Not for the squeamish

To protect against unwanted shock, I'm going to fill space so the picture needs to be scrolled to. These are plexiglass panels featuring a thin section of the human body; male on left & female on right.
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Are we over-medicating our children?

I come here to say what's on my mind. Sometimes it is fluff, other times it is something that really affects me. Today I want to talk about a nephew and some recent diagnoses that frankly worry me.

Things are very different than when I grew up. As a kid I was bored in school. I was smarter than the average student so I was already done with that section while the teacher was still trying to get the slower students up to speed. This hasn't changed in today's classroom. There has always been and will always be faster and slower students.

In my case, this boredom showed in talking to myself, talking to neighbors, or reading a fiction book when I could get away with it. I still remember at a very early age being put in the corner for talking in class and then having my parents called in because I was talking to myself in the corner. It's funny now.

This weekend at a birthday party I found out a nephew has been diagnosed with ADHD & Oppositional Disorder for what is effectively the same actions I had done. It scares me that they may medicate him for things that I consider normal. I said as much to his mother, my niece.

I hesitate to think of what they would do to the 13 yr old me in today's society. Would I have become me or some Borg equivalent to me? Are we dooming the thinkers of our society to having that "wild streak" medicated out of them.

Lest you think I have a high view of myself, I'll admit that I ended up self-medicating in high school and college. I don't recommend it. There is much of my childhood I don't remember at all. Not just fuzzy recollections, but none whatsoever. Those brain cells are dead.

I make a good living and someone thinks I'm productive or I wouldn't be making that living. But I wonder what I could have become in different circumstances. And I wonder what my nephew will be stopped from becoming. That's the saddest part of looking back with 50 year old vision.

What do you think?

Are we over-medicating our children?

Are we medicating the spark out of children that could become the next truly free thinkers.

Does this worry you?

I hope this isn't an online journal trend

Readers, 2013 is starting off with a disturbing trend for those of us heavily involved in access to journal contents online. So far we've identified two associations that are reserving online access to their journal for association members. Any one, individual or institution, can subscribe to their print journal, but only association members can access the journal online and They Don't Offer Institutional Membership (or at least not to American institutions).

I'm not going to name the associations. However, one is Canadian and the other is Japanese. These are both medical associations (I work pretty exclusively with Medical Journals.)

Library patrons have grown use to reading articles online and many libraries have made budget decisions to stop getting print for titles they access online when there is a significant saving for dropping he print.

Now we have another worry added. Before this, we had to worry about titles that ceased and weren't archived online at PMC, Portico, LOCKSS, etc. Now we have to worry about associations deciding their online presence is something to be protected from access, even if money is offered.

I pray these are just two silly associations and no more appear. Unfortunately, my years of dealing with journals have made me a pessimist.

[Updated 03/21/2013]

The count all year is now up to four. Two Japanese associations, one Canadian, and a Non-Profit that has decided to embargo their online issues for 1 year. They are open access after that year.

Consumer Marketing needs a new Director

Received in my Saturday mail Feb 2nd:
(Subscriber Account Number, Phone Number, & Sender's Signature redacted)

My response emailed at 9 am on Sunday Feb 3rd:
(Addressed to the postcard sender  his title is Director of Consumer Marketing, the Newspaper's Editor & First Assistant, and the generic Customer Satisfaction account)

I have to tell you, if you screwed up this bad in my company, you'd be fired.

I'm sure you meant well when you came up with this idea to sell everyone the Monday Special Edition. You were looking at a pile of complaints from folks who wanted a paper and couldn't find one. I hope you realize that failure belongs firmly on the shoulders of the Circulation Manager. They decide how many copies of an issue get printed.

Unfortunately, your solution took that problem and turned it on its head. I can't fathom the leap in logic needed to decide that x number of complaints on not finding an edition equals everyone wants this paper. No. The pile of complaints mean everyone who went out of their way to find a special paper wanted to find that paper. You may logically extend that thought to these people will go out of their way to get the Super Bowl Special Edition too, but you went to another universe.

Here's my problem: I get my Saturday mail at 10 pm Saturday. It includes a postcard telling me I'm paying $1.50 for a paper I never ordered. I have the right of refusal if I call you. The only hours available to make that call are 8 am to 12 pm Sunday. I'm writing this at 9 am Sunday. Your phone system is either entirely broke or it can't handle the volume. I've given up trying. I've already spent more effort on this than my $1.50 is worth and I'm mostly writing this email to help lower my blood pressure.

This might have been a good idea if you'd come up with it on Tuesday and got the cards out to your weekend subscribers on Wednesday. Then there would have been adequate time to refuse this delivery. It might have been OK if we got the cards on Friday and the automated system had an option to cancel the special edition delivery. As it is, I'm sure you're going to hear an earful from folks that get their card on Monday and had no chance to refuse.

The 100% absolute correct and time tested solution to the problem folks found last Monday is (drum-roll please) print more papers this Monday. You may have helped a handful of interested parties that only subscribe to the Sunday paper for the ads. You did nothing for the folks that only pick up an occasional paper at the 7-11.

I wish you luck in your future endeavors  Don't let the door hit you on the way out. You're fired.

J.

What do you think?

Would you fire this Director if it was within your power?

Is my email too harsh? 

Discuss

The Soundtrack of My Life

The soundtrack of our lives is ever changing, but I think it is an interesting reflection to occasionally write down the top twenty songs from your soundtrack. Here's mine:

1) Hallelujah – Leonard Cohen
2) Tweeter and the Monkey Man – Traveling Willburys
3) Downeaster Alexa – Billy Joel
4) The River – Bruce Springsteen
5) Sounds of Silence – Simon & Garfunkel
6) Aqualung – Jethro Tull
7) Allentown – Billy Joel
8) You Took the Words Right Out of My Mouth (Hot Summer Night) - Meatloaf
9) Nights in White Satin – Moody Blues
10) Friends in Low Places – Garth Brooks
11) An Innocent Man – Billy Joel
12) Moondance – Van Morrison
13) Paradise by the Dashboard Light - Meatloaf
14) The Wreck of the Edmund Fitzgerald – Gordon Lightfoot
15) Johnny 99 – Bruce Springsteen
16) Leaving on a Jet Plane – Peter, Paul, & Mary
17) Pour Some Sugar on Me – Def Leppard
18) Scenes from an Italian Restaurant – Billy Joel
19) Detroit Rock City – Kiss
20) You Give Love a Bad Name – Bon Jovi

What's yours?

Gun Control

I’ve been meaning to write this blog for days since the school massacre at Newtown happened. Those who know I’m an Air Force veteran will probably not be surprised that I own a gun and I favor people owning guns.

Friends, I have been shot at and I have shot at enemy troops. I do not expect that a full scale war requiring that response will occur in the United States. I’m sure my forefather farming a plot North of Gettysburg, PA in 1860 didn’t expect it either. We all know now that he was wrong and he was lucky. The war came knocking on his front steps, but it never entered his life.

I have been to Bergen-Belsen, and Dachau, and Anne Frank’s Hidden Annex. I have seen the results of tyranny taking over a peaceful people who did not have the power to resist its rule.

Our founding fathers following a war to overthrow an absent leader understood that the average man needed the means to reject authoritative rule. Yes, the 2^nd Amendment says: A well trained militia being necessary to the preservation of freedom, congress shall make no laws abridging the people’s right to keep and bear arms. Please parse that sentence. It does not say Congress can’t stop people from being in a militia. It doesn’t require you to be in a well trained militia to own a gun. The beginning is a subordinate clause. It explains the reason for the sentence, but doesn’t modify it in any way. In short, the action in the sentence is “Congress shall make no law abridging the right”.

That is why I believe everyone should start with the right to keep & bear arms. However, like other rights, I do agree there are ways you might lose the right. Just as convicted felons can’t vote, I don’t want them to have guns either. I can easily see owning guns being registered and licensed just like owning a car and driving it are managed. I include testing, inspections, registering, liability insurance, and the means to revoke the right in that process. My wife had a stroke in 2006. Her Doctor submitted paperwork to the state and she was notified that she had lost her right to drive and what she needed to do to get that right back. I think we can enact the same rules regarding mental health and gun owners’ rights.

Is this change going to be easy? No. The idea for cars started when there were very few cars on the road and it was easy to enforce. The continued enforcement has been handled by requiring car dealers registering vehicles before they leave the dealership. I’ve no idea of a practical means to register already owned guns. There will be a certain percent that voluntarily do so, but will that even be 50%? I don’t think so, but I’m just guessing.

Now some of you are going to ask me, “All guns?” Do you all realize that 12% of the US population is Veterans? Want to guess what weapons we are most familiar with? Yeah.

I have a pistol and only a pistol. I’m too old and too fat to be in a situation needing an assault weapon, but if the worst comes about, you can be damned sure my fire team will have a few. I’m more likely to grab a shotgun to fire for effect because it’s point and shoot; no aiming really required.

Am I sad about the events at Newtown? Of course I am. How can any human with a beating heart not be upset over the massacre of innocent children?

Do I think that will be the last such massacre? No, but I don’t think removing all guns from circulation is the answer. That simply opens us up to more problems down the road.

Are there other steps that can be done? Yes.

a.      I’m in favor of trained staff carrying guns everywhere.

b.     I’m also in favor of limiting the size of magazines.

c.      I can also agree to limit the sales of semi-automatic weapons.

The first limits massacres by shooting the offender, the latter two by limiting the number of rounds that can be fired in a given time.

What will congress do? They are supposed to represent us, so I hope they create a registration & licensing system.

Question for Type 1 Diabetics about Pumps & Continuous Glucose Monitors

Friends, I’m crowdsourcing a question.

I’m going to put a lot of narrative below, but my basic questions are:

 1)      What pump do you use?

       a.       Why?

2)      What infusion set do you use?

3)      Plastic or metal cannula/needle?

4)      Have you ever had problems with insulin leaking, the cannula or needle pulling out, or any other non-standard response?

5)      Do you use a Continuous Glucose Monitoring system?

       a.       If so, which one?

       b.      What are the pros and cons of that system?

 

If you feel you can answer those questions without any more info feel free. You can respond with comments, you can email me at 7shore@gmail.com, find me on FaceBook as Jules Shore (same picture) or via Twitter @7shores.

Now for that background: My wife, hereafter known as Mrs, has been a Type 1 Diabetic for 51 years. Hold your applause please, it doesn’t mean she’s done everything right. On the contrary, she’ll be the first to tell you she isn’t a good diabetic. She has exceeded all expectations of doctors. 20 years ago when we got married, she was expected to live about 5 years. It’s 20 years later and she’s slowed down some, but she’s still ticking.

Mrs works in a Doctor’s office (Family Practice). About two years ago a Medtronic pump salesperson approached the Dr to get him to recommend pumps for patients needing that type of therapy. The Dr wore a pump for two weeks with saline in the reservoir to get a feel for it. At the same time, they recruited Mrs to try pump therapy too. Of course, she had a real live pump full of insulin. That went well so they added on some other incentives and Mrs became a pumper at the cost of $1500.

Up until that time, our Primary Care Physician was following her diabetes. Mostly that meant checking the A1c and keeping up with prescription needs. They didn’t want to follow her use of the pump, so they really forced us to get an Endocrinologist.

When we signed up with the Endo, she already had a pump and supplies, so there wasn’t any discussion of which pump to use. Within a few months, they were pushing the CGMS integrated with the Medtronic paradigm pump that Mrs is using.

Mrs’ control has been great on the pump, but frankly it hasn’t been the easiest change to make. She had a lot of problems with the first Infusion sets she used. They had a needle inside a plastic cannula. After insertion, you pull the needle out and an internal valve is supposed to keep the insulin from coming out the hole. That didn’t work for us, after a number of instances of changing the infusion set while on the phone with Medtronic customer support, we resorted to covering the hole with tape. On a following visit to the Endo, we were put in touch with a different Medtronic salesperson. They may call them case worker or similar title, but I call a spade a spade. She switched Mrs to the Sure-T infusion set. That model has a needle stay in the whole time, so there is no hole for leakage. Unfortunately it has a smaller patch of adhesive and Mrs has pulled needles out on occasion. We reinsert it and cover it with band aids or tape and change at the next expected change.

Mrs also tried the Glucose monitor system from Medtronic that integrates with her pump. Frankly it was a pain in the ass. (My blog; my rules.) She couldn’t take any of the IV covers they wanted her to use. Tegaderm works fine in the hospital, but after three days around the sensor she’d be all red and bumpy at the edges. Without a cover, the sensor adhesive would sweat off before 3 days were up. In addition, she’d have to check her BG 8 times a day to keep the sensor calibrated.

Thru Twitter contacts, I’ve discovered there are other brands of pumps and also CGMs that aren’t integrated with the pump. So I’m looking for some feedback from real users about their equipment; good, bad, or ugly. I can do research all day long, but none of that is as valuable as the info I can get from real users. Feel free to pass this around via any social media to all of the Type 1 pumpers you know.

 If there are any other sugestions, feel free to share those too. It seems strange to be newbies at the process 51 years into a disease, but it is true that we are newbie pumpers compared to some of you.

Thank you,

J.