Friday, April 22, 2016

Correcting deficits in bariatric treatment

I am very frustrated with the state of bariatric treatment.  I'm not talking about surgery.

Surgery does not work for everyone.

First, doctors are reluctant to do surgery on people who weigh more than 400 lbs, lest the lungs of the patient collapse under the patient's own weight, while the patient is under anesthesia.

Second, people figure out how to eat past the surgery.  They gain the weight back. The problem is in the person's brain, not in their digestive tract.

Super morbidly obese people need rehabilitation.  I find that their treatment is often misguided.  I had a super morbidly obese friend die at top weight 800 lbs.  I saw numerous opportunities where he could have been saved, but medical personnel -- who were treating him improperly -- ultimately caused his death, when I feel that could have been avoided.

Here is a list of points that they apparently did not know.

1. Aquatherapy
            Fat is lighter than water, so bariatric patients can exercise normally in water, whereas they cannot on dry land.  I saw my super morbidly obese friend unable to lift his leg because of a several hundred pound grade 5 panniculus resting on it.  He could lift his leg fine if in water.
            Bariatric patients develop infections, both fungal and bacterial, in the folds of their skin.  Showers cannot adequately clean these areas.  Submerging in salt water is amazingly effective.  My friend’s final illness was triggered by bacterial infections in the folds of his skin.
            Doctors kept treating the fungus that they saw there, while not adequately treating the bacteria, which were more dangerous.
            He was in several rehab facilities specializing in bariatric patients, but none of those facilities had aquatherapy.
2. Food addiction
            Many bariatric patients are addicted to certain foods.  Common triggers for addictive behavior are: refined carbs (sugar, flour, starch), sweeteners mixed with fat, and salt mixed with fat.  Many dieticians cling to the false belief that overweight people can eat these foods in moderation.  The food addict can no more eat their trigger foods in moderation than an alcoholic can drink alcohol in moderation.  I have seen many abstinent food addicts relapse in hospitals because hospital dieticians fed them trigger foods.  In a weakened, helpless state, they ate those trigger foods.  This is appalling to me.

3. Restrictive diets
            People are overweight, because they are overeating.  They do not need to be put on a restrictive diet.  They need to be put on a normal, maintenance level food plan.  
            Restrictive diets result in starve/binge eating behavior.  People maintain the restrictive diet for a while. Then, when they get hungry enough, they binge.  This is a very effective way of gaining weight: yo-yo dieting.  Restrictive diets put the body into a low metabolism storage state.  In this state, the body gains more weight from a binge than it would if the person were eating normally.
            Super morbidly obese patients can die of an anorexia induced heart attack before they reach goal weight if they are eating a restrictive diet.  Fat is a symptom of past eating behavior, not of current eating behavior. 
            People lose weight faster on a maintenance level food plan, because their metabolism is more efficient.  Super morbidly obese people may actually have to eat more because of the extreme effort they are putting in to carry around hundreds of extra pounds.  They will still lose weight, because even if they’re eating 3000 calories they’re still eating a whole lot less than they have been eating.

4. Psychiatric
            The vast majority of people who are more than 100 lbs overweight have been severely abused as children, either violently or sexually or both.  Many have severe mental health issues such as bipolar, borderline personality, or schizoaffective disorder.  They are using food to medicate themselves for their severe mental health issues.  If they stop overeating without proper psychiatric support, they will very likely have a breakdown.  Trying to put a very overweight person on a weight loss diet without adequate psychiatric support is a recipe for doom.
            12 step programs use the 12 steps to deal with emotional problems, but that may not be sufficient for everyone. 

5. Prayer and Meditation
            The effect of prayer and meditation on the brain has been slightly, but not extensively, researched.  12 step programs are based on the belief that prayer and meditation are good for interrupting compulsive behavior. 

6. Lying on back
            Pregnant women are told to sleep on their left sides, because the weight of their pregnancy resting on the circulatory system can cause extensive health issues.  This problem is even worse for a super morbidly obese person who is more than 100 lbs overweight.  Yet such patients are routinely put on their backs. 
            My super morbidly obese person could not breath lying on his back, because of the weight of his body crushing his lungs.  Yet, the hospital where he died insisted on putting him on his back.  I believe that this decision was the direct cause of his death. 
            They had to entubate him.  Ultimately, they did a tracheotomy.  The surgery killed him, because he was too weak for surgery.
            However, even if he was breathing, lying on his back was still causing circulation to be cut off to the lower half of his body – and making his toes go black. 
            Another problem was that they were making insufficient efforts to turn him, because of his weight, and he was lying on bedsores that were big enough to put your fist in.

7. Restraints
            Another issue was that they put him in restraints, because he was trying to free himself from tubes, so he could roll over.  The restraints were too small and cut deeply into his wrists.  I found this appalling

Sunday, April 17, 2016

Mental Illness -- It takes a village

I maneuvered impatiently to get past them to get on the train — the mother pushing a baby carriage while shouting at the boy trailing behind to hurry.  I wanted to get on the train myself.  I figured I would let her deal with whatever it was.

I got in the train and walked through the aisle through several cars to get closer to the front, to be suer to get a seat.

Curiously, despite her hurry to get her son on the train, she walked outside the train to the same car where I ended up.  Then she stood in the door yelling at him to get on the train.  I could hear the desperation in her voice as he refused and ran the other way.   She called for people to help her.  Her voice was hoarse.  She complained that she was sick and could not run after him.

I recognized that desperation.  Having raised 2 kids with Asperger’s Syndrome, I know what it is to have children who don’t obey, who have no sense when something is important, no sense that they are causing their mother pain, no sense that they are being completely inappropriate and outrageous.

The signals were ringing indicating that the doors were closing.  She was standing in the doorway holding the door open and he was running the other way.  I went to the next car and alerted the conductors.

Finally a burly black man, about 40, grabbed this boy, who was white, concerned that he wasn’t obeying his mom, and brought screaming for his mom onto the train. It was a bold thing for him to do, to grab a white child to help a white mom.  His move could easily have been misinterpreted.  I felt he was very brave.

Then, curiously, the mother did not get on the train, and the boy was there inside screaming for her.

I was puzzled.  A black woman, who claimed she did this every week, explained that the boy had a day pass to visit his mom and he normally lived in a group home. 

The black man was there with his own children and he got the boy calmed down.  He tried to encourage the boy by saying if he could clean up his behavior he could be with his mother all the time.   He introduced the boy to his own children.  He said he was stepfather of one.

The boy calmed down.  He was happy to find people to talk to.

The conductor came by and thanked me for alerting them to the problem.  The mother had explained the situation to me. Another conductor came by and told the boy that he would look for him next Sunday and that he was going to become the boy’s friend.

When they got off the train, the boy tried to say goodbye to the man, addressing him as stepfather, clearly hungry for that.  The man was looking at his cell phone, which broke my heart, but got off at the same stop. I hope he said goodbye nicely, because the boy had obviously become attached to him.

It was one of those examples of what Hillary Clinton meant when she said “It takes a village to raise a child.”  Normally in NYC we don’t want to get involved, but here people did. They intervened to help a mother who needed backup to gain control of a child.

I hoped that the man was right, that the boy would be able to get his act together and go back to his mom.  I doubted it, though.  I felt that once in a group home this boy’s chances were poor. 

It reminded me of when my younger son was evaluated in high school by a private neuropsychologist and she said we should send him to a residential treatment facility.  We didn’t do it.  I couldn’t bear the thought of sending him away.  He’s never really been able to get back on his feet and now lives as a parasitic computer addict.  I’ve wondered whether we did the wrong thing by not sending him away, but then I think it could have been much worse.  He might have hated being sent away and done worse than he has.  You can never know.  Fortunately, he’s at least a nice young man, despite being dysfunctional.

I wondered whether than man knew how good he is with kids, whether he knew he had a chance to make a difference in that boy’s life, that the boy really came to like him, that he hoped that he had made a new friend. 

I wondered if I would ever see that boy again.  Maybe if I take that same train some Sunday?  And could I help him, when I couldn’t really help my own sons?  Or did I do better than I think?  Are they doing better than they might have without me? 

So many questions.



Wednesday, April 13, 2016

Answers to those who are suddenly abandoning Sanders

I am distressed at issues which are apparently causing former Sanders supporters to change over to Clinton.

Issue #1: He does not yet know how he will break up major banks.

This is the correct answer. Breakups of monopolies are done through the FTC.  These breakups need to be done after study and through proper legal channels.  They are not done solo by POTUS.  He should not yet know how they should be done.

Issue #2: He does not campaign for other Democratic party candidates.

He is not the machine candidate.  We already knew that.

Hillary scratched everyone’s backs carefully before running.  That’s why she has all those pledged super delegates who may give her the nomination even if Sanders wins the majority of the regular delegates.  That’s also probably why Elizabeth Warren refused to run, even though progressives wanted her to.

He’s not the machine candidate.  He was the only one who voted against the War on Iraq -- the war that has nearly bankrupted us, that was improperly and deceptively justified, that overthrew a stable government and instituted a state of violent anarchy where terrorism thrives.  He does not go along with the crowd.

He’s the one who wants Medicare for all.  He’s the only one saying that.  He does not go along with the crowd.

He’s the one saying addiction is a disease not a crime.  Hillary is the one who is saying that young people are predators, when in fact many young people of color are being entrapped by law enforcement officials who convince young people to buy and sell drugs.  Yes young people will do foolish things.  We give white young people a pass on youthful offenses.  We send young people of color to jail.  Bernie does not go along with the crowd.

Why should he be campaigning for other party candidates?  What have they done for him?  He isn’t plugged into the machine to know who to endorse — to know whose positions might be incompatible with his. 

Hillary is all plugged in, getting large donations and speaking fees from the wealthy.  Is that really what we wanted?  Isn’t that why we didn’t want her in the first place?

******

These issues do not persuade me to change my opinion

Monday, April 11, 2016

Laura Poitras at The Whitney

On Saturday evening, I went to the Whitney Museum with a friend.  I hadn’t realized that the Whitney had moved to Greenwich Village.  I hadn’t realized it was right next to a big Samsung office that had something of an art exhibit in the lobby as well.  I hadn’t realized that Google has a big office building not too far away either. 

I went with an out of town friend who was visiting for the weekend.  That’s the cool thing about friends visiting.  You go do things that you probably should have done a long time ago, but never got around to doing.

I never got around to taking my kids to the top of the World Trade Center.  I always thought I would have plenty of time to get there, or they would.  Wrong.

In any case, this exhibit I went to see, with work by Laura Poitras, was probably not one that I would have chosen to go see in any case.  The description online was singularly uninspiring to me.  And there is not an infinite amount of time to go see it.  It closes May 1.

The artist is a journalist who has done work investigating the results of our war on terror.  I think I might have expected a documentary.  I think my friend expected a documentary.

In going to this exhibit, it’s important to realize that it is *not* a documentary.  You’re not necessarily going to see information that you did not already know, if you’re reasonably informed —about how we tortured people, about our video surveillance program, about our drones, about our invasion of Iraq. 

This is an art museum.  This is art.  The point is to give an emotional impression. 

It reminded me a bit of the Holocaust museum.  It was dark.  There was spooky music playing.  You get a feeling of how real people were affected.   You get the feeling of what it is to be on the other side of what we’re doing.

Curiously, my friend was not that much affected by the exhibit, nor was a young woman we heard on the elevator. 

I was deeply affected.  I felt a feeling of doom — as if I were inside the dark tour of Sauron in LOTR looking out at the hordes of orcs and other horrific monsters that have been dispatched in my name in other countries.  Moreover, I got the feeling that creatures dispatched on my behalf are not necessarily ones whose judgment I would trust — not that that should have been a surprise.

I felt a feeling of doom, knowing that really our country is not so large and the whole world is MUCH larger — and they are going to come after us, just like the valiant hobbits went after and defeated Sauron: finding his weak point, attacking his weak point, and destroying him, despite his impressively massed orcs and wraiths and flying monsters.  And they’re not necessarily going to be nice to us, just as we were not nice to them.

Sunday, April 10, 2016

@potus arguments against suing apple

Some years back, I worked for a multi-national conglomerate.  They bought a Silicon Valley company, while I was working there, in the hopes of bolstering their semi-conductor manufacturing division.  They bought this company hoping to keep it mostly intact and integrate it into their existing division.

Unfortunately, the conglomerate was not able to persuade the employees in the target company to stay.  Everyone left and the conglomerate was left with nothing, basically an empty bag, which was a grave disappointment.

Having watched this fiasco, I am very concerned with what is going on with the US government suing Apple to try to force Apple to unlock phones. 

Apple has already said that their security department may quit if anyone tries to force them to unlock the phones. 

I don’t think that the US government is really taking this possibility seriously enough.  If all of Apple’s experienced security engineers quit, this will handicap them in making future products and in maintaining existing products.  If the government keeps pushing after that, more engineers may quit.  This could actually destroy the company.

People in Washington don’t understand Silicon Valley culture.  They don’t understand how mobile techies out there are.

Apple is a big company that employs lots of people.  The US government should not be attempting to force this situation.  They don’t see how it’s a scorched earth policy.  They don’t see how they might be endangering one of our most important employers.

This whole situation is illustrative of the classic legal principle that equity will generally be reluctant to affirmatively force people to take certain actions.  Injunctions are more favored.

Saturday, April 2, 2016

@DarnTough socks from @VTStore

I am unretracting this story.  The new socks came without the marks that I show in the picture below and developed them later.  I don't believe that the new socks have the mark.  They only get them after being washing. I think the sales lady lied to me.

 *******

 RETRACTION

Very embarassing.  I sent the socks back and was told that they are SUPPOSED to look that way.  I hadn't noticed the mark before and thought it was new, but it was a feature, not a defect.  So Vermont Country Store is actually sending me an extra pair of socks.  Very sweet.
🙄 Sorry.

******

I actually went to the real Vermont Country Store in Weston, VT.  I’ve been getting their catalog for years, so I wanted to try out the actual store, and I was in Weston for an audition, so I went.

I bought a couple of pairs of Darn Tough socks.  They were pricey, but they promised to last a lifetime because they were made in the USA.  I actually already had a pair of Darn Tough socks, which were doing pretty well, so I felt good about this purchase.

I get so mad at all the cheap Chinese junk I buy that breaks right away and often does not even work at all right out of the box.  The idea of buying made in USA goods really inspired me.

So the third time I wore this pair of socks, it was with a pair of Mary Janes and the strap caused the surface pattern to disintegrate.  This was only the third time  I wore this pair of socks — and naturally I had already thrown out the packaging.  I called the Vermont Country Store — and since I bought the socks from the physical store and not from the catalog — they referred me over to the physical store and wouldn’t deal with me in catalog customer returns.  I left a voice mail. I didn’t even get to speak to a human being.

Really depressing.

It’s not even the $34 or so that I paid for the socks.  It’s the annoyance that this is yet another worthless piece of junk that I have to waste time on.  The time is almost not worth it.

But I am so sick and tired of buying junk and being cheated.  I feel particularly betrayed that these creeps played on my patriotism to buy even worse junk than I would have bought made in China.  I trusted these folks and they betrayed me.  Hell hath no fury like a woman scorned, you know.

I should get little voodoo dolls and start sticking pins in them.  That’s what I should do.

Here's a picture showing where the straps from my shoes wore off the surface pattern of the socks. It's those stripey, grey blotches.