Friday, October 30, 2009

Friday Funny

It's getting "punny" around here...


funny pictures of cats with captions
see more Lolcats and funny pictures

Oh, I Just Can't Resist Posting This

I was wandering around the internet, looking for any photos of MAST paramedics at work that I might use for a future post. I found this recruiting video for MAST, shot in May 2009. First, compare and contrast to the video about Freedom House. Second, contemplate the changes that will take place in recruitment if MAST becomes part of the fire department. Third, contemplate all the little details that need to be considered when/if MAST becomes part of the fire department. Anyway the video is fun to watch, and to see some a little bit inside the ambulances and what paramedics and EMTs do since the majority of people will not require ambulance service very much.

More EMS History...


Ambulance--1971

Ambulance--2009

Some More on the History of Emergency Medical Services

While we are on the subject of the history of EMS, I want to give you an opportunity to read the landmark report from 1965. This report, Accidental Death and Disability: The Neglected Disease of Modern Society, provoked the deliberate planning and helped put in place the structure that has given rise to our modern emergency medicine, both outside and in the hospital. Everything that has happened since goes back to this report. It's hard to conceive of it, emergency transport being done by funeral homes in hearses and police departments in paddy wagons--because these were the only vehicles that could accommodate a recumbent patient. Care along the way was nonexistent. No board certified ER doctors, no surgeons specializing in trauma, no research into ways to improve survival of cardiac arrest or severe trauma. While EMS is not perfect, and is struggling with issues of professionalism and leadership, it's a far cry from these bad old days.










Lost History--Freedom House on EMS Cutting Edge

I was doing some window shopping--looking around TJ Maxx yesterday. They had a display of 2010 calenders and appointment books; you know, the ones with themes and pictures. One was 365 days of African-American History. It attracted my attention with its Library of Congress pictures--on the cover was a group photo of the Pullman Porter's Union. I opened it up and it fell to a page with a picture of an open ambulance rear door and two Black men wheeling a cart with a patient. I stopped and read about Freedom House in Pittsburgh, PA. And it is a truly amazing story; starting in 1967 this organization trained men who had little formal education how to be paramedics. This was just two years after the landmark report "Accidental Death and Disability: The Neglected Disease of Modern Society" had been issued. They were doing just about everything out in the field that our paramedics do today. Among the pioneers of this organization were Dr. Peter Safar, who basically invented CPR, and Dr. Nancy Caroline, who wrote one of the best paramedic text books ever. There is now a documentary film available about Freedom House, and a website. Here is an article from the Pittsburgh Tribune-Review that was also carried on the EMS museum website. Here is a clip of the trailer for the film.




Every paramedic in this city stands on the shoulders of these pioneers, men who were throwaways, from the worst neighborhood in Pittsburgh. They have been forgotten. We would do well to take time to remember them.

Wednesday, October 28, 2009

I Feel a Need to Explain...

I just had the most amazing dialogue in the comments section of Tony's Kansas City. We were in the entry about Lesa Gonzalez excusing herself from Citizens to Save MAST. I engaged with an anonymous commenter with regard to MAST.

You should read the dialogue. We're near the end of the comment section, maybe the last 5 or so comments. I'll wait.

Welcome back. Now for those of you who have been following my entries on MAST in this blog, you would rightly come to the conclusion that I am against the changes in MAST's governance and I believe that MAST should not change. This is mostly accurate, but not complete. My concern is for the patient care given on the street. I have never played politics particularly well; I don't like stuff that gets in the way of taking care of the patient. If Louie Wright and his silly games down at City Hall get in the way of taking care of the patient, then I am not in favor of Louie and his organization taking over. If MAST's administration has been misusing money and treating MAST employees badly, then that needs to change, because it gets in the way of taking care of the patient. Contented and happy people, who trust their administration give good care. I've seen this over and over in the hospital setting.

So I am all about the process. I am all about the facts and structures of the organization. Because that directly influences taking care of the patient. When the first plan was to have MAST as a separate "ambulance department", there were no facts, no numbers and no structure. With this plan to place the ambulance service under the fire department, we have a few more facts but precious few numbers and only vague thoughts about structure and operational issues. We went at this all back assed; made the decision without all the facts. I have participated in decisions while on church boards of small churches with more facts. Public input also was lacking. I can hear people saying most of the public doesn't have a clue about what's going on. The public does need to hear that the transition from a private company to city governance will be handled correctly, or the public will just think it will be bungled like bulky item pick up or other city services that indicate the city does not have its shit together.

Perhaps I am not as emotionally invested in preserving the status quo as others. The only irons I have in the fire are personal (as a potential patient) and professional (as a caregiver in the chain of patient care). While I think that the city has been poorly run by the mayor, city council and city manager the past two years, I have not had enough involvement to have a personal feeling about this. This has been all about what will work to give the best care to the patient on the street for me.

Maybe this was something that needed to happen; to make this change is to improve the emergency medical service in Kansas City and to improve the working conditions and morale of the men and women who provide this service. But, Lord, we sure did stumble into it back asswardly

I'm not quite ready to stop gathering signatures and call it a done deal. I still would like to slow down the process and get everything out on the table--clearly not all the facts have been displayed openly by either side. Putting it to a vote of the people, even just that threat, might slow everyone down, and open things up a bit.

In the end, it's all about taking care of the patient.

Wayside Waifs Wednesday

Normally, you would find a posting here about dogs and cats up for adoption at Wayside Waifs. Well, just hang on, you'll get your orphan animal fix later. First, some fun. Darla Jaye, the evening talker at KMBZ was guest judge at the Frontier Feline Fanciers cat shot this past Saturday. It was a blast. I even think Darla enjoyed herself...
Darla gets up close with the eventual winner, a Devon Rex dressed up as a Parisian--mais oui--complete with beret.
Darla and show judge Brian Pierson pose with the winner. Now, on to Wayside Waifs for just some quick looks at the life of the shelter.

Here are some cats that are available for adoption at Wayside Waifs. They are lounging around a part of the shelter called "the storefront". Often several cats are in these two rooms, just roaming around, not in cages. It's fun to step in, sit down and visit with the cats.

A volunteer with a "lap dog" (?!? ) Often volunteers will bring dogs into the volunteer office and work on training and socialization.
Wayside Waifs is located at 3901 Martha Truman Road in Kansas City. (The paving is done!) Hours are Weds-Friday 2 pm-8 pm ; Sat-Sun 12noon-6 pm; closed Monday and Tuesday. On the web at http://www.waysidewaifs.org/.

This is Awesome Stuff on Healthcare!

This guy, Gregg Easterbrook, writes a (mostly football) column, "Tuesday Morning Quarterback" for ESPN's Page 2. But he writes about the issues of the day as well. Here are his credentials: He is the author of The Progress Paradox: How Life Gets Better While People Feel Worse, and other books. He is also a contributing editor for The New Republic, The Atlantic Monthly and The Washington Monthly. His most recent column included this piece on pricing in health care, a topic that has not been discussed nearly enough, as well as thoughts on insurance. Read, enjoy and think!

Why Not Standard Pricing? I don't really understand what's in the congressional health care plan at the moment -- and since it changes daily, I bet most members of the House and Senate don't really understand either. Health care is only the single largest segment of the U.S. economy, so surely there is no risk in passing a 1,000-page health care bill no one understands! Universal access to health insurance is a moral imperative. But huge cost increases are likely to be triggered: Extending coverage will create more demand for services, and rising demand means rising price.
If reform eliminates the dreaded "pre-existing condition" basis for denial of coverage -- which makes sense for individual insurers and is nonsensical for society as a whole -- that will be significant. Denying coverage to people with medical conditions is not only unjust, it causes insurers to waste money engaging in wars with their own customers. If health insurers must sell to anyone who wishes to buy, then their resources can be better invested in providing care. There needs to be a standard-price rule imposed, too, so insurers can't effectively bar pre-existing conditions by saying, "Sure we will insure you, the price is $100,000 per year." My impression is that so much lobbying attention has focused on the handouts, giveaways and interest-group demands for a gigantic new civil-service bureaucracy that not enough attention has gone to a simple change that would remove much of the injustice from health insurance -- standard rates with no denials for existing conditions. This is the key to the successful
health care system of the Netherlands.
So far as I know, health care proposals now in the Senate are so utterly fixated on handouts and giveaways that they don't even address a core problem -- the inability of individuals to buy at insurer's prices. This is the PPO problem, and is serious. Most health insurance now operates through some variation on the Preferred Provider Organization. Physicians and clinics sign up with some insurers but not others; they agree to discount their list prices; if the patient goes to someone within the PPO, the provider gets business while the patient and insurer pay less. Sensible? The system is full of crazy disincentives.
Recently, a family member needed an MRI. The clinic had a list price of $1,500 for the scan but was in the insurer's PPO, and so discounted ("adjusted") the price to $690, of which we paid 10 percent and the insurer paid the rest. Clearly, that $690 price allows the MRI clinic to do business, pay its technicians and radiologists, etc., or else the clinic would not participate in the PPO. Yet if I'd walked in off the street and said, "I will buy this MRI myself," the price would have been $1,500. Meanwhile, if the clinic had not been a member of my PPO, the insurer would have paid the same $621 it pays within the PPO, and I would have been on the hook for the rest, $879. The benefits sections of insurance manuals make it appear that if you use a PPO you pay 10 percent and if you go outside the PPO you pay 20 or 30 percent. Not mentioned, or stated in legalese, is that outside the PPO, the insurer only pays its "adjusted" amount -- you pay 20 or 30 percent plus the balance of the list price.
The distinction between list prices and "adjusted" prices prevents health care services from functioning as a rational marketplace. It's not just that many physicians refuse to speak about dollar figures. ("We don't discuss prices over the phone," a doctor's office told me a few months ago when I had the gall to ask what something would cost, adding, "after the doctor has seen you, then we will tell you what the visit cost.") It's not just that many physicians' offices and clinics do not have anyone authorized to discuss prices: They have minimum-wage receptionists and Mercedes-driving docs who expect the max under all conditions, but no one who will talk price with patients. The larger issue is that the system prevents the consumer from seeking the best price. If an MRI makes money for the clinic at $690, any customer should be able to buy at that price. The theory of the PPO from the provider's prospective is that the provider grants a discount in order to get business: The self-pay customer represents business, just like the PPO customer. But the self-pay customer can't get the PPO price, and the PPO price is the true price of the service. This prevents the bargaining-for-a-good-deal seen in the parts of the free-market system that function smoothly and hold down prices.
That the typical person cannot get the best price for health services is the big obstacle to transitioning away from the pass-along mentality that dominates health care. Right now Americans gripe about health insurance costs, but as
this fascinating article by Ron Haskins shows, don't directly pay most of the cost -- most is paid by employers or government (which, in the latter case, means billed to the young via deficit spending). If you're not directly paying most of the costs, you have little incentive to make smart consumer decisions. And if you can't buy at the best price, you can't make smart consumer decisions.
Think about a radically different way to attain health care -- in which most people carry only catastrophic-cost insurance, then pay other health costs themselves. No one can budget for a severe illness or injury; every family will always need insurance against catastrophic medical expense. Suppose insurance covered only catastrophes, and you paid the rest. You might think, "No way I am paying some doctor hundreds of dollars to set a broken arm." But today a typical family's health care policy that appears to cost the family $5,000 a year actually costs $15,000, it's just that much of the money is hidden as employer's costs -- and thus, as higher wages the employer can't pay. If you spent $5,000 a year for catastrophic coverage but earned an additional $10,000 a year, you could cover those strep-throat and broken-arm bills yourself, and probably come out ahead. Plus you'd have a keen incentive to comparison shop. Doctors could no longer loftily say, "We don't discuss prices."
Homeowner's insurance is catastrophe insurance. It pays if the house burns down -- the kind of thing no one can budget for. It doesn't cover all costs of maintaining a home; you pay most ownership costs and you comparison shop. If homeowner's insurance worked like American health insurance, it would not only pay for fires but also cover utility bills, replacing broken appliances, baseballs hit into the window and all the food, drink and paper towels that pass through the kitchen. Certainly, a company could offer an insurance product that covered absolutely every expense of living in a home. But such insurance would be phenomenally expensive and full of ultra-complex rules; the insurer would also acquire an incentive to dream up excuses to deny payment. Just like American health care insurance!
Gradually transitioning to a system in which most people carry catastrophic-cost medical insurance but pay the rest themselves could rationalize health care economics while restraining costs, because the wasteful paperwork aspect of the system would decline. The first step would be a standard-price rule -- specifying that providers must offer the same price to all comers, whether insured patients, self-pay or Medicare. And the standard price must be published to allow comparison shopping. Good physicians and hospitals could still distinguish themselves through quality of care; in most of the free market, prices are similar, and quality is the basis of sales appeal. Stipulating that health care providers offer standard, published prices would lay the groundwork for an informed free market in health care delivery -- and free markets control costs. They do it on their own, without layers of agencies and regulations. We've got to control health care costs or the future doesn't work. Yet the current health-care reform plan is to add more agencies and regulations.

Tuesday, October 27, 2009

Breaking Save MAST News

From Tony's Kansas City: Lesa Gonzalez, one of the leaders of the Citizens to Save MAST movement has been forced to stop being involved with the group. Lesa is a MAST employee, and over the past two months, Local 42 has been taking steps to discourage MAST employees from becoming involved in the petition drive to bring the MAST takeover by the fire department to a vote of the people by declaring it a "rival organization". In Lesa's email, partially reprinted by Tony, she explains:
"In light of the fact that the group, Save Mast has been declared a rival organization of the entire IAFF, at the bequest of Louie Wright, President of Firefighters Local 42, I will no longer be able to participate in activities of the group, Save Mast. A member has been recruited to bring internal union charges against me and out of fear of suffering severe financial repercussions as well as problems stemming from activities of certain fellow union members, I have chosen to go this route. I will no longer participate in the group Save Mast."
This certainly goes past fire crackers next to the ambulance. This is a kind of intense pressure that is unfathomable. It' s the kind of thing that is hard even to imagine. Unions have certainly moved from organizations looking out for their workers to organizations looking out for their power base.

I hope to have more later on how you can help Citizens to Save MAST. Remember, the plan is to take a world class ambulance service, and completely change its leadership and insert it into a different culture. If you don't think that is going to change the quality of the service, well, I have this nice bridge in New York I'd like to sell you.

In the meantime, keep Lesa in your prayers.

Lesa Gonzalez speaks at the community meeting back in August.

Public Inebriates

What in the world is a "public inebriate"?

A person drunk in public. Immobile drunk. Not staggering out of a bar with friends, but passed out cold on the ground in public. Not someone who is a social person out having fun, but a hard core alcoholic, whose goal in life is to get drunk. Someone who will start having nasty with drawl symptoms if they got below the legal limit to drive.

It's a problem in Anchorage, AK. The New York Times did an article and a video piece on the topic. Basically, Anchorage is going to do short and long term "insanity" commitments on some of those they pick up drunk off the street. Anchorage is not the only city with this problem; Kansas City has it too. Anchorage's is highlighted by their extreme winter weather, which will kill those passed out outside. An additional factor for Anchorage is their native North American population. Inuits, like Indians in the lower 48, seem especially vulnerable to the ravages of Demon Rum. Don't worry though, Kansas City has chronic public inebriates too. They're coming to an Emergency Room near you.

Here's the sequence of events: there's a guy (it's usually a guy; there are a few women, but more often, it's a guy.) lying on the ground where he can be seen. Usually it's a public place, like a park or the street. A citizen spots this guy lying there. Maybe, if the citizen is really brave, they might go over and try to wake the guy up, get him moving. Most times though, the citizen calls up 911 and reports the guy lying in the street. This then proceeds through the dispatch system. Police will typically be dispatched to "check the need for an ambulance". The ambulance will be dispatched for "unconscious person"; this call nature will trigger an automatic dispatch of a fire crew as well. There are other types of 911 calls that will bring the EMS system and the police in contact with a drunk person, but this type of call is pretty typical.

Now, if the person wakes up, and can walk, and is oriented to person, place, time and situation, and doesn't wish to go to the hospital, and clears the criminal check by PD, he can go. He'll be encouraged to go "home", wherever that is, and sleep it off in private. If he is oriented as above, but has legal issues, he'll go to jail. However, if the person is not ambulatory, not oriented and cannot protect himself, he will go to the hospital. Even with legal issues. Yes, to the hospital. Kansas City does not have a place for public inebriates to "sleep it off". People this drunk are not accepted at the jail, due to fear of them coming to harm and then suing the city.

According to my informants, Truman Hospital Hill has a special room for the supervision of drunks while they sleep it off. They still have some medical interventions, typically an intravenous line is started and they are given vitamin, folic acid and thiamine laced IV solution, but generally, it's just a safe place for them to be while their liver metabolizes the alcohol and their BAC returns to a safer level. (BACs on these folks can typically run in the 300-450 range--and higher. To put it in the familiar terms drivers know, they would be at 0.3 to 0.45--the legal limit is 0.08.) Generally, once a chronic drinker drops into the 150-200 range, he looks and acts pretty normal. At that point, they can leave the ER. If Truman is on ambulance diversion, the drunk will end up at the next closest open ER. Another place that ends up with chronic drunks is the Kansas City VA Medical Center. They may not be able to walk, but they can produce that VA card.

This may happen several times a week. And this is where it's gets relevant to the health care system, because it costs money. They take an ER bed. They require staff supervision. Sometimes, even though they can't walk, they will resist any intervention physically, requiring restraint. They're messy, they puke, poop and piss all over the place. Rarely, unless they are old enough for Medicare, do they have insurance. (Single people, especially men, rarely, if ever qualify legitimately for Medicaid.) So the cost of care given to them is rarely reimbursed. If they are on a government program (Medicare, Medicare, VA), it's your tax dollars at work, sobering them up, so they can go out and do it again. So they cost money, time, effort and compassion.

Anchorage authorities are hoping to rehab a few of these folks and get them out of the cycle, thus saving money and other resources better used elsewhere. I hope it works. I know we need something different in Kansas City. I can't tell you how many times I've had an ambulance bring me a drunk guy I just saw last week--also drunk. It has got to be getting expensive handling these drunks through the Emergency Department. I hope Kansas City is watching what is happening in Alaska. It might be a helpful model for us.

In the meantime, if you see a drunk person passed out, and he's breathing and obviously alive, and he's relatively safe (not in traffic, not flat on his back, the weather's temperate), don't call 911.

I joke. Call 911 if you're not sure about things. But give it some thought before you call.


I Sent Sports to its Own Blog

Sports was taking over. I could tell. I have been and still am a big sports fan. It was becoming impossible to keep the sports opinions from overrunning the non-sports opinions. It was easier to write sports entries, and the photos are compelling and fun. So I could do an sports entry and call it a day. I thought the quality of this blog was suffering. So, I've started a sports blog: www.lookinglive.blogspot.com. The title is after Brent Musberger's signature sign on at the start of a game. I debated this. Would I have enough time to do two decent blogs? Enough passion? Yes, I believe so. I think it will improve this blog too. You may still see an occasional sports story over here. But most of the sports stuff will be on "Looking Live".

Oh, and with the exception of "You're Looking Live" itself, all the sports blogs in the blog roll are going over there too.

Monday, October 26, 2009

A Few Thoughts on the Chiefs

I think this about sums it up. Todd Haley after yesterday's loss. Photo from www.nfl.com.

Everyone was maybe thinking the Chiefs had turned a corner with a win over the Washington Redskins. However, maybe, not so much. A few thoughts on the Chiefs:

I really thought they had an upset win in them. Now, I am not so sure. They just don't have enough talent.

Rookie head coach Todd Haley is in over his head. He needs to either demote himself to offensive coordinator or delegate play calling to someone else.

Larry Johnson needs to pay the price for his tweets and general idiocy. I vote for keeping him inactive the rest of the year, then cutting him. I think it would be worse for him to sit on the sidelines and have no option to play. If he is released, he will be picked up and play for someone. Either way, he'll make his money. Let's make him sit.

The defense of the New York Giants is in trouble. New Orleans is for real. You, up in Minnesota, don't let Bret Favre throw so much--his arm might fall off. JaMarcus Russell is a really bad quarterback and should try another position. New England is back.

Very interesting football season, even with the Chiefs losing.

Friday, October 23, 2009

Friday Funny

And a left and a right and a left...

Denver Bronco Throwback Unis Part 2

The AFL legacy games have been continuing, and the Broncos played the San Diego Chargers. The Chargers were smartly attired in their light blue unis and the Broncos were in their brown and yellow duds. Although,not so much yellow on the road. And yes, according to the gang on Uniwatch, the yellow stripes down the sides of the Broncos pants are correct. This photo is here, not because it shows the uniforms, but because it is a great photo! Look at that concentration by the Denver receiver!

Well, there you are. I don't know if this is the last of the brown/yellow/white Broncos. I do know that they have kept right on winning and their fans are getting more and more insufferable.

Flu-ish Foolishness

A reminder: Do not use this blog post (or anything else on the internets) as your sole source of info with regard to flu shots. Consult your health care provider with any questions you have, and use him/her as your primary resource while trying to make decisions regarding your health.

If you hang around any group of people, like coworkers, for any period of time, you are likely to hear all manner of opinion with regard to getting flu shots. You will hear some good information, very accurate, and you will hear some complete and utter horse shit. You will hear personal experience that is presented as fact. You will hear rumors of conspiracy and evil doings.

Please take it all with a grain of salt. Or two grains. Oh, heck, bring the whole salt shaker.

I have never heard so much misplaced knowledge, ignorance and just general garbage then on this topic. It's a perfect storm of half-knowledge and no knowledge; of rumor, junk science, and conspiracy. Now, I am no fan of the medical-industrial complex, but immunizations are one of the things we have done well, and have markedly increased the quality of life in our country. Find someone in their 80s. Ask about polio, measles, and small pox. Ask them about typhoid fever and diphtheria. Ask what it was like to nurse a child with whooping cough. Ask them about when an infectious illness would rip through a community. You know what happens when chicken pox gets loose in a group of children, like a school or day care. Imagine debilitating and fatal illnesses running amok like that involving the entire population, including those who do all the vital things we take for granted every day. Let's get started with some basic science. This is by no means a comprehensive review; if you need more, ask your health care provider and/or go to the library and do some research.

Vaccines work by exposing the body to a weakened or dead form of the infectious agent, thus causing antibodies to that agent to form in the body, which will fight the disease if you are exposed after you get vaccinated. Vaccines are made by growing the infectious agent, then modifying it or killing it. Flu vaccines, among others, are made using eggs as a medium to culture the flu viruses in. (That's why you are asked about egg allergies when you go get a flu shot; there may be stray egg proteins in the vaccine, which would provoke an allergic reaction if you are allergic.) When you take a vaccine, you may experience some very mild symptoms of illness, but nothing that is as severe or lasts as long as the illness itself. Your arm may be sore at the injection site. You may have absolutely no change in how you feel whatsoever; this is the experience of the majority of people. A very few people have some bad reactions. 1 out of 1,000,000 of people getting a flu shot might get a neurological condition called Guillian-Barre Syndrome. Some people discover allergies they didn't know they had the hard way, with a nasty anaphylactic reaction, that will occur within 15 minutes of receiving the shot. A very, very few people will experience some weird adverse reaction that is even more than a one in a million shot, like the cheerleader in Washington .

When you decide to get a vaccine, you are balancing these possibilities against the risk of a full-blown case of the illness, which may cause disability and/or death. In addition, you protect other people, in two ways: one, by preventing yourself from being sick and spreading the illness to others, and two, by boosting the "herd immunity" of the community, decreasing the number of people in a given community who can get sick.

Right now, there is a substantial anti-vaccine movement among parents. This post is not about that topic per se, but if enough kids are not vaccinated against common childhood illnesses, we may see those illnesses again, as our communities lose their "herd immunity". Most of the fear has centered around vaccines causing autism. However, strong scientific studies have shown that there is no connection between vaccines and the development of autism. Despite this, some have continued to insist that vaccines are harmful, and the studies are rigged by "Big Pharma". This is known as a "catch 22" or "can't please these people no how." If I had kids, they'd get their shots, both for their protection and the community's.

So. let's drill down to flu shots in particular, and the situation currently, with both seasonal flu shots and H1N1 (Swine) flu shots. Flu shots, like all vaccines, carry the side effect profile outlined above. Most will experience no side effects. A few will have very mild side effects. A very few will have allergic or adverse effects. The virus in injectable flu immunizations is dead, and cannot give you the flu. The nasal form of vaccine is a highly modified virus that will not make you sick. Now, the vaccine takes a week or two to give full immunity, depending on your immune system. If you are exposed in that time, before full immunity, you will get sick. If your immune system is not working as it should, you may not respond to the vaccine in a normal way, and have a full immunity. In this situation, you will get sick with the flu if exposed to the virus.

H1N1 is a particular flu virus that created epidemic to pandemic conditions in the northern hemisphere during the spring of 2009 and has continued to spread throughout the world during the summer and early fall. Reports from the southern hemisphere, which is just coming out of their winter flu season, indicate continued spread, and no change in the virus or illness profile. It emerged too late to be included in the seasonal flu shot. Vaccines, made in the same manner as the seasonal flu shots, have been fast tracked into production. Clinical trials were done with 10,000 to 12,000 participants without any marked problems emerging. The H1N1 vaccine carries the same side effect and risk profile as the seasonal flu shot.

So, should you get a flu shot? An H1N1 flu shot? It's a very personal decision. It involves a lot of issues ranging from the scientific issues and facts discussed above to the fact that some people will decide based on psychological factors such as disliking being told what to do. Scientifically, it's a balance between the risks of the vaccine and the risks of getting the illness, with a little consideration of the health of the community thrown in. Some people are viewing the H1N1 shot as a little bit riskier than the seasonal flu shot, due to the rapidity of its development and testing. Some just view all flu shots as bad, since they swore they got sick because of the flu shot back five years ago. A few people have decided that all vaccines are bad, causing all manner of problems. And the risk of the flu? Death rates can be hard to pin down but a number closed to 36,000 has been developed. An episode of the flu, especially in those with risk factors and preexisting health problems, can lead to other illness that may ultimately cause death. As the linked article notes, influenza related deaths may be somewhat underestimated. H1N1 has been hard on people under 25, and pregnant ladies, causing bad illnesses and occasionally death.

If you have questions, ask your health care provider. Do research on the internet, but stick to sources of information that are well known and/or are documented with reliable sources. Read skeptically, with a questioning mind. There's a lot of junk out there, don't let it scare you. Your decision needs to come from a rational mind, satisfied that it understands. Not a mind full of fear, hearing rumors, not fully understanding, just running from something unknown or poorly understood.

And whatever you decide: to get the seasonal flu immunization and the H1N1, to get just one or the other, or none at all, practice good hygiene. Wash your hands before eating or touching the eyes, nose or mouth. Wash your hands after touching your eyes, nose, mouth, or coughing/sneezing. Wash after using the restroom. Wash hands after using a public surface, like a communal computer keyboard. Cover the cough or sneeze with the inside of your elbow. Stay home, out of public circulation, if you are sick with fever, chills, and having a lot of secretions. No vaccine is 100% protective; these simple measures will protect you and others from illness where the vaccine falls short. As well, take good care of yourself during the flu season. Get the sleep you need. Eat good food. Watch your stress level. Work on keeping your body and immune system strong.

You expected that I was going to give you a definitive answer: yes, no, maybe--did you expect that? Sorry, nope. This is one aspect of health care that has changed a lot: providers will advise, educate, maybe even encourage or cajole. But when it comes down to the nitty-gritty, health decisions are the patient's to make, not the provider on behalf of the patient. I'm not even going to tell you what I'm doing; that's between me and my doctor.

Wednesday, October 21, 2009

From a Patient's Perspective

These entries from Midtown Miscreant on his (mis)adventures at the VA are the best! He really gets the flavor of the place. This is the most recent one . Here's a link to my previous entry that will link you to the prior MM posts. Please consider: do you want doctors, nurses and techs to have all the interest and compassion of the DMV?


Wayside Waifs Wednesday

Don't be discouraged by the repaving of Martha Truman Road (Yay!), Wayside Waifs is open. All sorts of fabulous animals are there just waiting to meet you and become part of your family. Like George 2 here. He is a year and 3/4 old, Aussie cattle dog/Shepard mix, mostly white as you can see. He likes dog treats; that's how I got him to sit so pretty for his photo here. He will need an active owner, willing to take time with him, but the reward will be great. Look at that doggie smile! Wayside Waifs is running an adoption special in October which is"Adopt a Dog Month" Dogs weighing more than 45 lbs will cost $1/pound up to a max of 75 pounds/dollars. Not sure how much George 2 here weighs; why don't you go on down and find out.

Or maybe cats are your thing. Meet Tatiana. She is a tortie semi long hair girl. Pictures just don't do this beauty justice. She is what the cat fancy call a "smoke"; her undercoat is white. She is also just short of 2 years old. You really have to come see her in person. She enjoys petting and is playful. She'll adjust well to having her own home.
Tatiana says I like the sisal scratching post. Note the light undertones at the base of her tail.
Wayside Waifs is at 3901 Martha Truman Road in Kansas City. Feel free to call ahead at 816-761-8151 to check on the road and for directions as needed. Hours are Wednesday through Friday 2 pm to 8 pm and Saturday and Sunday 12 noon-6 pm. Closed Monday and Tuesday. On the web at www.waysidewaifs.org.

Saturday, October 17, 2009

On High School Football

Nick Sloan has a wonderful post about watching high school football, the honor of watching the kids give it all. No pay for play here. They play because they love the sport. They play for the pride of representing their community and school. Even in this fractured day and age, young boys/men come out to the gridiron to play.

Oh, in some places, like Texas, the players are treated very well, almost like professionals. They even have fan clubs, and hangers-on, looking for a free ride. But in most of the free world, they are kids, playing a game and having fun. (Olathe North and Lawrence Kansas City Star photo)
And they play hard! There is nothing easy for anyone on a high school gridiron. Play goes on until the whistle blows. But in all the high school football I've watched, I have rarely seen dirty play. And unsportsmanlike conduct is not tolerated. Just ask the Ruskin player who got ejected earlier this year for poor conduct. (Burlington and South Burlington Burlington Free Press photo. Note the charming weather.)
Sometimes, you see some sweet football. The great catch (here are two examples), the play perfectly executed, the sack exactly when needed. It's amazing to watch the kids rise up to the occasion. (Essex and Burlington Burlington Free Press photo)
Sometimes, of course, they don't quite meet the needs of the situation: a critical penalty, a fumble, a blown assignment, and victory is lost. But that is something to learn too, how to respond to adversity, how to come back from defeat, how to know that you can contribute even when the situation looks bad. (Lone Jack and University Academy Kansas City Star photo)

How did I get started watching high school football? Doing ambulance standbys in Pennsylvania! Providing just-in-case EMS service at Lower Merion High School (Kobe Bryant's alma mater). In Vermont, when I lived there, there were a good number of Saturday day games (to skip playing every game in the cold of night. Also, some schools may not have had lights at their fields.), I would go and take my camera. Since Vermont games are much more relaxed and laid back, I actually snuck onto the sidelines. Even just working the sideline outside the bench area, I was able, especially as I got used to the game at that ground level, to get some outstanding photos. (Remember film? Well, they are in that format. Now, there's a project...)

So, I would encourage you; go out and see some high school football this year. This is the best part of the season, when teams are trying to get into state playoffs. But it doesn't last forever. High school football is done in November.

As I've advised before, keep your eyes on the field during play. You might miss something otherwise.

Tada! The 100th post. Now, I can be syndicated. Whodathunkit?

Friday, October 16, 2009

Friday Funny

Tough call on Friday Funny this week. Lots of offerings on the various sites of the cheezburger kingdom caused me to laugh out loud (so embarrassing in the library).

We dedicate this Friday Funny to the Kansas City city council for their unerring pursuit of good planning and decision making, as evidenced by the non-profit making red light cameras, among other things.

Your tax dollars at work!

So Was the Boy in the Balloon a Hoax?

Well, that was one wild news ride. Kid in balloon, balloon up in air, balloon down, where's kid, oh up in the attic hiding. Or not. Or something. Kid goes on CNN and spills beans--"did it for the show." Or not. Kid and family make rounds of a.m. network news shows, kid loses breakfast twice. Bad food? Bad flight? Or maybe, too much pressure for a kid.

This family is weird. Dad in particular seems a few screws short. They seem to live for publicity. The family went on "Wife Swap". Dad fancies himself an inventor. I think your screws must be a little loose to do reality TV. When the show, "The Biggest Loser" was in town, I did give a thought to an audition. But then I considered, not just the practical, like taking time off from work, and finding someone to look after my cats, but, well, how would my mother who-lives-in-a-small-town feel, to how would I feel about losing privacy, and being put in positions which may cause big embarrassment. So I think to be willing to gain that notoriety, even for just a short time, is to have a little bit of crazy, no?

One thing I do know: The taxpayers of Colorado should not have to pay one dime of the cost of the search and rescue. This odd ball group needs to compensate the tax payers for their lack of parental supervision, and possible collusion in ginning up a missing kid story.

And if the kid is telling the truth about being "too scared" to show himself to his father, what on earth is his father doing to him in the name of punishment?

My Thoughts Exactly

While I was writing the first Rush Limbaugh post, a little part of me said to me, "Isn't this the same stuff I wrote about race just a little bit ago? This topic is starting to bore me." But I put the thought out of my mind, after all if my little blog is going to major on news and opinion, then I have to write what's in the news. But, boy, there are just times I'd sooner put pretty or cute or funny pictures up. I wondered if I was alone in this type of sentiment, when this day, our friend Midtown Miscreant nailed it just right. He is referring to crime topics, but I can relate to a lot to what he is talking about when I think about racial issues and racism:

On another note, you may have noticed an absence of the usual "local crime" type posts on this blog over the past few days. Last week was the last time I covered any type of local crime. Nothing would make me happier than to say crime has taken leave from Kansas City, nobody has been killed, raped or robbed, we are now living in the land of Love, Peace, and lollipops, free unicorn rides and cotton candy are the theme of the day, but that wouldn't be the truth. The truth is, I was starting to sound like a broken record, and frankly there are already more than a few of those around these parts. The truth is, I've given that shit a rest because at some point it just becomes lip service. Folks are still killing one another, there's a rapist loose in Waldo, and Quik Trips are still ATM's for petty crooks. So I decided to give it a rest, at least for a few days until something extra heinous occurs. A person can only express so much outrage, there are only so many words one can write on a subject, until those words just become repetitive self serving horse shit. So it's not that I've lost my concern or my contempt, I'm just looking for a new angle, or a story that makes me feel something other than, the same old same. In the meantime, I'm putting together a multi part story from my sordid past and should have the first installment up come Monday. (Link to the full post here. The bold is from me.)

So, unless breaking news demands it, I am giving racial issues a rest for a while.

Thursday, October 15, 2009

Those Red Light Cameras

Red light cameras were deemed by the city council to be a good idea, to make the city safer, and along the way, make the city a little money. The safety thing is a little controversial*, but other cities have made money from their red light cameras. Well, it turns out that Kansas City is not making any money off the cameras. It is requiring two police officers to review the pictures. People are going to court and contesting the tickets. Something like two hundred cases are pending in the court system.

Now, I am pretty sure that the camera at US 71 and Red Bridge snapped my pic at least twice taking a legal right hand turn on red after a full stop. Now, when I come to that intersection and prepare to turn right on red, I come to a full stop behind the line on the pavement, move a little, stop again and look for traffic, then go. What a pain. Now, I rejoice when I see a green light at the intersection. I'm not the only one: A group of folks who deal with the cameras on the intersections further up 71, at Meyer, 59th and 55th are also saying that they were photographed taking legal right-on-red turns, and got tickets in the mail. That's a big waste of time for the police and courts, having to deal with these inappropriately taken photos.

What to do? How much would it cost just to cancel the contract and turn off the cameras? Because that what ought to be done. Simple as that. If the cameras don't really enhance safety and they apparently aren't producing profit for the city, then the red light camera era should end, ASAP.

*The controversy with the cameras is that while they do seem to cut down on the amount of folks running the lights and possibly causing collisions in the intersection, there is a marked increase in the number of rear end collisions just before these intersections. Maybe these rear enders are less likely to cause fatalities and serious injury, but cars are damaged, and a lot of bullshit whiplash occurs. So the safety advantages may not measure up objectively, only subjectively. If only people would shut up and drive...

Update: Rush Dropped from Group Bidding to Buy St. Louis Rams

Correction: Dadgumit, I made a mistake. I looked at the edit postings list, not the archive list, and it lied to me. This actually is only the 95th post actually posted. That other list includes drafts. Dadgumit. No syndication yet.

The group, led by Dave Checkkets, decided to drop Rush Limbaugh from their roster. The heat got hot, rejection was looking likely, so they decided to let Rush go. Many commentators have burned Checkkets for being a wuss for letting the critics intimidate him. However, I understand his move. He wants his bid to succeed. It's a shame that he had to drop Rush in order to facilitate that.

The Indianapolis Colts owner, Irsay, has a lot of nerve commenting on Rush's integrity and appropriateness for the NFL. He is part of a family ownership that packed the team up in the dead of night one winter and moved from Baltimore to Indy. A lotta nerve.

And Al Sharpton should keep his cake hole shut--who elected him to the Commissioner's Office at the NFL?

Rush's politics should not have entered into this. The only reason Rush's views are known is because he opines for a living. If he had made his millions selling widgets or providing a service and kept his mouth closed regarding his politics, no one would have looked twice at his being part of a bid to buy an NFL team. To me, it's a part of the rampaging political correctness of this world, and also the increasing blandness of everything. In order not to be attacked in the present or have something held against you in the future, you wash out or hold back interesting and potentially controversial parts of yourself. After awhile, everything starts looking the same.

Sad. And a real restriction on speech and expression. And St. Louis' loss, as Rush would have been a fun part of the team ownership.

Some Links: NBC Sports: Limbaugh Blames Checketts

ESPN: Limbaugh: Checketts Approached Me

Wednesday, October 14, 2009

Radioman KC: The Commenting Blogger Everyone Loves to Hate

There's a blogger called Radioman KC. His blog is called http://www.radiomankc.blogspot.com Like me, he likes to read Tony's Kansas City and comment on the stories. Truly, I do not know what this man did to offend the other readers of Tony's Kansas City; every time he comments, he gets verbally abused. When I noticed this pattern of abuse, I went to his blog to see what was on it, to see if it was the blog that annoyed so many people. I found that I actually enjoyed his writings and postings. We don't agree on much; he is pretty much a liberal progressive and I am pretty much a conservative Christian type, but he argues and writes well. He also doesn't just blog about politics, he talks about media, especially radio, and posts fun things like this post of a wonderful photo of a grateful dog and a tired firefighter. He has good links and fun things on the side of his blog too.

So if you are reading this, and you know why Radioman annoys so many people, can you comment and explain it to me?

Thank you.

Sully Wrote a Book

Capt. Chesley "Sully" Sullenburger wrote a book about his life and the landing that made him famous. Check him out on video visiting the Today show. and here with a small excerpt from the book. Note how calm his body is during the visit on the Today Show. It's quite a contrast with most people, who act like they've had a Red Bull or two. That's a man who can respond in an emergency. I read research that noted that once a person's heart rate reached 140/minute or higher their ability to reason and make decisions takes a noticeable dip. Something to consider if you are in emergency services!

He is also visiting Kansas City on October 21st. I would love to see him speak, but money's a little short around the observer's house. You, on the other hand, if you can, you should go.

Here is a link to 980 KMBZ. I imagine seats are going fast, so you better get on the stick.

The VA: An Example of Government Health Care!?!

Midtown Miscreant, one of my favorite bloggers here in the Big Town, is blogging on his adventures in the Government Health System. He goes to the Veteran's Administration Hospital, and he's blogging about it. Check it out here and here. He hasn't blogged for a while; he says in one of his posts that his appointment is at 3 p.m. I hope he was seen promptly and didn't have to spend much more time sitting in the germ pool of the waiting area than he already has. Please click the links and check him out. If he posts again on his adventures at the VA, I will link that one up too.

These Things Just Bug Me

A couple of newsy items that got my attention during the morning news and blog review, mostly in a negative way...

I am hugely tired of the weather we're having. Grey and cold, 20 degrees below the average, often drippy. Had to turn on the heat and this is at least two weeks earlier than I usually start using this much heat. Argh!

Lewis Diuguid was a good columnist when I first moved to KC two decades ago. Now, he is a one note Charley, always writing about racism and how the Black people are dragged down and how much help they need and how the world is against Black people. As stated before in this blog, racism is not a done deal in America, but it also is not the source of every evil and ill that befall Black people. Here's a link, so you can be annoyed too. Or maybe you won't be annoyed. But chances are high you'll be annoyed. Read the comments, too.

A complaint was filed against the Kansas City Police Department by the mom of a young man who got pulled over while dropping his kid sister at Martin City Elementary. KSHB has the details. I wish these things would not come to light until investigated. Then we can see the dash cam video, and hear all points of view, because the police cannot comment publicly until the investigation is complete. The complainers can blather all they want, poisoning the well. Personally, I need more details. For example, was there loud music in the car that impeded the young driver from hearing the siren? Was he texting or talking on the phone? It also concerns me that our young drivers, with the best sensory equipment are so situationally unaware when they are driving out on the road. (The general crappiness of young drivers is a subject for another rant.) Police officers will react in a predictable way to people getting out of a car at a traffic stop. For their own safety, they are ready to defend themselves. The spokesman states in the report that the officer did not draw a weapon. We will wait for the dash cam video. So here is the lesson: If you are stopped by a police officer in a patrol car, do not get out of your vehicle unless requested by the officer to do so. Keep your hands visible and wait for instruction. Cops operate on a hair trigger; they do this, because there are bad people out there who want to kill them. These bad people are not labelled, so cops operate on a basis of caution with everyone. They want to go home at night.

There, got that off my chest...

Wayside Waifs Wednesday

Here are Wednesday's Waifs for October 14th, 2009. Check them out:
Maybe it's because I'm a cat owner that I like dogs with pricked ears. Or maybe I just like the way they look, I'm not sure. But I like this fellow, Salvador, a border collie mix. Interestingly, he has a dark tongue. He is of a medium size, and won't grow much more than the 35-40 lbs he is now. He is very smart, as most herding breeds, and their mixes are. So he'll need involved owners who can put in some training and play time. He already knows some tricks that the trainers at Wayside have taught him. His pointy ears are not completely rigid; as you can tell from the photos, the cartilage at the tips is flexible and moves when he does. It is a completely cute and endearing look!

Meet Sophie. Sophie is 7 years old. Her owners moved and left her behind. Luckily she was discovered before any harm came to her. When she first came to Wayside, she was quite shy, but now she is very outgoing. She is a cuddlier, a lap cat and a conversationalist. She's a pretty patched calico tabby--note how all her color spots have striping. Wayside Waifs has a special program for seniors adopting senior animals--if you are over 60 (still young at heart!), check it out.
Wayside Waifs is located at 3901 Martha Truman Drive in Kansas City, Mo. On the web at www.waysidewaifs.org. hours: closed Monday and Tuesday. Open Wednesday thru Friday 2 pm to 8 pm. Open Sat and Sun 12 noon-6 pm.

Tuesday, October 13, 2009

Rush Limbaugh and the NFL

When I first heard that Rush Limbaugh was interested in being a part of a group that was going to put a bid in on buying the St. Louis Rams, I thought that it was a very positive thing. Rush is a big sports fan, especially football, and he would be good energy for an organization that needs some good energy. The Rams are having a season as sad and long as the Chiefs season, and have not been able to regain their footing since "The Greatest Show on Turf" was dismantled. But then came along the controversies, like thunderstorms on a hot summer day. The first storm was two NFL players stating they would not play for him. Then the Race Pimps, Sharpton and Jackson show up. Now, there are a fair number of people saying that Rush is bad for the NFL and should not be allowed to participate in ownership of a team. Now, the National Football League is a privately owned organization, and they do have say as to who they allow to own a team. Rush Limbaugh is a free citizen of the United States and may do anything with his time, effort and money he wants as long as it does not violate the laws of the land. So, all these people calling for any kind of government interference are way out of line. If you hear that, it's nonsense, and don't pay any more attention to the person saying it. Now, there are people with concerns that Rush Limbaugh is prejudiced against Black people. They are using various statements that he has made over the years to prove this. First of all, one of the statements is of dubious origin, the one where Rush supposedly says positive things about slavery. I'm not going to go into all that here, Rush deals with it nicely on his show. Then there is his statement about Donovan McNabb, the Black man who is the quarterback for the Philadelphia Eagles. He basically used McNabb, who at that time was not playing well, as a negative example of "Affirmative Action", that McNabb's race was causing people to hold back on critical assessment of his performance. ESPN fired Limbaugh for this statement of truth. Today, Limbaugh played a clip of Mercury Morris, a retired Black football player, stating that Rush was only saying what everyone else was thinking. Most recently, Limbaugh compared football to the fights between the Bloods and the Crips. Now, seriously. Football as a war is an old metaphor--in fact a lot of football lingo is very warlike. He could have just as easily said football was like the US and the Nazis in WWII. Maybe, it wasn't the most sensitive selection of warlike sides to chose. Would have it been better if he included the Latin Kings, or the Aryan Brotherhood?

I think that if Rush Limbaugh passes muster with other owners and the commissioner of the NFL, he should be allowed to participate as an NFL owner. If players don't wish to play for the Rams if he is part of the ownership, it will only hurt them, not Rush. There are quite a few players who I would bet don't really care about the political views of the person who signs their check. Also, many players do have a love for the game, and appreciate any opportunity to play. Rush does opinion for a living. He will say things that annoy people pretty frequently. Does that disqualify him from participating in life? So, I still think Rush Limbaugh as an NFL owner, especially in St. Louis, very close to his boyhood home, is a positive thing.

One more thing: If Rush Limbaugh doesn't like Black people, and has a negative perception of Black people, why would he want to get in to an organization in which the majority of its employees and participants are Black?
Photo credit: www.nfl.com.

Monday, October 12, 2009

Oh, Deer

There has been much to-do about the deer herd in Shawnee Mission Park and making it smaller, since it is having a negative impact on the park. Some organization called The Bite Club has emerged to protest the deer culling.
Now, I enter into this with fear and trembling: people involved on both sides have felt threatened and unsafe. Alonzo Washington has a email stalker who has introduced himself/herself into the situation. So feelings run high. Which is pretty typical for the upper middle class suburban folk who inhabit most of Johnson County. Most of them don't hunt, have never hunted, have never fired a gun, and just don't understand. The state I regard as my roots, Vermont, has had strategic extensions of hunting season and doe seasons to keep the deer herd at the correct size for years. All Vermonters, including my animal loving non-hunting parents understood this. You see, my parents would fit right in in Johnson County, culturally and by education and income. But they always understood: there is finite space, so for the health of the deer and the environment, the herd needs to be kept at a certain size. It really benefits the deer for there not to be too many of them. And it keeps the environment from being stripped by hungry deer herds. Not to mention fewer vehicle-deer encounters, which always end badly for the deer and often badly for the vehicle. So The Bite Club has understandable but misguided concerns about the culling of the deer herd. I say let the culling begin--the deer will be healthier in the long run and there will be venison for the homeless and poor. Also deer meat makes great jerky...

Meanwhile Back at Arrowhead

Chiefs dressed as the Dallas Texans this past Sunday, and the Cowboys dressed in their throwback unis (note not white but blue). The Chiefs actually had some nice moments yesterday, including some timely defensive play and a terrific two minute drive in the fourth quarter to tie the game and send it into OT. But missed tackles cost plenty...
especially this one, which allowed the receiver, to run 60 yards for the winning TD. (Kansas City Star photo)

It's gonna be a long year...

The Denver Broncos Throwback Uniforms

Unless you are a total non-sports fan, and/or have been living under a rock, you know that as a way to celebrate the fortieth anniversary of the founding of the American Football League, the NFL has been having the original AFL teams dress in the uniform of their first year of operation. So during the year, we have had the Chiefs (Texans), Titans (Oilers), Chargers, Raiders, Bills, Patriots, Jets (Titans) and Broncos dressing in throwback unis (For more information on uniforms in general check out the Uni Watch Blog--also for more pics of the throwbacks.)
We have always known the Broncos as dressing in some combo of blue and orange, but when they first started they wore brown and yellow. With vertical striped socks. They were a site to behold--check out the pictures.

The original AFL refs wore these red striped shirts instead of black stripes. The ref is still the "white hat" but the other officials are "red hats" instead of "black hats". In this picture, we have the ref and another official talking with the Denver coaches. I think Champ Bailey does not like the way the conversation is going! (photo from nfl.com)
Those throwback Patriots unis are really nice--I wish they were their regular unis. The only bad news in all this: The Broncos won in OT to go 5-0 for the season, thus making Bronco fans even more annoying than usual. (photo from nfl.com)