Saturday, October 25, 2014

Ebola ? Worry About This Instead

                 As regular readers know, my daughter has been a juvenile diabetic since age 9. (Which was 1993)    No, she is not overweight. She will never outgrow this, and losing weight or any such life change or magic will never impact the fact that she will never make insulin herself again.  She does not have Type II diabetes, the current scourge of the United States, she has the rarer autoimmune variety which afflicts about 10% of diabetics, and is actually a different illness than the Diabetes Mellitus Type II which is so common now.        How did she get it ?    We do not know how all cases of Type I autoimmune diabetes mellitus start, but we do know this information, in her particular case.

                   When my daughter was 9, my father-in-law caught a virus in his office.  (He was in his fifties and worked as a engineer in a large office in the city.)   Within several days he became ill enough to be hospitalized with pneumonia, cardiac arrhythmia, and  generally was miserable with a flu-like illness.   The doctors thought he would be released by Monday, but he thought he was dying.  It turned out,  he was correct.  Despite being in a cardiac monitored intensive care stepdown unit,, he coded and died as the physician in charge was actually watching the monitor, and could therefore start attempts at resuscitation immediately.  Since this was an unexpected death, the hospital paid for a full autopsy and the results were surprising.   The causative organism to his flu was Coxsackie B4, which among other things, can invade the heart's conduction system and cause death, just as it did in this case.   We were all in shock as we made funeral arrangements, and many of the people where he worked came to the funeral although I noted many of them were sick or recovering from a viral illness also.   None of our physicians indicated that there may be implications for our family, and no one asked us about the health of the rest of our family or our kids.  They had the sniffles, but nothing more.

                 During the viewing, a room was set up in another part of the funeral home for the family and especially the kids. There was a television  and food was set up there.   In a very brief period of time, our daughter who had the sniffles downed quite a bit of soda,  and ate quite a bit.   Each time we checked on her, she seemed to be in the bathroom a great deal. This was quite uncharacteristic for her.and so I called the pediatrician to report rapid onset   polydipsia, polyuria and polyphagia,** all things that indicated that new onset Type I Diabetes Mellitus needed to be ruled out.  The pediatrician thought this was a grief reaction and tried to discourage our coming in.  When I called later to report a flushed face with a fever, she agreed to "let us be reassured" by the pediatric endocrinologist.  The endocrinologist thought she looked great and took blood for thyroid testing, but declined to get even a blood sugar. He proclaimed that she was simply in a growth spurt.  I was not okay with this. I wanted diabetes ruled out even though no one in my family had ever had it   So, on the way back from the endocrinologists office, I bought an inexpensive screening test kit at the CVS Pharmacy for glucose and sugar in urine. We didn't have to wait long on our return home to check it.  It was highly positive for glucose and ketones.  I took the time to explain to my daughter that there was no other reason this could be true that I knew of, other than a new case of juvenile diabetes.  I also told her that blood glucose monitoring devices and that teeny insulin syringes and improvements in technology have made this a much easier disease to control than it was even a few years prior.  I also told her that between the two of us, we could control it, and that after a brief hospitalization, she would give all her own insulin.  She accepted this, and while she went to pack and get her teddy bear, I called the endocrinologist and the pediatrician to arrange the inpatient emergency hospitalization.

                 The endocrinologist was flabbergasted that a parent who called his attention to something was actually correct.  "I should have listened to you, because you are a nurse !"  he said.  " That's not why you should have listened to me", I said.   When any parent tells you that something is really wrong with their child, then you should listen, because the parent is the expert historian on their child."    When my daughter was admitted to the hospital with a glucose level of 547,  (70-120 being the desirable range.)   we were told that she likely escaped death in her sleep because we had acted so quickly.   When I brought up whether this could have anything to do with the virus that had killed my father-in-law just a few days before, initially I was pooh-poohed.   My daughter's fever made it harder for them to brush me off.    Eventually the labs were done which indicated that my daughter too, had Coxsackie B4, and that it had likely activated the autoimmune chain of events which wiped out her ability to make insulin on the beta cell level.     I did not know of Coxsackie B4 virus at the time, but I learned that it can both invade the conduction systems of hearts and cause lethal arrhythmias, or it can cause a cascading effect which can cause the patient to attack and destroy their own beta cells, the functional unit in the Islets of Langerhans in the pancreas.  Both my father-in-law and my daughter were severely impacted by the same virus !  The link between viral exposure and Type I diabetes has been known for 40 years, yet is seldom discussed, even by nurses or physicians.

              This leads me to my concern in the present day.   While many are obsessing about Ebola, they are ignoring Enterovirus, which is much more common and much more easily transmissible.  A large nationwide study in Taiwan, published recently, indicates that children with enterovirus have a whopping 48% increased likelihood of developing Type I (autoimmune, juvenile) diabetes mellitus !    This is the first such study of its kind and the implications to the world are staggering.  No antiviral strategies are yet effective against it.   The article postulates that perhaps we can develop a vaccine for Enterovirus to try to head off some of these cases of Type I diabetes mellitus that will be heading down the pike. We are already seeing an increase in the incidence of the Type I variety of diabetes mellitus.   Learning to control this chronic illness is time consuming, expensive, and it can be life limiting. Not all of the children who develop it, survive. This needs to be a major focus of public health.

    So, think a bit about taking your baby or young child out to crowded places.   The old strategy of masks on visitors to babies, and frequent handwashing is a good one.  Perhaps a smaller daycare is a better idea than a large one.Perhaps having someone who does good daycare for only two children in her home has merit. Perhaps you are one of the lucky ones who can sidestep all the germs and viruses in daycare altogether.  Can you or your wife work from home ? Can one of you stay home with your young child ?

             Before you bet the farm on bugging out due to Ebola, please realize that there are far more common and more likely infections out there, which can be physically and financially devastating, and can change your child's life and your own forever.

                As for my daughter, it was hard work for us all controlling her blood sugars, even with the insulin pump she eventually received.   She grew up, went to college, graduated with honors,  drives a car, and has a life partner and a new home.  She has survived the birth and  the first month of her own new baby's life.   She realizes how layered viral exposures can adversely impact her child's life and is taking steps to limit those exposures.  I don't think my daughter will be taking her baby to the Coliseum to watch Sesame Street on Ice, as I did when the kids were toddlers.   She uses a pediatrician where sick children are segregated from those who are ill as they all wait.   Please think about doing the same. We need to do more to keep our children from layered viral infections.

**  Polydipsia means drinking liquids a great deal, polyuria means urinating frequently and in larger amounts, and polyphagia means eating a great deal.  These are earmarks of new onset diabetes, especially Type I.

More information:

Friday, October 24, 2014

A Tribute to Gerald Frantz

Gerald and Jane Frantz       Photo courtesy of John Wesley Smith

I have been away from the computer for several weeks as I have stayed with my daughter helping her with her new baby, her juvenile diabetes, shopping, and care of her animals.  I am home long enough to take care of my horses and other animals and then I flit back again until she is better able to manage.  There is progress, but she needs rest and routine sufficient to control her blood sugars during a time of hormonal turmoil. I will also be starting my new job teaching college again soon.

       Yesterday afternoon, while I scrubbed out horse water buckets, mucked stalls, and measured out their grain, Gerald passed from this Earth to the next life.   I had the incredible good fortune to have phoned him two days ago, and we had a very lengthy conversation, which I will always cherish.

         Some years ago, I became acquainted with Gerald when he appeared on a friend's blogroll.   He penned a blog called "The Last Robin" which were both musings of his life, and observations.   He was clearly an incredibly gifted writer, and quite a Biblical scholar, and teacher.   His eloquent writings however, were not the reason we became friends.  He periodically commented here on this blog, and was a good friend to me, and I know to others as well.   Who was Gerald Frantz ?     To most observers he might have appeared as a widowed older man who spent the last couple of years in a nursing home while writing a poignant blog.   However, I don't think that's who he was.   I think Gerald was a true creature of light.   Most of us come to Earth in infancy as a creature of light who is all at once encased in a small human flesh suit.   Our knowledge of light and all that we know becomes deflected by the complexities of maintaining that suit.  We must eat, then we must endure other functions, and then we must sleep. As we move through life and we grow, we learn to manage sleeping and eating, but by then, the trappings of the world have seduced us.  In youth, our friends, our schools, our families all take us farther from being the creatures of light we were meant to be.  Our worlds give way to anxieties and for thoughts of perhaps not being good enough to stand beside the other "flesh suits".  Then as we venture into adulthood, where there may be losses and events we perceive as failures, we may fall farther and farther from the people we were meant to be on our journey, which is egregiously short.     Gerald did not let a stroke, the loss of his beloved wife, or his leukemia interfere with his being a creature of light.   He had an uncanny memory for the things you had told him.  Even though he recalled scripture better than almost anyone I've known, this did not motivate him to be judgmental.   He was wholly supportive.  He was also bright enough to follow what you were saying and anticipate the extension of what you were saying, along with its implications.

         He chose not to fight his leukemia, but to go home when the time came.  This always leaves nurses in a difficult position.  On the one hand, we must honor the wishes of human beings and be supportive, and on the other, we must wonder whether we have done a good enough job of explaining how far cancer treatments and treatments for leukemia have come, in order that each patient can make the most informed decision for themselves.   I remember Gerald telling me about one of his physicians who some time ago visited him and spent a great deal of time explaining the treatment options for Gerald's cancer.  Gerald listened and no doubt left an indelible print on the doctor.  When Gerald eloquently explained why he was choosing to take the natural course with regard to the illness, the doctor hugged him, no doubt impacted by Gerald's eloquence, bravery, and most of all, his golden faith.

         Gerald believed different things about Heaven than I do, and yet he never corrected my perceptions.  He knew that I am a child on a journey, and also that I might need to believe what I do, in order to make sense of what happened when I lost my youngest son at 12. Perhaps he thought there is still some time for me to grow and learn more.

          Gerald passed at 5:25pm Central Time yesterday, and did not wish a funeral. Today he was buried  with the least amount of fuss, as was consistent with his wishes.

         Should you wish to memorialize this wonderful man, you may consider a gift to his last stop while on Earth, which was:

        Hospice Compassus, 3050 I-70 Drive SE, Columbia, MO 65201.

He conveyed what a wonderful job they did for him, especially with regard to controlling his pain with sufficient skill to allow him to still be clear enough to continue to communicate via phone with his many friends.  I will always be most grateful for the conversation we had, just two days ago.
         My favorite recollection of Gerald's was the story of the "Library Cat".  It so epitomized his personality and generous spirit, and it also reminded me of something my own father might have done.

          I will remember this remarkable man and creature of light for many things, for the funny anecdotes, for the sad ones, and for a golden faith.  Gerald believed that those who accepted God would meet again but only upon the resurrection.    Once again, I need to be comforted by knowing that today, he will see God and his beloved bride Janie.  In the time which follows I imagine, or perhaps I hope that my beloved father and my son can meet with Gerald and share stellar conversations.  It comforts me to think this.

If you wish to read some of the writings of a creature of light, then these are links to specific posts:

The entire anthology of this great man can be found at:

Godspeed, Gerald

Saturday, October 18, 2014

Interesting Updates in US Hospital Managed Childbearing


        My last child was born eighteen years ago in an excellent hospital in Richmond, Virginia.   Just recently, I attended my daughter during her labor, her delivery  and in her week of hospitalization afterward, in a major university medical center.  Both of our pregnancies and labor and deliveries were high risk, but for very different reasons. The evolution as to how childbearing women are managed since then has been quite interesting.

                 Often in medicine, something that is done as custom, completely reverses in a few years in response to the latest and greatest new study on the subject.  Sometimes, change is for very good reason, and sometimes, well, not so much.  Sometimes, the studies which change the tides of practice are not that large, and perhaps should not be taken quite as seriously.   Often I think that rather than embracing the other side of the pendulum's swing that we should simply approach childbirth, child rearing and general medical care using a more flexible mindset in the beginning. Each patient, each family, and each baby is an individual, and one size fits all, is rarely a healthy medical treatment strategy.

                   In 1996, only those families who had attended the full Prepared Childbirth classes (often Lamaze styled training given in hospitals by specially certified nurses) were permitted in the delivery room.  This helped to ensure that the participants knew where to stand and when to stay out of the way in an emergency. It also meant that they understood enough about the process to accept an emergency cesarean section if rapidly necessary.    In 2014, this was not even a point of inquiry.  Whomever the woman wished to have with her in the delivery room was just fine.  In 1996, the hospital also provided scrubs to the individual who would remain in the delivery room with the laboring woman.  This time, there were no scrubs offered.

                    In 1996, there was a paper medical record and everyone caring for us knew the prior medical history and the plan of care.  In 2014, there was a wholly electronic medical record. However, it would only update periodically (leaving prior medical history out, upon admission, until the software update occurred) and as a result, my daughter was in labor several days without a number of members of the team knowing her entire medical history.   Since only one screen of data is available at a time, many health care workers are unaware of the entire picture, and know only the snippet they need for each task.  In a complex case, this can be a problem.  The function or dysfunction of the electronic medical record resulted in a Type I diabetic who requires insulin on a real time continuous basis, to experience seven hours after labor and delivery without any form of insulin whatsoever, when she was assumed to be a "gestational diabetic" who might not require continuous insulin reordered immediately. (Go ahead, and tell me again how much safer we are with an electronic medical record !)

                    In 1996,  I saw a regular obstetrician, a high risk obstetrician for my thyroid issues, and an endocrinologist.  These were on different days and in different locations in the same city. Non-stress tests, labwork, other tests were done in different locations. It was hard work getting a pregnant and hypertensive woman (me) to all those appointments safely, and I was driving and had small children with me for most of the appointments.    In 2014, high risk pregnancies came to one hospital location where my daughter saw an obstetrician, a high risk obstetrician, an endocrinologist, the lab for labwork, an ultrasonographer and a technician for a non-stress test in about the same location, and  often on the same day.  This meant that she did not become exhausted simply in the course of getting intensive medical care during pregnancy.  The prenatal high risk health care system was a vast improvement over the experience in 1996.

                   In 1996, in labor, we were allowed nothing to eat or drink for the duration of labor, except for a few lemon barley lollipops which our prepared childbirth classes told us to buy and bring to the hospital.  This was done because digestion of food does not occur during labor anyway, and anesthesiologists in particular, if they must attend a patient having an emergency cesarean section, prefer to be working on a patient who has an empty stomach and cannot aspirate stomach contents while under a general anesthesia.      In 2014,  my daughter was allowed to have clear fluids through the course of her labor, even if she were vomiting. This is done now to keep the woman comfortable and aid in hydration. It also permitted her labor to go on longer and was part of how she was able to endure such a long trip and avoid a cesarean section.

                    In 1996, most women still received an episiotomy.  Toward the end of labor, the obstetrician cuts an incision on the posterior vaginal wall at a 90 degree angle with scissors, thus widening the opening and preventing potential deep vaginal tissue tears during delivery. (These are quickly sutured closed after delivery and the straight clean incision usually heals quite quickly.)  Although this is still practiced as a method of preventing serious tearing in a great deal of the world, it is no longer routinely practiced in the US.   Now, a first degree vaginal laceration itself,  which occurs during childbirth is stitched up afterward.   I had several episiotomies which healed quite quickly.  I am noting, that my daughter is still quite uncomfortable without one, three weeks past delivery.
                    In 1996, the nursery filled with lots of babies, where families could visit and compare still existed.    Since I was breastfeeding, my baby was brought to me fairly frequently after delivery, and then he returned to the newborn nursery with nurses in attendance.  As I recovered, he spent more time with me in the room, and less in the newborn nursery.  I remember being a few doors from the elevator and in my slight post partum anxiety, I was afraid to go to sleep with the baby in the room.  I feared someone coming up the elevator and taking the baby while I slept.     In 2014, my daughter was moved from labor and delivery where she also completed her recovery to a Mother Baby Unit.    Both she and her baby remained in the room 24/7 to facilitate breast feeding.   The Mother Baby Unit is high security and is a locked unit, a bit like a modern day psychiatric unit.  Family members with a pass must be buzzed in each time they wish to enter.  To prevent babies being kidnapped, each baby is not only double labelled, but is fitted with an RFID tag.   The baby remains in the room with the mother and cannot ambulate outside her room with her, as I so often did, in 1996.   The RFID tag causes a loud alarm to go off in the unit anytime a baby leaves the desired area, and there are sensors throughout the unit and on the elevators outside.

                   In 1996, the emphasis was on having new mothers ambulate as much as possible on the hallways of the post partum unit to avoid blood clots, to hasten recovery and in order to get to the small kitchen on the unit to get tea or milk.   (Probably also a way of helping to transition a woman going home from the hospital who will take on the tasks of caring for other children as well as her new baby, on arriving at home.)   In 2014,  my daughter was discouraged from leaving her room or interacting with any other patients.  There was no on unit kitchen, and she had difficulty getting hot tea when she wanted it, which she actually needed for diuresis. In addition, being confined to the room meant that when she was discharged after a week, she required an evaluation for deep vein thrombosis and pulmonary embolism. (medical speak for blood clot which can travel to the lung and potentially cause death)

                  In 1996, if you were discharged and your baby needed to stay, then you were thrown to the wolves sitting in a rocking chair until your baby was discharged, and this was not helpful to milk production.  In 2014, my daughter was discharged a day ahead of her son, but she was allowed to remain in their room as a "boarder" with him with her own bed, breastpump, and meals provided, as it is now understood that this is best for both of them.  This new strategy was very much appreciated.

                 In 1996, there were no specific directions about positioning newborns (other than avoiding suffocation with blankets, softtoys or crib bumpers) but now, the American Academy of Pediatrics is very clear that studies indicate that a baby should be put down on his back to avoid SIDS.   I am not sure what they do with newborns who turn their heads or bodies to the side after you place them on their backs.

               The last and most interesting difference is the stance on breast feeding.  In 1996, I was a curiosity. I was a nurse who had chosen to breast feed, and I was indulged as this was considered "quaint".   How could a working woman keep up with breast feeding ?  Why, it's so difficult !!    Now, the pendulum has swung and the attitudes are quite different.  Now, there is a "take no prisoners" attitude toward breast feeding.  The Obama administration now requires health insurers to pay for at least some types of breast pumps via insurance.  There are no more formula samples given to families.  There are no pacifiers permitted.  Babies are to be breast feeding !   Even mothers who endure daily visits by 74 medical students, interns, residents, fellows, attendings, attending physicians undertaking studies of childbearing women etc.,  and a bevy of registered nurse lactation consultants are to be either breast feeding their baby, or using the rolling breast pump.  No one seemed to know though, that Type I diabetics, or those with hypothyroidism or other endocrine issues tend to get a lactation response a bit later than other women, and so my daughter was guilted by some of those on the pediatric service.    I am actually a proponent of breast feeding, but again, a forced inflexible response to any situation generally does not work well for most patients.

              In conclusion, some of the approaches and procedures in 2014 at a major world class medical center were far better than those in 1996.  However, some were not.  In future, I think my daughter will chose to be a "non-teaching patient" and will sidestep all the extra physicians.   Consistency can be a wonderful thing.

Tuesday, October 14, 2014

About Friends


            When I look back, I have always been fortunate to have had really good friends, whatever the challenges we have endured.  However, with difficult and challenging times to come, there are a few things I would like you to consider with regard to friends. Consequently, I have run the mile for them, and then been the recipient of some really herculean aid and sometimes wonderful gestures when events turned dark in my own life. I will always be grateful to those people, and I think they likely already know who they are.

                True friends are rare.  Most of us have neighbors who aren't really friends but are acquaintances.  They may seem to have your back and to be available to you, but they aren't really friends. If you were to move out of state, would they still be your friend ?  Would you still rate as more than a Christmas card ?  Would you rate as a Christmas e-card ?    Would they extend themselves or inconvenience themselves in an emergency ?  If not, then they are neighbors on which you are on good terms, they are not friends.

                 Most of us have some "work friends".  These are people with whom we have worked, often for many years, and we are often on very good terms with them and have developed trusting relationships with them in the workplace.  However, if you changed jobs, would you see them again ?  In six months, would they remain in your life ?  If not, then they are more correctly "workplace acquaintances" or professional collegues.    It's important to have good solid relationships within the workplace, but it's also important not to mistake these connections as friendships, because often they are not.

                My accountant, my financial advisors, my doctors and our insurance agent have all been with us for many years.  I know some of them socially, and when our youngest son died, most of them dropped everything to attend his funeral.   However, these may still be people to whom you are a valued client, they still may not really be your friend.

                 Friends are people in which you can confide, and in whom such confidence is not misplaced.  They are people who would endure inconvenience and discomfort if you had troubles.   Relatives can sometimes be friends, but often they are not really your friends. We can't choose our relatives, but we can choose our friends.

                  When I was in high school, we all recognized the syndrome of the friend who pretended to be, but when the going got tough, sold us out for one reason or another.  This was the friend who dated your boyfriend after you and he took a break.    We called these people false friends, but my kids call them frenemies.   These are not just restricted to high school.  They exist in all walks of life, in all occupations,  and in all age groups.  Sometimes people inadvertently betray us, and sometimes, they do it deliberately.

                We can have many acquaintances in life, but most of us have few true friends.  With difficult times ahead it is very important to know which is which.    Remember that friends know your political affiliations.  They know where you bank.  They usually know what you have and what your weak points are.  They know that your town requires a septic tank be pumped every five years and that you haven't had your pumped in seven.   They probably know enough to effectively perpetrate identity theft.  They certainly could inadvertently mention personal information of yours to someone who could betray you.   Most of them would never do such a thing, but do they know enough not to mention your new car to another friend ?   Do they know enough not to mention where you keep your safe and that you have one ?  Something said quite innocently to another could be devastating to you.  Good friends can be a godsend whereas you can be left destroyed by a bad friend whom you have misjudged.    A male friend of ours found that his wife had been having an affair with his best friend, for years !   Another friend of ours found that the friend who was supposedly giving his son a great job reference, was actually providing a bad one.  We are vulnerable when opening ourselves to friends.

               If the world became even more frightening than it is just now, would your friends keep you safe ?
Would your friends who have the room,  let you stay with them following a flood or an earthquake ?    When food or incentives are given by government for turning in those with a food stockpile, would your friends or neighbors turn you in ?   How much do they know about your stores and supplies?  How much do they know about your legal firearms and where they are ?  Have you ever unwisely said to them that you "would never turn in your firearms to the federal government" if they ever called for them ?  This would be an unwise comment to make.

                One of my friends once told me that she is a good friend to us because I have always been a good friend to her.  I think this is indeed part of it.  I have always tried to be a good friend.  Like most people on Earth, I have fallen short from time to time, mostly through errors of omission or by being too busy to be present enough during their trials of life.  However, at times, I have indeed been a good friend.

               Keep in mind that no matter how close you believe your friend to be, and how honorable you think he/she is, that once private information is provided to them, it can't simply be called back. Once private information is out there, it's out of the box and can't be put back.  This means that you should be much more careful about what type of information you reveal to friends or on the internet and especially in social media.  Keep in mind that in a couple of hours, a person searching us with only a name can amass quite a little dossier on all of us.  Make sure that this is very little information, for many reasons.

This is an uplifting song to help counter the somber tone of this post

Casting Crowns                                                             "Thrive"

Friday, October 10, 2014

Activities from the Depression

This is my daughter at a festival recently. She looks a great deal like my grandmothers, even when not dressed for the era. I am glad she has an appreciation for the eras which preceded our own.   (Photo: Copyright © 2014 )


              My father was a little boy during the Depression in the US.   My mother was a tiny child during the Depression in England.  I have a fair amount of background knowledge as to what they saw during the Depression in those locations. I also know from the frugal manner in which they raised me, that they always thought the possibility of another collapse was there.   I also know from my grandparents what their fears were, and how they coped with them. A Depression or financial collapse here in the American South in the present day would have both commonalities and differences from the Depression that my parents knew as tots and small children.

            My father's family were considered to be upper middle class at the beginning of the Depression. He hailed from a connected California family.  My grandfather was a civil engineer and he designed and oversaw bridge building in California. . He bought a new car every year prior to the Depression.  He and my grandmother had two sons, my father who was the younger, and his half brother from my grandmother's prior marriage.  My grandfather had only known life as a fairly wealthy person, a child of by then wealthy cattle ranchers, and he lost his job at the beginning of the Depression. This required a lot of adjustment on the part of both of my grandparents. Eventually, they decided that their best strategy to safely surviving the Depression was to take their family somewhere isolated and safe that had a low cost of living, and simply wait out the Depression. They placed their possessions in storage with family members and moved to Tahiti for the duration.   This of course, took them from their large family as a support system, but the strategy largely worked, and taught their sons much about the ocean, life in another land, ships, and about flexibility.  Children often make very good use of the challenges their families are handed, particularly if the family loves them, and they remain together.

            My mother's family were governmental workers on a number of different levels in England during the Depression.  My maternal grandfather kept his job but found it insufficient in which to pay for his family. My grandmother did not work because she was already quite busy taking care of her husband and her three very young daughters. This began a pattern of clothing and possessions being hard to come by, and this was reinforced in England, during the war.  Things were so tight that my mother and aunts never had any type of pet because it would have been another mouth to feed.  Eventually, my grandfather kept his job during the day, and a few evenings a week drove a taxi as well.  When the war came, he was assigned also a job of being a voluntary driver to a firetruck which was called in England, the Fire Brigade.
            As a result of the war my parents lost people they likely would have married in other times.  They found each other later in life as a result, and therefore were mature parents when I arrived.  They knew of the Depression and they knew of the shortages and uncertainties of a world war. As a result, they raised me frugally and conservatively.

            After the war my parents moved from England to California where both of them worked in very good jobs. Their focus was to save as much money as possible before buying a home and raising children. Eventually, my father took a good job in the Northeast where I was to be raised.  A few years later we moved to the country there, where ostensibly, I was raised until college.

             Interestingly, as a result of their broad travels during and after the war, they had different views than many of the neighbors in 1960s.   Most of our neighbors continued my grandfather's practice of buying a new car annually.  My father never did.  He bought a used car and then did all the maintenance and oil changes on it himself.  My mother practiced conservation in all areas,  because this is what was done in England.  I often used to wonder why my parents didn't seem to enjoy life and spend money with the same use patterns as my friend's parents.  It took me many years to learn that they weren't frugal because we were poor, because we weren't. (Although there is no shame in being poor. A lot of the real work of the world is done by people who could be considered poor.)    They took a small mortgage on their home, selected it carefully, and then paid it off within five years.  At the end of that time, they made payments the same as the mortgage, to their own accounts.  They were frugal because no one knows what the future holds, and because frugality is not learned from lecturing about it. People need to see frugality and a work ethic applied, otherwise, they just don't get it.  My parents applied frugality because it was a set of lessons they wished their children to know.

             As my parents moved into old age, they still practiced certain aspects of frugality.  My Dad still bought canned supplies, labelled them with the date and kept a supply closet.  He also traveled extensively and without apology.   My mother still made all her own food from scratch.  However, she did like expensive clothing and shoes, and she did have some really lovely clothing and coats.

              Perhaps some of the best keys to living in challenging times is to look to see what our parents and our grandparents did, that worked.   Of course, no one is perfect, and I don't make fabulous decisions a hundred percent of the time myself, however, many of us have relatives who lived in very challenging times before us. Sometimes a gaze backward can be a big help with regard to present day decision making..

Wednesday, October 8, 2014

Spain's Public Health Authorities Euthanize Ebola Stricken Nurses Dog

This is  Teresa Ramos' dog Excalibur, euthanized today.  (Photo:

        Of course, all of us are watching the Ebola virus situation.  CDC officials in the US claim that the virus is not airborne, and yet a cameraman working with Dr. Nancy Snyderman in Africa, is now fighting the virus here at home. No one is sure how he caught it.  The Canadian and the French public health authorities believe that the virus has been proven to be airborne, at least in some strains, and they say so on their websites.  The gentleman in a Texas hospital fighting Ebola has been reported to have died.  (Yes, a second time.  This was reported and then recanted a week ago, and now announced again today.)  A nursing assistant in Spain who had only two minimal contacts with a Spanish priest who had been working in Africa, is also now also fighting Ebola.  Her husband and about fifty other contacts are being quarantined and closely observed.  Today, following a court order to do so, a van drove up to the nursing assistant's  home, collected her dog and euthanized it.   Apparently, no one knows whether a dog can spread Ebola, and Spanish public health officials weren't bright enough to study the situation and actually find out.  Let's hope their decisions with regard to human public health are more intelligent than their moves with regard to veterinary public health.  This sets a dangerous and concerning precedent.  If this is allowed to continue, how long before some hot shot orders all the animals in Nigeria, Guinea, Sierra Leone, and Liberia euthanized, and once again, we will never know whether animals are a good vector for this virus, or whether they are completely unaffected and can remain alive as food for survivors or even as companionship for those who are dying.

                Although we cannot expect public health officials to perform each task perfectly, we should expect reasonable actions designed to protect the public, especially those which restrict travel across borders and in planes.  I don't support the euthanization of animals who have not yet shown any indication of being able to act as a carrier for this particular contagion.

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Our prior posts on the Ebola virus:

Sunday, October 5, 2014

Learning to "Upcycle"

Stores charge quite a bit for nice durable tote bags. ( Photo: )

              We have all heard the slogan, "Reuse, Reduce, and Recycle", but how many of us have taken it to the next level and developed a plan to Upcycle ?    When we upcycle, we carefully consider something we have in abundance, often as a leftover from another essential activity at our location.  Then, we formulate a plan to redevelop it as something else that will be prized more highly, and that may actually make us some money.  Our activity will also place less in the landfills.

              One example of upcycling would be the local family who lived on a farm, and like me, had large numbers of sturdy feed bags for animals.  The bags themselves are water resistant, attractive, and very sturdy.  I keep them myself should we ever need to assemble sandbags or claybags.  The family who learned to upcycle, took a variety of the bags they use for different feeds, and turned the bags into attractive totebags for shopping and into bib style aprons as gifts, just using a normal sewing machine they already owned.  The bags  are durable, quite attractive, and can be sold as well as given as gifts.  In the last couple of years I have gotten away from gift wrapping irregularly shaped gifts and I now give them in tote bags after being wrapped in a small amount of tissue paper.

This bag's photo by:

               The bags can be structured and used as is, or additionally lined if you wish.   These make excellent shopping bags which can cut down on the number of paper or plastic bags you acquire in the course of shopping, if you wish.
                Additionally, in this era of Ebola, MRSA, and enterovirus, these bags have the exterior lined with a durable plastic, and so, after shopping, you can take a paper towel with isopropyl alcohol on it, and clean the outside of these bags as a supplemental way of limiting the viruses and bacteria you are bringing into your home.

                 The holidays are just a few months away.  With time, assets, and money being in short supply for most everyone, now is the time to think about making gifts of all kinds and about how they might be wrapped.  The entire concept of "upcycling" is an inspiring one.

Thursday, October 2, 2014

More Skin in the Game


He was six pounds and six ounces, and yes, he is a bit yellow, and has spent some time underneath some bili-lights in order to treat newborn hyperbilirubinemia.  (Photo: Copyright J. Krehbiel)


        I have been away from the blog and the internet entirely for  a couple of weeks.  My eldest daughter has been a juvenile diabetic since she was nine years old.   Juvenile diabetes is the Type I autoimmune variety which requires insulin for survival.  It is not the same disorder as the Type II diabetes which afflicts people in increasing number in the US, and can often be managed with weight loss and  dietary restriction.  My daughter developed Type I diabetes following a Coxsackie B4 viral infection which was prevalent that year in our area.  She is presently maintained using an insulin pump. She drives, graduated from university, has a good job and bought her own home when she was a single woman. However, the victories have been hard fought for, and often difficult. Juvenile diabetes can be profoundly disruptive to not only the life of a child, but to life, an education, family life, holidays, and lastly to the careers of the parents, because much time and attention must be paid to periodic regulation, as the child, teen or young adult grows.

            As late as 1981, Type I diabetic women were still being encouraged not to give birth to children, as the demands of pregnancy and glucose control were likely to cause or to contribute to kidney failure.  One of my closest friends chose not to have children biologically because she has Type I diabetes.   You may remember the character Julia Roberts played in Steel Magnolias who dies of complications of Type I diabetes with renal failure after having a baby, and this perception has stayed with many. Of course, we have always been reticent as we approached the days when my daughter chose to have a child. 

            Things of course, have changed.  The advent of  over-the-counter glucose monitoring devices rather than double voided urine specimens alone as a tool to determine sliding scale insulin doses,  has revolutionized the treatment of Type I diabetes.  Good and complete studies have also indicated that very tight and intensive glucose control of adults and children with Type I diabetes can result in their having the same life expectancy as the rest of us.   Insulin pumps don't take the job of endocrinologists and educated and well trained diabetics, but they can help to provide much better control and therefore a much better life than the autoimmune diabetic could have had otherwise.   An insulin pump works by providing a subcutaneous infusion of a basal rate of insulin hourly. It is ideally the amount of insulin that the patient needs to live if she doesn't eat at all.    Then,a calculated bolus doses of insulin can be dialed in to cover food.  These are called meal boluses.   This does not free the patient to eat bon bons and banana splits, but it does free the patient to eat a healthy diet and still keep blood sugars in the normal range most of the time. It can also be helpful in avoiding diabetic ketoacidosis, insulin shock, car accidents from the aforementioned two extremes of glucose levels. etc.   Since the insulin pump can be set to administer temporary basal rates, the user can run, or perform activities that would ordinarily deplete their blood sugar and require the user sometimes to snack when they don't really wish to.  It is now possible for a well controlled juvenile diabetic to at least theoretically have children relatively safely without sacrificing her kidneys, her vascular system, her vision, or her life, to do so.

            Insulin pumping still does not make glucose regulation elementary.   Particularly in women, many things trigger broad changes in glucose levels, and require a reworking of insulin dose via frequent injections or via the pump itself.   The insulin doses which worked will be thrown for a loop when the young woman starts having periods as most hormones directly oppose insulin.  Many women require an insulin adjustment every time they have a menstrual period, and this can be an increase of as much as 30% for those days.  Conversely, the increase must be removed quickly after the period is over.  Illness, even the flu can also throw blood sugar levels for a curve.  Dietary changes when a user goes to college will also trigger a need for insulin basal and bolus adjustments.  Sometimes these changes can be carefully made by trained diabetics and their families and sometimes, these changes must be undertaken by an endocrinologist.   Endocrinologists should have oversight over all insulin adjustments.  Pregnancy also challenges glucose regulation.  As the placenta and the baby grows, more and more insulin is required as a basal amount.  Sometimes, this amount of insulin doubles throughout the pregnancy, and then falls to below pre-pregnancy levels afterward.  Regulation can be a nerve wracking and labor intensive process.

         The babies of Type I diabetic mothers also need to be watched carefully.  The insulin injected by the mother's pump does not reach the baby through the placenta, but higher than normal levels of glucose do.  In response, the growing baby develops swelling beta cells in his pancreas to keep his own glucose level within the normal range.  After birth, these babies tend to develop hypoglycemia which can be quite dangerous until they adapt sufficiently to regulating their own blood sugar.    In addition, Type I diabetic pregnant women have higher potential pregnancy complications, including higher risks of miscarriage, stillbirth and birth defects, particularly of the heart.   They are generally followed with many multiple visits, ultrasounds and non stress tests throughout their pregnancy.  They do not necessarily have to deliver via cesarean section, although many of them tend to have larger babies.   During labor, Type I diabetics are often managed using an insulin driip infusion regulated by an intravenous pump. After delivery, many of these babies are cared for, at least initially, in a NICU.  Some of them will experience difficulties learning to feed, and will have trouble with breast feeding.  Breast feeding may also present some glucose regulation`challenges for Type I diabetic women.

          Somehow, this year,  my daughter managed to work a high powered job to which she is devoted, a Type I diabetic pregnancy, and a life in balance. Her little son was born in late September, following three days of labor and two hours of pushing.  They both remained in the hospital for a bit more than a week afterward.  I was present for private duty nursing, and her partner and I shared the tasks of labor coach.    This was a difficult and challenging set of tasks for her, and I don't think I have ever been more proud of a young woman who never lost focus, never became frustrated or frightened enough to stop doing everything exactly as she should.   My grandson is a very lucky little man to have her as his mother.

         I will still likely be away from the computer for a time.  As a person who works in preparedness, and with this new little soul here, I care even more about the direction in which the world is going.  With this little man now on the Earth, we have even more of a stake in what happens here, and even more "skin in the game".