Friday, March 23, 2018

When John McCain ran against Barak Obama, I was stunned at the poor choice conservatives had been given. McCain was a RINO and did not have the popularity in the Republican Party to generate enough excitement among the base to win. It was dismal election and I was not the least bit surprised to see the man who promised to fundamentally change our country become elected. Then, for the next 8 years, he proceeded to do as he had promised, without the help of the Congress. I felt an aching hollowness in my gut for those 8 long years. I did not protest his election, pledge resistance or practice civil disobedience; I just waited for the next opportunity.
With 13 Republican candidates to choose from in 2016, I hardly expected Donald Trump to be the winning candidate, but it finally became obvious that he was really the only candidate that could actually win against the Democrat machine. Despite Hillary Clinton’s obvious flaws, it now appears that she not only had the press in her pocket, the machine on her side even before the primary was over, and apparently the CIA, the FBI, the justice department, the unions, and the rest of the Deep State apparatus on her side.
Despite his personal failings, Donald Trump generated excitement from the forgotten masses to go to the polls and was fairly elected by the system laid out in the Constitution. His promises rang true because they were what the conservative underclass wanted to hear: Stop Illegal immigration, build the wall, lower taxes, restore balance to the Supreme Court, end the rampant racism stoked by Obama, improve employment prospects for working Americans, etc.
While there has been the unfailingly negative coverage of everything he has done by the press, the unceasing sabotage from the Democrat party, and the endless partisan investigations, he has achieved several of his noteworthy objectives. Until today.
I was stunned to see the Republicans support a budget that was clearly against their stated interests so that each member of Congress could take home his own bit of pork. But what really disheartened me was that the President knuckled under and signed the spending bill that specifically disallowed the promises that his supporters expected to be fulfilled, i.e….the wall, and the funding of Planned Parenthood, to name but a few.
The empty hollowness has returned, and the excitement that the Republicans need to win the midterms has been dissipated. Chuck Schumer and Nancy Pelosi have both declared a victory, despite the Republicans being in control of both the Presidency and the Congress. It is an embarrassment and a travesty…..hardly The Art Of The Deal.

Thursday, March 22, 2018

Some Of The Important Things We Learned In School........

Close to 60 years ago, I began my official education at Washington Elementary School in Phoenix. One of the most important things I learned was how to make mud cups. On the far side of the playground, we boys would scrape together enough soft dirt to make a small pile. Then, we would run to the drinking fountain clear across the field and fill our mouths with water. After racing back to the mound of dirt, we would stick our elbow in to make an indentation and then spit the water into the concavity and watch the water soak into the dry dirt, maybe half an inch. Another trip across the playground for another load of water gave us the capacity to fill the cup again and, after it had soaked in, we would dig away the loose dirt surrounding the mud cup. It was an art form of the finest precision; digging away the dirt too soon or without the proper finesse caused the cup to break into pieces. But, with the proper patience and careful touch, we would hold in our hands a useless piece of cup-shaped mud that we could put in a safe spot in the sun to dry to perfection.

Think of the first grade lessons we learned from that exercise; perseverance, a light touch, how to run without breathing through your mouth, patience, hope. We could imagine ourselves like the Indians who made pottery hundreds of years before, in possibly the same spot. Strangely, I don’t remember Mrs. Williams ever congratulating us on our achievement. In fact, it’s likely she never knew.

Washington Elementary was an old school, even way back then. We had just moved in to our new home about a mile away, but a brand new school was under construction and the kids in our neighborhood would be changing schools the next September to be the first students at Palo Verde Elementary. Somehow, the art of mud-cup making didn’t transcend the boundary between the schools. 

The new playground for the first through 3rd grades sported Monkey Bars, and a slide of infinite height and length attached to the end of monstrous swing set. All of the playground equipment was galvanized steel and, in Phoenix’s late summer, reached temperatures hot enough to melt the flesh right off the bones of the average 2nd Grader. Fortunately, we were not average children; we had grown up in Phoenix and had learned all of the tricks to keep bare skin unburnt. We boys wore pants, but the girls were at a particular disadvantage. This was in the dark ages when girls were required to wear dresses, and they became quite adept at sliding down the slide with their legs in the air to avoid skin contact.

The lines to climb the ladder to the top of the slide were endless, and in time, the metal gave up enough of its heat to the bottoms passing by that it was tolerable to sit on. The Monkey Bars had the same problem. You could climb only until your hands could no longer grip the pipe, and then while balancing without holding on, allow your hands to cool enough to proceed to the top.
The playground equipment was nearly indestructible, but after a few decades, the Powers That Be determined that it was a safety hazard and it was all replaced with smaller, plastic-coated versions.

Wednesday, November 18, 2015

The Hemorrhoids-Day of Surgery

Tempis Fugit they say. And for those not inclined toward the Latin side of things, Time Flies. In keeping with that theme, I believe Herman and I became acquainted about 18 years ago, and while time is always flying, the relationship Herman and I have maintained through the years has been less than agreeable. I have, in fact, wanted to end that relationship many times, but Herman has continued to be an unwelcome companion. I visited a professional 9 years ago to see what I could do about severing our connection, and the professional suggested a less-than-satisfactory solution. She was fully capable of administering a final solution, so to speak, but because she was concerned that the aftermath of the cure might endanger those who have entrusted their care to me, she was unwilling at that time. She therefore performed only a partial exorcism, and the relationship diminished in intensity…..for a while. In far too soon a period, Herman was back in his ever-presently annoying manifestation. Herman, you see, is a hemorrhoid. We have become so close that I have felt justified in using his Christian name even though nothing would have made me happier than to do away with his existence.
For those of you who may not understand the problem that a hemorrhoid can be, I will attempt to briefly acquaint you with pain in the backside that they are. My first understanding of hemorrhoids was when my mother became afflicted. I was but a young boy, certainly less than 10 years old, and was concerned when she went away to the hospital. She had only done that previously when she was pregnant, and she always came home with a sister, but in this instance, she came home without a bundle of joy in her arms. In fact, I remember her coming home with only a little white vinyl life preserver. I remember that she was decidedly uncomfortable, but other than that I only remember that Metamucil became a standard item in the contents of the kitchen cupboard, and that she was completely committed to its consumption.
I, of course, learned about hemorrhoids in my professional training, but had no real-life experience with them until I was in my General Practice Residency. I was assigned to a Family Practice physician and was privileged to spend two weeks with him. I distinctly remember a patient who was maybe 30 years old, who was on the examination table with the goods exposed. I had never imagined that anyone could look so miserable. His hemorrhoids were ringing his orifice and swollen hugely, red and bloody and I could only wonder how he managed to take care of business. In fact, he was having difficulty taking care of business, but because it was a follow up visit, I could only assume that there had been improvement. I could barely imagine what they must have looked like in the first place.
The doctor assured me that this was not an unusual problem and that, while there had been improvement, the patient would need more definitive treatment. He would be joining my mother in the ranks of those who, having suffered for their physical impairment and surgical resolution, would heal… time.
While my hemorrhoids had never been in a crisis state like the young man’s had, they were uncomfortable. Some sufferers complain of pain, itching and bleeding. I had only ever experienced occasional bleeding with use of standard toilet paper. My anal comfort had long been a priority, so I did my very best to keep our relationship as agreeable as possible. When on a hunting trip, one of my companions returned from his own visit to the facilities and remarked to me, “Baby wipes are wonderful.” A little slow on the uptake, I didn’t understand his reference, but as time went on I began to appreciate his opinion completely, and it became my own.
My wife and I traveled to Israel and Egypt several years ago and were amused to see that every toilet had a water jet built into the toilet that would wash the wall opposite if the seat wasn’t occupied. We quickly discovered that its purpose was truly genius from a hygiene perspective. We were almost immediately enamored of its usefulness, and when we returned home it became my mission to add such a contrivance to our own toilet. As it turned out, an addition was readily and inexpensively available. It was called a bidet, which it is not, but we have since lovingly referred to it as our “booty washer”. We tried to interest our children in the concept and, in fact, gifted one to each of them the following Christmas. We have been puzzled to find that only 1 of the six has seen use. My suspicion is that as they notice the inevitable march of time affecting their very own bodies, the others may be employed as well.
9 years ago I visited a colorectal surgeon for a colonoscopy and pointed out that I was unhappy with the state of my sphincter. It seems that an internal hemorrhoid (there are internal and external versions of the specie) that grows large enough in size will prolapse (hang out), and while it can be pushed back inside, has a definite desire to see more of the world. She said that definitive care would be excision, but that I could not work while taking narcotic pain medications, so I would have to wait until I could take 2+ weeks off. In the meantime, she suggested an infrared treatment that would burn the hemorrhoid and that as it scarred on healing, would shrink and become more manageable. She did perform this treatment and there was improvement for a while, but recurrence was inevitable and so it has recurred.
Baby wipes and the “Booty Washer” had become my mainstay and only when forced to use toilet paper extensively would I see enough bleeding to concern me, but my view was that I would rather deal with the problem at 61 years old while it was less severe than at 71 when it was a real problem.  Following a recent colonoscopy, I once again suggested that the ultimate solution might be indicated, and the doctor agreed and referred me once again to a colorectal surgeon.
The surgeon examined my anal appendages and informed me that they were more severe than I gave them credit for. On a grading system of 1 to 4, I scored a 4. While I have always been competitive, I did not view this as an achievement. He explained treatment options, but the only permanent solution was excision, and that was what I had expected anyway. I told him that my partner could cover the practice for whatever period was necessary, and he was pleased to schedule the surgery.
On my way to the surgery center today, I mentioned to my wife that maybe this was a bit extreme. I had been living with the problem for a long time, and I was voluntarily submitting myself to a procedure that would leave me miserable for somewhere between 2 and 6 weeks. For entertainment purposes only, I looked up blogs that described the aftermath of hemorrhoidectomy, and they were not encouraging. My favorite suggested that the first bowel movement following surgery felt like it was razor blades dipped in tabasco sauce with glass shards mixed in. I couldn’t wait.
I arrived at the surgery center 10 minutes early and was taken to pre op almost as soon as I had signed consent for everything from anesthesia, surgery, payment, and assignment of benefits from the insurance company. The nurse was very sweet and competent, and was moonlighting. Her full-time job was in labor and delivery. Almost the right terrain anyway. She had me undress completely and put on the shortest OR gown I had ever seen. Not that I wear a Teddy, but you can imagine…..Anyway, she gave me lovely purple socks to keep my feet warm and the standard green OR hat, started the IV and put the EKG leads on, and then I was left to wait a few minutes.
My wife was brought back and she began working on some salt clay ornaments she plans to give to our children for the grandkids to hang on the Christmas tree. I told her that I was sure she was the only one who had ever thought to work clay in the pre op treatment room, but everyone who came in was interested, proving that variety keeps people engaged.
The surgeon came in dressed in scrubs and a matching hat and we had a pleasant conversation. He reminded me that we would not be friends after the anesthetic began wearing off, but was very reassuring about the procedure.  The anesthesiologist came in for more consent, and we agreed on deep sedation with Fentynl, Versed, and Propofol rather than endotracheal intubation. He injected the first drug into the IV to give me a taste of what was to come. He told me I would have to scoot over to the OR table when we got to the OR. I suppose I did, but I wouldn’t know if they had brought in a crane to move me. I was out.
After the surgery and in recovery, I felt great. The surgeon had told me that he would he would use a long-acting local anesthetic (Marcaine) at the end of the procedure so I could expect it to be numb for4-6 hours. In fact, I didn’t feel particularly numb, as in a fat lip after a dental nerve block, but was extremely comfortable. I chatted with the nurse for a few minutes and she said her fiancĂ© had undergone the same surgery two weeks before and he was acutely uncomfortable in recovery. I was gratified to think I wasn’t. In fact this gave me hope that my recovery would be much easier that that poor fellows.
I got dressed and went to visit a friend in the same building and stopped for chicken feed on the way home. The nurse had given me 2 Percocet tablets before I left and I felt fine. The prescription for the Percocet (narcotic pain killer) said 1 or 2 every 4-6 hours, and I planned to stay on that schedule. My experience with taking out wisdom teeth had taught me not to let the pain get ahead of the pain meds or it would be much harder to control.
I ate lunch (my patented fried salad) figuring the bulk was exactly what the doctor ordered….so to speak. He had mentioned that laxatives that liquefy the stool were a mistake because the injured muscular ring has got to stretch regularly. Otherwise, scarring occurs and the ability of the sphincter to stretch becomes greatly diminished leading to all sorts of complications… chronic constipation and fecal incontinence. I wasn’t going there, so I planned to eat my normal salad diet.
There is a trade-off….or maybe two…. With the pain meds. Narcotics kill pain pretty well, but they are also constipating which, in my situation, would be excruciating. Narcotics also can cause profound nausea if taken on an empty stomach, or to excess. I was fighting the constipation enemy, and quite frankly, disregarded nausea complication.
By late afternoon, the numbness was 80% gone, and the pain monster was starting to rear its ugly head. Sitting, standing, walking and pretty much any other normal activity were difficult. Like….worse than difficult. The doctor had said that relief might be found in a warm bath and I was ready to believe him. I ran water into the tub and lowered my tenderest parts into it, and miraculously, it felt much better….for 20 minutes or so. Then the throbbing and aching resumed. I watched half a movie trying to take my mind off my problem, and not for the first time reminded myself that this was ELECTIVE surgery. I got out and dried off, dressed for bed and whined to my loving wife. She had no magic bullet for me either, though, and went to bed about 11PM. I lay down on my front on the living room floor and began memorializing this experience.
November is National Novel Writing Month, and for the third year in a row, I am writing my own Great American Novel. On November 15, I was roughly half way done and expected that my recovery period would give me plenty of time to finish. This story, on the other hand, is one that must be told for posteriority (the number of lame jokes about this situation is almost amazing). So instead of writing my novel and keeping up with my word counts, I have now taken on another task.

Day 2
                By 1 AM I had taken another dose of the Percocet and was overcome with waves of nausea. I could not walk, crawl, or even stand up for fear of becoming a spewing fountain of vomit. The best I could do was put my head on the ground lying very still, and nap. In an hour, I believed I felt somewhat better and endeavored to crawl to the bedroom. I got as far as the closet where I once again lay as still as I could and tried to nap. Closer to 3, I crawled into bedroom, miserable with pain, dizziness, and the fear of leaving an indelible mark on our newly cleaned carpet. Beverly got up to take care of her own business, and she sweetly got me a hot pack, plugged in the charger for the computer, and unable to help any more, went back to bed.
                An hour later I raised myself sufficiently as to crawl into the bed, climbed under the covers and unhappily slept until 5 when my rear set off a wake-up call. Still dizzy, I pulled my clothes off and ran more water into the tub where I enjoyed another spate of temporary relief. I stayed in the bath for perhaps an hour, dried and dressed again, and crawled back into bed for another 2 hour nap.
                Because of the nausea, I took my last dose of the pain meds at 11PM last night, so at the moment I am appreciating what the sequelae of having deeply tender surgery in one of the most private of places without the benefit of pain medication. Some might call that going “Cold Turkey”, and I wouldn’t disagree with them.
                I fixed more salad at about 8 AM, and have found that if I sit on a living room couch with my hips far back and the laptop computer on my lap, I can write for a while. The writing making the position marginally endurable. The sweet nurse from the surgery center called to ask how I was doing, and having had no pain relief since 11PM the previous night, I told her I wasn’t doing well. The feeling of a lava pot bubbling in my drawers was constant. She suggested anti-nausea medication and a change to Hydrocodone from Oxycodone. My lovely wife rushed off to fill the prescription for the hydrocodone and I have now taken both meds, along with carrot soup for lunch, and was able to steal a nap on the couch. The nausea is, at present, minimal. As I woke up, I was pleased that the pain seemed to have abated…..until I moved…..and it came back with a vengeance. Medical professionals like to be able to quantify pain, and on a scale of 1 to 10, I estimate the discomfort at 6.5 to 7.
                I still have far more experience with widom tooth extraction pain than I do the present complaint, but the advice I have always given is to use cold packs the first day to limit swelling, no packs the second day while the wound is maturing, and hot packs the third day to increase circulation and take away the swelling. The surgeon’s advice for me was to let the bathtub become my best friend for a few weeks, taking 3 or 4 soaks per day. I’m not sure what my own patients did after receiving my advice to them, but my recent experience is that I would try anything for improvement. This meant alternating between ice packs and hot packs, hot baths, and showers. I haven’t tried to sit with my rear exposed in the snow, but the thought has occurred to me. Surprisingly, except for the fact that I had to stand, the shower gave the most continuous pain relief. The bath for a while and the same for the cold and hot packs.
                I tried to watch a couple of shows with Beverly and while I would like to say that the pain meds made me keep falling asleep, she would counter that sleeping while watching TV is just normal behavior. I finally made the trek to the bed and comfortably lay down. I slept until 1, waking with real pain. I got up and walked around, took more drugs, and then went back to bed until 3 when the need to urinate called to me.
                Urination is another subject that is impacted by the trauma. I suspect that the female urethra, all of an inch long, does not have the same complications that the male does. The edema and change in sensation make draining the bladder a decidedly difficult matter. In order to operate the urethral sphincter, the anal sphincter is also activated which results in a decidedly negative experience. Sort of like swallowing with an exquisitely sore throat. During the first day, it was painful to start the stream, but not to maintain it. By this evening it was no longer painful and that bit of blessed relief had continued since.

The Third Day
                This morning, I was finally ready to commit to my first bowel movement since the surgery. I quoted from a post-hemorrhoidectomy blog earlier about razor blades, tabasco sauce and glass shards. You can imagine I was not looking forward to the experience. I had taken my pain med dose at about 6:30AM and the doctor had prescribed topical 5% lidocaine ointment for use “before and after bowel movements”. I dutifully applied the ointment and then sat back (or actually forward) to let nature take its course. I wanted to experience as atraumatically an evacuative event as possible, but I so wanted to be able to write, “What about the fishhooks…I know there were fishhooks in there!” Fortunately, I am mostly happy to report that the experience was only somewhat unpleasant. I have to credit my salad diet and the addition of psyllium to creating a shaped but soft stool. The real difference between the stool I created and my normal construction had only to do with girth. The length similar, but there were two of them only half the normal diameter. This is, of course, only an estimate. I asked my wife to get a caliper but she declined.
                I went from the toilet to the shower and then dressed in my recovery uniform of pajama bottoms and an REI polar fleece shirt. If the theory is that stretching the orifice is necessary to ensure normal dimensions after healing has occurred, I have to report that there must have been stretching, because the discomfort in the hours after was notably greater. I sit tipped back in a recliner with a hot pack strategically placed feeling only somewhat uncomfortable. Imagine what your thumb feels like a few hours after hitting it with a hammer in an attempt to drive a nail. Except it’s not my thumb.
                Breakfast this morning was fried salad again followed by a soda, ginger tea, and ice cream for lunch. Sometimes you have to live a little. I wrote at my novel, looked for and failed to find something to watch on the television, and before I knew it, I was ready for bed. I had watched, or mostly watched, the two episodes of Castle that I had missed in the preceding weeks, and my bed was calling for me. I stopped by the hygienic facility to urinate, and I found where the fishhooks were hiding! I could feel a certain heaviness in my lower bowel, and with a lifetime of experience, decided that I might be ready for another bowel movement. I applied the topical anesthetic, but my level of systemic analgesic was probably minimal at that point. “Everything was going so well,” I thought, “that I should be back to normal in only a day or two.”
                From this point in the future, I look back with a sad smile at my naivetĂ©. I sat for a few moments with nothing happening and decided that a little force might be in order. I began to strain.
                I digress to talk about the dentate line. If you have bothered to look at a diagram of the anal mechanism and not just rely on my poor description, you may have noticed something called the dentate line. It is where the tissue of the rectum meets the tissue of the anus. Internal hemorrhoids are products of tissue above the dentate line, and external hemorrhoids are formed below the dentate line. There are no teeth involved. This is important because there are no pain fibers in the nerves above the dentate line. There are buckets of pain fibers in the tissue below the dentate line. If a doctor offers to “band” your internal hemorrhoids, he is saying he will place a rubber band around the internal hemorrhoid at its base to strangulate it, and when it becomes gangrenous and falls off, it is gone. Or most of it is gone. Because that takes place above the dentate line, there is little or no pain. Hemorrhoidectomy involves excising all that tissue and the excision runs through or below the dentate line and therefore pain becomes a factor.
                Getting back to the situation at hand, because of the swelling, there is really very little normal feeling of whether the rectum is ready to bear foul fruit….or not. My poor interpretation led me to strain, which was uncomfortable, but not unmanageable. I received little compensation for my effort. The aftermath, however, is uncomfortable to recall. Surgeons speak about a bowel being “boggy”, and this I understand to mean “swollen, unmoving, turgid, and uncomfortable.” I believe that the word boggy might be applied to that swollen tissue that I was now dealing with. With the buckets of nerve endings carrying millions of volts of high energy pain. I got up from the toilet unhappy with my production and realized that I was about to die. The fishhooks had been lanced through my tenderest tissues and I could not get away from them. I imagine that is what women feel like when they finally realize that the baby is coming out and there is nothing they can do about it except go along for the ride.
                I could do nothing except go along for the ride. I applied more topical in a Hail Mary attempt to relieve the discomfort, to no avail. I took a double dose of the Hydrocodone, and as I was chewing it, started the shower. I wanted Morphine. NOW. I didn’t get it. The shower helped, but the boggy feeling remained. Finally, as the pain meds were beginning to kick in, I crawled in to bed and prayed for sleep. I woke 3 times to urinate, but decided that putting that boggy tissue in a dependent (hanging down) attitude was unwise and stood to relieve myself. The lesson I had learned was not to be an overachiever. Trust the bulky diet. Trust the body to tell you that it is time to use the toilet Right Now, or there will be a messy reward. I vowed to proceed on that premise for the duration.

Day 4
                While I was up during the night, I continued to take the pain meds, and by morning was feeling better. Normal is still a ways off, but better. The thing is, I feel fine. Mind and body are functioning normally, with one exception. And that exception becomes quite uncomfortably painful if the pain meds are not on board. A second rule to live by for the near future is to not let the pain meds run clear out. Just like I used to tell my own surgery patients, stay ahead of the pain. It’s really difficult and quite uncomfortable to try and overcome pain when it is already established.
                Let me tell you about hygiene. The bidet is great, and many have suggested the Squatty Potty as an adjunct. I believe it is useful, mostly for people with shorter legs. My legs are long and sitting normally, my knees are higher than my hips, so the Squatty Potty is uncomfortable for me to use. I have one that I received from my daughter last Christmas who knows how Bowel-Aware I am, and I am grateful for her thoughtfulness, but my wife finds it more useful than I do.
                Panty liners, however, have been something the girls have been keeping to themselves for far too long. I could see that with external hemorrhoids, one could avoid having stained underwear all the time, but post surgically, they are nothing but a blessing. I asked the doctor how much bleeding I could expect and he said that he basically left an open wound inside of my anus. I could expect bleeding after a bowel movement, and seepage at other times. He was correct, and the panty liner that I stole from my wife has kept me from having blood-soaked underwear most of the time. I should use the plural, as in liners, because I have changed them.
                My salad breakfast still has fed me well as has the psyllium mixture I have supplemented my diet with several times a day. Throughout the day, I felt my lower bowel giving the gassy signs of potential evacuation, and I, with justifiable fear and trembling, ignored them. I was going to steadfastly adhere to my new Rule #1. And finally, just before dinner time, I knew that I could only ignore the prompting at my peril, so I made my way to the porcelain altar. I had premedicated with narcotics, applied the topical anesthetic, delayed as long as practical, and finally sat to contemplate nature. Relaxation and a clear conscience were rewarded, and with little fanfare, I produced a now “normal”, half-size manifestation embodied in twin corpuses. I went immediately to the bathtub for a soak and the bogginess was present, but with far less discomfort than I had the misfortune to experience the previous evening.
                The rest of the evening was spent with my loving companion serving me dinner in front of the television while the recliner with a seat warmer was applying its own loving touches to my tenderest parts.
                And evening and morning and…..

The 5th day.
                I was told at the outset that the 5th day would likely be the worst, but I had completely forgotten the threat until I was looking back over the day. We had gotten 8-10 inches of snow overnight, and I successfully ignored it for most of the day. Fried Vegetable Salad for breakfast with increments of Psyllium and water contributed to my smooth character, and I felt none of the constipating effects I had been warned about from the narcotic meds. When I could tell that the urge to be productive was inexorable, I had already been well-dosed with the appropriate meds and retired to the throne to once again contemplate nature. With little fanfare, the contemplation seemed a success. A problem with the swollen and surgically impaired tissue is that it is a poor feedback mechanism for when the task is complete, but sitting there with that tender tissue in a dependent attitude becomes quickly uncomfortable, and I hurried, perhaps too much, to rise. I pulled off my clothes and stepped into the shower and enjoyed the sensation of the gentle warm spray anointing those hallowed parts, when I suddenly became aware that I needed to revisit the porcelain altarpiece. Soaking wet but for a towel on my face, I two-stepped to the toilet and felt lightened by the experience. I moved back to the shower and resumed my ministrations when I felt the exact same calling, and repeated the exercise. Finally, I dried completely, reapplied the topical, and went on about the day. Unlike before, I did not feel completely debilitated by a normal, natural and universal human function.
                I want to address the topical anesthetic for a moment. 5% lidocaine, when applied to a moist mucous membrane, is an effective medicament. In my professional experience, ideal contact time is about 5 minutes. The label on the bottle says that it is to be applied before and after bowel movements, as well as when needed. The problem is that where it is needed is within the sphincter and below the dentate line. External application is only somewhat useful, at best. Placement in the most important region with a digit is problematic……and painful. A small applicator, like a q-tip, might be possible, but when you need it, there is competition for the space as other things are on the threshold of leaving.  And did I mention that expanding that healing muscle ring is painful.
                The take-away message is not that the topical is useless, but that keeping it in contact in the right region for 5 minutes before there is competition for the area requires plenty of pre-planning, early application, and stoical ability to ignore the discomfort in favor of its placement.
                As much as I really didn’t want to plow the road in the afternoon before it got dark, I walked around outside and discovered that the snow was deeper than I had expected. I got the plow truck started after charging the battery for several hours, and then successfully cleared the area around the house, the two switchbacks, and began to address the steeper part of the driveway despite taking pain medication and being only somewhat uncomfortable. On my last pass before the steepest section, I noticed a black line in the snow extending from the rear of the vehicle. Viewing that as perhaps emblematic of my own experience of the last few days, I stopped the engine and got out to look. It was obvious that engine oil was leaking from something at a great rate. I was .4 miles from the house and it was uphill all the way.  I was not going to walk in my debilitated condition. I tried to call my wife and was unable to get her at first. Mercifully, she finally answered the phone and I asked her to bring a flashlight and a gallon of oil. She did, I refilled the oil pan, started the engine and drove the massively leaking truck back to the entrance of the garage where it now sits waiting for appropriate diagnosis and treatment.
                We watched two movies late in the evening, went to bed at a ridiculous hour, and getting up only twice for urine calls, I slept until 9 AM. No pain meds since 9 PM the previous night.

Sunday, October 4, 2015

Insurance Again......The ACA for 2016

It’s time for my annual protest about health insurance.  Two years ago I wrote a more involved post   ( ) on the subject, and I’m afraid I’m going to reprise the same subject with updated data, and the open question of, “How can this work?”

In the beginning of the Obamacare era, there were only two companies that offered policies in Alaska: Moda and Blue Cross.  Last year another company offered policies, but notified their subscribers mid-year that they would be leaving the market.  Comparable plans had almost exactly the same premiums so it didn’t seem to matter which we chose.

My only desire was to buy insurance to cover my wife and I in the case of a catastrophic accident or illness, but those sorts of policies are not legal under the ACA.  To get as close to this goal as possible, this past year we chose a policy with the highest deductible available, namely $12,700 for the family.  My premium for that peace of mind was only $20,000 per year. 

Beverly had a kidney stone that had to be surgically removed and along with other medical expenses, for the first time as a couple, we actually met our deductible.  Since we met the deductible, we felt empowered to have a few other things taken care of that we have neglected in the past, but our total medical expenses for the year will probably be at the highest, $20,000. If our claims are that high, the insurance company will have paid roughly $7300 after I have paid $20,000 in premiums and $12,7000 in deductible, or a total of $32,700.  The insurance company will still have taken in $12,700 more than they have paid out on our behalf. Not a bad return if you can get it.

I got my annual premium notice for next year a week or so ago.  It appears that the return is obviously not good enough.  My premium for the same policy will be raised to $30,000 and the deductible raised to $13,700.  I will have to pay out $43,700 in insurance plus deductible before the insurance company pays anything. How can this be tenable?   

The federal government pays subsidies for income levels 100%-400% of the federal poverty level.  All subsidies are phased out at a joint income of $97,000 for next year.  Assuming others are paying similar premiums, that means that a family earning $97,000 per year really only has $67,000 per year on non-medical expenses and will have to pay another $12,700 of their disposable income in health care costs before their insurance is any good to them.

It seems an anticlimax to a life to be in a hurry to reach 65 so that Medicare kicks in and you can afford your health care, or at least pass the expenses off to the next generation.  It’s only fair……

Tuesday, September 30, 2014

September 29, 2014

Reflections on Turning 60
On July 5 of this year, Carolyn, Jonathon, Robert and I climbed Mt. Magnificent.  On the climb, Carolyn pointed out that I would be turning 60 in September.  She asked, “What do you want to do for your birthday?”  Without giving it much thought, I replied that I wanted to climb Mt. Magnificent.  She has not let me forget it.  Though I have a million end-of-summer things to get accomplished before it gets cold, she reminded me again yesterday and I agreed to go today.
We started the hike at about noon on what seemed like, at the time, a nice September day.  I thought we only had about 3 hours so we hurried along.  When she told me that her husband would pick up the kids, I suggested that we climb the next mountain up the valley.  From where we were standing at the base of Mt. Magnificent, it looked like only a hop, skip, and a jump.  We walked along Meadow Creek for another mile or so and then began to climb up.  Steeply up.  I have never seen so many blueberries, ripe and with no leaves on the bushes.  I would take a handful every time I stopped, and the berries were there every time I stopped.  The incline continued to increase as we neared the top, and the rocks grew more slippery.  I reached the summit 10 minutes or so before she did, and the clouds were rolling in, the wind blowing.  By the time she climbed up to the last false-summit it was 7 minutes after 3 and I hurried her along to the peak, and then back.  The clouds were like pea soup by that time and we could just see our way down.  We hadn’t been descending for 5 minutes when Carolyn spied the first snowflake, and it snowed on us the rest of the way home.  Between skree-surfing and hopping between the tufts of vegetation, we got back on the trail and reached home a few minutes after 5.
I’m one of the last of the high school class of 1972 to turn 60, I guess.  My birthday was late in the year and I remember when I started school I was younger than almost everyone else.  Then it was uncomfortable.  I’m OK with it now.  Younger sounds kind of good in fact. 
There is an uncertain feeling about completing the sixth decade of life, and even more ominously, beginning the seventh.  Turning 30 didn’t seem like too much of a change.  40 wasn’t too psyche-shattering, and 50 was OK.  60…..well… a young man that seemed almost unreachable.  People were supposed to retire at 65 and die shortly after.   I watch my own parents who are now in their 80s and realize that they were quite active and happy in their 60s and I have resolved to be also. 
My own children are grown and gone, and most of their children have already been born.  My oldest grandchild is 13, and the other 21 trickle down from there. I echo what has been said by many others:  Grandchildren are the best!  You can spoil them until you get tired of them or they get tired of you and then send them home with their parents.  I am blessed to have more than half of mine living close by and the others migrate home on a more-or-less frequent basis.  I love all of them, and just as importantly, I like all of them.  Their parents must be doing something right.
            One of my biggest pleasures is watching how my children get along and interact.  Despite their sometimes combative actions in their teenage years, now they enjoy each other’s company are friends.  That brings peace and joy to my heart and soul as we will all be saddled together for eternity.  That their children are best friends with each other is just as gratifying.  They play together so well that they seem to be a matched set.  Seldom is there any bickering or fighting, except within their immediate families, and I guess that is pretty normal.
            The teens and early 20s were neurotically concerned with education and career and beginning a family.  The 30s and 40s were about career advancement and watching the family grow.  The 50s about preparing for retirement and watching the grandchildren come along.  The 60s seem to be about winding down a career, worrying about retirement provisions and continuing to see the progeny prosper, but the worries of being mortal don’t go away, despite the successes of the past.  “Did I put away enough for retirement?  Will my body keep working or will my health deteriorate soon?  Will my loved ones be happy and healthy and fulfilled?  Will my business keep running and my employees remain happy?” Looking back, life seems to have been pretty smooth, but there was adequate worry and stress in each stage to take a little of the fun out of living. 
            I was so fortunate to have met the woman of my dreams when I was 20.  While we haven’t always agreed on everything, we have made a good and lasting companionship sewn together with love and respect and commitment.  I can see no advantage at all of waiting for marriage.  The love and support we gain from each other allows us to overcome the uncertainties of life and not only celebrate, but create it’s victories.
            Faith in God and Jesus Christ, and service to our fellow men are part of what gives life purpose.  Having the biggest box of toys when we die won’t be very fulfilling, I’m afraid.  And the closer I come to the end of mortality, the more the two rules I have adopted in the last two decades of my life seem to speak surely: 1.  Don’t sweat the small stuff.   2.  It’s all small stuff.

            For those of you with a metaphorical bent, maybe you can appreciate the hike I began with in another context.  The struggle in life is uphill, and sometimes is difficult.  Pause to enjoy the blueberries along the way.  If you miss them, you will be missing out on some of the greatest pleasures of life on this earth.  The clouds will roll in and confuse your sense of direction; the snow and the wind will deprive you of your sensibilities from time to time. Remember to listen to the Supreme Guide and His Spirit who will see you safely home.  And if you can do these things, joy will be your reward.

Sunday, December 15, 2013

Sunday, December 15, 2013

Raising chickens continues to be an avocation laced with travail.  After the Grizzly Bears destroyed the chicken pen and ate all but 3 of the 14 chickens summer before last, my enthusiasm for hen fruit had diminished, but last winter I continued to feed and water our remaining two hens (the rooster was picked off by another predator) along with 4 hens given us by a friend.  Only two of those made it all the way through the winter.  We came home from a few days away to find a trail of feathers (or maybe 2 trails as the varmint came back for seconds) leading from the chicken coop up the stairs and around to the front of the house, disappearing in the more commonly traveled area.  By late spring, I found the last headless hen with the crop gone. 

At that point, I had pretty much decided that chicken ranching would not be my niche.  My daughter Carolyn, however, decided that it would be hers. She ordered some meat hens along with a “Surprise Special” consisting of an unknown number of chicks as well as geese, ducks and turkeys.  All told, she had upwards of 40 birds when a little girl she babysits killed some of them.  The mother was so apologetic that she ordered another “Surprise Special” which booster her numbers to around 70 birds.  The attrition rate was pretty dramatic with all of the young children, dogs, and predator birds around, and by the time they butchered the meat hens, they only had 35 or 40 left.  A friendly fox would come visiting a couple of times a week and carry away one bird on each trip, so their feed bill decreased a bit, but they were still left with 2 geese, a turkey, a duck and a flock of chickens. 

Carolyn asked if I would like some of her birds and, after careful consideration, began recouping the chicken pen.  (OK, only a small chicken joke)  I decided that to stand up to the bears, it needed to be a sturdy pen, so I put an 8 foot chain link fence complete with a top rail all the way around the coop and began to cover the roof of the pen with chicken wire.  Sadly, I ran out of chicken wire and left a few holes in the top, but I judged that it should be sufficient protection. 

It actually takes from about April to November for hens to mature enough to begin laying.  The investment in birds and pens and feed and water make it only attractive if you aren’t concerned with the per-egg cost.  Buying 5 dozen eggs at a time from Costco is far cheaper than raising your own, and you don’t even have to walk in the chicken poop, but since Carolyn had already borne the expense of raising them almost to laying age, I gratefully accepted 5 hens and rooster from her and put them in my new safe-and-secure chicken enclosure.  A sweet lady at work had grown tired of her declining flock, and gave me her last two hens, so all told I had 7 birds.

Three nights ago I put on my snow boots to wade through the icy accumulation and down the hill to the chicken pen to bring the anxiously waiting chickens the kitchen scraps.  I opened the garage door and cackled to the silence, but got no answer which was unusual.  I looked down the hill to see a large black shape in the corner of the pen.  I took a couple of steps in that direction, and a huge owl tried to fly out of the pen through the unfinished roof.  He finally succeeded and landed in a Cottonwood tree, silhouetted in the moonlight, and grudgingly watched me remove the two headless hens that he had killed. 

I locked the other chickens in the hen house and the next day in 15 degrees and 10 inches of snow, finished the roof on the chicken pen.

I believe they are finally secure, but the owl has put a little fear in them and they have only been coming out far enough to eat a little snow before retreating to the safety of the hen house.  The temperature is dropping and there were no eggs tonight, so I had a serious talk with the girls.  They need to do their part in all of this effort.

Sunday, December 1, 2013

Sunday, December 1, 2013

The day before Thanksgiving, my sweet wife and I went walking in the woods searching for the perfect Christmas Tree.  The Christmas Tree, in our family tradition, is cut and erected and decorated within a few days of Thanksgiving, and since half of the children and their families were coming for dinner on Thanksgiving, that seemed the perfect time.  Erected is the appropriate word because our tree is always a big one.  We set it up in our atrium which faces the front of the house and is two stories tall.  The tallest tree we could have is 24 feet, but this year we marked 3 prospective candidates in the 21 foot range. Curtis, my son-in-law, and I, with assorted grandchildren tagging along for moral support, chose the one furthest away, but it was downhill clear back to the road.  I fired up the trusty chain saw and in a moment, our tree was lying on the ground. 
            Ordinarily, I wrap the tree with a tarp before hauling out of the woods, but there wasn’t a lot of room and we quite handily carried it down to the road where the 6-wheeler awaited us.  Snow was only about 6” deep and the day was gloriously beautiful.  We wrapped the tree and then, instead of hoisting it on top of the 6-wheeler, elected to drag it along behind.  Towing the tree proved quite easy, and we deposited it outside the front door of the house. 
            After dinner, the time was at hand to bring the tree inside. Wrapped as it was, there were few handholds, and the motive force was provided by Robert, Curtis and I.  We could see that we didn’t have enough oomph to squeeze it through the door, so we asked our wives to help and they pitched in on their way out the door to engage in the other tradition of commercial exchange. 
            I knew we were in trouble because the tree was just stiffer than normal.  Of course it was frozen, but that was usual.  As we pulled it in through the doorway, audible and heart-rending cracks emanated from beneath the tarp as the branches broke instead of bending.  We laid the tree in the atrium and began untying the tarp to reveal many of the largest branches that would normally extend from the trunk in the bottom 6 feet of its length laying forlornly next the tree.  I applied the stand and a rope midway up the trunk and with a cooperative effort, hoisted the tree upright. 
            Its shortcomings were immediately obvious.  The tree in an unbroken state could not be charitably called “full”, and disabled as it was, appeared quite sad.  Branches on one side were easily 3 times longer than on the other, and if it could have walked, it would have done so with a decided limp.  The discussion among all was whether it was better to haul it back out and make another attempt in a few days, or to salvage what we could of the ignoble spruce. 
            I decided to wait a day to make a decision.  There was no big hurry, and maybe the light of day would improve the appearance.  It did not.  Not willing to give up on the homely specimen, however, I got out my trusty drill and bored several holes into the trunk where I could situate the broken limbs and restore a modicum of balance.  I know from previous experience that the “grafted” limbs will not make it ‘til Christmas, but I am willing to replace them as the need arises.  The limbs in the forest that need pruning abound.  Lit and ornamented, the tree is not the most beautiful we have ever had, but it is beautiful, and it teaches a profound lesson.

            Each of us is like the tree.  We have so many faults that our Father In Heaven likely wonders, at times, if it is possible to put us to rights.  But he loves us, broken limbs and all.  And because he does, he has provided a Savior for us, a Master Gardener that has the ability to graft us and shape us and help us to grow to perfection, if we but desire it. As we prepare to celebrate the Christmas season, let us remember our Savior, Jesus Christ, and the price he has paid to see us return to live with our Heavenly Father in eternity.