever—even if we got in the door. We didn’t just have to prove we were equal. We had to prove we were better.
Anyway, as I read the articles I wrote for the Ramshorn Journal 50 years ago, I begin to realize why I had no memory of having written them. It gradually becomes less strange that I still don’t really remember much of my time at Huston-Tillotson College, one of the historically black colleges and universities (HBCU) in America. But I needed that experience, even if I did pay dearly for it.
Click in the gallery; click on the picture, click the icon with an “i” in a circle, click view full size, click the plus sign to enlarge the image.
I’m thinking about the upcoming commemoration of the 24th Anniversary of the 9/11/2001 attack on America. There will be the annual event in New York City.
In Muscatine, Iowa, there will be the annual Patriot Day ceremonies sponsored by the City of Muscatine and the Muscatine Fire Department. After the morning ceremony, the Memorial Stair Climb will begin at 8:52 a.m. at the Muscatine High School football stadium bleachers.
The KCRG news reported on August 7, 2025 that 3 more World Trade Center victims were identified last month by DNA testing. The New York medical examiner’s office continues testing the remains recovered from the wreckage.
Like many people, I remember where I was and what I was doing when the attack happened in 2001. I was the general hospital psychiatric consultant on duty at the hospital at the time. I was hustling up the stairs back to my office after responding to a consultation request.
I happened to glance at the big television screen on the wall of the main floor lobby in the south part of the hospital. I watched in horror as a newscast showed the fire and smoke coming from one of the towers, which I later learned came from the plane crashing into the building. The rest of the day was full of reports of the attack.
When we visited New York City in 2017, we saw the Memorial & Museum Plaza as well as the Survivor Tree, the Callery Pear. It was discovered at Ground Zero, scarred and scorched but alive and replanted at the Memorial in 2010 after being nursed back to health at the city nursery. It is still alive and well today. It remains a symbol of strength, hope, and a reminder of our connection to each other.
Sena and I got our latest updated seasonal Covid-19 and flu vaccines today. Manpower was low at Walgreens so we ended up sitting for about an hour, but otherwise this was a routine trip. We’re thankful.
We noticed there were a few people waiting—mostly our age. No word up yet on the CDC ACIP site about the Sept. 18-19 meeting as far as an agenda, speakers, or slides.
I watched the 1956 Universal-International Pictures production of “The Creature Walks Among Us” last night on the Svengoolie show. It’s a movie about chain-smoking scientists who capture the aquatic Gill-Man, transform it into an air-breather and blow smoke into its face to make it cough. This annoys it so much it starts breaking stuff.
The scientist who pushes the whole project is Dr. William Barton (Jeff Morrow) who at times can be seen smoking 10 cigarettes simultaneously which sets his hair on fire. He’s bald for the rest of the movie, which doesn’t endear him to his wife Marcia (Leigh Snowden) who copes with his pathological jealousy by playing several musical instruments throughout the movie.
The team of scientists includes a geneticist, Dr. Thomas Morgan (Rex Reason), a prince of a guy who spars with Dr. Barton about the pros and cons of contributing to the delinquency of a major monster by altering its biology, moving it closer to the “jungle or the stars.” Dr. Barton doesn’t buy this metaphor and is bent only on pursuing a maniacal plan to teach the creature how to shoplift cigarettes and bottles of Thunderbird wine.
Dr. Morgan is sweet on Marcia but so is the guide, Jed Grant (Gregg Palmer). Marcia plays various musical instruments to keep between her and Jed, starting with a piano, progressing to a guitar and, when he gets more insistent on messing up her hair, she hauls out a cello!
The group of scientists catch the creature out on the river. They’re all smoking when it suddenly leaps into the boat and when it picks up a gas can spilling the contents all over itself, all they have to do is flick their cigarettes at it on a pre-arranged signal (Dr. Barton farts). While the creature is wrapped in flames, the crew takes a little while to figure out which fire extinguisher they should use (what works on scales, foam or dry chemical?).
Apparently, the Creature evolves spontaneously once it’s out of the water and grows a feeble set of lungs. The scales fall off to be replaced by skin, and it develops fingers. Then it tries to steal Marcia’s banjo.
The scientists imprison the creature in a pen which has an electrified fence, which Dr. Barton forgets to re-activate after he dumps Jed (whom he has knocked out with Marcia’s clarinet) in there to distract it.
This doesn’t fool the creature but I wouldn’t want to spoil the ending for you. The moral of the story is that smoking is bad for your health.
Sena went over to ForeverGreen, a popular landscaping and garden center locally, to see the butterfly house. She got pictures and video clips which showed the monarch butterfly management operation they have. They have quite a conservation program, including a large monarch butterfly house enclosure along with demos of life cycle stages. The butterfly house is just part of the deal and it’s open to the public. It opened in June of this year and runs until September 14th. The schedule shows there’ll be a big release then and possibly even tagging prior to that. You might want to call ahead and check to see if they’re still going to tag the monarchs.
I think this is also a good way to rehabilitate Bigfoot’s image because they could be sort of like ranch hands tending to the monarch as they go through their life cycle. The monarchs migrate to Mexico every fall. You can learn more about the monarch watch program and why many people believe the monarchs are at risk of extinction.
Today, the Big Mo Pod Show was about how blues music can you help you “exorcise your demons” as Big Mo himself put it today. Isn’t that what it’s always about? And I can’t explain how that even works.
After a short break during the Thanksgiving holiday your hosts are back at it again with another episode! This week features the usual mix of blues eras you’ve come to expect along with a few Californian artists, tune in to see which ones! Songs featured in the episode: Solomon Hicks – “Further On Up The … Continue reading
But I don’t always understand how it works. I’m going to admit I’m not sure at all how one song last night by Toranzo Cannon would help anybody, and that’s “I Hate Love.” Of course, it’s contradictory and ironic. I’m not going to pretend I know what blues music is all about and how it can sometimes heal your inner soul pain.
But a lot of people believe that blues can help you get past the pain and it seems that it works paradoxically. I don’t always get it. But I’ve been listening to the Big Mo Blues Show for years.
That reminds me. We had a couple of guys install motorized window shades yesterday and one of them was a blues musician. He plays bass guitar and I gather he plays in local bands. He wore the best hat; it’s a fedora! Sena and I sort of ribbed him about it, but I had a fedora like that once, decades ago. It was gray with a narrow leather band. I don’t have it anymore.
I told him that I wore it while I was interviewing for residency. I wore it to dinner in a hotel in St. Louis, Missouri and a woman passing through the hotel restaurant looked at me and said with a grin, “Wear that hat!”
Sena reacted as if she’d never heard that story before. The fedora guy thought it was funny. Fedora man had that style to him that I think is fairly common in musicians. They look and may act in a way that makes you notice them. I don’t think you can always tell what somebody does just by the way he or she dresses. But when he told us he was a musician who liked the blues, that didn’t surprise us.
What did surprise us was that he didn’t recognize the name of a prominent blues musician in Iowa and a lot of other places—Kevin Burt. But he did have a sense of humor.
I think most blues musicians have a kind of slant sense of humor. It probably comes out in some of the music. I’m more drawn to blues music that makes me chuckle. On the other hand, I liked one song on the blues show last night they didn’t discuss today on the pod show. It’s not funny and I had a hard time finding the lyrics for it. It’s “I’ll Always Remember You” by the Robert Cray Band. I found a couple of sites I think got the lyrics below wrong and didn’t make sense. The way I heard the song the lines went like this:
“Old clothes and worn-out shoes Empty bottles and a book that’s way past due.”
The line I keep finding that I think is wrong is the second one, which is often written as “Empty bottles and I put this way past due.”
I think the line “a book that’s way past due” makes more sense because it conveys a sense of regret, waste and loss and promises not kept and opportunities lost and probably a half-dozen other ideas that you probably can’t easily encapsulate. It evokes sorrow that is only partly fixed by the letter’s promise— “I’ll always remember you.”
That may not completely heal you, but it’s a little like something I read about kintsugi. It’s about mending broken pottery with gold in a literal sense. In a metaphorical sense, it’s about repairing what might be broken emotionally broken in us and, despite not being the same as we were before we were broken, we’re somehow still functional and healed though not perfect. A psychiatry resident blogger wrote about that.
I won cribbage solitaire in six deals (meaning I got to 121) on my first try today. Lucky break. I’m beginning to think I should just film these because, at least lately, I seem to be on a winning streak. My first and most recent win was 3 days ago and I think I’ve played once or twice since then.
Rules summarized and demo video below:
Cribbage solitaire has six hands and six cribs and you peg your six hands.
Start by dealing two cards down to form part of your hand, then one down to form part of the crib. Deal two more to your hand, one more to the crib, and finally two more to your hand (which now has six cards and the crib has two.
Discard two of the six cards to form a four-card crib. Then flip the top card of the deck for the starter card.
Then peg your hand for maximum count, which would not always be the way you’d peg in a game with an opponent. Colbert’s example paraphrased: if you hold 5-10-10-jack. Play the 5 first, then a 10 for “15-2,” then the other 10 for “25, a pair for two and a go.” The remaining jack also scores a “go” for one point. Your peg is six points total.
After scoring the peg, count your hand, then your crib.
Then start the second deal by using the first-hand starter card, which becomes one of the first six cards for your hand. Again, deal the crib two cards. Repeat this process until you complete the game with the sixth deal (the deck will have four cards after six deals). (Colvert, 2015)
Reference
Colvert, D. (2015). Play Winning Cribbage 5th ed. Missoula, Montana: Starr Studios.
Go Retire Psychiatrist 