General – Page 3 – Retired White Coat

March 4, 2023

AI (Artificial Intelligence) meets 21st Century Dog Blog

I took my canine blog piece this week to ChatGPT and asked to convert it into Shakespearean sonnet and then write it in the New Yorker magazine style. All of four seconds passed when I received this output. It did not “red line” my original nor summon me to the English office after school hours. After a few minutes of sadness about the state of human creativity, I realized that we are doomed to the only job in the future: pushing a button like George Jetson working for Spacely Space Sprockets. Comments welcome.

Oh, how quaint and retro I may seem,

A lover of dogs from a bygone dream.

Gravy train and kibble, an old soup bone,

A shag rug for my faux dog throne.

Lassie, dear Lassie, my model of canine grace,

Saving grandpa from that mine shaft, what a race!

Rin Tin and Airbud, oh how they shone,

Snoopy, that smug dog, his charm never gone.

But now, in the 21st century, a grandpuppy has come,

A blend of beagle, pug, and a touch of Old Yeller’s gumption.

Watching stress-reducing videos on YouTube,

Meeting rodents in the forest, the views reaching 13 million, oh how true!

His bones, oh what a vast array,

No longer just bovine, they come in every flavor and day.

Rawhide, nylon, rubber, antler, oh what a delight,

Calcium phosphate, magnesium, salt-poor, salt-rich, what a sight!

Improved mouth health, jaw strength, tartar removal, all for the taking,

Supplemental vitamins and minerals, turning a dog into a Kennel Club sensation.

A Frisbee, an old treasure, the grandpup found,

But a new one from Amazon, a Kong, we quickly found.

Durability and universal love of dogs, oh what a claim,

Over the desiccated Portuguese Man o Wars, our pup was not the least bit tame.

Doggie health insurance, oh how grand,

Medicare coverage at 65/7, that’s a plan!

But what of fame and fortune, oh what can a pup do,

Hollywood is not the only path, I never knew.

Dog entrepreneurs, with their grooming and accessories galore,

Supporting animal shelters and having patents and trademarks to adore.

Manny The Frenchie, with a non-profit and a net worth of a million,

Walter Geoffrey, with his clothing line and sass, and a rap album in the making, how thrilling!

Loki The Wolfdog, co-founder of a travel app and a movie deal with Netflix,

Tuna, the Instagram celebrity, with an overbite that always smiles, and a book deal with Penguin Random House to fix.

Opportunities are endless, for the new century pup,

With improved nutrition, emotional adjustment, and love, they can really strut.

If only our grandpup would watch that instructional video on Frisbee catching,

The next Super Bowl halftime show, he’ll be ready, dispatching.

The New Yorker Style

As a proud retro dog lover, I was content with the basics: gravy train, kibble, an old soup bone, and a shag rug for a faux dog bed. My 20th century pup had it made. Lassie was the epitome of canine responsibility (Timmy: “Lassie, grandpa fell into the abandoned mine shaft again, go get help) and Rin Tin Tin and Airbud oozed star power. And let’s not forget Snoopy, with his smug confidence radiating from the daily comics.

But my recent encounter with a 21st-century pup shattered my nostalgic bubble. Baby-sitting my grandpuppy, a 9-month-old Orlando Rescue pup, I watched in amazement as he relaxed while watching a stress-reducing YouTube video of a Labrador retriever strolling through a verdant forest meeting a variety of rodents. This channel had 13 million views, although it wasn’t clear if they were the human or canine type.

And then there was the bone aisle at Petco – a cornucopia of choices that made choosing a variant of Pinot Noirs from multiple continental terroirs seem easy. Rawhide, nylon, rubber, antler versus bovine, calcium phosphate, magnesium, salt poor and rich and anti-oxidants. Bacon and cheese flavors could be added for those picky “chewers.” The packaging touted improved mouth health, jaw strengthening, tartar removal, improved oral microbiome, fresh breath, and supplemental vitamins and minerals that could turn your dog into an American Kennel Club icon.

Our grandpup discovered an old Frisbee in the closet which he immediately bonded with. But thanks to the mass of dog owners and capitalist ingenuity, I found Kong – a natural rubberized Frisbee that had nearly 27 thousand 4 1/2/5 star reviews touting its durability and universal love of dogs for this flying disc. I ordered it on Amazon and it arrived seemingly a few hours later. Our pup was bouncing after it on the sand and over the desiccated, beached Portuguese Man o’ Wars on the South Florida shores. And with top-notch “doggie” health insurance, he had no worries about jellyfish envenomation. I couldn’t help but wonder – at what age would he be converted to Medicare coverage? 65 years? 7? The thought amused me.

But wait, there’s more. Who knew that dogs have become entrepreneurs and started their own businesses? Grooming, training, accessories, food, and treats are just a few of the products and services offered. And some dogs even have patents or trademarks for their inventions or innovations. Manny The Frenchie (@manny_the_frenchie) not only runs a non-profit organization that supports animal shelters but also has a net worth of $1 million. Walter Geoffrey (@waltergeoffreythefrenchie) sells his own line of clothing and accessories that feature his signature sass and has a rap album coming out soon. And Loki The Wolfdog (@loki) co-founded a travel app called Loki The Wolfdog that lets you explore the world with your furry friend and has a movie deal with Netflix. Dog influencers populate the internet and often have more subscribers than humans. Tuna (@tunameltsmyheart), an Instagram celebrity, has a distinctive overbite that makes him look like he’s always smiling and also has a book deal with Penguin Random House.

So the opportunities are endless for the modern-day pooch. With improved nutrition, better emotional adjustment, and plenty of love, our grandpup can be the best dog he can be. If only I can get him to watch the YouTube instructional video on Frisbee.

November 4, 2022

Learning From the Dead: Life Lessons of the Cemetery

A field trip to the Green-wood Cemetery, nestled between bodegas and diners in Brooklyn NY, seemed timely as my own expiration date looms closer as the aging process inexplicably marches on despite my total commitment to sunscreen and healthy eating. Just days from Halloween, the compulsion to explore an iconic burial ground beckoned and detoured me from my previously decided upon destination having been the Brooklyn Museum and Botanical Gardens. My wife and partner appeared dubious. We boarded the Q train for Brooklyn at 72nd street. We disembarked at the Green-Wood Cemetery transit station. Our journey started somewhat inauspiciously upon emerging from the SW exit. I saw signs for the transfer train lines: The D, The N and The R (DNR). Was this a deliberate attempt at macabre humor by the NY Transit Authority? My wife, a fellow physician, recognized the DNR or DO NOT RESUSCITATE acronym in full display as we entered the cemetery from the 36th St. entrance and she chuckled to herself.

Green-Wood unrolled in front of us as we entered the gates and passed the guardhouse on our left. Bucolic best describes the 478 acre land that was dotted with multiple bodies of water, fountains, trees, rolling lawns, massive gravestones and individual family mausoleums constructed with stone, glass and marble. Breathtaking! I briefly stopped at an information kiosk and learned that this South Brooklyn cemetery had been established in 1838 as a burial site for the burgeoning city in which it lies.. As an amateur student of history, I was drawn to the celebrity names of the past promised in the self-guiding map provided. For these departed individuals, the splendor of the mausoleums and monuments of their burial sites broadcast their influence and importance in their past lives.

DeWitt Clinton, 6th governor of New York and father of the Erie Canal, is buried on a green covered hill with a life-sized statue of himself standing on an oversized marble sarcophagus. He gazes over all of Brooklyn with his left hand raised as if shielding himself from the sun to better his view. Commanding!

Boss William Tweed, head of the 19th century corrupt political machine known as Tammany Hall, was prominently interred on Battle Hill, a revered site at Green-wood cemetery because it was the site of George Washington’s battle with the British at the inception of the Revolutionary War. A world class rogue and huckster, Tweed siphoned millions of dollars from construction of the Brooklyn Bridge, Central Park and the Courthouse in Downtown New York.

Among the century old London Plane trees and Dogwoods lies Samuel Morse beneath a Greco-Roman inspired monument. The inventor of the telegraph, classical painter and Morse Code originator had a near perfect record until he advocated for slavery during the Civil War.

While the glamor of the granite palaces marking the famous and infamous in death never failed to impress, I realized that the essence of humanity was to be found in the more modest gravesites. Thousands of small granite tombstones marked those who had served in the Civil War and the World Wars. Rows and rows of tombstones lined the grassy knolls as if the stones were marching in a regimented formation.

Fighting on opposite sides of the Civil War, William and Clifton Prentiss were reunited after sustaining mortal wounds in the same battle and interred together in perpetuity at Green-Wood.

Louis Abel, an electrical engineer serving in the 112th Infantry was stationed behind enemy lines in France during World War I. He writes his brother a letter 13 days before his death:

My dear Brother Eugene: 

As the war goes on and as I come out of each engagement still alive, I think often of those at home and wonder if I will ever see them again. You are all in my thoughts continually when I have time to think of other things besides the continual shellfire and fighting. My nerves have been sorely tried and many officers and men have lost out completely due to nervous strain making them useless. I sincerely hope all is well with you and yours. Love to all and may God who watches over us all bring us together again.

Lovingly your brother, Louis

Charlotte, a 17 year old girl on the verge of becoming a married woman, was accidentally killed in a carriage accident in 1844. She is interred next to her fiance who took his life in complete and utter grief over her unexpected death. Do-Hum-Me, an 18 year old Sac and Fox Nation Indian woman, was brought to the East in 1843 from her native lands in Iowa by her father to negotiate treaties with the federal government. She was hired by P.T. Barnum to perform Indian war dances in his New York theater. Without resistance to Western disease, Do-Hum-Me fell ill and died of an infectious disease. P.T. Barnum was so distraught he paid for her burial and tombstone. Two women, ill-fated for early deaths and thus virtually unknown during their lives, have become well-known and are frequently visited gravesites at Green-wood.

The sky darkens and a late October rain begins to fall. My wife and I open our umbrellas and prepare to depart the cemetery. We are headed back to the subway to return to Manhattan. We cannot help but to reflect on the beauty of the cemetery and the lessons it has taught us: it is the quiet lives of so many who are unsung in the world that reach out to us in the most unexpected places that remind us the importance and beauty of every life.

September 19, 2022

Tree Surgeon

The second hand swept past twelve midnight on the operating room clock as the retractor dug into the palm of my hand and my biceps lactate level soared. “Hmm, you’re choosing Internal medicine?”, intoned Dr. G, as he directed the surgical resident to place catgut sutures into a human gut that was defiled by a stab wound in the heat of a gang altercation in East Los Angeles in 1977. I pulled on the retractor as Dr. G. sermoned his soliloquy on the superiority of surgical practice. “Who is going to save the patient with appendicitis or peritonitis from certain death? The surgeon!”, he emphatically answered.

Morning arrived quickly and surgical rounds began as a retinue of visiting professors, fellows, residents, interns, social workers, case workers, physical and occupational therapists and finally third year medical students filed in behind Dr. G. In my sleep deprived mind, I saw his surgical cap as a tri-cornered hat, his pocketed stethoscope as a sword and his entry through the door of the large L.A. County Hospital ward as passing under a faux Arc de Triomphe after his conquests at Austerlitz. Moments later, he transmogrified into a fusion Perry Mason and Clarence Darrow, as he interrogated a profusely sweating surgical resident who had the misfortune of a post cholecystectomy wound infection.

Many decades later, playing “where are they now?,” I did the perspicacious detective work of finding out what accolades Dr. G. had received in the 21st century. In other words, I had googled his name. Up came the answer: He had retired to a South Pacific Island to manage a greenhouse and take care of plants and trees on the island. He had become a plant and tree doctor! The head of Los Angeles County Trauma Response who had mended miles of injured intestines, cauterized thousands of bleeding blood vessels, and drained an ocean of abscesses had become a tree and plant caretaker. I was gobsmacked to say the least.

Trees were meant to be cut down to make way for McDonalds’ parking lots, inspire insipid poems that 4th graders needed to memorize, and knock down errant golf balls. (Dwight Eisenhower, the Supreme Commander of D- Day and former U. S. President, urged Augusta National Golf Club to cut down a tree on the 17th hole that consistently stymied his tee shot).

As the years peeled away and I grew more gray, I learned respect for green. Peripatetic journeys with my botany-wise spouse and selected artificial intelligence plant apps opened up the world of beauty and ecological necessities of our flora. The mountain ash leaves feeding an army of tadpoles, our Red Osier Dogwood stabilizing our topsoil and preventing erosion, sunflowers blooming in summer and providing sustenance for bees, the Oregon Crabapple providing shelter and food for the Bluebird and Cardinal, and the joyful human stroll under the elevated tunnel of American Elms lining the Literary Walk at Central Park, are fine examples of the edification and beauty I had discovered in my new-found hobby of tree identification and exploration.

Dr. G had seen decades of turmoil and tragedy mending the human body in East LA. He found tranquility and peace tending the South Pacific flora thousands of miles from the mainland. His time spent caring for trees, I would like to think, was like a healing tonic for a soul undoubtedly troubled and fractured from the many toils and challenges of practicing medicine and surgery for decades. In a sense, he was finding his humanity and giving back to the planet what we have taken for granted for so long: the life-giving beauty of the Kingdom Plantae. I have to admit, I completely understood.

June 25, 2022

Peering into the Past and Future: Riding Down the Rhine and Danube

It was time to travel despite a war in Eastern Europe, runaway inflation, political turmoil and exploding Omicron SARS-CoV2 variants. With a KN-95 mask, COVID antigen tests and $50 worth of digital guidebooks in hand, we boarded a river boat to glide upstream down the Rhine, Mein and Danube, from Amsterdam to Budapest to find history, fine spirits and the origins of ancestor’s past.

We were going to the edge of civilization, as the Romans had defined it circa 2000 years ago. The Rhine and Danube were the North and Eastern boundaries of the empire, warding off the barbarians, the Goths, Vandals, Visigoths and Franks. The Franks had plundered Eastern and Western Europe, united under Charlemagne and eventually (?with the help of intermarriage and French wine) settled down in France so their ancestors could appreciate fine architecture, food and Jerry Lewis.

The tragedies of history were retold by guides, museums and historical plaques as the craft dodged buoys and passed feudal castles. In Amsterdam, Cologne, Regensburg, Vienna, Rothenburg, Bratislava and Budapest were military monuments, holocaust memorials, mass graves, ramparts and moats, museum artifacts, artillery and ballistic impacts on stone walls that testified to perpetual war and oppression from the Middle Ages onward. The grievances are engraved in our schoolbooks: Romans v. Barbarians, Christians v. Arabs (Crusades 1-4), Protestants v. Catholics (30 Years War and others), Ottoman Empire v. “Civilized” Europe, Habsburgs v. National Uprisings in the mid nineteenth Century, Prussian Wars of the late 19th century. The 20th century brought us World Wars I and II ending the Holy Roman and Ottoman Empires and Hitler and the Third Reich at the expense of over 60 million lives.

As we headed South and East along the Rivers, I encountered glimpses of my Jewish heritage. The Jewish Diaspora from antiquity forced migration from Western to Eastern Europe along the Rhine and Danube. Jews were multilingual merchants, bridging the Arab and European divide and helping to create the trade routes from Asia, Africa and Europe. They were artisans in the pre-industrial world and creators of the financial world that allowed the development of city-states. Judaism financed the release of Richard the Lion Hearted of England’s release from captivity and paid for the defense of Vienna against Ottoman Invasion in the 17th century. Yet, each town’s history was marked by the same recurring theme: Jewish expulsion and persecution.

Tragedy often begets opportunity. Science, medicine and art blossomed along these European river tributaries. Booerhaave, the Dutch physician, organized hospital divisions, defined pathology and described his eponymous esophageal rupture syndrome. Dicke, an Amsterdam physician, recognized abdominal pain and diarrhea in Dutch children reintroduced to bread following privations of World War II and described celiac disease. Down the Rhine at Erlangen, Germany, Demling and Classen devised a modified electrified wire passed through an endoscope and allowed non surgical removal of bile duct stones in a jaundiced nurse in 1973, introducing therapeutic biliary endoscopy to the world. Wilhelm Conrad Rontgen, discoverer of X rays, taught on the Mein River at Wurzburg in the late 19th century. Sigmund Freud’s psychoanalysis treatise and practice was a part of 1890’s Vienna. Laszlo Biro from Budapest, invented the ballpoint pen and freed the world from fountain pen leakage.

Music flourished along the river, providing the world with the classics from Mahler, Mozart, Beethoven and Liszt.

History was infused in everything we saw and consumed. I ate herring in Amsterdam as the Dutch West India Company sailors did before traveling to Nieuw Amsterdam and quaffed Riesling from The Rhine Valley from Middle Age monastery vineyards. A McDonalds and statues of Ronald Reagan and George Bush in Budapest were symbols of who won the Cold War.

The realities of the past portend the fragility of peace for the future. The murmurs from these ancient rivers give us pause to respect and cherish our freedoms.

December 21, 2021

The Real Genie in Genealogy

As new grandparents, we await the wondrous moments of human development to flow into our much loved grandson. It has also awakened our curiosity of what lies ahead during his lifetime after we are a forgotten footnote of family lore. Sensing our own sense of evanescence, my wife and I embarked on the worldwide pursuit of genealogy. Who are our ancestors? What were their struggles? What can we learn about the past that we can pass on to the future members of our family?

I strolled through the American Museum of Natural History and came across the hominid tree. Australopithecus, Homo erectus, and Homo sapiens were primitive versions of modern man but broadly complex and contained too many branch points to fully understand and impossible, of course, to trace back to our grandson. Lessons of life on the Serengeti may not be helpful in our grandson’s future. Consequently, I narrowed the scope by 250,000 years by downloading MacFamily Tree 2019 and joining ancestry.com.

Standing on the shoulders of prior family tree creators, I embarked on tracing my wife’s ancestors. A few clicks and I was back eight generations and landed in the 17th century in Scotland and Ireland. Her tree was historically stocked with five Revolutionary War heroes, an indispensable aide-de-camp of George Washington, and our 11th President, James Knox Polk.

Documenting my dearly departed Ashkenazi Jewish brethren proved a more difficult challenge. I summoned wisps of memory from late relatives recalling a “Civil War soldier,” an “uncle with a battle injury,” and a “Wall Street merchant.” The documents were sparse to non-existent until I summoned the meager Eastern European geography clues left in the U.S. census forms of my ancestors. One patriarch listed his origin as Poland Russia and emigrated to New York in 1865, returned to his native land and then returned again to the US in 1875 with a wife 30 years his junior. What were the circumstances that prompted this circuitous path? What made him leave the US so quickly after his perilous journey? Unlike my wife’s clearly documented centuries of ancestor life, including details of her Presidential cousin’s kidney stones in 1812, my great grandfather’s trail turned cold. Serendipitously, he showed up in a Civil War Archive as a private in the 41st Regiment in 1865. As a replacement soldier, he received $300 so that the wealthy could be spared the injury and death that the war bestowed upon its participants. His regiment consisted of European foreigners regaled in the New York press due to their “extensive experience” in wars fought in Eastern Europe. Their return to New York City in 1865, after 70% of the regiment had perished, was snubbed by the mayor who sent a city councilman to attend the ceremony. I could understand his return to his native land and family after these events. But WHY did he return ten years later? History of Russian Poland filled in the explanation. Poland ceased to exist in 1795 and was carved up by the imperial powers of Russia, The Habsburg Monarchy (Austria) and Prussia. Numerous national uprisings against the occupying powers occurred in the 19th century. Russia was particularly brutal in suppressing the uprisings and singling out ethnic groups, especially Jews for punishment. The Pale of Settlement, enacted by Catherine the Great in 1791 and enforced by subsequent Tsars, prevented Jews from migrating eastward to Russia and limited Jewish involvement in public life. Jews were forced to serve in Russian military service for 20 years and their children were coerced to participate in exchange programs with other ethnic families so that Jewish children could be “Russified” and their Jewish heritage could be suppressed. With the assassination of the Tsar Alexander II in 1881, widespread pogroms that indiscriminately killed Jews were encouraged by the government. Fascism, while not invented in Eastern Europe, thrived in the urban and rural areas. This singled out the Jewish minority for the ills of society and excluded them from national life. Out of this maelstrom of terror and unrest came Jewish charity and unified cooperation amongst communities for survival and ultimately migration Westward.

With this background, my great-grandfather permanently emigrated to New York City. His children took jobs as clerks, shop girls, “fancy goods” peddlers and paper cutters. One young relative was employed as a “lemon squeezer” in presumptively a bar. The family took in boarders to put food on the table. My great-grandmother, known to me when I was 8 and in the throes of advanced dementia, had many years earlier extricated herself from poverty and became a nurse-midwife. Sacrifice for the family was evident when sifting through the detailed census information at the turn of the 20th century. Military records recorded service in the first and second World Wars with distinguished service and injuries incurred in battle.

Our hominid ancestors gave us upright walking, tools and reasoning. As my genealogy tree branched and diverted to other spurs, it became apparent that the accomplishments of my generation and my descendants had only been possible by the sacrifices and tribulations endured by my family. Gratitude, respect and knowing the inter-connectedness of the human condition is the take home lesson to pass on to my new grandson who begins his story before our very eyes.

September 10, 2021September 10, 2021

City Circadian Rhythms Meet the Countryside

My pineal gland fired itself up on a foggy April morning in 1953. This is when my circadian rhythms met the cycle of life in the Bronx and Queens. A city dweller for most of my existence, I woke to the sounds of city and suburban life: the honk of the impatient taxi driver in Manhattan, the click of Melmac¹ coffee cups deposited in the sink as my father scurried to make his subway commute, the nerve jarring wound up alarm clock ring and the WINS radio broadcaster reciting school closures after a winter storm propelled me from my nighttime torpor. Off to college in 1970, I had a state-of-the-art “tech” alarm clock with a numerical display that flipped the numbers down from a spool and onto the window display (as seen in the movie, “Ground Hog’s Day”). As an upgraded item imbedded in this slumber interrupting device was the ultimate in modern technology of its time: A snooze button. It woke me for years through college finals, the Medical College Admission Test, and hangover recoveries. I held it in such high esteem that when the number 5 fell off the spool, I still kept it for years after. I reluctantly abandoned the alarm clock world with the advent of the iPhone in 2007. To have an array of sleep shattering choices that included a range from classical music to San Quentin’s very own “Prisoner Escaped Alarm” blasting me up from a dream filled night was just too tempting. I had to give the iPhone a try. It did not disappoint.

My mechanical sleep alarms were left home when my family and I traveled to Southeast Asia. Off to Chiang Mai, where we met a guide and hiked through jungle terrain to the self-subsistence rice farming Karen Tribe² in Northern Thailand near the Myanmar border. After 4 hours of a grueling uphill journey, replete with mosquitoes, leeches and excessive sweat, we arrived at the encampment. My sense of accomplishment was dampened quickly when the Guide informed me, my wife and our teenage boys that the school children in the tribe make the same trip twice daily. With the livestock huddled under the stilt supported wooden abodes, our ‘farm to table’ chicken meal had a short transportation impact. Exhausted, we slept on the dirt floor in a tree house with paper thin mats. We were fast asleep in seconds with our melatonin levels peaking from heat, food and altitude.

The horizon was barely illuminated when a 110 decibel sound emitted from multiple moving sources around our elevated bedroom. I bolted upright, needing this noxious sound to cease to restore tranquility. Peering out the open window, I saw the parade of roosters crowing at unimaginable volume. This was no Loony Tubes Foghorn Leghorn^3.“Could the rooster’s head comb serve as a snooze button?” I was fully awake within moments with multiple thoughts racing through my head. “Could this natural alarm clock be more effective than an Apple product?”

Many circadian driven mornings have since come and gone from that fateful trip to Thailand. The kids have moved on and now reside in a different time zone. My now retired self no longer has to get up in the morning and go to work. My wife and I find ourselves traveling from place to place. During one recent trip to Utah, I was reminded of the roosters from our Thailand expedition. Finding refuge in the Wasatch mountains, one morning I awoke to the cacophonous chirping of Magpies foraging in the front yard. This scene was repeated each morning. To my surprise, the Magpies packed their bellies and beaks by 1 PM each day like clockwork and were replaced by an equally vocal group of Robins. Pecking and browsing for grubs and earthworms, this group departed in the gloaming and were followed by an aquatic band of mallards, Canadian geese and the occasional surprise appearance of Wild Turkeys (not the drink but the bird). Nature’s circadian rhythm was outside my window and all I needed to do was listen and observe.

The light is dimming as I write these words from our home in San Diego. I cannot fight the escalating melatonin levels impacting my hypothalamus and finding my eyelids growing heavy with the urge to sleep. I search frantically for the iPhone sound effects for the Magpies and come up empty handed. I quietly crawl into bed with a glimmer of hope and a sense of confidence that I will be awakened by the sound’s of nature emerging for the new day. I set the iPhone to “Do not disturb.”

¹ Plastic dish-ware popular in the 1950’s and ‘60s, manufactured by a now defunct company, American Cyanamid Corporation.

² The Karen reside predominantly in Myanmar and Northern Thailand and are linked by a Sino-Tibetan language heritage. They have practiced crop rotation agriculture for centuries.

³ A Warner Brothers Cartoon Rooster, appearing in Looney Tunes and patterned after a fictitious bombastic Southern Senator, Beauregard Claghorn. Foghorn often strolled though the chicken coop, humming Camptown Races.

March 29, 2021March 29, 2021

Traveling In Pandemic Times

My parents provided me with the usual survival tactics in childhood: “don’t put your finger in the electric socket; “don’t play stickball in a busy street;” “look both ways when crossing the street;” “put a jacket on to prevent pneumonia.” But no pandemic advice. My father, born in 1921, had missed out on the Great Influenza pandemic by 3 years. He survived the depression, World War II, the Korean War, The Cold War and Stagflation, but he had no pandemic real world experience.

Mastering COVID avoidance was easy. I didn’t go out the front door. I wiped down every delivery with Clorox wipes. I interrogated delivery workers at the front door from 6 feet away. I masked up and social distanced with friends who took science and survival seriously. My only brush with the outside world was beamed in with cable news and internet pictures.

With viral mRNA inoculated twice into my arm, the lure of travel beckoned and with it the reality and trepidation of return to the unknown. What would airports, big cities, seeing friends and family be like after a monastic-like life for almost a year?

Armed with an N95, surgical mask and face shield barrier, I pushed the UBER request on my app for a ride to the airport. “Please roll down the front and back windows for cross ventilation,” I directed the driver, thinking viral kinetics and air exchange. He didn’t blink an eye. At the airport, Homeland Security officers donned face shields and stood behind window barriers. Driver license identity was self-swiped at a distance. The Starbuck’s line imprints on the floor were spaced 6 feet apart and baristas looked like they were part of a surgical OR team. Sipping coffee, a learned skill honed in the past, became a conundrum when faced with two masks blocking the oral route. Should I slip the masks down or up? Should I replace the mask after each sip? Should I take the masks off completely? Should I just gulp the coffee quickly and then replace the mask? Thoughts of Dr. Fauci and the CDC flashed through my head: 10 minutes of exposure, high viral load, ventilation and symptomatic patients. I headed to the far reaches of the airport terminal, separated myself from the unmasked masses, and bolted the coffee down, nearly incurring mouth burns.

Boarding the plane entered me into a strange world. The cheap seats in the back of the plane got first dibs on boarding to limit contact time. Finally, seated, I breathed a sigh of relief when the hotly debated middle seat vacancy was enforced. Anxiety returned, as the flight attendants distributed the snacks. Was it worth unmasking for a granola bar and a small package of chips? The lure of Pringles was too great and I succumbed to temptation, all the while contemplating my eulogy, “he gave his life for a a few plain potato chips.”

The plane hovered over LaGuardia Airport awaiting the final approach. Built on a garbage dump used for Brooklyn’s excess waste, I pondered the early Queen’s denizens grappling over their microbe challenge: Salmonella and Shigella. The plane landed, the gate opened and I marched single file, 6 feet apart, masked and into the terminal where multiple, camouflaged clad military awaited me. Did I take the wrong flight and land in Mogadishu, Somalia? No, New York City, where Andrew Cuomo’s quarantine rules were being enforced against the blasé non-Northeastern states where I was now residing. It seemed surreal to be approached by a military serviceman and servicewoman who were both armed with weapons and asked if I had a Covid 19 PCR test performed in the last 72 hours, and if so, what was the result? Things had changed.

After claiming my luggage, I entered a NYC taxi cab to the final push to Manhattan. As I gazed upon the the facial scowl of our driver, I thought it best not to bring up the cross ventilation directions again. As I entered FDR Drive, I fixated on the credit card swipe. Can COVID exist on the card? Can I Clorox the gap? “What would Dr. Fauci do?”

Walking in Manhattan, I could immediately sense the gravity and public health compliance of the borough. This pandemic was not some abstract chyron endlessly streaming on a CNN telecast. Families and friends had been stricken with serious illness and death at the beginning of the pandemic and this crystallized the importance of public health measures. Multiple restaurants had outdoor seating ensconced within a plastic dome. At night, the yellow and purple lighting from restaurant isolation tables provided an extra-terrestrial feel.

The ordeal was worth it after ending a year absence from family. Hugging my fully vaccinated son and and elbow bumping my unvaccinated son and daughter-in-law in the social distancing expanse of Prospect Park (thank you ,Frederick Law Olmstead) was priceless.

Many years from now, when my grandchildren gather around me and ask about the Pandemic, I’ll reply, you have to carefully peel off your N-95 mask just like this, and then get the Starbucks lid under the face shield that protects your mask and..…”

Fortitude, NY Public Library Lion, Masked

January 30, 2021

COVID and Nasal Memories

The Door Dash delivery was on the top of the steps, delivered from a pizza service in San Diego that claimed “New York Style Pizza.” After the ritual disinfection of the pizza carton, the lid was lifted and I was delivered into another time and place. Scotty, the owner of a Queens pizza restaurant 60 years ago, was ensconced in my olfactory memory. He was flipping the dough as his octogenarian mother was lovingly molding a veal parmigiana hero that could make a grown man cry. Melted mozzarella, oregano, sausage and mushroom fumes reawakened a gustatory experience that I experienced for the first time, many years ago. With hops entering my nostrils from my Dad’s 1965 Miller High life, I left the COVID virus prison and entered a happier time when New York City was a palace of gustatory delights and my childhood garden was in full bloom.

Through my nose, to the ethmoid sinuses, onto the olfactory epithelium and 60,000 smell neurons directed my pizza delivery directly to the frontal lobes and limbic system where Scotty’s still lived in vivid memory. This ecstatic experience is being stolen from millions by a renegade virus which has shut down the world for the last year. Expunging the smell and taste in some of the 25 million who have had COVID, which may have long lasting and permanent damage of the olfactory system. Malnutrition, depression and the loss of warning symptoms to natural gas leaks or tainted foods may be the legacy of sufferers of nasal COVID injury.

The least regarded of the five senses, smell and taste have taken a back seat in medical training and in popular culture. Medical school has few lectures on the proper function and diseases of smell and taste. Medical history taking neglects inquiry of one’s nasal and lingual capabilities. Olfaction has been a butt of jokes for generations of comics from the Simpson’s “smell you later”, Hawkeye Pierce’s ridicule on food sniffing in M*A*S*H and Mel Brooks flatulence scene in “Blazing Saddles.”

The dismissal of this forsaken sense is belied by its prominent location. The olfactory nerve, the shortest of the cranial nerves, sits in the front of the brain and sends projections to multiple areas including the emotional hub, the limbic system. Our evolutionary ancestors and current mammalian brethren rely on scent to distinguish friend from foe and food from poison. Our beloved canine, Millie, the Jack Russell Terrier from times past would apply the sniff test and rarely made a bad decision on food or domicile choices.

Obscure medical jargon has entered the mainstream with anosmia (lack of smell), parosmia (smell that fails to correctly match the odor) and phantosmia (phantom smells) appearing on long hauler COVID social sites. “Everything smells like burnt coffee” I heard a patient exclaim. “No longer can I taste the citrus in my tea,” another laments. “I ate a hamburger and I miss the onion smell and taste.” Essential oil kits are hawked on Amazon in the hope that olfactory re-education may hasten recovery. While the long term outcomes are not apparent in so recent a disease, it appears that up to 5% of smell sufferers may not regain perception at 6 months.

“Don’t it always seems to go that you don’t know what you’ve got ’til its gone,” Joni Mitchell’s ballad went in the ’60’s. And so it goes with Scotty’s appetizing, fragrant pies from the same decade. Enjoy your senses and don’t forget to stop and smell the pizza.

November 2, 2020November 3, 2020

Understanding Oxygen and the Apple Watch 6: A Primer on Oxygen Saturation 101

The tech world has had a hold on the imagination and pocketbook of Americans for decades, improving our day to day communication, entertainment and educational options, all contained in the device we hold in our hands. More recently, tech companies have entered the multi-billion dollar health and wellness market, claiming a roseate outlook on life quality by revealing a wealth of “health” data populated on our iPhone or Android phones for us to peruse. For those that majored in business, art, political science or philosophy in college, watched “Keeping Up with the Kardashians” instead of “Mr. Wizard” reruns and did not take a physiology or human biology course, these numbers may be bewildering. It is time to let some “air into this room” and provide a background for understanding tech and health devices. After 4 decades around EKG’s and pulse oximeters attached to humans and a user of Apple products for almost as long, I will provide the introductory course on the latest Apple foray into health: oxygen saturation and the pulse oximeter.

Oxygen is a key to human health. Before it’s atmospheric debut, we had bacteria for a billion years with few tech inventions during this period, save for the flagella, a whip like structure that could take you a few inches across a scum filled pond. Queue the plants (algae and other photo-synthesizers) and oxygen enters the atmosphere allowing for multicellular organisms and ultimately us (now is the time to hug your house plant out of gratitude). What did oxygen do for us? It unlocked the ability to generate much more energy from food sources that allowed us to dig a ditch, launch a satellite or use your TV remote. As any biochemistry or medical student knows, ATP, the powerhouse chemical we use to store and release energy, is manufactured 16 fold in the presence of oxygen (for the curious, see oxidative phosphorylation and electron transport chain for more details).

The engineering dilemma that evolution was faced with for us multicellular beings was a supply and distribution problem. How to get oxygen from the air to each of our cells? To move a substance, you need a pressure gradient to drive the work and the atmosphere pressurizes oxygen to move from high to low pressure zones. But this does not get the prized element to deeper tissues. For that obstacle, we evolved the lungs, blood vessels, blood and heart to circulate oxygenated blood to tissues to bypass this problem.

Yes, blood, that substance thicker than water. Oxygen can dissolve in blood but at very low concentrations. To improve on the quantity of oxygen, we inherited the red blood cell and its key constituent, hemoglobin. Hemoglobin is the main oxygen carrier in the blood and allows pick up and delivery of 02 to the tissues. Oxygenated blood is bright red (usually arterial) and less oxygenated blood (usually venous) is blue. We can exploit this light absorbing property to determine how much oxygen is bound to hemoglobin at a particular moment by shining a frequency of light at a blood vessel and checking how much is absorbed and reflected at one time in the heart beat cycle. The ratio of oxygenated to de-oxygenated hemoglobin is measured, and reported as oxygen saturation.

Do you need a device that warns you of oxygen shortage? Shouldn’t you feel short of breath, breathe faster and get yourself into an emergency room in time? Not always, as your brain, highly dependent on oxygen, can go haywire with confusion, lethargy and poor judgement as a consequence. This is why the flight attendant always directs you to put your oxygen mask on first before your children. What about turning blue (cyanosis) from low oxygen? Unfortunately, this is a late occurring sign which occurs when fully ⅓ of the hemoglobin is devoid of oxygen.

Is there an early warning device to warn us of oxygen deprivation?Cue the pulse oximeter: oxygen saturation can be measured by a pulse oximeter, or more recently with tech watches that have similar technology. Healthy lungs at sea level usually allow for oxygen saturation over 95%. As with all technologies, certain pitfalls apply. If your hemoglobin is abnormal it may not be measured properly. Carbon monoxide poisoning, for instance, renders hemoglobin incapable of binding to oxygen but is not registered by the pulse oximeter. Yes, you can asphyxiate with a normal pulse oximeter reading. The sensors must be close to the skin and not moving or else a faulty reading could result. Even expensive devices can be subject to error. Many a time in the surgery center, a reading of 60% could appear in an awake, non sedated patient. Repositioning the sensor, recalibrating the device or wheeling a new machine into the OR solved the false reading.

So what can you glean from the result? High altitude can lower oxygen saturation due to lower oxygen pressures. Altitude sickness can result with headaches, shortness of breath and in extreme circumstances, flooding of the lungs with fluid. Severe pneumonia can lower oxygen saturation and in the case of COVID 19, may not result in air hunger which would normally warn you of severe lung infection. Severe asthma could also cause a drop in oxygen saturation. Apple has started a research trial examining the usefulness of the Apple Watch 6 in this circumstance.

The most important use of this technology may be in screening for obstructive sleep apnea. This condition is quite common in the U.S with a prevalence up to 30% of males and 15% of females). Celebrities such as Rosie O’Donnell, Shaquille O’Neal, William Shatner, (aka Captain Kirk of Star Trek fame), Quincy Jones, Randy Jackson (of American Idol fame) are afflicted. Luminaries whose death may have been influenced by sleep apnea include William Howard Taft (former 27th President), Jerry Garcia (of the Greatful Dead), Justice Antonin Scalia, Carrie Fisher (of Star Wars fame) and James Gandolfini (of Sopranos fame). Sleep apnea has severe health consequences and has acceptable, effective therapy. With the increase in risk factors such as adult obesity and sedentary nature of the population, obstructive sleep apnea is becoming epidemic, resulting in upper airway obstruction at night with snoring, interruption of breathing and dangerous reduction in oxygen saturation. This condition often results in headaches, daytime fatigue, hypertension, acceleration of cardiac disease and premature death. A continuous positive pressure mask can ameliorate this condition. A convenient, readily available screening tool such as a reliable pulse oximeter for nighttime use could potentially save multiple lives by directing those into the office of sleep specialists for definitive diagnosis and treatment.

So should you climb on board the day and night pulse oximetry tech train? With certain caveats (a device that has reproducible results and matched to gold standard testing, FDA approval and that works for night-time monitoring) this metric may benefit you when hitting the ski slopes and when your significant other has had it with your snoring and asks you to “do something about it.” Take a deep breath and ponder that.

May 23, 2020May 23, 2020

Gut Punch Against COVID-19

“You are what you eat.”Jean Anthelme Brillant-Savarin, a French lawyer, epicurean and father of the low carbohydrate diet, penned these words in the 18th century. As we struggle through the COVID-19 pandemic, we search for personal ways to influence our health and our immune system to combat this pestilence. Food choices are an overlooked variable that may alter our fate.

Our human engagement with infections is played out daily through our immune system. Ironically, we are dependent upon our commensal microbes that happily reside in our bodies to assist in the fight against environmental, viral and bacterial invaders. Over one hundred trillion bacteria and untold fungi, archaea and microscopic multicellular microbes take up residence in the gut after birth. These microbes are a virtual army responsible for innate immunity and the initial fighting response to pathogenic agents. Furthermore, these bacteria contribute forty times more genes in the gut than human genes in the entire body. The exact role of these genes is uncertain, but they may produce proteins that may influence the bodies fighting power. It is believed this gut bacterial diversity and their metabolites protect us by establishing an intact mechanical barrier, facilitating the release of bacterial and human antimicrobial chemicals and competing with pathogens for nutrients. They trigger the inflammasome, a coordinated release of immune stimulating chemicals (cytokines) that arm the lymphocytes, macrophages, neutrophils, dendritic and plasma cells that produce the coordinated inflammatory response. A delayed innate response can result in a virus that gains a foothold that cannot be stopped. Similar to friendly fire, an over exuberant immune response can injure tissue from toxic inflammatory chemicals long after the pathogen has been vanquished.

Older age, diabetes and obesity are clearly risk factors for severe adverse outcomes with COVID-19. The common metric of these risks are a dysfunctional immune response. A slow initial response or an unregulated and injurious inflammatory reaction can result in devastating consequences for the infected host. The gut microbes and their genes, the so called microbiome, are fundamental for a proper defense to infectious agents. A healthy microbiota is still being defined, but with new molecular biological techniques, a diverse population of organisms is critical to drive down the middle lane of life–away from infectious disease and autoimmune/allergic disorders. Altered microbiota or dysbiosis, is the hallmark of obesity and diabetes. And our country is flush with these risks. Over 40% of the U.S. is obese, representating a four-fold increase in prevalence since the 1960’s.

The microbiota can be malleable and is dictated by food for good or bad. And, food choices in our country may have steered us into more fatal outcomes with COVID-19. Processed food, hydrogenated and trans fats, high fructose corn syrup, larger portion size with higher calories and antibiotic tainted meats have assaulted the beneficial microbes in us. Could this be one of the reasons we are the leading country in COVID-19 cases and deaths?

Social distancing and masks are first line defenses against the Coronavirus fight. Food choices MAY be another volitional pathway to maintain health. Fermented foods can select for beneficial commensal bacteria that make-up one’s microbiota. Greek yogurt, sauerkraut, tempeh, kimchi, and miso can favor the growth of Lactobacilli and Bifidobacter genera, both known to be healthy members of the microbiome. Germany, Korea and Japan have low per capita rates of disease, attributed to timely public health measures and widespread COVID-19 testing. Might these differences be partly explained by eating sauerkraut in Germany, kimchi in Korea and miso in Japan? Do some long standing cultural food preferences select for a healthier microbiome that is protective for Coronavirus infection or helps to modulate an appropriate immune response? It seems to this clinician that it’s worth a clinical study as we, the people of every culture and nation, come together to collectively look to each other for any possible clue to mitigate the ravages of this virus.

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