Itching and Scratching

Friends forever

So, Mike got home today  from Emory, headed for the living room, and picked up his book. Jackson jumped up on his lap, and they both promptly fell asleep. Mike just woke up, and he is still a little groggy. He didn’t sleep well again last night. He started in with another rash a few days ago, and it is spreading and has started to sting and itch, especially at night. His doctor once again put a hold on the Revlimid, but they gave him the rest of his medication. One of the meds was dexamethasone, which might knock out the rash. Let’s hope so. I keep telling Mike that he has to expect things like this, and he realizes it and isn’t complaining. He is grateful that he has had no nausea, and no more serious complications of chemo so far.

If Mike is vulnerable to any side effects it would be a rash. As an infant and up to age 22 he had severe atopic dermatitis (eczema). He itched constantly, and scratched himself bloody every night. He would wake up with blood under his fingernails, and on his pajamas and bed linens. When he was little his father tried to splint his arms so he couldn’t bend his elbows to scratch himself. This was not effective. I may have mentioned previously that when he was in college a doctor told him to put Vaseline on the rash. He used to walk around campus with his face excoriated and glistening. It was pretty grim. After a year or two he finally figured out that the Vaseline was making his rash worse, so he stopped using it. He was accepted to medical school for the incoming class of 1963, and during the previous winter break went to the student health service there for his physical exam, as part of the admission process. The doctor (Dr. Ziolkowski, God bless him) there sent him to the dermatology clinic, where they put him on a short course of steroids (methylprednisolone), and within 1 week his skin was 90% improved. Mike couldn’t believe it. On the one hand, he was thrilled and immensely grateful, and on the other hand, he realized that he could have had relief years ago and it was never offered to him. The reality of the situation is that there are all kinds of potential complications with steroids, and the benefit didn’t last very long. Well before he started medical school he was back to his baseline rash. Eventually, he went back to the dermatology clinic where they refused to order the medication, saying it was too risky. So Mike went back to the student health service and saw Dr. Ziolkowski again. He agreed to treat him. The steroids never did work quite as well as the first time, and the benefit was very short lived. One month Mike held off on starting his medication because he thought he might have been exposed to a virus. (Steroids can impair the immune response.) Within a couple of weeks his rash began to fade, and it has never returned. That was 54 years ago. However, even though there was no rash, Mike has continued to itch constantly. He says it is a big joke that God has played on him. So, it is not surprising that he would break out in a rash from chemo. This is the 3rd time already. He has some schmear to put on it. Let’s hope he will sleep better tonight. And, oh, you should see how short he keeps his fingernails trimmed.

At the top of this page is a picture of Mike and his friend, Jack Kramer. I mentioned that Jack and his wife, Pamela, were coming for a visit this past weekend in my most recent post (A New Low in Demagoguery, July 19, 2019) . There is nothing like old friends. They had a wonderful visit, talking about old times. They reminisced about their parents. The Kramers were very loving people who took many people into their home who had no other place to go. This was often at great expense to them, both materially and emotionally. Jack and Pamela have done the same. Jack’s father died of a broken heart, 1 month after the Cubs blew the 1984 pennant. They had the best record in the National League, and played San Diego for the pennant (At that time there were only 2 divisions per league.) The Cubs won the first 2 games of a 5 game series, and then lost the next 2. In the fifth and final game they lost it when Leon Durham pulled a Bill Buckner, and let a ground ball go between his legs into right field. To be more accurate, this happened to the Cubs first, so it was Bill Buckner who pulled a Leon Durham. It was all very unfortunate. After Buckner’s error, his name was forever associated with that play, despite his otherwise excellent career. He passed away recently, and of course, the notice on the sports page had to make mention of the infamous play. I wonder if Mike’s obituary will make mention of him always scratching himself. I hope not. But back to Arnie Kramer; he did have a weak heart, and I guess the strain of the Cubs collapse, and the manner in which they collapsed. was just too much for him. Let’s hope that wherever he is now the Cubs are perpetual World Series champions.

It was 2 years later that Mike’s father passed away. He had end-stage Parkinson’s disease with a very poor quality of life. At the very end he had a lymph node pop up in his neck that was biopsied positive for lymphoma. I think I have mentioned this before. I believe God sent the lymphoma to end his misery. He died 12 days after the node was found. Arnie Kramer and Moe Gordon were both lovely men, and they are still missed and remembered fondly.

Back to the present, this is what Mike saw when he awakened from his slumbers this afternoon.


Twins and tree



Three cats

So, that’s all the news for now from Happy Meadows. I don’t want you to get the wrong idea. Mike is doing and feeling very well. I hope you are all doing smashingly as well. Until next time, be safe, be well, and enjoy your blessings.

A New Low in Demagoguery

So, we have reached a new low in the behavior of the Liar in Chief, and of his supporters who don’t publicly acknowledge that his behavior is disgusting (and may not even think that it is disgusting and reprehensible)and trending more and more to that of a dictator. Mike said back in 2015 that he would make a much better dictator than a president. I still have faith in the strength of the institutions of our great country, and the people of good character who can lead us back to a  functioning democracy where freedom for all is a cardinal principle.

I came home about 4:30 yesterday morning, and Mike was already up getting ready for an early trip to Emory for his chemo. Michelle came over, spent the night, and it was great seeing her. Mike said that chemo was uneventful.  A colleague of his, Dr. Erik, has put Mike in touch with a group of medical geneticists in Houston who may look into his case. This could prove to be very interesting. Stay tuned.

So, yesterday’s Atlanta Journal Constitution ran an article about a group that is combating vaccine fears in the Orthodox Jewish community in Brooklyn. The author is Lena H. Sun, and it originated in the Washington Post. This is timely because I just posted  “The Measles” a few days ago. I was raging because of the people who, for reasons of their own are manipulating vulnerable groups of people into not vaccinating their children against childhood diseases, measles in particular. This puts not only their own children at risk, but also others in society whose immune systems are not up to par, Mike for instance. Please check the article out.

In another follow up, we just saw an article on line from US News which reported that 40% of doctors are refusing to accept new chronic pain patients into their practices. (See “Ouch, that Hurts”, November 25, 2018.) Many chronic pain patients who have been stable on their opioid pain medication for years are finding themselves abandoned by their pain doctors as an unintended consequence of doctor’s and some regulator’s misinterpretation of the CDC Guidelines for pain management. Furthermore, many doctors in pain management are only interested in performing procedures on patients, injections for which they can bill and be reimbursed hundreds to thousands of dollars by insurance companies. These doctors are dismissing patients who refuse injections, saying they are doing fine without them, as long as they can continue their medication. At the same time, a great many primary care physicians are not accepting these patients, not wanting to load their already busy practices up with pain management patients, or attract the attention of regulators. It’s a damn shame.

So, have you ever heard of Pallas’s cat? Also known as manul, it is a felid that lives in cold Central Asia. They look a lot like domestic cats, and are about the same size. Mike and I have tried to put up a picture, but incompetence rules! Mike and Judy watch a zoo show on TV, and they featured Pallas’s cat recently. I happened to be in the room at the time. Pallas’s cats are endangered because of shrinkage of their habitat, mostly, although their reproductive behavior isn’t conductive to prolific results. The females are fertile for very short periods (up to 42 hours) once per year, and they produce 2-6 kittens. Many zoos around the world are working on preservation of the species, but it is hard work. Go on line and look at some pictures. I think you will find them interesting. By the way, I should be sure to point out that even though I talk about people I think are very destructive to society (even already in this post: liars, dictator wannabes, antivaccination activists), fortunately there are many more people who in their own way, day by day, on a small or a large scale, are spreading love and trying to save our planet and the people and other living things that live on it. Thanks for doing your part.

Mike was up very early again this morning thanks to the dexamethasone that he gets as part of his chemo. He should start hiccoughing soon. On Sunday we are expecting a visit from Jack and Pamela who live in Chicago. Jack and Mike have been best friends since their freshman year at South Shore high school. Jack is a musician, and I wrote about him and the Electronic Valve Instrument that he plays, but I can’t find the post now. I’m sure I could if I tried harder, but after all, I am a cat, and you can look for it yourself if you are interested. He is being promoted as “Grandpa Jack”, and you can find him and listen to his music on Facebook. Absolutely lovely. We also had a visit Wednesday from our neighbors, Diana and Paul, who were acting on their Christian values and visiting the sick. This was the first time in Mike’s life that anyone has ever paid a sick call on him. He was appreciative, but it felt strange, especially since he barely got back from work on time for the visit. Pamela and Jack will be the second. Mike and Judy flew out to Seattle to visit his Cousin Sandy, who had pancreatic cancer about 3 years ago. Mike and Judy both think it was one of the best things they have done in their lives. Sandy was a wonderful fellow. He lived another year, and made the most of his life, especially enjoying his grandbaby, Aaron. We are expecting a visit from Mike’s niece, Sharona, next month, also from Seattle. She is an admirable woman, about whom I will tell you more later.

It’s time to wrap things up. Thanks for visiting my blog. I would write anyway, but it is nice that I do have followers. Be well, be loving, be safe, and so long from Happy Meadows!

The Measles

So, it is still up in the air whether Mike will have to undergo a bone marrow transplant, as I said in my last post, “Winding Down.” (July 13, 2019) The procedure is designed to be curative for some types of cancer. It involves harvesting healthy stem cells from the blood, preserving them, and saving them for transfusion back into the patient. Prior to the procedure the patient is given a lethal dose of chemo drugs which kills off all the cancer cells, along with all the blood forming cells, and the entire immune system. Once the poison is cleared from the body, the healthy stem cells are returned to the patient. The cells migrate to the bone marrow and repopulate it, creating new red cells, white cells, and platelets. What I did not realize (why would I?) is that the procedure destroys all the immunity against infections built up during a person’s lifetime. So, 12-18 months later, the patient needs to be vaccinated against all the diseases that he had contracted as a child, or had been vaccinated against. If Mike has this done, he will go a year or more during which time he will be vulnerable to polio, chicken pox, mumps, tetanus, whooping cough, diphtheria, and yes, measles. His vulnerability makes me nervous. I kind of like the guy, and I don’t want him to get sick. What really makes me angry, though, is the number of people who are not having their children vaccinated. We are seeing measles outbreaks in the USA at this time, after a several year period in which the disease was nearly eradicated.

Measles is a highly contagious disease that causes runny nose, cough, and rash. The case fatality rate is around 1-2 cases per thousand infected patients. Immuno-compromised people are more susceptible to complications. The most common cause of death is pneumonia, but death can also be caused by encephalitis or overwhelming infection leading to cardiovascular collapse and death. Many cases of measles encephalitis are followed by signs of permanent brain damage. There is also a syndrome caused by the measles virus called Subacute Sclerosing Panencephalitis which can appear several years after the measles infection, and is debilitating and usually fatal. Measles is spread by droplets excreted into the atmosphere from the mouth, nose, or throat. The virus can survive in a closed room for up to 2 hours. Viral excretion begins up to 4 days prior to onset of symptoms, and 10-12 days prior to the onset of the rash. Susceptible persons exposed to measles virus have at least 90% chance of contracting the disease. So, it is one of the most contagious diseases known. There is no animal reservoir. Cats or dogs can’t get the measles. However, the virus is closely related to the distemper virus.

Measles is at least 97% preventable by vaccination. In the USA the first dose is given between 12-15 months of age. It is a live-virus vaccine, and is given in combination with the mumps and rubella vaccines (MMR) or as a measles, mumps, rubella, and varicella (chicken pox) vaccine (MMRV.) Unfortunately, there are people who are not having their children vaccinated, and it has reached a level in which we are seeing measles outbreaks. There have always been people who object to vaccination, ever since the practice was developed in the 1700’s. A few preachers have railed against the practice, seeing it as an attempt to frustrate God’s means of retribution for sinfulness. Thus, to vaccinate is to form an alliance with the Devil. There are also people who just don’t like other people, especially the government, telling them what to do. There are people who are naturally suspicious. You can find them scouring the internet reading about various conspiracy theories.

In 1998 an article authored by Dr.  Andrew Wakefield was published in the Lancet, a highly respected British medical journal. Dr. Wakefield presented evidence that the measles vaccine caused autism. Subsequently, his data was questioned, and many studies established that his finding was false. It was determined that he had received funding from litigants against vaccine manufacturers. The Lancet retracted the article, and Wakefield was banned from practicing medicine in the UK. But the damage was done. There are still plenty of people who believe that the vaccine causes autism.

Another source of measles outbreaks in unvaccinated populations is among the Orthodox Jews, mostly in Israel and in New York. Most Orthodox rabbis are strong advocates for vaccination, but one rabbi in particular has influenced his followers in New York to not have their children vaccinated. So people may not have their children vaccinated out of fear, ignorance, paranoia, superstition, or cantankerousness, among other reasons. The net result is that both children and adults are getting sick, and putting people at risk. As I said, it really makes me angry. I just needed to get this off my chest.

It has been another hot, steamy day in Happy Meadows. Mike and I went outside after the boys left this morning. He pulled weeds and I snooped around. We had a couple of deer visit, and lots of hummingbirds. Mike got pretty tired so we came back inside. It was a pleasant way to spend the morning. Now I’m thinking it’s time for one of my special power naps. I hope you also had a pleasant day, wherever you might be. And do us all a favor, and make sure your cats, dogs, and kids get all their shots.  Be safe, be well, and always know that you are blessed. So long from Happy Meadows!

Winding Down

So, I am happy to say that for the past few days Mike has felt like his old healthy self. The cough and fever are gone, and the rash is almost gone. He had a good meeting with Dr. K. at Emory Thursday, and has resumed chemo, so far with no adverse effects. He is now working at the office Monday, Tuesday, and Wednesday mornings, and is back at the Berman Center on Fridays. However, he is facing up to the fact that it is time for him to close his practice. He started letting his patients know about a month ago that he is retiring. He is working on spending the summer winding down and transitioning his patents to other doctors. This is not easy for him or the patients, some of who have been with him for many years. They have real relationships, and tears have been shed. Mike is encouraging those who want to keep up with him to follow my blog. It has been 52 years since Mike graduated from medical school, and 48 years since he started his family practice. The family practice morphed into an addiction medicine practice 46 years ago. In a strangely timed event, Mike has just been honored to be named as a Fellow of the American Society of Addiction Medicine. He will close his office on September 30, but stop seeing patients in the middle of the month.  He plans on continuing his work at the Berman Center. In the meeting with Dr. K. he learned that the bone marrow transplant, if it happens, won’t happen until at least November. I will let you know of any developments.

I just got back from the Donkles. I went over earlier today to visit, and to get my dish of cream. Richie let me in through the sliding patio door, but he didn’t seem to know that I wanted cream. Anyway, after my usual snooping, I realized no one else was home. I curled up on his bed and took a long nap, only to be awakened by a loud clap of thunder. It was pouring rain outside. Richard was home and I heard him talking on the phone when I wandered down to the kitchen.

“Hello, Mike,” he said. “This is Richard. Yes. Say, We are getting ready to go out, and Sambo is over here. It is raining too hard to let him out. Can Richie and I bring him over to your house? Yes, right away. No, it’s no trouble. No. I’ll be there shortly.”

The next thing I know Richie has scooped me up and we went to the garage where we got into the car. I don’t like riding in the car, but we were home in no time. Mike had opened the garage door, and Richie jumped out with me and brought me inside wrapped up in his jacket to keep me dry. Mike met us in the garage and opened the kitchen door for me to run inside.

“Would you like to stay for a few minutes?” he said to Richie. “I can make some fresh coffee, and Judy has made a delicious key lime pie.”

“We have to run,” Richie answered, “but it sounds like a plan. Maybe later.”

I don’t think Michelle is coming over this weekend. She met Mike and Judy for lunch at the Battery. This is a mixed-use development, shops, restaurants, and condos, the centerpiece of which is Sun Trust Stadium where the Atlanta Braves play. It was an enjoyable afternoon for them, and I’m glad they got home before the rain, so I didn’t have to be stuck at the Donkle’s all night. That of course would not be that terrible, but Mike and Judy would worry if I didn’t come home. And, also of course, it would be much better than being outside in a pouring rain with lightning all over the place. I don’t have much else to report today, so I will sign off. Enjoy the rest of your weekend, and stay dry. Farewell from Happy Meadows!


Schrodinger’s Cat

So, I continue to stress the importance of cats to the understanding that humans have of their world. I must say at the outset, that I don’t begin the comprehend the physics of what I am about to relate, and I assure you, neither does Mike. Nevertheless, let’s give it a try. The beginning of the last century saw the development of theories of quantum mechanics. This involved the existence and behavior of atomic and subatomic particles. One interesting aspect of this is the observation that at times a particle such as a photon (light particle) behaved as though it was a particle, and at other times behaved as though it was a wave. Because of the size of the particles involved there was a limit to the accuracy of observations that could be made. For example, if you wanted to look at a photon you would shine a light on it. Since the light you shine is made up of other photons of a mass equal to the photon you are trying to examine, the act of illuminating the photon would cause it to be knocked out of its original position. In 1927 professor Werner Heisenberg formulated what has come to be known as Heisenberg’s Uncertainty Principle. It states that it is not possible to know both the position and the momentum of a particle at the same instant. Heisenberg believed that this was a fundamental principle in nature, and independent of the limitations placed on the observer of the particle. Einstein disagreed, stating that there must be a more fundamental principle in reality that is not yet known.

Because of the limits of observation, according to quantum theory not only could one not know if the photon was behaving as a wave or as a particle, you could say that it existed as both a particle and a wave at the same time. Schrodinger believed this was absurd, and in 1935 devised a thought experiment to look at this phenomenon on a macro level. He imagined a closed steel box in which a cat had been placed. Also in the chamber was a source of radioactivity and a device to detect the decay of radioactive atoms. If the device detected the decay of an atom, it would trigger a hammer which would shatter a glass flask of poison, thus killing the cat (shudder.) In theory in 1 hour there was a 50% chance of the cat remaining alive, and 50% chance of it being dead. The observer would not know unless he opened the box. Schrodinger said that according to the theory of a photon being both a wave and a particle at the same time (in the absence of a measurement) then one must say that the cat must be both alive and dead at the same time. This is clearly absurd. If you are interested there is a great deal of scholarly work available on the subject, but you had better bring your math chops with you.

What really interests Mike about this is the convergence of physics and spirituality. On the surface one would think they would be so different, physics being an exact measurable science, and spirituality being unmeasurable and mysterious. It seems that the deeper one gets into physics the more mysterious it becomes. So maybe they are two different ways of looking at the same thing. Mike says there are 2 kinds of seekers that turn to religion. One kind is those who need definite answers. They tend to place complete trust and faith in their sacred texts, follow the precepts found therein, and are thus comforted in the knowledge of their salvation. The other kind is those that prefer the mystery. They believe that whatever force or energy rules in the universe, it is ultimately unknowable at our current level of existence. One can appreciate the world and its Creator from a state of awe, hope, and wonder. The mystery works better for me, and Mike is with me on that. In counseling his patients Mike often tells them that learning to deal with uncertainty is one of the great challenges we all face in life.

Not that long ago the cats here in the family got Mike a shirt for his birthday.20190627_184508

Doesn’t he look fine? Well, maybe not so much, but it is a great shirt.

He did want me to mention that he is feeling much better, and that he thanks all of you for your love and prayers.

Not too much is going on right now in Happy Meadows. People are still setting off fireworks, but that is bound to stop soon. I know the dogs will be happy about that. Until next time, from Happy Meadows, be well, and be safe. We love you all!

Freedom for all

So, Mike is finally feeling much better, although he did cough frequently last night and disturbed everyone’s sleep, especially his own. No fever for 5 days. He saw the dermatologist Tuesday who grimaced when he saw Mike’s legs, and said Mike has been on way too many medications. No argument, but what is he supposed to do? Anyway, he did prescribe a tapering dose of prednisone, and Mike is much better. The rash is not so angry looking, and stopped itching, so Mike can sleep again (unless he coughs all night.) Today will be he second Thursday in a row with no chemo, so his body gets a break. He sees his myeloma doctor next Thursday, and may resume chemo. He was back at work part time this week.  He finally felt uncontagious enough yesterday to get a haircut. He was dreading this because he knew Noemi, his hairdresser, would cry when he told her he has cancer. She is a very sweet lady from Columbia. She offered to come to the house to give him a haircut if he needs one while he is in isolation after his bone marrow transplant (if he has one.) She will also pray for him. Mike also continues to get cards from his patients that are very loving and supportive. Most people are wonderful, not the same picture you get if you watch the news, or read history.

So, today is Independence Day here in the USA. We also call it the 4th of July, but it is the 4th of July everywhere on earth today. On this date in 1776 the leading American colonists gathered in Philadelphia, having had enough of the King of England extracting taxes and giving nothing much in return, including the right to vote. “No taxation without representation” was the operative slogan. Thomas Jefferson wrote a document called the “Declaration of Independence” in which he said something like “all men are created equal” and were endowed by their Creator with certain “Unalienable rights”, namely, “life, liberty, and the pursuit of happiness.” I think that, great as these words sound, he was literally not talking about all people, but rather, about white, male landowners. If you were a woman, stay home, sew, and make babies. Jefferson was a slaveowner, and saw no contradiction between his ideals of freedom for himself, and the lack of same for slaves. Times have changed, but I guarantee you, the haves will always try to keep the have-nots poor and without power to take their rightful share of the wealth of this country. So, please go ahead and have your parades, make your speeches, and eat your hot dogs, but lets try to make this a more equitable country where freedom is a reality for everyone.

Mike saw a not entirely unrelated article in the sports page yesterday, noting that on July 3, 1947 the Cleveland Indians purchased Larry Doby from the Newark Eagles of the Negro National League, making him the second black player in the major leagues, and the first in the American League. I should clarify by saying that it wasn’t Doby that was purchased, but rather, the right to sign him to a contract. By 1947 slavery was illegal in the USA, and had been for over 80 years. Also worth noting is that the owner of the Cleveland Indians at that time was Bill Veeck, of whom I wrote in my blogpost “You can’t be too careful” on January 1, 2018. Doby had to put up with the same kind of discrimination and abuse that Jackie Robinson did, but he excelled on and off the field. He had a fine career and is in the Baseball Hall of Fame.

I was going to talk about Schroedinger’s Cat, but I want to get this out today, so look for it next, along with, of course, a Mike update. Michelle has come over today to be with us. I always enjoy her visits. And Mike’s good friend Powell is here from North Carolina. He came over for a visit with Mike this morning. They were so glad to be with each other and get caught up on each other’s lives. Friendship is a wonderful thing. So, enjoy the rest of your holiday, be safe, and you will hear from me again soon. So long from Happy Meadows.