Category Archives: Health and Wellness

Live DocThoughts 3/24/20

Due to technical difficulties, I did last night’s live talk on Facebook on my personal page. I will do another tonight (8:30 P.M. Eastern time), also from my personal page – while on Facebook, search for “Abi Schildcrout”. You can choose to “follow” me if you want my public posts to show in your feed. I do not accept friend requests from people I don’t know.

Last night’s talk dealt mainly with public health and societal issues related to COVID 19. Tonight’s talk will deal more with personal/individual issues related to this outbreak. From my Facebook description for this evening: “Body, mind, “soul.” Will touch on Advil/NSAIDs, ACE-inhibitors, steroids, asthma, high blood pressure, and other chronic conditions and how they play into this, disinfection/self protection, differentiating health/medical bullshit from non-bullshit, “self care” – staying at optimal health and staying sane during this time, and elevating our selves and others so that this crisis brings out our best. If this gets to be too much for one session, I’ll continue these subjects tomorrow. I plan to do this nightly as long as people are interested and as long as I’m helping.”

You will be able to view the videos after the live talks are over, but they won’t be interactive for Q&A as they are in real time.

Please let me know if there is anything in particular you’d like me to touch on during these talks.

Stay healthy. Stay home. Stay away from others.

Thoughts on COVID 19

People are either calling me in a panic or rolling their eyes at what they believe to be massive overreaction.

Big actions are being taken. Ones most of us haven’t seen before.

Universities are moving to “remote learning” for the rest of the academic year. The NBA has suspended its season. St. Patrick’s Day parades have been cancelled. There is temporary restriction on people entering the U.S. People are being told to change their behaviors – to stand a few feet away from others when out in public, to avoid crowds, to cancel large gatherings.

It seems terrifying.

But the above is not cause for panic nor for eye-rolling – it is prudent, it is sensible, and it is cause to be reassured that the public and private sectors are working together to slow the spread of a highly contagious disease before it has a chance to overwhelm our medical infrastructure.

The disease itself is concerning. COVID-19 (this particular circulating corona virus, which is related to previous viral outbreaks such as SARS and MERS from past years) has a reasonably high mortality (death) rate in lab-confirmed cases. This overestimates the actual mortality rate, since many people will have only mild symptoms and not seek medical care and no one knows they have the virus because they aren’t that sick and so they aren’t counted in the denominator of people with the disease. This virus is really bad for older individuals, those with weakened immune systems, and those with underlying heart or lung issues. Everyone should be diligent with general hygiene and infection-control practices to reduce spread (frequent hand-washing, not touching your face/mouth/nose/eyes, not sharing drinks/silverware/etc., covering coughs/sneezes, frequently disinfecting high-touch surfaces (door knobs, tabletops, etc.), keeping a few feet away from people when out in public, and staying home and away from others when you feel sick). All of the aforementioned, I might add, is what we should do in general, but we tend to get sloppy about it when there aren’t publicized or imminent infectious threats.

People with underlying heart or lung issues, older individuals, people with compromised immunity, and others at higher risk (or who spend time with those who are at higher risk) will want to be more aggressive about avoiding public or crowded places. Follow WHO and CDC recommendations and the recommendations of your local health department. From current data in Korea (where they have done extensive testing for the virus), it appears that the overall mortality rate is around 0.6% (although current worldwide case mortality is looking like 2-3.5%, and we won’t know more exactly for some time), which is higher than that of influenza (which is generally about 0.1% or so in the U.S.). And even though most young, healthy people who are exposed to and contract this virus will be fine, some will die. The number of cases is likely to increase substantially – the reason for avoiding crowd exposure and cancelling conventions and big events/gatherings is so that we can avoid too many people getting the virus at once, causing us to run out of ICU beds and/or ventilators if the spread isn’t contained/slowed down (which is why we should listen to WHO and CDC recommendations, as well as the recommendations of our local health departments).

Here’s some of what we know so far about the clinical aspects of COVID 19: Virus symptoms start with achiness, feeling run-down, cough, low fevers, then development of difficulty breathing about 8 days in, and lung inflammation about 9 days in. (This is in contrast to influenza, which hits you like a Mack truck). Fever is usually, but not always, present. The most common lab finding is a low lymphocyte count (a specific type of white blood cell), but overall white blood cell count can be elevated or low. The CT scan findings show patchy inflammatory changes in the lungs. No other symptom/lab/radiologic findings are consistently found. Looking at a large group of patients in China, it appears that onset of symptoms from time of exposure is between two to nine days, with a median of 5 days, but there are reports of incubation periods up to two weeks, so quarantines are officially two weeks for those who have been exposed. The virus seems to be most contagious when a person has symptoms. A person can “shed” viral RNA for several weeks after they’re better, but it is not yet known whether those post-illness viral RNA particles are actually infectious. So for now, patients are kept isolated until there are two consecutive negative tests (i.e. no viral RNA detected) at least 24 hours apart.

Most people in the U.S. who have severe disease have been receiving Remdesivir (an anti-viral medication) from the company Gilead on a compassionate use basis, but soon patients receiving it will need to be in an official randomized controlled trial. There are other medication recommendations coming out of China and Korea that are indicating that there has been success decreasing the mortality rates (death rates) with other anti-viral medications, with chloroquine (an anti-malarial med), and also with some other types of drugs which target the immune system response, since some of the severity of illness and death is due to the immune system’s reaction to the virus.

There are some very smart brains in multiple countries working on medication and vaccine development to combat COVID 19, but it will take some time to figure out and, once figured out, to ramp up production, so slowing the spread of this virus is our best defense at this time.

Our best chance to slow the spread of COVID 19 is for all of us to work together. Wash your hands. Keep your hands away from your face. If official large gatherings have been cancelled, don’t make your own unofficial large gatherings instead. Avoid movie theaters for a few weeks and watch T.V. with a couple of friends instead. Don’t share drinks/plates/eating utensils. Keep at least 3 feet between you and other people, 6 feet if possible. Wash your hands. Keep your hands away from your face. Avoid unnecessary travel in busses/planes/trains/subways. Wash your hands. Keep your hands away from your face. Work from home if you can. Stay away from others if you feel sick. Disinfect high-touch surfaces regularly. Wash your hands. Keep your hands away from your face.

There will be inconvenience. There will be economic consequences. But hopefully there will be lives saved and grief averted if we all do our part and work together.

Oh, and wash your hands and keep them away from your face.

M-ing My Own B – Or Not

Sometimes I suck at minding my own business. Usually I’m pretty good at it, but it’s harder for me when I really care about someone. And unfortunately (or fortunately, which is how I generally look at it), I really care about a lot of people.

So sometimes I open my big mouth.

When I do it in a way that I know risks crossing a line, it’s because 1- I know what I’m talking about, 2- I genuinely believe that disseminating the information has the potential to make an impact on someone’s life/health, and 3- I care about the person enough that the risk of pissing them off is outweighed by the potential that the information/suggestion will do good in that person’s life.

And it’s hard to take the doctor out of a doctor. When a patient is sitting in front of me in an exam room, or when a medical advocacy client is talking to me about a health/medical/weight-loss issue, I have carte blanche to give my opinion. I mean, that’s why the patient is there, and that’s why my clients pay me. They asked for my opinion.

But sometimes, when something is revealed in a personal, not professional interaction, and my opinion wasn’t asked for, the doctor in me comes out anyway.

It actually comes out all the time – like most docs, I’m always analyzing, synthesizing information, asking ridiculous numbers of questions, and trying to find answers. That questioning is probably inborn and leads a lot of people to become physicians, and through the process of becoming a doctor it is honed into a sharp weapon of third-degree-interrogation.

And then information comes out that puts me in a spot of feeling compelled to offer unsolicited advice. So of course it’s my own fault.

Anyway, I was with a (relatively new) friend today, and what started out as normal small talk conversation about candy bars and fast food got Abi-ified into a little more questioning and resultant disclosure that this friend and his wife “really aren’t doctor people,” and therefore he had no idea about his blood pressure because he hadn’t seen a doctor in almost 40 years.

Which of course then shot my blood pressure up about 20 points as I swallowed and thought about 1- how doctors in general have done a horrific PR job and how a doc with a less-than-ideal bedside manner can turn people off from all doctors and how the corporatization of medicine is making that even worse and driving wedges into whatever tenuous doctor-patient relationship had been there in the past, and 2- what, as an internist, are my biggest worries when a middle-aged patient walks into my exam room who hasn’t seen a doctor in decades and what are the things most likely to kill him if we don’t check now and what is a person who’s not-a-doctor-person possibly going to listen to and would have the biggest potential impact of overall health, function, and longevity and if I say something to this person in front of me who’s not my patient or client am I going to annoy him or piss him or his family off and cause problems or if I say something could I maybe get him to consider getting just a few basic things checked and save himself and his family potential heartache or if I don’t say something will something awful happen that I could have prevented by not being chicken-shit and just saying something.

Yes, I always have that many thoughts at once. I should really learn to meditate.

But yeah, I said something.

In the few-second brain arc between his disclosure and my opening my mouth, I figured the things with the biggest bang for the buck would be checking blood pressure, screening for diabetes, and colon cancer screening. There’s more, but if I had to pick three, those would be the big primary-care-doc-office-visit items I’d hit first (at least without knowing any other specific medical history, and even with my incessant questions I do have an understanding of basic boundaries and don’t do complete medical interviews with my social contacts), so I suggested he consider seeing a doc to discuss these things and explained (minimally) why they were so important. If he were a woman, I’d have thrown in suggesting a PAP smear and a mammogram. And if I had thought fast enough, I’d have also recommended a flu shot and a tetanus booster and a few other immunizations (which, if he actually goes to a doctor’s office, the doc will suggest).

I assume he won’t listen to me. But maybe he will. I’ll zip him the name and office number of a doctor I know and trust who works near where this friend lives.

If someone with professional knowledge of building structures were in my house and noticed a crack indicating a loss of structural integrity, I’d want him/her to tell me so I could do what was needed to prevent my house from collapsing. If someone with a knowledge of cars heard that I changed the oil in my car myself so never took it in to the mechanic but I’d never checked any fluid levels or spark plugs or tire treads or break wear, I’d want them to share their expertise and tell me what I didn’t know so that I didn’t end up broken down on the side of the road in the middle of nowhere or in an accident because of something that could have been prevented or caught early and fixed.

I really don’t want to be a pain in the ass. But I do show my colors pretty openly, so if someone chooses to spend time with me then they are well aware of my pain-in-the-assness.  

Somewhat recently, I didn’t like the description of a complaint by another friend of mine when we were exercising. I pushed her to see her doctor immediately. I was a pain in the ass. And it turned out she needed cardiac bypass surgery.

So yeah, I’ll keep on being me – a pain in the posterior who asks a lot of questions. At least you know that if you’re getting unsolicited advice from me, I’ve spent some brainwaves agonizing over whether I should have said anything.

A Letter to a Young Writer

So.

Doug and I have grown three pretty amazing people. Mostly by luck, but we’ll take credit for having introduced them to good music and the great outdoors, and for teaching them to cook and to change a tire.

One of the best side effects of growing these people is that they end up finding other amazing people and bringing them into our lives. They’ve brought us a nice bunch of extra humans to love.

One of these delightful bonus kids is Caroline, a brand-new college graduate with fantastic culinary, percussion, and theatrical skills. She is also a writer. Her latest blog post deals with sensitive personal medical issues and she does an excellent job of explaining the clinical aspects. Her account is raw and honest. She also touches on doctor-patient relationship and communication issues, and she has kindly given me permission to weigh in on these. (You can read her post here – you’ll want to keep that tab open so you can click through and read more of her posts later – she’s a great storyteller).

Dear Caroline,

In your post, you share openly about experiences with very personal gynecologic issues, and in doing so you give other people the power of knowledge to seek help for themselves. You describe some interactions with doctors that are far from ideal, far from helpful, and which need to be addressed.

One can read what’s behind your words. Your title: “My Vulva is Melting (And Yours Might Be, Too),” was developed because of the shock/impact your physician’s specific word had on you. You put a picture of a slightly melting ice cream cone in the part of your story where you relay your doctor’s words. And you repeat the word “melting” a few different times. It obviously (and understandably) disturbs you.

Doctors learn a whole language of medical terms. We learn to speak precisely with this language. And then we learn to translate it back into language our patients can understand. Sometimes the translations leave something to be desired. What your doctor was describing is called “adhesions” – tissue can adhere to other tissue and become permanently attached. This is what your doctor meant. By trying to simplify medical terms, your doctor conveyed a confusing and upsetting image. Thankfully she was later able to explain what she had meant, and I am glad that she is helping you deal with your medical issues.

Several parts of your story hearken back to experiences with prior doctors, ones who do not seem to have been successful in positioning themselves as listening, caring, medical professionals who were in your corner. This is not to say that they weren’t, but they did not succeed in convincing you that they were.

When you describe an episode in high school in which mononucleosis caused gynecologic symptoms, you describe your doctors as not believing you (they were sure you had an STD even though you had told them you weren’t sexually active). You put a GIF in your post describing doctors as sadists who like to watch lesser people scream, and the caption of that GIF describes the physician doing a procedure roughly, as if to be punitive. It was humorous – you frequently use humor in your writing, and it’s humanizing and wonderful. But there are elements of truth behind much humor, and I worry that you thought a doctor was trying to hurt you or didn’t care that they were causing you pain.

I believe fully that this was your experience. And I highly suspect that this was not what was in the brain of the doctor.

My medical school class had 300 students. I knew most of them. One was an irredeemable asshole. The rest genuinely were there because they wanted to help people, but some didn’t have the best communication skills. I have found a similar pattern among the practicing physicians with whom I have worked. In fact, the doctor assholes are generally assholes to other doctors who they believe are not doing the right things for their patients. The overwhelming majority of doctors really do care about and want to help their patients, and they dedicate an enormous proportion of their lives to doing so. But sometimes they suck at parts of it.

Doctors are trained to look at signs and symptoms of a patient and synthesize everything they’ve learned in in-depth academic and clinical courses to come up with a differential diagnosis – a list of things that could be causing a patient’s presentation. Docs are taught that, in general, hoofbeats mean horses, but occasionally there’s a zebra. If it looks like a duck and quacks like a duck, most of the time it’s a duck. But not always.

If a doctor suspects an STD in an adolescent, it would be gross malpractice not to test for one, no matter what the patient says about risk factors, because missing that diagnosis could result in irreversible long-term sequelae, such as permanent infertility. Or severe systemic infection. And, for a variety of reasons, people frequently don’t give their doctors the full story (and a large proportion of sexually active teens deny sexual activity if they think their parents could find out). It’s simple to check and rule out an STD that could have potential devastating consequences. But that needs to be done in a way that respects the patient so that she feels she’s believed and listened to. “I know you told me that you’re not sexually active and I believe what you tell me. Because this looks so much like X, I’m going to test for it even though the fact that you’re not sexually active makes it very unlikely. I am looking for other causes, too, and I need to be complete.”

As far as the rough, painful specimen collection, there is of course a chance that the gynecologist was a sadistic asshole. But the far more likely scenario is that the doctor had not established trust and didn’t talk you through the procedure. I suspect it would have made a difference if the doctor had said, “Those ulcers are probably quite tender, so when I swab them to send some cells to the lab to figure out what it is that’s causing this, it’s going to hurt. I am using a soft, cotton swab, and I will be as gentle as I can be, but it may feel to you like I’m using sandpaper. I’m sorry that this is painful – I want to figure out exactly what this is so I can help you get better.”

In describing seeking help from a previous gynecologist for symptoms related to your new diagnosis, again there seems to be a deficit in communication. It seems that the doctor may have only been suspecting horses of making the hoofbeats, or at least the doctor didn’t let you know that other causes were being considered. It’s the doctor’s job to come up with the differential diagnosis, but sometimes it helps if a patient asks, “what else could this be?” – then you know what else, if anything, the doctor is thinking about.

When you reported to that doctor that you had pain during sex, the doctor made sure to tell you to stop your partner if you were in pain. Your response in your piece (not to the doc) was the equivalent of “no shit, Sherlock.” Yup. It’s all well and good to advise a patient not to do something that causes pain, but if a normal activity causes pain, it needs to be evaluated thoroughly. A reported symptom needs to be addressed. Perhaps your doctor would have investigated further had you not politely let it go when you received a “’Doc, it hurts when I do this,’ ‘So don’t do this’” message – a request for more thoughts might have prompted more response. “I of course stop when it hurts. But it’s not supposed to hurt. I’m not doing anything rough or unusual. What are your thoughts about why I might be having this pain?” might help a doctor who’s overwhelmed with patients stop for a moment and really focus on the one in the room. (Please note – I’m not at all “victim blaming” here – it’s absolutely the doc’s job to do all this anyway, but doctors are under significant pressure and sometimes a gentle nudge goes a long way).

Your advice to your readers is to listen to their bodies and investigate anything that seems abnormal for them. You balance this with a caveat against self-over-diagnosis. I second your advice wholeheartedly. Advocate for yourself. Don’t walk out of your doctor’s office if you don’t understand what was said to you (by the way, I’d be happy to discuss ureaplasma with you), or if you don’t think your issue has been heard and addressed. There might not be an immediate answer, but there needs to be a plan in place to find the answer and address the issue.

I also highly suggest that those on their way to becoming doctors listen to these stories. They need to hear their patients. They should be writers themselves – understanding the importance of words, understanding the importance of pictures, and always thinking about how their patients may be hearing them.

Thank you, Caroline, for sharing your stories. People are learning more from you than you know.

Some People Don’t Listen

My official medical advice is to avoid hot tubs. Always.

They’re germ soup. The temperature is perfect for bacteria to thrive and multiply. You can get some nasty skin infections from going in those things, it’s possible to get lung infections from pathogens aerosolized by all the bubbling, and heaven forbid you should get that water in your mouth.

Just say no. Period, the end.

So after my workout this morning, I got into the hot tub at the gym.

When you’re a doctor, you’re always weighing risks and benefits. You’re uber aware of risks. It’s such a bedrock of the years of medical education and training that it becomes ingrained, automatic, a reflex, to think of what can go wrong with any decision you make and how you could kill someone. You’re also weighing how any decision you make can help someone. It’s a balance.

Anyhoo, back to the hot tub.

I recently decided to kick my fitness routine up a few notches. I pushed it a little too hard, and a few days ago I pulled a muscle.

Nothing like doing that to make you feel old.

I rested it a couple days and got back to my workouts yesterday and today. And today’s workout finished in the pool. Right next to the hot tub.

My muscle was a little sore. And the pool was a little cold. And the jets in the hot tub were on. And I knew how good it would feel to get in that hot water and hold my sore muscle near a jet.

I thought about the likely bacterial level. And I thought about how I see gym personnel checking pH levels and adding disinfectant regularly in both the pool and hot tub.

I thought about potential skin infections. And I thought about the fact that I haven’t shaved my legs since two days ago so probably didn’t have any micro-nicks in my skin where bacteria were likely to get in.

I thought about potential lung infections. And I thought about the fact that I have a good immune system and healthy lungs.

I thought about the potential of accidentally getting any of that water in my mouth. And I thought about how easy it would be to keep my face out of the water, and that no one was splashing.

I got in. And put my sore muscle against the jet. And stayed there a good 10 minutes.

And damn, did it feel good.

And it stopped the soreness.

I got out, took a shower (I may or may not have soaped up a second time), got dressed, and went on with my day.

Glad that today I did not follow my own medical advice, and will let you know if I end up with hot tub lung.

A Pleasant Touch of Insomnia

I can’t sleep. It happens sometimes. So I’m downstairs in my parents’ house, reflecting.

Today I’m not annoyed at being awake this early, where normally I would be. Normally, when I do this early-wake-up thing (one of the joys of the hormonal changes of getting older that no one really warned me about), I look at the clock and get really pissed off. I lie there angrily, sometimes for a couple hours, until it’s time to get up. I play with my phone. You know, exactly what I tell my patients not to do.

I stayed up too late last night. I do this frequently when we’re all together. My son’s friend, who is with us for this trip, described it just as I experience it – wanting to be with people means he stays up way later than he should. I, too, am fueled by being with people. At least with people I care about. I probably wouldn’t want to stay up late hanging out with a bunch of assholes. But when it’s MY people, the draw of the social connection is stronger than the draw of my bed. It’s actually stronger than any other draw I can think of.

The four boys and I (and yeah, the “boys” range in age from 18 to 23, and they’re fully men, but from what I can tell about myself, I will always refer to them as the boys or the kids or the babies) went skiing/snowboarding yesterday. It was fantastic – conditions were perfect. It wasn’t crowded, the temperature was in the mid-to-upper-20s, the view was beautiful, the snow was great, and the feeling of flying over that snow was everything it always is. And it was physically exhausting – in that every-muscle-system-got-a-workout, got-my-heart-rate-up-for-hours, laughed-enough-that-my-abs-got-even-more-workout kind of way. So I was tired. I needed a good night’s sleep.

Around one a.m., I fell asleep in front of a movie we were watching together. That happens frequently – the family is together, we’re happy, and I feel so relaxed and content that I just fall asleep while watching a favorite. And of course the being-tired-from-staying-up-too-late probably plays a part. Movie was over around 1:20, and I went to bed and fell asleep next to Doug. A deep, contented, tired, good sleep.

And then I woke up at 6:30.

I talk to my patients all the time about sleep. I talk to my weight loss clients about it as well. I talk to my kids about it. It’s so basic, and yet so many of us don’t do it right.

We just don’t get enough. Adults really do need about 8 hours. It helps with brain functioning. We’re sharper when we sleep well. It helps maintain healthy cortisol levels. Our metabolism works better when we’ve had enough sleep. Our stress levels are better. Our blood pressure is better.

When we don’t sleep well, we don’t function at our prime. We handle stressful situations with less resilience. We put on weight. We don’t remember things as well. Our bodies and minds aren’t at their best.

And I’ve just had a 5-hour sleep.

But this morning I’m enjoying it. I am fully content. There are seven people I love sleeping peacefully under this roof. The view outside the window of the pond and trees covered in a light layer of snow is peaceful. I’ll read for a bit. Eventually others will awaken and join me, and we’ll talk politics and movies and music and sports and people. We’ll play games. We’ll eat. We’ll laugh a lot.

And I’ll stay up too late again.

So yes, it would be better for my health not to wake up early like this. But sometimes these late nights and early mornings are good for my soul.

A Well-Balanced Breakfast

So.

I was frying up some eggs this morning for me and my youngest son. Three of the four were in the pan, and as I tapped the last egg against the side of the pan to crack it, I saw a Huge. Ass. Motherf#@ing. Spider. In the pan. Sizzling in the oil.

I did what any reasonable, smart, well-educated, outdoorsy, nature-loving, competent adult would do: I stood there with the cracked egg dripping into my hand, and screamed.

Andrew ran into the kitchen. “Mom! Are you ok? What’s wrong?”

All I could do was gesture, egg dripping down my arm, to the pan.

He looked. And he did what any reasonable, smart, well-educated, outdoorsy, nature-loving, competent adult would do: he screamed. Well, to be fair, it was less of a scream and more of a really loud “holy shit,” but I’ll count it as a scream for literary purposes.

At this point, the sizzling spider popped loudly. I screamed again. “Do something!”

So my resourceful college sophomore grabbed a couple of spoons and extricated the deep-fried arachnid from the frying pan.

As he dumped the spider in the trashcan, I plopped what was still contained in the open eggshell into the pan.

I tossed the shell into the garbage and washed my hands, as I contemplated the big question: Do we eat the eggs from the spider pan?

Medical analysis: as Andrew pointed out, the pan was full of boiling oil – no spider-trafficked microbes were likely to maintain their pathogenicity.

Human analysis: Ew.

Medical analysis: any potential toxin from semi-exploded spider unlikely to be potent enough in whatever traces might have reached egg to cause any noticeable clinical effect.

Human analysis: Ew.

Practical considerations: out of eggs upstairs, in a bit of a rush, and hungry.

Verdict: Meh.

We ate the eggs. I gave the ones furthest from the spider to Andrew, took the somewhat close one for myself, and tossed out the one that had gone directly onto the spot where the eight-legged creature had actually been. I viewed that as a reasonable approach. You know, from a clinical standpoint.

Anyway, the spider was much worse off for the whole experience than I and my son.

We discussed the situation over breakfast, noting that we all eat plenty of bugs and bug parts all the time, in blissful unawareness.

But seeing it is different.

Our minds are powerful. Our defense mechanisms are powerful. We have the capacity to contemplate our mortality, the vastness of the universe, the complexities of DNA, or the presence of bug parts in our food. But we also have the capacity to put those thoughts aside so that we can get things done and live our lives.

Sometimes something comes along that knocks us out of our blissful, practical-repression-of-stuff state and makes us face our mortality (or a spider). The mortality is always there. We ignore it. The spiders are always there. We ignore them.

Until one drops into our frying pan. At that point, we deal.

Sometimes it’s a little spider. Sometimes it’s a really big one. Sometimes it’s venomous. Sometimes it’s kinda cute. Sometimes we notice its magnificent web. Sometimes it scares the daylights out of us. Sometimes we just brush it away.

And, the vast majority of the time, the spider causes us no harm.

But worrying about the spiders, thinking about the spiders, can be paralyzing.

Some of us live where there are dangerous, potentially lethal spiders. In those areas, it’s wise to take precautions.

We should shake out boots that have been left outside or in the garage before we stick our feet into them.

But worrying about any potential spider in our house? Not practical. Not helpful. And if we’re too meticulous about removing every known spider, who’s going to eat the other bugs?

There’s always a balance. Always a weighing of the pros and cons, the risks and benefits.

The eggs were good. As was the coffee.

We didn’t look too closely in our cups.

No. No. Just No.

Words matter. Words have consequences. Lies matter. Lies have consequences. People have understood this for a very long time – note the biblical prohibition against bearing false witness against one’s neighbor (that one actually made it into the Top 10 list).

What our current president stated at his recent rally in Wisconsin is false witness, defamation, slander, against doctors. It goes beyond that to incitement. His words, his lying, defamatory, slanderous words, will cause death.

Doctors do not “execute infants.” Full stop.

They do not wrap a living, breathing baby in a blanket and “determine whether or not they will execute the baby.”

This particular outright lie of Donald Trump has painted bullseyes on doctors, nurses, and patients for violent anti-abortion extremists. Doctors may be killed because of his words. Nurses may be killed because of his words. Patients may be killed because of his words. His false words. His slander. His lies.

He has harmed doctor-patient relationships with his slander. His defamatory words drive a wedge between those who have spent lifetimes dedicated to helping others in their times of greatest need and those who need their help.

He has born false witness. He is quite possibly inciting murder. He has put my colleagues’ lives in danger. He has put my patients’ lives in danger – both from direct violence by those agitated by his lies attacking people seeking care, and by alienating patients from doctors who are there to help them.

The blood will be on your hands, Mr. Trump.

It Happens

Spent a big chunk of the afternoon cleaning up shit.

No, this is not a metaphor. We have a dog, and although most of the year we make it a point to clean up the yard daily, it’s been really cold and snowy and rainy and cold and snowy and muddy and cold and rainy and did I mention cold? and I just haven’t been in the mood to do it for a while. And today it’s in the 40’s and dry and actually (I think) supposed to stay warm for many days in a row, and so it was time to get out there and clean up the mess. And today is garbage pick-up day, and although the recycle truck comes early, the garbage truck comes late in the afternoon, so if I got out there and did the turd pick-up quickly enough, I could get it to the curb in time to be taken away from my house today.

So out I went.

The process involves significant risk of stepping on poop land mines, so, wisely, I wore Doug’s shoes (sorry, Dougie, but you weren’t home and your shoes were conveniently located at the back door and I love you!).

In my “reduce/reuse” effort to decrease our plastic impact on the planet, I save produce bags and newspaper delivery bags to pick up after our pooch, and I filled up quite a few.

So here come the metaphors (you knew they were coming):

Health? Life? Politics? Let’s throw in a little of all of the above.

We’ll start with the produce bags: onions, broccoli, and zucchini in, poop out. So the produce bags can be a metaphor for intestines. And we’re discussing chores we don’t necessarily want to do. Perfect segue for an update on the American Cancer Society’s colon cancer screening recommendations. They now recommend that people of average risk for colon cancer begin screening at age 45 (the old recommendation was 50). Gold standard for screening is colonoscopy (starting age 45 and then every 10 years for the average-risk folks). Those at higher-than-average risk likely need to start earlier and do it more frequently. The prep isn’t overly pleasant, but it’s way better than late-stage colon cancer. So talk to your doc about it. This public service announcement brought to you by a bunch of canine backyard bowel movements.

Moving on:

It’s fairly easy to be methodical in the collection endeavor, as our pup is quite consistent in his tendency to defecate along the periphery of our property – he’s an edge-pooper. For the most part, I knew where to look: within a foot of the fence. This is true for most of us. We learn when and where to expect crap. Yes, every once in a while, there’s a big steaming pile in the middle of the lawn where you don’t expect it, but by and large, in the day-to-day, it’s where it usually is. There’s a lot of traffic at rush hour. There are long lines at Trader Joe’s the day before the Super Bowl. You don’t get as much sleep as you’d like when you have exams or when you’re on call. Your spouse is snippy when he/she is under stress. You expect it. You plan for it. You deal with it. It might not be pleasant, but it’s not surprising.

Along the perimeter of our fence we have all sorts of perennials – day lilies, crocuses, hydrangeas, peonies, various other pretty green and/or flowery things that I don’t know the names of. And under the piles of fecal matter I found a plethora of green shoots. The icky and the good are right up next to each other. The fertilizer feeds the flowers.

Much of the excrement has been through multiple freeze-thaw-get-rained-on-and-snowed-on-and-frozen-again-and-thawed-again cycles, and although you can certainly tell that it’s shit, it’s not fresh shit – a lot of it is really dried out and actually somewhat easy to scoop up and most of it doesn’t really even have much of a smell. When life throws general crap at us is can seem pretty awful at first. The fresh stuff stinks – we should pick it up right then and get rid of it, because if you step in it, it embeds in every crevice of your shoe and you have to do the twist on the grass to get the big chunks off and then bring the shoe straight to the utility sink and scrub the rest out of the treads. But if you’ve just stayed away from the crap for a good part of the winter, it might not be so bad when you come back to deal with it later. Works for some things, not necessarily others. Breast lump? Deal with it now. But some things that seem like a big deal right now turn out not to be such a big deal through the lens of time.

Of course, we’d never leave our dog’s waste on the ground when out walking – you don’t leave that for someone else to step in or have to clean up. But we don’t always afford ourselves the same courtesies we give to others. Maybe we should.

I seem to recall I said I’d find a way to tie this to politics as well. I used a bunch of newspaper bags. Need I say more?

Truth be told, I only got around 40% or so of our property’s perimeter-o-poop (there was only so much I wanted to deal with at one time), so will head back out later today or maybe tomorrow. My shoes (well, Doug’s shoes) are clean for now.