Category: Medical Topics

After A Stroke

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The Book of the Week is “After A Stroke, 300 Tips for Making Life Easier” by Cleo Hutton, published in 2005. The author of this short paperback had a stroke in 1992, but gives many tips that are still relevant to recovery from an event that adversely affects the brain, and therefore, specific body functions– that commonly impair one side of the body.

In recent decades, a huge amount of attention has been paid, and money spent on research for: raising awareness of stroke prevention and symptoms, treatment, and the introduction of products to make activities of daily living easier for stroke patients.

The author briefly discussed the neurological effects of a stroke, which are on a continuum; every patient is different. She explained that “constraint-induced therapy” helps a patient’s brain transmit messages through alternate neurological routes through the unaffected side of the body.

The author listed the common frustrations and situations recoverers might encounter:

  • feeling overwhelmed by everyday decisions, such as product-selections while shopping (in the United States, especially!);
  • loquaciousness upon regaining the ability to speak;
  • linguistic impairments such as usage of expletives in speech due to groping for the correct word– even for patients who wouldn’t normally utter them, or inability to understand idioms;
  • personality change;
  • seeing specific items in certain situations that prompts crying or laughing at inappropriate times due to damage to the visual association cortex.

The author recommended keeping aspirin in the freezer to help keep it fresh, if one is taking it.

Read the book to learn a slew of other useful tips for facilitating dealing with: the emotional problems arising from bodily impairments, getting around, communicating, cooking, eating, taking care of the home and one’s body, etc., etc, etc.

Black Box Thinking

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The Book of the Week is “Black Box Thinking, Why Most People Never Learn From Their Mistakes– But Some Do” by Matthew Syed, published in 2015. This volume attempted to answer the question: “How does failure-denial become so deeply entrenched in human minds and systems?”

The author described two ways of thinking:

1. Some people believe their abilities are fixed, so they won’t improve with practice. They have fear of failure, and make excuses and / or blame others for their failures.

2. Other people believe they can get better with practice, and they are honest about admitting they have made errors. They learn from them. Success is achieved only through trial and error, hard work and persistence.

Number 1 above is also described in the following quote from Bertrand Russell: “There is something feeble and a little contemptible about a man who cannot face the perils of life without the help of comfortable myths. Almost inevitably some part of him is aware that they are myths and that he believes them only because they are comforting. But he dare not face this thought! Moreover, since he is aware, however dimly, that his opinions are not rational, he becomes furious when they are disputed.” Yet another way of putting it is “hubris syndrome.”

Two of America’s recent presidents– George W. Bush and Donald Trump– were this kind of thinker. According to the author’s thesis, they succeeded against the odds (if success is defined as getting elected president), considering that they were blind to their own character flaws.

BUT– their common beginnings saw them through: They both began with the special advantages of inheriting money, mentors, lawyers, and valuable career and political contacts. They proceeded to fail upwards until they reached their peak “Peter principle” level, kind of like the joke: How do you make a small fortune in Israel? Answer: Come with a large one.

The author drew parallels between the topic-areas of aviation and healthcare delivery. These involve life-and-death scenarios when things go extremely wrong. However, that is where the similarities stop. People who have shaped the evolution of aviation have built up a knowledge-base that has served to produce lower and lower death tolls when catastrophes have occurred; powerful, influential people working in healthcare have been stubbornly resistant to adopting measures that would result in a drastic reduction in unnecessary deaths.

The author cited real-life examples from Great Britain and the United States. But there are other major reasons why his comparison is mostly invalid. These involve lawsuits, unions, government regulations and the political climate at the time of the disasters, and the following:

Obviously, workers in aviation have more of an incentive to improve safety, because in a disaster, many more people might die all at once in a plane crash, compared to the one patient on an operating table or examination table. Even if members of the flight crew survive a disaster, their careers are likely over. Even when doctors are at fault, they usually continue their careers.

The author discussed the pros and cons of just-culture versus blame-culture. He described the latter thusly: “It may be intellectually satisfying to have a culprit, someone to hang their disaster on. And it certainly makes life simple.”

The author recounted how a public-relations campaign can fool even intelligent people into believing a particular method of crime-prevention among young people, works wonders. The only way to debunk such a myth is through numerous Randomized Control Trials.

Read the book to learn about additional concepts surrounding psychological self-deceptions that humans employ in order to avoid admitting failures: cognitive dissonance, narrative fallacy, top-down versus bottom-up product development, various biases, and others.

The Emergency

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The Book of the Week is “The Emergency, A Year of Healing and Heartbreak in A Chicago ER” by Thomas Fisher, published in 2022.

At the start of the COVID-19 pandemic in 2020, friendly bedside manner disappeared in the Emergency Room of the author’s employer, a medical center affiliated with the University of Chicago, on Chicago’s South Side. The author, a medical doctor, was tasked with judging whether to put newly arrived patients on ventilators.

Already a stressful place, the Emergency Department was put under excessive tension when an edict was issued that everyone entering the building was required to cover his or her mouth and nose (with any old piece of germy fabric or a plastic shield; most wore the fabric). The authorities perpetuated the scientifically questionable assertion that covering one’s face (with anything) would stem the spread of disease.

BUT, requiring the country’s entire population to wear medical masks would be impractical and unenforceable. There wouldn’t be enough medical masks for everyone; meaning, masks that would filter one’s toxic exhalations, allow one to breathe relatively easily, while presumably, disallowing most germs from entering and exiting one’s mouth and nose. So, instead, across the country, there was rampant abuse of power by numerous officials in controlling the population with petty, dishonest mask-orders.

Anyway, a nearby Chicago hospital had no more ventilators, and another had only three on hand. A patient might not have COVID, but still might be struggling to breathe because she had heart failure from postpartum cardiomyopathy. The author decided to treat a young patient such as this one with magnesium, additional Lasix and nitroglycerin instead of a ventilator, because she would be more likely to survive than an older patient in poor health who had severe COVID.

“Still, too many physicians and scientists accept that the inequities around us emerge from inside the body we treat, rather than in relation to prevailing societal structures or systems… But it is society that shapes the population-wide patterns we see.”

This volume presented, in a series of anecdotes on the patients admitted and treated by the author, reasons why this country desperately needs NATIONAL HEALTHCARE. It is the right thing to do at this time in history. Other reasons can be found in this blog’s posts:

Morphine, Ice Cream, and Tears. (sic); Chasing My Cure; Clinging to the Wreckage; and I Shall Not Hate.

Read the book to learn of the physical and psychological traumas suffered by not just patients, but also caregivers, that could be prevented or minimized by improving policies in national healthcare in the United States.

Dr. Folkman’s War

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The Book of the Week is “Dr. Folkman’s War, Angiogenesis and the Struggle to Defeat Cancer” by Robert Cooke, published in 2001.

In the 1970’s, Judah Folkman was a competent surgeon and a very popular professor at Harvard Medical School, but his first love was medical research. He hypothesized about why and how a tumor grows. He inferred that blood vessels grow toward a tumor, but was unable to provide proof for a very long time. He was ostracized for having this radical idea, so he had difficulty attracting enthusiastic graduate students to assist him, and with getting funding for his research.

Traditionally, university medical studies in laboratories had been funded by government grants. Profiteering from patents and medical products resulting from research was considered sleazy in scientific circles. In 1974, Harvard broke the taboo and partnered with the large, profit-making organization called Monsanto.

Even after receiving generous funding, Dr. Folkman worked around the clock simply because making new medical discoveries requires months or years of blood, sweat and tears. The materials required to do experiments can be expensive, messy, odorous and pose unanticipated problems. For a while, Folkman’s lab was working with vast quantities of cow and shark meat (and other obscure, problematic materials) because the animals’ cartilage contains no blood vessels.

Even after the doctor’s studies yielded exciting breakthroughs, media articles influenced the medical community and the public in ways that were harmful to Folkman’s research operations. There were even accusations of fraud against him. It turned out that in his team’s haste to treat cancer patients, many errors were made. Time was of the essence, and procedures for organized data collection were lacking. Folkman wasn’t deliberately trying to deceive anyone.

Folkman was a rare bird in that he was quite altruistic with his time and talents. His patience and persistence allowed him to ignore his detractors and the naysayers (most of whom were jealous). He eventually acquired an area of expertise that not only spawned a new way of thinking about cancer treatment, but also led to treatments for other medical conditions, and whole new industries, including biotech. He also helped shatter a myth in cancer treatment. But this additional idea of Folkman’s still might not be fully accepted in oncology circles (due to GREED), even two decades after the writing of this book.

This is what he learned: The approach to cancer-drug delivery to a tumor of:

“low [dosage] and slow [buildup over the long-term]” was shown to be superior to

“might makes right” and come in with guns blazing; in the past, it was hoped that immediate, large doses would eliminate the tumor before metastasis, and before the patient died from the deaths of too many healthy cells that were also killed in the process.

In other words: The patient’s treatment should begin with a low drug dosage, and if that proves ineffective, increase the dosage gradually until it is effective. Folkman’s experiences with patients showed that that was the successful way to go, and he even saw a few miraculous cures.

Read the book to learn many more details on Folkman’s trials and tribulations and the reasons for them, and what transpired when he finally found vindication.

Ghosts from the Nursery

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The Book of the Week is “Ghosts from the Nursery, Tracing the Roots of Violence” by Robin Karr-Morse and Meredith S. Wiley, published in 1997. The authors cited scientific studies to support their assertions about the links between the increasingly younger ages at which Americans are committing increasingly more frequent horrific crimes, and the social and cultural trends that are driving this alarming revelation.

At the book’s writing, in the United States, criminal justice system spending was three times (!) the entire healthcare budget. The authors argued that the seeds of criminality in humans are planted in the womb rather than in early childhood, as previously thought.

Environmental factors, such as a future mother’s or father’s consumption or inhalation of toxic substances, alters the reproductive mechanisms in a fetus’ brain cells. If the fetus’ environment is neglectful, chaotic or hostile– people are raucous, or physically abusing the mother-to-be– it stands to reason that the child might have behavioral problems later on. These problems could range from hyperactivity, impulsivity, attention deficits and learning disabilities to criminality.

The range and extent of damage done varies with the time frame in which the abuses occur. It has been found that any amount of alcohol drunk by a potential father or mother can adversely affect: spermatozoa and ova weeks before conception, the zygote, embryo, fetus and then the child’s health thereafter. Maximum visual damage is done to the brain of a fetus, when the abuses occur during the limited time, for instance, in which the neural connection from the retina to the visual cortex is made. Language skills develop or fail to develop, similarly.

The opposite is true, too: a nurturing environment will maximize benefits for the child (even in the womb!) when parents’ soothing or happy voices are heard by the fetus during his or her audiological development. After emergence from the womb, the baby can recognize his or her mother’s, father’s or others’ voices. Preverbal memory (an emotional vibe emitted by parents and others– a mood felt by the fetus and then infant and then child) stays with everyone through their entire lives. Parents have been shown to display the same behaviors their parents did with their own babies and children.

The authors mentioned several European studies that showed the incidences of juvenile criminality and suicide increased with an increase in unwanted pregnancies. That’s obviously a can of worms. But, since reams and reams of data have been collected from decades and decades of sociological, psychological, medical and legal studies worldwide, perhaps a multi-pronged approach applied locally would help– instead of commissioning more, additional expensive studies for the purposes of procrastination and patronage.

HOWEVER, one particularly rich vein of data on how to invite failure of the multi-pronged approach at the federal level of poverty-fighting (and on a related topic, crime-prevention), can be found in the administration archives of the late president Lyndon B. Johnson. A 20/20 hindsight look at the enduring actions he did take, are unfairly omitted from the history books that show an anti-liberal bias. His administration saw the start of Medicare and Medicaid and the passing of landmark civil rights legislation. BUT, these great accomplishments were overshadowed by conspiracy theories that he plotted the assassination of JFK and of course, his role in a needless war.

Johnson had grand plans to eliminate poverty at home, but shortly after he came to power, he decided to send Americans abroad to fight a war that led to countless deaths and ruined lives. And continued to rationalize why it needed to continue. Johnson’s anti-poverty programs weren’t given sufficient time to succeed because they became starved for funds.

That is why this country has regressed on the social-programs front: Every American president has sold his soul to the MILITARY [Currently, that military is fighting a war at the Mexican border instead of overseas; a future post of this blog will elaborate on this].

The only president fully justified in diverting significant taxpayer monies from improving conditions at home, toward fighting a war, was FDR. Since WWII, alpha males with hubris syndrome have been funding military actions whose long-term costs outweigh the benefits.

As a final insult that indicated that Johnson had major control issues, was the fact that he cruelly teased his own Democratic party by withdrawing from a 1968 reelection bid at the last minute, leaving the field to a few other candidates, and uncertainty in his wake. He also gave his political opponents a golden invitation to smear him in so many ways.

Granted, there are countless other vicissitudes of history that come into play with any president’s actions, but as is well known, campaign-finance regulation in America has become horribly eviscerated in recent decades, so the increase in financial influence of special-interest groups other than the military, has also played a role in this nation’s shifting priorities.

Be that as it may, the United States’ practices fly in the face of reason by bringing in a “pound of cure” (after the fact!) via a complicated, expensive bunch of bloated, bureaucratic government services (special-education, welfare, foster care, criminal justice, etc.). Instead of an “ounce of prevention.” One specific program has been found to be the most effective solution thus far in preventing crime in the long run: infant home-visitation programs, because the problems are dealt with early! This was the conclusion of a criminology team who submitted a report to the U.S. Congress in April 1997.

Clearly, different levels of government can implement more of a combination of social programs and legislation in order of what works best pursuant to all those scientific studies (preferably longitudinal ones), regardless of costs, limited by whatever the budget will reasonably bear; instead of going the easy, greedy, or power-hungry, politically expedient (and fraught military) route.

A grass-roots movement would have to hold officials’ feet to the fire on that– perhaps appealing to their egos by giving them a legacy via a footnote in the history books crediting them for getting it done. This, while keeping political patronage to a minimum (It used to be called “honest graft” but has reached excessive levels in certain regions; time will tell whether upcoming elections oust the “Tammany Hall/Boss Tweed” contingents.).

So, for instance, a hypothetical mandate for a large, diversely-populated city might consist of:

First, an infant home-visitation program;

Second, no-charge universal pre-kindergarten program;

Third, stricter background checks and bans on specific firearms and loophole-closing;

Fourth, a community-policing program (that does not involve military hardware) like those mentioned in this blog’s posts, “L.A. Justice” and “Riverkeepers”; and

Fifth, imposing and enforcing a legal maximum to class sizes in early-childhood education.

If additional funding is found (for whatever reasons), there could be other kinds of education programs that deal with issues such as: teen pregnancy, sex education, contraception, substance abuse prevention (all possibly as a part of the high school health-class curriculum), parenting classes, family planning, welfare-to-work, at-risk youth centers, and job training– again, prioritized from the most to the least effective outcomes.

Anyway, read the book to learn much more about research results on this topic, and the authors’ suggestions on crime prevention via focusing on ways to improve outcomes in connection with pregnancy and child care.